ATI RN PEDIATRIC NURSING LEVEL 3 PROCTORED
ASSESSMENT
Comprehensive Practice Exam & Clinical Judgment Guide
This document provides an exhaustive, Level 3 standard practice examination modeled after
official ATI Pediatric Nursing assessments, featuring traditional multiple-choice items and Next
Generation Nursing (NGN) clinical judgment case studies. Use this comprehensive resource to
test your mastery, review rationales, and refine clinical decision-making across all pediatric
client needs.
Section 1: Core Pediatric Nursing & Growth and Development (Q1 - Q20)
Question 1 [Multiple Choice]
A nurse is assessing an 8-month-old infant who is hospitalized with acute gastroenteritis and
moderate dehydration. Which of the following findings should the nurse expect?
A. Heart rate 110/min
B. Capillary refill time 4 seconds
C. Soft, flat fontanels
D. Urine output 1.5 mL/kg/hr
Correct Answer: B. Capillary refill time 4 seconds
Rationale: Moderate dehydration in infants is characterized by clinical signs such as delayed capillary
refill (2 to 4 seconds or greater), tachycardia, irritability, dry mucous membranes, and decreased urine
output (less than 1 mL/kg/hr). A soft, flat fontanel and a normal heart rate (typically 120-160/min for an
infant) indicate normal hydration status.
Question 2 [Multiple Choice]
A nurse is providing discharge instructions to the parents of a school-age child who has a
new prescription for osmotic diuresis and management of nephrotic syndrome. Which of the
following statements by the parents indicates an understanding of the teaching?
A. 'We will test our child's urine for glucose daily.'
B. 'We should restrict our child's fluid intake significantly during remission.'
C. 'We will monitor our child's daily weight and report steady increases.'
D. 'We can expect our child's urine to remain tea-colored throughout treatment.'
Correct Answer: C. 'We will monitor our child's daily weight and report steady increases.'
Rationale: Monitoring daily weight is the most sensitive indicator of fluid balance and edema status in
nephrotic syndrome. Weight gain indicates fluid retention and relapse. Fluid restriction is typically not
required during remission unless severe edema is present. Tea-colored urine is characteristic of acute
glomerulonephritis, not nephrotic syndrome.
Question 3 [Multiple Choice]
A nurse is admitting a toddler who has acute lymphocytic leukemia (ALL) and is receiving
chemotherapy. Which of the following room assignments is the most appropriate?
, A. A private room with positive pressure airflow
B. A private room with negative pressure airflow
C. A semi-private room with another child who has a viral respiratory infection
D. A semi-private room with a child who has sickle cell anemia
Correct Answer: A. A private room with positive pressure airflow
Rationale: Children receiving chemotherapy for ALL are severely immunocompromised and
neutropenic, placing them at high risk for opportunistic infections. A private room with protective
isolation (positive pressure airflow) minimizes exposure to airborne pathogens. Negative pressure is
for airborne precautions (e.g., tuberculosis).
Question 4 [Multiple Choice]
A nurse is assessing a 4-year-old child during a well-child visit. Which of the following
developmental milestones should the nurse expect the child to perform?
A. Tie shoelaces independently
B. Skip on alternating feet
C. Draw a person with three parts
D. Print first and last name
Correct Answer: C. Draw a person with three parts
Rationale: A 4-year-old preschooler is expected to draw a person with at least three to four body parts.
Tying shoelaces, skipping on alternating feet, and printing a full name are typically mastered around
age 5 to 6 years (school-age).
Question 5 [Multiple Choice]
A nurse is caring for an infant who has a myelomeningocele and is scheduled for surgical
closure. Which of the following preoperative nursing actions is the priority?
A. Apply a clean, dry dressing over the sac every 8 hours.
B. Place the infant in a supine position.
C. Maintain the infant in an incubator without clothing.
D. Administer prophylactic broad-spectrum oral antibiotics.
Correct Answer: C. Maintain the infant in an incubator without clothing.
Rationale: Maintaining the infant in an incubator or radiant warmer without clothing prevents pressure,
trauma, and contamination of the sac while allowing direct thermal regulation. The infant should be
placed in a prone or modified side-lying position, and dressings must be sterile, moist, and
nonadherent (saline-soaked) rather than dry.
Question 6 [Multiple Choice]
A nurse is teaching the parents of a 2-year-old toddler regarding nutritional needs. Which of
the following statements by the parents indicates understanding?
A. 'We should switch our child to skim milk to prevent adult cardiovascular disease.'
B. 'Our toddler's decreased appetite is normal due to slowed growth velocity.'
C. 'We should offer three large meals daily and eliminate all snacks.'
D. 'Juice intake should be limited to 12 ounces per day.'
Correct Answer: B. 'Our toddler's decreased appetite is normal due to slowed growth
velocity.'
Rationale: Toddlers experience physiological anorexia due to a slowing of growth velocity after
infancy, resulting in erratic appetite patterns. Whole cow's milk is recommended until age 2 for
, neurological development. Snacks are necessary to meet caloric needs due to small stomach
capacity, and juice should be limited to 4-6 ounces daily.
Question 7 [Multiple Choice]
A nurse is caring for a school-age child who has type 1 diabetes mellitus and is admitted with
diabetic ketoacidosis (DKA). Which of the following intravenous solutions should the nurse
anticipate initiating first?
A. 0.9% sodium chloride infusion
B. 5% dextrose in 0.45% sodium chloride
C. 0.225% sodium chloride
D. 10% dextrose in water
Correct Answer: A. 0.9% sodium chloride infusion
Rationale: Initial fluid resuscitation for DKA in pediatric clients begins with an isotonic solution (0.9%
sodium chloride) to expand intravascular volume and restore tissue perfusion before adding dextrose
when blood glucose reaches approximately 250-300 mg/dL.
Question 8 [Multiple Choice]
A nurse is assessing a 6-month-old infant during a routine health supervision visit. Which of
the following findings should the nurse report to the provider immediately?
A. Inability to hold a rattle
B. Absence of a babinski reflex
C. Inability to sit unsupported
D. Presence of asymmetric tonic neck reflex persisting past 6 months
Correct Answer: D. Presence of asymmetric tonic neck reflex persisting past 6 months
Rationale: Primitive reflexes such as the asymmetric tonic neck reflex typically disappear by 3 to 4
months of age. Persistence beyond 6 months indicates possible neurological impairment or cerebral
palsy. Infants at 6 months are not expected to sit unsupported independently yet (usually achieved
around 8 months).
Question 9 [Multiple Choice]
A nurse is planning care for an adolescent client who has acute osteomyelitis of the tibia.
Which of the following interventions should the nurse include in the plan?
A. Encourage high-impact weight-bearing exercises.
B. Administer long-term intravenous antibiotic therapy.
C. Apply cold packs to the affected extremity every 2 hours.
D. Restrict dietary protein intake.
Correct Answer: B. Administer long-term intravenous antibiotic therapy.
Rationale: Acute osteomyelitis requires aggressive, prolonged parenteral antibiotic therapy (often
lasting 4 to 6 weeks or longer via PICC line) to eradicate bone infection. Affected extremities require
immobilization and rest rather than exercise or cold therapy.
Question 10 [Multiple Choice]
A nurse is providing discharge teaching to the parents of an infant following surgical
correction of cleft palate. Which of the following instructions should the nurse include?
A. 'Allow your infant to use a pacifier to soothe post-operative fussiness.'
B. 'Clean the suture line with a cotton-tipped swab soaked in hydrogen peroxide after every feed.'
ASSESSMENT
Comprehensive Practice Exam & Clinical Judgment Guide
This document provides an exhaustive, Level 3 standard practice examination modeled after
official ATI Pediatric Nursing assessments, featuring traditional multiple-choice items and Next
Generation Nursing (NGN) clinical judgment case studies. Use this comprehensive resource to
test your mastery, review rationales, and refine clinical decision-making across all pediatric
client needs.
Section 1: Core Pediatric Nursing & Growth and Development (Q1 - Q20)
Question 1 [Multiple Choice]
A nurse is assessing an 8-month-old infant who is hospitalized with acute gastroenteritis and
moderate dehydration. Which of the following findings should the nurse expect?
A. Heart rate 110/min
B. Capillary refill time 4 seconds
C. Soft, flat fontanels
D. Urine output 1.5 mL/kg/hr
Correct Answer: B. Capillary refill time 4 seconds
Rationale: Moderate dehydration in infants is characterized by clinical signs such as delayed capillary
refill (2 to 4 seconds or greater), tachycardia, irritability, dry mucous membranes, and decreased urine
output (less than 1 mL/kg/hr). A soft, flat fontanel and a normal heart rate (typically 120-160/min for an
infant) indicate normal hydration status.
Question 2 [Multiple Choice]
A nurse is providing discharge instructions to the parents of a school-age child who has a
new prescription for osmotic diuresis and management of nephrotic syndrome. Which of the
following statements by the parents indicates an understanding of the teaching?
A. 'We will test our child's urine for glucose daily.'
B. 'We should restrict our child's fluid intake significantly during remission.'
C. 'We will monitor our child's daily weight and report steady increases.'
D. 'We can expect our child's urine to remain tea-colored throughout treatment.'
Correct Answer: C. 'We will monitor our child's daily weight and report steady increases.'
Rationale: Monitoring daily weight is the most sensitive indicator of fluid balance and edema status in
nephrotic syndrome. Weight gain indicates fluid retention and relapse. Fluid restriction is typically not
required during remission unless severe edema is present. Tea-colored urine is characteristic of acute
glomerulonephritis, not nephrotic syndrome.
Question 3 [Multiple Choice]
A nurse is admitting a toddler who has acute lymphocytic leukemia (ALL) and is receiving
chemotherapy. Which of the following room assignments is the most appropriate?
, A. A private room with positive pressure airflow
B. A private room with negative pressure airflow
C. A semi-private room with another child who has a viral respiratory infection
D. A semi-private room with a child who has sickle cell anemia
Correct Answer: A. A private room with positive pressure airflow
Rationale: Children receiving chemotherapy for ALL are severely immunocompromised and
neutropenic, placing them at high risk for opportunistic infections. A private room with protective
isolation (positive pressure airflow) minimizes exposure to airborne pathogens. Negative pressure is
for airborne precautions (e.g., tuberculosis).
Question 4 [Multiple Choice]
A nurse is assessing a 4-year-old child during a well-child visit. Which of the following
developmental milestones should the nurse expect the child to perform?
A. Tie shoelaces independently
B. Skip on alternating feet
C. Draw a person with three parts
D. Print first and last name
Correct Answer: C. Draw a person with three parts
Rationale: A 4-year-old preschooler is expected to draw a person with at least three to four body parts.
Tying shoelaces, skipping on alternating feet, and printing a full name are typically mastered around
age 5 to 6 years (school-age).
Question 5 [Multiple Choice]
A nurse is caring for an infant who has a myelomeningocele and is scheduled for surgical
closure. Which of the following preoperative nursing actions is the priority?
A. Apply a clean, dry dressing over the sac every 8 hours.
B. Place the infant in a supine position.
C. Maintain the infant in an incubator without clothing.
D. Administer prophylactic broad-spectrum oral antibiotics.
Correct Answer: C. Maintain the infant in an incubator without clothing.
Rationale: Maintaining the infant in an incubator or radiant warmer without clothing prevents pressure,
trauma, and contamination of the sac while allowing direct thermal regulation. The infant should be
placed in a prone or modified side-lying position, and dressings must be sterile, moist, and
nonadherent (saline-soaked) rather than dry.
Question 6 [Multiple Choice]
A nurse is teaching the parents of a 2-year-old toddler regarding nutritional needs. Which of
the following statements by the parents indicates understanding?
A. 'We should switch our child to skim milk to prevent adult cardiovascular disease.'
B. 'Our toddler's decreased appetite is normal due to slowed growth velocity.'
C. 'We should offer three large meals daily and eliminate all snacks.'
D. 'Juice intake should be limited to 12 ounces per day.'
Correct Answer: B. 'Our toddler's decreased appetite is normal due to slowed growth
velocity.'
Rationale: Toddlers experience physiological anorexia due to a slowing of growth velocity after
infancy, resulting in erratic appetite patterns. Whole cow's milk is recommended until age 2 for
, neurological development. Snacks are necessary to meet caloric needs due to small stomach
capacity, and juice should be limited to 4-6 ounces daily.
Question 7 [Multiple Choice]
A nurse is caring for a school-age child who has type 1 diabetes mellitus and is admitted with
diabetic ketoacidosis (DKA). Which of the following intravenous solutions should the nurse
anticipate initiating first?
A. 0.9% sodium chloride infusion
B. 5% dextrose in 0.45% sodium chloride
C. 0.225% sodium chloride
D. 10% dextrose in water
Correct Answer: A. 0.9% sodium chloride infusion
Rationale: Initial fluid resuscitation for DKA in pediatric clients begins with an isotonic solution (0.9%
sodium chloride) to expand intravascular volume and restore tissue perfusion before adding dextrose
when blood glucose reaches approximately 250-300 mg/dL.
Question 8 [Multiple Choice]
A nurse is assessing a 6-month-old infant during a routine health supervision visit. Which of
the following findings should the nurse report to the provider immediately?
A. Inability to hold a rattle
B. Absence of a babinski reflex
C. Inability to sit unsupported
D. Presence of asymmetric tonic neck reflex persisting past 6 months
Correct Answer: D. Presence of asymmetric tonic neck reflex persisting past 6 months
Rationale: Primitive reflexes such as the asymmetric tonic neck reflex typically disappear by 3 to 4
months of age. Persistence beyond 6 months indicates possible neurological impairment or cerebral
palsy. Infants at 6 months are not expected to sit unsupported independently yet (usually achieved
around 8 months).
Question 9 [Multiple Choice]
A nurse is planning care for an adolescent client who has acute osteomyelitis of the tibia.
Which of the following interventions should the nurse include in the plan?
A. Encourage high-impact weight-bearing exercises.
B. Administer long-term intravenous antibiotic therapy.
C. Apply cold packs to the affected extremity every 2 hours.
D. Restrict dietary protein intake.
Correct Answer: B. Administer long-term intravenous antibiotic therapy.
Rationale: Acute osteomyelitis requires aggressive, prolonged parenteral antibiotic therapy (often
lasting 4 to 6 weeks or longer via PICC line) to eradicate bone infection. Affected extremities require
immobilization and rest rather than exercise or cold therapy.
Question 10 [Multiple Choice]
A nurse is providing discharge teaching to the parents of an infant following surgical
correction of cleft palate. Which of the following instructions should the nurse include?
A. 'Allow your infant to use a pacifier to soothe post-operative fussiness.'
B. 'Clean the suture line with a cotton-tipped swab soaked in hydrogen peroxide after every feed.'
