HESI PEDIATRICS EXIT /HESI EXIT PEDIATRICS EXAM LATEST REAL EXAM ALL 100
QUESTIONS AND CORRECT ANSWERS|ALREADY GRADED A+
Question 1
A nurse in the emergency department is assessing a 3-year-old child who presents with a sudden
high fever, muffled voice, and is drooling. The child is sitting upright and leaning forward with
their chin thrusted out. Which of the following actions should the nurse take first?
A) Obtain a throat culture to rule out Group A Streptococcus.
B) Place the child in a supine position to facilitate a physical exam.
C) Administer a dose of oral acetaminophen for the fever.
D) Prepare the child for emergency endotracheal intubation.
E) Use a tongue blade to visualize the posterior pharynx.
Correct Answer: D) Prepare the child for emergency endotracheal intubation.
Rationale: The child is exhibiting the classic clinical triad of epiglottitis: drooling, dysphonia
(muffled voice), and distress (tripod positioning). Epiglottitis is a medical emergency
caused by bacterial inflammation that can lead to rapid, total airway obstruction. The
nurse’s absolute priority is maintaining a patent airway. Any attempt to visualize the throat
with a tongue blade (Option E) or a throat swab (Option A) is strictly contraindicated, as it
can trigger a laryngospasm and immediate respiratory arrest. Placing the child in a supine
position (Option B) will further compromise the airway. While fever management is
important, airway stabilization (Option D) is the life-saving priority.
Question 2
A nurse is assessing a 4-week-old infant whose mother reports "projectile vomiting" after every
feeding. Upon assessment, the nurse palpates an olive-shaped mass in the right upper quadrant of
the abdomen. Which of the following conditions is most likely?
A) Intussusception
B) Hirschsprung's disease
C) Hypertrophic pyloric stenosis
D) Gastroesophageal reflux disease (GERD)
E) Meckel’s diverticulum
Correct Answer: C) Hypertrophic pyloric stenosis
Rationale: Hypertrophic pyloric stenosis is the thickening of the pyloric sphincter, which
, 2
creates an outlet obstruction from the stomach to the duodenum. The hallmark clinical
manifestations include non-bilious projectile vomiting (often occurring shortly after
feeding) and a palpable olive-shaped mass in the epigastrium (Option C). This condition
typically presents between 3 and 6 weeks of age. Intussusception (Option A) presents with
"currant jelly" stools and a sausage-shaped mass. Hirschsprung's (Option B) presents with
constipation and ribbon-like stools. GERD (Option D) involves spitting up but is rarely
projectile or associated with an abdominal mass.
Question 3
A nurse is caring for a 10-year-old child who is in a vaso-occlusive sickle cell crisis. Which of
the following nursing interventions is the priority?
A) Administering oxygen at 2 L/min via nasal cannula.
B) Applying cold compresses to the painful joints.
C) Administering intravenous fluids at 1.5 times the maintenance rate.
D) Assessing the child’s neurological status every 8 hours.
E) Administering meperidine for severe pain management.
Correct Answer: C) Administering intravenous fluids at 1.5 times the maintenance rate.
Rationale: In a vaso-occlusive crisis, sickled red blood cells clump together and obstruct
blood flow, leading to tissue ischemia and extreme pain. Aggressive hydration (Option C) is
the priority because it reduces blood viscosity and "un-clumps" the sickled cells, restoring
circulation. While oxygen (Option A) is helpful, it cannot reach the ischemic tissues until
the blockage is cleared via hydration. Cold compresses (Option B) are contraindicated
because they cause vasoconstriction, which worsens the sickling and obstruction.
Meperidine (Option E) is avoided in pediatric sickle cell patients due to the high risk of
normeperidine-induced seizures.
Question 4
A nurse is providing discharge teaching to the parents of a child with cystic fibrosis (CF)
regarding the administration of pancreatic enzymes. Which of the following instructions should
the nurse include?
A) Administer the enzymes only if the child consumes a high-fat meal.
, 3
B) Give the enzymes 30 minutes after the child has finished eating.
C) Swallow the capsules whole or sprinkle them on applesauce.
D) Increase the dose if the child begins to have hard, dry stools.
E) Mix the enzyme powder into a warm bowl of oatmeal.
Correct Answer: C) Swallow the capsules whole or sprinkle them on applesauce.
Rationale: Pancreatic enzymes are required for the digestion of fats, proteins, and
carbohydrates in children with CF due to pancreatic insufficiency. The capsules can be
swallowed whole or opened and sprinkled on a small amount of an acidic food with a soft
texture, like applesauce (Option C), to ensure they reach the small intestine. Enzymes must
be taken with every meal and snack (Option A is incorrect) and should be
taken before or during the meal, not after (Option B). They should not be mixed with warm
or alkaline foods like oatmeal (Option E), as heat and alkalinity can deactivate the
enzymes. Effectiveness is monitored by the frequency and consistency of stools; fatty, foul-
smelling stools (steatorrhea) indicate a need for a higher dose, not hard stools (Option D).
Question 5
A nurse is assessing a 12-month-old infant during a well-child visit. Which of the following
developmental milestones should the nurse expect the infant to have achieved?
A) Building a tower of six blocks.
B) Walking while holding onto furniture (cruising).
C) Saying 10 to 15 distinct words.
D) Drawing a vertical line on a piece of paper.
E) Jumping in place with both feet.
Correct Answer: B) Walking while holding onto furniture (cruising).
Rationale: By 12 months, gross motor development typically includes the ability to "cruise"
or walk while holding onto furniture (Option B). Some infants may even take their first
independent steps. Building a tower of six blocks (Option A) is a 24-month milestone.
Saying 10-15 words (Option C) is typically achieved by 18 months; a 12-month-old usually
says 3 to 5 words. Drawing a vertical line (Option D) is a 2-year-old skill, and jumping in
place (Option E) is a 30-month milestone.
, 4
Question 6
A nurse is assessing a 5-year-old child who has been diagnosed with nephrotic syndrome. Which
of the following laboratory findings should the nurse expect?
A) Gross hematuria and elevated serum creatinine.
B) Massive proteinuria and hypoalbuminemia.
C) Low serum cholesterol and decreased hemoglobin.
D) Bacteriuria and positive nitrates.
E) Hypokalemia and metabolic alkalosis.
Correct Answer: B) Massive proteinuria and hypoalbuminemia.
Rationale: Nephrotic syndrome is a glomerular disorder characterized by increased
permeability of the glomerular capillary wall to proteins. This results in massive
proteinuria (Option B). The loss of protein in the urine leads to a decrease in serum
albumin (hypoalbuminemia), which in turn causes a shift in osmotic pressure, leading to
generalized edema (anasarca). Hematuria (Option A) is more characteristic of acute
glomerulonephritis. Nephrotic syndrome is also associated with hyperlipidemia (high
cholesterol), making Option C incorrect.
Question 7
A nurse is assessing a 7-month-old infant who is experiencing sudden, episodic abdominal pain,
drawing their knees to their chest, and passing stools that resemble "currant jelly." Which of the
following interventions should the nurse anticipate?
A) Scheduling an emergency appendectomy.
B) Preparing the infant for a barium or air enema.
C) Administering a dose of polyethylene glycol.
D) Placing the infant in a prone position for comfort.
E) Testing the stool for the presence of ova and parasites.
Correct Answer: B) Preparing the infant for a barium or air enema.
Rationale: The symptoms of sudden episodic pain, knee-to-chest positioning, and "currant
jelly" stools (blood and mucus) are hallmark signs of intussusception. Intussusception
occurs when a segment of the bowel telescopes into another. A barium or air enema (Option
QUESTIONS AND CORRECT ANSWERS|ALREADY GRADED A+
Question 1
A nurse in the emergency department is assessing a 3-year-old child who presents with a sudden
high fever, muffled voice, and is drooling. The child is sitting upright and leaning forward with
their chin thrusted out. Which of the following actions should the nurse take first?
A) Obtain a throat culture to rule out Group A Streptococcus.
B) Place the child in a supine position to facilitate a physical exam.
C) Administer a dose of oral acetaminophen for the fever.
D) Prepare the child for emergency endotracheal intubation.
E) Use a tongue blade to visualize the posterior pharynx.
Correct Answer: D) Prepare the child for emergency endotracheal intubation.
Rationale: The child is exhibiting the classic clinical triad of epiglottitis: drooling, dysphonia
(muffled voice), and distress (tripod positioning). Epiglottitis is a medical emergency
caused by bacterial inflammation that can lead to rapid, total airway obstruction. The
nurse’s absolute priority is maintaining a patent airway. Any attempt to visualize the throat
with a tongue blade (Option E) or a throat swab (Option A) is strictly contraindicated, as it
can trigger a laryngospasm and immediate respiratory arrest. Placing the child in a supine
position (Option B) will further compromise the airway. While fever management is
important, airway stabilization (Option D) is the life-saving priority.
Question 2
A nurse is assessing a 4-week-old infant whose mother reports "projectile vomiting" after every
feeding. Upon assessment, the nurse palpates an olive-shaped mass in the right upper quadrant of
the abdomen. Which of the following conditions is most likely?
A) Intussusception
B) Hirschsprung's disease
C) Hypertrophic pyloric stenosis
D) Gastroesophageal reflux disease (GERD)
E) Meckel’s diverticulum
Correct Answer: C) Hypertrophic pyloric stenosis
Rationale: Hypertrophic pyloric stenosis is the thickening of the pyloric sphincter, which
, 2
creates an outlet obstruction from the stomach to the duodenum. The hallmark clinical
manifestations include non-bilious projectile vomiting (often occurring shortly after
feeding) and a palpable olive-shaped mass in the epigastrium (Option C). This condition
typically presents between 3 and 6 weeks of age. Intussusception (Option A) presents with
"currant jelly" stools and a sausage-shaped mass. Hirschsprung's (Option B) presents with
constipation and ribbon-like stools. GERD (Option D) involves spitting up but is rarely
projectile or associated with an abdominal mass.
Question 3
A nurse is caring for a 10-year-old child who is in a vaso-occlusive sickle cell crisis. Which of
the following nursing interventions is the priority?
A) Administering oxygen at 2 L/min via nasal cannula.
B) Applying cold compresses to the painful joints.
C) Administering intravenous fluids at 1.5 times the maintenance rate.
D) Assessing the child’s neurological status every 8 hours.
E) Administering meperidine for severe pain management.
Correct Answer: C) Administering intravenous fluids at 1.5 times the maintenance rate.
Rationale: In a vaso-occlusive crisis, sickled red blood cells clump together and obstruct
blood flow, leading to tissue ischemia and extreme pain. Aggressive hydration (Option C) is
the priority because it reduces blood viscosity and "un-clumps" the sickled cells, restoring
circulation. While oxygen (Option A) is helpful, it cannot reach the ischemic tissues until
the blockage is cleared via hydration. Cold compresses (Option B) are contraindicated
because they cause vasoconstriction, which worsens the sickling and obstruction.
Meperidine (Option E) is avoided in pediatric sickle cell patients due to the high risk of
normeperidine-induced seizures.
Question 4
A nurse is providing discharge teaching to the parents of a child with cystic fibrosis (CF)
regarding the administration of pancreatic enzymes. Which of the following instructions should
the nurse include?
A) Administer the enzymes only if the child consumes a high-fat meal.
, 3
B) Give the enzymes 30 minutes after the child has finished eating.
C) Swallow the capsules whole or sprinkle them on applesauce.
D) Increase the dose if the child begins to have hard, dry stools.
E) Mix the enzyme powder into a warm bowl of oatmeal.
Correct Answer: C) Swallow the capsules whole or sprinkle them on applesauce.
Rationale: Pancreatic enzymes are required for the digestion of fats, proteins, and
carbohydrates in children with CF due to pancreatic insufficiency. The capsules can be
swallowed whole or opened and sprinkled on a small amount of an acidic food with a soft
texture, like applesauce (Option C), to ensure they reach the small intestine. Enzymes must
be taken with every meal and snack (Option A is incorrect) and should be
taken before or during the meal, not after (Option B). They should not be mixed with warm
or alkaline foods like oatmeal (Option E), as heat and alkalinity can deactivate the
enzymes. Effectiveness is monitored by the frequency and consistency of stools; fatty, foul-
smelling stools (steatorrhea) indicate a need for a higher dose, not hard stools (Option D).
Question 5
A nurse is assessing a 12-month-old infant during a well-child visit. Which of the following
developmental milestones should the nurse expect the infant to have achieved?
A) Building a tower of six blocks.
B) Walking while holding onto furniture (cruising).
C) Saying 10 to 15 distinct words.
D) Drawing a vertical line on a piece of paper.
E) Jumping in place with both feet.
Correct Answer: B) Walking while holding onto furniture (cruising).
Rationale: By 12 months, gross motor development typically includes the ability to "cruise"
or walk while holding onto furniture (Option B). Some infants may even take their first
independent steps. Building a tower of six blocks (Option A) is a 24-month milestone.
Saying 10-15 words (Option C) is typically achieved by 18 months; a 12-month-old usually
says 3 to 5 words. Drawing a vertical line (Option D) is a 2-year-old skill, and jumping in
place (Option E) is a 30-month milestone.
, 4
Question 6
A nurse is assessing a 5-year-old child who has been diagnosed with nephrotic syndrome. Which
of the following laboratory findings should the nurse expect?
A) Gross hematuria and elevated serum creatinine.
B) Massive proteinuria and hypoalbuminemia.
C) Low serum cholesterol and decreased hemoglobin.
D) Bacteriuria and positive nitrates.
E) Hypokalemia and metabolic alkalosis.
Correct Answer: B) Massive proteinuria and hypoalbuminemia.
Rationale: Nephrotic syndrome is a glomerular disorder characterized by increased
permeability of the glomerular capillary wall to proteins. This results in massive
proteinuria (Option B). The loss of protein in the urine leads to a decrease in serum
albumin (hypoalbuminemia), which in turn causes a shift in osmotic pressure, leading to
generalized edema (anasarca). Hematuria (Option A) is more characteristic of acute
glomerulonephritis. Nephrotic syndrome is also associated with hyperlipidemia (high
cholesterol), making Option C incorrect.
Question 7
A nurse is assessing a 7-month-old infant who is experiencing sudden, episodic abdominal pain,
drawing their knees to their chest, and passing stools that resemble "currant jelly." Which of the
following interventions should the nurse anticipate?
A) Scheduling an emergency appendectomy.
B) Preparing the infant for a barium or air enema.
C) Administering a dose of polyethylene glycol.
D) Placing the infant in a prone position for comfort.
E) Testing the stool for the presence of ova and parasites.
Correct Answer: B) Preparing the infant for a barium or air enema.
Rationale: The symptoms of sudden episodic pain, knee-to-chest positioning, and "currant
jelly" stools (blood and mucus) are hallmark signs of intussusception. Intussusception
occurs when a segment of the bowel telescopes into another. A barium or air enema (Option
