HESI RN PEDIATRICS (PEDS) EXAM 200 ACTUAL
QUESTIONS AND CORRECT ANSWERS WITH RATIONALE
LATEST 2026 ASSURED PASS
The HESI RN Pediatrics (PEDS) exam is a standardized, computerized test
designed by Elsevier to evaluate nursing students' readiness for the NCLEX-
RN in the specialty of pediatric nursing. The exam emphasizes clinical
judgment, prioritization, and family-centered care across the pediatric
lifespan, from neonates to adolescents. Questions are presented in the Next
Generation NCLEX (NGN) format, featuring multiple-choice, multiple-select,
and unfolding case studies. Key content areas include growth and
developmental milestones (Piaget, Erikson), common acute and chronic
pediatric conditions (asthma, diabetes, congenital heart defects, infections),
pediatric pharmacology and dosage calculations, as well as safety and health
promotion. The exam is a critical component of nursing curricula, used to
predict success on the NCLEX-RN and to ensure competency in providing
safe, evidence-based care to children and their families.
1. A 2-year-old child is brought to the emergency department with stridor,
drooling, and a high fever. The child appears anxious and is sitting upright with the
chin thrust forward. What is the nurse's priority action?
A) Inspect the throat with a tongue depressor
B) Prepare for immediate endotracheal intubation
C) Obtain a throat culture
D) Administer a nebulized bronchodilator
Answer: B
Rationale: The child is presenting with classic signs of epiglottitis, a life-
threatening airway emergency. The priority is to prepare for intubation or
tracheostomy. Any manipulation of the throat, including inspection or throat
cultures, can trigger complete airway obstruction and should be avoided.
Nebulized bronchodilators are not effective for epiglottitis.
2. A 4-month-old infant with a history of bronchiolitis is admitted with respiratory
distress. Which assessment finding is the earliest indicator of impending
respiratory failure?
A) Nasal flaring
B) Grunting respirations
C) Cyanosis of the lips
,D) Decreased respiratory rate and fatigue
Answer: D
Rationale: A decreased respiratory rate and lethargy or fatigue are late signs of
impending respiratory failure, indicating that the infant is tiring out and losing the
ability to maintain the work of breathing. Nasal flaring, grunting, and cyanosis are
earlier signs of respiratory distress, but decreasing effort with exhaustion is more
critical.
3. A nurse is providing discharge teaching to the parents of a 6-month-old infant
with a diagnosis of gastroesophageal reflux disease (GERD). Which statement by
the parent indicates a need for further teaching?
A) "I will keep my baby upright for 30 to 60 minutes after feedings."
B) "I will thicken the formula with rice cereal."
C) "I will place my baby on the stomach to sleep to prevent vomiting."
D) "I will give smaller, more frequent feedings."
Answer: C
Rationale: Infants with GERD should be placed on their back to sleep to reduce the
risk of sudden infant death syndrome (SIDS). Prone (stomach) positioning is not
recommended. Upright positioning after feeds, thickening formula, and smaller
feedings are appropriate interventions for GERD.
4. A 10-year-old child with a history of asthma is experiencing an acute
exacerbation. The nurse notes a peak expiratory flow rate (PEFR) of 50% of the
child's personal best. Which action should the nurse take first?
A) Administer a rescue bronchodilator via nebulizer
B) Give a dose of oral corticosteroids
C) Place the child in a supine position
D) Notify the respiratory therapist for a breathing treatment
Answer: A
Rationale: A PEFR of 50% indicates a moderate to severe asthma exacerbation
requiring immediate bronchodilation with a short-acting beta-agonist (rescue
inhaler or nebulized albuterol). Corticosteroids are adjunctive but not the first
action. The child should be positioned upright to facilitate breathing.
5. A child with newly diagnosed type 1 diabetes mellitus is being discharged. The
mother asks about signs of hypoglycemia. Which response by the nurse is most
accurate?
A) "Your child will have fruity-smelling breath and deep, rapid breathing."
B) "Look for signs like irritability, tremors, and sweating."
C) "Your child will be very thirsty and urinate frequently."
,D) "You should expect your child to have nausea and vomiting."
Answer: B
Rationale: Irritability, tremors, sweating, and pallor are classic signs of
hypoglycemia in children. Fruity-smelling breath, deep breathing, polyuria, and
polydipsia are signs of hyperglycemia and diabetic ketoacidosis.
6. A 3-year-old child is admitted with a diagnosis of bacterial meningitis. Which
finding would the nurse expect to assess?
A) Positive Kernig's sign
B) Positive Moro reflex
C) Sunken fontanel
D) Bradycardia and hypotension
Answer: A
Rationale: Kernig's sign (pain and resistance with knee extension) and Brudzinski's
sign (neck stiffness with hip flexion) are classic signs of meningeal irritation in
meningitis. The Moro reflex is a primitive reflex in infants and should not be
present at age 3 years. A bulging fontanel (not sunken) is seen in infants with
meningitis. Bradycardia is a late sign.
7. A nurse is caring for a child with acute glomerulonephritis. Which assessment
finding is most important to report to the provider?
A) Blood pressure of 140/90 mmHg
B) Tea-colored urine
C) Periorbital edema
D) Weight gain of 1 kg in 24 hours
Answer: A
Rationale: Hypertension is a common complication of acute glomerulonephritis
and requires prompt treatment to prevent hypertensive encephalopathy or heart
failure. While tea-colored urine, edema, and weight gain are all expected findings,
elevated blood pressure is the most critical to address immediately.
8. A 6-month-old infant is brought to the clinic for routine immunizations. Which
vaccines are recommended at this age according to the CDC schedule?
A) DTaP, IPV, Hib, PCV, and Rotavirus
B) MMR, Varicella, and Hepatitis A
C) Tdap, MCV4, and HPV
D) Hepatitis B and Influenza only
Answer: A
, Rationale: At 6 months, the CDC recommends DTaP, IPV, Hib, PCV, and
Rotavirus. MMR and Varicella are given at 12-15 months, and Hepatitis A at 12
months. Tdap, MCV4, and HPV are for adolescents.
9. A child with a ventriculoperitoneal shunt for hydrocephalus presents with
irritability, vomiting, and sunsetting eyes. What is the priority nursing action?
A) Administer antiemetics for vomiting
B) Notify the provider immediately for possible shunt malfunction
C) Place the child in a darkened room to reduce eye strain
D) Obtain a blood culture to rule out infection
Answer: B
Rationale: Irritability, vomiting, and sunsetting eyes are signs of increased
intracranial pressure, which in a child with a VP shunt indicates possible shunt
malfunction or infection. The provider must be notified immediately for
evaluation. Antiemetics would mask symptoms and delay treatment.
10. A 5-year-old child is prescribed amoxicillin for otitis media. The child's parent
reports a rash and hives after the first dose. What is the nurse's best action?
A) Continue the medication and monitor the rash
B) Administer diphenhydramine and continue the amoxicillin
C) Hold the next dose and notify the provider
D) Reassure the parent that this is a common side effect
Answer: C
Rationale: A rash and hives after the first dose suggest a possible allergic reaction.
The medication should be held, and the provider should be notified to change the
antibiotic. Continuing the medication could lead to anaphylaxis.
11. A 2-year-old child with cystic fibrosis is admitted with a respiratory infection.
Which nursing intervention is most important for this child?
A) Restrict fluids to reduce pulmonary secretions
B) Perform chest physiotherapy and postural drainage
C) Place the child in a negative pressure isolation room
D) Administer sedatives to promote rest
Answer: B
Rationale: Chest physiotherapy and postural drainage are essential for mobilizing
and clearing thick pulmonary secretions in children with cystic fibrosis. Fluids
should be encouraged, not restricted, to thin secretions. Sedatives should be
avoided as they can depress the respiratory drive.
QUESTIONS AND CORRECT ANSWERS WITH RATIONALE
LATEST 2026 ASSURED PASS
The HESI RN Pediatrics (PEDS) exam is a standardized, computerized test
designed by Elsevier to evaluate nursing students' readiness for the NCLEX-
RN in the specialty of pediatric nursing. The exam emphasizes clinical
judgment, prioritization, and family-centered care across the pediatric
lifespan, from neonates to adolescents. Questions are presented in the Next
Generation NCLEX (NGN) format, featuring multiple-choice, multiple-select,
and unfolding case studies. Key content areas include growth and
developmental milestones (Piaget, Erikson), common acute and chronic
pediatric conditions (asthma, diabetes, congenital heart defects, infections),
pediatric pharmacology and dosage calculations, as well as safety and health
promotion. The exam is a critical component of nursing curricula, used to
predict success on the NCLEX-RN and to ensure competency in providing
safe, evidence-based care to children and their families.
1. A 2-year-old child is brought to the emergency department with stridor,
drooling, and a high fever. The child appears anxious and is sitting upright with the
chin thrust forward. What is the nurse's priority action?
A) Inspect the throat with a tongue depressor
B) Prepare for immediate endotracheal intubation
C) Obtain a throat culture
D) Administer a nebulized bronchodilator
Answer: B
Rationale: The child is presenting with classic signs of epiglottitis, a life-
threatening airway emergency. The priority is to prepare for intubation or
tracheostomy. Any manipulation of the throat, including inspection or throat
cultures, can trigger complete airway obstruction and should be avoided.
Nebulized bronchodilators are not effective for epiglottitis.
2. A 4-month-old infant with a history of bronchiolitis is admitted with respiratory
distress. Which assessment finding is the earliest indicator of impending
respiratory failure?
A) Nasal flaring
B) Grunting respirations
C) Cyanosis of the lips
,D) Decreased respiratory rate and fatigue
Answer: D
Rationale: A decreased respiratory rate and lethargy or fatigue are late signs of
impending respiratory failure, indicating that the infant is tiring out and losing the
ability to maintain the work of breathing. Nasal flaring, grunting, and cyanosis are
earlier signs of respiratory distress, but decreasing effort with exhaustion is more
critical.
3. A nurse is providing discharge teaching to the parents of a 6-month-old infant
with a diagnosis of gastroesophageal reflux disease (GERD). Which statement by
the parent indicates a need for further teaching?
A) "I will keep my baby upright for 30 to 60 minutes after feedings."
B) "I will thicken the formula with rice cereal."
C) "I will place my baby on the stomach to sleep to prevent vomiting."
D) "I will give smaller, more frequent feedings."
Answer: C
Rationale: Infants with GERD should be placed on their back to sleep to reduce the
risk of sudden infant death syndrome (SIDS). Prone (stomach) positioning is not
recommended. Upright positioning after feeds, thickening formula, and smaller
feedings are appropriate interventions for GERD.
4. A 10-year-old child with a history of asthma is experiencing an acute
exacerbation. The nurse notes a peak expiratory flow rate (PEFR) of 50% of the
child's personal best. Which action should the nurse take first?
A) Administer a rescue bronchodilator via nebulizer
B) Give a dose of oral corticosteroids
C) Place the child in a supine position
D) Notify the respiratory therapist for a breathing treatment
Answer: A
Rationale: A PEFR of 50% indicates a moderate to severe asthma exacerbation
requiring immediate bronchodilation with a short-acting beta-agonist (rescue
inhaler or nebulized albuterol). Corticosteroids are adjunctive but not the first
action. The child should be positioned upright to facilitate breathing.
5. A child with newly diagnosed type 1 diabetes mellitus is being discharged. The
mother asks about signs of hypoglycemia. Which response by the nurse is most
accurate?
A) "Your child will have fruity-smelling breath and deep, rapid breathing."
B) "Look for signs like irritability, tremors, and sweating."
C) "Your child will be very thirsty and urinate frequently."
,D) "You should expect your child to have nausea and vomiting."
Answer: B
Rationale: Irritability, tremors, sweating, and pallor are classic signs of
hypoglycemia in children. Fruity-smelling breath, deep breathing, polyuria, and
polydipsia are signs of hyperglycemia and diabetic ketoacidosis.
6. A 3-year-old child is admitted with a diagnosis of bacterial meningitis. Which
finding would the nurse expect to assess?
A) Positive Kernig's sign
B) Positive Moro reflex
C) Sunken fontanel
D) Bradycardia and hypotension
Answer: A
Rationale: Kernig's sign (pain and resistance with knee extension) and Brudzinski's
sign (neck stiffness with hip flexion) are classic signs of meningeal irritation in
meningitis. The Moro reflex is a primitive reflex in infants and should not be
present at age 3 years. A bulging fontanel (not sunken) is seen in infants with
meningitis. Bradycardia is a late sign.
7. A nurse is caring for a child with acute glomerulonephritis. Which assessment
finding is most important to report to the provider?
A) Blood pressure of 140/90 mmHg
B) Tea-colored urine
C) Periorbital edema
D) Weight gain of 1 kg in 24 hours
Answer: A
Rationale: Hypertension is a common complication of acute glomerulonephritis
and requires prompt treatment to prevent hypertensive encephalopathy or heart
failure. While tea-colored urine, edema, and weight gain are all expected findings,
elevated blood pressure is the most critical to address immediately.
8. A 6-month-old infant is brought to the clinic for routine immunizations. Which
vaccines are recommended at this age according to the CDC schedule?
A) DTaP, IPV, Hib, PCV, and Rotavirus
B) MMR, Varicella, and Hepatitis A
C) Tdap, MCV4, and HPV
D) Hepatitis B and Influenza only
Answer: A
, Rationale: At 6 months, the CDC recommends DTaP, IPV, Hib, PCV, and
Rotavirus. MMR and Varicella are given at 12-15 months, and Hepatitis A at 12
months. Tdap, MCV4, and HPV are for adolescents.
9. A child with a ventriculoperitoneal shunt for hydrocephalus presents with
irritability, vomiting, and sunsetting eyes. What is the priority nursing action?
A) Administer antiemetics for vomiting
B) Notify the provider immediately for possible shunt malfunction
C) Place the child in a darkened room to reduce eye strain
D) Obtain a blood culture to rule out infection
Answer: B
Rationale: Irritability, vomiting, and sunsetting eyes are signs of increased
intracranial pressure, which in a child with a VP shunt indicates possible shunt
malfunction or infection. The provider must be notified immediately for
evaluation. Antiemetics would mask symptoms and delay treatment.
10. A 5-year-old child is prescribed amoxicillin for otitis media. The child's parent
reports a rash and hives after the first dose. What is the nurse's best action?
A) Continue the medication and monitor the rash
B) Administer diphenhydramine and continue the amoxicillin
C) Hold the next dose and notify the provider
D) Reassure the parent that this is a common side effect
Answer: C
Rationale: A rash and hives after the first dose suggest a possible allergic reaction.
The medication should be held, and the provider should be notified to change the
antibiotic. Continuing the medication could lead to anaphylaxis.
11. A 2-year-old child with cystic fibrosis is admitted with a respiratory infection.
Which nursing intervention is most important for this child?
A) Restrict fluids to reduce pulmonary secretions
B) Perform chest physiotherapy and postural drainage
C) Place the child in a negative pressure isolation room
D) Administer sedatives to promote rest
Answer: B
Rationale: Chest physiotherapy and postural drainage are essential for mobilizing
and clearing thick pulmonary secretions in children with cystic fibrosis. Fluids
should be encouraged, not restricted, to thin secretions. Sedatives should be
avoided as they can depress the respiratory drive.
