HESI RN Pediatric Exam 2025/2026 –
Verified Questions & Expert
Rationales | Real Exam Content
Question 1
A 6-month-old infant is admitted with bronchiolitis. The nurse notes the infant is in the
sensorimotor stage of development. What is the most appropriate intervention to promote
attachment during hospitalization? A. Encourage the infant to play with mobile toys
independently B. Allow the parent to room-in and participate in care C. Limit parental visits to
once a day to reduce infection risk D. Place the infant in a quiet room with minimal stimulation
Correct Answer: B
Rationale: At 6 months (sensorimotor stage per Piaget), infants rely on primary caregivers for
trust (Erikson's stage 1). Allowing parental room-in promotes attachment and reduces separation
anxiety. Pediatric pharmacology is not directly applicable, but ensuring stable care supports
medication adherence by minimizing distress.
Question 2
A 2-year-old toddler is prescribed amoxicillin 40 mg/kg/day for otitis media, divided q8h. The
child weighs 12 kg. How many mg per dose should the nurse administer? A. 120 mg B. 160 mg
C. 200 mg D. 240 mg
Correct Answer: B
Rationale: Total daily dose = 40 mg/kg * 12 kg = 480 mg/day; divided by 3 doses = 160
mg/dose. At 2 years (autonomy vs. shame stage per Erikson), toddlers assert independence, so
explain simple dosing to parent for compliance. Amoxicillin's pediatric pharmacokinetics require
weight-based calculation to avoid subtherapeutic levels.
Question 3
During a well-child visit, the parent of a 4-year-old asks about discipline. The child is in the
preoperational stage. What is the best response? A. Use physical punishment to establish
boundaries B. Set clear rules and use time-outs for consistency C. Ignore misbehavior to avoid
attention-seeking D. Allow the child to decide their own consequences
Correct Answer: B
,Rationale: In preoperational stage (Piaget), 4-year-olds understand simple cause-effect but not
abstract reasoning; Erikson's initiative vs. guilt benefits from consistent, non-punitive limits. No
pharmacology, but consistent routines support medication schedules if needed.
Question 4
A 7-year-old school-age child is receiving chemotherapy with vincristine 1.5 mg/m² IV weekly.
The child’s BSA is 0.9 m². What is the dose? A. 1 mg B. 1.35 mg C. 1.5 mg D. 2 mg
Correct Answer: B
Rationale: Dose = 1.5 mg/m² * 0.9 m² = 1.35 mg. At 7 years (industry vs. inferiority per
Erikson, concrete operational per Piaget), children need explanations to build competence;
vincristine's pediatric neurotoxicity (e.g., neuropathy) requires monitoring developmental
milestones like fine motor skills.
Question 5
A 10-month-old is assessed for milestones. Crawling typically occurs at what developmental
stage? A. 2-4 months B. 6-10 months C. 12-15 months D. 18 months
Correct Answer: B
Rationale: Crawling aligns with 6-10 months in sensorimotor stage (Piaget), promoting
exploration and trust (Erikson). If delayed, assess for pharmacology issues like anticonvulsants
affecting motor development.
Question 6
A 3-year-old preschooler is prescribed acetaminophen 15 mg/kg/dose q4h PRN for fever. Child
weighs 15 kg. Maximum single dose? A. 150 mg B. 225 mg C. 300 mg D. 450 mg
Correct Answer: B
Rationale: 15 mg/kg * 15 kg = 225 mg. In initiative vs. guilt stage (Erikson), preschoolers
(preoperational Piaget) benefit from story-based explanations for meds; acetaminophen's
hepatotoxicity in peds requires weight-based dosing to avoid overdose.
Question 7
A 13-year-old adolescent is in Tanner stage 3. What is an expected finding? A. No secondary sex
characteristics B. Pubic hair coarse and curly, extending to thighs C. Peak height velocity D.
Menarche
Correct Answer: C
, Rationale: Tanner 3: Growth spurt peaks; identity vs. role confusion (Erikson), formal
operational (Piaget) allows abstract thinking about body changes. Pharmacology: Monitor for
acne meds like isotretinoin, teratogenic in females.
Question 8
A 1-year-old toddler receives DTaP vaccine. What is the primary pharmacologic concern? A.
Risk of anaphylaxis B. Local reaction and fever C. Contraindication in preterm infants D.
Interaction with antibiotics
Correct Answer: B
Rationale: DTaP causes mild fever (up to 38.9°C) in 25%; autonomy stage (Erikson) means
comfort measures aid coping. Pediatric vaccine pharmacology emphasizes monitoring post-
vaccination reactions.
Question 9
A 9-month-old in trust vs. mistrust stage cries during separation. Best intervention? A. Distract
with toys only B. Provide transitional object like blanket C. Ignore to promote independence D.
Administer sedative
Correct Answer: B
Rationale: Transitional objects support attachment in sensorimotor stage (Piaget). No
pharmacology, but if sedatives used (rare), monitor respiratory depression in infants.
Question 10
A 4-year-old is prescribed albuterol 0.15 mg/kg q4-6h PRN for asthma. Weight 18 kg. Dose? A.
1.8 mg B. 2.7 mg C. 3.6 mg D. 4.5 mg
Correct Answer: B
Rationale: 0.15 * 18 = 2.7 mg. Preoperational stage (Piaget), initiative (Erikson); use spacer for
delivery, as albuterol's beta-2 selectivity minimizes tachycardia in kids.
Question 11
A 2-week-old newborn's Moro reflex is elicited. This assesses: A. Primitive reflexes for
neurologic integrity B. Fine motor skills C. Social smile D. Grasping
Correct Answer: A
Rationale: Moro (startle) present birth-6 months; trust stage (Erikson). Absence may indicate
neurologic issue; no pharmacology, but relevant for phenobarbital dosing in seizures.
Verified Questions & Expert
Rationales | Real Exam Content
Question 1
A 6-month-old infant is admitted with bronchiolitis. The nurse notes the infant is in the
sensorimotor stage of development. What is the most appropriate intervention to promote
attachment during hospitalization? A. Encourage the infant to play with mobile toys
independently B. Allow the parent to room-in and participate in care C. Limit parental visits to
once a day to reduce infection risk D. Place the infant in a quiet room with minimal stimulation
Correct Answer: B
Rationale: At 6 months (sensorimotor stage per Piaget), infants rely on primary caregivers for
trust (Erikson's stage 1). Allowing parental room-in promotes attachment and reduces separation
anxiety. Pediatric pharmacology is not directly applicable, but ensuring stable care supports
medication adherence by minimizing distress.
Question 2
A 2-year-old toddler is prescribed amoxicillin 40 mg/kg/day for otitis media, divided q8h. The
child weighs 12 kg. How many mg per dose should the nurse administer? A. 120 mg B. 160 mg
C. 200 mg D. 240 mg
Correct Answer: B
Rationale: Total daily dose = 40 mg/kg * 12 kg = 480 mg/day; divided by 3 doses = 160
mg/dose. At 2 years (autonomy vs. shame stage per Erikson), toddlers assert independence, so
explain simple dosing to parent for compliance. Amoxicillin's pediatric pharmacokinetics require
weight-based calculation to avoid subtherapeutic levels.
Question 3
During a well-child visit, the parent of a 4-year-old asks about discipline. The child is in the
preoperational stage. What is the best response? A. Use physical punishment to establish
boundaries B. Set clear rules and use time-outs for consistency C. Ignore misbehavior to avoid
attention-seeking D. Allow the child to decide their own consequences
Correct Answer: B
,Rationale: In preoperational stage (Piaget), 4-year-olds understand simple cause-effect but not
abstract reasoning; Erikson's initiative vs. guilt benefits from consistent, non-punitive limits. No
pharmacology, but consistent routines support medication schedules if needed.
Question 4
A 7-year-old school-age child is receiving chemotherapy with vincristine 1.5 mg/m² IV weekly.
The child’s BSA is 0.9 m². What is the dose? A. 1 mg B. 1.35 mg C. 1.5 mg D. 2 mg
Correct Answer: B
Rationale: Dose = 1.5 mg/m² * 0.9 m² = 1.35 mg. At 7 years (industry vs. inferiority per
Erikson, concrete operational per Piaget), children need explanations to build competence;
vincristine's pediatric neurotoxicity (e.g., neuropathy) requires monitoring developmental
milestones like fine motor skills.
Question 5
A 10-month-old is assessed for milestones. Crawling typically occurs at what developmental
stage? A. 2-4 months B. 6-10 months C. 12-15 months D. 18 months
Correct Answer: B
Rationale: Crawling aligns with 6-10 months in sensorimotor stage (Piaget), promoting
exploration and trust (Erikson). If delayed, assess for pharmacology issues like anticonvulsants
affecting motor development.
Question 6
A 3-year-old preschooler is prescribed acetaminophen 15 mg/kg/dose q4h PRN for fever. Child
weighs 15 kg. Maximum single dose? A. 150 mg B. 225 mg C. 300 mg D. 450 mg
Correct Answer: B
Rationale: 15 mg/kg * 15 kg = 225 mg. In initiative vs. guilt stage (Erikson), preschoolers
(preoperational Piaget) benefit from story-based explanations for meds; acetaminophen's
hepatotoxicity in peds requires weight-based dosing to avoid overdose.
Question 7
A 13-year-old adolescent is in Tanner stage 3. What is an expected finding? A. No secondary sex
characteristics B. Pubic hair coarse and curly, extending to thighs C. Peak height velocity D.
Menarche
Correct Answer: C
, Rationale: Tanner 3: Growth spurt peaks; identity vs. role confusion (Erikson), formal
operational (Piaget) allows abstract thinking about body changes. Pharmacology: Monitor for
acne meds like isotretinoin, teratogenic in females.
Question 8
A 1-year-old toddler receives DTaP vaccine. What is the primary pharmacologic concern? A.
Risk of anaphylaxis B. Local reaction and fever C. Contraindication in preterm infants D.
Interaction with antibiotics
Correct Answer: B
Rationale: DTaP causes mild fever (up to 38.9°C) in 25%; autonomy stage (Erikson) means
comfort measures aid coping. Pediatric vaccine pharmacology emphasizes monitoring post-
vaccination reactions.
Question 9
A 9-month-old in trust vs. mistrust stage cries during separation. Best intervention? A. Distract
with toys only B. Provide transitional object like blanket C. Ignore to promote independence D.
Administer sedative
Correct Answer: B
Rationale: Transitional objects support attachment in sensorimotor stage (Piaget). No
pharmacology, but if sedatives used (rare), monitor respiratory depression in infants.
Question 10
A 4-year-old is prescribed albuterol 0.15 mg/kg q4-6h PRN for asthma. Weight 18 kg. Dose? A.
1.8 mg B. 2.7 mg C. 3.6 mg D. 4.5 mg
Correct Answer: B
Rationale: 0.15 * 18 = 2.7 mg. Preoperational stage (Piaget), initiative (Erikson); use spacer for
delivery, as albuterol's beta-2 selectivity minimizes tachycardia in kids.
Question 11
A 2-week-old newborn's Moro reflex is elicited. This assesses: A. Primitive reflexes for
neurologic integrity B. Fine motor skills C. Social smile D. Grasping
Correct Answer: A
Rationale: Moro (startle) present birth-6 months; trust stage (Erikson). Absence may indicate
neurologic issue; no pharmacology, but relevant for phenobarbital dosing in seizures.
