HESI Pediatric Nursing Examination
2026/2027 Questions | NGN-Aligned |
Answers | Evidence-Based Rationales
GROWTH & DEVELOPMENT MILESTONES (1–20)
1. A nurse is assessing a 4-month-old infant during a well-child visit. Which
developmental milestone should the infant have achieved by this age?
A. Holds head steady when sitting with support
B. Rolls from back to front unassisted
C. Walks independently
D. Uses two-word phrases
Rationale: By 4 months, infants gain head control. Rolling typically occurs at 5–6
months, walking at 12 months, and phrases at 24 months.
2. A parent of a 2-year-old toddler asks the nurse about expected language
development. Which response is most accurate?
A. Speaks in complete sentences of 5–6 words
B. Has a vocabulary of 50–300 words and begins two-word phrases
C. Reads simple words
D. Language is not significant until preschool
Rationale: At 2 years, toddlers use telegraphic speech (2-word phrases). Sentences
come later (age 4-5). Reading emerges at school age.
3. According to Erikson, which stage is most relevant for a hospitalized
preschooler (3–5 years)?
A. Trust vs. Mistrust
B. Autonomy vs. Shame and Doubt
C. Initiative vs. Guilt
D. Industry vs. Inferiority
Rationale: Preschoolers are in Initiative vs. Guilt. Hospitalization can cause guilt
if they view illness as punishment. Offer choices to support initiative.
,4. A nurse is teaching a parent about the Denver II screening test. What does
this tool primarily assess?
A. Intelligence quotient
B. Personal-social, fine motor, language, and gross motor skills
C. Hearing and vision
D. Nutritional status
Rationale: Denver II screens developmental delays across four domains. It does
not measure IQ or isolated sensory deficits.
5. Which fine motor skill is expected in a 10-month-old infant?
A. Uses a pincer grasp to pick up a small raisin
B. Transfers a toy from one hand to the other
C. Builds a tower of two cubes
D. Scribbles spontaneously
Rationale: Transferring objects hand-to-hand emerges by 7–8 months. Pincer
grasp appears by 10–12 months; building towers and scribbling are 12–15 months.
6. The parent of a 6-month-old asks which gross motor milestone is expected.
The nurse should state that the infant should be able to:
A. Sit unsupported for several minutes
B. Roll over from back to abdomen and abdomen to back
C. Crawl on hands and knees
D. Pull to stand
Rationale: Rolling both ways is a 6-month milestone. Sitting unsupported occurs
at 7–8 months, crawling at 8–10 months, pulling to stand at 9–12 months.
7. A 15-month-old toddler is brought for a well visit. The parent reports that
the child has not yet begun to walk. What is the nurse’s best response?
A. Immediate referral to a neurologist
B. Explain that most children walk by 15 months; assess for other milestones
C. Tell the parent to force walking exercises
D. Recommend a walker
Rationale: Walking independently can occur between 9–15 months. A
,15-month-old not walking warrants further assessment but is not automatically
abnormal if other milestones are met. Walkers are unsafe and discouraged.
8. Which play activity is most developmentally appropriate for a 3-year-old
child?
A. Playing a board game with complex rules
B. Playing side-by-side (parallel play) with similar toys
C. Competitive sports
D. Solitary play with no interaction
Rationale: Preschoolers engage in parallel play (alongside, not with). Cooperative
play begins later (4-5 years). Board games and competitive sports are for
school-age children.
9. A nurse is assessing a 7-year-old child. According to Piaget, which cognitive
stage should this child be in?
A. Sensorimotor
B. Preoperational
C. Concrete operational
D. Formal operational
Rationale: Concrete operational stage (7–11 years) features logical thinking about
concrete events, conservation, and reversibility. Preoperational is 2–7 years; formal
operational is adolescence.
10. The parent of a 9-month-old expresses concern that the infant cries when
left with a babysitter. Which response by the nurse is most appropriate?
A. “This is abnormal and requires evaluation.”
B. “This is normal stranger anxiety that peaks around 9 months.”
C. “Leave the infant with strangers more often to desensitize.”
D. “The infant is spoiled.”
Rationale: Stranger anxiety begins at 6-8 months, peaks at 9-12 months, and is a
normal developmental phenomenon. It reflects healthy attachment.
, 11. An 18-month-old is hospitalized. The nurse expects which gross motor
ability?
A. Kicks a ball forward
B. Walks independently and pulls a toy
C. Jumps in place
D. Rides a tricycle
Rationale: By 18 months, toddlers walk well and pull/ carry toys. Kicking a ball
occurs at 2 years; jumping at 2.5-3 years; tricycle at 3 years.
12. Which statement about physical growth is true for preschool-age children
(3–5 years)?
A. They gain about 10-15 pounds per year
B. They grow approximately 2-3 inches per year
C. Head circumference increases rapidly
D. Permanent teeth erupt
Rationale: Preschoolers grow steadily (2-3 in/year, 4-6 lb/year). Permanent teeth
erupt in school-age. Head growth slows after infancy.
13. A nurse is teaching a parent about separation anxiety in a 10-month-old.
Which behavior is typical?
A. The infant shows no distress when parent leaves
B. The infant protests when parent leaves but is easily comforted by a familiar
person
C. The infant becomes aggressive toward other children
D. The infant refuses to eat for days
Rationale: Separation anxiety phase: protest (crying, clinging), then despair, then
detachment. Being comforted by a familiar caregiver is expected. Prolonged
refusal to eat is concerning.
14. The nurse is assessing a 4-year-old child. Which fine motor skill is
developmentally appropriate?
A. Ties shoelaces
B. Copies a circle and draws a person with 2-4 body parts
C. Prints letters
2026/2027 Questions | NGN-Aligned |
Answers | Evidence-Based Rationales
GROWTH & DEVELOPMENT MILESTONES (1–20)
1. A nurse is assessing a 4-month-old infant during a well-child visit. Which
developmental milestone should the infant have achieved by this age?
A. Holds head steady when sitting with support
B. Rolls from back to front unassisted
C. Walks independently
D. Uses two-word phrases
Rationale: By 4 months, infants gain head control. Rolling typically occurs at 5–6
months, walking at 12 months, and phrases at 24 months.
2. A parent of a 2-year-old toddler asks the nurse about expected language
development. Which response is most accurate?
A. Speaks in complete sentences of 5–6 words
B. Has a vocabulary of 50–300 words and begins two-word phrases
C. Reads simple words
D. Language is not significant until preschool
Rationale: At 2 years, toddlers use telegraphic speech (2-word phrases). Sentences
come later (age 4-5). Reading emerges at school age.
3. According to Erikson, which stage is most relevant for a hospitalized
preschooler (3–5 years)?
A. Trust vs. Mistrust
B. Autonomy vs. Shame and Doubt
C. Initiative vs. Guilt
D. Industry vs. Inferiority
Rationale: Preschoolers are in Initiative vs. Guilt. Hospitalization can cause guilt
if they view illness as punishment. Offer choices to support initiative.
,4. A nurse is teaching a parent about the Denver II screening test. What does
this tool primarily assess?
A. Intelligence quotient
B. Personal-social, fine motor, language, and gross motor skills
C. Hearing and vision
D. Nutritional status
Rationale: Denver II screens developmental delays across four domains. It does
not measure IQ or isolated sensory deficits.
5. Which fine motor skill is expected in a 10-month-old infant?
A. Uses a pincer grasp to pick up a small raisin
B. Transfers a toy from one hand to the other
C. Builds a tower of two cubes
D. Scribbles spontaneously
Rationale: Transferring objects hand-to-hand emerges by 7–8 months. Pincer
grasp appears by 10–12 months; building towers and scribbling are 12–15 months.
6. The parent of a 6-month-old asks which gross motor milestone is expected.
The nurse should state that the infant should be able to:
A. Sit unsupported for several minutes
B. Roll over from back to abdomen and abdomen to back
C. Crawl on hands and knees
D. Pull to stand
Rationale: Rolling both ways is a 6-month milestone. Sitting unsupported occurs
at 7–8 months, crawling at 8–10 months, pulling to stand at 9–12 months.
7. A 15-month-old toddler is brought for a well visit. The parent reports that
the child has not yet begun to walk. What is the nurse’s best response?
A. Immediate referral to a neurologist
B. Explain that most children walk by 15 months; assess for other milestones
C. Tell the parent to force walking exercises
D. Recommend a walker
Rationale: Walking independently can occur between 9–15 months. A
,15-month-old not walking warrants further assessment but is not automatically
abnormal if other milestones are met. Walkers are unsafe and discouraged.
8. Which play activity is most developmentally appropriate for a 3-year-old
child?
A. Playing a board game with complex rules
B. Playing side-by-side (parallel play) with similar toys
C. Competitive sports
D. Solitary play with no interaction
Rationale: Preschoolers engage in parallel play (alongside, not with). Cooperative
play begins later (4-5 years). Board games and competitive sports are for
school-age children.
9. A nurse is assessing a 7-year-old child. According to Piaget, which cognitive
stage should this child be in?
A. Sensorimotor
B. Preoperational
C. Concrete operational
D. Formal operational
Rationale: Concrete operational stage (7–11 years) features logical thinking about
concrete events, conservation, and reversibility. Preoperational is 2–7 years; formal
operational is adolescence.
10. The parent of a 9-month-old expresses concern that the infant cries when
left with a babysitter. Which response by the nurse is most appropriate?
A. “This is abnormal and requires evaluation.”
B. “This is normal stranger anxiety that peaks around 9 months.”
C. “Leave the infant with strangers more often to desensitize.”
D. “The infant is spoiled.”
Rationale: Stranger anxiety begins at 6-8 months, peaks at 9-12 months, and is a
normal developmental phenomenon. It reflects healthy attachment.
, 11. An 18-month-old is hospitalized. The nurse expects which gross motor
ability?
A. Kicks a ball forward
B. Walks independently and pulls a toy
C. Jumps in place
D. Rides a tricycle
Rationale: By 18 months, toddlers walk well and pull/ carry toys. Kicking a ball
occurs at 2 years; jumping at 2.5-3 years; tricycle at 3 years.
12. Which statement about physical growth is true for preschool-age children
(3–5 years)?
A. They gain about 10-15 pounds per year
B. They grow approximately 2-3 inches per year
C. Head circumference increases rapidly
D. Permanent teeth erupt
Rationale: Preschoolers grow steadily (2-3 in/year, 4-6 lb/year). Permanent teeth
erupt in school-age. Head growth slows after infancy.
13. A nurse is teaching a parent about separation anxiety in a 10-month-old.
Which behavior is typical?
A. The infant shows no distress when parent leaves
B. The infant protests when parent leaves but is easily comforted by a familiar
person
C. The infant becomes aggressive toward other children
D. The infant refuses to eat for days
Rationale: Separation anxiety phase: protest (crying, clinging), then despair, then
detachment. Being comforted by a familiar caregiver is expected. Prolonged
refusal to eat is concerning.
14. The nurse is assessing a 4-year-old child. Which fine motor skill is
developmentally appropriate?
A. Ties shoelaces
B. Copies a circle and draws a person with 2-4 body parts
C. Prints letters
