1
2025–2026 HESI RN Pediatric Exam V1 & V2 | 300
Actual Questions & Correct Answers with Detailed
Rationales | GRADED A+
Question 1
A 2-year-old toddler is admitted with croup and presents with a barking cough, inspiratory
stridor, and mild retractions. The nurse notes that the child becomes more agitated when upset.
The provider orders humidified oxygen and nebulized racemic epinephrine. Which is the most
appropriate nursing action to support airway patency while minimizing distress?
A. Insert a nasopharyngeal airway
B. Perform frequent oral suctioning
C. Keep the child calm and avoid unnecessary stimulation
D. Place the child in a supine position
Correct Answer: C. Keep the child calm and avoid unnecessary stimulation
Rationale: In children with croup, agitation increases oxygen demand and can worsen airway
obstruction due to laryngeal edema. The priority is to maintain a calm environment and avoid
any interventions that could provoke crying or distress. Suctioning or inserting airway devices
,2
may cause further airway compromise unless absolutely necessary. Supine positioning can
worsen respiratory effort.
📚 Source: HESI Comprehensive Review for the NCLEX-RN 6th Ed., Ch. 7 Pediatrics; ATI RN
Nursing Care of Children, Ch. 16
✅ Question 2
A 6-month-old infant is brought to the emergency department with a temperature of 38.9°C
(102°F), irritability, and a bulging fontanel. The nurse notes poor feeding and a high-pitched cry.
A lumbar puncture confirms bacterial meningitis. What is the nurse’s immediate priority?
A. Administer IV antibiotics as prescribed
B. Initiate seizure precautions
C. Monitor for signs of increased intracranial pressure
D. Place the child in droplet isolation
Correct Answer: A. Administer IV antibiotics as prescribed
Rationale: Bacterial meningitis in infants is a medical emergency. Early administration of
broad-spectrum IV antibiotics is essential to reduce morbidity and mortality. While isolation,
seizure precautions, and monitoring for increased ICP are important, antibiotic therapy must
begin promptly to target the infection. Delay in antibiotic administration worsens outcomes.
📚 Source: HESI NCLEX-RN Review 6th Ed., Ch. 7; ATI RN Peds, Ch. 5 Meningitis
✅ Question 3
,3
The nurse is assessing a 3-year-old with suspected Kawasaki disease. The child has had a fever
for 6 days, bilateral conjunctival redness, strawberry tongue, and a widespread rash. Which
physician order should the nurse expect next?
A. Administer IV immunoglobulin and aspirin
B. Begin corticosteroid therapy and nebulized albuterol
C. Prepare for tonsillectomy
D. Initiate seizure precautions and obtain a CT scan
Correct Answer: A. Administer IV immunoglobulin and aspirin
Rationale: Kawasaki disease is a pediatric vasculitis requiring early treatment with IVIG and
high-dose aspirin to reduce inflammation and prevent coronary artery aneurysms. Steroids are
not first-line. Tonsillectomy is not indicated. CT is unnecessary unless neurological symptoms
are present.
📚 Source: ATI RN Nursing Care of Children, Ch. 21; HESI NCLEX-RN Review, Ch. 7
✅ Question 4
A nurse is caring for a 4-year-old child with nephrotic syndrome. The child has significant
periorbital edema, decreased urine output, and is receiving corticosteroid therapy. Which is the
most appropriate nursing intervention?
A. Encourage increased fluid intake
B. Monitor daily weights and abdominal girth
, 4
C. Place the child on strict fluid restriction
D. Prepare the child for dialysis
Correct Answer: B. Monitor daily weights and abdominal girth
Rationale: Monitoring weight and girth helps assess fluid retention and the effectiveness of
therapy in nephrotic syndrome. Diuretics may be used, but fluid intake is not typically increased
or strictly restricted unless specifically ordered. Dialysis is rarely the first intervention.
📚 Source: HESI Review 6th Ed., Ch. 7; ATI RN Nursing Care of Children, Ch. 26
✅ Question 5
A 12-year-old with type 1 diabetes presents to the clinic with fruity-smelling breath, fatigue, and
deep respirations. The child is alert but lethargic. What is the nurse’s initial action?
A. Encourage oral fluids and reassess in 1 hour
B. Administer subcutaneous insulin
C. Start an IV line and begin isotonic fluids
D. Call the provider to report ketoacidosis
Correct Answer: C. Start an IV line and begin isotonic fluids
Rationale: This child is exhibiting signs of diabetic ketoacidosis (DKA), which requires
immediate correction of dehydration. Isotonic fluids are the first-line treatment, followed by
insulin infusion once labs are obtained. Oral fluids are not safe in this case.
📚 Source: ATI RN Peds, Ch. 33 Diabetes; HESI NCLEX-RN Review 6th Ed.
2025–2026 HESI RN Pediatric Exam V1 & V2 | 300
Actual Questions & Correct Answers with Detailed
Rationales | GRADED A+
Question 1
A 2-year-old toddler is admitted with croup and presents with a barking cough, inspiratory
stridor, and mild retractions. The nurse notes that the child becomes more agitated when upset.
The provider orders humidified oxygen and nebulized racemic epinephrine. Which is the most
appropriate nursing action to support airway patency while minimizing distress?
A. Insert a nasopharyngeal airway
B. Perform frequent oral suctioning
C. Keep the child calm and avoid unnecessary stimulation
D. Place the child in a supine position
Correct Answer: C. Keep the child calm and avoid unnecessary stimulation
Rationale: In children with croup, agitation increases oxygen demand and can worsen airway
obstruction due to laryngeal edema. The priority is to maintain a calm environment and avoid
any interventions that could provoke crying or distress. Suctioning or inserting airway devices
,2
may cause further airway compromise unless absolutely necessary. Supine positioning can
worsen respiratory effort.
📚 Source: HESI Comprehensive Review for the NCLEX-RN 6th Ed., Ch. 7 Pediatrics; ATI RN
Nursing Care of Children, Ch. 16
✅ Question 2
A 6-month-old infant is brought to the emergency department with a temperature of 38.9°C
(102°F), irritability, and a bulging fontanel. The nurse notes poor feeding and a high-pitched cry.
A lumbar puncture confirms bacterial meningitis. What is the nurse’s immediate priority?
A. Administer IV antibiotics as prescribed
B. Initiate seizure precautions
C. Monitor for signs of increased intracranial pressure
D. Place the child in droplet isolation
Correct Answer: A. Administer IV antibiotics as prescribed
Rationale: Bacterial meningitis in infants is a medical emergency. Early administration of
broad-spectrum IV antibiotics is essential to reduce morbidity and mortality. While isolation,
seizure precautions, and monitoring for increased ICP are important, antibiotic therapy must
begin promptly to target the infection. Delay in antibiotic administration worsens outcomes.
📚 Source: HESI NCLEX-RN Review 6th Ed., Ch. 7; ATI RN Peds, Ch. 5 Meningitis
✅ Question 3
,3
The nurse is assessing a 3-year-old with suspected Kawasaki disease. The child has had a fever
for 6 days, bilateral conjunctival redness, strawberry tongue, and a widespread rash. Which
physician order should the nurse expect next?
A. Administer IV immunoglobulin and aspirin
B. Begin corticosteroid therapy and nebulized albuterol
C. Prepare for tonsillectomy
D. Initiate seizure precautions and obtain a CT scan
Correct Answer: A. Administer IV immunoglobulin and aspirin
Rationale: Kawasaki disease is a pediatric vasculitis requiring early treatment with IVIG and
high-dose aspirin to reduce inflammation and prevent coronary artery aneurysms. Steroids are
not first-line. Tonsillectomy is not indicated. CT is unnecessary unless neurological symptoms
are present.
📚 Source: ATI RN Nursing Care of Children, Ch. 21; HESI NCLEX-RN Review, Ch. 7
✅ Question 4
A nurse is caring for a 4-year-old child with nephrotic syndrome. The child has significant
periorbital edema, decreased urine output, and is receiving corticosteroid therapy. Which is the
most appropriate nursing intervention?
A. Encourage increased fluid intake
B. Monitor daily weights and abdominal girth
, 4
C. Place the child on strict fluid restriction
D. Prepare the child for dialysis
Correct Answer: B. Monitor daily weights and abdominal girth
Rationale: Monitoring weight and girth helps assess fluid retention and the effectiveness of
therapy in nephrotic syndrome. Diuretics may be used, but fluid intake is not typically increased
or strictly restricted unless specifically ordered. Dialysis is rarely the first intervention.
📚 Source: HESI Review 6th Ed., Ch. 7; ATI RN Nursing Care of Children, Ch. 26
✅ Question 5
A 12-year-old with type 1 diabetes presents to the clinic with fruity-smelling breath, fatigue, and
deep respirations. The child is alert but lethargic. What is the nurse’s initial action?
A. Encourage oral fluids and reassess in 1 hour
B. Administer subcutaneous insulin
C. Start an IV line and begin isotonic fluids
D. Call the provider to report ketoacidosis
Correct Answer: C. Start an IV line and begin isotonic fluids
Rationale: This child is exhibiting signs of diabetic ketoacidosis (DKA), which requires
immediate correction of dehydration. Isotonic fluids are the first-line treatment, followed by
insulin infusion once labs are obtained. Oral fluids are not safe in this case.
📚 Source: ATI RN Peds, Ch. 33 Diabetes; HESI NCLEX-RN Review 6th Ed.
