HESI PEDIATRIC PRACTICE EXAM [2026/2027]
QUESTIONS AND 100% VERIFIED ANSWERS
WITH RATIONALES GRADED A+ LATEST
1. A 6-year-old child is brought to the clinic with a 3-day history of fever,
cough, and difficulty breathing. On examination, the nurse notes intercostal
retractions and nasal flaring. Which action should the nurse take first?
A. Administer acetaminophen for fever
B. Obtain a chest X-ray
C. Assess oxygen saturation and administer oxygen if needed
D. Encourage oral fluids
Answer: C. Assess oxygen saturation and administer oxygen if needed
Rationale: Airway and breathing are priority in pediatric emergencies. Intercostal
retractions and nasal flaring indicate respiratory distress that requires immediate
assessment and oxygen support.
2. Which of the following vaccines is recommended at 12 months of age?
A. Hepatitis B (HepB)
B. Measles, Mumps, Rubella (MMR)
C. Diphtheria, Tetanus, Pertussis (DTaP) – 1st dose
D. Polio (IPV) – 1st dose
Answer: B. Measles, Mumps, Rubella (MMR)
Rationale: The first MMR vaccine is recommended at 12–15 months. HepB is
usually given at birth, 1–2 months, and 6 months. DTaP and IPV are given in
multiple doses earlier.
,3. A nurse is caring for a 4-year-old child with acute asthma exacerbation.
The child is using accessory muscles and has a respiratory rate of 38
breaths/min. Which medication should the nurse anticipate administering
first?
A. Oral corticosteroid
B. Inhaled short-acting beta-agonist (albuterol)
C. IV magnesium sulfate
D. Leukotriene receptor antagonist
Answer: B. Inhaled short-acting beta-agonist (albuterol)
Rationale: Short-acting bronchodilators are first-line therapy for acute asthma
exacerbation to relieve bronchospasm. Corticosteroids may follow but do not act
immediately.
4. A 2-year-old child is being evaluated for dehydration. Which finding is the
most reliable indicator of fluid loss in toddlers?
A. Capillary refill time
B. Presence of tears when crying
C. Weight loss
D. Dry mucous membranes
Answer: C. Weight loss
Rationale: Weight loss is the most accurate and objective indicator of dehydration
in children. Other signs can be variable.
5. A parent asks why the recommended daily iron intake is higher for toddlers
than for infants. What is the best explanation?
A. Toddlers have faster metabolism than infants
B. Toddlers lose more iron through urine
C. Toddlers are more prone to anemia due to rapid growth
D. Iron absorption decreases with age
,Answer: C. Toddlers are more prone to anemia due to rapid growth
Rationale: Rapid growth increases iron requirements. Infants have iron stores
from birth, but toddlers need dietary iron to prevent anemia.
6. A 7-year-old child with type 1 diabetes mellitus is experiencing shakiness,
diaphoresis, and irritability. Blood glucose is 55 mg/dL. Which is the priority
action?
A. Administer subcutaneous insulin
B. Provide 15 g of fast-acting carbohydrate orally
C. Encourage the child to eat a protein-rich snack
D. Notify the healthcare provider
Answer: B. Provide 15 g of fast-acting carbohydrate orally
Rationale: Hypoglycemia is an immediate threat. Administering fast-acting
carbohydrate will rapidly raise blood glucose. Insulin is contraindicated in
hypoglycemia.
7. Which is the earliest sign of increased intracranial pressure (ICP) in a
child?
A. Hypertension
B. Bradycardia
C. Headache and irritability
D. Altered pupil response
Answer: C. Headache and irritability
Rationale: Early signs of ICP include behavioral changes like irritability,
headache, and vomiting. Vital sign changes occur later.
8. A nurse is educating parents on the prevention of sudden infant death
syndrome (SIDS). Which statement indicates correct understanding?
A. “Our baby should sleep on the stomach to prevent choking.”
B. “Soft bedding is safe as long as the baby is swaddled.”
, C. “Placing the baby on the back to sleep reduces the risk of SIDS.”
D. “Room-sharing with the baby is discouraged.”
Answer: C. “Placing the baby on the back to sleep reduces the risk of SIDS.”
Rationale: Back sleeping on a firm surface is the most effective strategy for SIDS
prevention. Soft bedding and stomach sleeping increase risk.
9. A 5-year-old child with nephrotic syndrome presents with generalized
edema and frothy urine. Which laboratory finding would the nurse expect?
A. Hypoalbuminemia
B. Hypernatremia
C. Leukocytosis
D. Hypokalemia
Answer: A. Hypoalbuminemia
Rationale: Nephrotic syndrome causes protein loss in urine, leading to low serum
albumin, edema, and hyperlipidemia.
10. A 10-year-old child presents with fever, sore throat, and a fine, sandpaper-
like rash. Which infection is most likely?
A. Measles
B. Scarlet fever
C. Chickenpox
D. Rubella
Answer: B. Scarlet fever
Rationale: Scarlet fever is caused by Group A Streptococcus and is characterized
by fever, pharyngitis, and a sandpaper-like rash.
QUESTIONS AND 100% VERIFIED ANSWERS
WITH RATIONALES GRADED A+ LATEST
1. A 6-year-old child is brought to the clinic with a 3-day history of fever,
cough, and difficulty breathing. On examination, the nurse notes intercostal
retractions and nasal flaring. Which action should the nurse take first?
A. Administer acetaminophen for fever
B. Obtain a chest X-ray
C. Assess oxygen saturation and administer oxygen if needed
D. Encourage oral fluids
Answer: C. Assess oxygen saturation and administer oxygen if needed
Rationale: Airway and breathing are priority in pediatric emergencies. Intercostal
retractions and nasal flaring indicate respiratory distress that requires immediate
assessment and oxygen support.
2. Which of the following vaccines is recommended at 12 months of age?
A. Hepatitis B (HepB)
B. Measles, Mumps, Rubella (MMR)
C. Diphtheria, Tetanus, Pertussis (DTaP) – 1st dose
D. Polio (IPV) – 1st dose
Answer: B. Measles, Mumps, Rubella (MMR)
Rationale: The first MMR vaccine is recommended at 12–15 months. HepB is
usually given at birth, 1–2 months, and 6 months. DTaP and IPV are given in
multiple doses earlier.
,3. A nurse is caring for a 4-year-old child with acute asthma exacerbation.
The child is using accessory muscles and has a respiratory rate of 38
breaths/min. Which medication should the nurse anticipate administering
first?
A. Oral corticosteroid
B. Inhaled short-acting beta-agonist (albuterol)
C. IV magnesium sulfate
D. Leukotriene receptor antagonist
Answer: B. Inhaled short-acting beta-agonist (albuterol)
Rationale: Short-acting bronchodilators are first-line therapy for acute asthma
exacerbation to relieve bronchospasm. Corticosteroids may follow but do not act
immediately.
4. A 2-year-old child is being evaluated for dehydration. Which finding is the
most reliable indicator of fluid loss in toddlers?
A. Capillary refill time
B. Presence of tears when crying
C. Weight loss
D. Dry mucous membranes
Answer: C. Weight loss
Rationale: Weight loss is the most accurate and objective indicator of dehydration
in children. Other signs can be variable.
5. A parent asks why the recommended daily iron intake is higher for toddlers
than for infants. What is the best explanation?
A. Toddlers have faster metabolism than infants
B. Toddlers lose more iron through urine
C. Toddlers are more prone to anemia due to rapid growth
D. Iron absorption decreases with age
,Answer: C. Toddlers are more prone to anemia due to rapid growth
Rationale: Rapid growth increases iron requirements. Infants have iron stores
from birth, but toddlers need dietary iron to prevent anemia.
6. A 7-year-old child with type 1 diabetes mellitus is experiencing shakiness,
diaphoresis, and irritability. Blood glucose is 55 mg/dL. Which is the priority
action?
A. Administer subcutaneous insulin
B. Provide 15 g of fast-acting carbohydrate orally
C. Encourage the child to eat a protein-rich snack
D. Notify the healthcare provider
Answer: B. Provide 15 g of fast-acting carbohydrate orally
Rationale: Hypoglycemia is an immediate threat. Administering fast-acting
carbohydrate will rapidly raise blood glucose. Insulin is contraindicated in
hypoglycemia.
7. Which is the earliest sign of increased intracranial pressure (ICP) in a
child?
A. Hypertension
B. Bradycardia
C. Headache and irritability
D. Altered pupil response
Answer: C. Headache and irritability
Rationale: Early signs of ICP include behavioral changes like irritability,
headache, and vomiting. Vital sign changes occur later.
8. A nurse is educating parents on the prevention of sudden infant death
syndrome (SIDS). Which statement indicates correct understanding?
A. “Our baby should sleep on the stomach to prevent choking.”
B. “Soft bedding is safe as long as the baby is swaddled.”
, C. “Placing the baby on the back to sleep reduces the risk of SIDS.”
D. “Room-sharing with the baby is discouraged.”
Answer: C. “Placing the baby on the back to sleep reduces the risk of SIDS.”
Rationale: Back sleeping on a firm surface is the most effective strategy for SIDS
prevention. Soft bedding and stomach sleeping increase risk.
9. A 5-year-old child with nephrotic syndrome presents with generalized
edema and frothy urine. Which laboratory finding would the nurse expect?
A. Hypoalbuminemia
B. Hypernatremia
C. Leukocytosis
D. Hypokalemia
Answer: A. Hypoalbuminemia
Rationale: Nephrotic syndrome causes protein loss in urine, leading to low serum
albumin, edema, and hyperlipidemia.
10. A 10-year-old child presents with fever, sore throat, and a fine, sandpaper-
like rash. Which infection is most likely?
A. Measles
B. Scarlet fever
C. Chickenpox
D. Rubella
Answer: B. Scarlet fever
Rationale: Scarlet fever is caused by Group A Streptococcus and is characterized
by fever, pharyngitis, and a sandpaper-like rash.
