HESI Pediatrics RN Exit Exam Study Guide | 2026/2027
HESI PEDIATRICS RN EXIT EXAM
Comprehensive Exam
2026/2027 Academic Year | NGN-Aligned Review
Verified Questions & Detailed Rationales | 75 Items
EXAM INSTRUCTIONS
• This Exam contains 75 multiple-choice and select-all-that-apply questions aligned with the HESI
Pediatrics RN Exit Exam and Next Generation NCLEX (NGN) standards.
• Testing time: 90–120 minutes. Passing benchmark: typically 75–85% (institution-specific).
• For SATA items, select ALL correct answers — two or more options may apply.
• Correct answers are highlighted in green bold. Detailed rationales follow each question.
• Domains: Growth & Development, Family-Centered Care, Pediatric Assessment, Childhood Illnesses,
Pharmacology, Safety, Nursing Interventions, Congenital/Chronic Conditions, Emergency Care, and
Mental Health.
EXAM CONTENT BREAKDOWN
Domain Questions Format
I. Growth & Development 10 MCQ / SATA
II. Family-Centered Care 8 MCQ / SATA
III. Pediatric Assessment 8 MCQ / SATA
IV. Common Childhood Illnesses 7 MCQ / SATA
V. Pediatric Pharmacology 5 MCQ / SATA
VI. Safety & Injury Prevention 6 MCQ / SATA
VII. Nursing Interventions 6 MCQ / SATA
VIII. Congenital & Chronic 8 MCQ / SATA
Conditions
IX. Emergency & Critical Care 7 MCQ / SATA
X. Mental Health & Psychosocial 10 MCQ / SATA
TOTAL 75 75 Items
Page 1
, HESI Pediatrics RN Exit Exam Study Guide | 2026/2027
Growth & Development Milestones
10 Questions
1. A nurse is assessing a 2-month-old infant who is hospitalized. Which action by the parent
indicates successful achievement of Erikson's Trust vs. Mistrust stage?
[Single Best Answer]
A) The parent allows the infant to cry for 10 minutes before responding to encourage self-soothing.
B) The parent promptly responds to the infant's cries by offering feeding, comfort, and eye
contact.
C) The parent encourages the infant to hold the bottle independently during feedings.
D) The parent places the infant in a playpen alone to promote environmental exploration.
Correct Answer: B
Erikson's Trust vs. Mistrust stage (birth to 18 months) centers on the infant's need for consistent,
responsive caregiving to develop a sense of trust. Prompt response to the infant's needs with feeding,
comfort, and eye contact fosters a secure attachment and basic trust in the environment. Delayed
response (A) or premature independence expectations (C, D) can lead to mistrust and insecurity in the
infant (Hockenberry & Wilson, Wong's Nursing Care of Infants and Children, 12th ed.).
2. A mother of a 9-month-old infant tells the nurse, "My baby gets very upset when I cover a
toy with a blanket—it's like the toy has disappeared." Which Piagetian concept should the
nurse explain?
[Single Best Answer]
A) Conservation
B) Object permanence
C) Egocentrism
D) Centration
Correct Answer: B
Object permanence is a key milestone of the sensorimotor stage (birth to 2 years) and typically develops
between 8 and 12 months of age. It refers to the understanding that objects continue to exist even when
they cannot be seen, heard, or touched. Conservation (A) and centration (D) are preoperational stage
concepts, while egocentrism (C) emerges during the preoperational stage as well (Hockenberry &
Wilson, Wong's Nursing Care of Infants and Children, 12th ed.).
3. A nursing instructor is teaching students about Erikson's psychosocial developmental
stages. Which pairings of age group with the corresponding Erikson stage are accurate?
Select all that apply.
[Select All That Apply]
A) Birth to 18 months: Trust vs. Mistrust
B) 18 months to 3 years: Autonomy vs. Shame and Doubt
C) 3 to 6 years: Industry vs. Inferiority
D) 6 to 12 years: Industry vs. Inferiority
Correct Answer: A, B, D
Erikson's stages paired correctly are Trust versus Mistrust (birth to 18 months, A), Autonomy versus
Shame and Doubt (18 months to 3 years, B), and Industry versus Inferiority (6 to 12 years, D). The
preschool period (3 to 6 years) corresponds to Initiative versus Guilt, not Industry versus Inferiority,
Page 2
, HESI Pediatrics RN Exit Exam Study Guide | 2026/2027
making option C incorrect (Hockenberry & Wilson, Wong's Nursing Care of Infants and Children, 12th
ed.).
4. A 12-month-old infant is brought to the well-child clinic for a routine visit. The nurse
observes that the infant cannot sit independently without support and does not babble. What
is the nurse's best interpretation of these findings?
[Single Best Answer]
A) These findings are within normal limits for a 12-month-old.
B) These findings suggest a developmental delay requiring further evaluation.
C) These findings indicate regression due to a recent illness.
D) These findings suggest the infant is developing at an advanced pace.
Correct Answer: B
By 12 months, an infant should be able to sit independently (achieved by approximately 6–8 months)
and should be babbling or saying single words. The inability to sit without support and absence of
babbling at 12 months represent significant developmental red flags across both gross motor and
language domains, warranting referral for comprehensive developmental evaluation and early
intervention services per AAP 2024 guidelines (Hockenberry & Wilson, Wong's Nursing Care of Infants
and Children, 12th ed.).
5. A nurse is conducting a developmental screening on an 18-month-old toddler. Which
findings would the nurse identify as developmental red flags requiring further evaluation?
Select all that apply.
[Select All That Apply]
A) Not yet walking independently
B) Using fewer than 6 words
C) Unable to stack two blocks
D) Exhibits stranger anxiety when approached by an unfamiliar nurse
Correct Answer: A, B, C
By 18 months, a toddler should be walking independently (typically achieved by 12–15 months, A), using
at least 6–20 words (B), and able to stack 2–4 blocks (C). Stranger anxiety (D) is a normal
developmental behavior expected around 8–12 months and persisting through toddlerhood, not a red
flag. Each delayed milestone warrants further evaluation and possible referral to early intervention
services (Hockenberry & Wilson, Wong's Nursing Care of Infants and Children, 12th ed.; AAP 2024
Bright Futures Guidelines).
6. A parent of a 2-year-old child asks the nurse when toilet training should begin. Which
response by the nurse is most appropriate based on developmental readiness?
[Single Best Answer]
A) "Toilet training should begin as soon as the child turns 2 years old."
B) "Start training when the child can stay dry for 2 hours and shows interest in the toilet."
C) "Wait until the child is at least 3 years old before introducing toilet training."
D) "Begin training immediately since bowel control is expected by 18 months."
Correct Answer: B
The AAP recommends initiating toilet training when the child demonstrates physiological readiness
(staying dry for 2+ hours, regular bowel movements) and behavioral readiness (showing interest, able
to follow simple directions, pulling pants up/down). This typically occurs between 18 and 24 months, but
Page 3
, HESI Pediatrics RN Exit Exam Study Guide | 2026/2027
readiness varies per child. Beginning at exactly 2 years (A) or delaying until 3 (C) are arbitrary
timelines, and bowel control is not reliably achieved by 18 months (D) (Hockenberry & Wilson, Wong's
Nursing Care of Infants and Children, 12th ed.; AAP 2024).
7. A 4-year-old child is hospitalized and insists that the sun follows her to the hospital because
it wants to shine on her. The nurse recognizes this thinking is characteristic of which
Piagetian stage?
[Single Best Answer]
A) Sensorimotor stage
B) Preoperational stage
C) Concrete operational stage
D) Formal operational stage
Correct Answer: B
The preoperational stage (ages 2–7 years) is characterized by egocentrism, animism (attributing lifelike
qualities to inanimate objects), magical thinking, and centration. Believing the sun "follows" or "wants"
to shine on her demonstrates both animism and egocentric thinking, which are hallmark features of this
stage. The sensorimotor stage (A) involves learning through senses and motor actions, while concrete
operational (C) and formal operational (D) stages involve logical and abstract reasoning, respectively
(Hockenberry & Wilson, Wong's Nursing Care of Infants and Children, 12th ed.).
8. A nurse is providing anticipatory guidance to the parent of a 4-year-old child at a well-child
visit. Which developmental milestones should the nurse expect the child to have achieved?
Select all that apply.
[Select All That Apply]
A) Can hop on one foot
B) Can draw a person with at least 3 body parts
C) Can speak in sentences of 4–5 words
D) Can ride a tricycle
Correct Answer: B, C, D
By age 4, a child should be able to draw a person with 3 or more body parts (B), speak in 4–5 word
sentences (C), and ride a tricycle (D). Hopping on one foot (A) is typically achieved by age 5–6 and is not
expected at age 4. These milestones align with AAP 2024 Bright Futures developmental surveillance
recommendations (Hockenberry & Wilson, Wong's Nursing Care of Infants and Children, 12th ed.).
9. A 10-year-old child recently failed a spelling test and tells the school nurse, "I'm stupid and
everyone knows it. I'll never be good at anything." Based on Erikson's theory, which
psychosocial crisis is this child experiencing?
[Single Best Answer]
A) Initiative vs. Guilt
B) Industry vs. Inferiority
C) Trust vs. Mistrust
D) Identity vs. Role Confusion
Correct Answer: B
Erikson's Industry versus Inferiority stage (6–12 years) centers on the child's need to develop
competence through schoolwork and skill mastery. Negative feedback or failure can lead to feelings of
inferiority, as demonstrated by this child's statements. Initiative versus Guilt (A) applies to preschoolers,
Page 4
HESI PEDIATRICS RN EXIT EXAM
Comprehensive Exam
2026/2027 Academic Year | NGN-Aligned Review
Verified Questions & Detailed Rationales | 75 Items
EXAM INSTRUCTIONS
• This Exam contains 75 multiple-choice and select-all-that-apply questions aligned with the HESI
Pediatrics RN Exit Exam and Next Generation NCLEX (NGN) standards.
• Testing time: 90–120 minutes. Passing benchmark: typically 75–85% (institution-specific).
• For SATA items, select ALL correct answers — two or more options may apply.
• Correct answers are highlighted in green bold. Detailed rationales follow each question.
• Domains: Growth & Development, Family-Centered Care, Pediatric Assessment, Childhood Illnesses,
Pharmacology, Safety, Nursing Interventions, Congenital/Chronic Conditions, Emergency Care, and
Mental Health.
EXAM CONTENT BREAKDOWN
Domain Questions Format
I. Growth & Development 10 MCQ / SATA
II. Family-Centered Care 8 MCQ / SATA
III. Pediatric Assessment 8 MCQ / SATA
IV. Common Childhood Illnesses 7 MCQ / SATA
V. Pediatric Pharmacology 5 MCQ / SATA
VI. Safety & Injury Prevention 6 MCQ / SATA
VII. Nursing Interventions 6 MCQ / SATA
VIII. Congenital & Chronic 8 MCQ / SATA
Conditions
IX. Emergency & Critical Care 7 MCQ / SATA
X. Mental Health & Psychosocial 10 MCQ / SATA
TOTAL 75 75 Items
Page 1
, HESI Pediatrics RN Exit Exam Study Guide | 2026/2027
Growth & Development Milestones
10 Questions
1. A nurse is assessing a 2-month-old infant who is hospitalized. Which action by the parent
indicates successful achievement of Erikson's Trust vs. Mistrust stage?
[Single Best Answer]
A) The parent allows the infant to cry for 10 minutes before responding to encourage self-soothing.
B) The parent promptly responds to the infant's cries by offering feeding, comfort, and eye
contact.
C) The parent encourages the infant to hold the bottle independently during feedings.
D) The parent places the infant in a playpen alone to promote environmental exploration.
Correct Answer: B
Erikson's Trust vs. Mistrust stage (birth to 18 months) centers on the infant's need for consistent,
responsive caregiving to develop a sense of trust. Prompt response to the infant's needs with feeding,
comfort, and eye contact fosters a secure attachment and basic trust in the environment. Delayed
response (A) or premature independence expectations (C, D) can lead to mistrust and insecurity in the
infant (Hockenberry & Wilson, Wong's Nursing Care of Infants and Children, 12th ed.).
2. A mother of a 9-month-old infant tells the nurse, "My baby gets very upset when I cover a
toy with a blanket—it's like the toy has disappeared." Which Piagetian concept should the
nurse explain?
[Single Best Answer]
A) Conservation
B) Object permanence
C) Egocentrism
D) Centration
Correct Answer: B
Object permanence is a key milestone of the sensorimotor stage (birth to 2 years) and typically develops
between 8 and 12 months of age. It refers to the understanding that objects continue to exist even when
they cannot be seen, heard, or touched. Conservation (A) and centration (D) are preoperational stage
concepts, while egocentrism (C) emerges during the preoperational stage as well (Hockenberry &
Wilson, Wong's Nursing Care of Infants and Children, 12th ed.).
3. A nursing instructor is teaching students about Erikson's psychosocial developmental
stages. Which pairings of age group with the corresponding Erikson stage are accurate?
Select all that apply.
[Select All That Apply]
A) Birth to 18 months: Trust vs. Mistrust
B) 18 months to 3 years: Autonomy vs. Shame and Doubt
C) 3 to 6 years: Industry vs. Inferiority
D) 6 to 12 years: Industry vs. Inferiority
Correct Answer: A, B, D
Erikson's stages paired correctly are Trust versus Mistrust (birth to 18 months, A), Autonomy versus
Shame and Doubt (18 months to 3 years, B), and Industry versus Inferiority (6 to 12 years, D). The
preschool period (3 to 6 years) corresponds to Initiative versus Guilt, not Industry versus Inferiority,
Page 2
, HESI Pediatrics RN Exit Exam Study Guide | 2026/2027
making option C incorrect (Hockenberry & Wilson, Wong's Nursing Care of Infants and Children, 12th
ed.).
4. A 12-month-old infant is brought to the well-child clinic for a routine visit. The nurse
observes that the infant cannot sit independently without support and does not babble. What
is the nurse's best interpretation of these findings?
[Single Best Answer]
A) These findings are within normal limits for a 12-month-old.
B) These findings suggest a developmental delay requiring further evaluation.
C) These findings indicate regression due to a recent illness.
D) These findings suggest the infant is developing at an advanced pace.
Correct Answer: B
By 12 months, an infant should be able to sit independently (achieved by approximately 6–8 months)
and should be babbling or saying single words. The inability to sit without support and absence of
babbling at 12 months represent significant developmental red flags across both gross motor and
language domains, warranting referral for comprehensive developmental evaluation and early
intervention services per AAP 2024 guidelines (Hockenberry & Wilson, Wong's Nursing Care of Infants
and Children, 12th ed.).
5. A nurse is conducting a developmental screening on an 18-month-old toddler. Which
findings would the nurse identify as developmental red flags requiring further evaluation?
Select all that apply.
[Select All That Apply]
A) Not yet walking independently
B) Using fewer than 6 words
C) Unable to stack two blocks
D) Exhibits stranger anxiety when approached by an unfamiliar nurse
Correct Answer: A, B, C
By 18 months, a toddler should be walking independently (typically achieved by 12–15 months, A), using
at least 6–20 words (B), and able to stack 2–4 blocks (C). Stranger anxiety (D) is a normal
developmental behavior expected around 8–12 months and persisting through toddlerhood, not a red
flag. Each delayed milestone warrants further evaluation and possible referral to early intervention
services (Hockenberry & Wilson, Wong's Nursing Care of Infants and Children, 12th ed.; AAP 2024
Bright Futures Guidelines).
6. A parent of a 2-year-old child asks the nurse when toilet training should begin. Which
response by the nurse is most appropriate based on developmental readiness?
[Single Best Answer]
A) "Toilet training should begin as soon as the child turns 2 years old."
B) "Start training when the child can stay dry for 2 hours and shows interest in the toilet."
C) "Wait until the child is at least 3 years old before introducing toilet training."
D) "Begin training immediately since bowel control is expected by 18 months."
Correct Answer: B
The AAP recommends initiating toilet training when the child demonstrates physiological readiness
(staying dry for 2+ hours, regular bowel movements) and behavioral readiness (showing interest, able
to follow simple directions, pulling pants up/down). This typically occurs between 18 and 24 months, but
Page 3
, HESI Pediatrics RN Exit Exam Study Guide | 2026/2027
readiness varies per child. Beginning at exactly 2 years (A) or delaying until 3 (C) are arbitrary
timelines, and bowel control is not reliably achieved by 18 months (D) (Hockenberry & Wilson, Wong's
Nursing Care of Infants and Children, 12th ed.; AAP 2024).
7. A 4-year-old child is hospitalized and insists that the sun follows her to the hospital because
it wants to shine on her. The nurse recognizes this thinking is characteristic of which
Piagetian stage?
[Single Best Answer]
A) Sensorimotor stage
B) Preoperational stage
C) Concrete operational stage
D) Formal operational stage
Correct Answer: B
The preoperational stage (ages 2–7 years) is characterized by egocentrism, animism (attributing lifelike
qualities to inanimate objects), magical thinking, and centration. Believing the sun "follows" or "wants"
to shine on her demonstrates both animism and egocentric thinking, which are hallmark features of this
stage. The sensorimotor stage (A) involves learning through senses and motor actions, while concrete
operational (C) and formal operational (D) stages involve logical and abstract reasoning, respectively
(Hockenberry & Wilson, Wong's Nursing Care of Infants and Children, 12th ed.).
8. A nurse is providing anticipatory guidance to the parent of a 4-year-old child at a well-child
visit. Which developmental milestones should the nurse expect the child to have achieved?
Select all that apply.
[Select All That Apply]
A) Can hop on one foot
B) Can draw a person with at least 3 body parts
C) Can speak in sentences of 4–5 words
D) Can ride a tricycle
Correct Answer: B, C, D
By age 4, a child should be able to draw a person with 3 or more body parts (B), speak in 4–5 word
sentences (C), and ride a tricycle (D). Hopping on one foot (A) is typically achieved by age 5–6 and is not
expected at age 4. These milestones align with AAP 2024 Bright Futures developmental surveillance
recommendations (Hockenberry & Wilson, Wong's Nursing Care of Infants and Children, 12th ed.).
9. A 10-year-old child recently failed a spelling test and tells the school nurse, "I'm stupid and
everyone knows it. I'll never be good at anything." Based on Erikson's theory, which
psychosocial crisis is this child experiencing?
[Single Best Answer]
A) Initiative vs. Guilt
B) Industry vs. Inferiority
C) Trust vs. Mistrust
D) Identity vs. Role Confusion
Correct Answer: B
Erikson's Industry versus Inferiority stage (6–12 years) centers on the child's need to develop
competence through schoolwork and skill mastery. Negative feedback or failure can lead to feelings of
inferiority, as demonstrated by this child's statements. Initiative versus Guilt (A) applies to preschoolers,
Page 4
