HESI Specialty Exam: Pediatrics
& Maternity (2024/2025)
SECTION 1: PEDIATRIC NURSING (30 Questions)
Q1: A nurse is caring for a 6-month-old infant brought to the clinic for a well-child visit. The
parent reports the infant can sit with support, rolls from back to front, and reaches for toys
but cannot yet sit independently. Which action by the nurse is most appropriate?
A. Refer the infant for developmental evaluation due to delayed sitting skills
B. Reassure the parent that these milestones are appropriate for age [CORRECT]
C. Instruct the parent to begin assisted walking exercises immediately
D. Document developmental delay and schedule follow-up in 1 week
Correct Answer: B
Rationale: According to Denver II developmental screening guidelines, sitting without support
typically emerges between 5-7 months of age. At 6 months, sitting with support, rolling both
ways, and reaching are all age-appropriate milestones. Independent sitting usually develops
by 7-8 months. Option A is incorrect because independent sitting is not yet expected at 6
months. Option C is inappropriate as walking preparation should not begin before standing
independently (9-12 months). Option D incorrectly labels normal variation as delay, potentially
causing unnecessary parental anxiety (AAP, 2023).
Q2: A 4-year-old child is admitted with suspected dehydration secondary to gastroenteritis.
Assessment reveals: heart rate 128 bpm, blood pressure 88/52 mmHg, capillary refill 4
seconds, and skin turgor with tenting noted on the abdomen. The child has dry mucous
membranes and has had only one wet diaper in 8 hours. Which nursing intervention is the
priority?
A. Offer oral rehydration solution in small, frequent amounts
B. Initiate IV access and begin isotonic fluid resuscitation [CORRECT]
C. Insert a nasogastric tube for enteral rehydration
,D. Administer antidiarrheal medication per protocol
Correct Answer: B
Rationale: This child demonstrates moderate to severe dehydration (tachycardia, prolonged
capillary refill >3 seconds, skin tenting, decreased urine output, dry mucous membranes). The
priority follows the ABCs of pediatric assessment—maintaining circulation. IV fluid
resuscitation with isotonic solution (normal saline or lactated Ringer's) is indicated for
moderate-severe dehydration or when oral intake is insufficient. Option A is inappropriate for
moderate-severe dehydration where oral fluids are contraindicated. Option C delays definitive
treatment. Option D is contraindicated as antidiarrheals can worsen certain infections and
mask severity (AAP, 2022).
Q3: A nurse is teaching parents of a 2-month-old infant about the recommended
immunization schedule. Which statement by the parent indicates understanding of the
teaching?
A. "My baby will receive the first dose of MMR vaccine at this visit"
B. "The hepatitis B vaccine requires a total of three doses over 6 months" [CORRECT]
C. "I can delay all vaccines until my baby starts daycare at 6 months"
D. "The DTaP vaccine protects against measles, mumps, and rubella"
Correct Answer: B
Rationale: The hepatitis B vaccine series consists of three doses: birth, 1-2 months, and 6-18
months. Option A is incorrect—MMR (measles-mumps-rubella) is first administered at 12-15
months. Option C demonstrates a dangerous misconception; vaccines should not be delayed
unnecessarily as infants are vulnerable to serious vaccine-preventable diseases. Option D is
incorrect—DTaP protects against diphtheria, tetanus, and pertussis (whooping cough), not
measles. The CDC Advisory Committee on Immunization Practices (ACIP) recommends
beginning the primary immunization series at 2 months including DTaP, IPV, Hib, PCV13, and
rotavirus (CDC, 2024).
Q4: A school nurse is caring for a 7-year-old with asthma who arrives at the health office with
wheezing, mild retractions, and an respiratory rate of 28 breaths/minute. The child can speak
in full sentences. Which action should the nurse take first?
A. Call 911 for emergency transport immediately
B. Administer the child's prescribed quick-relief bronchodilator [CORRECT]
, C. Have the child lie flat to improve ventilation
D. Contact the parent to pick up the child without intervention
Correct Answer: B
Rationale: This child exhibits mild asthma exacerbation (speaking in full sentences, RR
28/min—slightly elevated for age, mild retractions). According to NHLBI asthma guidelines,
the first-line treatment for acute symptoms is a short-acting beta-agonist (SABA)
bronchodilator. The nurse should administer the child's prescribed rescue inhaler with spacer.
Option A is premature as there are no severe distress signs (inability to speak, cyanosis,
severe retractions). Option C is contraindicated—supine positioning worsens respiratory
distress; the child should sit upright. Option D delays necessary treatment and jeopardizes
safety (NHLBI, 2022).
Q5: A nurse is caring for a 12-year-old newly diagnosed with Type 1 Diabetes Mellitus. The
child asks, "Why do I need insulin shots when my friend with diabetes just takes pills?" Which
response by the nurse is most appropriate?
A. "Your friend probably has Type 2 diabetes, which is caused by lifestyle choices"
B. "Type 1 diabetes means your pancreas doesn't make insulin, so you need injections to
replace it" [CORRECT]
C. "You'll probably be able to switch to pills once your blood sugar is controlled"
D. "Children always need insulin; adults can sometimes use pills instead"
Correct Answer: B
Rationale: This response provides developmentally appropriate education distinguishing Type
1 (autoimmune destruction of pancreatic beta cells, absolute insulin deficiency) from Type 2
(insulin resistance with relative deficiency). Type 1 requires exogenous insulin for survival.
Option A incorrectly implies Type 2 is solely lifestyle-related and may induce shame. Option C
is factually incorrect—Type 1 diabetes always requires insulin regardless of control. Option D
is inaccurate as both children and adults with Type 1 require insulin. The explanation
supports the child's understanding of their chronic condition (ADA, 2024).
Q6: A pediatric nurse is caring for a 3-month-old with a ventricular septal defect (VSD). Which
assessment finding requires immediate notification of the healthcare provider?
A. Heart murmur audible at the left sternal border
& Maternity (2024/2025)
SECTION 1: PEDIATRIC NURSING (30 Questions)
Q1: A nurse is caring for a 6-month-old infant brought to the clinic for a well-child visit. The
parent reports the infant can sit with support, rolls from back to front, and reaches for toys
but cannot yet sit independently. Which action by the nurse is most appropriate?
A. Refer the infant for developmental evaluation due to delayed sitting skills
B. Reassure the parent that these milestones are appropriate for age [CORRECT]
C. Instruct the parent to begin assisted walking exercises immediately
D. Document developmental delay and schedule follow-up in 1 week
Correct Answer: B
Rationale: According to Denver II developmental screening guidelines, sitting without support
typically emerges between 5-7 months of age. At 6 months, sitting with support, rolling both
ways, and reaching are all age-appropriate milestones. Independent sitting usually develops
by 7-8 months. Option A is incorrect because independent sitting is not yet expected at 6
months. Option C is inappropriate as walking preparation should not begin before standing
independently (9-12 months). Option D incorrectly labels normal variation as delay, potentially
causing unnecessary parental anxiety (AAP, 2023).
Q2: A 4-year-old child is admitted with suspected dehydration secondary to gastroenteritis.
Assessment reveals: heart rate 128 bpm, blood pressure 88/52 mmHg, capillary refill 4
seconds, and skin turgor with tenting noted on the abdomen. The child has dry mucous
membranes and has had only one wet diaper in 8 hours. Which nursing intervention is the
priority?
A. Offer oral rehydration solution in small, frequent amounts
B. Initiate IV access and begin isotonic fluid resuscitation [CORRECT]
C. Insert a nasogastric tube for enteral rehydration
,D. Administer antidiarrheal medication per protocol
Correct Answer: B
Rationale: This child demonstrates moderate to severe dehydration (tachycardia, prolonged
capillary refill >3 seconds, skin tenting, decreased urine output, dry mucous membranes). The
priority follows the ABCs of pediatric assessment—maintaining circulation. IV fluid
resuscitation with isotonic solution (normal saline or lactated Ringer's) is indicated for
moderate-severe dehydration or when oral intake is insufficient. Option A is inappropriate for
moderate-severe dehydration where oral fluids are contraindicated. Option C delays definitive
treatment. Option D is contraindicated as antidiarrheals can worsen certain infections and
mask severity (AAP, 2022).
Q3: A nurse is teaching parents of a 2-month-old infant about the recommended
immunization schedule. Which statement by the parent indicates understanding of the
teaching?
A. "My baby will receive the first dose of MMR vaccine at this visit"
B. "The hepatitis B vaccine requires a total of three doses over 6 months" [CORRECT]
C. "I can delay all vaccines until my baby starts daycare at 6 months"
D. "The DTaP vaccine protects against measles, mumps, and rubella"
Correct Answer: B
Rationale: The hepatitis B vaccine series consists of three doses: birth, 1-2 months, and 6-18
months. Option A is incorrect—MMR (measles-mumps-rubella) is first administered at 12-15
months. Option C demonstrates a dangerous misconception; vaccines should not be delayed
unnecessarily as infants are vulnerable to serious vaccine-preventable diseases. Option D is
incorrect—DTaP protects against diphtheria, tetanus, and pertussis (whooping cough), not
measles. The CDC Advisory Committee on Immunization Practices (ACIP) recommends
beginning the primary immunization series at 2 months including DTaP, IPV, Hib, PCV13, and
rotavirus (CDC, 2024).
Q4: A school nurse is caring for a 7-year-old with asthma who arrives at the health office with
wheezing, mild retractions, and an respiratory rate of 28 breaths/minute. The child can speak
in full sentences. Which action should the nurse take first?
A. Call 911 for emergency transport immediately
B. Administer the child's prescribed quick-relief bronchodilator [CORRECT]
, C. Have the child lie flat to improve ventilation
D. Contact the parent to pick up the child without intervention
Correct Answer: B
Rationale: This child exhibits mild asthma exacerbation (speaking in full sentences, RR
28/min—slightly elevated for age, mild retractions). According to NHLBI asthma guidelines,
the first-line treatment for acute symptoms is a short-acting beta-agonist (SABA)
bronchodilator. The nurse should administer the child's prescribed rescue inhaler with spacer.
Option A is premature as there are no severe distress signs (inability to speak, cyanosis,
severe retractions). Option C is contraindicated—supine positioning worsens respiratory
distress; the child should sit upright. Option D delays necessary treatment and jeopardizes
safety (NHLBI, 2022).
Q5: A nurse is caring for a 12-year-old newly diagnosed with Type 1 Diabetes Mellitus. The
child asks, "Why do I need insulin shots when my friend with diabetes just takes pills?" Which
response by the nurse is most appropriate?
A. "Your friend probably has Type 2 diabetes, which is caused by lifestyle choices"
B. "Type 1 diabetes means your pancreas doesn't make insulin, so you need injections to
replace it" [CORRECT]
C. "You'll probably be able to switch to pills once your blood sugar is controlled"
D. "Children always need insulin; adults can sometimes use pills instead"
Correct Answer: B
Rationale: This response provides developmentally appropriate education distinguishing Type
1 (autoimmune destruction of pancreatic beta cells, absolute insulin deficiency) from Type 2
(insulin resistance with relative deficiency). Type 1 requires exogenous insulin for survival.
Option A incorrectly implies Type 2 is solely lifestyle-related and may induce shame. Option C
is factually incorrect—Type 1 diabetes always requires insulin regardless of control. Option D
is inaccurate as both children and adults with Type 1 require insulin. The explanation
supports the child's understanding of their chronic condition (ADA, 2024).
Q6: A pediatric nurse is caring for a 3-month-old with a ventricular septal defect (VSD). Which
assessment finding requires immediate notification of the healthcare provider?
A. Heart murmur audible at the left sternal border
