HESI Pediatrics Exam 2025/2026 – Verified
Questions with Rationales
1. According to Erikson, a 4-year-old child who says “I can do it myself!” is
successfully mastering which stage?Autonomy vs. Shame and Doubt (age 18
months–3 years) transitioning to Initiative vs. Guilt (3–5 years) Rationale: Preschool
children (3–5 years) develop initiative by directing play and making choices. Excessive
criticism leads to guilt.
2. At what age should a child first be able to build a tower of 10 cubes?4 years
Rationale: Fine motor milestone: 2 cubes at 15 months, 6 cubes at 2 years, 10 cubes at
4 years.
3. A 9-month-old should have how many teeth typically?2–4 (central incisors)
Rationale: Lower central incisors erupt first at 6–10 months, upper at 8–12 months.
4. Which immunization is given at birth in the U.S.?Hepatitis B #1 Rationale: CDC
schedule: Hep B within 24 hours of birth prevents perinatal transmission.
5. A 15-month-old is due for which vaccines at the 15-month visit?Hib #4, PCV15/20
#4, MMR #1, Varicella #1, Hep A #1 Rationale: 12–15 month visit includes first doses of
MMR, varicella, and Hep A (two-dose series 6 months apart).
6. Rotavirus vaccine is contraindicated in infants with a history of:Uncorrected
congenital malformation of the GI tract or previous intussusception Rationale: Live oral
vaccine; risk of intussusception increases if bowel obstruction present (e.g.,
Hirschsprung’s).
7. A 5-year-old has not received DTaP #5. When can it be given?4–6 years (preschool
booster) Rationale: Final DTaP dose is recommended at 4–6 years; Tdap replaces it at
11–12 years.
8. A 2-month-old with fever 38.5°C (101.4°F) presents to ED. What is the priority
action?Full sepsis workup (CBC, blood/urine/CSF cultures, LP) and empiric antibiotics
Rationale: Infants <90 days with fever ≥38°C are considered high risk for serious
bacterial infection (SBI); Rochester criteria may be used, but most centers do full workup
under 60 days.
9. A 3-year-old with epiglottitis is drooling and in tripod position. What is the most
important nursing action?Allow child to remain in position of comfort; do NOT attempt
to visualize throat Rationale: Epiglottitis (usually H. influenzae type B pre-vaccine era,
now often Strep) can cause complete airway obstruction if irritated.
10.Kawasaki disease complete criteria include fever ≥5 days plus at least 4 of 5
principal features. What are they?Bilateral conjunctivitis, oral changes (strawberry
tongue, cracked lips), rash, extremity changes (edema, erythema, peeling), cervical
lymphadenopathy ≥1.5 cm Rationale: IVIG 2 g/kg within 10 days + high-dose aspirin
prevents coronary aneurysms.
11.A 6-week-old presents with projectile non-bilious vomiting. Diagnosis and first
test?Pyloric stenosis; abdominal ultrasound Rationale: Hypertrophy of pyloric muscle →
gastric outlet obstruction; classic hypochloremic, hypokalemic metabolic alkalosis.
, 12.A newborn has a loud, single S2 and cyanosis that does not improve with oxygen.
Likely diagnosis?Transposition of the Great Arteries (TGA) Rationale: Parallel
circulations; PGE1 keeps ductus open until balloon atrial septostomy (Rashkind
procedure).
13.A 2-day-old infant has bilateral milky white pupil reflex (leukocoria). Most likely
diagnosis?Congenital cataract or retinoblastoma Rationale: Urgent ophthalmology
referral; retinoblastoma is malignant and can be hereditary.
14.A 3-year-old with Down syndrome is scheduled for cardiac evaluation. Most
common heart defect?Atrioventricular septal defect (endocardial cushion defect)
Rationale: Seen in 40–50% of children with trisomy 21.
15.An 18-month-old with tetralogy of Fallot has a “tet spell.” Immediate
intervention?Place in knee-chest position, give 100% oxygen, morphine 0.1–0.2 mg/kg
IV/IM Rationale: Hypercyanotic spell caused by acute increase in right-to-left shunting;
knee-chest increases systemic vascular resistance.
16.Safe dose of acetaminophen in children is:10–15 mg/kg/dose every 4–6 hours (max
75 mg/kg/day or 4 g/day) Rationale: Overdose causes hepatotoxicity; always confirm
concentration (160 mg/5 mL most common).
17.A 4-year-old weighs 16 kg and needs ceftriaxone for pneumonia. Safe dose?50–75
mg/kg IV once daily → 800–1200 mg/day Rationale: Standard dose for
community-acquired pneumonia; max 2 g/day.
18.A 6-year-old is prescribed amoxicillin 90 mg/kg/day divided TID for otitis media.
Weight 20 kg. Total daily dose?1800 mg/day → 600 mg TID Rationale: High-dose
amoxicillin required for resistant S. pneumoniae.
19.First sign of respiratory distress in an infant is usually:Nasal flaring and tachypnea
Rationale: Infants are obligate nose breathers; accessory muscle use appears later.
20.A 7-month-old with bronchiolitis has SpO₂ 89% on room air. Next step?Start heated
high-flow nasal cannula (HFNC) or CPAP Rationale: RSV bronchiolitis; HFNC reduces
work of breathing and need for intubation.
21.A 2-year-old with croup has stridor at rest and retractions. Best
treatment?Racemic epinephrine + dexamethasone 0.6 mg/kg (max 10 mg) Rationale:
Moderate–severe croup; observe 3–4 hours post-nebulized epinephrine.
22.A 4-year-old with sickle cell disease has fever 39°C. Immediate actions?CBC, retic,
blood culture, ceftriaxone 75 mg/kg IV (max 2 g) Rationale: Functional asplenia → high
risk encapsulated organisms (S. pneumoniae).
23.A 9-month-old with roseola has high fever for 3 days followed by rash as fever
breaks. Management?Supportive care only Rationale: HHV-6; rash appears after
defervescence; benign, self-limited.
24.A 5-year-old with new-onset diabetes has blood glucose 450 mg/dL, pH 7.25,
ketones. Diagnosis?Diabetic ketoacidosis (DKA) Rationale: Insulin deficiency →
lipolysis → ketoacids. Treat with careful fluid bolus then insulin drip.
25.A 3-week-old with coarctation of the aorta presents with shock when ductus
closes. Immediate treatment?Prostaglandin E1 (alprostadil) infusion Rationale: Keeps
PDA open to perfuse lower body until surgical repair.
Questions with Rationales
1. According to Erikson, a 4-year-old child who says “I can do it myself!” is
successfully mastering which stage?Autonomy vs. Shame and Doubt (age 18
months–3 years) transitioning to Initiative vs. Guilt (3–5 years) Rationale: Preschool
children (3–5 years) develop initiative by directing play and making choices. Excessive
criticism leads to guilt.
2. At what age should a child first be able to build a tower of 10 cubes?4 years
Rationale: Fine motor milestone: 2 cubes at 15 months, 6 cubes at 2 years, 10 cubes at
4 years.
3. A 9-month-old should have how many teeth typically?2–4 (central incisors)
Rationale: Lower central incisors erupt first at 6–10 months, upper at 8–12 months.
4. Which immunization is given at birth in the U.S.?Hepatitis B #1 Rationale: CDC
schedule: Hep B within 24 hours of birth prevents perinatal transmission.
5. A 15-month-old is due for which vaccines at the 15-month visit?Hib #4, PCV15/20
#4, MMR #1, Varicella #1, Hep A #1 Rationale: 12–15 month visit includes first doses of
MMR, varicella, and Hep A (two-dose series 6 months apart).
6. Rotavirus vaccine is contraindicated in infants with a history of:Uncorrected
congenital malformation of the GI tract or previous intussusception Rationale: Live oral
vaccine; risk of intussusception increases if bowel obstruction present (e.g.,
Hirschsprung’s).
7. A 5-year-old has not received DTaP #5. When can it be given?4–6 years (preschool
booster) Rationale: Final DTaP dose is recommended at 4–6 years; Tdap replaces it at
11–12 years.
8. A 2-month-old with fever 38.5°C (101.4°F) presents to ED. What is the priority
action?Full sepsis workup (CBC, blood/urine/CSF cultures, LP) and empiric antibiotics
Rationale: Infants <90 days with fever ≥38°C are considered high risk for serious
bacterial infection (SBI); Rochester criteria may be used, but most centers do full workup
under 60 days.
9. A 3-year-old with epiglottitis is drooling and in tripod position. What is the most
important nursing action?Allow child to remain in position of comfort; do NOT attempt
to visualize throat Rationale: Epiglottitis (usually H. influenzae type B pre-vaccine era,
now often Strep) can cause complete airway obstruction if irritated.
10.Kawasaki disease complete criteria include fever ≥5 days plus at least 4 of 5
principal features. What are they?Bilateral conjunctivitis, oral changes (strawberry
tongue, cracked lips), rash, extremity changes (edema, erythema, peeling), cervical
lymphadenopathy ≥1.5 cm Rationale: IVIG 2 g/kg within 10 days + high-dose aspirin
prevents coronary aneurysms.
11.A 6-week-old presents with projectile non-bilious vomiting. Diagnosis and first
test?Pyloric stenosis; abdominal ultrasound Rationale: Hypertrophy of pyloric muscle →
gastric outlet obstruction; classic hypochloremic, hypokalemic metabolic alkalosis.
, 12.A newborn has a loud, single S2 and cyanosis that does not improve with oxygen.
Likely diagnosis?Transposition of the Great Arteries (TGA) Rationale: Parallel
circulations; PGE1 keeps ductus open until balloon atrial septostomy (Rashkind
procedure).
13.A 2-day-old infant has bilateral milky white pupil reflex (leukocoria). Most likely
diagnosis?Congenital cataract or retinoblastoma Rationale: Urgent ophthalmology
referral; retinoblastoma is malignant and can be hereditary.
14.A 3-year-old with Down syndrome is scheduled for cardiac evaluation. Most
common heart defect?Atrioventricular septal defect (endocardial cushion defect)
Rationale: Seen in 40–50% of children with trisomy 21.
15.An 18-month-old with tetralogy of Fallot has a “tet spell.” Immediate
intervention?Place in knee-chest position, give 100% oxygen, morphine 0.1–0.2 mg/kg
IV/IM Rationale: Hypercyanotic spell caused by acute increase in right-to-left shunting;
knee-chest increases systemic vascular resistance.
16.Safe dose of acetaminophen in children is:10–15 mg/kg/dose every 4–6 hours (max
75 mg/kg/day or 4 g/day) Rationale: Overdose causes hepatotoxicity; always confirm
concentration (160 mg/5 mL most common).
17.A 4-year-old weighs 16 kg and needs ceftriaxone for pneumonia. Safe dose?50–75
mg/kg IV once daily → 800–1200 mg/day Rationale: Standard dose for
community-acquired pneumonia; max 2 g/day.
18.A 6-year-old is prescribed amoxicillin 90 mg/kg/day divided TID for otitis media.
Weight 20 kg. Total daily dose?1800 mg/day → 600 mg TID Rationale: High-dose
amoxicillin required for resistant S. pneumoniae.
19.First sign of respiratory distress in an infant is usually:Nasal flaring and tachypnea
Rationale: Infants are obligate nose breathers; accessory muscle use appears later.
20.A 7-month-old with bronchiolitis has SpO₂ 89% on room air. Next step?Start heated
high-flow nasal cannula (HFNC) or CPAP Rationale: RSV bronchiolitis; HFNC reduces
work of breathing and need for intubation.
21.A 2-year-old with croup has stridor at rest and retractions. Best
treatment?Racemic epinephrine + dexamethasone 0.6 mg/kg (max 10 mg) Rationale:
Moderate–severe croup; observe 3–4 hours post-nebulized epinephrine.
22.A 4-year-old with sickle cell disease has fever 39°C. Immediate actions?CBC, retic,
blood culture, ceftriaxone 75 mg/kg IV (max 2 g) Rationale: Functional asplenia → high
risk encapsulated organisms (S. pneumoniae).
23.A 9-month-old with roseola has high fever for 3 days followed by rash as fever
breaks. Management?Supportive care only Rationale: HHV-6; rash appears after
defervescence; benign, self-limited.
24.A 5-year-old with new-onset diabetes has blood glucose 450 mg/dL, pH 7.25,
ketones. Diagnosis?Diabetic ketoacidosis (DKA) Rationale: Insulin deficiency →
lipolysis → ketoacids. Treat with careful fluid bolus then insulin drip.
25.A 3-week-old with coarctation of the aorta presents with shock when ductus
closes. Immediate treatment?Prostaglandin E1 (alprostadil) infusion Rationale: Keeps
PDA open to perfuse lower body until surgical repair.
