About the ATI PN Pediatric Nursing Proctored Exam 2026
The ATI PN Pediatric Nursing proctored assessment measures how well practical nursing students apply pediatric knowledge to real situations with infants, children, adolescents and their families. It is less about memorizing diseases and more about knowing what is normal for each age, spotting early warning signs, giving medications safely, reinforcing teaching for parents and knowing when a finding must be reported to the RN or provider.
Most PN programs give the ATI peds proctored exam at the end of the pediatric or maternal-child nursing course. The result is often a course requirement, and it gives your program an early read on your readiness for the PN Comprehensive Predictor and the NCLEX-PN. Because it is proctored, you take it on a secure browser under supervision, either on campus or through remote proctoring, depending on your school.
Item count, time limit and the proficiency level you need are set by ATI and your program, and they can change between versions. Check your syllabus or ATI student account for your exact requirements.
ATI PN Pediatric Nursing 2023 — the previous edition with its own 68-question bank.
How this practice test is built
These 70 questions are original practice items modeled on the content and style of the ATI PN Pediatric Nursing assessment. They are not actual exam questions. Each one is written for the LPN/LVN scope of practice, so answers focus on data collection, age-appropriate care, safe medication administration, reinforcing teaching and timely reporting rather than RN-only actions such as initial assessment or independent care planning.
How the ATI PN Pediatric Nursing 2026 Exam Is Scored
ATI does not report a simple pass or fail. It converts your score into a proficiency level:
Level 3 — Exceeds expectations
Strong readiness in pediatric nursing. High probability of passing related NCLEX-PN content.
Level 2 — Meets expectations
Readily meets expectations. The most common program benchmark and minimum target.
Level 1 — Below expectations
Just meets the minimum. Most programs require focused remediation at this level.
Below Level 1
Does not meet the minimum. Remediation and often a retake are required.
Your score report also breaks results down by topic. Use that list alongside the rationales in this practice test: if the report flags “growth and development,” go back to every question in that area and reread why each wrong option is wrong.
For a full explanation of ATI levels, retakes and remediation, see our ATI proctored exam guide.
Pediatric Growth and Development Milestones for the 2026 Exam
Growth and development runs through almost every ATI pediatric question. Before you choose an answer, ask: “How old is this child, and what is normal at that age?” The ages below are typical; individual children vary.
| Age group | Key milestones | Erikson stage | Play and safe toys |
|---|---|---|---|
| Infant (birth–12 months) | Social smile about 2 months; rolls over about 4–6 months; sits unsupported about 6–8 months; pincer grasp and stranger anxiety about 9 months; first words and pulling to stand by about 12 months | Trust vs. mistrust | Solitary play. Rattles, mobiles, soft blocks, mirrors; nothing small enough to swallow |
| Toddler (1–3 years) | Walks by about 12–15 months; two-word phrases by about 2 years; separation anxiety peaks; ritual and routine matter | Autonomy vs. shame and doubt | Parallel play. Push-pull toys, large blocks, shape sorters, simple puzzles |
| Preschool (3–6 years) | Rides a tricycle about 3 years; magical thinking and fears of body injury; may see illness as punishment | Initiative vs. guilt | Associative play. Dress-up, medical play with dolls, coloring, simple games |
| School-age (6–12 years) | Concrete thinking; rules and collecting; peers grow in importance | Industry vs. inferiority | Cooperative play. Board games, crafts, books, collections |
| Adolescent (12–20 years) | Abstract thinking; body image and privacy concerns; peer group is central | Identity vs. role confusion | Music, video games, phone or visits with friends; include them in care decisions |
Growth and hospitalization essentials
- Weight: birth weight roughly doubles by about 6 months and triples by 12 months
- Fontanels: posterior closes by about 2–3 months, anterior by about 12–18 months; bulging suggests increased intracranial pressure, sunken suggests dehydration
- Separation anxiety: strongest in toddlers, who move through protest, despair and detachment; encourage parents to stay and keep home routines
- Preparing for procedures: toddlers and preschoolers just before the procedure with simple words and dolls; school-age children a little earlier with simple explanations; adolescents with full information and privacy
- Pain scales: FLACC for infants and nonverbal children, FACES for about age 3 and up, numeric scale for school-age children and adolescents
- Regression: a toddler losing toilet training during illness is expected; do not punish it
High-Yield ATI PN Pediatric Disorders for 2026
These are the pediatric topics that show up again and again in PN questions. The “report immediately” boxes cover the findings the exam most often expects you to recognize.
Respiratory
- Croup: barking cough, hoarseness, inspiratory stridor, often worse at night; cool mist and calm the child
- Epiglottitis: drooling, dysphagia, muffled voice, tripod position, high fever; never inspect the throat with a tongue blade; keep the child upright and calm; airway emergency
- Bronchiolitis (RSV): contact precautions, suction the nose before feedings and sleep, monitor oxygen saturation and hydration
- Asthma: wheezing, cough, retractions; quick-relief albuterol first; teach peak flow zones and spacer use; rinse the mouth after inhaled steroids
- Cystic fibrosis: thick secretions, salty skin, fatty stools; pancreatic enzymes with every meal and snack; high-calorie, high-protein diet; chest physiotherapy
- Tonsillectomy: side-lying position; frequent swallowing or clearing the throat suggests bleeding; no straws, red liquids, or coughing hard
drooling with stridor, nasal flaring, grunting or retractions, falling oxygen saturation, frequent swallowing after tonsillectomy, a quiet chest in a child having an asthma attack.
Cardiovascular
- Heart failure in infants: fast breathing, sweating and tiring during feedings, poor weight gain
- Tetralogy of Fallot: “tet spells” with cyanosis; place the infant in the knee-chest position and keep calm
- Kawasaki disease: fever for 5 or more days, red eyes, strawberry tongue, peeling hands and feet; IV immunoglobulin and aspirin as prescribed; delay live vaccines for about 11 months after IVIG
- Rheumatic fever: follows untreated strep throat; teach completing the full antibiotic course
- Digoxin: count the apical pulse for a full minute before every dose (hold parameters are in the medication table)
Gastrointestinal and Fluid Balance
- Dehydration: dry mucous membranes, fewer wet diapers, sunken fontanel, no tears, weight loss; daily weights and intake and output; oral rehydration solution for mild to moderate cases, not juice or sports drinks
- Pyloric stenosis: projectile vomiting after feeding in an infant who stays hungry, olive-shaped mass; risk of metabolic alkalosis
- Intussusception: sudden severe intermittent pain with knees drawn up, “currant jelly” stools, sausage-shaped mass
- Hirschsprung disease: no meconium within 24–48 hours, ribbon-like stools, abdominal distension
- Cleft lip and palate: feed upright with special nipples, burp often; after repair, protect the incision and avoid putting objects in the mouth
- Celiac disease: lifelong gluten-free diet; avoid barley, rye, oats (unless certified gluten-free) and wheat
- Appendicitis: sudden relief of severe pain can mean rupture; no heat to the abdomen and no laxatives
no urine output for 6–8 hours in an infant, lethargy with dehydration, green (bilious) vomiting, currant jelly stools, sudden relief of abdominal pain followed by fever.
Renal and Genitourinary
- Nephrotic syndrome: heavy proteinuria, generalized edema, low albumin; corticosteroids, daily weights, skin care, infection prevention
- Acute glomerulonephritis: often after a strep infection; tea- or cola-colored urine, hypertension, periorbital edema; monitor blood pressure and fluid status
- Urinary tract infection: fever, irritability, poor feeding in infants; complete the full antibiotic course
- Wilms tumor: abdominal mass; do not palpate the abdomen and post a sign at the bedside
- Hypospadias: no circumcision before repair, since the foreskin may be used
Neurological
- Febrile seizures: usually ages 6 months to 5 years; teach parents seizure safety and fever management with acetaminophen or ibuprofen (no aspirin)
- Seizure care: side-lying, protect the head, nothing in the mouth, do not restrain, time the seizure
- Bacterial meningitis: fever, irritability, nuchal rigidity, bulging fontanel in infants; droplet precautions until 24 hours of antibiotics; a purple petechial rash suggests meningococcal infection
- Hydrocephalus and shunts: rising head circumference, bulging fontanel, high-pitched cry, vomiting and irritability can signal shunt malfunction
- Myelomeningocele: cover the sac with a sterile, moist, non-adherent dressing; prone position; latex precautions
- Reye syndrome: linked to aspirin during viral illness; teach parents to avoid aspirin and salicylates
a seizure lasting more than 5 minutes, a bulging fontanel, change in level of consciousness, a petechial or purpuric rash with fever, signs of shunt malfunction.
Infectious Disease and Immunizations
- Immunizations: a mild cold or low-grade fever is not a reason to delay; a severe allergic reaction to a previous dose is; live vaccines (MMR, varicella) are generally avoided in children who are immunocompromised
- Varicella: airborne and contact precautions until all lesions are crusted; keep nails short
- Measles: airborne precautions
- Pertussis and mumps: droplet precautions
- Pediculosis (lice): medicated shampoo, comb out nits, wash bedding in hot water, bag items that cannot be washed
Hematology and Oncology
- Sickle cell crisis: hydration, pain management, oxygen as prescribed, rest; avoid cold compresses, which cause vasoconstriction
- Hemophilia: avoid IM injections and rectal temperatures; for joint bleeding, rest, ice, compression and elevation; factor replacement as prescribed
- Iron deficiency anemia: give oral iron between meals with vitamin C (such as orange juice), through a straw or dropper toward the back of the mouth; dark stools are expected; limit cow’s milk in toddlers
- Leukemia and chemotherapy: neutropenic precautions, bleeding precautions, mouth care, no live vaccines
Musculoskeletal
- Casts: neurovascular checks; elevate the extremity; report pain not relieved by medication, coolness or numbness
- Developmental dysplasia of the hip: uneven thigh skin folds, limited abduction; Pavlik harness worn as prescribed with skin checks
- Scoliosis: brace worn about 18–23 hours a day as prescribed; a T-shirt under the brace protects the skin
Safety, Poisoning and Child Maltreatment
- Car seats: rear-facing as long as possible and at least until about age 2, in the back seat
- Poisoning: call Poison Control first; do not induce vomiting unless told to; keep medicines and cleaners locked up
- Lead poisoning: peeling paint in older homes, developmental delays, abdominal pain; screening as recommended
- Burns and drowning: set water heaters to 120°F (49°C) or lower; never leave a young child alone in or near water
- Child maltreatment: injuries that don’t match the history or the child’s developmental stage, patterned bruises or burns, bruises in different healing stages, delays in seeking care; nurses are mandated reporters
any suspicion of abuse or neglect, an injury that doesn’t fit the history or developmental age, signs of poisoning or ingestion.
Pediatric Vital Signs and Lab Values by Age
ATI gives you a number and asks whether it is normal for that age. Normal ranges are approximate and vary by reference, so learn the pattern: the younger the child, the faster the heart rate and breathing.
| Age | Heart rate (bpm) | Respiratory rate (/min) | Clinical tip |
|---|---|---|---|
| Newborn–infant | About 100–160 | About 30–60 | Count the apical pulse and respirations for a full minute; infants breathe with their abdomen. |
| Toddler | About 90–150 | About 24–40 | Take vital signs while calm; crying raises both rates. |
| Preschool | About 80–140 | About 22–34 | Let the child handle the equipment first to reduce fear. |
| School-age | About 70–120 | About 18–30 | Explain the steps simply before you start. |
| Adolescent | About 60–100 | About 12–20 | Close to adult values; provide privacy. |
| Lab / measure | Expected range | Clinical tip |
|---|---|---|
| Urine output | About 1–2 mL/kg/hr (infants and children) | Less than about 1 mL/kg/hr suggests dehydration or poor perfusion. |
| Urine specific gravity | About 1.005–1.030 | A high value points to dehydration. |
| Hemoglobin (child) | About 11–13 g/dL (varies by age) | Low values with pallor and fatigue suggest iron deficiency anemia. |
| Blood lead level | Below the CDC reference value of 3.5 mcg/dL | Values at or above the reference need follow-up and environmental review. |
| Digoxin level | About 0.8–2.0 ng/mL | Vomiting, poor feeding and slow heart rate suggest toxicity. |
| Blood glucose (type 1 diabetes) | Target set by the provider; often about 70–180 mg/dL | Shaky, sweaty or irritable children need a fast-acting carbohydrate and a recheck. |
Study tip: for every number, ask: “Is this normal for this age? If not, what is the PN action?” That is exactly how ATI frames the question.
Pediatric Medication Administration and Must-Know Drugs (2026)
Pediatric doses are based on weight, so a small error can cause serious harm. ATI tests both safe technique and the specific drugs below.
Safe administration
- Weight-based dosing: weigh in kilograms, check the safe dose range (mg/kg) and question any dose outside it before giving
- Oral meds: use an oral syringe directed toward the inner cheek; never add medicine to a full bottle of formula
- IM injections: vastus lateralis for infants; use the smallest suitable volume and needle
- Ear drops: pull the pinna down and back for children under about 3, up and back for older children
- Fever and pain: acetaminophen or ibuprofen as prescribed; never aspirin in children and teens with viral illness
| Medication | Key nursing points |
|---|---|
| Digoxin | Count the apical pulse for 1 full minute. Hold and report if below about 90–110 bpm in infants, 70 in children or 60 in adolescents. Toxicity: vomiting, poor feeding, slow heart rate. |
| Albuterol | Quick-relief bronchodilator for asthma. Expect a faster heart rate and jitteriness. Give before inhaled steroids when both are due. |
| Inhaled corticosteroids | Long-term asthma control. Rinse the mouth afterward to prevent thrush. Use a spacer for young children. |
| Pancreatic enzymes | For cystic fibrosis. Give with every meal and snack. Do not crush; capsules can be opened and sprinkled on a soft, acidic food such as applesauce. |
| Oral iron | Between meals with vitamin C, through a straw or dropper to avoid staining teeth. Expect dark green or black stools. |
| Corticosteroids (prednisone) | Nephrotic syndrome and asthma. Raises infection risk and blood glucose. Never stop abruptly. |
| Methylphenidate | For ADHD. Give in the morning to avoid insomnia. Monitor appetite, weight and growth. |
| Antibiotics (amoxicillin) | Finish the full course even when the child feels better. Watch for rash or allergic reaction. |
| Anticonvulsants | Give at the same times daily. Do not stop suddenly. Some require blood level checks. |
| Insulin | Know onset and peak times. Match the dose to meals and activity. Teach the signs of hypoglycemia. |
For weight-based calculation practice, see the ATI dosage calculation guide.
Prioritization and PN Scope of Practice in Pediatric Nursing
Children compensate well and then decline quickly, so ATI pediatric priority questions reward catching early warning signs.
How to approach a prioritization question
- Airway, breathing, circulation. Respiratory problems are the leading cause of decline in children. A child with drooling and stridor comes first.
- Unstable over stable. An infant with a bulging fontanel and vomiting outranks a stable child with a cast.
- Unexpected over expected. Separation anxiety in a toddler is expected; a lethargic toddler who won’t respond is not.
- Actual over risk. A child having a seizure outranks a child on seizure precautions.
PN scope on ATI pediatric questions
- The LPN collects data such as vital signs, intake and output, daily weights and observations, but does not perform the initial comprehensive assessment.
- The LPN reinforces teaching for parents and children that the RN has already started.
- The LPN cares for stable children with predictable outcomes. A child with a compromised airway or a new admission needs the RN.
- The LPN reports changes and any suspicion of maltreatment. If one option says “assess” and another says “notify the RN,” look closely at which fits the PN role.
ATI PN Pediatric Nursing 2026 Sample Questions with Rationales
Each example shows the kind of reasoning ATI expects. Read the rationale even if you get the answer right, because the exam often tests the same concept from a different angle.
Question 1 — Epiglottitis (Respiratory)
A 4-year-old arrives with a high fever, drooling, a muffled voice and is sitting upright leaning forward. Which action should the practical nurse take?
- Inspect the throat with a tongue blade.
- Place the child flat to rest.
- Keep the child upright and calm and notify the RN immediately.
- Obtain a throat culture.
Question 2 — Digoxin in an Infant (Medications)
A practical nurse is about to give digoxin to a 6-month-old with heart failure. The apical pulse, counted for 1 full minute, is 84 bpm. Which action is correct?
- Give the dose and recheck the pulse in 1 hour.
- Hold the dose and report the heart rate.
- Give half the dose.
- Recheck the pulse at the radial site and give the dose if it is higher.
Question 3 — After Tonsillectomy (Postoperative)
Four hours after a tonsillectomy, a 6-year-old is swallowing frequently. What does this finding most likely mean?
- The child is thirsty and needs fluids.
- The child may be bleeding from the surgical site.
- The anesthetic is wearing off.
- This is an expected finding after surgery.
Question 4 — Toy for a Hospitalized Toddler (Growth and Development)
Which toy is most appropriate for a hospitalized 18-month-old?
- A 100-piece puzzle.
- A push-pull toy.
- A set of small plastic beads.
- A board game with rules.
Question 5 — Signs of Dehydration (Gastrointestinal)
A 9-month-old has had diarrhea for 2 days. Which finding should the practical nurse report first?
- Two loose stools in the past 4 hours.
- Mild diaper rash.
- A sunken anterior fontanel and no wet diaper for 8 hours.
- Asking for a bottle frequently.
Study Plans for the ATI PN Pediatric Nursing 2026 Exam: 4 Weeks and 2 Weeks
4-week plan
| Week | Focus | What to do |
|---|---|---|
| 1 | Growth and development, safety | Learn milestones, Erikson stages and play by age. Answer every development and safety question here and read all rationales. |
| 2 | Respiratory, cardiac, GI | Compare look-alike conditions such as croup vs. epiglottitis and pyloric stenosis vs. intussusception. Add the medication table to flashcards. |
| 3 | Neuro, renal, hematology, infectious | Finish the remaining systems and isolation types. Do a timed run of all 70 questions. |
| 4 | Review and weak areas | Redo missed questions, focusing on prioritization, vital signs by age and PN scope. Do a second timed run 2 days before the exam. |
2-week plan
| Week | Focus | What to do |
|---|---|---|
| 1 | All content areas | Take the full 70-question test untimed. Mark every question you miss or guess on and sort them by topic. |
| 2 | Weak areas + timed run | Study only the topics where you missed the most. Redo those questions, then do one final timed run. |
Whichever plan you choose: read every rationale, even for questions you get right. ATI often tests the same concept from a new angle.
Common Mistakes on the ATI PN Pediatrics 2026 Exam
- Using adult normals. A heart rate of 130 is normal for an infant and abnormal for a teenager.
- Ignoring the child’s age. The right toy, explanation or pain scale depends on developmental stage.
- Missing early respiratory signs. Nasal flaring, grunting and retractions come before a falling oxygen saturation.
- Mixing up isolation types. Varicella and measles are airborne; pertussis and mumps are droplet; RSV is contact.
- Choosing the RN action. Changing a dose or doing the initial assessment is not the PN role; collecting data and reporting is.
- Overlooking maltreatment cues. An injury that doesn’t fit the history or the child’s age must be reported.
Test-Day Strategies for the 2026 Pediatrics Exam
- Pace yourself. Divide the time allowed by the number of items. Flag hard questions and come back to them.
- Underline the age. In pediatrics, the child’s age often decides the answer.
- Read the stem carefully. Watch for “first,” “priority,” “immediately” and “report.”
- Eliminate unsafe options first. Anything that threatens the airway or delays reporting is usually wrong.
- When two options look equal, pick the safest one. Safety is the ATI default.
- Do your last practice run 2 days before the exam, then use the final day for light review and rest.
Pediatric Nursing Glossary: Terms You Will See on the Exam
- Fontanel
- Soft spot on an infant’s skull. Bulging suggests increased intracranial pressure; sunken suggests dehydration.
- Stridor
- High-pitched sound on breathing in, caused by a narrowed upper airway.
- Retractions
- Skin pulling in between or below the ribs with each breath; a sign of respiratory distress.
- Tripod position
- Sitting up and leaning forward on the hands to ease breathing.
- Steatorrhea
- Bulky, greasy, foul-smelling stools; seen in cystic fibrosis.
- Currant jelly stool
- Stool mixed with blood and mucus; a sign of intussusception.
- Nuchal rigidity
- Stiff neck that resists bending forward; a sign of meningitis.
- Opisthotonos
- Severe arching of the back and neck; seen with meningitis in infants.
- Vaso-occlusive crisis
- Painful blockage of blood flow by sickled cells.
- Hemarthrosis
- Bleeding into a joint; common in hemophilia.
- Regression
- Return to earlier behavior during stress, such as a toddler losing toilet training.
- Parallel play
- Children playing side by side without interacting; typical of toddlers.
- Pica
- Eating non-food items such as dirt or paint chips; linked to lead poisoning and iron deficiency.
- Mandated reporter
- A professional, including nurses, legally required to report suspected child abuse or neglect.
What Students Are Saying
Real video feedback from students who used our practice questions to prepare for their exam.
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