Latest 2026/2027 PEDS HESI Practice Exam with verified
answers plus rationales
1. A 15-year-old girl tells the school nurse that all of her friends have started their periods
and she feels abnormal because she has not. Which response is best for the nurse to
provide?
A) "Will you be able to support a baby?"
B) "Do you have plans to continue school?"
C) "Explain that menarche varies and occurs between the ages of 12 and 18 years."
D) "Have you talked with your parents about this?"
Correct Answer: C
Rationale: This response provides accurate, non-judgmental information that addresses the
client's concerns about being "abnormal" . Menarche can occur as late as 18 years, and this
education is developmentally appropriate.
2. When assessing a preschooler, which finding warrants further assessment by the nurse?
A) Able to ride a tricycle.
B) Talks about an imaginary friend.
C) Dresses independently.
D) Gains 2 pounds (0.9 kg) in 12 months.
Correct Answer: D
Rationale: Preschool children gain an average of 5 pounds (2.3 kg) per year . Therefore, a gain
of 2 pounds (0.9 kg) is less than half of the expected weight gain and should be investigated
further.
3. What is the best action for the nurse to take when initiating contact with a toddler for
the first time?
A) Ask the toddler to point to where it hurts.
B) Tell the child your name and that you are the nurse.
C) Call the child by name while picking up the toddler.
D) Kneel in front of the toddler and speak softly.
Correct Answer: D
Rationale: The toddler perceives the nurse as a stranger . Placing oneself at the toddler's eye
level and speaking softly can be less threatening. A more positive interaction occurs when the
toddler perceives the meeting in a nonthreatening way.
,4. The parents of a toddler brought to the clinic for a well-child visit tell the nurse that the
child becomes upset if even the smallest things change in the environment. What
information should the nurse provide the parents?
A) A child is insecure because trust is not fostered and developed during infancy.
B) A toddler should be exposed to different routines to promote adapting to new experiences.
C) Children of this age are comfortable with ritualism and display global thinking.
D) Objects should be frequently moved in the environment to teach the child to acclimate to
change.
Correct Answer: C
Rationale: A 2-year-old is ritualistic and wants consistency and routine . Changes in the
toddler's environment or schedule are upsetting. When there is a change in one small part of the
environment, the 2-year-old's composure disintegrates.
5. An infant weighs 7 pounds (3.18 kg) at birth. How much would the nurse expect the
infant to weigh at age 6 months?
A) 12 lb (5.44 kg).
B) 14 lb (6.35 kg).
C) 17 lb (7.71 kg).
D) 21 lb (9.53 kg).
Correct Answer: B
Rationale: A healthy infant should double their birth weight by 6 months . 7 lb × 2 = 14 lb.
6. A nurse is caring for a 3-year-old child who is 2 hours postop from a cardiac
catheterization via the right femoral artery. Which assessment finding is an indication of
arterial obstruction?
A) Right foot is cool to the touch and appears pale and blanched.
B) Pedal pulse is palpable and strong.
C) Site is dry with no bleeding.
D) Warm, pink toes.
Correct Answer: A
Rationale: A cool, pale, or blanched extremity indicates impaired circulation due to arterial
obstruction . This requires immediate intervention to prevent loss of the limb.
,7. An infant with Tetralogy of Fallot becomes acutely cyanotic and hyperpneic. Which
action should the nurse implement first?
A) Administer oxygen.
B) Place the infant in a knee-chest position.
C) Notify the healthcare provider.
D) Prepare for emergency surgery.
Correct Answer: B
Rationale: The knee-chest position decreases venous return and increases systemic vascular
resistance, which improves oxygenation during a "tet spell" . The knee-chest position is the first-
line intervention for a hypercyanotic spell.
8. A child admitted with diabetic ketoacidosis is demonstrating Kussmaul respirations. The
nurse determines that the increased respiratory rate is a compensatory mechanism for
which acid-base alteration?
A) Metabolic acidosis.
B) Metabolic alkalosis.
C) Respiratory acidosis.
D) Respiratory alkalosis.
Correct Answer: A
Rationale: Kussmaul respirations are deep, rapid breaths seen as the body tries to blow off CO₂
to compensate for metabolic acidosis .
9. A child with diarrhea for 3 days is likely to exhibit which acid-base imbalance?
A) Metabolic acidosis.
B) Metabolic alkalosis.
C) Respiratory acidosis.
D) Respiratory alkalosis.
Correct Answer: A
Rationale: Diarrhea causes loss of bicarbonate-rich intestinal fluids, leading to metabolic
acidosis . The loss of stomach acid through vomiting leads to alkalosis.
, 10. Which drink choice on a hot day indicates to the nurse that a teenager with sickle cell
anemia understands dietary considerations related to the disease?
A) Lemonade.
B) Cola.
C) Iced tea.
D) Sports drink.
Correct Answer: A
Rationale: Hydration is critical to prevent sickling episodes . Lemonade is a good choice as it's
hydrating without excessive caffeine or sugar. Sugary, caffeinated, or dehydrating beverages are
less appropriate.
11. The HR for a 3-year-old with CHF has steadily decreased over the last few hours, now
is 76 bpm, the previous reading 4 hours ago was 110 bpm. Which additional finding should
be reported immediately?
A) Blood pressure of 70/40.
B) Respiratory rate of 24.
C) Oxygen saturation of 95%.
D) Urine output of 30 mL/hr.
Correct Answer: A
Rationale: Bradycardia with hypotension in a child with heart failure indicates decompensation
and requires immediate intervention . The combination of decreasing heart rate and low blood
pressure is a critical finding.
12. A 2-year-old is admitted with possible encephalitis, and a lumbar puncture is
scheduled. Which information should the nurse provide?
A) Describe the side-lying, knees-to-chest position.
B) Explain that the child will be NPO.
C) Explain that the procedure will require general anesthesia.
D) Describe the sitting upright position.
Correct Answer: A
Rationale: The side-lying, knees-to-chest position flexes the spine to facilitate safe needle
insertion . This position separates the vertebrae and makes the procedure easier.
answers plus rationales
1. A 15-year-old girl tells the school nurse that all of her friends have started their periods
and she feels abnormal because she has not. Which response is best for the nurse to
provide?
A) "Will you be able to support a baby?"
B) "Do you have plans to continue school?"
C) "Explain that menarche varies and occurs between the ages of 12 and 18 years."
D) "Have you talked with your parents about this?"
Correct Answer: C
Rationale: This response provides accurate, non-judgmental information that addresses the
client's concerns about being "abnormal" . Menarche can occur as late as 18 years, and this
education is developmentally appropriate.
2. When assessing a preschooler, which finding warrants further assessment by the nurse?
A) Able to ride a tricycle.
B) Talks about an imaginary friend.
C) Dresses independently.
D) Gains 2 pounds (0.9 kg) in 12 months.
Correct Answer: D
Rationale: Preschool children gain an average of 5 pounds (2.3 kg) per year . Therefore, a gain
of 2 pounds (0.9 kg) is less than half of the expected weight gain and should be investigated
further.
3. What is the best action for the nurse to take when initiating contact with a toddler for
the first time?
A) Ask the toddler to point to where it hurts.
B) Tell the child your name and that you are the nurse.
C) Call the child by name while picking up the toddler.
D) Kneel in front of the toddler and speak softly.
Correct Answer: D
Rationale: The toddler perceives the nurse as a stranger . Placing oneself at the toddler's eye
level and speaking softly can be less threatening. A more positive interaction occurs when the
toddler perceives the meeting in a nonthreatening way.
,4. The parents of a toddler brought to the clinic for a well-child visit tell the nurse that the
child becomes upset if even the smallest things change in the environment. What
information should the nurse provide the parents?
A) A child is insecure because trust is not fostered and developed during infancy.
B) A toddler should be exposed to different routines to promote adapting to new experiences.
C) Children of this age are comfortable with ritualism and display global thinking.
D) Objects should be frequently moved in the environment to teach the child to acclimate to
change.
Correct Answer: C
Rationale: A 2-year-old is ritualistic and wants consistency and routine . Changes in the
toddler's environment or schedule are upsetting. When there is a change in one small part of the
environment, the 2-year-old's composure disintegrates.
5. An infant weighs 7 pounds (3.18 kg) at birth. How much would the nurse expect the
infant to weigh at age 6 months?
A) 12 lb (5.44 kg).
B) 14 lb (6.35 kg).
C) 17 lb (7.71 kg).
D) 21 lb (9.53 kg).
Correct Answer: B
Rationale: A healthy infant should double their birth weight by 6 months . 7 lb × 2 = 14 lb.
6. A nurse is caring for a 3-year-old child who is 2 hours postop from a cardiac
catheterization via the right femoral artery. Which assessment finding is an indication of
arterial obstruction?
A) Right foot is cool to the touch and appears pale and blanched.
B) Pedal pulse is palpable and strong.
C) Site is dry with no bleeding.
D) Warm, pink toes.
Correct Answer: A
Rationale: A cool, pale, or blanched extremity indicates impaired circulation due to arterial
obstruction . This requires immediate intervention to prevent loss of the limb.
,7. An infant with Tetralogy of Fallot becomes acutely cyanotic and hyperpneic. Which
action should the nurse implement first?
A) Administer oxygen.
B) Place the infant in a knee-chest position.
C) Notify the healthcare provider.
D) Prepare for emergency surgery.
Correct Answer: B
Rationale: The knee-chest position decreases venous return and increases systemic vascular
resistance, which improves oxygenation during a "tet spell" . The knee-chest position is the first-
line intervention for a hypercyanotic spell.
8. A child admitted with diabetic ketoacidosis is demonstrating Kussmaul respirations. The
nurse determines that the increased respiratory rate is a compensatory mechanism for
which acid-base alteration?
A) Metabolic acidosis.
B) Metabolic alkalosis.
C) Respiratory acidosis.
D) Respiratory alkalosis.
Correct Answer: A
Rationale: Kussmaul respirations are deep, rapid breaths seen as the body tries to blow off CO₂
to compensate for metabolic acidosis .
9. A child with diarrhea for 3 days is likely to exhibit which acid-base imbalance?
A) Metabolic acidosis.
B) Metabolic alkalosis.
C) Respiratory acidosis.
D) Respiratory alkalosis.
Correct Answer: A
Rationale: Diarrhea causes loss of bicarbonate-rich intestinal fluids, leading to metabolic
acidosis . The loss of stomach acid through vomiting leads to alkalosis.
, 10. Which drink choice on a hot day indicates to the nurse that a teenager with sickle cell
anemia understands dietary considerations related to the disease?
A) Lemonade.
B) Cola.
C) Iced tea.
D) Sports drink.
Correct Answer: A
Rationale: Hydration is critical to prevent sickling episodes . Lemonade is a good choice as it's
hydrating without excessive caffeine or sugar. Sugary, caffeinated, or dehydrating beverages are
less appropriate.
11. The HR for a 3-year-old with CHF has steadily decreased over the last few hours, now
is 76 bpm, the previous reading 4 hours ago was 110 bpm. Which additional finding should
be reported immediately?
A) Blood pressure of 70/40.
B) Respiratory rate of 24.
C) Oxygen saturation of 95%.
D) Urine output of 30 mL/hr.
Correct Answer: A
Rationale: Bradycardia with hypotension in a child with heart failure indicates decompensation
and requires immediate intervention . The combination of decreasing heart rate and low blood
pressure is a critical finding.
12. A 2-year-old is admitted with possible encephalitis, and a lumbar puncture is
scheduled. Which information should the nurse provide?
A) Describe the side-lying, knees-to-chest position.
B) Explain that the child will be NPO.
C) Explain that the procedure will require general anesthesia.
D) Describe the sitting upright position.
Correct Answer: A
Rationale: The side-lying, knees-to-chest position flexes the spine to facilitate safe needle
insertion . This position separates the vertebrae and makes the procedure easier.
