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HESI Exit Exam Pediatric Fluids &
Nutrition Bank: Hydration,
Electrolytes & GI Disorders
Table of Contents
Subtopic 1: Pediatric Hydration Status and Fluid Balance...............................2
Subtopic 2: Pediatric Nutritional Requirements and Malnutrition...................10
Subtopic 3: Intravenous and Enteral Nutrition in Pediatrics...........................19
Subtopic 4: Electrolyte Replacement and Pediatric Metabolic Balance..........27
Subtopic 5: Gastrointestinal Disorders Impacting Fluid & Nutritional Balance
in Children......................................................................................................36
Subtopic 6: Pediatric Feeding Disorders and Nutritional Therapy..................44
Subtopic 7: Parenteral Nutrition and Long-Term Feeding Support in Pediatrics
.......................................................................................................................53
Subtopic 8: Pediatric Malnutrition – Assessment, Screening, and Management
.......................................................................................................................62
Subtopic 9: Pediatric Gastrointestinal Conditions Affecting Nutrition &
Hydration.......................................................................................................70
Subtopic 10: Pediatric Feeding Challenges in Special Populations (e.g., NICU,
Neurologic Impairment, Congenital Anomalies).............................................79
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Subtopic 1: Pediatric Hydration Status and
Fluid Balance
Question 1:
A 2-year-old child is admitted with severe diarrhea and vomiting. Which
clinical sign best indicates moderate dehydration?
A. Sunken fontanelles
B. Dry mucous membranes and tachycardia
C. Generalized edema
D. Bradycardia
Correct Answer: B. Dry mucous membranes and tachycardia
Rationale: Dry mucous membranes and an increased heart rate are hallmark
signs of moderate dehydration in pediatric patients. Sunken fontanelles are
more indicative in infants, while bradycardia is typically a late sign of severe
compromise.
Question 2:
Which laboratory value is most likely elevated in a dehydrated child?
A. Hemoglobin
B. Blood urea nitrogen (BUN)
C. Albumin
D. Bilirubin
Correct Answer: B. Blood urea nitrogen (BUN)
Rationale: Dehydration leads to hemoconcentration, and BUN often elevates
due to reduced renal perfusion and fluid volume deficit.
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Question 3:
A nurse is caring for an infant with suspected dehydration. Which is the most
reliable assessment for hydration status?
A. Blood pressure
B. Lung auscultation
C. Daily weight
D. Head circumference
Correct Answer: C. Daily weight
Rationale: Daily weight is the most accurate and sensitive indicator of fluid
status changes in infants and children.
Question 4:
Which sign differentiates mild from moderate dehydration in a pediatric
patient?
A. Decreased urine output
B. Capillary refill time of 3 seconds
C. Crying without tears
D. Pale skin
Correct Answer: B. Capillary refill time of 3 seconds
Rationale: A capillary refill time greater than 2 seconds may suggest
moderate dehydration. Mild dehydration usually presents with minimal
symptoms.
Question 5:
A child is receiving IV fluids for dehydration. What is the most important
action for the nurse?
A. Encouraging oral fluids
, 4
B. Monitoring for signs of fluid overload
C. Checking temperature every 2 hours
D. Providing a high-protein diet
Correct Answer: B. Monitoring for signs of fluid overload
Rationale: Pediatric patients are susceptible to fluid overload due to smaller
circulatory volume. Nurses must assess for rales, edema, and changes in
respiratory status.
Question 6:
Which fluid is appropriate for initial IV rehydration in a severely dehydrated
child?
A. D5W
B. 0.45% Normal Saline
C. 0.9% Normal Saline
D. Lactated Ringer’s with Dextrose
Correct Answer: C. 0.9% Normal Saline
Rationale: Isotonic fluids such as 0.9% Normal Saline are used initially to
restore circulating volume in severe dehydration.
Question 7:
A toddler has severe diarrhea. What electrolyte imbalance is the child most
at risk for?
A. Hypercalcemia
B. Hypokalemia
C. Hypernatremia
D. Hypoglycemia
HESI Exit Exam Pediatric Fluids &
Nutrition Bank: Hydration,
Electrolytes & GI Disorders
Table of Contents
Subtopic 1: Pediatric Hydration Status and Fluid Balance...............................2
Subtopic 2: Pediatric Nutritional Requirements and Malnutrition...................10
Subtopic 3: Intravenous and Enteral Nutrition in Pediatrics...........................19
Subtopic 4: Electrolyte Replacement and Pediatric Metabolic Balance..........27
Subtopic 5: Gastrointestinal Disorders Impacting Fluid & Nutritional Balance
in Children......................................................................................................36
Subtopic 6: Pediatric Feeding Disorders and Nutritional Therapy..................44
Subtopic 7: Parenteral Nutrition and Long-Term Feeding Support in Pediatrics
.......................................................................................................................53
Subtopic 8: Pediatric Malnutrition – Assessment, Screening, and Management
.......................................................................................................................62
Subtopic 9: Pediatric Gastrointestinal Conditions Affecting Nutrition &
Hydration.......................................................................................................70
Subtopic 10: Pediatric Feeding Challenges in Special Populations (e.g., NICU,
Neurologic Impairment, Congenital Anomalies).............................................79
, 2
Subtopic 1: Pediatric Hydration Status and
Fluid Balance
Question 1:
A 2-year-old child is admitted with severe diarrhea and vomiting. Which
clinical sign best indicates moderate dehydration?
A. Sunken fontanelles
B. Dry mucous membranes and tachycardia
C. Generalized edema
D. Bradycardia
Correct Answer: B. Dry mucous membranes and tachycardia
Rationale: Dry mucous membranes and an increased heart rate are hallmark
signs of moderate dehydration in pediatric patients. Sunken fontanelles are
more indicative in infants, while bradycardia is typically a late sign of severe
compromise.
Question 2:
Which laboratory value is most likely elevated in a dehydrated child?
A. Hemoglobin
B. Blood urea nitrogen (BUN)
C. Albumin
D. Bilirubin
Correct Answer: B. Blood urea nitrogen (BUN)
Rationale: Dehydration leads to hemoconcentration, and BUN often elevates
due to reduced renal perfusion and fluid volume deficit.
, 3
Question 3:
A nurse is caring for an infant with suspected dehydration. Which is the most
reliable assessment for hydration status?
A. Blood pressure
B. Lung auscultation
C. Daily weight
D. Head circumference
Correct Answer: C. Daily weight
Rationale: Daily weight is the most accurate and sensitive indicator of fluid
status changes in infants and children.
Question 4:
Which sign differentiates mild from moderate dehydration in a pediatric
patient?
A. Decreased urine output
B. Capillary refill time of 3 seconds
C. Crying without tears
D. Pale skin
Correct Answer: B. Capillary refill time of 3 seconds
Rationale: A capillary refill time greater than 2 seconds may suggest
moderate dehydration. Mild dehydration usually presents with minimal
symptoms.
Question 5:
A child is receiving IV fluids for dehydration. What is the most important
action for the nurse?
A. Encouraging oral fluids
, 4
B. Monitoring for signs of fluid overload
C. Checking temperature every 2 hours
D. Providing a high-protein diet
Correct Answer: B. Monitoring for signs of fluid overload
Rationale: Pediatric patients are susceptible to fluid overload due to smaller
circulatory volume. Nurses must assess for rales, edema, and changes in
respiratory status.
Question 6:
Which fluid is appropriate for initial IV rehydration in a severely dehydrated
child?
A. D5W
B. 0.45% Normal Saline
C. 0.9% Normal Saline
D. Lactated Ringer’s with Dextrose
Correct Answer: C. 0.9% Normal Saline
Rationale: Isotonic fluids such as 0.9% Normal Saline are used initially to
restore circulating volume in severe dehydration.
Question 7:
A toddler has severe diarrhea. What electrolyte imbalance is the child most
at risk for?
A. Hypercalcemia
B. Hypokalemia
C. Hypernatremia
D. Hypoglycemia
