2022 HESI RN Pediatrics Exam - Study
Guide, Practice Questions & Review
1. A toddler is admitted with severe dehydration from acute gastroenteritis. Which
assessment finding best indicates the child has progressed from moderate to severe
dehydration?
A. Capillary refill of 3 seconds
B. Sunken fontanel and absent tears
C. Heart rate of 130 beats/min
D. Dry mucous membranes
Answer: B. Sunken fontanel and absent tears
Rationale: Severe dehydration is characterized by profound signs such as sunken fontanel,
absent tears, and lethargy, reflecting >10% fluid loss. Capillary refill of 3 seconds,
tachycardia, and dry mucous membranes are seen in moderate dehydration.
2. Which statement by a parent indicates correct understanding of home management
for a child with newly diagnosed type 1 diabetes mellitus?
A. "I will rotate insulin injection sites within the same area each week."
B. "I should check blood glucose only before breakfast and dinner."
C. "I will treat a low blood sugar with 15 grams of a fast-acting carbohydrate."
D. "I can skip insulin doses when my child is not eating."
Answer: C. "I will treat a low blood sugar with 15 grams of a fast-acting
carbohydrate."
Rationale: The rule of 15 (15 g fast-acting carbohydrate, recheck in 15 minutes) is
standard for hypoglycemia management. Rotating sites within the same area can cause
lipohypertrophy; glucose should be checked more frequently; and insulin must never be
skipped without provider guidance.
Page 1 of 49
,3. A child with nephrotic syndrome is receiving prednisone. Which finding requires
immediate follow-up?
A. Weight gain of 0.5 kg over 2 days
B. Blood pressure 118/78 mm Hg
C. Serum potassium 3.2 mEq/L
D. Increased appetite
Answer: C. Serum potassium 3.2 mEq/L
Rationale: Corticosteroids can cause hypokalemia; a potassium of 3.2 mEq/L is below the
normal pediatric range (3.5-5.0) and may precipitate dysrhythmias. Weight gain, elevated
but acceptable BP, and increased appetite are expected steroid effects.
4. A child with cystic fibrosis is prescribed pancreatic enzymes. Which instruction
should the nurse include?
A. Administer the enzymes with meals and snacks.
B. Give the enzymes only when the child has fatty stools.
C. Crush the enzymes and mix with a hot beverage.
D. Withhold the enzymes if the child has abdominal pain.
Answer: A. Administer the enzymes with meals and snacks.
Rationale: Pancreatic enzymes must be taken with every meal and snack to aid fat
digestion. They should not be given PRN, crushed and mixed with hot liquids (heat
inactivates enzymes), or withheld for abdominal pain without provider order.
Page 2 of 49
,5. A child with a ventriculoperitoneal shunt for hydrocephalus is brought to the clinic
with a headache and vomiting. Which assessment finding is most concerning for shunt
malfunction?
A. Sunsetting eyes
B. Shunt tract erythema
C. Abdominal distention
D. Irritability
Answer: A. Sunsetting eyes
Rationale: Sunsetting eyes (downward deviation of the eyes) indicates increased
intracranial pressure from shunt malfunction. Erythema suggests infection, abdominal
distention may be unrelated, and irritability is nonspecific.
6. A child is prescribed digoxin for heart failure. Which assessment finding should the
nurse report before administering the dose?
A. Apical heart rate of 80 beats/min
B. Serum potassium of 5.8 mEq/L
C. Blood pressure of 100/60 mm Hg
D. Respiratory rate of 24 breaths/min
Answer: B. Serum potassium of 5.8 mEq/L
Rationale: Hyperkalemia increases the risk of digoxin toxicity. The apical pulse should be
checked for bradycardia (hold if <90-110 depending on age), but a rate of 80 may be
acceptable in older children. BP and RR are within normal limits.
Page 3 of 49
, 7. A child with acute lymphoblastic leukemia is receiving methotrexate. Which
laboratory value should the nurse monitor most closely?
A. Serum creatinine
B. Hemoglobin
C. Platelet count
D. White blood cell count
Answer: A. Serum creatinine
Rationale: Methotrexate is nephrotoxic and can cause acute kidney injury; serum
creatinine is the most sensitive indicator of renal function. While myelosuppression affects
blood counts, renal monitoring is critical for preventing toxicity.
8. A child with a new cast for a fractured femur reports severe pain unrelieved by
opioids and has pale, cool toes. Which action should the nurse take first?
A. Elevate the casted leg on pillows.
B. Notify the provider immediately.
C. Administer a second dose of analgesic.
D. Check capillary refill in the toes.
Answer: B. Notify the provider immediately.
Rationale: These signs suggest compartment syndrome, a surgical emergency. The nurse
should notify the provider immediately; elevating the leg can worsen ischemia, and further
analgesia does not address the underlying cause. Capillary refill is part of assessment but
not the first action.
Page 4 of 49
Guide, Practice Questions & Review
1. A toddler is admitted with severe dehydration from acute gastroenteritis. Which
assessment finding best indicates the child has progressed from moderate to severe
dehydration?
A. Capillary refill of 3 seconds
B. Sunken fontanel and absent tears
C. Heart rate of 130 beats/min
D. Dry mucous membranes
Answer: B. Sunken fontanel and absent tears
Rationale: Severe dehydration is characterized by profound signs such as sunken fontanel,
absent tears, and lethargy, reflecting >10% fluid loss. Capillary refill of 3 seconds,
tachycardia, and dry mucous membranes are seen in moderate dehydration.
2. Which statement by a parent indicates correct understanding of home management
for a child with newly diagnosed type 1 diabetes mellitus?
A. "I will rotate insulin injection sites within the same area each week."
B. "I should check blood glucose only before breakfast and dinner."
C. "I will treat a low blood sugar with 15 grams of a fast-acting carbohydrate."
D. "I can skip insulin doses when my child is not eating."
Answer: C. "I will treat a low blood sugar with 15 grams of a fast-acting
carbohydrate."
Rationale: The rule of 15 (15 g fast-acting carbohydrate, recheck in 15 minutes) is
standard for hypoglycemia management. Rotating sites within the same area can cause
lipohypertrophy; glucose should be checked more frequently; and insulin must never be
skipped without provider guidance.
Page 1 of 49
,3. A child with nephrotic syndrome is receiving prednisone. Which finding requires
immediate follow-up?
A. Weight gain of 0.5 kg over 2 days
B. Blood pressure 118/78 mm Hg
C. Serum potassium 3.2 mEq/L
D. Increased appetite
Answer: C. Serum potassium 3.2 mEq/L
Rationale: Corticosteroids can cause hypokalemia; a potassium of 3.2 mEq/L is below the
normal pediatric range (3.5-5.0) and may precipitate dysrhythmias. Weight gain, elevated
but acceptable BP, and increased appetite are expected steroid effects.
4. A child with cystic fibrosis is prescribed pancreatic enzymes. Which instruction
should the nurse include?
A. Administer the enzymes with meals and snacks.
B. Give the enzymes only when the child has fatty stools.
C. Crush the enzymes and mix with a hot beverage.
D. Withhold the enzymes if the child has abdominal pain.
Answer: A. Administer the enzymes with meals and snacks.
Rationale: Pancreatic enzymes must be taken with every meal and snack to aid fat
digestion. They should not be given PRN, crushed and mixed with hot liquids (heat
inactivates enzymes), or withheld for abdominal pain without provider order.
Page 2 of 49
,5. A child with a ventriculoperitoneal shunt for hydrocephalus is brought to the clinic
with a headache and vomiting. Which assessment finding is most concerning for shunt
malfunction?
A. Sunsetting eyes
B. Shunt tract erythema
C. Abdominal distention
D. Irritability
Answer: A. Sunsetting eyes
Rationale: Sunsetting eyes (downward deviation of the eyes) indicates increased
intracranial pressure from shunt malfunction. Erythema suggests infection, abdominal
distention may be unrelated, and irritability is nonspecific.
6. A child is prescribed digoxin for heart failure. Which assessment finding should the
nurse report before administering the dose?
A. Apical heart rate of 80 beats/min
B. Serum potassium of 5.8 mEq/L
C. Blood pressure of 100/60 mm Hg
D. Respiratory rate of 24 breaths/min
Answer: B. Serum potassium of 5.8 mEq/L
Rationale: Hyperkalemia increases the risk of digoxin toxicity. The apical pulse should be
checked for bradycardia (hold if <90-110 depending on age), but a rate of 80 may be
acceptable in older children. BP and RR are within normal limits.
Page 3 of 49
, 7. A child with acute lymphoblastic leukemia is receiving methotrexate. Which
laboratory value should the nurse monitor most closely?
A. Serum creatinine
B. Hemoglobin
C. Platelet count
D. White blood cell count
Answer: A. Serum creatinine
Rationale: Methotrexate is nephrotoxic and can cause acute kidney injury; serum
creatinine is the most sensitive indicator of renal function. While myelosuppression affects
blood counts, renal monitoring is critical for preventing toxicity.
8. A child with a new cast for a fractured femur reports severe pain unrelieved by
opioids and has pale, cool toes. Which action should the nurse take first?
A. Elevate the casted leg on pillows.
B. Notify the provider immediately.
C. Administer a second dose of analgesic.
D. Check capillary refill in the toes.
Answer: B. Notify the provider immediately.
Rationale: These signs suggest compartment syndrome, a surgical emergency. The nurse
should notify the provider immediately; elevating the leg can worsen ischemia, and further
analgesia does not address the underlying cause. Capillary refill is part of assessment but
not the first action.
Page 4 of 49
