HESI RN Pediatrics Exit Exam 2025/2026
– 90 Actual Questions with Correct
Verified Answers
1. A 6-month-old infant with congestive heart failure (CHF) is prescribed digoxin elixir.
Which observation by the nurse requires immediate intervention?
A. Respiratory rate of 30 breaths per minute
B. Sweating across the forehead
C. Apical heart rate of 60
D. Poor feeding
Rationale: An apical heart rate of 60 is significantly lower than the normal range for a 6-
month-old (80–150 BPM when awake, 70 BPM when sleeping). This bradycardia
indicates potential digoxin toxicity or worsening heart failure, requiring immediate
intervention. Respiratory rate of 30, sweating, and poor feeding are expected in CHF but
do not require immediate action compared to bradycardia.
2. A newborn delivered via C-section has a myelomeningocele detected prenatally. Surgery
is scheduled within 48 hours. Which nursing action is most appropriate?
A. Place the infant in a semi-Fowler’s position to decrease spinal cord pressure
B. Apply a heat lamp to facilitate drying of the sac
C. Apply soft restraints to prevent disruption of the sac
D. Assess head circumference and fontanels for signs of increased intracranial
pressure (ICP)
Rationale: Assessing for signs of increased ICP, such as increased head circumference or
bulging fontanels, is critical in myelomeningocele due to the risk of hydrocephalus.
Semi-Fowler’s position may increase pressure on the sac, heat lamps are contraindicated
as they may dry and damage the sac, and restraints are unnecessary if the infant is
positioned prone to protect the defect.
3. A 3-year-old with bacterial meningitis and hydrocephalus is admitted. Which assessment
finding indicates increased intracranial pressure (ICP)?
A. Tachycardia and tachypnea
B. Sluggish and unequal pupillary responses
C. Increased head circumference and bulging fontanels
D. Blood pressure fluctuations and syncope
Rationale: Sluggish and unequal pupillary responses are direct indicators of increased
ICP in a 3-year-old, reflecting neurological compromise. Increased head circumference
and bulging fontanels are more specific to infants. Tachycardia and tachypnea are
nonspecific, and blood pressure fluctuations with syncope are less common in pediatric
ICP.
4. A 2-year-old with cystic fibrosis is diagnosed. The father asks, “What is our major
concern now, and what will we deal with in the future?” What is the nurse’s best
response?
, A. “There is a probability of lifelong complications.”
B. “Cystic fibrosis results in nutritional concerns that can be managed.”
C. “Thin, tenacious secretions from the lungs are a constant struggle in cystic
fibrosis.”
D. “You will work with a team of experts and have access to a support group.”
Rationale: The primary concern in cystic fibrosis is managing thin, tenacious lung
secretions, which lead to recurrent infections and respiratory complications. While
lifelong complications, nutritional concerns, and support systems are relevant, the
hallmark issue is pulmonary secretion management.
5. A 7-year-old with persistent vomiting has a nasogastric tube on low intermittent suction.
Which finding should the nurse report to the healthcare provider?
A. Shift intake of 640 mL IV fluids plus 30 mL PO ice chips
B. Serum pH of 7.45
C. Gastric output of 100 mL in the last 8 hours
D. Serum potassium of 3.0 mEq/L
Rationale: A serum potassium of 3.0 mEq/L indicates hypokalemia, a critical electrolyte
imbalance that can lead to cardiac arrhythmias and requires prompt reporting. The other
findings are within expected ranges for a child with a nasogastric tube.
6. A child with sickle cell anemia (SCA) is being discharged. Which information is most
important for the nurse to provide to the parents?
A. Instructions about how much fluid the child should drink daily
B. Signs of addiction to opioid pain medications
C. Information about non-pharmaceutical pain relief measures
D. Referral for social services for the child and family
Rationale: Adequate hydration is critical in SCA to prevent vaso-occlusive crises by
reducing blood viscosity. While pain management and social services are important,
hydration is the priority to prevent complications.
7. A 4-year-old is admitted with dehydration due to gastroenteritis. Which assessment
finding requires immediate intervention?
A. Dry mucous membranes
B. Capillary refill time of 4 seconds
C. Heart rate of 120 beats per minute
D. Sunken fontanels
Rationale: A capillary refill time of 4 seconds indicates severe dehydration and poor
perfusion, requiring immediate intervention. Dry mucous membranes, tachycardia, and
sunken fontanels are expected in dehydration but are less urgent than prolonged capillary
refill.
8. A 10-year-old with type 1 diabetes mellitus reports nausea and abdominal pain. The
blood glucose level is 450 mg/dL. What is the nurse’s priority action?
A. Administer an antiemetic as prescribed
B. Notify the healthcare provider immediately
C. Encourage oral fluid intake
D. Administer insulin per sliding scale
Rationale: Nausea, abdominal pain, and a blood glucose of 450 mg/dL suggest diabetic
ketoacidosis (DKA), a medical emergency. Notifying the provider is the priority to
, initiate treatment. Administering insulin or fluids without orders or addressing symptoms
alone could worsen the condition.
9. A 6-year-old with asthma is prescribed albuterol via a metered -dose inhaler (MDI). The
nurse observes the child using the MDI without a spacer. What should the nurse do?
A. Praise the child for using the inhaler correctly
B. Teach the child to use a spacer with the MDI
C. Administer the next dose via nebulizer
D. Contact the provider to change the prescription
Rationale: A spacer improves medication delivery to the lungs in children using an MDI,
as it ensures proper inhalation technique. Teaching the child to use a spacer is the
priority. The other options do not address the need for improved delivery.
10. A 5-year-old with a fever of 102°F is prescribed acetaminophen. The child weighs 15 kg.
The safe dose is 15 mg/kg every 4–6 hours. What is the appropriate dose?
A. 150 mg
B. 225 mg
C. 300 mg
D. 450 mg
Rationale: The safe dose is calculated as 15 mg/kg × 15 kg = 225 mg per dose. This is
within the safe range for acetaminophen. Other doses are either too low or exceed the
safe limit.
11. A 3-month-old infant is brought to the emergency department with a fever of 100.8°F.
Which action should the nurse prioritize?
A. Obtain a full set of vital signs and assess for infection
B. Administer acetaminophen immediately
C. Encourage oral rehydration
D. Notify the provider of the fever
Rationale: A fever in a 3-month-old is concerning and may indicate a serious bacterial
infection. Obtaining vital signs and assessing for infection sources is the priority to guide
further management. Administering medication or fluids without assessment is
premature.
12. A 9-year-old with a new diagnosis of epilepsy is prescribed phenytoin. Which instruction
should the nurse include in the discharge teaching?
A. Avoid all physical activity while taking the medication
B. Brush teeth regularly to prevent gingival hyperplasia
C. Take the medication with meals to prevent nausea
D. Expect yellowing of the skin as a normal side effect
Rationale: Phenytoin is associated with gingival hyperplasia, and good oral hygiene,
including regular brushing, can help prevent this side effect. Physical activity is not
contraindicated, meals are not required for absorption, and yellowing of the skin is not a
normal side effect.
13. A 2-year-old is admitted with suspected intussusception. Which symptom is most
concerning and should be reported immediately?
A. Intermittent abdominal pain
B. Currant jelly stools
C. Vomiting
D. Fever of 100.5°F
– 90 Actual Questions with Correct
Verified Answers
1. A 6-month-old infant with congestive heart failure (CHF) is prescribed digoxin elixir.
Which observation by the nurse requires immediate intervention?
A. Respiratory rate of 30 breaths per minute
B. Sweating across the forehead
C. Apical heart rate of 60
D. Poor feeding
Rationale: An apical heart rate of 60 is significantly lower than the normal range for a 6-
month-old (80–150 BPM when awake, 70 BPM when sleeping). This bradycardia
indicates potential digoxin toxicity or worsening heart failure, requiring immediate
intervention. Respiratory rate of 30, sweating, and poor feeding are expected in CHF but
do not require immediate action compared to bradycardia.
2. A newborn delivered via C-section has a myelomeningocele detected prenatally. Surgery
is scheduled within 48 hours. Which nursing action is most appropriate?
A. Place the infant in a semi-Fowler’s position to decrease spinal cord pressure
B. Apply a heat lamp to facilitate drying of the sac
C. Apply soft restraints to prevent disruption of the sac
D. Assess head circumference and fontanels for signs of increased intracranial
pressure (ICP)
Rationale: Assessing for signs of increased ICP, such as increased head circumference or
bulging fontanels, is critical in myelomeningocele due to the risk of hydrocephalus.
Semi-Fowler’s position may increase pressure on the sac, heat lamps are contraindicated
as they may dry and damage the sac, and restraints are unnecessary if the infant is
positioned prone to protect the defect.
3. A 3-year-old with bacterial meningitis and hydrocephalus is admitted. Which assessment
finding indicates increased intracranial pressure (ICP)?
A. Tachycardia and tachypnea
B. Sluggish and unequal pupillary responses
C. Increased head circumference and bulging fontanels
D. Blood pressure fluctuations and syncope
Rationale: Sluggish and unequal pupillary responses are direct indicators of increased
ICP in a 3-year-old, reflecting neurological compromise. Increased head circumference
and bulging fontanels are more specific to infants. Tachycardia and tachypnea are
nonspecific, and blood pressure fluctuations with syncope are less common in pediatric
ICP.
4. A 2-year-old with cystic fibrosis is diagnosed. The father asks, “What is our major
concern now, and what will we deal with in the future?” What is the nurse’s best
response?
, A. “There is a probability of lifelong complications.”
B. “Cystic fibrosis results in nutritional concerns that can be managed.”
C. “Thin, tenacious secretions from the lungs are a constant struggle in cystic
fibrosis.”
D. “You will work with a team of experts and have access to a support group.”
Rationale: The primary concern in cystic fibrosis is managing thin, tenacious lung
secretions, which lead to recurrent infections and respiratory complications. While
lifelong complications, nutritional concerns, and support systems are relevant, the
hallmark issue is pulmonary secretion management.
5. A 7-year-old with persistent vomiting has a nasogastric tube on low intermittent suction.
Which finding should the nurse report to the healthcare provider?
A. Shift intake of 640 mL IV fluids plus 30 mL PO ice chips
B. Serum pH of 7.45
C. Gastric output of 100 mL in the last 8 hours
D. Serum potassium of 3.0 mEq/L
Rationale: A serum potassium of 3.0 mEq/L indicates hypokalemia, a critical electrolyte
imbalance that can lead to cardiac arrhythmias and requires prompt reporting. The other
findings are within expected ranges for a child with a nasogastric tube.
6. A child with sickle cell anemia (SCA) is being discharged. Which information is most
important for the nurse to provide to the parents?
A. Instructions about how much fluid the child should drink daily
B. Signs of addiction to opioid pain medications
C. Information about non-pharmaceutical pain relief measures
D. Referral for social services for the child and family
Rationale: Adequate hydration is critical in SCA to prevent vaso-occlusive crises by
reducing blood viscosity. While pain management and social services are important,
hydration is the priority to prevent complications.
7. A 4-year-old is admitted with dehydration due to gastroenteritis. Which assessment
finding requires immediate intervention?
A. Dry mucous membranes
B. Capillary refill time of 4 seconds
C. Heart rate of 120 beats per minute
D. Sunken fontanels
Rationale: A capillary refill time of 4 seconds indicates severe dehydration and poor
perfusion, requiring immediate intervention. Dry mucous membranes, tachycardia, and
sunken fontanels are expected in dehydration but are less urgent than prolonged capillary
refill.
8. A 10-year-old with type 1 diabetes mellitus reports nausea and abdominal pain. The
blood glucose level is 450 mg/dL. What is the nurse’s priority action?
A. Administer an antiemetic as prescribed
B. Notify the healthcare provider immediately
C. Encourage oral fluid intake
D. Administer insulin per sliding scale
Rationale: Nausea, abdominal pain, and a blood glucose of 450 mg/dL suggest diabetic
ketoacidosis (DKA), a medical emergency. Notifying the provider is the priority to
, initiate treatment. Administering insulin or fluids without orders or addressing symptoms
alone could worsen the condition.
9. A 6-year-old with asthma is prescribed albuterol via a metered -dose inhaler (MDI). The
nurse observes the child using the MDI without a spacer. What should the nurse do?
A. Praise the child for using the inhaler correctly
B. Teach the child to use a spacer with the MDI
C. Administer the next dose via nebulizer
D. Contact the provider to change the prescription
Rationale: A spacer improves medication delivery to the lungs in children using an MDI,
as it ensures proper inhalation technique. Teaching the child to use a spacer is the
priority. The other options do not address the need for improved delivery.
10. A 5-year-old with a fever of 102°F is prescribed acetaminophen. The child weighs 15 kg.
The safe dose is 15 mg/kg every 4–6 hours. What is the appropriate dose?
A. 150 mg
B. 225 mg
C. 300 mg
D. 450 mg
Rationale: The safe dose is calculated as 15 mg/kg × 15 kg = 225 mg per dose. This is
within the safe range for acetaminophen. Other doses are either too low or exceed the
safe limit.
11. A 3-month-old infant is brought to the emergency department with a fever of 100.8°F.
Which action should the nurse prioritize?
A. Obtain a full set of vital signs and assess for infection
B. Administer acetaminophen immediately
C. Encourage oral rehydration
D. Notify the provider of the fever
Rationale: A fever in a 3-month-old is concerning and may indicate a serious bacterial
infection. Obtaining vital signs and assessing for infection sources is the priority to guide
further management. Administering medication or fluids without assessment is
premature.
12. A 9-year-old with a new diagnosis of epilepsy is prescribed phenytoin. Which instruction
should the nurse include in the discharge teaching?
A. Avoid all physical activity while taking the medication
B. Brush teeth regularly to prevent gingival hyperplasia
C. Take the medication with meals to prevent nausea
D. Expect yellowing of the skin as a normal side effect
Rationale: Phenytoin is associated with gingival hyperplasia, and good oral hygiene,
including regular brushing, can help prevent this side effect. Physical activity is not
contraindicated, meals are not required for absorption, and yellowing of the skin is not a
normal side effect.
13. A 2-year-old is admitted with suspected intussusception. Which symptom is most
concerning and should be reported immediately?
A. Intermittent abdominal pain
B. Currant jelly stools
C. Vomiting
D. Fever of 100.5°F
