Pediatrics HESI Exam
400 Questions with Correct Answers
With Rationales Reviewed 2026- 2027
1. A six-month-old returns from surgery with elbow restraints in place. What nursing care
should be included when caring for any restrained child?
Keep restraints on at all times.
Remove restraints one at a time and provide range of motion exercises.
Remove all restraints simultaneously and provide play activities.
Renew the healthcare provider's prescription for restraints every 72 hours. - ANSWER-
Remove restraints one at a time and provide range of motion exercises.
Removing restraints one at a time (B) is safer than removing all of them at once (C). The
child needs to exercise and should not be kept in restraints at all times (A). The renewal
of the healthcare provider's prescription varies with hospitals (D), and it does not really
answer the question.
2. All of the following interventions can be used to evaluate the effectiveness of nursing and
medical interventions used to treat diarrhea. Which intervention is least useful in the
nurse's evaluation of a 20-month-old child?
Weighing diapers.
Assessing fontanels.
Checking skin turgor.
Observing mucous membranes for moisture. - ANSWER-Assessing fontanels.
All of these interventions evaluate fluid status in infants. But, how old is this child?
Posterior fontanel closes at 2 months and anterior fontanel closes by 18 months of age
(B)! Remember normal growth and development!
3. As part of the physical assessment of children, the nurse observes and palpates the
fontanels. Which child's fontanel finding should be reported to the healthcare provider?
A 6-month-old with failure to thrive that has a closed anterior fontanel.
A 24-month-old with gastroenteritis that has a closed posterior fontanel.
A 2-month-old with chickenpox that has an open posterior fontanel.
A 28-month-old with hydrocephalus that has an open anterior fontanel. - ANSWER-A 6-
month-old with failure to thrive that has a closed anterior fontanel.
At six months of age the anterior fontanel should be open, and it should not be closed
until approximately 18 months of age. (B and C) are normal findings. A child with
hydrocephalus may have a delayed closing of the fontanel (D).
4. The nurse receives a lab report stating a child with asthma has a theophylline level of 15
mcg/dl. What action will the nurse take?
Pass the information on in the report.
Notify the healthcare provider because the value is high.
, Repeat the lab study because the value is too high.
Hold the next dose of theophylline. - ANSWER-Pass the information on in the report.
The therapeutic level of theophylline is 10 to 20 mcg/dl, so the child's level is within the
therapeutic range. This information evaluates the prescribed therapy and should be
communicated in the nurse's report (A). (B, C, and D) would be inappropriate actions in
view of the laboratory finding.
5. The nurse is having difficulty communicating with a hospitalized 6-year-old child. Which
approach by the nurse is most helpful in establishing communication?
Engage the child through drawing pictures.
Suggest that the parent read a book to the child.
Provide paper and pencil for the child to keep a diary.
Ask the parent if the child is always uncommunicative. - ANSWER-Engage the child
through drawing pictures.
Drawing pictures (A) is a valuable form of non-verbal communication. As the nurse and
child look at the drawings, a verbal story can be told that projects the child's thinking. (B)
may distract the child, but does not establish communication with the nurse. (C) is useful
for an older child who is able to write. (D) is important, but engaging the child is more
effective in establishing communication patterns.
6. The nurse is caring for a 12-year-old with Syndrome of Inappropriate Antidiuretic
Hormone (SIADH). This child should be carefully assessed for which complication?
Poor skin turgor resulting from dehydration.
Changes in level of consciousness.
Premature aging as the disease progresses.
Severe edema from an excess of water and sodium. - ANSWER-Changes in level of
consciousness.
The child must be monitored for signs and symptoms of hyponatremia, which creates
secondary central nervous system alterations such as changes in level of consciousness,
seizure, and coma (B). Fluid overload occurs with SIADH, not (A) (which occurs with
diabetes insipidus). (C) is caused by hypersecretion of growth hormone, not SIADH. (D)
is not found in children with SIADH because edema is caused by an excess of both water
and sodium.
7. A 6-month-old infant with congestive heart failure (CHF) is receiving digoxin elixir.
Which observation by the nurse warrants immediate intervention?
Apical heart rate of 60.
Sweating across the forehead.
Doesn't suck well.
Respiratory rate of 30 breaths per minute. - ANSWER-Apical heart rate of 60.
, A heart rate of 60 (A) is much lower than normal for a 6-month-old and warrants
immediate intervention. The normal heart rate for a 6-month-old is 80 to 150 BPM when
awake, and a rate of 70 while sleeping is considered within normal limits. (B and C) are
expected symptoms of heart failure in an infant. (D) is within normal limits for an infant.
8. The nurse is teaching the parents of a 5-year-old with cystic fibrosis about respiratory
treatments. Which statement indicates to the nurse that the parents understand?
Perform postural drainage before starting aerosol therapy.
Give respiratory treatments when the child is coughing a lot.
Administer aerosol therapy followed by postural drainage before meals.
Ensure respiratory therapy is done daily during any respiratory infection. - ANSWER-
Administer aerosol therapy followed by postural drainage before meals.
9. Postural drainage for a child with cystic fibrosis is most effective when performed after
nebulization and before meals (C) or at least 1 hour after eating to prevent nausea and
vomiting. Postural drainage uses gravity to promote mucous removal after nebulization
(A) treatments which open the airways. Pulmonary toileting or respiratory treatments
should be given 3 to 4 times daily, not episodically (B and D).
10. A female teenager is taking oral tetracycline HCL (Achromycin V) for acne vulgaris.
What is the most important instruction for the nurse to include in this client's teaching
plan?
Use sunscreen when lying by the pool.
Cleanse the skin at least 4 times a day.
Take the medication with a glass of milk.
Menstrual periods may become irregular. - ANSWER-Use sunscreen when lying by the
pool.
Photosensitivity is a common side effect of tetracycline HCL (Achromycin V) therapy.
Severe sunburn can occur with minimal sun exposure and clients should be instructed to
avoid sunlight and to use sunscreen (A). (B and D) are not related to tetracycline HCL
(Achromycin V) therapy. (C) should be avoided because dairy products interfere with the
absorption of tetracyclines.
11. What preoperative nursing intervention should be included in the plan of care for an
infant with pyloric stenosis?
Monitor for signs of metabolic acidosis.
Estimate the quantity of diarrhea stools.
Place in a supine position after feeding.
Observe for projectile vomiting. - ANSWER-Observe for projectile vomiting.
Projectile vomiting (D), which contributes to metabolic alkalosis (A), is the classic sign
of pyloric stenosis. (B) is not indicated. (C) is dangerous, due to the potential for
aspiration with frequent vomiting.
, 12. An infant is born with a ventricular septal defect (VSD) and surgery is planned to correct
the defect. The nurse recognizes that surgical correction is designed to achieve which
outcome?
Stop the flow of unoxygenated blood into systemic circulation.
Increase the flow of unoxygenated blood to the lungs.
Prevent the return of oxygenated blood to the lungs.
Reduce peripheral tissue hypoxia and nailbed clubbing - ANSWER-Prevent the return of
oxygenated blood to the lungs.
Closure of vsds stops oxygenated blood from being shunted from the left ventricle to the
right ventricle (C). Vsds are a cyanotic defects, which means that no unoxygenated blood
enters the systemic circulation (A and B). (D) is common with Tetrology of Fallot, which
is a cyanotic defect.
13. A 3-week-old newborn is brought to the clinic for follow-up after a home birth. The
mother reports that her child bottle feeds for 5 minutes only and then falls asleep. The
nurse auscultates a loud murmur characteristic of a ventricular septal defect (VSD), and
finds the newborn is a cyanotic with a respiratory rate of 64 breaths per minute. What
instruction should the nurse provide the mother to ensure the infant is receiving adequate
intake? (Select all that apply.)
A. Monitor the infant's weight and number of wet diapers per day.
B. Increase the infant's intake per feeding by 1 to 2 ounces per week.
C. Mix the dose of prophylactic antibiotic in a full bottle of formula.
D. Allow the infant to rest and refeed on demand or every 2 hours.
E. Use a softer nipple or increase the size of the nipple opening. - ANSWER-A.
Monitor the infant's weight and number of wet diapers per day.
B. Increase the infant's intake per feeding by 1 to 2 ounces per week.
D. Allow the infant to rest and refeed on demand or every 2 hours.
E. Use a softer nipple or increase the size of the nipple opening.
14. Antibiotic prophylaxis is recommended for infants with vsds, but should not be mixed in
a bottle of formula (C) because it is difficult to ensure that the total dose is consumed.
They should be monitored for weight gain and at least 6 wet diapers per day (A). A one-
month old infant should ingest 2 to 4 ounces of formula per feeding and progress to about
30 ounces per day by 4-months of age (B)
Preoperative nursing care for a child with Wilms' tumor should include which
intervention?
Gently percuss the abdomen for evidence of trapped air.
Observe the abdomen for any noticeable discolorations.
Apply cold compresses to the abdomen to reduce edema.
Put a sign on the bed reading, "DO NOT PALPATE ABDOMEN." - ANSWER-Put a
sign on the bed reading, "DO NOT PALPATE ABDOMEN."
400 Questions with Correct Answers
With Rationales Reviewed 2026- 2027
1. A six-month-old returns from surgery with elbow restraints in place. What nursing care
should be included when caring for any restrained child?
Keep restraints on at all times.
Remove restraints one at a time and provide range of motion exercises.
Remove all restraints simultaneously and provide play activities.
Renew the healthcare provider's prescription for restraints every 72 hours. - ANSWER-
Remove restraints one at a time and provide range of motion exercises.
Removing restraints one at a time (B) is safer than removing all of them at once (C). The
child needs to exercise and should not be kept in restraints at all times (A). The renewal
of the healthcare provider's prescription varies with hospitals (D), and it does not really
answer the question.
2. All of the following interventions can be used to evaluate the effectiveness of nursing and
medical interventions used to treat diarrhea. Which intervention is least useful in the
nurse's evaluation of a 20-month-old child?
Weighing diapers.
Assessing fontanels.
Checking skin turgor.
Observing mucous membranes for moisture. - ANSWER-Assessing fontanels.
All of these interventions evaluate fluid status in infants. But, how old is this child?
Posterior fontanel closes at 2 months and anterior fontanel closes by 18 months of age
(B)! Remember normal growth and development!
3. As part of the physical assessment of children, the nurse observes and palpates the
fontanels. Which child's fontanel finding should be reported to the healthcare provider?
A 6-month-old with failure to thrive that has a closed anterior fontanel.
A 24-month-old with gastroenteritis that has a closed posterior fontanel.
A 2-month-old with chickenpox that has an open posterior fontanel.
A 28-month-old with hydrocephalus that has an open anterior fontanel. - ANSWER-A 6-
month-old with failure to thrive that has a closed anterior fontanel.
At six months of age the anterior fontanel should be open, and it should not be closed
until approximately 18 months of age. (B and C) are normal findings. A child with
hydrocephalus may have a delayed closing of the fontanel (D).
4. The nurse receives a lab report stating a child with asthma has a theophylline level of 15
mcg/dl. What action will the nurse take?
Pass the information on in the report.
Notify the healthcare provider because the value is high.
, Repeat the lab study because the value is too high.
Hold the next dose of theophylline. - ANSWER-Pass the information on in the report.
The therapeutic level of theophylline is 10 to 20 mcg/dl, so the child's level is within the
therapeutic range. This information evaluates the prescribed therapy and should be
communicated in the nurse's report (A). (B, C, and D) would be inappropriate actions in
view of the laboratory finding.
5. The nurse is having difficulty communicating with a hospitalized 6-year-old child. Which
approach by the nurse is most helpful in establishing communication?
Engage the child through drawing pictures.
Suggest that the parent read a book to the child.
Provide paper and pencil for the child to keep a diary.
Ask the parent if the child is always uncommunicative. - ANSWER-Engage the child
through drawing pictures.
Drawing pictures (A) is a valuable form of non-verbal communication. As the nurse and
child look at the drawings, a verbal story can be told that projects the child's thinking. (B)
may distract the child, but does not establish communication with the nurse. (C) is useful
for an older child who is able to write. (D) is important, but engaging the child is more
effective in establishing communication patterns.
6. The nurse is caring for a 12-year-old with Syndrome of Inappropriate Antidiuretic
Hormone (SIADH). This child should be carefully assessed for which complication?
Poor skin turgor resulting from dehydration.
Changes in level of consciousness.
Premature aging as the disease progresses.
Severe edema from an excess of water and sodium. - ANSWER-Changes in level of
consciousness.
The child must be monitored for signs and symptoms of hyponatremia, which creates
secondary central nervous system alterations such as changes in level of consciousness,
seizure, and coma (B). Fluid overload occurs with SIADH, not (A) (which occurs with
diabetes insipidus). (C) is caused by hypersecretion of growth hormone, not SIADH. (D)
is not found in children with SIADH because edema is caused by an excess of both water
and sodium.
7. A 6-month-old infant with congestive heart failure (CHF) is receiving digoxin elixir.
Which observation by the nurse warrants immediate intervention?
Apical heart rate of 60.
Sweating across the forehead.
Doesn't suck well.
Respiratory rate of 30 breaths per minute. - ANSWER-Apical heart rate of 60.
, A heart rate of 60 (A) is much lower than normal for a 6-month-old and warrants
immediate intervention. The normal heart rate for a 6-month-old is 80 to 150 BPM when
awake, and a rate of 70 while sleeping is considered within normal limits. (B and C) are
expected symptoms of heart failure in an infant. (D) is within normal limits for an infant.
8. The nurse is teaching the parents of a 5-year-old with cystic fibrosis about respiratory
treatments. Which statement indicates to the nurse that the parents understand?
Perform postural drainage before starting aerosol therapy.
Give respiratory treatments when the child is coughing a lot.
Administer aerosol therapy followed by postural drainage before meals.
Ensure respiratory therapy is done daily during any respiratory infection. - ANSWER-
Administer aerosol therapy followed by postural drainage before meals.
9. Postural drainage for a child with cystic fibrosis is most effective when performed after
nebulization and before meals (C) or at least 1 hour after eating to prevent nausea and
vomiting. Postural drainage uses gravity to promote mucous removal after nebulization
(A) treatments which open the airways. Pulmonary toileting or respiratory treatments
should be given 3 to 4 times daily, not episodically (B and D).
10. A female teenager is taking oral tetracycline HCL (Achromycin V) for acne vulgaris.
What is the most important instruction for the nurse to include in this client's teaching
plan?
Use sunscreen when lying by the pool.
Cleanse the skin at least 4 times a day.
Take the medication with a glass of milk.
Menstrual periods may become irregular. - ANSWER-Use sunscreen when lying by the
pool.
Photosensitivity is a common side effect of tetracycline HCL (Achromycin V) therapy.
Severe sunburn can occur with minimal sun exposure and clients should be instructed to
avoid sunlight and to use sunscreen (A). (B and D) are not related to tetracycline HCL
(Achromycin V) therapy. (C) should be avoided because dairy products interfere with the
absorption of tetracyclines.
11. What preoperative nursing intervention should be included in the plan of care for an
infant with pyloric stenosis?
Monitor for signs of metabolic acidosis.
Estimate the quantity of diarrhea stools.
Place in a supine position after feeding.
Observe for projectile vomiting. - ANSWER-Observe for projectile vomiting.
Projectile vomiting (D), which contributes to metabolic alkalosis (A), is the classic sign
of pyloric stenosis. (B) is not indicated. (C) is dangerous, due to the potential for
aspiration with frequent vomiting.
, 12. An infant is born with a ventricular septal defect (VSD) and surgery is planned to correct
the defect. The nurse recognizes that surgical correction is designed to achieve which
outcome?
Stop the flow of unoxygenated blood into systemic circulation.
Increase the flow of unoxygenated blood to the lungs.
Prevent the return of oxygenated blood to the lungs.
Reduce peripheral tissue hypoxia and nailbed clubbing - ANSWER-Prevent the return of
oxygenated blood to the lungs.
Closure of vsds stops oxygenated blood from being shunted from the left ventricle to the
right ventricle (C). Vsds are a cyanotic defects, which means that no unoxygenated blood
enters the systemic circulation (A and B). (D) is common with Tetrology of Fallot, which
is a cyanotic defect.
13. A 3-week-old newborn is brought to the clinic for follow-up after a home birth. The
mother reports that her child bottle feeds for 5 minutes only and then falls asleep. The
nurse auscultates a loud murmur characteristic of a ventricular septal defect (VSD), and
finds the newborn is a cyanotic with a respiratory rate of 64 breaths per minute. What
instruction should the nurse provide the mother to ensure the infant is receiving adequate
intake? (Select all that apply.)
A. Monitor the infant's weight and number of wet diapers per day.
B. Increase the infant's intake per feeding by 1 to 2 ounces per week.
C. Mix the dose of prophylactic antibiotic in a full bottle of formula.
D. Allow the infant to rest and refeed on demand or every 2 hours.
E. Use a softer nipple or increase the size of the nipple opening. - ANSWER-A.
Monitor the infant's weight and number of wet diapers per day.
B. Increase the infant's intake per feeding by 1 to 2 ounces per week.
D. Allow the infant to rest and refeed on demand or every 2 hours.
E. Use a softer nipple or increase the size of the nipple opening.
14. Antibiotic prophylaxis is recommended for infants with vsds, but should not be mixed in
a bottle of formula (C) because it is difficult to ensure that the total dose is consumed.
They should be monitored for weight gain and at least 6 wet diapers per day (A). A one-
month old infant should ingest 2 to 4 ounces of formula per feeding and progress to about
30 ounces per day by 4-months of age (B)
Preoperative nursing care for a child with Wilms' tumor should include which
intervention?
Gently percuss the abdomen for evidence of trapped air.
Observe the abdomen for any noticeable discolorations.
Apply cold compresses to the abdomen to reduce edema.
Put a sign on the bed reading, "DO NOT PALPATE ABDOMEN." - ANSWER-Put a
sign on the bed reading, "DO NOT PALPATE ABDOMEN."
