HESI PEDIATRICS PRACTICE EXAM 2026
Q&AS WITH HIGH-YIELD EXPLANATIONS &
DOSAGE CALCULATIONS
This premium, high-yield study resource features verified practice
questions and answers comprehensively covering versions 1, 2, and 3 of
the HESI Pediatrics Exit Exam. Every entry is meticulously detailed with
correct answers in italics and extensive, bolded rationales that break down
complex Next-Generation NCLEX (NGN) clinical judgment cues, fluid
calculations, and growth milestones. Perfect for nursing students seeking
an advanced, graded A+ prep tool, this document is guaranteed to
accelerate test-day confidence and secure top-tier scores.
Cardiovascular and Hematology Disorders
1. A 2-year-old child with Tetralogy of Fallot
becomes severely cyanotic and agitated during
a blood draw. Which nursing action is the
absolute priority?
A) Administer 100% oxygen via face mask.
B) Place the child in the knee-chest position.
C) Prepare a dose of intravenous morphine.
D) Assess the child's vital signs and oxygen
saturation.
Answer: B) Place the child in the knee-chest
position.
Rationale: Placing the child in a knee-chest
position increases systemic vascular
resistance. This shunts blood back into the
pulmonary artery, increasing pulmonary
, blood flow and rapidly improving
oxygenation during a hypercyanotic ("tet")
spell.
2. A nurse is reviewing laboratory results for an 8-
year-old child receiving chemotherapy for
leukemia. Which finding requires immediate
protective isolation precautions?
A) Platelet count of 75,000/mm³
B) Hemoglobin of 9.2 g/dL
C) Absolute neutrophil count (ANC) of 450/mm³
D) White blood cell count of 4,000/mm³
Answer: C) Absolute neutrophil count (ANC) of
450/mm³
Rationale: An ANC below 500/mm³ indicates
severe neutropenia, placing the child at
critical risk for life-threatening infections.
Protective isolation (neutropenic
precautions) must be implemented
immediately.
3. A child with hemophilia A is admitted to the
emergency department after hitting his head on
a playground structure. What is the nurse's first
action?
A) Apply a cold compress to the site of impact.
B) Perform a detailed neurological assessment.
, C) Administer the prescribed intravenous factor
VIII concentrate.
D) Prepare the child for a scheduled head CT
scan.
Answer: C) Administer the prescribed
intravenous factor VIII concentrate.
Rationale: For a child with hemophilia, any
head trauma is considered potentially life-
threatening due to intracranial bleeding.
Administering factor VIII to stop or prevent
hemorrhage takes priority over diagnostic
tests or local treatments.
4. A nurse is assessing an infant with a suspected
ventricular septal defect (VSD). Which clinical
manifestation is most characteristic of this
congenital heart defect?
A) A harsh, holosystolic murmur heard best at
the left lower sternal border.
B) Discrepancies in blood pressure between the
upper and lower extremities.
C) Severe cyanosis within the first hours of life.
D) Bounding peripheral pulses and a widened
pulse pressure.
Answer: A) A harsh, holosystolic murmur heard
best at the left lower sternal border.
, Rationale: A ventricular septal defect allows
left-to-right shunting of blood, which
typically produces a loud, harsh holosystolic
murmur at the left lower sternal border.
Cyanosis is not standard because it is an
acianotic defect.
5. A child diagnosed with Kawasaki disease is
being prepared for discharge. Which discharge
teaching instruction is crucial for the parents to
understand?
A) Administer aspirin daily as prescribed and
monitor for signs of bleeding or Reye syndrome.
B) Avoid all live virus vaccines for at least 2
weeks following discharge.
C) Keep the child on strict bed rest for at least
one month.
D) Report any peeling of the skin on the fingers
and toes immediately to the provider.
Answer: A) Administer aspirin daily as
prescribed and monitor for signs of bleeding or
Reye syndrome.
Rationale: High-dose aspirin is used for its
anti-inflammatory and antiplatelet effects to
prevent coronary artery aneurysms in
Kawasaki disease. Parents must monitor for
Q&AS WITH HIGH-YIELD EXPLANATIONS &
DOSAGE CALCULATIONS
This premium, high-yield study resource features verified practice
questions and answers comprehensively covering versions 1, 2, and 3 of
the HESI Pediatrics Exit Exam. Every entry is meticulously detailed with
correct answers in italics and extensive, bolded rationales that break down
complex Next-Generation NCLEX (NGN) clinical judgment cues, fluid
calculations, and growth milestones. Perfect for nursing students seeking
an advanced, graded A+ prep tool, this document is guaranteed to
accelerate test-day confidence and secure top-tier scores.
Cardiovascular and Hematology Disorders
1. A 2-year-old child with Tetralogy of Fallot
becomes severely cyanotic and agitated during
a blood draw. Which nursing action is the
absolute priority?
A) Administer 100% oxygen via face mask.
B) Place the child in the knee-chest position.
C) Prepare a dose of intravenous morphine.
D) Assess the child's vital signs and oxygen
saturation.
Answer: B) Place the child in the knee-chest
position.
Rationale: Placing the child in a knee-chest
position increases systemic vascular
resistance. This shunts blood back into the
pulmonary artery, increasing pulmonary
, blood flow and rapidly improving
oxygenation during a hypercyanotic ("tet")
spell.
2. A nurse is reviewing laboratory results for an 8-
year-old child receiving chemotherapy for
leukemia. Which finding requires immediate
protective isolation precautions?
A) Platelet count of 75,000/mm³
B) Hemoglobin of 9.2 g/dL
C) Absolute neutrophil count (ANC) of 450/mm³
D) White blood cell count of 4,000/mm³
Answer: C) Absolute neutrophil count (ANC) of
450/mm³
Rationale: An ANC below 500/mm³ indicates
severe neutropenia, placing the child at
critical risk for life-threatening infections.
Protective isolation (neutropenic
precautions) must be implemented
immediately.
3. A child with hemophilia A is admitted to the
emergency department after hitting his head on
a playground structure. What is the nurse's first
action?
A) Apply a cold compress to the site of impact.
B) Perform a detailed neurological assessment.
, C) Administer the prescribed intravenous factor
VIII concentrate.
D) Prepare the child for a scheduled head CT
scan.
Answer: C) Administer the prescribed
intravenous factor VIII concentrate.
Rationale: For a child with hemophilia, any
head trauma is considered potentially life-
threatening due to intracranial bleeding.
Administering factor VIII to stop or prevent
hemorrhage takes priority over diagnostic
tests or local treatments.
4. A nurse is assessing an infant with a suspected
ventricular septal defect (VSD). Which clinical
manifestation is most characteristic of this
congenital heart defect?
A) A harsh, holosystolic murmur heard best at
the left lower sternal border.
B) Discrepancies in blood pressure between the
upper and lower extremities.
C) Severe cyanosis within the first hours of life.
D) Bounding peripheral pulses and a widened
pulse pressure.
Answer: A) A harsh, holosystolic murmur heard
best at the left lower sternal border.
, Rationale: A ventricular septal defect allows
left-to-right shunting of blood, which
typically produces a loud, harsh holosystolic
murmur at the left lower sternal border.
Cyanosis is not standard because it is an
acianotic defect.
5. A child diagnosed with Kawasaki disease is
being prepared for discharge. Which discharge
teaching instruction is crucial for the parents to
understand?
A) Administer aspirin daily as prescribed and
monitor for signs of bleeding or Reye syndrome.
B) Avoid all live virus vaccines for at least 2
weeks following discharge.
C) Keep the child on strict bed rest for at least
one month.
D) Report any peeling of the skin on the fingers
and toes immediately to the provider.
Answer: A) Administer aspirin daily as
prescribed and monitor for signs of bleeding or
Reye syndrome.
Rationale: High-dose aspirin is used for its
anti-inflammatory and antiplatelet effects to
prevent coronary artery aneurysms in
Kawasaki disease. Parents must monitor for
