Comprehensive EVOLVE HESI Pediatrics (PEDS) Exam
Study Guide – Complete Pediatric Nursing Practice
Questions, Rationales, Review Notes & HESI Success
Strategies for Nursing Students Preparing for the EVOLVE
HESI PEDS Assessment
Question 1: A nurse is assessing a 6-month-old infant during a well-child visit. Which
developmental milestone should the nurse expect the infant to have achieved?
A. Sitting without support
B. Rolling from back to abdomen
C. Walking with assistance
D. Using a pincer grasp
CORRECT ANSWER: B. Rolling from back to abdomen
Rationale: By 6 months of age, most infants can roll from back to abdomen. Sitting without
support typically occurs around 7-8 months, walking with assistance around 9-12 months, and
the pincer grasp around 9-10 months.
Question 2: A child with cystic fibrosis is prescribed pancreatic enzyme replacements. When
should the nurse instruct the parents to administer this medication?
A. One hour after meals
B. With every meal and snack
C. Only when the child has loose stools
D. At bedtime only
CORRECT ANSWER: B. With every meal and snack
Rationale: Pancreatic enzymes must be taken with all meals and snacks to ensure proper
digestion and absorption of nutrients, particularly fats and proteins.
Question 3: A toddler is admitted with a diagnosis of epiglottitis. Which nursing intervention
is the highest priority?
A. Obtain a throat culture
B. Keep the child calm and avoid agitating them
C. Encourage the child to drink fluids
D. Place the child in a supine position
CORRECT ANSWER: B. Keep the child calm and avoid agitating them
Rationale: Agitation can cause laryngospasm and complete airway obstruction in epiglottitis.
Procedures like throat cultures should be avoided until the airway is secured.
Question 4: A nurse is teaching a parent about car seat safety for a 2-year-old child who
weighs 30 pounds. What is the recommended positioning?
A. Forward-facing in the front seat
B. Rear-facing in the back seat
C. Forward-facing in the back seat
D. Booster seat in the back seat
CORRECT ANSWER: B. Rear-facing in the back seat
Rationale: Current guidelines recommend children remain in a rear-facing car seat until they
reach the maximum weight or height limit allowed by the car seat manufacturer, often beyond
age 2.
,Question 5: A child with leukemia is experiencing neutropenia. Which precaution is most
important for the nurse to implement?
A. Strict hand hygiene and protective isolation
B. Encouraging raw fruits and vegetables
C. Allowing fresh flowers in the room
D. Limiting fluid intake
CORRECT ANSWER: A. Strict hand hygiene and protective isolation
Rationale: Neutropenia increases the risk of infection; strict hand hygiene and protective
measures are essential to prevent exposure to pathogens. Raw foods and flowers can harbor
bacteria or fungi.
Question 6: An infant is diagnosed with hypertrophic pyloric stenosis. Which clinical finding
should the nurse anticipate?
A. Bilious vomiting
B. Olive-shaped mass in the epigastrium
C. Diarrhea
D. Fever
CORRECT ANSWER: B. Olive-shaped mass in the epigastrium
Rationale: Hypertrophic pyloric stenosis typically presents with non-bilious projectile vomiting
and a palpable olive-shaped mass in the right upper quadrant.
Question 7: A school-age child is admitted with a sickle cell crisis. What is the priority nursing
intervention?
A. Administering cold compresses
B. Ensuring adequate hydration and pain management
C. Restricting movement to prevent fatigue
D. Administering iron supplements
CORRECT ANSWER: B. Ensuring adequate hydration and pain management
Rationale: Hydration helps reduce blood viscosity and prevent further sickling, while pain
management is critical during a vaso-occlusive crisis. Cold compresses can induce
vasoconstriction and worsen the crisis.
Question 8: A nurse is caring for a child with a ventriculoperitoneal (VP) shunt. Which sign
indicates potential shunt malfunction?
A. Decreased head circumference
B. Bulging fontanelle and vomiting
C. Increased appetite
D. Hyperactive behavior
CORRECT ANSWER: B. Bulging fontanelle and vomiting
Rationale: Signs of increased intracranial pressure, such as a bulging fontanelle, vomiting, and
irritability, indicate possible VP shunt malfunction or obstruction.
Question 9: A parent asks about the timing of the MMR vaccine. When should the first dose
typically be administered?
A. At birth
B. Between 6 and 12 months
,C. Between 12 and 15 months
D. Between 4 and 6 years
CORRECT ANSWER: C. Between 12 and 15 months
Rationale: The first dose of the Measles, Mumps, and Rubella (MMR) vaccine is routinely
scheduled between 12 and 15 months of age.
Question 10: A child with type 1 diabetes is experiencing hypoglycemia. Which symptom
should the nurse recognize?
A. Polyuria
B. Kussmaul respirations
C. Diaphoresis and tremors
D. Fruity breath odor
CORRECT ANSWER: C. Diaphoresis and tremors
Rationale: Diaphoresis, tremors, palpitations, and confusion are classic signs of hypoglycemia.
Polyuria and fruity breath are signs of hyperglycemia.
Question 11: A nurse is assessing a child with suspected appendicitis. Where is McBurney's
point located?
A. Left lower quadrant
B. Right upper quadrant
C. Right lower quadrant
D. Epigastric region
CORRECT ANSWER: C. Right lower quadrant
Rationale: McBurney's point is located in the right lower quadrant and is the site of maximal
tenderness in acute appendicitis.
Question 12: An infant with bronchiolitis caused by RSV is admitted. Which isolation
precaution is required?
A. Airborne
B. Droplet
C. Contact
D. Standard
CORRECT ANSWER: C. Contact
Rationale: RSV is highly contagious and spreads via direct contact with secretions; contact
precautions including gloves and gowns are required.
Question 13: A child is diagnosed with Kawasaki disease. Which complication is the nurse
most concerned about preventing?
A. Renal failure
B. Coronary artery aneurysms
C. Pulmonary hypertension
D. Hepatic encephalopathy
CORRECT ANSWER: B. Coronary artery aneurysms
Rationale: Kawasaki disease causes vasculitis, and the most serious complication is the
development of coronary artery aneurysms, which can lead to myocardial infarction.
, Question 14: A nurse is teaching a parent about iron supplementation for an infant. Which
instruction is appropriate?
A. Administer with milk to improve taste
B. Give with vitamin C-rich juice to enhance absorption
C. Expect black tarry stools to be reported immediately
D. Stop medication if teeth stain slightly
CORRECT ANSWER: B. Give with vitamin C-rich juice to enhance absorption
Rationale: Vitamin C enhances iron absorption. Iron should not be given with milk as it inhibits
absorption. Dark stools are a normal side effect, and staining can be minimized by using a
dropper toward the back of the mouth.
Question 15: A toddler ingests a button battery. What is the immediate priority?
A. Induce vomiting
B. Administer activated charcoal
C. Prepare for endoscopic removal
D. Observe for 24 hours
CORRECT ANSWER: C. Prepare for endoscopic removal
Rationale: Button batteries can cause severe tissue necrosis due to electrical current and
leakage; immediate removal via endoscopy is critical. Inducing vomiting is contraindicated.
Question 16: A child with nephrotic syndrome is being assessed. Which finding is
characteristic of this condition?
A. Hematuria
B. Massive proteinuria
C. Hypertension
D. Decreased lipid levels
CORRECT ANSWER: B. Massive proteinuria
Rationale: Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia,
edema, and hyperlipidemia. Hematuria is more common in nephritic syndrome.
Question 17: A nurse is caring for a child with a cleft lip repair. What is the priority
postoperative positioning?
A. Prone
B. Supine
C. Side-lying or upright
D. Trendelenburg
CORRECT ANSWER: C. Side-lying or upright
Rationale: Positioning the infant on their side or upright facilitates drainage of secretions and
prevents aspiration while protecting the surgical site.
Question 18: A child is admitted with a diagnosis of intussusception. Which stool finding
should the nurse expect?
A. Clay-colored stools
B. Currant jelly stools
C. Steatorrhea
D. Melena
Study Guide – Complete Pediatric Nursing Practice
Questions, Rationales, Review Notes & HESI Success
Strategies for Nursing Students Preparing for the EVOLVE
HESI PEDS Assessment
Question 1: A nurse is assessing a 6-month-old infant during a well-child visit. Which
developmental milestone should the nurse expect the infant to have achieved?
A. Sitting without support
B. Rolling from back to abdomen
C. Walking with assistance
D. Using a pincer grasp
CORRECT ANSWER: B. Rolling from back to abdomen
Rationale: By 6 months of age, most infants can roll from back to abdomen. Sitting without
support typically occurs around 7-8 months, walking with assistance around 9-12 months, and
the pincer grasp around 9-10 months.
Question 2: A child with cystic fibrosis is prescribed pancreatic enzyme replacements. When
should the nurse instruct the parents to administer this medication?
A. One hour after meals
B. With every meal and snack
C. Only when the child has loose stools
D. At bedtime only
CORRECT ANSWER: B. With every meal and snack
Rationale: Pancreatic enzymes must be taken with all meals and snacks to ensure proper
digestion and absorption of nutrients, particularly fats and proteins.
Question 3: A toddler is admitted with a diagnosis of epiglottitis. Which nursing intervention
is the highest priority?
A. Obtain a throat culture
B. Keep the child calm and avoid agitating them
C. Encourage the child to drink fluids
D. Place the child in a supine position
CORRECT ANSWER: B. Keep the child calm and avoid agitating them
Rationale: Agitation can cause laryngospasm and complete airway obstruction in epiglottitis.
Procedures like throat cultures should be avoided until the airway is secured.
Question 4: A nurse is teaching a parent about car seat safety for a 2-year-old child who
weighs 30 pounds. What is the recommended positioning?
A. Forward-facing in the front seat
B. Rear-facing in the back seat
C. Forward-facing in the back seat
D. Booster seat in the back seat
CORRECT ANSWER: B. Rear-facing in the back seat
Rationale: Current guidelines recommend children remain in a rear-facing car seat until they
reach the maximum weight or height limit allowed by the car seat manufacturer, often beyond
age 2.
,Question 5: A child with leukemia is experiencing neutropenia. Which precaution is most
important for the nurse to implement?
A. Strict hand hygiene and protective isolation
B. Encouraging raw fruits and vegetables
C. Allowing fresh flowers in the room
D. Limiting fluid intake
CORRECT ANSWER: A. Strict hand hygiene and protective isolation
Rationale: Neutropenia increases the risk of infection; strict hand hygiene and protective
measures are essential to prevent exposure to pathogens. Raw foods and flowers can harbor
bacteria or fungi.
Question 6: An infant is diagnosed with hypertrophic pyloric stenosis. Which clinical finding
should the nurse anticipate?
A. Bilious vomiting
B. Olive-shaped mass in the epigastrium
C. Diarrhea
D. Fever
CORRECT ANSWER: B. Olive-shaped mass in the epigastrium
Rationale: Hypertrophic pyloric stenosis typically presents with non-bilious projectile vomiting
and a palpable olive-shaped mass in the right upper quadrant.
Question 7: A school-age child is admitted with a sickle cell crisis. What is the priority nursing
intervention?
A. Administering cold compresses
B. Ensuring adequate hydration and pain management
C. Restricting movement to prevent fatigue
D. Administering iron supplements
CORRECT ANSWER: B. Ensuring adequate hydration and pain management
Rationale: Hydration helps reduce blood viscosity and prevent further sickling, while pain
management is critical during a vaso-occlusive crisis. Cold compresses can induce
vasoconstriction and worsen the crisis.
Question 8: A nurse is caring for a child with a ventriculoperitoneal (VP) shunt. Which sign
indicates potential shunt malfunction?
A. Decreased head circumference
B. Bulging fontanelle and vomiting
C. Increased appetite
D. Hyperactive behavior
CORRECT ANSWER: B. Bulging fontanelle and vomiting
Rationale: Signs of increased intracranial pressure, such as a bulging fontanelle, vomiting, and
irritability, indicate possible VP shunt malfunction or obstruction.
Question 9: A parent asks about the timing of the MMR vaccine. When should the first dose
typically be administered?
A. At birth
B. Between 6 and 12 months
,C. Between 12 and 15 months
D. Between 4 and 6 years
CORRECT ANSWER: C. Between 12 and 15 months
Rationale: The first dose of the Measles, Mumps, and Rubella (MMR) vaccine is routinely
scheduled between 12 and 15 months of age.
Question 10: A child with type 1 diabetes is experiencing hypoglycemia. Which symptom
should the nurse recognize?
A. Polyuria
B. Kussmaul respirations
C. Diaphoresis and tremors
D. Fruity breath odor
CORRECT ANSWER: C. Diaphoresis and tremors
Rationale: Diaphoresis, tremors, palpitations, and confusion are classic signs of hypoglycemia.
Polyuria and fruity breath are signs of hyperglycemia.
Question 11: A nurse is assessing a child with suspected appendicitis. Where is McBurney's
point located?
A. Left lower quadrant
B. Right upper quadrant
C. Right lower quadrant
D. Epigastric region
CORRECT ANSWER: C. Right lower quadrant
Rationale: McBurney's point is located in the right lower quadrant and is the site of maximal
tenderness in acute appendicitis.
Question 12: An infant with bronchiolitis caused by RSV is admitted. Which isolation
precaution is required?
A. Airborne
B. Droplet
C. Contact
D. Standard
CORRECT ANSWER: C. Contact
Rationale: RSV is highly contagious and spreads via direct contact with secretions; contact
precautions including gloves and gowns are required.
Question 13: A child is diagnosed with Kawasaki disease. Which complication is the nurse
most concerned about preventing?
A. Renal failure
B. Coronary artery aneurysms
C. Pulmonary hypertension
D. Hepatic encephalopathy
CORRECT ANSWER: B. Coronary artery aneurysms
Rationale: Kawasaki disease causes vasculitis, and the most serious complication is the
development of coronary artery aneurysms, which can lead to myocardial infarction.
, Question 14: A nurse is teaching a parent about iron supplementation for an infant. Which
instruction is appropriate?
A. Administer with milk to improve taste
B. Give with vitamin C-rich juice to enhance absorption
C. Expect black tarry stools to be reported immediately
D. Stop medication if teeth stain slightly
CORRECT ANSWER: B. Give with vitamin C-rich juice to enhance absorption
Rationale: Vitamin C enhances iron absorption. Iron should not be given with milk as it inhibits
absorption. Dark stools are a normal side effect, and staining can be minimized by using a
dropper toward the back of the mouth.
Question 15: A toddler ingests a button battery. What is the immediate priority?
A. Induce vomiting
B. Administer activated charcoal
C. Prepare for endoscopic removal
D. Observe for 24 hours
CORRECT ANSWER: C. Prepare for endoscopic removal
Rationale: Button batteries can cause severe tissue necrosis due to electrical current and
leakage; immediate removal via endoscopy is critical. Inducing vomiting is contraindicated.
Question 16: A child with nephrotic syndrome is being assessed. Which finding is
characteristic of this condition?
A. Hematuria
B. Massive proteinuria
C. Hypertension
D. Decreased lipid levels
CORRECT ANSWER: B. Massive proteinuria
Rationale: Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia,
edema, and hyperlipidemia. Hematuria is more common in nephritic syndrome.
Question 17: A nurse is caring for a child with a cleft lip repair. What is the priority
postoperative positioning?
A. Prone
B. Supine
C. Side-lying or upright
D. Trendelenburg
CORRECT ANSWER: C. Side-lying or upright
Rationale: Positioning the infant on their side or upright facilitates drainage of secretions and
prevents aspiration while protecting the surgical site.
Question 18: A child is admitted with a diagnosis of intussusception. Which stool finding
should the nurse expect?
A. Clay-colored stools
B. Currant jelly stools
C. Steatorrhea
D. Melena
