Practice for the ATI RN Pediatric Nursing proctored exam 2026 and Online Practice 2026 with 70 exam-style questions and detailed rationales. Covers NGN clinical judgment, growth and development, pediatric disorders across every body system, fluids and dosage calculations, delegation and prioritization at the RN level.
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The ATI RN Pediatric Nursing Proctored Exam 2026 tests your readiness to care for infants, children and adolescents at the registered nurse level of practice. It is also the content base for the ATI RN Pediatric Nursing Online Practice 2026 assessments many programs assign as formative practice before the graded proctored exam.
At the RN level, questions go beyond recognizing signs and symptoms. You are expected to assess, interpret clinical data, set priorities, make judgment calls under ambiguity, delegate appropriately and evaluate outcomes — the reasoning tested by Next Generation NCLEX (NGN) clinical judgment items.
ATI reports results as a proficiency level rather than a simple percentage.
| Level | What it means |
|---|---|
| Below Level 1 | Significant gaps; focused remediation strongly recommended |
| Level 1 | Minimum expected proficiency; some programs require remediation |
| Level 2 | Solid proficiency; the benchmark most programs require |
| Level 3 | Advanced proficiency; associated with stronger NCLEX-RN pass predictors |
Check your own course syllabus for the exact benchmark your program requires — policies vary by school.
Next Generation NCLEX items use the NCSBN Clinical Judgment Measurement Model: recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, and evaluate outcomes. Expect extended drag-and-drop, matrix, bow-tie and trend-based case study questions built around this model.
A case study gives you a 4-month-old with vomiting, poor weight gain and a palpable olive-shaped mass in the upper abdomen.
| Age group | Key milestones | RN priorities |
|---|---|---|
| Infant (0–1 yr) | Head control by 4 mo, sits by 6 mo, pincer grasp by 9–10 mo, first words around 12 mo | Immunization schedule, safe sleep (back to sleep, no loose bedding), car seat rear-facing |
| Toddler (1–3 yr) | Walks independently, parallel play, tantrums, toilet training readiness | Poisoning and fall prevention, autonomy vs. shame and doubt (Erikson) |
| Preschool (3–6 yr) | Magical thinking, cooperative play begins, pretend play | Simple, concrete explanations before procedures; initiative vs. guilt |
| School-age (6–12 yr) | Concrete operational thought, peer relationships, industry vs. inferiority | Involve in care decisions appropriate to age; privacy |
| Adolescent (12–18 yr) | Abstract thought, identity formation, peer influence dominant | Confidentiality, HEEADSSS psychosocial assessment, risk screening |
| Condition | Key findings | RN priority action |
|---|---|---|
| Asthma (acute exacerbation) | Wheezing, prolonged expiration, accessory muscle use, silent chest is ominous | Bronchodilator first, assess work of breathing, prepare for escalation if silent chest |
| Bronchiolitis / RSV | Infant with tachypnea, retractions, nasal flaring, poor feeding | Contact precautions, suction before feeds, monitor oxygen saturation |
| Croup (laryngotracheobronchitis) | Barking cough, inspiratory stridor, worse at night | Cool mist or humidified air; stridor at rest signals severity |
| Epiglottitis | Sudden high fever, drooling, tripod position, muffled voice | Do not examine the throat or lay the child flat; prepare for emergency airway |
| Cystic fibrosis | Chronic cough, steatorrhea, failure to thrive, salty-tasting skin | Chest physiotherapy before meals, pancreatic enzymes with food, airway clearance |
| Category | Examples | Key feature |
|---|---|---|
| Increased pulmonary blood flow | ASD, VSD, PDA | Left-to-right shunt; signs of heart failure, not cyanosis |
| Decreased pulmonary blood flow | Tetralogy of Fallot, tricuspid atresia | Right-to-left shunt; cyanosis, hypercyanotic (“tet”) spells relieved by knee-chest position |
| Obstructive defects | Coarctation of the aorta, aortic/pulmonic stenosis | Blood flow obstructed; unequal pulses/BP in coarctation |
| Mixed defects | Transposition of the great arteries | Oxygenated and deoxygenated blood mix; severe cyanosis at birth |
Fever ≥5 days, conjunctivitis, strawberry tongue, rash, swollen hands/feet, cervical lymphadenopathy. Give IVIG and high-dose aspirin as prescribed; monitor for coronary artery aneurysm risk with echocardiography.
| Condition | Key findings | RN priority |
|---|---|---|
| Increased ICP (infant) | Bulging fontanel, high-pitched cry, irritability, setting-sun eyes | Elevate HOB 30°, maintain neutral head position, minimize stimulation |
| Increased ICP (child) | Headache, vomiting without nausea, altered LOC, Cushing triad (late) | Frequent neuro checks, seizure precautions, avoid factors that raise ICP |
| Bacterial meningitis | Fever, nuchal rigidity, photophobia, petechial rash (meningococcal) | Droplet precautions, antibiotics promptly, monitor for increased ICP |
| Hydrocephalus / VP shunt | Enlarged head circumference in infants; shunt malfunction signs in older children | Measure head circumference; report vomiting, irritability, lethargy with a shunt |
| Spina bifida (myelomeningocele) | Visible sac on spine, motor/sensory deficits below defect | Cover sac with sterile, moist, non-adherent dressing; latex precautions |
| Seizures | Tonic-clonic activity, post-ictal confusion | Protect from injury, time the seizure, position side-lying, do not restrain |
| Finding | Significance |
|---|---|
| Polyuria, polydipsia, polyphagia, weight loss | Classic new-onset type 1 diabetes presentation |
| Fruity breath, Kussmaul respirations, abdominal pain, altered LOC | Diabetic ketoacidosis (DKA) — a medical emergency |
| Headache and decreasing LOC during DKA treatment | Possible cerebral edema — notify the provider immediately |
DKA management priority: IV fluids first, then regular insulin infusion, with hourly glucose and electrolyte monitoring (especially potassium, since insulin drives it intracellularly).
| Condition | Key findings | RN priority |
|---|---|---|
| Nephrotic syndrome | Massive proteinuria, periorbital/generalized edema, hypoalbuminemia | Daily weight, monitor urine protein, infection risk from immunosuppressants |
| Pyloric stenosis | Projectile vomiting, olive-shaped mass, metabolic alkalosis | Correct fluids/electrolytes before surgery; NPO |
| Intussusception | Currant jelly stools, sudden intermittent abdominal pain, sausage-shaped mass | Report bloody stools immediately; prepare for air/contrast enema |
| Hirschsprung disease | Failure to pass meconium in 24–48 hr, ribbon-like stools | Monitor for enterocolitis; bowel management teaching |
| Appendicitis | Periumbilical pain migrating to RLQ (McBurney point), rebound tenderness | Sudden pain relief may mean perforation — report immediately |
| Dehydration | Sunken fontanel, dry mucous membranes, decreased urine output, tachycardia | Oral rehydration first if mild; IV fluids for moderate/severe |
| Condition | Key findings | RN priority |
|---|---|---|
| Sickle cell disease | Vaso-occlusive crisis pain, dactylitis, acute chest syndrome | Hydration, oxygen, pain management; chest pain + hypoxia is an emergency |
| Hemophilia | Prolonged bleeding, hemarthrosis | Factor replacement, avoid IM injections and contact sports |
| Leukemia (ALL) | Fatigue, bruising, bone pain, recurrent infections | Neutropenic precautions, bleeding precautions, no rectal temps |
| Tumor lysis syndrome | Hyperkalemia, hyperphosphatemia, hyperuricemia after chemo starts | Hydration, monitor electrolytes and renal function closely |
Use an age-adjusted chart (Lund-Browder) rather than the adult rule of nines for burn size in children. Parkland formula: 4 mL × weight (kg) × % TBSA burned = fluid for the first 24 hours, with half given in the first 8 hours post-burn.
| Condition | Key findings | RN priority |
|---|---|---|
| Developmental dysplasia of the hip | Asymmetric thigh folds, limited abduction, positive Ortolani/Barlow in infants | Pavlik harness teaching; do not remove per schedule |
| Scoliosis | Uneven shoulders/hips, asymmetric rib hump on forward bend | Screen at well visits; brace compliance teaching if prescribed |
| Fractures (growth plate) | Salter-Harris classification; growth plate injuries risk future growth disturbance | Neurovascular checks (the 5 P's) distal to injury |
| Duchenne muscular dystrophy | Gower sign (using hands to push up from floor), calf pseudohypertrophy | Monitor respiratory and cardiac function as disease progresses |
Ranges are approximate and vary by reference. On the RN exam you are expected to interpret the value, connect it to a condition and choose the action.
| Measure | Approximate normal | What an abnormal value suggests |
|---|---|---|
| Heart rate | Infant 100–160; toddler 90–150; school-age 70–120; adolescent 60–100 | Tachycardia is an early sign of shock in children; bradycardia is a late, ominous sign. |
| Respiratory rate | Infant 30–60; toddler 24–40; school-age 18–30; adolescent 12–20 | Rising rate with retractions signals respiratory distress. |
| Blood pressure | Rises with age; minimum systolic for a child 1–10 is about 70 + (2 × age in years) | Hypotension is a late sign of shock; children maintain pressure until they decompensate. |
| Urine output | About 1–2 mL/kg/hr | Below about 1 mL/kg/hr suggests poor perfusion or dehydration. |
| Potassium | About 3.5–5.0 mEq/L | Watch during DKA treatment, diuretics and digoxin therapy. |
| Sodium | About 135–145 mEq/L | Rapid shifts can cause seizures or cerebral edema. |
| Arterial blood gas | pH 7.35–7.45; PaCO2 35–45 mm Hg; HCO3 22–26 mEq/L | DKA causes metabolic acidosis; pyloric stenosis causes metabolic alkalosis. |
| Absolute neutrophil count | Above about 1,500/mm³ | Below 500/mm³ means severe neutropenia and high infection risk. |
| Platelets | About 150,000–400,000/mm³ | Low counts require bleeding precautions. |
| Digoxin level | About 0.8–2.0 ng/mL | Vomiting, poor feeding and bradycardia suggest toxicity. |
Weight-based dosing is tested on almost every ATI RN Pediatric Nursing exam. Always convert pounds to kilograms (divide by 2.2) and check the safe dose range before you give a medication.
An 18-kg child is prescribed acetaminophen 240 mg every 6 hours. The safe range is 10–15 mg/kg per dose.
Daily fluid needs: 100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg, and 20 mL/kg for each kg above 20.
| Medication | RN-level nursing points |
|---|---|
| Digoxin | Apical pulse for 1 full minute; hold if below about 90–110 bpm in infants, 70 in children, 60 in adolescents. Check potassium; low potassium raises toxicity risk. |
| IV potassium chloride | Never IV push. Confirm urine output first. Use an infusion pump and monitor the IV site and heart rhythm. |
| Regular insulin (IV, for DKA) | Continuous infusion as prescribed after fluids are started. Hourly glucose; dextrose is usually added as glucose falls. |
| Albuterol and ipratropium | Quick relief for acute asthma. Expect tachycardia and tremor. Reassess breath sounds and work of breathing after each dose. |
| Corticosteroids | Asthma, croup and nephrotic syndrome. Monitor glucose, blood pressure and infection risk. Taper rather than stop abruptly after long courses. |
| IV immunoglobulin (IVIG) | Kawasaki disease. Monitor for infusion reactions. Delay live vaccines for about 11 months. |
| Opioids and PCA | Monitor sedation and respiratory rate. Naloxone is the reversal agent. Only the child presses the PCA button unless the facility authorizes otherwise. |
| Acetylcysteine | Antidote for acetaminophen overdose. Most effective when started early. |
| Methylphenidate | ADHD. Give early in the day. Monitor growth, appetite, sleep and blood pressure. |
| Chemotherapy | Safe handling, antiemetics before doses, neutropenic and bleeding precautions, no live vaccines. |
For more calculation practice, see the ATI dosage calculation guide.
Children compensate well and then decline fast. RN pediatric priority questions reward early recognition and correct delegation.
| Who | Can do | Should not do |
|---|---|---|
| RN | Initial and ongoing assessment, new teaching, care planning, evaluation, IV push medications, care of unstable children | Delegate assessment, teaching or evaluation |
| LPN/LVN | Care of stable children, data collection, reinforcing teaching, many oral and IM medications (per state and facility) | Initial assessment, new teaching, care of unstable children |
| Assistive personnel | Vital signs on stable children, intake and output, weights, feeding, bathing, ambulation | Any task needing assessment, judgment or teaching |
These show the RN-level reasoning ATI expects. Read every rationale, including why each wrong option is wrong.
The nurse receives report on four children. Which child should the nurse assess first?
Answer: B. Chest pain with hypoxia in a child with sickle cell disease suggests acute chest syndrome, a life-threatening complication. Option A has no stridor at rest. Option C shows adequate hydration. Option D describes expected postoperative pain.
Which task can the RN delegate to assistive personnel?
Answer: B. Measuring intake and output for a stable child is routine and needs no clinical judgment. Option A is new teaching, option C is an initial assessment, and option D is IV medication administration; all belong to licensed nurses.
An 18-kg child is prescribed acetaminophen 300 mg orally every 6 hours. The safe dose range is 10–15 mg/kg per dose. What should the nurse do?
Answer: C. The safe range is 180–270 mg (18 × 10 and 18 × 15). A 300-mg dose exceeds the maximum, so the nurse holds it and clarifies with the provider. Options B and D change a prescription without an order. Option A gives an unsafe dose.
An 8-month-old with a ventriculoperitoneal shunt has vomited twice, has a high-pitched cry and a bulging anterior fontanel. What is the nurse’s priority action?
Answer: C. Vomiting, a high-pitched cry and a bulging fontanel signal rising intracranial pressure from shunt malfunction, which needs urgent treatment. Option A treats vomiting as a GI problem. Option B should not be done without a specific prescription. Option D ignores a dangerous change.
A 12-year-old is receiving IV fluids and an insulin infusion for diabetic ketoacidosis. Which finding requires immediate follow-up?
Answer: B. A new headache and declining level of consciousness during DKA treatment suggest cerebral edema, the most serious complication in children. Option A is a gradual, expected drop. Option C shows improving acidosis. Option D is within normal range.
| Week | Focus | What to do |
|---|---|---|
| 1 | Development, health promotion, respiratory | Review developmental red flags and immunization rules. Take Online Practice 2026 A if your program assigns it, and note weak areas. |
| 2 | Cardiac, neuro, endocrine | Learn congenital heart defect categories, ICP signs and DKA management. Answer every related question here and read the rationales. |
| 3 | Fluids, renal, heme/onc, burns, calculations | Practice safe-dose, maintenance fluid and Parkland calculations daily. Do a timed run of all 70 questions. |
| 4 | Prioritization, delegation, NGN | Redo missed questions. Take Online Practice 2026 B if assigned. Do a final timed run 2 days before the exam. |
| Week | Focus | What to do |
|---|---|---|
| 1 | All content areas | Take the full 70-question test untimed. Sort every missed or guessed question by topic. |
| 2 | Weak areas + timed run | Study only your weakest topics plus calculations. Redo those questions, then do one final timed run. |
Real video feedback from students who used our practice questions to prepare for their exam.
Studying for more than one ATI exam? These practice tests cover related pediatric and RN content. Browse all pediatric nursing practice exams.
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Quick answers about the ATI RN Pediatric Nursing Practice 2026 _Questions with Answers and Explanations
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