HESI Pediatrics Exam 2026/2027 | Pediatric
Nursing Practice Questions & Verified Answers
| Comprehensive Review
Original Practice Question Bank - Complete Set (150 Questions)
Key: green = correct answer yellow = rationale blue = clinical pearl
Question #1
A nurse in the emergency department assesses a 3-year-old who is sitting upright, leaning forward with the
chin thrust out, drooling, and speaking in a muffled voice. Temperature is 103.2 F (39.6 C) and respirations
are 38/min. Which action should the nurse take first?
A. Examine the child's throat with a tongue depressor to look for swelling.
B. Collect a throat culture to identify the causative organism.
C. Keep the child calm in a position of comfort and notify the provider while preparing airway equipment.
D. Lay the child supine to obtain an accurate set of vital signs.
Correct Answer: C. Keep the child calm in a position of comfort and notify the provider while preparing
airway equipment.
Rationale: Drooling, muffled voice, high fever, and a tripod posture indicate epiglottitis, a bacterial infection
that can swell the epiglottis and obstruct the airway suddenly. Anything that agitates the child or stimulates
the throat can trigger complete obstruction, so the priority is airway protection: keep the child calm in the
position the child chose, get immediate help, and have intubation or tracheostomy equipment ready.
Diagnostic tests and throat inspection wait until the airway is secured, usually in a controlled setting such as
the operating room. Remember: with suspected epiglottitis, never inspect the throat and never upset the
child.
Why each distractor is incorrect:
A. Throat inspection can cause laryngospasm and total obstruction.
B. Swabbing the throat stimulates the same risk and does not help the airway.
C. Correct.
D. Lying flat can allow the swollen epiglottis to fall back and block the airway; upright positioning keeps the
airway open.
Clinical Pearl: Drooling + tripod position + toxic appearance = airway emergency; do not touch the throat.
Learning Objective: Prioritize care for suspected epiglottitis | Difficulty: Moderate | Cognitive Level: Clinical Judgment |
Type: Priority
HESI Pediatrics Practice Question Bank - Page 1
,Question #2
A nurse is caring for a 2-year-old admitted with croup. Which findings indicate worsening respiratory distress
and require immediate provider notification? Select all that apply.
A. Stridor present at rest
B. Barking, seal-like cough
C. Increasing restlessness and agitation
D. Suprasternal and substernal retractions
E. Hoarse voice
F. Oxygen saturation falling from 96% to 90%
Correct Answer: A, C, D, F
Rationale: Croup narrows the subglottic airway, so stridor, cough, and hoarseness are expected. Worsening
obstruction shows up as stridor at rest, retractions, anxiety or restlessness (an early sign of hypoxia), and
falling oxygen saturation. These signal that the child is working harder to move air and may be heading
toward respiratory failure. Remember to separate expected disease features from signs of increasing work of
breathing and hypoxia.
Why each distractor is incorrect:
A. Correct: stridor at rest signals significant airway narrowing.
B. Incorrect: the barking cough is a hallmark of croup, not a sign of deterioration.
C. Correct: restlessness is an early hypoxia sign in children.
D. Correct: retractions show increased respiratory effort.
E. Incorrect: hoarseness is expected from laryngeal inflammation.
F. Correct: a falling SpO2 shows worsening gas exchange.
Clinical Pearl: In children, restlessness and agitation come before lethargy as signs of hypoxia; lethargy is
late and ominous.
Learning Objective: Differentiate expected from worsening croup findings | Difficulty: Moderate | Cognitive Level: Analysis
| Type: Select-All-That-Apply
Question #3
A nurse assesses a 4-month-old with RSV bronchiolitis. Which finding requires immediate intervention?
A. Clear nasal drainage and congestion
B. Respiratory rate of 48/min while sleeping
C. Grunting respirations with oxygen saturation of 87% on room air
D. Temperature of 100.4 F (38 C)
Correct Answer: C. Grunting respirations with oxygen saturation of 87% on room air
Rationale: Grunting is the infant's attempt to create positive end-expiratory pressure and keep alveoli open,
signaling significant respiratory distress. Combined with hypoxemia (SpO2 87%), it requires prompt
intervention such as supplemental oxygen, suctioning, and notifying the provider. Nasal congestion, a
sleeping respiratory rate of 48 (the normal infant range is roughly 30 to 60), and a low-grade fever are all
expected with bronchiolitis. Remember to look for the combination of increased work of breathing and
hypoxemia.
HESI Pediatrics Practice Question Bank - Page 2
,Why each distractor is incorrect:
A. Expected with viral upper airway involvement.
B. Within the normal range for a sleeping infant.
C. Correct.
D. Low-grade fever is common in RSV and not an emergency.
Clinical Pearl: Grunting, nasal flaring, and retractions in an infant mean impending fatigue; act before the
child tires.
Learning Objective: Identify respiratory distress in an infant with bronchiolitis | Difficulty: Moderate | Cognitive Level:
Clinical Judgment | Type: Priority
Question #4
A 9-year-old with asthma reports chest tightness. The child's personal best peak expiratory flow rate is 300
L/min, and the current reading is 135 L/min. Which action should the nurse take?
A. Encourage normal activity and recheck the peak flow tomorrow.
B. Give the quick-relief inhaler and arrange immediate medical evaluation.
C. Give the daily controller medication and let the child rest for an hour.
D. Instruct the child to use the inhaler only if wheezing begins.
Correct Answer: B. Give the quick-relief inhaler and arrange immediate medical evaluation.
Rationale: 135 divided by 300 equals 45% of personal best, which is in the red zone (below 50%). The red
zone indicates a severe airway narrowing that needs immediate rescue medication (a short-acting
beta-agonist such as albuterol) and urgent medical care. Controller medications do not act quickly enough for
an acute episode. Remember: calculate peak flow as a percentage of the personal best: green is 80-100%,
yellow 50-79%, red below 50%.
Why each distractor is incorrect:
A. This approach fits the green zone and would delay treatment.
B. Correct.
C. Controllers are for long-term inflammation control, not rescue, and waiting is unsafe.
D. Waiting for wheezing delays treatment; the reading already shows severe obstruction.
Clinical Pearl: Percent of personal best, not the raw number, determines the asthma zone.
Learning Objective: Interpret peak flow zones and act on an asthma action plan | Difficulty: Moderate | Cognitive Level:
Application | Type: Calculation / Application
Question #5
A nurse teaches the parents of a 5-year-old with cystic fibrosis about pancreatic enzyme replacement. Which
parent statement indicates understanding?
A. "I will give the enzymes once each morning."
B. "I will crush the beads and mix them with milk."
C. "I will give the enzymes at bedtime after the last snack."
D. "I will give the enzymes with every meal and snack and not crush the beads."
HESI Pediatrics Practice Question Bank - Page 3
, Correct Answer: D. "I will give the enzymes with every meal and snack and not crush the beads."
Rationale: In cystic fibrosis, thick secretions block pancreatic ducts, so fat and protein are poorly digested.
Enzymes must be present in the gut with food, so they are given with every meal and snack, with the dose
matched to the amount of fat. Beads are enteric coated and must be swallowed whole or sprinkled (not
crushed) on a small amount of acidic soft food such as applesauce so that they are protected until they reach
the small intestine. Remember to time enzymes with food.
Why each distractor is incorrect:
A. A single daily dose would not cover meals and snacks.
B. Crushing destroys the coating, causes mouth irritation, and reduces effectiveness.
C. Enzymes given after eating are not available to digest the food.
D. Correct.
Clinical Pearl: Greasy, foul-smelling stools and poor weight gain suggest inadequate enzyme dosing.
Learning Objective: Teach pancreatic enzyme administration in cystic fibrosis | Difficulty: Easy | Cognitive Level:
Application | Type: Patient Teaching
Question #6
A 5-week-old has projectile, nonbilious vomiting after every feeding. Arterial blood gas results are: pH 7.50,
PaCO2 46 mm Hg, HCO3 34 mEq/L. Which acid-base imbalance should the nurse identify?
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
Correct Answer: A. Metabolic alkalosis
Rationale: The pH is high (alkalosis), and bicarbonate is high, so the primary problem is metabolic. The
mildly elevated PaCO2 is the body's attempt to compensate by retaining carbon dioxide. In pyloric stenosis,
repeated vomiting causes loss of hydrochloric acid and results in hypochloremic metabolic alkalosis with
dehydration and often hypokalemia. Remember: pH tells direction, then match it to the component (HCO3 or
PaCO2) that moves the same way.
Why each distractor is incorrect:
A. Correct.
B. Acidosis would show a low pH with low bicarbonate.
C. Respiratory alkalosis would show a low PaCO2.
D. Respiratory acidosis would show a low pH with high PaCO2.
Clinical Pearl: Pyloric stenosis: projectile nonbilious vomiting, olive-shaped mass, hypochloremic metabolic
alkalosis.
Learning Objective: Interpret ABG results in pyloric stenosis | Difficulty: Moderate | Cognitive Level: Analysis | Type:
Interpretation of Data
HESI Pediatrics Practice Question Bank - Page 4
Nursing Practice Questions & Verified Answers
| Comprehensive Review
Original Practice Question Bank - Complete Set (150 Questions)
Key: green = correct answer yellow = rationale blue = clinical pearl
Question #1
A nurse in the emergency department assesses a 3-year-old who is sitting upright, leaning forward with the
chin thrust out, drooling, and speaking in a muffled voice. Temperature is 103.2 F (39.6 C) and respirations
are 38/min. Which action should the nurse take first?
A. Examine the child's throat with a tongue depressor to look for swelling.
B. Collect a throat culture to identify the causative organism.
C. Keep the child calm in a position of comfort and notify the provider while preparing airway equipment.
D. Lay the child supine to obtain an accurate set of vital signs.
Correct Answer: C. Keep the child calm in a position of comfort and notify the provider while preparing
airway equipment.
Rationale: Drooling, muffled voice, high fever, and a tripod posture indicate epiglottitis, a bacterial infection
that can swell the epiglottis and obstruct the airway suddenly. Anything that agitates the child or stimulates
the throat can trigger complete obstruction, so the priority is airway protection: keep the child calm in the
position the child chose, get immediate help, and have intubation or tracheostomy equipment ready.
Diagnostic tests and throat inspection wait until the airway is secured, usually in a controlled setting such as
the operating room. Remember: with suspected epiglottitis, never inspect the throat and never upset the
child.
Why each distractor is incorrect:
A. Throat inspection can cause laryngospasm and total obstruction.
B. Swabbing the throat stimulates the same risk and does not help the airway.
C. Correct.
D. Lying flat can allow the swollen epiglottis to fall back and block the airway; upright positioning keeps the
airway open.
Clinical Pearl: Drooling + tripod position + toxic appearance = airway emergency; do not touch the throat.
Learning Objective: Prioritize care for suspected epiglottitis | Difficulty: Moderate | Cognitive Level: Clinical Judgment |
Type: Priority
HESI Pediatrics Practice Question Bank - Page 1
,Question #2
A nurse is caring for a 2-year-old admitted with croup. Which findings indicate worsening respiratory distress
and require immediate provider notification? Select all that apply.
A. Stridor present at rest
B. Barking, seal-like cough
C. Increasing restlessness and agitation
D. Suprasternal and substernal retractions
E. Hoarse voice
F. Oxygen saturation falling from 96% to 90%
Correct Answer: A, C, D, F
Rationale: Croup narrows the subglottic airway, so stridor, cough, and hoarseness are expected. Worsening
obstruction shows up as stridor at rest, retractions, anxiety or restlessness (an early sign of hypoxia), and
falling oxygen saturation. These signal that the child is working harder to move air and may be heading
toward respiratory failure. Remember to separate expected disease features from signs of increasing work of
breathing and hypoxia.
Why each distractor is incorrect:
A. Correct: stridor at rest signals significant airway narrowing.
B. Incorrect: the barking cough is a hallmark of croup, not a sign of deterioration.
C. Correct: restlessness is an early hypoxia sign in children.
D. Correct: retractions show increased respiratory effort.
E. Incorrect: hoarseness is expected from laryngeal inflammation.
F. Correct: a falling SpO2 shows worsening gas exchange.
Clinical Pearl: In children, restlessness and agitation come before lethargy as signs of hypoxia; lethargy is
late and ominous.
Learning Objective: Differentiate expected from worsening croup findings | Difficulty: Moderate | Cognitive Level: Analysis
| Type: Select-All-That-Apply
Question #3
A nurse assesses a 4-month-old with RSV bronchiolitis. Which finding requires immediate intervention?
A. Clear nasal drainage and congestion
B. Respiratory rate of 48/min while sleeping
C. Grunting respirations with oxygen saturation of 87% on room air
D. Temperature of 100.4 F (38 C)
Correct Answer: C. Grunting respirations with oxygen saturation of 87% on room air
Rationale: Grunting is the infant's attempt to create positive end-expiratory pressure and keep alveoli open,
signaling significant respiratory distress. Combined with hypoxemia (SpO2 87%), it requires prompt
intervention such as supplemental oxygen, suctioning, and notifying the provider. Nasal congestion, a
sleeping respiratory rate of 48 (the normal infant range is roughly 30 to 60), and a low-grade fever are all
expected with bronchiolitis. Remember to look for the combination of increased work of breathing and
hypoxemia.
HESI Pediatrics Practice Question Bank - Page 2
,Why each distractor is incorrect:
A. Expected with viral upper airway involvement.
B. Within the normal range for a sleeping infant.
C. Correct.
D. Low-grade fever is common in RSV and not an emergency.
Clinical Pearl: Grunting, nasal flaring, and retractions in an infant mean impending fatigue; act before the
child tires.
Learning Objective: Identify respiratory distress in an infant with bronchiolitis | Difficulty: Moderate | Cognitive Level:
Clinical Judgment | Type: Priority
Question #4
A 9-year-old with asthma reports chest tightness. The child's personal best peak expiratory flow rate is 300
L/min, and the current reading is 135 L/min. Which action should the nurse take?
A. Encourage normal activity and recheck the peak flow tomorrow.
B. Give the quick-relief inhaler and arrange immediate medical evaluation.
C. Give the daily controller medication and let the child rest for an hour.
D. Instruct the child to use the inhaler only if wheezing begins.
Correct Answer: B. Give the quick-relief inhaler and arrange immediate medical evaluation.
Rationale: 135 divided by 300 equals 45% of personal best, which is in the red zone (below 50%). The red
zone indicates a severe airway narrowing that needs immediate rescue medication (a short-acting
beta-agonist such as albuterol) and urgent medical care. Controller medications do not act quickly enough for
an acute episode. Remember: calculate peak flow as a percentage of the personal best: green is 80-100%,
yellow 50-79%, red below 50%.
Why each distractor is incorrect:
A. This approach fits the green zone and would delay treatment.
B. Correct.
C. Controllers are for long-term inflammation control, not rescue, and waiting is unsafe.
D. Waiting for wheezing delays treatment; the reading already shows severe obstruction.
Clinical Pearl: Percent of personal best, not the raw number, determines the asthma zone.
Learning Objective: Interpret peak flow zones and act on an asthma action plan | Difficulty: Moderate | Cognitive Level:
Application | Type: Calculation / Application
Question #5
A nurse teaches the parents of a 5-year-old with cystic fibrosis about pancreatic enzyme replacement. Which
parent statement indicates understanding?
A. "I will give the enzymes once each morning."
B. "I will crush the beads and mix them with milk."
C. "I will give the enzymes at bedtime after the last snack."
D. "I will give the enzymes with every meal and snack and not crush the beads."
HESI Pediatrics Practice Question Bank - Page 3
, Correct Answer: D. "I will give the enzymes with every meal and snack and not crush the beads."
Rationale: In cystic fibrosis, thick secretions block pancreatic ducts, so fat and protein are poorly digested.
Enzymes must be present in the gut with food, so they are given with every meal and snack, with the dose
matched to the amount of fat. Beads are enteric coated and must be swallowed whole or sprinkled (not
crushed) on a small amount of acidic soft food such as applesauce so that they are protected until they reach
the small intestine. Remember to time enzymes with food.
Why each distractor is incorrect:
A. A single daily dose would not cover meals and snacks.
B. Crushing destroys the coating, causes mouth irritation, and reduces effectiveness.
C. Enzymes given after eating are not available to digest the food.
D. Correct.
Clinical Pearl: Greasy, foul-smelling stools and poor weight gain suggest inadequate enzyme dosing.
Learning Objective: Teach pancreatic enzyme administration in cystic fibrosis | Difficulty: Easy | Cognitive Level:
Application | Type: Patient Teaching
Question #6
A 5-week-old has projectile, nonbilious vomiting after every feeding. Arterial blood gas results are: pH 7.50,
PaCO2 46 mm Hg, HCO3 34 mEq/L. Which acid-base imbalance should the nurse identify?
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
Correct Answer: A. Metabolic alkalosis
Rationale: The pH is high (alkalosis), and bicarbonate is high, so the primary problem is metabolic. The
mildly elevated PaCO2 is the body's attempt to compensate by retaining carbon dioxide. In pyloric stenosis,
repeated vomiting causes loss of hydrochloric acid and results in hypochloremic metabolic alkalosis with
dehydration and often hypokalemia. Remember: pH tells direction, then match it to the component (HCO3 or
PaCO2) that moves the same way.
Why each distractor is incorrect:
A. Correct.
B. Acidosis would show a low pH with low bicarbonate.
C. Respiratory alkalosis would show a low PaCO2.
D. Respiratory acidosis would show a low pH with high PaCO2.
Clinical Pearl: Pyloric stenosis: projectile nonbilious vomiting, olive-shaped mass, hypochloremic metabolic
alkalosis.
Learning Objective: Interpret ABG results in pyloric stenosis | Difficulty: Moderate | Cognitive Level: Analysis | Type:
Interpretation of Data
HESI Pediatrics Practice Question Bank - Page 4
