Pediatric HESI Practice Questions
A 2-year-old child with trisomy 21 (Down syndrome) is brought to the clinic for a routine
evaluation. Which assessment finding suggests the presence of a common complication often
experienced by those with Down syndrome?
A.Presence of a systolic murmur
B.New onset of patchy alopecia
C.Complaints of long bone pain
D.Recent projectile vomiting - ANS - ANS: A
Congenital heart disease occurs in 40% to 50% of children with trisomy 21 (Down syndrome).
Defects of the atrial or ventricular septum that create systolic murmurs (A) are the most common
heart defects associated with this congenital anomaly. (B, C, and D) are not recognized as
common complications of trisomy 21.
A 3-month-old infant returns from surgery with elbow restraints and a Logan's bow over a cleft
lip suture line. Which intervention should the nurse implement to maintain suture line integrity
during the initial postoperative period?
A.Place the infant upright in an infant seat position.
B.Provide mittens with the use of elbow restraints.
C.Use soft rubber catheters for nasal suctioning.
D.Apply water-soluble lubricant to the suture line. - ANS - ANS: A
The use of an infant seat simulates a supine position with the head elevated (A) and also
prevents aspiration. Prone positioning should be avoided to prevent disruption of the protective
Logan's bow and prevent the infant from rubbing the face on the bed surface. Mittens (B) are
not necessary and decrease the ability to provide sensory comfort, such as hand holding. Nasal
suctioning (C) should be avoided to prevent trauma or dislodging clots at the surgical site.
Water-soluble lubricant (D) will dry the suture line and cause crusting, which predisposes the
suture line to poor healing and scarring.
A 3-month-old infant weighing 10 lb 15 oz has an axillary temperature of 98.9° F. What caloric
amount does this child need?
,A.400 calories/day
B.500 calories/day
C.600 calories/day
D.700 calories/day - ANS - ANS: C
An infant requires 108 calories/kg/day. The first step is to change 10 lb 15 oz to 10.9 lb. Then
convert pounds to kilograms by dividing pounds by 2.2, which is 10.9/2.2 = 4.954 kg, rounded to
5 kg. The second step is to multiply 108 calories/kg/day (108 × 5 = 540 calories/day). However,
this infant requires 10% more calories because of the 1° F temperature elevation. Ten percent of
540 (calories/day) is 54 and 540 + 54 = 594. This infant will require approximately 600
calories/day (C). (A, B, and D) are incorrect.
A 3-week-old infant is referred to an orthopedic clinic because the pediatrician heard a click
when flexing the child's right hip during a routine physical examination. The orthopedic physician
suspects that the child might have developmental dysplasia of the hip (DDH). The parents ask
the nurse to identify risk factors commonly associated with DDH. Which response is accurate?
A.Vertex delivery
B.Male gender
C.Breech presentation
D.Second-born child - ANS - ANS: C
infants who present in the breech position (C), not the vertex (head-first) position (A). Twice as
many females as males present in breech position; thus, 80% of children with DDH are females,
not males (B). Of breech presentations, 60% occur with first-born children, not subsequent
siblings (D), possibly because of the unstretched uterus and compaction of the surrounding
abdominal contents, which tend to increase compression on the uterus in the nulliparous
woman.
A 4-year-old child has cystic fibrosis. Which stage of Erikson's theory of psychosocial
development is the nurse addressing when teaching inhalation therapy?
A.Autonomy
B.Industry
C.Trust
, D.Initiative - ANS - ANS: D
Children 4 to 5 years of age are in the "Initiative vs. Guilt" stage of Erikson's theory of
psychosocial development (D). They enjoy being active and participating in role playing.
"Autonomy vs. Shame and Doubt" occurs at 1 to 3 years of age (A). "Industry vs. Inferiority"
occurs at 6 to 11 years (B); "Trust vs. Mistrust" (C) occurs from birth to 1 year of age.
A 6-month-old male infant is admitted to the postanesthesia care unit with elbow restraints in
place. He has an endotracheal tube and is ventilator-dependent but will be extubated soon
following recovery from anesthesia. Which nursing intervention should be included in this child's
plan of care?
A.Keep restraints on at all times to prevent unplanned extubation.
B.Remove restraints one at a time and provide range-of-motion exercises.
C.Remove all restraints simultaneously and provide play activities.
D.Document the reason for application of the restraints every 72 hours. - ANS - ANS: B
Removing restraints one at a time (B) is safer than (C). The infant should have the restrained
extremities assessed frequently for signs of neurologic or vascular impairment, and
range-of-motion exercises should be performed with these assessments. Under no
circumstances should restraints be applied to the client continuously (A). Documentation of
assessment findings regarding the restrained extremities must occur much more frequently than
every 72 hours (D); however, the reason for using restraints must be justified and should be
stated in the medical record.
A 7-month-old infant with a rotavirus causing severe diarrhea is admitted for treatment. Which
intervention should the nurse implement first?
A.Obtain a scale to weigh the infant's diapers.
B.Instruct the mother to offer Pedialyte regularly.
C.Insert an intravenous (IV) line and begin IV fluids.
D.Obtain a stool specimen for analysis. - ANS - ANS: C
An infant with severe diarrhea is at high risk for dehydration, so the nurse's priority is to initiate
IV fluids (C) to rehydrate the infant. (A, B, and D) can then be implemented as needed.
A 7-month-old male infant diagnosed with spastic cerebral palsy is seen by the nurse in the
clinic. Which statement by the parent warrants immediate intervention by the nurse?
A 2-year-old child with trisomy 21 (Down syndrome) is brought to the clinic for a routine
evaluation. Which assessment finding suggests the presence of a common complication often
experienced by those with Down syndrome?
A.Presence of a systolic murmur
B.New onset of patchy alopecia
C.Complaints of long bone pain
D.Recent projectile vomiting - ANS - ANS: A
Congenital heart disease occurs in 40% to 50% of children with trisomy 21 (Down syndrome).
Defects of the atrial or ventricular septum that create systolic murmurs (A) are the most common
heart defects associated with this congenital anomaly. (B, C, and D) are not recognized as
common complications of trisomy 21.
A 3-month-old infant returns from surgery with elbow restraints and a Logan's bow over a cleft
lip suture line. Which intervention should the nurse implement to maintain suture line integrity
during the initial postoperative period?
A.Place the infant upright in an infant seat position.
B.Provide mittens with the use of elbow restraints.
C.Use soft rubber catheters for nasal suctioning.
D.Apply water-soluble lubricant to the suture line. - ANS - ANS: A
The use of an infant seat simulates a supine position with the head elevated (A) and also
prevents aspiration. Prone positioning should be avoided to prevent disruption of the protective
Logan's bow and prevent the infant from rubbing the face on the bed surface. Mittens (B) are
not necessary and decrease the ability to provide sensory comfort, such as hand holding. Nasal
suctioning (C) should be avoided to prevent trauma or dislodging clots at the surgical site.
Water-soluble lubricant (D) will dry the suture line and cause crusting, which predisposes the
suture line to poor healing and scarring.
A 3-month-old infant weighing 10 lb 15 oz has an axillary temperature of 98.9° F. What caloric
amount does this child need?
,A.400 calories/day
B.500 calories/day
C.600 calories/day
D.700 calories/day - ANS - ANS: C
An infant requires 108 calories/kg/day. The first step is to change 10 lb 15 oz to 10.9 lb. Then
convert pounds to kilograms by dividing pounds by 2.2, which is 10.9/2.2 = 4.954 kg, rounded to
5 kg. The second step is to multiply 108 calories/kg/day (108 × 5 = 540 calories/day). However,
this infant requires 10% more calories because of the 1° F temperature elevation. Ten percent of
540 (calories/day) is 54 and 540 + 54 = 594. This infant will require approximately 600
calories/day (C). (A, B, and D) are incorrect.
A 3-week-old infant is referred to an orthopedic clinic because the pediatrician heard a click
when flexing the child's right hip during a routine physical examination. The orthopedic physician
suspects that the child might have developmental dysplasia of the hip (DDH). The parents ask
the nurse to identify risk factors commonly associated with DDH. Which response is accurate?
A.Vertex delivery
B.Male gender
C.Breech presentation
D.Second-born child - ANS - ANS: C
infants who present in the breech position (C), not the vertex (head-first) position (A). Twice as
many females as males present in breech position; thus, 80% of children with DDH are females,
not males (B). Of breech presentations, 60% occur with first-born children, not subsequent
siblings (D), possibly because of the unstretched uterus and compaction of the surrounding
abdominal contents, which tend to increase compression on the uterus in the nulliparous
woman.
A 4-year-old child has cystic fibrosis. Which stage of Erikson's theory of psychosocial
development is the nurse addressing when teaching inhalation therapy?
A.Autonomy
B.Industry
C.Trust
, D.Initiative - ANS - ANS: D
Children 4 to 5 years of age are in the "Initiative vs. Guilt" stage of Erikson's theory of
psychosocial development (D). They enjoy being active and participating in role playing.
"Autonomy vs. Shame and Doubt" occurs at 1 to 3 years of age (A). "Industry vs. Inferiority"
occurs at 6 to 11 years (B); "Trust vs. Mistrust" (C) occurs from birth to 1 year of age.
A 6-month-old male infant is admitted to the postanesthesia care unit with elbow restraints in
place. He has an endotracheal tube and is ventilator-dependent but will be extubated soon
following recovery from anesthesia. Which nursing intervention should be included in this child's
plan of care?
A.Keep restraints on at all times to prevent unplanned extubation.
B.Remove restraints one at a time and provide range-of-motion exercises.
C.Remove all restraints simultaneously and provide play activities.
D.Document the reason for application of the restraints every 72 hours. - ANS - ANS: B
Removing restraints one at a time (B) is safer than (C). The infant should have the restrained
extremities assessed frequently for signs of neurologic or vascular impairment, and
range-of-motion exercises should be performed with these assessments. Under no
circumstances should restraints be applied to the client continuously (A). Documentation of
assessment findings regarding the restrained extremities must occur much more frequently than
every 72 hours (D); however, the reason for using restraints must be justified and should be
stated in the medical record.
A 7-month-old infant with a rotavirus causing severe diarrhea is admitted for treatment. Which
intervention should the nurse implement first?
A.Obtain a scale to weigh the infant's diapers.
B.Instruct the mother to offer Pedialyte regularly.
C.Insert an intravenous (IV) line and begin IV fluids.
D.Obtain a stool specimen for analysis. - ANS - ANS: C
An infant with severe diarrhea is at high risk for dehydration, so the nurse's priority is to initiate
IV fluids (C) to rehydrate the infant. (A, B, and D) can then be implemented as needed.
A 7-month-old male infant diagnosed with spastic cerebral palsy is seen by the nurse in the
clinic. Which statement by the parent warrants immediate intervention by the nurse?
