2024 HESI Pediatric RN Exit Exam
Questions
Instructions
This document contains 80 pediatric-focused questions designed for the 2024
HESI RN Exit Exam. Each question includes four answer choices, with one cor-
rect answer and a detailed rationale. Topics include growth milestones, com-
mon pediatric disorders, pharmacology, and health promotion. All questions
are aligned with current nursing standards and NCLEX-RN test blueprints. Use
this resource to prepare for the HESI Pediatric RN Exit Exam.
Questions
1. The nurse is assessing a 2-year-old child during a well-child visit. Which
developmental milestone is expected for this age?
A. Sits unsupported
B. Ties shoelaces independently
C. Speaks in 2- to 3-word sentences
D. Throws a ball overhand
Correct Answer: C. Speaks in 2- to 3-word sentences
Rationale: By 2 years of age, children typically begin speaking in 2- to
3-word sentences, reflecting early language development. Sitting unsup-
ported is achieved by 8 months, throwing a ball overhand by 18 months,
and tying shoelaces by 5 years.
2. A 3-year-old child is admitted post-motor vehicle accident and has a spica
cast applied. Which toy is most appropriate for this child?
A. A squeaky rubber duck
B. A fashion doll with clothes
C. A set of cloth hand puppets
D. A handheld video game
1
, Correct Answer: C. A set of cloth hand puppets
Rationale: Cloth hand puppets are ideal for a 3-year-old in a spica cast,
as they encourage imaginative play without requiring mobility. A squeaky
duck is more suitable for younger children, a fashion doll may require fine
motor skills, and a video game is not age-appropriate for prolonged use.
3. An infant with tetralogy of Fallot becomes acutely cyanotic and hyperpneic.
What is the nurse’s priority action?
A. Administer morphine sulfate
B. Start IV fluids
C. Place the infant in a knee-chest position
D. Provide 100% oxygen by face mask
Correct Answer: C. Place the infant in a knee-chest position
Rationale: The knee-chest position increases systemic vascular resistance,
reducing right-to-left shunting in tetralogy of Fallot, improving oxygena-
tion during a hypercyanotic spell. Oxygen, morphine, or IV fluids may fol-
low but are not the priority.
4. A child with diabetic ketoacidosis (DKA) exhibits Kussmaul respirations.
What is the underlying cause?
A. Hypoxemia
B. Respiratory alkalosis
C. Metabolic acidosis
D. Hypercapnia
Correct Answer: C. Metabolic acidosis
Rationale: Kussmaul respirations are rapid, deep breaths that occur as a
compensatory mechanism for metabolic acidosis in DKA, as the body at-
tempts to eliminate excess carbon dioxide to raise blood pH.
5. A 7-year-old with persistent vomiting has a nasogastric tube on low inter-
mittent suction. Which finding should the nurse report immediately?
A. Gastric output of 100 mL in 8 hours
B. Intake of 640 mL IV fluids plus 30 mL PO ice chips
C. Serum potassium of 3.0 mEq/L
D. Serum pH of 7.45
Correct Answer: C. Serum potassium of 3.0 mEq/L
Rationale: A serum potassium of 3.0 mEq/L indicates hypokalemia, a criti-
cal finding in a child with vomiting, as it can lead to arrhythmias. The other
findings are within normal limits or less urgent.
6. A child with celiac disease is evaluated for dietary teaching. Which food
choice indicates effective teaching?
2
, A. Creamed corn
B. Pancakes
C. Rye crackers
D. Cooked oatmeal
Correct Answer: A. Creamed corn
Rationale: Creamed corn is gluten-free and safe for celiac disease. Pan-
cakes, rye crackers, and oatmeal may contain gluten, which is harmful to
children with celiac disease.
7. During a well-baby check, a 9-month-old looks for a block hidden under a
blanket. Which milestone is this infant developing?
A. Object permanence
B. Stranger anxiety
C. Social smiling
D. Separation anxiety
Correct Answer: A. Object permanence
Rationale: Looking for a hidden object demonstrates object permanence,
a cognitive milestone typically achieved by 9–12 months, indicating the in-
fant understands that objects exist even when out of sight.
8. A nurse is caring for a 3-year-old 2 hours post-cardiac catheterization via
the right femoral artery. Which finding indicates arterial obstruction?
A. Blood pressure trending downward
B. Right foot cool and pale
C. Weaker pulse in the left foot
D. Oozing at the dressing site
Correct Answer: B. Right foot cool and pale
Rationale: A cool, pale right foot indicates arterial obstruction, likely from
clot formation post-catheterization. The other findings are concerning but
less specific to arterial obstruction.
9. A nurse is preparing to administer a medication to a 4-year-old child. The
prescription is for 5 mg/kg, and the child weighs 20 kg. How many mil-
ligrams should the nurse administer?
A. 50 mg
B. 75 mg
C. 100 mg
D. 125 mg
3
Questions
Instructions
This document contains 80 pediatric-focused questions designed for the 2024
HESI RN Exit Exam. Each question includes four answer choices, with one cor-
rect answer and a detailed rationale. Topics include growth milestones, com-
mon pediatric disorders, pharmacology, and health promotion. All questions
are aligned with current nursing standards and NCLEX-RN test blueprints. Use
this resource to prepare for the HESI Pediatric RN Exit Exam.
Questions
1. The nurse is assessing a 2-year-old child during a well-child visit. Which
developmental milestone is expected for this age?
A. Sits unsupported
B. Ties shoelaces independently
C. Speaks in 2- to 3-word sentences
D. Throws a ball overhand
Correct Answer: C. Speaks in 2- to 3-word sentences
Rationale: By 2 years of age, children typically begin speaking in 2- to
3-word sentences, reflecting early language development. Sitting unsup-
ported is achieved by 8 months, throwing a ball overhand by 18 months,
and tying shoelaces by 5 years.
2. A 3-year-old child is admitted post-motor vehicle accident and has a spica
cast applied. Which toy is most appropriate for this child?
A. A squeaky rubber duck
B. A fashion doll with clothes
C. A set of cloth hand puppets
D. A handheld video game
1
, Correct Answer: C. A set of cloth hand puppets
Rationale: Cloth hand puppets are ideal for a 3-year-old in a spica cast,
as they encourage imaginative play without requiring mobility. A squeaky
duck is more suitable for younger children, a fashion doll may require fine
motor skills, and a video game is not age-appropriate for prolonged use.
3. An infant with tetralogy of Fallot becomes acutely cyanotic and hyperpneic.
What is the nurse’s priority action?
A. Administer morphine sulfate
B. Start IV fluids
C. Place the infant in a knee-chest position
D. Provide 100% oxygen by face mask
Correct Answer: C. Place the infant in a knee-chest position
Rationale: The knee-chest position increases systemic vascular resistance,
reducing right-to-left shunting in tetralogy of Fallot, improving oxygena-
tion during a hypercyanotic spell. Oxygen, morphine, or IV fluids may fol-
low but are not the priority.
4. A child with diabetic ketoacidosis (DKA) exhibits Kussmaul respirations.
What is the underlying cause?
A. Hypoxemia
B. Respiratory alkalosis
C. Metabolic acidosis
D. Hypercapnia
Correct Answer: C. Metabolic acidosis
Rationale: Kussmaul respirations are rapid, deep breaths that occur as a
compensatory mechanism for metabolic acidosis in DKA, as the body at-
tempts to eliminate excess carbon dioxide to raise blood pH.
5. A 7-year-old with persistent vomiting has a nasogastric tube on low inter-
mittent suction. Which finding should the nurse report immediately?
A. Gastric output of 100 mL in 8 hours
B. Intake of 640 mL IV fluids plus 30 mL PO ice chips
C. Serum potassium of 3.0 mEq/L
D. Serum pH of 7.45
Correct Answer: C. Serum potassium of 3.0 mEq/L
Rationale: A serum potassium of 3.0 mEq/L indicates hypokalemia, a criti-
cal finding in a child with vomiting, as it can lead to arrhythmias. The other
findings are within normal limits or less urgent.
6. A child with celiac disease is evaluated for dietary teaching. Which food
choice indicates effective teaching?
2
, A. Creamed corn
B. Pancakes
C. Rye crackers
D. Cooked oatmeal
Correct Answer: A. Creamed corn
Rationale: Creamed corn is gluten-free and safe for celiac disease. Pan-
cakes, rye crackers, and oatmeal may contain gluten, which is harmful to
children with celiac disease.
7. During a well-baby check, a 9-month-old looks for a block hidden under a
blanket. Which milestone is this infant developing?
A. Object permanence
B. Stranger anxiety
C. Social smiling
D. Separation anxiety
Correct Answer: A. Object permanence
Rationale: Looking for a hidden object demonstrates object permanence,
a cognitive milestone typically achieved by 9–12 months, indicating the in-
fant understands that objects exist even when out of sight.
8. A nurse is caring for a 3-year-old 2 hours post-cardiac catheterization via
the right femoral artery. Which finding indicates arterial obstruction?
A. Blood pressure trending downward
B. Right foot cool and pale
C. Weaker pulse in the left foot
D. Oozing at the dressing site
Correct Answer: B. Right foot cool and pale
Rationale: A cool, pale right foot indicates arterial obstruction, likely from
clot formation post-catheterization. The other findings are concerning but
less specific to arterial obstruction.
9. A nurse is preparing to administer a medication to a 4-year-old child. The
prescription is for 5 mg/kg, and the child weighs 20 kg. How many mil-
ligrams should the nurse administer?
A. 50 mg
B. 75 mg
C. 100 mg
D. 125 mg
3
