Evolve HESI Paediatrics Exam 2026| Actual
Exam Questions and Verified Answers
1. A 6-month-old infant with congestive heart failure (CHF) is receiving digoxin elixir. Which
observation by the nurse warrants immediate intervention?
A) Apical heart rate of 60.
B) Sweating across the forehead.
C) Doesn't suck well.
D) Respiratory rate of 30 breaths per minute.
Correct Answer: Apical heart rate of 60.
Explanation: A heart rate of 60 is much lower than normal for a 6-month-old (normal awake
range is 80-150 BPM). Bradycardia in an infant receiving digoxin is a sign of potential toxicity
and warrants immediate intervention. Sweating, poor feeding, and a respiratory rate of 30 are
common findings in CHF but are not as acutely concerning as severe bradycardia.
2. 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?
A) Perform postural drainage before starting aerosol therapy.
B) Give respiratory treatments when the child is coughing a lot.
C) Administer aerosol therapy followed by postural drainage before meals.
D) Ensure respiratory therapy is done daily during any respiratory infection.
Correct Answer: Administer aerosol therapy followed by postural drainage before meals.
Explanation: In cystic fibrosis, nebulized aerosol therapy should be given first to open the
airways, followed by postural drainage to promote mucus clearance. Performing this sequence
before meals (or at least 1 hour after eating) helps prevent nausea and vomiting. Treatments
should be scheduled routinely (3–4 times daily), not only when coughing is severe.
3. 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?
A) Use sunscreen when lying by the pool.
B) Cleanse the skin at least 4 times a day.
,C) Take the medication with a glass of milk.
D) Menstrual periods may become irregular.
Correct Answer: Use sunscreen when lying by the pool.
Explanation: Tetracyclines cause significant photosensitivity. Severe sunburn can occur with
minimal sun exposure, so clients must be taught to avoid direct sunlight and use sunscreen. Dairy
products interfere with absorption (C), and skin cleansing or menstrual changes are not primary
concerns with this medication.
4. What preoperative nursing intervention should be included in the plan of care for an infant
with pyloric stenosis?
A) Monitor for signs of metabolic acidosis.
B) Estimate the quantity of diarrhea stools.
C) Place in a supine position after feeding.
D) Observe for projectile vomiting.
Correct Answer: Observe for projectile vomiting.
Explanation: Projectile vomiting is the classic sign of pyloric stenosis and leads to metabolic
alkalosis (not acidosis). Frequent vomiting increases aspiration risk, so the infant should not be
placed supine immediately after feeding. Diarrhea is not a feature of pyloric stenosis.
5. 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?
A) Stop the flow of unoxygenated blood into systemic circulation.
B) Increase the flow of unoxygenated blood to the lungs.
C) Prevent the return of oxygenated blood to the lungs.
D) Reduce peripheral tissue hypoxia and nailbed clubbing.
Correct Answer: Prevent the return of oxygenated blood to the lungs.
Explanation: VSD is an acyanotic defect that allows oxygenated blood to shunt from the left
ventricle back to the right ventricle and lungs. Surgical closure prevents this left-to-right
shunting. VSD does not cause unoxygenated blood to enter systemic circulation or typically
cause clubbing (which is seen in cyanotic defects like Tetralogy of Fallot).
6. 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
, acyanotic 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.
Correct Answer: A, B, D, E.
Explanation: Infants with VSD tire easily during feeding due to increased cardiac workload.
Monitoring weight and wet diapers assesses hydration and nutrition. Small, frequent feedings
with rest periods, and using a softer/larger-holed nipple improve intake. Antibiotics should not be
mixed in formula because it is difficult to ensure the full dose is consumed.
7. Preoperative nursing care for a child with Wilms' tumor should include which intervention?
A) Gently percuss the abdomen for evidence of trapped air.
B) Observe the abdomen for any noticeable discolorations.
C) Apply cold compresses to the abdomen to reduce edema.
D) Put a sign on the bed reading, "DO NOT PALPATE ABDOMEN."
Correct Answer: Put a sign on the bed reading, "DO NOT PALPATE ABDOMEN."
Explanation: Wilms' tumor is an encapsulated renal tumor. Abdominal palpation can cause
rupture and dissemination of cancer cells, so it must be strictly avoided. Percussion, observation
for discoloration, and cold compresses are not indicated.
8. At 8 a.m. the unlicensed assistive personnel (UAP) informs the charge nurse that a female
adolescent client with acute glomerulonephritis has a blood pressure of 210/110. The 4 a.m.
blood pressure reading was 170/88. The client reports to the UAP that she is upset because her
boyfriend did not visit last night. What action should the nurse take first?
A) Give the client her 9 a.m. prescription for an oral diuretic early.
B) Administer PRN prescription of nifedipine (Procardia) sublingually.
C) Notify the healthcare provider and inform the nursing supervisor of the client's condition.
D) Attempt to calm the client and retake the blood pressure in thirty minutes.
Correct Answer: Administer PRN prescription of nifedipine (Procardia) sublingually.
Exam Questions and Verified Answers
1. A 6-month-old infant with congestive heart failure (CHF) is receiving digoxin elixir. Which
observation by the nurse warrants immediate intervention?
A) Apical heart rate of 60.
B) Sweating across the forehead.
C) Doesn't suck well.
D) Respiratory rate of 30 breaths per minute.
Correct Answer: Apical heart rate of 60.
Explanation: A heart rate of 60 is much lower than normal for a 6-month-old (normal awake
range is 80-150 BPM). Bradycardia in an infant receiving digoxin is a sign of potential toxicity
and warrants immediate intervention. Sweating, poor feeding, and a respiratory rate of 30 are
common findings in CHF but are not as acutely concerning as severe bradycardia.
2. 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?
A) Perform postural drainage before starting aerosol therapy.
B) Give respiratory treatments when the child is coughing a lot.
C) Administer aerosol therapy followed by postural drainage before meals.
D) Ensure respiratory therapy is done daily during any respiratory infection.
Correct Answer: Administer aerosol therapy followed by postural drainage before meals.
Explanation: In cystic fibrosis, nebulized aerosol therapy should be given first to open the
airways, followed by postural drainage to promote mucus clearance. Performing this sequence
before meals (or at least 1 hour after eating) helps prevent nausea and vomiting. Treatments
should be scheduled routinely (3–4 times daily), not only when coughing is severe.
3. 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?
A) Use sunscreen when lying by the pool.
B) Cleanse the skin at least 4 times a day.
,C) Take the medication with a glass of milk.
D) Menstrual periods may become irregular.
Correct Answer: Use sunscreen when lying by the pool.
Explanation: Tetracyclines cause significant photosensitivity. Severe sunburn can occur with
minimal sun exposure, so clients must be taught to avoid direct sunlight and use sunscreen. Dairy
products interfere with absorption (C), and skin cleansing or menstrual changes are not primary
concerns with this medication.
4. What preoperative nursing intervention should be included in the plan of care for an infant
with pyloric stenosis?
A) Monitor for signs of metabolic acidosis.
B) Estimate the quantity of diarrhea stools.
C) Place in a supine position after feeding.
D) Observe for projectile vomiting.
Correct Answer: Observe for projectile vomiting.
Explanation: Projectile vomiting is the classic sign of pyloric stenosis and leads to metabolic
alkalosis (not acidosis). Frequent vomiting increases aspiration risk, so the infant should not be
placed supine immediately after feeding. Diarrhea is not a feature of pyloric stenosis.
5. 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?
A) Stop the flow of unoxygenated blood into systemic circulation.
B) Increase the flow of unoxygenated blood to the lungs.
C) Prevent the return of oxygenated blood to the lungs.
D) Reduce peripheral tissue hypoxia and nailbed clubbing.
Correct Answer: Prevent the return of oxygenated blood to the lungs.
Explanation: VSD is an acyanotic defect that allows oxygenated blood to shunt from the left
ventricle back to the right ventricle and lungs. Surgical closure prevents this left-to-right
shunting. VSD does not cause unoxygenated blood to enter systemic circulation or typically
cause clubbing (which is seen in cyanotic defects like Tetralogy of Fallot).
6. 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
, acyanotic 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.
Correct Answer: A, B, D, E.
Explanation: Infants with VSD tire easily during feeding due to increased cardiac workload.
Monitoring weight and wet diapers assesses hydration and nutrition. Small, frequent feedings
with rest periods, and using a softer/larger-holed nipple improve intake. Antibiotics should not be
mixed in formula because it is difficult to ensure the full dose is consumed.
7. Preoperative nursing care for a child with Wilms' tumor should include which intervention?
A) Gently percuss the abdomen for evidence of trapped air.
B) Observe the abdomen for any noticeable discolorations.
C) Apply cold compresses to the abdomen to reduce edema.
D) Put a sign on the bed reading, "DO NOT PALPATE ABDOMEN."
Correct Answer: Put a sign on the bed reading, "DO NOT PALPATE ABDOMEN."
Explanation: Wilms' tumor is an encapsulated renal tumor. Abdominal palpation can cause
rupture and dissemination of cancer cells, so it must be strictly avoided. Percussion, observation
for discoloration, and cold compresses are not indicated.
8. At 8 a.m. the unlicensed assistive personnel (UAP) informs the charge nurse that a female
adolescent client with acute glomerulonephritis has a blood pressure of 210/110. The 4 a.m.
blood pressure reading was 170/88. The client reports to the UAP that she is upset because her
boyfriend did not visit last night. What action should the nurse take first?
A) Give the client her 9 a.m. prescription for an oral diuretic early.
B) Administer PRN prescription of nifedipine (Procardia) sublingually.
C) Notify the healthcare provider and inform the nursing supervisor of the client's condition.
D) Attempt to calm the client and retake the blood pressure in thirty minutes.
Correct Answer: Administer PRN prescription of nifedipine (Procardia) sublingually.
