EVOLVE HESI PEDIATRICS (PDF) | 2026 EXAM QUESTIONS
AND ANSWERS + RATIONALES | STUDY GUIDE | 100%
CORRECT
1. The nurse is caring for a 3-year-old child who is 2 hours post-cardiac catheterization via
the right femoral artery. Which assessment finding indicates a potential arterial
obstruction?
A) Right foot is warm and pink with palpable pulses
B) Right foot is cool to the touch and appears pale and blanched
C) Child reports mild discomfort at the insertion site
D) Pedal pulse is weaker on the left foot compared to the right
Correct Answer: Right foot is cool to the touch and appears pale and blanched
Rationale: Cool, pale, or blanched extremities indicate impaired circulation distal to the
catheterization site, suggestive of arterial obstruction or thrombus. This finding requires
immediate intervention to prevent tissue ischemia. Warmth and normal color suggest adequate
perfusion, and mild site discomfort is expected .
2. An infant with Tetralogy of Fallot becomes acutely cyanotic and hyperpneic. Which
action should the nurse implement first?
A) Administer supplemental oxygen via face mask
B) Place the infant in a knee-chest position
C) Prepare for emergency intubation
D) Begin intravenous fluid bolus
Correct Answer: Place the infant in a knee-chest position
Rationale: The knee-chest position decreases venous return from the lower extremities, increases
systemic vascular resistance, and reduces the right-to-left shunt, improving pulmonary blood
flow and oxygenation. This is the priority intervention for a "tet spell." Oxygen and fluids are
adjunctive; intubation is reserved for respiratory failure .
3. A child admitted with diabetic ketoacidosis is demonstrating Kussmaul respirations. This
respiratory pattern is a compensatory mechanism for which acid-base alteration?
A) Respiratory acidosis
B) Metabolic acidosis
C) Respiratory alkalosis
D) Metabolic alkalosis
Correct Answer: Metabolic acidosis
Rationale: Kussmaul respirations are deep, rapid, and labored breaths that occur as the body
attempts to blow off excess carbon dioxide to compensate for metabolic acidosis. This is a
hallmark of DKA. Respiratory acidosis would involve hypoventilation, and alkalosis would
present differently .
, 4. A 2-year-old is admitted with possible encephalitis, and a lumbar puncture is scheduled.
Which information should the nurse provide to the child's parents about the procedure?
A) The child will be placed in a side-lying, knees-to-chest position
B) The child will be sedated and will not remember the procedure
C) The procedure will take approximately one hour
D) The child will need to remain flat for 24 hours afterward
Correct Answer: The child will be placed in a side-lying, knees-to-chest position
Rationale: The side-lying, knees-to-chest position flexes the spine to widen the interspinous
spaces, facilitating safe needle insertion for a lumbar puncture. While comfort measures and
positioning are important, this position is the most accurate description of the procedural setup .
5. A child has a platelet count of 45,000/mm³. What nursing precaution is most important to
include in the plan of care?
A) Strict intake and output monitoring
B) Bleeding precautions
C) Contact isolation
D) Fluid restriction
Correct Answer: Bleeding precautions
Rationale: A platelet count below 50,000/mm³ significantly increases bleeding risk. Nursing
interventions include avoiding intramuscular injections, using soft toothbrushes, applying
pressure to venipuncture sites, and monitoring for signs of hemorrhage. The other options are not
the priority for thrombocytopenia .
6. The nurse is assessing an infant with pyloric stenosis. Which acid-base imbalance is most
likely to occur from the pathophysiological mechanism of this condition?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Correct Answer: Metabolic alkalosis
Rationale: Pyloric stenosis causes persistent projectile vomiting, leading to the loss of gastric
acid (hydrochloric acid). This loss of hydrogen ions results in metabolic alkalosis. Metabolic
acidosis is not a classic finding in pyloric stenosis .
7. A mother brings her 2-year-old to the clinic for ear pulling and fever. What should the
nurse ask to identify the most likely underlying condition?
A) "Has the child had a runny nose recently?"
B) "Has the child been around other sick children?"
C) "Is the child teething?"
D) "Has the child had a recent fall?"
Correct Answer: "Has the child had a runny nose recently?"
, Rationale: Otitis media is often preceded by an upper respiratory infection, which causes
eustachian tube dysfunction and allows fluid to accumulate in the middle ear. A runny nose is a
common preceding symptom, making this the most relevant question .
8. The parents of a 14-year-old girl tell the nurse that their daughter dresses as a tomboy and
plays baseball one day and the next day dresses in feminine clothes. What information
should the nurse use to respond to the parents?
A) Teenagers need a strong role model to emulate
B) Adolescents try on different roles while seeking their identity
C) Such erratic behavior needs further investigation
D) Fourteen-year-olds often try to please parents with their role choices
Correct Answer: Adolescents try on different roles while seeking their identity
Rationale: During adolescence, experimentation with different roles, behaviors, and identities is
a normal part of development. This "trying on" of identities helps teens establish a cohesive
sense of self and is not typically a cause for concern unless accompanied by other red flags .
9. A 6-month-old infant with congestive heart failure is receiving digoxin elixir. Which
observation warrants immediate intervention?
A) Apical heart rate of 60 beats/min
B) Sweating across the forehead
C) Poor feeding
D) Respiratory rate of 30 breaths/min
Correct Answer: Apical heart rate of 60 beats/min
Rationale: A heart rate of 60 beats/min in a 6-month-old is bradycardic and indicates potential
digoxin toxicity. The apical pulse should be counted for a full minute before administering
digoxin; the medication is typically withheld if the pulse is below 100-110 in infants. The other
findings are signs of heart failure but are not immediate medication-related safety concerns .
10. A 4-year-old boy is brought to the emergency department by his parent, who reports that
the child has been pointing at his stomach and saying, "It hurts so bad." Which pain-
assessment tool should the nurse use?
A) Descriptor Scale
B) Brief Pain Inventory
C) Numeric rating scale
D) Wong-Baker FACES Scale
Correct Answer: Wong-Baker FACES Scale
Rationale: The Wong-Baker FACES Pain Rating Scale is developmentally appropriate for
children ages 3 and older. It uses faces to help children express their pain level. Numeric scales
are appropriate for older children, and the other scales are not typically used in this age group .
11. Which clinical finding should the nurse expect a child with nephrotic syndrome to
exhibit?
AND ANSWERS + RATIONALES | STUDY GUIDE | 100%
CORRECT
1. The nurse is caring for a 3-year-old child who is 2 hours post-cardiac catheterization via
the right femoral artery. Which assessment finding indicates a potential arterial
obstruction?
A) Right foot is warm and pink with palpable pulses
B) Right foot is cool to the touch and appears pale and blanched
C) Child reports mild discomfort at the insertion site
D) Pedal pulse is weaker on the left foot compared to the right
Correct Answer: Right foot is cool to the touch and appears pale and blanched
Rationale: Cool, pale, or blanched extremities indicate impaired circulation distal to the
catheterization site, suggestive of arterial obstruction or thrombus. This finding requires
immediate intervention to prevent tissue ischemia. Warmth and normal color suggest adequate
perfusion, and mild site discomfort is expected .
2. An infant with Tetralogy of Fallot becomes acutely cyanotic and hyperpneic. Which
action should the nurse implement first?
A) Administer supplemental oxygen via face mask
B) Place the infant in a knee-chest position
C) Prepare for emergency intubation
D) Begin intravenous fluid bolus
Correct Answer: Place the infant in a knee-chest position
Rationale: The knee-chest position decreases venous return from the lower extremities, increases
systemic vascular resistance, and reduces the right-to-left shunt, improving pulmonary blood
flow and oxygenation. This is the priority intervention for a "tet spell." Oxygen and fluids are
adjunctive; intubation is reserved for respiratory failure .
3. A child admitted with diabetic ketoacidosis is demonstrating Kussmaul respirations. This
respiratory pattern is a compensatory mechanism for which acid-base alteration?
A) Respiratory acidosis
B) Metabolic acidosis
C) Respiratory alkalosis
D) Metabolic alkalosis
Correct Answer: Metabolic acidosis
Rationale: Kussmaul respirations are deep, rapid, and labored breaths that occur as the body
attempts to blow off excess carbon dioxide to compensate for metabolic acidosis. This is a
hallmark of DKA. Respiratory acidosis would involve hypoventilation, and alkalosis would
present differently .
, 4. A 2-year-old is admitted with possible encephalitis, and a lumbar puncture is scheduled.
Which information should the nurse provide to the child's parents about the procedure?
A) The child will be placed in a side-lying, knees-to-chest position
B) The child will be sedated and will not remember the procedure
C) The procedure will take approximately one hour
D) The child will need to remain flat for 24 hours afterward
Correct Answer: The child will be placed in a side-lying, knees-to-chest position
Rationale: The side-lying, knees-to-chest position flexes the spine to widen the interspinous
spaces, facilitating safe needle insertion for a lumbar puncture. While comfort measures and
positioning are important, this position is the most accurate description of the procedural setup .
5. A child has a platelet count of 45,000/mm³. What nursing precaution is most important to
include in the plan of care?
A) Strict intake and output monitoring
B) Bleeding precautions
C) Contact isolation
D) Fluid restriction
Correct Answer: Bleeding precautions
Rationale: A platelet count below 50,000/mm³ significantly increases bleeding risk. Nursing
interventions include avoiding intramuscular injections, using soft toothbrushes, applying
pressure to venipuncture sites, and monitoring for signs of hemorrhage. The other options are not
the priority for thrombocytopenia .
6. The nurse is assessing an infant with pyloric stenosis. Which acid-base imbalance is most
likely to occur from the pathophysiological mechanism of this condition?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Correct Answer: Metabolic alkalosis
Rationale: Pyloric stenosis causes persistent projectile vomiting, leading to the loss of gastric
acid (hydrochloric acid). This loss of hydrogen ions results in metabolic alkalosis. Metabolic
acidosis is not a classic finding in pyloric stenosis .
7. A mother brings her 2-year-old to the clinic for ear pulling and fever. What should the
nurse ask to identify the most likely underlying condition?
A) "Has the child had a runny nose recently?"
B) "Has the child been around other sick children?"
C) "Is the child teething?"
D) "Has the child had a recent fall?"
Correct Answer: "Has the child had a runny nose recently?"
, Rationale: Otitis media is often preceded by an upper respiratory infection, which causes
eustachian tube dysfunction and allows fluid to accumulate in the middle ear. A runny nose is a
common preceding symptom, making this the most relevant question .
8. The parents of a 14-year-old girl tell the nurse that their daughter dresses as a tomboy and
plays baseball one day and the next day dresses in feminine clothes. What information
should the nurse use to respond to the parents?
A) Teenagers need a strong role model to emulate
B) Adolescents try on different roles while seeking their identity
C) Such erratic behavior needs further investigation
D) Fourteen-year-olds often try to please parents with their role choices
Correct Answer: Adolescents try on different roles while seeking their identity
Rationale: During adolescence, experimentation with different roles, behaviors, and identities is
a normal part of development. This "trying on" of identities helps teens establish a cohesive
sense of self and is not typically a cause for concern unless accompanied by other red flags .
9. A 6-month-old infant with congestive heart failure is receiving digoxin elixir. Which
observation warrants immediate intervention?
A) Apical heart rate of 60 beats/min
B) Sweating across the forehead
C) Poor feeding
D) Respiratory rate of 30 breaths/min
Correct Answer: Apical heart rate of 60 beats/min
Rationale: A heart rate of 60 beats/min in a 6-month-old is bradycardic and indicates potential
digoxin toxicity. The apical pulse should be counted for a full minute before administering
digoxin; the medication is typically withheld if the pulse is below 100-110 in infants. The other
findings are signs of heart failure but are not immediate medication-related safety concerns .
10. A 4-year-old boy is brought to the emergency department by his parent, who reports that
the child has been pointing at his stomach and saying, "It hurts so bad." Which pain-
assessment tool should the nurse use?
A) Descriptor Scale
B) Brief Pain Inventory
C) Numeric rating scale
D) Wong-Baker FACES Scale
Correct Answer: Wong-Baker FACES Scale
Rationale: The Wong-Baker FACES Pain Rating Scale is developmentally appropriate for
children ages 3 and older. It uses faces to help children express their pain level. Numeric scales
are appropriate for older children, and the other scales are not typically used in this age group .
11. Which clinical finding should the nurse expect a child with nephrotic syndrome to
exhibit?
