HESI Pediatrics Review Exam Prep – Real Practice Questions, Answers &
Detailed Rationales (Updated 2026) | Growth & Development
Milestones, Pediatric Assessment & Vital Signs, Childhood Diseases &
Infections, Pediatric Pharmacology, Respiratory & Cardiac Disorders,
Immunizations & Safety, Family-Centered Care, NCLEX-Style Clinical
Judgment & HESI Pediatrics Success
Question 1: Which of the following is the most appropriate initial action when
assessing a 2-year-old child with suspected epiglottitis?
A. Perform a thorough throat examination using a tongue depressor
B. Administer nebulized racemic epinephrine immediately
C. Obtain intravenous access for fluid resuscitation
D. Maintain the child in a position of comfort and avoid any stimulation of the
oropharynx
CORRECT ANSWER: D. Maintain the child in a position of comfort and avoid any
stimulation of the oropharynx
Rationale: Epiglottitis is a medical emergency characterized by acute inflammation of
the epiglottis, which can lead to rapid airway obstruction. Any attempt to examine the
throat (e.g., with a tongue depressor) may precipitate complete airway closure. The
priority is to keep the child calm, in a position of comfort (often sitting upright), and
avoid any procedures that could trigger laryngospasm until a controlled airway can be
established by specialists.
Question 2: A 6-month-old infant presents with failure to thrive, chronic diarrhea,
and recurrent respiratory infections. Sweat chloride testing reveals a value of 75
mmol/L. What is the most likely diagnosis?
A. Cystic fibrosis
B. Celiac disease
C. Hirschsprung disease
D. Gastroesophageal reflux disease (GERD)
CORRECT ANSWER: A. Cystic fibrosis
Rationale: Cystic fibrosis (CF) is an autosomal recessive disorder caused by mutations
in the CFTR gene, leading to thick, viscous secretions affecting multiple organ systems.
Classic signs include failure to thrive, steatorrhea (due to pancreatic insufficiency),
recurrent pulmonary infections, and elevated sweat chloride levels (>60 mmol/L is
diagnostic). The clinical presentation and confirmatory sweat test strongly support CF.
Question 3: Which developmental milestone is typically achieved by a healthy 9-
month-old infant?
A. Walking independently
B. Speaking in two-word sentences
,C. Transferring objects from one hand to the other
D. Building a tower of three cubes
CORRECT ANSWER: C. Transferring objects from one hand to the other
Rationale: By 9 months of age, infants typically demonstrate refined fine motor skills
such as transferring objects between hands, using a pincer grasp (developing around
this time), and sitting without support. Walking independently usually occurs around
12–15 months, two-word sentences emerge closer to 18–24 months, and building a
three-cube tower is expected around 18 months.
Question 4: A 4-year-old child is admitted with nephrotic syndrome. Which
laboratory finding is most characteristic of this condition?
A. Hematuria
B. Hypoalbuminemia
C. Elevated serum complement C3
D. Hyperkalemia
CORRECT ANSWER: B. Hypoalbuminemia
Rationale: Nephrotic syndrome is defined by massive proteinuria (>40 mg/m²/hr in
children), hypoalbuminemia (<3 g/dL), hyperlipidemia, and edema. The loss of albumin
through the glomerular basement membrane leads to low serum albumin levels, which
drives fluid shifts and causes peripheral edema. Hematuria and low complement levels
are more typical of nephritic syndromes like post-streptococcal glomerulonephritis.
Question 5: What is the recommended route and site for intramuscular injection in
a 2-month-old infant?
A. Deltoid muscle, 90-degree angle
B. Vastus lateralis muscle, 45-degree angle
C. Vastus lateralis muscle, 90-degree angle
D. Ventrogluteal site, 90-degree angle
CORRECT ANSWER: C. Vastus lateralis muscle, 90-degree angle
Rationale: In infants under 12 months of age, the vastus lateralis muscle (located on the
anterolateral thigh) is the preferred site for intramuscular injections due to its size and
lack of major nerves or blood vessels. A 90-degree needle insertion is used to ensure
proper deposition into the muscle tissue, even in young infants.
Question 6: A 10-year-old child with type 1 diabetes presents with nausea,
vomiting, abdominal pain, and Kussmaul respirations. Blood glucose is 450 mg/dL,
and urine ketones are large. What is the priority nursing intervention?
A. Administer subcutaneous insulin as prescribed
B. Provide oral fluids with electrolytes
C. Initiate intravenous insulin infusion after starting IV fluids
D. Encourage ambulation to reduce acidosis
, CORRECT ANSWER: C. Initiate intravenous insulin infusion after starting IV fluids
Rationale: This child is presenting with diabetic ketoacidosis (DKA), a life-threatening
complication of type 1 diabetes. Management begins with isotonic intravenous fluid
resuscitation to restore perfusion and correct dehydration, followed by a continuous IV
insulin infusion to lower blood glucose and halt ketogenesis. Subcutaneous insulin is
ineffective in DKA due to poor absorption during dehydration and acidosis.
Question 7: Which vaccine is contraindicated in a child with a history of
anaphylaxis to egg protein?
A. Hepatitis B vaccine
B. Inactivated polio vaccine (IPV)
C. Measles, mumps, rubella (MMR) vaccine
D. None of the above
CORRECT ANSWER: D. None of the above
Rationale: Current formulations of MMR and influenza vaccines (which historically
raised concerns due to egg-based production) contain negligible amounts of egg
protein and are considered safe even for children with severe egg allergies. Major health
organizations, including the CDC and AAP, state that egg allergy is not a
contraindication to MMR or flu vaccines. Hepatitis B and IPV do not contain egg
proteins.
Question 8: A newborn is diagnosed with congenital hypothyroidism. What is the
primary reason for early detection and treatment?
A. To prevent cardiac arrhythmias
B. To avoid irreversible intellectual disability
C. To reduce risk of neonatal jaundice
D. To prevent growth hormone deficiency
CORRECT ANSWER: B. To avoid irreversible intellectual disability
Rationale: Congenital hypothyroidism results from inadequate thyroid hormone
production, which is critical for normal brain development in the first few years of life.
Without early treatment (ideally within the first 2 weeks of life), profound and
irreversible cognitive impairment can occur. Newborn screening programs aim to detect
and treat this condition promptly to ensure normal neurodevelopment.
Question 9: Which clinical finding is most indicative of increased intracranial
pressure (ICP) in an infant?
A. Sunken fontanelle
B. Bradycardia
C. Bulging anterior fontanelle
D. Tachypnea
CORRECT ANSWER: C. Bulging anterior fontanelle
Detailed Rationales (Updated 2026) | Growth & Development
Milestones, Pediatric Assessment & Vital Signs, Childhood Diseases &
Infections, Pediatric Pharmacology, Respiratory & Cardiac Disorders,
Immunizations & Safety, Family-Centered Care, NCLEX-Style Clinical
Judgment & HESI Pediatrics Success
Question 1: Which of the following is the most appropriate initial action when
assessing a 2-year-old child with suspected epiglottitis?
A. Perform a thorough throat examination using a tongue depressor
B. Administer nebulized racemic epinephrine immediately
C. Obtain intravenous access for fluid resuscitation
D. Maintain the child in a position of comfort and avoid any stimulation of the
oropharynx
CORRECT ANSWER: D. Maintain the child in a position of comfort and avoid any
stimulation of the oropharynx
Rationale: Epiglottitis is a medical emergency characterized by acute inflammation of
the epiglottis, which can lead to rapid airway obstruction. Any attempt to examine the
throat (e.g., with a tongue depressor) may precipitate complete airway closure. The
priority is to keep the child calm, in a position of comfort (often sitting upright), and
avoid any procedures that could trigger laryngospasm until a controlled airway can be
established by specialists.
Question 2: A 6-month-old infant presents with failure to thrive, chronic diarrhea,
and recurrent respiratory infections. Sweat chloride testing reveals a value of 75
mmol/L. What is the most likely diagnosis?
A. Cystic fibrosis
B. Celiac disease
C. Hirschsprung disease
D. Gastroesophageal reflux disease (GERD)
CORRECT ANSWER: A. Cystic fibrosis
Rationale: Cystic fibrosis (CF) is an autosomal recessive disorder caused by mutations
in the CFTR gene, leading to thick, viscous secretions affecting multiple organ systems.
Classic signs include failure to thrive, steatorrhea (due to pancreatic insufficiency),
recurrent pulmonary infections, and elevated sweat chloride levels (>60 mmol/L is
diagnostic). The clinical presentation and confirmatory sweat test strongly support CF.
Question 3: Which developmental milestone is typically achieved by a healthy 9-
month-old infant?
A. Walking independently
B. Speaking in two-word sentences
,C. Transferring objects from one hand to the other
D. Building a tower of three cubes
CORRECT ANSWER: C. Transferring objects from one hand to the other
Rationale: By 9 months of age, infants typically demonstrate refined fine motor skills
such as transferring objects between hands, using a pincer grasp (developing around
this time), and sitting without support. Walking independently usually occurs around
12–15 months, two-word sentences emerge closer to 18–24 months, and building a
three-cube tower is expected around 18 months.
Question 4: A 4-year-old child is admitted with nephrotic syndrome. Which
laboratory finding is most characteristic of this condition?
A. Hematuria
B. Hypoalbuminemia
C. Elevated serum complement C3
D. Hyperkalemia
CORRECT ANSWER: B. Hypoalbuminemia
Rationale: Nephrotic syndrome is defined by massive proteinuria (>40 mg/m²/hr in
children), hypoalbuminemia (<3 g/dL), hyperlipidemia, and edema. The loss of albumin
through the glomerular basement membrane leads to low serum albumin levels, which
drives fluid shifts and causes peripheral edema. Hematuria and low complement levels
are more typical of nephritic syndromes like post-streptococcal glomerulonephritis.
Question 5: What is the recommended route and site for intramuscular injection in
a 2-month-old infant?
A. Deltoid muscle, 90-degree angle
B. Vastus lateralis muscle, 45-degree angle
C. Vastus lateralis muscle, 90-degree angle
D. Ventrogluteal site, 90-degree angle
CORRECT ANSWER: C. Vastus lateralis muscle, 90-degree angle
Rationale: In infants under 12 months of age, the vastus lateralis muscle (located on the
anterolateral thigh) is the preferred site for intramuscular injections due to its size and
lack of major nerves or blood vessels. A 90-degree needle insertion is used to ensure
proper deposition into the muscle tissue, even in young infants.
Question 6: A 10-year-old child with type 1 diabetes presents with nausea,
vomiting, abdominal pain, and Kussmaul respirations. Blood glucose is 450 mg/dL,
and urine ketones are large. What is the priority nursing intervention?
A. Administer subcutaneous insulin as prescribed
B. Provide oral fluids with electrolytes
C. Initiate intravenous insulin infusion after starting IV fluids
D. Encourage ambulation to reduce acidosis
, CORRECT ANSWER: C. Initiate intravenous insulin infusion after starting IV fluids
Rationale: This child is presenting with diabetic ketoacidosis (DKA), a life-threatening
complication of type 1 diabetes. Management begins with isotonic intravenous fluid
resuscitation to restore perfusion and correct dehydration, followed by a continuous IV
insulin infusion to lower blood glucose and halt ketogenesis. Subcutaneous insulin is
ineffective in DKA due to poor absorption during dehydration and acidosis.
Question 7: Which vaccine is contraindicated in a child with a history of
anaphylaxis to egg protein?
A. Hepatitis B vaccine
B. Inactivated polio vaccine (IPV)
C. Measles, mumps, rubella (MMR) vaccine
D. None of the above
CORRECT ANSWER: D. None of the above
Rationale: Current formulations of MMR and influenza vaccines (which historically
raised concerns due to egg-based production) contain negligible amounts of egg
protein and are considered safe even for children with severe egg allergies. Major health
organizations, including the CDC and AAP, state that egg allergy is not a
contraindication to MMR or flu vaccines. Hepatitis B and IPV do not contain egg
proteins.
Question 8: A newborn is diagnosed with congenital hypothyroidism. What is the
primary reason for early detection and treatment?
A. To prevent cardiac arrhythmias
B. To avoid irreversible intellectual disability
C. To reduce risk of neonatal jaundice
D. To prevent growth hormone deficiency
CORRECT ANSWER: B. To avoid irreversible intellectual disability
Rationale: Congenital hypothyroidism results from inadequate thyroid hormone
production, which is critical for normal brain development in the first few years of life.
Without early treatment (ideally within the first 2 weeks of life), profound and
irreversible cognitive impairment can occur. Newborn screening programs aim to detect
and treat this condition promptly to ensure normal neurodevelopment.
Question 9: Which clinical finding is most indicative of increased intracranial
pressure (ICP) in an infant?
A. Sunken fontanelle
B. Bradycardia
C. Bulging anterior fontanelle
D. Tachypnea
CORRECT ANSWER: C. Bulging anterior fontanelle
