NUR 203/NUR203|Pediatric Nursing
Final Comprehensive Exam | HESI Specialty Benchmark
2026-2028 Testing Cycle | Newly Released
50 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Fortis College
Q1: A nurse is assessing a 20-month-old toddler who insists on feeding himself and becomes
frustrated when the mother attempts to help. According to Erikson's psychosocial development
theory, which nursing interpretation is most appropriate?
A. The toddler is demonstrating autonomy versus shame and doubt.
B. The toddler is exhibiting trust versus mistrust behaviors.
C. The toddler is showing initiative versus guilt conflict.
D. The toddler is displaying industry versus inferiority concerns.
Correct Answer: A
Rationale: Correct because according to Erikson's psychosocial theory, toddlers aged 1 to 3
years are in the autonomy versus shame and doubt stage, during which they strive for
independence in feeding, dressing, and toileting. The child's insistence on self-feeding is a
developmentally appropriate manifestation of this stage. Interfering excessively with these
attempts can foster shame and self-doubt rather than healthy autonomy.
Q2: A 5-year-old child is brought to the emergency department with sudden onset of fever,
drooling, and a muffled voice. The child appears anxious and is sitting upright leaning forward.
Which intervention is the nurse's priority?
A. Obtain a throat culture immediately
B. Place the child supine for examination
C. Maintain the child in a position of comfort and prepare for airway management
D. Administer a rapid-acting oral analgesic
,Correct Answer: C
Rationale: Correct because the presentation of drooling, muffled voice, and tripod positioning in
a preschooler is classic for epiglottitis, a life-threatening upper airway obstruction. The priority
nursing action is to maintain the child in a position of comfort while immediately preparing for
definitive airway management, as any manipulation of the oropharynx can precipitate complete
airway occlusion. Obtaining a throat culture or placing the child supine is contraindicated
because these actions may trigger laryngospasm and respiratory arrest.
Q3: A nurse is caring for a 3-year-old diagnosed with Wilms' tumor. The parents ask why the
healthcare provider has instructed them not to palpate the child's abdomen at home. Which
response by the nurse is most accurate?
A. "Palpation may cause the child unnecessary pain."
B. "The tumor is highly contagious through skin contact."
C. "Abdominal palpation can trigger severe hypertension."
D. "Palpation may rupture the tumor capsule and cause seeding of cancer cells."
Correct Answer: D
Rationale: Correct because Wilms' tumor is encapsulated, and abdominal palpation can rupture
the tumor capsule, causing seeding of malignant cells into the peritoneal cavity and precipitating
hemorrhage. This is why healthcare providers explicitly instruct parents and staff to avoid
palpating the abdomen. Although pain may occur, the primary rationale for avoiding palpation is
prevention of tumor dissemination and bleeding, not merely discomfort.
Q4: A nurse is assessing an infant with a suspected ventricular septal defect (VSD). Which
clinical findings support a diagnosis of a left-to-right cardiac shunt? Select all that apply.
A. Tachypnea with feeding
B. Failure to thrive
C. Clubbing of fingers and toes
D. Recurrent respiratory infections
Correct Answer(s): A, B, D
Rationale: Correct because a ventricular septal defect creates a left-to-right shunt in which
oxygenated blood flows from the high-pressure left ventricle to the low-pressure right ventricle,
causing pulmonary overcirculation. This pathophysiology produces tachypnea with feeding,
failure to thrive due to high metabolic demands, and recurrent respiratory infections from
pulmonary congestion. Clubbing of fingers and toes is not associated with uncomplicated left-to-
right shunts; instead, it indicates chronic hypoxemia seen in cyanotic defects such as tetralogy of
Fallot.
, Q5: A nurse is performing a neurologic assessment on a 4-month-old infant. Which finding
requires immediate follow-up as a sign of increased intracranial pressure?
A. Closed posterior fontanel
B. Bulging anterior fontanel at rest
C. Ability to track objects 180 degrees
D. Presence of the Moro reflex
Correct Answer: B
Rationale: Correct because a bulging anterior fontanel at rest in a 4-month-old is a cardinal sign
of increased intracranial pressure, as the open fontanel allows the skull to expand under rising
pressure. The posterior fontanel normally closes by 2 to 3 months of age, so its closure is
expected and not concerning. Tracking objects and the Moro reflex are normal developmental
findings for this age and do not indicate neurologic pathology.
Q6: The parents of a 3-week-old infant report projectile, non-bilious vomiting after every
feeding. On physical exam, the nurse palpates an olive-shaped mass in the right upper quadrant.
Which condition does the nurse suspect?
A. Pyloric stenosis
B. Intussusception
C. Hirschsprung disease
D. Gastroesophageal reflux
Correct Answer: A
Rationale: Correct because projectile, non-bilious vomiting in a 3-week-old infant accompanied
by an olive-shaped mass in the right upper quadrant is the classic presentation of pyloric stenosis
caused by hypertrophy of the pyloric muscle. Intussusception typically presents with bilious
vomiting and currant jelly stools, while gastroesophageal reflux does not produce a palpable
abdominal mass. Hirschsprung disease manifests with chronic constipation and abdominal
distension rather than projectile vomiting.
Q7: A school nurse identifies honey-colored crusted lesions around the mouth of a 6-year-old
student. Which action is most appropriate?
A. Send the child home immediately and request antibiotic ointment only
B. Allow the child to remain in class with a mask
C. Isolate the child and notify parents that the child may return 24 hours after starting antibiotics
D. Apply topical corticosteroids and observe for 48 hours
Final Comprehensive Exam | HESI Specialty Benchmark
2026-2028 Testing Cycle | Newly Released
50 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Fortis College
Q1: A nurse is assessing a 20-month-old toddler who insists on feeding himself and becomes
frustrated when the mother attempts to help. According to Erikson's psychosocial development
theory, which nursing interpretation is most appropriate?
A. The toddler is demonstrating autonomy versus shame and doubt.
B. The toddler is exhibiting trust versus mistrust behaviors.
C. The toddler is showing initiative versus guilt conflict.
D. The toddler is displaying industry versus inferiority concerns.
Correct Answer: A
Rationale: Correct because according to Erikson's psychosocial theory, toddlers aged 1 to 3
years are in the autonomy versus shame and doubt stage, during which they strive for
independence in feeding, dressing, and toileting. The child's insistence on self-feeding is a
developmentally appropriate manifestation of this stage. Interfering excessively with these
attempts can foster shame and self-doubt rather than healthy autonomy.
Q2: A 5-year-old child is brought to the emergency department with sudden onset of fever,
drooling, and a muffled voice. The child appears anxious and is sitting upright leaning forward.
Which intervention is the nurse's priority?
A. Obtain a throat culture immediately
B. Place the child supine for examination
C. Maintain the child in a position of comfort and prepare for airway management
D. Administer a rapid-acting oral analgesic
,Correct Answer: C
Rationale: Correct because the presentation of drooling, muffled voice, and tripod positioning in
a preschooler is classic for epiglottitis, a life-threatening upper airway obstruction. The priority
nursing action is to maintain the child in a position of comfort while immediately preparing for
definitive airway management, as any manipulation of the oropharynx can precipitate complete
airway occlusion. Obtaining a throat culture or placing the child supine is contraindicated
because these actions may trigger laryngospasm and respiratory arrest.
Q3: A nurse is caring for a 3-year-old diagnosed with Wilms' tumor. The parents ask why the
healthcare provider has instructed them not to palpate the child's abdomen at home. Which
response by the nurse is most accurate?
A. "Palpation may cause the child unnecessary pain."
B. "The tumor is highly contagious through skin contact."
C. "Abdominal palpation can trigger severe hypertension."
D. "Palpation may rupture the tumor capsule and cause seeding of cancer cells."
Correct Answer: D
Rationale: Correct because Wilms' tumor is encapsulated, and abdominal palpation can rupture
the tumor capsule, causing seeding of malignant cells into the peritoneal cavity and precipitating
hemorrhage. This is why healthcare providers explicitly instruct parents and staff to avoid
palpating the abdomen. Although pain may occur, the primary rationale for avoiding palpation is
prevention of tumor dissemination and bleeding, not merely discomfort.
Q4: A nurse is assessing an infant with a suspected ventricular septal defect (VSD). Which
clinical findings support a diagnosis of a left-to-right cardiac shunt? Select all that apply.
A. Tachypnea with feeding
B. Failure to thrive
C. Clubbing of fingers and toes
D. Recurrent respiratory infections
Correct Answer(s): A, B, D
Rationale: Correct because a ventricular septal defect creates a left-to-right shunt in which
oxygenated blood flows from the high-pressure left ventricle to the low-pressure right ventricle,
causing pulmonary overcirculation. This pathophysiology produces tachypnea with feeding,
failure to thrive due to high metabolic demands, and recurrent respiratory infections from
pulmonary congestion. Clubbing of fingers and toes is not associated with uncomplicated left-to-
right shunts; instead, it indicates chronic hypoxemia seen in cyanotic defects such as tetralogy of
Fallot.
, Q5: A nurse is performing a neurologic assessment on a 4-month-old infant. Which finding
requires immediate follow-up as a sign of increased intracranial pressure?
A. Closed posterior fontanel
B. Bulging anterior fontanel at rest
C. Ability to track objects 180 degrees
D. Presence of the Moro reflex
Correct Answer: B
Rationale: Correct because a bulging anterior fontanel at rest in a 4-month-old is a cardinal sign
of increased intracranial pressure, as the open fontanel allows the skull to expand under rising
pressure. The posterior fontanel normally closes by 2 to 3 months of age, so its closure is
expected and not concerning. Tracking objects and the Moro reflex are normal developmental
findings for this age and do not indicate neurologic pathology.
Q6: The parents of a 3-week-old infant report projectile, non-bilious vomiting after every
feeding. On physical exam, the nurse palpates an olive-shaped mass in the right upper quadrant.
Which condition does the nurse suspect?
A. Pyloric stenosis
B. Intussusception
C. Hirschsprung disease
D. Gastroesophageal reflux
Correct Answer: A
Rationale: Correct because projectile, non-bilious vomiting in a 3-week-old infant accompanied
by an olive-shaped mass in the right upper quadrant is the classic presentation of pyloric stenosis
caused by hypertrophy of the pyloric muscle. Intussusception typically presents with bilious
vomiting and currant jelly stools, while gastroesophageal reflux does not produce a palpable
abdominal mass. Hirschsprung disease manifests with chronic constipation and abdominal
distension rather than projectile vomiting.
Q7: A school nurse identifies honey-colored crusted lesions around the mouth of a 6-year-old
student. Which action is most appropriate?
A. Send the child home immediately and request antibiotic ointment only
B. Allow the child to remain in class with a mask
C. Isolate the child and notify parents that the child may return 24 hours after starting antibiotics
D. Apply topical corticosteroids and observe for 48 hours
