HESI RN PEDS Exam Questions & Answers (Verified Answers)
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190 Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Pediatric Nursing
Description Comprehensive examination covering growth and development, pediatric
pathophysiology, pharmacology, family-centered care, and evidence-based
interventions for children across the lifespan. Emphasizes clinical reasoning,
prioritization, and safety in pediatric nursing practice.
Expected Grade A+
Total Questions 190
Duration 3 hours
Learning Outcomes 1. Apply principles of growth and development to nursing care of children.
2. Analyze pathophysiological changes in common pediatric conditions.
3. Evaluate pharmacological interventions considering pediatric
pharmacokinetics.
4. Integrate family-centered care and ethical considerations in pediatric nursing.
5. Prioritize nursing interventions for acute and chronic pediatric conditions.
Accreditation This examination meets the standards of the Commission on Collegiate Nursing
Education (CCNE) for baccalaureate nursing programs.
Page 1
,1. A nurse is assessing a child with suspected increased intracranial pressure (ICP).
Which assessment finding is most indicative of early decompensation in a child
without a bulging fontanel?
A. Sunsetting eyes
B. Cushing's triad (bradycardia, hypertension, irregular respirations)
C. Pupillary dilation unresponsive to light
D. Decorticate posturing
Answer: A. Sunsetting eyes
Sunsetting eyes (downward gaze with sclera visible above the iris) is an early sign of
increased ICP in children, often preceding Cushing's triad. Cushing's triad (B) is a late
sign. Pupillary dilation (C) indicates midbrain compression. Decorticate posturing (D)
suggests severe brain injury.
2. A child with acute lymphoblastic leukemia (ALL) is receiving high-dose
methotrexate. Which laboratory value requires immediate intervention to prevent
nephrotoxicity?
A. Serum creatinine 0.6 mg/dL
B. Urine pH 5.0
C. Serum potassium 3.8 mEq/L
D. Hemoglobin 10.5 g/dL
Answer: B. Urine pH 5.0
Methotrexate precipitates in acidic urine, causing nephrotoxicity. Urine pH should be
>7.0 during therapy. A pH of 5.0 indicates acidic urine, requiring alkalinization. Serum
creatinine (A) is normal. Potassium (C) and hemoglobin (D) are within acceptable
ranges.
Page 2
,3. A nurse is teaching a family about managing a child with type 1 diabetes during
illness. Which statement by the parent indicates a correct understanding of sick-day
management?
A. I should stop insulin until the child is eating normally.
B. I should check urine for ketones every 4 hours.
C. I should give extra insulin if blood glucose is below 200 mg/dL.
D. I should avoid giving sugar-free liquids.
Answer: B. I should check urine for ketones every 4 hours.
During illness, ketone monitoring is essential to detect diabetic ketoacidosis. Insulin
should never be withheld (A); instead, doses may need adjustment. Extra insulin is not
given for hypoglycemia (C). Sugar-free liquids are recommended to maintain hydration
without elevating blood glucose (D).
4. A child with cystic fibrosis (CF) is admitted with a pulmonary exacerbation.
Which priority intervention should the nurse implement first?
A. Administer intravenous antibiotics as prescribed
B. Perform chest physiotherapy (CPT) immediately
C. Obtain sputum culture and sensitivity
D. Start oxygen via nasal cannula at 2 L/min
Answer: C. Obtain sputum culture and sensitivity
Obtaining a sputum culture before antibiotics ensures targeted therapy. Administering
antibiotics (A) without culture may be necessary if culture is delayed, but ideally
culture is obtained first. CPT (B) and oxygen (D) are important but secondary to
identifying the pathogen.
5. A nurse is evaluating a child with nephrotic syndrome. Which assessment finding
indicates a complication requiring immediate intervention?
A. Periorbital edema
B. Urine protein 3+
C. Abdominal pain with distention
D. Serum albumin 2.0 g/dL
Answer: C. Abdominal pain with distention
Abdominal pain with distention may indicate peritonitis or thrombosis, life-threatening
complications in nephrotic syndrome. Periorbital edema (A) and proteinuria (B) are
common findings. Low albumin (D) is expected but not emergent.
Page 3
, 6. A nurse is caring for a child with suspected appendicitis. Which assessment
finding is most suggestive of perforation?
A. Sudden relief of pain followed by generalized abdominal tenderness
B. Rebound tenderness at McBurney's point
C. Low-grade fever and anorexia
D. Positive psoas sign
Answer: A. Sudden relief of pain followed by generalized abdominal tenderness
Sudden pain relief followed by generalized tenderness indicates perforation as the
appendix ruptures, releasing pressure. Rebound tenderness (B) is common with acute
appendicitis. Low-grade fever (C) and psoas sign (D) are associated with inflammation
but not specific for perforation.
7. A child with sickle cell disease presents with severe vaso-occlusive crisis. Which
intervention should the nurse prioritize?
A. Administer meperidine for pain
B. Apply cold compresses to painful joints
C. Start intravenous fluids at 1.5 times maintenance
D. Transfuse packed red blood cells immediately
Answer: C. Start intravenous fluids at 1.5 times maintenance
Aggressive hydration is key to reduce blood viscosity and improve flow. Meperidine (A)
is avoided due to risk of seizures. Cold compresses (B) cause vasoconstriction and
worsen sickling. Transfusion (D) is reserved for acute chest syndrome or stroke, not
routine crisis.
8. A nurse is administering immunizations to an infant. Which injection site and
technique are correct for the DTaP vaccine?
A. Deltoid muscle, 1-inch needle, 90-degree angle
B. Vastus lateralis muscle, 1-inch needle, 90-degree angle
C. Ventrogluteal muscle, 5/8-inch needle, 45-degree angle
D. Subcutaneous tissue of the upper arm, 5/8-inch needle, 45-degree angle
Answer: B. Vastus lateralis muscle, 1-inch needle, 90-degree angle
DTaP is an intramuscular vaccine; the vastus lateralis is the preferred site in infants. A
1-inch needle ensures deep muscle penetration at 90 degrees. Deltoid (A) is used in older
children. Ventrogluteal (C) is for older children/adults. Subcutaneous (D) is incorrect
for DTaP.
Page 4
With Rationales, 100% Guaranteed Pass || Complete A+ Guide -
190 Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Pediatric Nursing
Description Comprehensive examination covering growth and development, pediatric
pathophysiology, pharmacology, family-centered care, and evidence-based
interventions for children across the lifespan. Emphasizes clinical reasoning,
prioritization, and safety in pediatric nursing practice.
Expected Grade A+
Total Questions 190
Duration 3 hours
Learning Outcomes 1. Apply principles of growth and development to nursing care of children.
2. Analyze pathophysiological changes in common pediatric conditions.
3. Evaluate pharmacological interventions considering pediatric
pharmacokinetics.
4. Integrate family-centered care and ethical considerations in pediatric nursing.
5. Prioritize nursing interventions for acute and chronic pediatric conditions.
Accreditation This examination meets the standards of the Commission on Collegiate Nursing
Education (CCNE) for baccalaureate nursing programs.
Page 1
,1. A nurse is assessing a child with suspected increased intracranial pressure (ICP).
Which assessment finding is most indicative of early decompensation in a child
without a bulging fontanel?
A. Sunsetting eyes
B. Cushing's triad (bradycardia, hypertension, irregular respirations)
C. Pupillary dilation unresponsive to light
D. Decorticate posturing
Answer: A. Sunsetting eyes
Sunsetting eyes (downward gaze with sclera visible above the iris) is an early sign of
increased ICP in children, often preceding Cushing's triad. Cushing's triad (B) is a late
sign. Pupillary dilation (C) indicates midbrain compression. Decorticate posturing (D)
suggests severe brain injury.
2. A child with acute lymphoblastic leukemia (ALL) is receiving high-dose
methotrexate. Which laboratory value requires immediate intervention to prevent
nephrotoxicity?
A. Serum creatinine 0.6 mg/dL
B. Urine pH 5.0
C. Serum potassium 3.8 mEq/L
D. Hemoglobin 10.5 g/dL
Answer: B. Urine pH 5.0
Methotrexate precipitates in acidic urine, causing nephrotoxicity. Urine pH should be
>7.0 during therapy. A pH of 5.0 indicates acidic urine, requiring alkalinization. Serum
creatinine (A) is normal. Potassium (C) and hemoglobin (D) are within acceptable
ranges.
Page 2
,3. A nurse is teaching a family about managing a child with type 1 diabetes during
illness. Which statement by the parent indicates a correct understanding of sick-day
management?
A. I should stop insulin until the child is eating normally.
B. I should check urine for ketones every 4 hours.
C. I should give extra insulin if blood glucose is below 200 mg/dL.
D. I should avoid giving sugar-free liquids.
Answer: B. I should check urine for ketones every 4 hours.
During illness, ketone monitoring is essential to detect diabetic ketoacidosis. Insulin
should never be withheld (A); instead, doses may need adjustment. Extra insulin is not
given for hypoglycemia (C). Sugar-free liquids are recommended to maintain hydration
without elevating blood glucose (D).
4. A child with cystic fibrosis (CF) is admitted with a pulmonary exacerbation.
Which priority intervention should the nurse implement first?
A. Administer intravenous antibiotics as prescribed
B. Perform chest physiotherapy (CPT) immediately
C. Obtain sputum culture and sensitivity
D. Start oxygen via nasal cannula at 2 L/min
Answer: C. Obtain sputum culture and sensitivity
Obtaining a sputum culture before antibiotics ensures targeted therapy. Administering
antibiotics (A) without culture may be necessary if culture is delayed, but ideally
culture is obtained first. CPT (B) and oxygen (D) are important but secondary to
identifying the pathogen.
5. A nurse is evaluating a child with nephrotic syndrome. Which assessment finding
indicates a complication requiring immediate intervention?
A. Periorbital edema
B. Urine protein 3+
C. Abdominal pain with distention
D. Serum albumin 2.0 g/dL
Answer: C. Abdominal pain with distention
Abdominal pain with distention may indicate peritonitis or thrombosis, life-threatening
complications in nephrotic syndrome. Periorbital edema (A) and proteinuria (B) are
common findings. Low albumin (D) is expected but not emergent.
Page 3
, 6. A nurse is caring for a child with suspected appendicitis. Which assessment
finding is most suggestive of perforation?
A. Sudden relief of pain followed by generalized abdominal tenderness
B. Rebound tenderness at McBurney's point
C. Low-grade fever and anorexia
D. Positive psoas sign
Answer: A. Sudden relief of pain followed by generalized abdominal tenderness
Sudden pain relief followed by generalized tenderness indicates perforation as the
appendix ruptures, releasing pressure. Rebound tenderness (B) is common with acute
appendicitis. Low-grade fever (C) and psoas sign (D) are associated with inflammation
but not specific for perforation.
7. A child with sickle cell disease presents with severe vaso-occlusive crisis. Which
intervention should the nurse prioritize?
A. Administer meperidine for pain
B. Apply cold compresses to painful joints
C. Start intravenous fluids at 1.5 times maintenance
D. Transfuse packed red blood cells immediately
Answer: C. Start intravenous fluids at 1.5 times maintenance
Aggressive hydration is key to reduce blood viscosity and improve flow. Meperidine (A)
is avoided due to risk of seizures. Cold compresses (B) cause vasoconstriction and
worsen sickling. Transfusion (D) is reserved for acute chest syndrome or stroke, not
routine crisis.
8. A nurse is administering immunizations to an infant. Which injection site and
technique are correct for the DTaP vaccine?
A. Deltoid muscle, 1-inch needle, 90-degree angle
B. Vastus lateralis muscle, 1-inch needle, 90-degree angle
C. Ventrogluteal muscle, 5/8-inch needle, 45-degree angle
D. Subcutaneous tissue of the upper arm, 5/8-inch needle, 45-degree angle
Answer: B. Vastus lateralis muscle, 1-inch needle, 90-degree angle
DTaP is an intramuscular vaccine; the vastus lateralis is the preferred site in infants. A
1-inch needle ensures deep muscle penetration at 90 degrees. Deltoid (A) is used in older
children. Ventrogluteal (C) is for older children/adults. Subcutaneous (D) is incorrect
for DTaP.
Page 4
