HESI RN Pediatrics Exit Exam 2025/2026
– Updated Actual 75 Questions with
Correct Answers and Rationales
Question 1
A 6-month-old infant is admitted with dehydration due to gastroenteritis. Which assessment
finding is most concerning?
A. Sunken fontanelles
B. Weight loss of 2%
C. Increased urine output
D. Moist mucous membranes
A. Sunken fontanelles
Rationale: Sunken fontanelles in an infant indicate severe dehydration, reflecting
significant fluid loss and requiring urgent intervention.
Question 2
A 4-year-old with sickle cell anemia is in vaso-occlusive crisis. What is the priority nursing
intervention?
A. Administer oxygen at 2 L/min
B. Initiate IV fluid hydration
C. Provide oral analgesics
D. Apply warm compresses
B. Initiate IV fluid hydration
Rationale: IV hydration reduces blood viscosity, promotes circulation, and prevents
further sickling, addressing the crisis's root cause.
Question 3
A 2-year-old is diagnosed with Kawasaki disease. Which symptom is most characteristic?
,A. Conjunctivitis without discharge
B. Productive cough
C. Generalized tonic-clonic seizures
D. Vesicular rash
A. Conjunctivitis without discharge
Rationale: Kawasaki disease presents with nonexudative conjunctivitis, high fever, and
mucocutaneous symptoms, distinguishing it from other conditions.
Question 4
A nurse is preparing to administer digoxin to a 3-month-old with heart failure. What is the
priority assessment?
A. Check respiratory rate
B. Measure apical pulse
C. Assess blood pressure
D. Monitor temperature
B. Measure apical pulse
Rationale: Digoxin can cause bradycardia; checking the apical pulse ensures safety,
holding the dose if the pulse is below 100 bpm in infants.
Question 5
A 10-year-old with type 1 diabetes reports nausea and abdominal pain. Blood glucose is 450
mg/dL. What is the nurse’s priority action?
A. Administer insulin per protocol
B. Encourage oral fluids
C. Check urine for ketones
D. Provide antiemetic medication
C. Check urine for ketones
Rationale: Hyperglycemia with nausea and abdominal pain suggests possible diabetic
ketoacidosis (DKA); checking ketones confirms the diagnosis for urgent treatment.
Question 6
A toddler is admitted with suspected meningitis. Which finding requires immediate intervention?
, A. Fever of 101°F
B. Nuchal rigidity
C. Bulging fontanelle
D. Photophobia
C. Bulging fontanelle
Rationale: A bulging fontanelle indicates increased intracranial pressure, a life-threatening
complication of meningitis requiring immediate action.
Question 7
A 5-year-old with asthma is wheezing and has a respiratory rate of 32/min. What is the nurse’s
first action?
A. Administer albuterol via nebulizer
B. Place in high Fowler’s position
C. Obtain a peak flow reading
D. Start oxygen at 4 L/min
A. Administer albuterol via nebulizer
Rationale: Albuterol is a bronchodilator that rapidly relieves wheezing by relaxing airway
smooth muscles, addressing the acute symptom.
Question 8
A newborn is diagnosed with respiratory distress syndrome (RDS). What is the primary
pathophysiological cause?
A. Surfactant deficiency
B. Pulmonary edema
C. Bronchial obstruction
D. Congenital heart defect
A. Surfactant deficiency
Rationale: RDS in newborns results from inadequate surfactant, leading to alveolar
collapse and impaired gas exchange.
Question 9
– Updated Actual 75 Questions with
Correct Answers and Rationales
Question 1
A 6-month-old infant is admitted with dehydration due to gastroenteritis. Which assessment
finding is most concerning?
A. Sunken fontanelles
B. Weight loss of 2%
C. Increased urine output
D. Moist mucous membranes
A. Sunken fontanelles
Rationale: Sunken fontanelles in an infant indicate severe dehydration, reflecting
significant fluid loss and requiring urgent intervention.
Question 2
A 4-year-old with sickle cell anemia is in vaso-occlusive crisis. What is the priority nursing
intervention?
A. Administer oxygen at 2 L/min
B. Initiate IV fluid hydration
C. Provide oral analgesics
D. Apply warm compresses
B. Initiate IV fluid hydration
Rationale: IV hydration reduces blood viscosity, promotes circulation, and prevents
further sickling, addressing the crisis's root cause.
Question 3
A 2-year-old is diagnosed with Kawasaki disease. Which symptom is most characteristic?
,A. Conjunctivitis without discharge
B. Productive cough
C. Generalized tonic-clonic seizures
D. Vesicular rash
A. Conjunctivitis without discharge
Rationale: Kawasaki disease presents with nonexudative conjunctivitis, high fever, and
mucocutaneous symptoms, distinguishing it from other conditions.
Question 4
A nurse is preparing to administer digoxin to a 3-month-old with heart failure. What is the
priority assessment?
A. Check respiratory rate
B. Measure apical pulse
C. Assess blood pressure
D. Monitor temperature
B. Measure apical pulse
Rationale: Digoxin can cause bradycardia; checking the apical pulse ensures safety,
holding the dose if the pulse is below 100 bpm in infants.
Question 5
A 10-year-old with type 1 diabetes reports nausea and abdominal pain. Blood glucose is 450
mg/dL. What is the nurse’s priority action?
A. Administer insulin per protocol
B. Encourage oral fluids
C. Check urine for ketones
D. Provide antiemetic medication
C. Check urine for ketones
Rationale: Hyperglycemia with nausea and abdominal pain suggests possible diabetic
ketoacidosis (DKA); checking ketones confirms the diagnosis for urgent treatment.
Question 6
A toddler is admitted with suspected meningitis. Which finding requires immediate intervention?
, A. Fever of 101°F
B. Nuchal rigidity
C. Bulging fontanelle
D. Photophobia
C. Bulging fontanelle
Rationale: A bulging fontanelle indicates increased intracranial pressure, a life-threatening
complication of meningitis requiring immediate action.
Question 7
A 5-year-old with asthma is wheezing and has a respiratory rate of 32/min. What is the nurse’s
first action?
A. Administer albuterol via nebulizer
B. Place in high Fowler’s position
C. Obtain a peak flow reading
D. Start oxygen at 4 L/min
A. Administer albuterol via nebulizer
Rationale: Albuterol is a bronchodilator that rapidly relieves wheezing by relaxing airway
smooth muscles, addressing the acute symptom.
Question 8
A newborn is diagnosed with respiratory distress syndrome (RDS). What is the primary
pathophysiological cause?
A. Surfactant deficiency
B. Pulmonary edema
C. Bronchial obstruction
D. Congenital heart defect
A. Surfactant deficiency
Rationale: RDS in newborns results from inadequate surfactant, leading to alveolar
collapse and impaired gas exchange.
Question 9
