[HESI Pediatrics] COMPLETE EXAM QUESTIONS AND
VERIFIED ANSWERS | 2026–2027 LATEST UPDATE |
GUARANTEED PASS | DETAILED RATIONALES | FULL STUDY
GUIDE | EXAM PREP | PRACTICE TEST | CERTIFICATION
PREPARATION
Section One: Questions 1–100
1. A 4-year-old child is brought to the emergency department with a fever of 103.2°F (39.6°C), a
harsh cough, and stridor that is worse at night. The nurse notes the child is restless and has
moderate suprasternal retractions. Which action should the nurse anticipate preparing for first?
A. Administration of a nebulized bronchodilator treatment
B. Obtaining a complete blood count and blood culture
C. Preparation for an emergent endotracheal intubation
D. Administration of a nebulized racemic epinephrine treatment
Correct Answer: D. Administration of a nebulized racemic epinephrine treatment
Rationale: The child's presentation of fever, harsh cough, stridor worse at night, and retractions is
classic for moderate to severe croup (laryngotracheobronchitis). The standard acute management for
moderate to severe croup includes a nebulized racemic epinephrine treatment to reduce subglottic
edema, along with dexamethasone. A bronchodilator is for reactive airway disease, not croup's
primary pathology. Blood work is secondary and would not be the first action. Intubation is a last
resort if medical management fails.
2. The nurse is calculating the maintenance fluid requirement for a 10-month-old infant who
weighs 9 kg. Using the standard weight-based formula, what is the 24-hour fluid requirement?
A. 900 mL
B. 1000 mL
C. 950 mL
D. 1100 mL
Correct Answer: B. 1000 mL
Rationale: The standard formula for maintenance fluids is 100 mL/kg for the first 10 kg. Therefore, 9
kg x 100 mL/kg = 900 mL per 24 hours. Option B is incorrect as it represents the calculation for a 10
kg infant. The other options are mathematically incorrect applications of the formula.
3. A 2-year-old toddler is admitted with pneumonia. The parents ask why their child is receiving
respiratory syncytial virus (RSV) immune globulin. What is the nurse's best response?
A. "This medication directly treats the RSV infection your child has."
B. "It is a routine immunization given to all children at this age."
C. "It provides passive immunity to help prevent serious complications from RSV."
D. "It is used to treat the fever and inflammation caused by the pneumonia."
Correct Answer: C. "It provides passive immunity to help prevent serious complications from RSV."
Rationale: RSV immune globulin (or palivizumab) provides passive immunity, meaning it gives the
child antibodies to fight the RSV virus. It is not a treatment for an active infection but a preventative
measure for high-risk children, such as premature infants or those with chronic lung disease. It is not
a routine immunization. It does not directly treat the pneumonia or reduce fever and inflammation.
,4. A nurse is performing a developmental screening on a 6-month-old infant. Which milestone
should the nurse expect the infant to be able to perform?
A. Sit unsupported for several minutes
B. Transfer an object from one hand to the other
C. Walk while holding onto furniture
D. Have a strong and steady pincer grasp
Correct Answer: B. Transfer an object from one hand to the other
Rationale: By 6 months, infants typically begin transferring objects from one hand to the other. Sitting
unsupported is a milestone usually achieved around 8 months. Walking while holding onto furniture
(cruising) occurs around 9-10 months. A pincer grasp is typically not developed until 9-10 months.
5. A 7-year-old child with type 1 diabetes mellitus is experiencing a "dawn phenomenon." The
parent asks the nurse what this means. What is the nurse's best explanation?
A. "This is a significant drop in blood sugar during the night, usually around 2 AM."
B. "This is a spike in blood sugar in the early morning hours due to growth hormone release."
C. "This is an increase in blood sugar after eating breakfast without adequate insulin."
D. "This is a reaction where the blood sugar drops dangerously low after exercise in the morning."
Correct Answer: B. "This is a spike in blood sugar in the early morning hours due to growth hormone
release."
Rationale: The dawn phenomenon is characterized by a natural surge in hormones (such as growth
hormone) during the early morning hours, which can cause a significant rise in blood glucose levels in
individuals with diabetes. Option A describes the Somogyi effect, which is a rebound high blood sugar
following a hypoglycemic episode during the night. The other options describe other common glucose
fluctuations.
6. A 3-year-old child presents with a sudden onset of severe coughing, wheezing, and cyanosis
after playing with a small toy. The nurse suspects a foreign body airway obstruction. Which of the
following findings is most consistent with a foreign body aspiration?
A. Bilateral expiratory wheezing that is worse in the upper lobes
B. Unilateral decreased breath sounds with expiratory wheezing
C. Barking cough and inspiratory stridor relieved by sitting upright
D. Tachypnea with a prolonged inspiratory phase
Correct Answer: B. Unilateral decreased breath sounds with expiratory wheezing
Rationale: An aspirated foreign body typically lodges in a bronchus, causing a partial obstruction.
This leads to air trapping and localized findings such as decreased breath sounds and expiratory
wheezing on the affected side. Bilateral findings suggest a more diffuse process like asthma. Barking
cough and stridor are typical of croup. The prolonged expiratory phase is a hallmark of obstructive
lung disease.
7. The nurse is assessing a 15-year-old adolescent with a diagnosis of depression. Which
assessment finding is the most critical priority for the nurse to address immediately?
A. Poor school performance and declining grades
B. Verbalizing statements of worthlessness and social isolation
C. Withdrawal from family and a history of substance use
D. A specific, detailed plan for suicide
Correct Answer: D. A specific, detailed plan for suicide
Rationale: A specific, detailed suicide plan indicates a high level of intent and imminent risk, making it
the highest priority for immediate intervention to ensure patient safety. While the other options are
,serious warning signs of depression and risk factors for suicide, they do not indicate the same level of
acute, immediate danger as having a concrete plan.
8. A 5-year-old child is 48 hours post-tonsillectomy and adenoidectomy. The parent reports the
child's throat pain is increasing and the child is refusing to drink. Which assessment finding is most
indicative of a potential postoperative hemorrhage?
A. A low-grade fever of 100.4°F (38°C)
B. Frequent swallowing and clearing of the throat
C. A hoarse voice and mild ear pain
D. Complaints of a stiff neck and nausea
Correct Answer: B. Frequent swallowing and clearing of the throat
Rationale: Frequent swallowing and throat clearing in a post-tonsillectomy patient can indicate
bleeding that is trickling down the back of the throat. A low-grade fever, hoarseness, and ear pain are
common and expected postoperative findings. A stiff neck is not a typical sign of hemorrhage.
9. A 9-month-old infant is hospitalized for failure to thrive. The nurse observes that the infant is
listless, avoids eye contact, and remains stiff when held. This behavior is most consistent with
which type of failure to thrive?
A. Organic failure to thrive
B. Psychosocial failure to thrive
C. Idiopathic failure to thrive
D. Gastroesophageal reflux-related failure to thrive
Correct Answer: B. Psychosocial failure to thrive
Rationale: Psychosocial failure to thrive is often characterized by infant behaviors like listlessness,
avoidance of eye contact, and a lack of responsiveness to being held (such as stiffening), which are
signs of poor caregiver-infant interaction. Organic failure to thrive stems from a medical condition
and may not present with these specific behavioral cues.
10. A nurse is providing education to the parents of a 6-month-old infant on preventing sudden
infant death syndrome (SIDS). Which of the following statements by a parent indicates a need for
further teaching?
A. "I will always place my baby on the back to sleep."
B. "I will make sure to remove all soft blankets and toys from the crib."
C. "I will let my baby sleep in our bed with us for easier feeding."
D. "I will offer a pacifier at nap time and bedtime."
Correct Answer: C. "I will let my baby sleep in our bed with us for easier feeding."
Rationale: The American Academy of Pediatrics recommends room-sharing without bed-sharing to
reduce the risk of SIDS. Bed-sharing is associated with an increased risk of SIDS and accidental
suffocation. The other statements reflect safe sleep practices: placing the infant on the back, a firm
sleep surface free of soft objects, and pacifier use.
11. An 8-year-old child is brought to the clinic with complaints of a headache, vomiting, and
photophobia. The child's temperature is 102.2°F (39°C). A stiff neck is noted on physical
examination. Which priority intervention should the nurse prepare to implement?
A. Administer an oral antiemetic and antipyretic
B. Administer a dose of acetaminophen and discharge home with rest
C. Prepare the child for a lumbar puncture
D. Place the child in a dark room with cold compresses
Correct Answer: C. Prepare the child for a lumbar puncture
Rationale: This child's symptoms of headache, vomiting, photophobia, fever, and nuchal rigidity are
, classic signs of meningitis. A lumbar puncture to obtain cerebrospinal fluid for analysis is the priority
diagnostic procedure to confirm the diagnosis. While comfort measures are important, they are
secondary to the diagnostic workup and initiation of appropriate antibiotics.
12. A nurse is teaching the parents of a 2-year-old child with iron deficiency anemia about dietary
management. Which food choices are most appropriate to recommend to enhance iron
absorption?
A. Milk and cheese with iron-fortified cereal
B. Iron-fortified cereal with a glass of orange juice
C. Spinach and broccoli with a glass of milk
D. Red meat with a glass of whole milk
Correct Answer: B. Iron-fortified cereal with a glass of orange juice
Rationale: Vitamin C (ascorbic acid) significantly enhances the absorption of non-heme iron found in
plant sources and fortified cereals. Orange juice is an excellent source of vitamin C. Dairy products like
milk and cheese, which are high in calcium, can inhibit iron absorption.
13. A 4-month-old infant is scheduled for a well-child visit. The nurse is preparing to administer
immunizations. Which immunizations are recommended for this age according to the standard
childhood immunization schedule?
A. DTaP, IPV, Hib, PCV13, and RV
B. DTaP, MMR, IPV, and Varicella
C. DTaP, Hib, MMR, and PCV13
D. DTaP, IPV, Hepatitis B, and MMR
Correct Answer: A. DTaP, IPV, Hib, PCV13, and RV
Rationale: At the 4-month visit, the recommended immunizations include the second dose of DTaP
(diphtheria, tetanus, acellular pertussis), IPV (inactivated poliovirus), Hib (Haemophilus influenzae
type b), PCV13 (pneumococcal conjugate), and RV (rotavirus). MMR (measles, mumps, rubella) and
Varicella are typically not given until the first dose at 12-15 months. Hepatitis B is given at birth, 1-2
months, and 6-18 months.
14. A 10-year-old child has been diagnosed with acute glomerulonephritis. Which assessment
finding should the nurse expect?
A. Periorbital edema and tea-colored urine
B. Polyuria and polydipsia
C. Severe flank pain and hematuria
D. Hypotension and tachycardia
Correct Answer: A. Periorbital edema and tea-colored urine
Rationale: Acute glomerulonephritis often presents with periorbital edema (due to fluid retention)
and tea-colored or cola-colored urine (due to the presence of red blood cell casts and hemoglobin).
Polyuria and polydipsia are characteristic of diabetes insipidus or mellitus. Flank pain is more
common with pyelonephritis or stones. Hypertension, not hypotension, is a common finding due to
fluid overload.
15. A nurse is caring for a 6-year-old child with a ventriculoperitoneal (VP) shunt for
hydrocephalus. Which assessment finding would be the earliest indicator of a shunt malfunction?
A. A bulging fontanel
B. Sunsetting eyes
C. Irritability and lethargy
D. Vomiting and a severe headache
Correct Answer: C. Irritability and lethargy
VERIFIED ANSWERS | 2026–2027 LATEST UPDATE |
GUARANTEED PASS | DETAILED RATIONALES | FULL STUDY
GUIDE | EXAM PREP | PRACTICE TEST | CERTIFICATION
PREPARATION
Section One: Questions 1–100
1. A 4-year-old child is brought to the emergency department with a fever of 103.2°F (39.6°C), a
harsh cough, and stridor that is worse at night. The nurse notes the child is restless and has
moderate suprasternal retractions. Which action should the nurse anticipate preparing for first?
A. Administration of a nebulized bronchodilator treatment
B. Obtaining a complete blood count and blood culture
C. Preparation for an emergent endotracheal intubation
D. Administration of a nebulized racemic epinephrine treatment
Correct Answer: D. Administration of a nebulized racemic epinephrine treatment
Rationale: The child's presentation of fever, harsh cough, stridor worse at night, and retractions is
classic for moderate to severe croup (laryngotracheobronchitis). The standard acute management for
moderate to severe croup includes a nebulized racemic epinephrine treatment to reduce subglottic
edema, along with dexamethasone. A bronchodilator is for reactive airway disease, not croup's
primary pathology. Blood work is secondary and would not be the first action. Intubation is a last
resort if medical management fails.
2. The nurse is calculating the maintenance fluid requirement for a 10-month-old infant who
weighs 9 kg. Using the standard weight-based formula, what is the 24-hour fluid requirement?
A. 900 mL
B. 1000 mL
C. 950 mL
D. 1100 mL
Correct Answer: B. 1000 mL
Rationale: The standard formula for maintenance fluids is 100 mL/kg for the first 10 kg. Therefore, 9
kg x 100 mL/kg = 900 mL per 24 hours. Option B is incorrect as it represents the calculation for a 10
kg infant. The other options are mathematically incorrect applications of the formula.
3. A 2-year-old toddler is admitted with pneumonia. The parents ask why their child is receiving
respiratory syncytial virus (RSV) immune globulin. What is the nurse's best response?
A. "This medication directly treats the RSV infection your child has."
B. "It is a routine immunization given to all children at this age."
C. "It provides passive immunity to help prevent serious complications from RSV."
D. "It is used to treat the fever and inflammation caused by the pneumonia."
Correct Answer: C. "It provides passive immunity to help prevent serious complications from RSV."
Rationale: RSV immune globulin (or palivizumab) provides passive immunity, meaning it gives the
child antibodies to fight the RSV virus. It is not a treatment for an active infection but a preventative
measure for high-risk children, such as premature infants or those with chronic lung disease. It is not
a routine immunization. It does not directly treat the pneumonia or reduce fever and inflammation.
,4. A nurse is performing a developmental screening on a 6-month-old infant. Which milestone
should the nurse expect the infant to be able to perform?
A. Sit unsupported for several minutes
B. Transfer an object from one hand to the other
C. Walk while holding onto furniture
D. Have a strong and steady pincer grasp
Correct Answer: B. Transfer an object from one hand to the other
Rationale: By 6 months, infants typically begin transferring objects from one hand to the other. Sitting
unsupported is a milestone usually achieved around 8 months. Walking while holding onto furniture
(cruising) occurs around 9-10 months. A pincer grasp is typically not developed until 9-10 months.
5. A 7-year-old child with type 1 diabetes mellitus is experiencing a "dawn phenomenon." The
parent asks the nurse what this means. What is the nurse's best explanation?
A. "This is a significant drop in blood sugar during the night, usually around 2 AM."
B. "This is a spike in blood sugar in the early morning hours due to growth hormone release."
C. "This is an increase in blood sugar after eating breakfast without adequate insulin."
D. "This is a reaction where the blood sugar drops dangerously low after exercise in the morning."
Correct Answer: B. "This is a spike in blood sugar in the early morning hours due to growth hormone
release."
Rationale: The dawn phenomenon is characterized by a natural surge in hormones (such as growth
hormone) during the early morning hours, which can cause a significant rise in blood glucose levels in
individuals with diabetes. Option A describes the Somogyi effect, which is a rebound high blood sugar
following a hypoglycemic episode during the night. The other options describe other common glucose
fluctuations.
6. A 3-year-old child presents with a sudden onset of severe coughing, wheezing, and cyanosis
after playing with a small toy. The nurse suspects a foreign body airway obstruction. Which of the
following findings is most consistent with a foreign body aspiration?
A. Bilateral expiratory wheezing that is worse in the upper lobes
B. Unilateral decreased breath sounds with expiratory wheezing
C. Barking cough and inspiratory stridor relieved by sitting upright
D. Tachypnea with a prolonged inspiratory phase
Correct Answer: B. Unilateral decreased breath sounds with expiratory wheezing
Rationale: An aspirated foreign body typically lodges in a bronchus, causing a partial obstruction.
This leads to air trapping and localized findings such as decreased breath sounds and expiratory
wheezing on the affected side. Bilateral findings suggest a more diffuse process like asthma. Barking
cough and stridor are typical of croup. The prolonged expiratory phase is a hallmark of obstructive
lung disease.
7. The nurse is assessing a 15-year-old adolescent with a diagnosis of depression. Which
assessment finding is the most critical priority for the nurse to address immediately?
A. Poor school performance and declining grades
B. Verbalizing statements of worthlessness and social isolation
C. Withdrawal from family and a history of substance use
D. A specific, detailed plan for suicide
Correct Answer: D. A specific, detailed plan for suicide
Rationale: A specific, detailed suicide plan indicates a high level of intent and imminent risk, making it
the highest priority for immediate intervention to ensure patient safety. While the other options are
,serious warning signs of depression and risk factors for suicide, they do not indicate the same level of
acute, immediate danger as having a concrete plan.
8. A 5-year-old child is 48 hours post-tonsillectomy and adenoidectomy. The parent reports the
child's throat pain is increasing and the child is refusing to drink. Which assessment finding is most
indicative of a potential postoperative hemorrhage?
A. A low-grade fever of 100.4°F (38°C)
B. Frequent swallowing and clearing of the throat
C. A hoarse voice and mild ear pain
D. Complaints of a stiff neck and nausea
Correct Answer: B. Frequent swallowing and clearing of the throat
Rationale: Frequent swallowing and throat clearing in a post-tonsillectomy patient can indicate
bleeding that is trickling down the back of the throat. A low-grade fever, hoarseness, and ear pain are
common and expected postoperative findings. A stiff neck is not a typical sign of hemorrhage.
9. A 9-month-old infant is hospitalized for failure to thrive. The nurse observes that the infant is
listless, avoids eye contact, and remains stiff when held. This behavior is most consistent with
which type of failure to thrive?
A. Organic failure to thrive
B. Psychosocial failure to thrive
C. Idiopathic failure to thrive
D. Gastroesophageal reflux-related failure to thrive
Correct Answer: B. Psychosocial failure to thrive
Rationale: Psychosocial failure to thrive is often characterized by infant behaviors like listlessness,
avoidance of eye contact, and a lack of responsiveness to being held (such as stiffening), which are
signs of poor caregiver-infant interaction. Organic failure to thrive stems from a medical condition
and may not present with these specific behavioral cues.
10. A nurse is providing education to the parents of a 6-month-old infant on preventing sudden
infant death syndrome (SIDS). Which of the following statements by a parent indicates a need for
further teaching?
A. "I will always place my baby on the back to sleep."
B. "I will make sure to remove all soft blankets and toys from the crib."
C. "I will let my baby sleep in our bed with us for easier feeding."
D. "I will offer a pacifier at nap time and bedtime."
Correct Answer: C. "I will let my baby sleep in our bed with us for easier feeding."
Rationale: The American Academy of Pediatrics recommends room-sharing without bed-sharing to
reduce the risk of SIDS. Bed-sharing is associated with an increased risk of SIDS and accidental
suffocation. The other statements reflect safe sleep practices: placing the infant on the back, a firm
sleep surface free of soft objects, and pacifier use.
11. An 8-year-old child is brought to the clinic with complaints of a headache, vomiting, and
photophobia. The child's temperature is 102.2°F (39°C). A stiff neck is noted on physical
examination. Which priority intervention should the nurse prepare to implement?
A. Administer an oral antiemetic and antipyretic
B. Administer a dose of acetaminophen and discharge home with rest
C. Prepare the child for a lumbar puncture
D. Place the child in a dark room with cold compresses
Correct Answer: C. Prepare the child for a lumbar puncture
Rationale: This child's symptoms of headache, vomiting, photophobia, fever, and nuchal rigidity are
, classic signs of meningitis. A lumbar puncture to obtain cerebrospinal fluid for analysis is the priority
diagnostic procedure to confirm the diagnosis. While comfort measures are important, they are
secondary to the diagnostic workup and initiation of appropriate antibiotics.
12. A nurse is teaching the parents of a 2-year-old child with iron deficiency anemia about dietary
management. Which food choices are most appropriate to recommend to enhance iron
absorption?
A. Milk and cheese with iron-fortified cereal
B. Iron-fortified cereal with a glass of orange juice
C. Spinach and broccoli with a glass of milk
D. Red meat with a glass of whole milk
Correct Answer: B. Iron-fortified cereal with a glass of orange juice
Rationale: Vitamin C (ascorbic acid) significantly enhances the absorption of non-heme iron found in
plant sources and fortified cereals. Orange juice is an excellent source of vitamin C. Dairy products like
milk and cheese, which are high in calcium, can inhibit iron absorption.
13. A 4-month-old infant is scheduled for a well-child visit. The nurse is preparing to administer
immunizations. Which immunizations are recommended for this age according to the standard
childhood immunization schedule?
A. DTaP, IPV, Hib, PCV13, and RV
B. DTaP, MMR, IPV, and Varicella
C. DTaP, Hib, MMR, and PCV13
D. DTaP, IPV, Hepatitis B, and MMR
Correct Answer: A. DTaP, IPV, Hib, PCV13, and RV
Rationale: At the 4-month visit, the recommended immunizations include the second dose of DTaP
(diphtheria, tetanus, acellular pertussis), IPV (inactivated poliovirus), Hib (Haemophilus influenzae
type b), PCV13 (pneumococcal conjugate), and RV (rotavirus). MMR (measles, mumps, rubella) and
Varicella are typically not given until the first dose at 12-15 months. Hepatitis B is given at birth, 1-2
months, and 6-18 months.
14. A 10-year-old child has been diagnosed with acute glomerulonephritis. Which assessment
finding should the nurse expect?
A. Periorbital edema and tea-colored urine
B. Polyuria and polydipsia
C. Severe flank pain and hematuria
D. Hypotension and tachycardia
Correct Answer: A. Periorbital edema and tea-colored urine
Rationale: Acute glomerulonephritis often presents with periorbital edema (due to fluid retention)
and tea-colored or cola-colored urine (due to the presence of red blood cell casts and hemoglobin).
Polyuria and polydipsia are characteristic of diabetes insipidus or mellitus. Flank pain is more
common with pyelonephritis or stones. Hypertension, not hypotension, is a common finding due to
fluid overload.
15. A nurse is caring for a 6-year-old child with a ventriculoperitoneal (VP) shunt for
hydrocephalus. Which assessment finding would be the earliest indicator of a shunt malfunction?
A. A bulging fontanel
B. Sunsetting eyes
C. Irritability and lethargy
D. Vomiting and a severe headache
Correct Answer: C. Irritability and lethargy
