ATI Pediatrics Proctored Exam Question Bank

Question 4 — Cardiovascular / Congenital Conditions

A nurse is caring for an infant with a diagnosed ventricular septal defect (VSD). Which finding should the nurse recognize as an early sign of heart failure in this infant?

• A. Bradycardia during feeding
• B. Diaphoresis and fatigue with feeding
• C. Increased urine output
• D. Weight gain above the expected growth curve

Correct Answer: B
Diaphoresis and fatigue during feeding are classic early signs of heart failure in infants with left-to-right shunting defects like VSD, reflecting the increased workload on the heart. Heart failure typically causes poor weight gain and decreased urine output, not increases.

Question 5 — Respiratory Emergencies

A nurse enters the room of a 4-year-old with a history of asthma and finds the child sitting upright, using accessory muscles, with a respiratory rate of 42/min and inaudible breath sounds on auscultation. What is the nurse's priority action?

• A. Document the findings and reassess in 30 minutes
• B. Encourage the child to lie flat and rest
• C. Notify the provider immediately and prepare for emergency intervention
• D. Offer oral fluids to loosen secretions

Correct Answer: C
Inaudible breath sounds with severe accessory muscle use signal an impending respiratory failure — the "silent chest" is an ominous sign, not an improvement. This requires immediate provider notification and emergency intervention, not routine reassessment.

Question 6 — Family-Centered Care

A 6-year-old is scheduled for a scheduled outpatient procedure. Which action best reflects family-centered care when preparing the child and parents?

• A. Explain the procedure only to the parents to avoid frightening the child
• B. Use simple, honest, age-appropriate language with the child and involve the parents in the plan
• C. Wait until immediately before the procedure to explain what will happen
• D. Ask the parents to leave the room during preparation to reduce their anxiety

Correct Answer: B
Family-centered care involves honest, developmentally appropriate communication with the child alongside active parental involvement, which reduces anxiety and builds trust for both the child and family.

Question 7 — Pain Assessment

A nurse needs to assess pain in a 3-year-old who is verbal but has limited vocabulary. Which pain assessment tool is most appropriate?

• A. Numeric Rating Scale (0–10)
• B. FLACC Scale
• C. Wong-Baker FACES Scale
• D. Visual Analog Scale

Correct Answer: C
The Wong-Baker FACES Scale uses illustrated facial expressions and is validated for children as young as 3 who can point to a face but may not yet grasp numeric scales. FLACC is used for preverbal or nonverbal children; numeric and visual analog scales require abstract reasoning typically not developed until later childhood.

Question 8 — Safety & Injury Prevention

A nurse is providing anticipatory guidance to the parent of a 9-month-old who has just started pulling to stand. Which statement by the parent indicates a need for further teaching?

• A. "We installed a gate at the top of the stairs."
• B. "We keep cleaning supplies under the sink since he can't reach that high yet."
• C. "We lowered the crib mattress to its lowest setting."
• D. "We cover unused electrical outlets."

Correct Answer: B
An infant who is pulling to stand can begin reaching cabinets and countertops. Cleaning supplies and other toxins should be stored in a locked cabinet, not simply "out of reach," since mobility milestones change quickly and unpredictably at this age.

Question 9 — NGN-Style Case Study

Scenario: A 5-year-old is brought to the clinic with a 2-day history of fever, sore throat, and a fine, sandpaper-like rash on the trunk. The parent reports the child was diagnosed with strep throat yesterday and started amoxicillin 12 hours ago.

For each finding below, indicate whether it is Expected or requires Further Follow-Up given this clinical picture:

• Sandpaper-textured rash on trunk — Expected (consistent with scarlet fever secondary to strep infection)
• Temperature of 101.5°F (38.6°C) 12 hours after starting antibiotics — Expected (fever may persist for 24–48 hours after starting treatment)
• New onset of facial swelling and hives — Further Follow-Up (possible allergic reaction to amoxicillin, requires prompt evaluation)
• Strawberry-red tongue — Expected (classic finding associated with scarlet fever)

Rationale: Scarlet fever presents with a sandpaper rash and strawberry tongue as expected findings following untreated or recently treated strep infection. Facial swelling and hives after starting a new antibiotic suggest a possible drug allergy and require immediate follow-up rather than being attributed to the underlying infection.

Question 10 — Delegation in Pediatric Care

A charge nurse is assigning tasks on a pediatric unit. Which task is most appropriate to delegate to an unlicensed assistive personnel (UAP)?

• A. Administering an oral antibiotic to a 4-year-old
• B. Measuring and recording the weight of a stable 6-year-old
• C. Assessing a newly admitted infant's respiratory status
• D. Teaching a parent how to use a nebulizer

Correct Answer: B
Measuring and recording weight on a stable patient is within a UAP's scope, since it does not require clinical judgment. Medication administration, assessment, and patient teaching all require the scope of practice of a licensed nurse.