HESI PEDIATRIC NUTRITION
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SECTION A: Growth & Developmental Nutrition (Questions 1-20)
1. A 4-month-old exclusively breastfed infant is seen for a well-child visit.
Which supplement is most important to recommend?
A. Vitamin A
B. Vitamin D (400 IU/day)
C. Iron drops
D. Fluoride
Rationale: Breast milk is low in vitamin D. The AAP recommends 400 IU/day of
vitamin D for all breastfed infants starting in the first few days of life.
2. The mother of a 9-month-old asks about introducing cow’s milk. Your best
response is:
A. “Start whole milk now.”
B. “Wait until 12 months of age.”
C. “Use skim milk for lower fat.”
D. “Mix cow’s milk 50/50 with formula.”
Rationale: Cow’s milk is not recommended before 12 months due to low iron
content, high renal solute load, and risk of milk protein allergy.
3. Which statement by a parent of a 6-month-old indicates correct
understanding of iron-rich food introduction?
A. “I’ll give honey in cereal.”
B. “Iron-fortified rice cereal is a good first food.”
C. “Egg whites are best at 6 months.”
D. “Fruit juice is the best iron source.”
,Rationale: Iron-fortified cereals are excellent first solid foods. Honey is avoided
until 12 months (botulism risk). Egg whites are allergenic; juice is low in iron.
4. The nurse teaches parents about choking risks. Which food should the
nurse emphasize as highest risk for a 2-year-old?
A. Mashed potatoes
B. Whole grapes
C. Yogurt
D. Applesauce
Rationale: Whole grapes are round, firm, and can completely occlude a child’s
airway. Must be quartered lengthwise.
5. A toddler refuses previously liked foods and wants only macaroni and
cheese daily. This behavior is:
A. Indicative of autism spectrum disorder
B. Normal “food jag” behavior in toddlers
C. Failure to thrive
D. Pica
Rationale: Toddlers often exhibit food jags (limited food preferences). It is
developmentally normal unless growth is affected.
6. Calculate the daily maintenance fluid requirement for a 15 kg child using
the 4-2-1 rule.
A. 1000 mL
B. 1100 mL
C. 1200 mL
D. 1500 mL
Rationale: 4 mL/kg for first 10 kg (40) + 2 mL/kg for next 10 kg (10 kg × 2 = 20)
= 60 mL/hr × 24 hr = 1440 mL? Correction: 4×10=40, 2×5=10, total 50 mL/hr
×24=1200 mL/day.
7. A 14-year-old female athlete consumes 1500 calories/day, runs 10 miles
daily, and has BMI <5th percentile. Most likely diagnosis:
A. Bulimia nervosa
B. Anorexia nervosa or female athlete triad
C. Diabetes mellitus
D. Hyperthyroidism
, Rationale: Low caloric intake with high expenditure, low BMI, and female athlete
triad (disordered eating, amenorrhea, osteoporosis) are suspected.
8. Which finding suggests an infant is ready for pureed solids? (Select all that
apply)
A. Good head control
B. Loss of tongue-thrust reflex
C. Presence of Moro reflex
D. Sitting with minimal support
E. Birth weight doubled
Rationale: Readiness includes head control, loss of tongue thrust, sitting support,
and doubled birth weight (~4-6 months).
9. A newborn’s feeding log shows 10 wet diapers and 5 stools/day. This
indicates:
A. Dehydration
B. Adequate hydration
C. Overfeeding
D. Malabsorption
Rationale: 6+ wet diapers and 3+ stools/day after day 4 indicate adequate
breastmilk intake.
10. A 2-year-old’s parent reports drinking 32 oz of whole milk daily. The
nurse’s priority concern is:
A. Obesity
B. Iron deficiency anemia
C. Dental caries
D. Hypernatremia
Rationale: Excess milk displaces iron-rich foods and causes GI blood loss, leading
to iron deficiency anemia.
11. A 7-month-old with cystic fibrosis needs pancreatic enzymes. When should
enzymes be given?
A. 30 minutes before feeding
B. Immediately before or with first bites
C. Only at bedtime
D. After the feeding is complete
EXAM (Latest 2026)|| questions and
answers with rationales/graded
A+/2026 update/100% correct /instant
download
SECTION A: Growth & Developmental Nutrition (Questions 1-20)
1. A 4-month-old exclusively breastfed infant is seen for a well-child visit.
Which supplement is most important to recommend?
A. Vitamin A
B. Vitamin D (400 IU/day)
C. Iron drops
D. Fluoride
Rationale: Breast milk is low in vitamin D. The AAP recommends 400 IU/day of
vitamin D for all breastfed infants starting in the first few days of life.
2. The mother of a 9-month-old asks about introducing cow’s milk. Your best
response is:
A. “Start whole milk now.”
B. “Wait until 12 months of age.”
C. “Use skim milk for lower fat.”
D. “Mix cow’s milk 50/50 with formula.”
Rationale: Cow’s milk is not recommended before 12 months due to low iron
content, high renal solute load, and risk of milk protein allergy.
3. Which statement by a parent of a 6-month-old indicates correct
understanding of iron-rich food introduction?
A. “I’ll give honey in cereal.”
B. “Iron-fortified rice cereal is a good first food.”
C. “Egg whites are best at 6 months.”
D. “Fruit juice is the best iron source.”
,Rationale: Iron-fortified cereals are excellent first solid foods. Honey is avoided
until 12 months (botulism risk). Egg whites are allergenic; juice is low in iron.
4. The nurse teaches parents about choking risks. Which food should the
nurse emphasize as highest risk for a 2-year-old?
A. Mashed potatoes
B. Whole grapes
C. Yogurt
D. Applesauce
Rationale: Whole grapes are round, firm, and can completely occlude a child’s
airway. Must be quartered lengthwise.
5. A toddler refuses previously liked foods and wants only macaroni and
cheese daily. This behavior is:
A. Indicative of autism spectrum disorder
B. Normal “food jag” behavior in toddlers
C. Failure to thrive
D. Pica
Rationale: Toddlers often exhibit food jags (limited food preferences). It is
developmentally normal unless growth is affected.
6. Calculate the daily maintenance fluid requirement for a 15 kg child using
the 4-2-1 rule.
A. 1000 mL
B. 1100 mL
C. 1200 mL
D. 1500 mL
Rationale: 4 mL/kg for first 10 kg (40) + 2 mL/kg for next 10 kg (10 kg × 2 = 20)
= 60 mL/hr × 24 hr = 1440 mL? Correction: 4×10=40, 2×5=10, total 50 mL/hr
×24=1200 mL/day.
7. A 14-year-old female athlete consumes 1500 calories/day, runs 10 miles
daily, and has BMI <5th percentile. Most likely diagnosis:
A. Bulimia nervosa
B. Anorexia nervosa or female athlete triad
C. Diabetes mellitus
D. Hyperthyroidism
, Rationale: Low caloric intake with high expenditure, low BMI, and female athlete
triad (disordered eating, amenorrhea, osteoporosis) are suspected.
8. Which finding suggests an infant is ready for pureed solids? (Select all that
apply)
A. Good head control
B. Loss of tongue-thrust reflex
C. Presence of Moro reflex
D. Sitting with minimal support
E. Birth weight doubled
Rationale: Readiness includes head control, loss of tongue thrust, sitting support,
and doubled birth weight (~4-6 months).
9. A newborn’s feeding log shows 10 wet diapers and 5 stools/day. This
indicates:
A. Dehydration
B. Adequate hydration
C. Overfeeding
D. Malabsorption
Rationale: 6+ wet diapers and 3+ stools/day after day 4 indicate adequate
breastmilk intake.
10. A 2-year-old’s parent reports drinking 32 oz of whole milk daily. The
nurse’s priority concern is:
A. Obesity
B. Iron deficiency anemia
C. Dental caries
D. Hypernatremia
Rationale: Excess milk displaces iron-rich foods and causes GI blood loss, leading
to iron deficiency anemia.
11. A 7-month-old with cystic fibrosis needs pancreatic enzymes. When should
enzymes be given?
A. 30 minutes before feeding
B. Immediately before or with first bites
C. Only at bedtime
D. After the feeding is complete
