HESI Pediatrics V1 | 2026 Q&A with
Rationale (HESI Peds Exam)
1. A 2-year-old child with cystic fibrosis is being discharged. Which instruction should the
nurse include regarding the administration of pancreatic enzymes?
A. Administer enzymes 2 hours after each meal.
B. Mix the enzymes in a bottle of warm formula.
C. Give enzymes with all meals and snacks.
D. Skip the dose if the child is having a small snack.
Correct Answer: C
Rationale: Pancreatic enzymes are necessary for the digestion of fats, proteins, and
carbohydrates in patients with cystic fibrosis. They must be taken with every meal and
snack to ensure proper nutrient absorption. Failing to provide enzymes can lead to
malabsorption and steatorrhea.
2. An infant with Tetralogy of Fallot becomes acutely cyanotic and agitated during a blood
draw. Which action should the nurse take first?
A. Place the infant in the knee-chest position.
B. Administer a dose of IV morphine.
C. Provide 100% oxygen via a non-rebreather mask.
,D. Call for a STAT chest X-ray.
Correct Answer: A
Rationale: The knee-chest position increases systemic vascular resistance, which helps
reduce the right-to-left shunt and improves pulmonary blood flow during a tet spell. This is
the immediate non-invasive nursing action required to stabilize the infant. Oxygen and
medications like morphine are secondary interventions.
3. The nurse is assessing a 4-week-old infant suspected of having hypertrophic pyloric
stenosis. Which finding should the nurse expect?
A. Currant jelly-like stools.
B. Ribbon-like stools.
C. Bile-stained emesis.
D. Projectile vomiting after feedings.
Correct Answer: D
Rationale: Projectile, non-bilious vomiting is the hallmark sign of pyloric stenosis due to
the narrowing of the pyloric sphincter. An olive-shaped mass may also be palpable in the
epigastrium. Currant jelly stools are more characteristic of intussusception.
4. A mother brings her 12-month-old infant to the clinic for a well-child visit. Which
developmental milestone should the nurse expect the child to have achieved?
A. Building a tower of six blocks.
,B. Speaking in three-word sentences.
C. Standing alone and taking a few steps.
D. Using a spoon without spilling.
Correct Answer: C
Rationale: By 12 months of age, most infants can stand alone and take their first
independent steps. They should also be able to use a pincer grasp and say a few simple
words like ‘mama’ or ‘dada.’ Building a tower of six blocks is a milestone typically seen
around 24 months.
5. The nurse is caring for a child diagnosed with nephrotic syndrome. Which clinical
manifestation is most characteristic of this condition?
A. Gross hematuria and hypertension.
B. Massive proteinuria and generalized edema.
C. Weight loss and increased urinary output.
D. Low serum cholesterol levels.
Correct Answer: B
Rationale: Nephrotic syndrome is characterized by heavy proteinuria, which leads to
hypoalbuminemia and subsequent generalized edema (anasarca). Children with this
condition often appear ‘puffy’ and gain weight rapidly due to fluid retention. Blood
pressure is usually normal or slightly low, unlike in acute glomerulonephritis.
, 6. A 5-year-old is brought to the emergency department with a high fever, muffled voice, and
is drooling. Which action by the nurse is contraindicated?
A. Monitoring oxygen saturation via pulse oximetry.
B. Allowing the child to sit in a tripod position.
C. Starting a peripheral IV for fluid resuscitation.
D. Obtaining a throat culture using a tongue depressor.
Correct Answer: D
Rationale: These symptoms are highly suggestive of acute epiglottitis, a medical
emergency. Inserting a tongue depressor or any object into the throat can trigger a
laryngospasm and completely obstruct the airway. The nurse must keep the child calm and
prepare for emergency intubation.
7. Which of the following are clinical manifestations of Kawasaki disease in the acute phase?
Select all that apply.
A. High fever unresponsive to antibiotics.
B. Strawberry tongue.
C. Desquamation of the hands and feet.
D. Bilateral conjunctival injection without exudate.
E. Cervical lymphadenopathy.
F. Splenomegaly.
Rationale (HESI Peds Exam)
1. A 2-year-old child with cystic fibrosis is being discharged. Which instruction should the
nurse include regarding the administration of pancreatic enzymes?
A. Administer enzymes 2 hours after each meal.
B. Mix the enzymes in a bottle of warm formula.
C. Give enzymes with all meals and snacks.
D. Skip the dose if the child is having a small snack.
Correct Answer: C
Rationale: Pancreatic enzymes are necessary for the digestion of fats, proteins, and
carbohydrates in patients with cystic fibrosis. They must be taken with every meal and
snack to ensure proper nutrient absorption. Failing to provide enzymes can lead to
malabsorption and steatorrhea.
2. An infant with Tetralogy of Fallot becomes acutely cyanotic and agitated during a blood
draw. Which action should the nurse take first?
A. Place the infant in the knee-chest position.
B. Administer a dose of IV morphine.
C. Provide 100% oxygen via a non-rebreather mask.
,D. Call for a STAT chest X-ray.
Correct Answer: A
Rationale: The knee-chest position increases systemic vascular resistance, which helps
reduce the right-to-left shunt and improves pulmonary blood flow during a tet spell. This is
the immediate non-invasive nursing action required to stabilize the infant. Oxygen and
medications like morphine are secondary interventions.
3. The nurse is assessing a 4-week-old infant suspected of having hypertrophic pyloric
stenosis. Which finding should the nurse expect?
A. Currant jelly-like stools.
B. Ribbon-like stools.
C. Bile-stained emesis.
D. Projectile vomiting after feedings.
Correct Answer: D
Rationale: Projectile, non-bilious vomiting is the hallmark sign of pyloric stenosis due to
the narrowing of the pyloric sphincter. An olive-shaped mass may also be palpable in the
epigastrium. Currant jelly stools are more characteristic of intussusception.
4. A mother brings her 12-month-old infant to the clinic for a well-child visit. Which
developmental milestone should the nurse expect the child to have achieved?
A. Building a tower of six blocks.
,B. Speaking in three-word sentences.
C. Standing alone and taking a few steps.
D. Using a spoon without spilling.
Correct Answer: C
Rationale: By 12 months of age, most infants can stand alone and take their first
independent steps. They should also be able to use a pincer grasp and say a few simple
words like ‘mama’ or ‘dada.’ Building a tower of six blocks is a milestone typically seen
around 24 months.
5. The nurse is caring for a child diagnosed with nephrotic syndrome. Which clinical
manifestation is most characteristic of this condition?
A. Gross hematuria and hypertension.
B. Massive proteinuria and generalized edema.
C. Weight loss and increased urinary output.
D. Low serum cholesterol levels.
Correct Answer: B
Rationale: Nephrotic syndrome is characterized by heavy proteinuria, which leads to
hypoalbuminemia and subsequent generalized edema (anasarca). Children with this
condition often appear ‘puffy’ and gain weight rapidly due to fluid retention. Blood
pressure is usually normal or slightly low, unlike in acute glomerulonephritis.
, 6. A 5-year-old is brought to the emergency department with a high fever, muffled voice, and
is drooling. Which action by the nurse is contraindicated?
A. Monitoring oxygen saturation via pulse oximetry.
B. Allowing the child to sit in a tripod position.
C. Starting a peripheral IV for fluid resuscitation.
D. Obtaining a throat culture using a tongue depressor.
Correct Answer: D
Rationale: These symptoms are highly suggestive of acute epiglottitis, a medical
emergency. Inserting a tongue depressor or any object into the throat can trigger a
laryngospasm and completely obstruct the airway. The nurse must keep the child calm and
prepare for emergency intubation.
7. Which of the following are clinical manifestations of Kawasaki disease in the acute phase?
Select all that apply.
A. High fever unresponsive to antibiotics.
B. Strawberry tongue.
C. Desquamation of the hands and feet.
D. Bilateral conjunctival injection without exudate.
E. Cervical lymphadenopathy.
F. Splenomegaly.
