HESI RN Pediatrics Exit Exam 2025 –
Verified Questions and Correct
Answers with Expert Rationales
Question 1
A 15-month-old is admitted with a history of a recent upper respiratory infection. Which
symptoms are consistent with laryngotracheobronchitis (croup)? Select all that apply.
A. Inspiratory stridor worse at night
B. Suprasternal retractions
C. Barking, seal-like cough
D. Lung sounds with crackles bilaterally
E. High-pitched wheezing on expiration
Correct Answer: A, B, C
Rationale: Laryngotracheobronchitis (croup) is characterized by inflammation of the upper
airway, leading to inspiratory stridor worse at night (A), suprasternal retractions due to increased
respiratory effort (B), and a barking, seal-like cough (C). Crackles (D) suggest fluid in the
alveoli, more typical of pneumonia. Expiratory wheezing (E) is more associated with asthma or
bronchiolitis.
Question 2
A nurse is caring for a 6-month-old with congestive heart failure (CHF) receiving digoxin elixir.
Which observation requires immediate intervention?
A. Apical heart rate of 60 bpm
B. Sweating across the forehead
C. Poor feeding
D. Respiratory rate of 30 breaths per minute
Correct Answer: A
Rationale: An apical heart rate of 60 bpm in a 6-month-old is significantly below the normal
range (80–150 bpm awake, 70 bpm asleep) and indicates potential digoxin toxicity or severe
cardiac compromise, requiring immediate intervention. Sweating (B) and poor feeding (C) are
expected symptoms of CHF. A respiratory rate of 30 (D) is within normal limits for an infant.
,Question 3
A 4-year-old presents with sudden onset of severe sore throat, drooling, and difficulty
swallowing. The temperature is 102.2°F (39°C). The child is anxious, flushed, and leaning
forward in a tripod position. What is the nurse’s priority action?
A. Administer acetaminophen
B. Prepare for emergency airway management
C. Obtain a throat culture
D. Encourage oral fluids
Correct Answer: B
Rationale: The symptoms suggest epiglottitis, a life-threatening condition due to airway
obstruction. The tripod position, drooling, and severe sore throat indicate potential airway
compromise, making emergency airway management the priority. Acetaminophen (A) addresses
fever but not the airway issue. A throat culture (C) risks further obstruction. Fluids (D) are
contraindicated due to swallowing difficulty.
Question 4
A nurse is teaching parents of a 5-year-old with cystic fibrosis about respiratory treatments.
Which statement indicates parental understanding?
A. “We’ll perform postural drainage before aerosol therapy.”
B. “We’ll give treatments only when coughing increases.”
C. “We’ll administer aerosol therapy followed by postural drainage before meals.”
D. “We’ll ensure treatments are done only during infections.”
Correct Answer: C
Rationale: For cystic fibrosis, aerosol therapy (e.g., bronchodilators or mucolytics) should
precede postural drainage to loosen secretions, ideally before meals to avoid vomiting.
Performing postural drainage first (A) is less effective. Treatments are routine, not only during
coughing (B) or infections (D).
Question 5
A 3-month-old develops oral thrush. Which pharmacologic agent should the nurse plan to
administer?
A. Fluconazole
B. Nystatin
C. Amoxicillin
D. Acyclovir
, Correct Answer: B
Rationale: Oral thrush, caused by Candida albicans, is treated with nystatin, an antifungal
applied directly to the oral mucosa. Fluconazole (A) is used for systemic fungal infections.
Amoxicillin (C) is an antibiotic, ineffective against fungi. Acyclovir (D) treats viral infections
like herpes.
Question 6
A nurse is assessing a newborn with suspected pyloric stenosis. Which finding is most
concerning?
A. Projectile vomiting after feeding
B. Frequent loose stools
C. Mild jaundice
D. Weight gain of 0.5 kg in one week
Correct Answer: A
Rationale: Projectile vomiting is a hallmark of pyloric stenosis, caused by hypertrophy of the
pylorus muscle, leading to gastric outlet obstruction. Loose stools (B) are unrelated. Mild
jaundice (C) is common in newborns and less urgent. Weight gain (D) is unlikely with pyloric
stenosis due to vomiting.
Question 7
A 6-year-old with suspected appendicitis is admitted. Which symptom requires immediate
reporting to the healthcare provider?
A. Rebound tenderness in the right lower quadrant
B. Fever of 100.4°F (38°C)
C. Mild abdominal distention
D. Decreased appetite
Correct Answer: A
Rationale: Rebound tenderness in the right lower quadrant is a critical sign of appendicitis,
indicating peritoneal irritation and possible perforation, requiring urgent surgical evaluation.
Fever (B), distention (C), and decreased appetite (D) are expected but less specific.
Question 8
A nurse is preparing a toddler for a lumbar puncture. Which intervention best reduces anxiety?
A. Explain the procedure in detail to the child
Verified Questions and Correct
Answers with Expert Rationales
Question 1
A 15-month-old is admitted with a history of a recent upper respiratory infection. Which
symptoms are consistent with laryngotracheobronchitis (croup)? Select all that apply.
A. Inspiratory stridor worse at night
B. Suprasternal retractions
C. Barking, seal-like cough
D. Lung sounds with crackles bilaterally
E. High-pitched wheezing on expiration
Correct Answer: A, B, C
Rationale: Laryngotracheobronchitis (croup) is characterized by inflammation of the upper
airway, leading to inspiratory stridor worse at night (A), suprasternal retractions due to increased
respiratory effort (B), and a barking, seal-like cough (C). Crackles (D) suggest fluid in the
alveoli, more typical of pneumonia. Expiratory wheezing (E) is more associated with asthma or
bronchiolitis.
Question 2
A nurse is caring for a 6-month-old with congestive heart failure (CHF) receiving digoxin elixir.
Which observation requires immediate intervention?
A. Apical heart rate of 60 bpm
B. Sweating across the forehead
C. Poor feeding
D. Respiratory rate of 30 breaths per minute
Correct Answer: A
Rationale: An apical heart rate of 60 bpm in a 6-month-old is significantly below the normal
range (80–150 bpm awake, 70 bpm asleep) and indicates potential digoxin toxicity or severe
cardiac compromise, requiring immediate intervention. Sweating (B) and poor feeding (C) are
expected symptoms of CHF. A respiratory rate of 30 (D) is within normal limits for an infant.
,Question 3
A 4-year-old presents with sudden onset of severe sore throat, drooling, and difficulty
swallowing. The temperature is 102.2°F (39°C). The child is anxious, flushed, and leaning
forward in a tripod position. What is the nurse’s priority action?
A. Administer acetaminophen
B. Prepare for emergency airway management
C. Obtain a throat culture
D. Encourage oral fluids
Correct Answer: B
Rationale: The symptoms suggest epiglottitis, a life-threatening condition due to airway
obstruction. The tripod position, drooling, and severe sore throat indicate potential airway
compromise, making emergency airway management the priority. Acetaminophen (A) addresses
fever but not the airway issue. A throat culture (C) risks further obstruction. Fluids (D) are
contraindicated due to swallowing difficulty.
Question 4
A nurse is teaching parents of a 5-year-old with cystic fibrosis about respiratory treatments.
Which statement indicates parental understanding?
A. “We’ll perform postural drainage before aerosol therapy.”
B. “We’ll give treatments only when coughing increases.”
C. “We’ll administer aerosol therapy followed by postural drainage before meals.”
D. “We’ll ensure treatments are done only during infections.”
Correct Answer: C
Rationale: For cystic fibrosis, aerosol therapy (e.g., bronchodilators or mucolytics) should
precede postural drainage to loosen secretions, ideally before meals to avoid vomiting.
Performing postural drainage first (A) is less effective. Treatments are routine, not only during
coughing (B) or infections (D).
Question 5
A 3-month-old develops oral thrush. Which pharmacologic agent should the nurse plan to
administer?
A. Fluconazole
B. Nystatin
C. Amoxicillin
D. Acyclovir
, Correct Answer: B
Rationale: Oral thrush, caused by Candida albicans, is treated with nystatin, an antifungal
applied directly to the oral mucosa. Fluconazole (A) is used for systemic fungal infections.
Amoxicillin (C) is an antibiotic, ineffective against fungi. Acyclovir (D) treats viral infections
like herpes.
Question 6
A nurse is assessing a newborn with suspected pyloric stenosis. Which finding is most
concerning?
A. Projectile vomiting after feeding
B. Frequent loose stools
C. Mild jaundice
D. Weight gain of 0.5 kg in one week
Correct Answer: A
Rationale: Projectile vomiting is a hallmark of pyloric stenosis, caused by hypertrophy of the
pylorus muscle, leading to gastric outlet obstruction. Loose stools (B) are unrelated. Mild
jaundice (C) is common in newborns and less urgent. Weight gain (D) is unlikely with pyloric
stenosis due to vomiting.
Question 7
A 6-year-old with suspected appendicitis is admitted. Which symptom requires immediate
reporting to the healthcare provider?
A. Rebound tenderness in the right lower quadrant
B. Fever of 100.4°F (38°C)
C. Mild abdominal distention
D. Decreased appetite
Correct Answer: A
Rationale: Rebound tenderness in the right lower quadrant is a critical sign of appendicitis,
indicating peritoneal irritation and possible perforation, requiring urgent surgical evaluation.
Fever (B), distention (C), and decreased appetite (D) are expected but less specific.
Question 8
A nurse is preparing a toddler for a lumbar puncture. Which intervention best reduces anxiety?
A. Explain the procedure in detail to the child
