2026 HESI PEDIATRICS (PEDS) PRACTICE EXAM 400
PRACTICE QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
A 6-month-
old infant with congestive heart failure (CHF) is receiving digoxin elixir. Which observation by the nurse wa
rrants immediate intervention?
Apical heart rate of 60.
Sweating across the forehead.
Doesn't suck well.
Respiratory rate of 30 breaths per minute. - correct answer-Apical heart rate of 60.
A heart rate of 60 (A) is much lower than normal for a 6-month-
old and warrants immediate intervention. The normal heart rate for a 6-month-
old is 80 to 150 BPM when awake, and a rate of 70 while sleeping is considered within normal limits. (B an
d C) are expected symptoms of heart failure in an infant. (D) is within normal limits for an infant.
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 par
ents understand?
Perform postural drainage before starting aerosol therapy.
Give respiratory treatments when the child is coughing a lot.
Administer aerosol therapy followed by postural drainage before meals.
Ensure respiratory therapy is done daily during any respiratory infection. - correct answer-
Administer aerosol therapy followed by postural drainage before meals.
Postural drainage for a child with cystic fibrosis is most effective when performed aſter nebulization and b
efore meals (C) or at least 1 hour aſter eating to prevent nausea and vomiting. Postural drainage uses grav
ity to promote mucous removal aſter nebulization (A) treatments which open the airways. Pulmonary toil
eting or respiratory treatments should be given 3 to 4 times daily, not episodically (B and D).
A female teenager is taking oral tetracycline HCL (Achromycin V) for acne vulgaris. What is the most impor
tant instruction for the nurse to include in this client's teaching plan?
,Use sunscreen when lying by the pool.
Cleanse the skin at least 4 times a day.
Take the medication with a glass of milk.
Menstrual periods may become irregular. - correct answer-Use sunscreen when lying by the pool.
Photosensitivity is a common side effect of tetracycline HCL (Achromycin V) therapy. Severe sunburn can
occur with minimal sun exposure and clients should be instructed to avoid sunlight and to use sunscreen (
A). (B and D) are not related to tetracycline HCL (Achromycin V) therapy. (C) should be avoided because d
airy products interfere with the absorption of tetracyclines.
What preoperative nursing intervention should be included in the plan of care for an infant with pyloric st
enosis?
Monitor for signs of metabolic acidosis.
Estimate the quantity of diarrhea stools.
Place in a supine position aſter feeding.
Observe for projectile vomiting. - correct answer-Observe for projectile vomiting.
Projectile vomiting (D), which contributes to metabolic alkalosis (A), is the classic sign of pyloric stenosis. (
B) is not indicated. (C) is dangerous, due to the potential for aspiration with frequent vomiting.
An infant is born with a ventricular septal defect (VSD) and surgery is planned to correct the defect. The n
urse recognizes that surgical correction is designed to achieve which outcome?
Stop the flow of unoxygenated blood into systemic circulation.
Increase the flow of unoxygenated blood to the lungs.
Prevent the return of oxygenated blood to the lungs.
Reduce peripheral tissue hypoxia and nailbed clubbing - correct answer-
Prevent the return of oxygenated blood to the lungs.
Closure of VSDs stops oxygenated blood from being shunted from the leſt ventricle to the right ventricle (
C). VSDs are acyanotic defects, which means that no unoxygenated blood enters the systemic circulation (
A and B). (D) is common with TetrologyxofxFallot,xwhichxisxaxcyanoticxdefect.
,x
Ax3-week-oldxnewbornxisxbroughtxtoxthexclinicxforxfollow-
upxaſterxaxhomexbirth.xThexmotherxreportsxthatxherxchildxbottlexfeedsxforx5xminutesxonlyxandxthenxfallsx
asle
ep.xThexnursexauscultatesxaxloudxmurmurxcharacteristicxofxaxventricularxseptalxdefectx(VSD),xandxfindsxth
e
newbornxisxacyanoticxwithxaxrespiratoryxratexofx64xbreathsxperxminute.xWhatxinstructionxshouldxthexnurs
A.
e xMonitorxthexthexinfant'sxweightxandxnumberxofxwetxdiapersxperxda
y.
providexthexmotherxtoxensurexthexinfantxisxreceivingxadequatexintake?x(Selectxallxthatxapply.)
B.xIncreasexthexinfant'sxintakexperxfeedingxbyx1xtox2xouncesxperxweek.
C.xMixxthexdosexofxprophylacticxantibioticxinxaxfullxbottlexofxformula.
D.xAllowxthexinfantxtoxrestxandxrefeedxonxdemandxorxeveryx2xhours.
E.xUsexaxsoſterxnipplexorxincreasexthexsizexofxthexnipplexopening.x-
xcorrectxanswer-
A.xMonitorxthexthexinfant'sxweightxandxnumberxofxwetxdiapersxperxday.
B.xIncreasexthexinfant'sxintakexperxfeedingxbyx1xtox2xouncesxperxwee
k.
D.xAllowxthexinfantxtoxrestxandxrefeedxonxdemandxorxeveryx2xhours.
E.xUsexaxsoſterxnipplexorxincreasexthexsizexofxthexnipplexopening.
AntibioticxprophylaxisxisxrecommendedxforxinfantsxwithxVSDs,xbutxshouldxnotxbexmixedxinxaxbottlexofxfor
mu
lax(C)xbecausexitxisxdifficultxtoxensurexthatxthextotalxdosexisxconsumed.
Theyxshouldxbexmonitoredxforxweightxgainxandxatxleastx6xwetxdiapersxperxdayx(A).xAxone-
monthxoldxinfantxshouldxingestx2xtox4xouncesxofxformulaxperxfeedingxandxprogressxtoxaboutx30xouncesx
per
dayxbyx4-monthsxofxagex(B)
PreoperativexnursingxcarexforxaxchildxwithxWilms'xtumorxshouldxincludexwhichxintervention
?
Gentlyxpercussxthexabdomenxforxevidencexofxtrappedxair.
Observexthexabdomenxforxanyxnoticeablexdiscolorations.
Applyxcoldxcompressesxtoxthexabdomenxtoxreducexedema.
Putxaxsignxonxthexbedxreading,x"DOxNOTxPALPATExABDOMEN."x-
xcorrectxanswer-
Putxaxsignxonxthexbedxreading,x"DOxNOTxPALPATExABDOMEN."
Preventionxofxabdominalxpalpationx(D)xminimizesxthexriskxofxrupturingxthexencapsulatedxtumorxandxsubs
e
quentxmetastasis.x(A)xisxunnecessary,xandxthisxactionxcouldxtraumatizexthextumorxinxthexsamexmannerxas
xp
alpation.x(BxandxC)xarexincorrectxsincexthexabdomenxisxnotxdiscoloredxandxcoldxcompressesxarexnotxindic
at
ed.
,x
Atx8xa.m.xthexunlicensedxassistivexpersonnelx(UAP)xinformsxthexchargexnursexthatxaxfemalexadolescentxcli
e
ntxwithxacute
170/88. xglomerulonephritis
xThexclient xreportsxtoxthexxhas
UAPxaxxthat
blood xpressure
xshe xof
xisxupset x210/110.
xbecause xThe
xher x4xa.m.xxblood
xboyfriend xpressure
didxnot xreading
xvisitxlastxnight.xw
asWha
txactionxshouldxthexnursextakexfirst?
Givexthexclientxherx9xa.m.xprescriptionxforxanxoralxdiureticxearly.
AdministerxPRNxprescriptionxofxnifedipinex(Procardia)xsublingually.
Notifyxthexhealthcarexproviderxandxinformxthexnursingxsupervisorxofxthexclient'sxcondition
.
Attemptxtoxcalmxthexclientxandxretakexthexbloodxpressurexinxthirtyxminutes.x-
xcorrectxanswer-
AdministerxPRNxprescriptionxofxnifedipinex(Procardia)xsublingually.
SublingualxProcardiax(B)xlowersxbloodxpressurexveryxquickly,xandxthisxshouldxbexdonexfirst.x(A)xmayxalsox
be
done,xbutxoralxdiureticsxdoxnotxworkxasxrapidlyxasxthexsublingualxantihypertensive.xWhenxnotifyingxthexh
ea
lthcarexprovider,xthexfirstxthingxhe/shexwillxwantxtoxknowxisxifxthexPRNxantihypertensivexhasxbeenxadmini
st
eredx(C).x(D)xdoesxnotxconsiderxthexseriousnessxofxthisxfinding.xThexnursexshouldxstayxwithxthexclientxunti
lThe
xt
xnursexisxassessingxanx8-month-
he
oldxxblood pressure
childxxwho xisxreduced.
xhasxaxmedicalxdiagnosisxofxTetrologyxofxFallot.xWhichxsymptomxisxthisxclientxmostxlikelyxto
xex
hibit?
Bradycardia.
Machineryxmurmur.
Weakxpedalxpulses.
Clubbedxfingers.x-xcorrectxanswer-Clubbedxfingers.
TetrologyxofxFallot,xaxcyanoticxheartxdefect,xcausesxclubbingxofxfingersxandxtoesx(D)xduextoxtissuexhypoxia
.xT
achycardia,xnotx(A),xisxaxmanifestationxofxcongenitalxheartxdisease.x(B)xisxaxclassicxsignxofxventricularxsept
al
defect.x(C)xisxcharacteristicxofxcoarctationxofxthexaorta.
Surgeryxisxbeingxdelayedxforxanxinfantxwithxundescendedxtestes.xInxcollaborationxwithxthexhealthcarexpro
vi
derxandxthexfamily,xwhichxprescriptionxshouldxthexnursexanticipate?
Axtrialxofxadrenocorticotrophicxhormonexinjections.
Frequentxstimulationxofxthexcremastericxreflex.
PRACTICE QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
A 6-month-
old infant with congestive heart failure (CHF) is receiving digoxin elixir. Which observation by the nurse wa
rrants immediate intervention?
Apical heart rate of 60.
Sweating across the forehead.
Doesn't suck well.
Respiratory rate of 30 breaths per minute. - correct answer-Apical heart rate of 60.
A heart rate of 60 (A) is much lower than normal for a 6-month-
old and warrants immediate intervention. The normal heart rate for a 6-month-
old is 80 to 150 BPM when awake, and a rate of 70 while sleeping is considered within normal limits. (B an
d C) are expected symptoms of heart failure in an infant. (D) is within normal limits for an infant.
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 par
ents understand?
Perform postural drainage before starting aerosol therapy.
Give respiratory treatments when the child is coughing a lot.
Administer aerosol therapy followed by postural drainage before meals.
Ensure respiratory therapy is done daily during any respiratory infection. - correct answer-
Administer aerosol therapy followed by postural drainage before meals.
Postural drainage for a child with cystic fibrosis is most effective when performed aſter nebulization and b
efore meals (C) or at least 1 hour aſter eating to prevent nausea and vomiting. Postural drainage uses grav
ity to promote mucous removal aſter nebulization (A) treatments which open the airways. Pulmonary toil
eting or respiratory treatments should be given 3 to 4 times daily, not episodically (B and D).
A female teenager is taking oral tetracycline HCL (Achromycin V) for acne vulgaris. What is the most impor
tant instruction for the nurse to include in this client's teaching plan?
,Use sunscreen when lying by the pool.
Cleanse the skin at least 4 times a day.
Take the medication with a glass of milk.
Menstrual periods may become irregular. - correct answer-Use sunscreen when lying by the pool.
Photosensitivity is a common side effect of tetracycline HCL (Achromycin V) therapy. Severe sunburn can
occur with minimal sun exposure and clients should be instructed to avoid sunlight and to use sunscreen (
A). (B and D) are not related to tetracycline HCL (Achromycin V) therapy. (C) should be avoided because d
airy products interfere with the absorption of tetracyclines.
What preoperative nursing intervention should be included in the plan of care for an infant with pyloric st
enosis?
Monitor for signs of metabolic acidosis.
Estimate the quantity of diarrhea stools.
Place in a supine position aſter feeding.
Observe for projectile vomiting. - correct answer-Observe for projectile vomiting.
Projectile vomiting (D), which contributes to metabolic alkalosis (A), is the classic sign of pyloric stenosis. (
B) is not indicated. (C) is dangerous, due to the potential for aspiration with frequent vomiting.
An infant is born with a ventricular septal defect (VSD) and surgery is planned to correct the defect. The n
urse recognizes that surgical correction is designed to achieve which outcome?
Stop the flow of unoxygenated blood into systemic circulation.
Increase the flow of unoxygenated blood to the lungs.
Prevent the return of oxygenated blood to the lungs.
Reduce peripheral tissue hypoxia and nailbed clubbing - correct answer-
Prevent the return of oxygenated blood to the lungs.
Closure of VSDs stops oxygenated blood from being shunted from the leſt ventricle to the right ventricle (
C). VSDs are acyanotic defects, which means that no unoxygenated blood enters the systemic circulation (
A and B). (D) is common with TetrologyxofxFallot,xwhichxisxaxcyanoticxdefect.
,x
Ax3-week-oldxnewbornxisxbroughtxtoxthexclinicxforxfollow-
upxaſterxaxhomexbirth.xThexmotherxreportsxthatxherxchildxbottlexfeedsxforx5xminutesxonlyxandxthenxfallsx
asle
ep.xThexnursexauscultatesxaxloudxmurmurxcharacteristicxofxaxventricularxseptalxdefectx(VSD),xandxfindsxth
e
newbornxisxacyanoticxwithxaxrespiratoryxratexofx64xbreathsxperxminute.xWhatxinstructionxshouldxthexnurs
A.
e xMonitorxthexthexinfant'sxweightxandxnumberxofxwetxdiapersxperxda
y.
providexthexmotherxtoxensurexthexinfantxisxreceivingxadequatexintake?x(Selectxallxthatxapply.)
B.xIncreasexthexinfant'sxintakexperxfeedingxbyx1xtox2xouncesxperxweek.
C.xMixxthexdosexofxprophylacticxantibioticxinxaxfullxbottlexofxformula.
D.xAllowxthexinfantxtoxrestxandxrefeedxonxdemandxorxeveryx2xhours.
E.xUsexaxsoſterxnipplexorxincreasexthexsizexofxthexnipplexopening.x-
xcorrectxanswer-
A.xMonitorxthexthexinfant'sxweightxandxnumberxofxwetxdiapersxperxday.
B.xIncreasexthexinfant'sxintakexperxfeedingxbyx1xtox2xouncesxperxwee
k.
D.xAllowxthexinfantxtoxrestxandxrefeedxonxdemandxorxeveryx2xhours.
E.xUsexaxsoſterxnipplexorxincreasexthexsizexofxthexnipplexopening.
AntibioticxprophylaxisxisxrecommendedxforxinfantsxwithxVSDs,xbutxshouldxnotxbexmixedxinxaxbottlexofxfor
mu
lax(C)xbecausexitxisxdifficultxtoxensurexthatxthextotalxdosexisxconsumed.
Theyxshouldxbexmonitoredxforxweightxgainxandxatxleastx6xwetxdiapersxperxdayx(A).xAxone-
monthxoldxinfantxshouldxingestx2xtox4xouncesxofxformulaxperxfeedingxandxprogressxtoxaboutx30xouncesx
per
dayxbyx4-monthsxofxagex(B)
PreoperativexnursingxcarexforxaxchildxwithxWilms'xtumorxshouldxincludexwhichxintervention
?
Gentlyxpercussxthexabdomenxforxevidencexofxtrappedxair.
Observexthexabdomenxforxanyxnoticeablexdiscolorations.
Applyxcoldxcompressesxtoxthexabdomenxtoxreducexedema.
Putxaxsignxonxthexbedxreading,x"DOxNOTxPALPATExABDOMEN."x-
xcorrectxanswer-
Putxaxsignxonxthexbedxreading,x"DOxNOTxPALPATExABDOMEN."
Preventionxofxabdominalxpalpationx(D)xminimizesxthexriskxofxrupturingxthexencapsulatedxtumorxandxsubs
e
quentxmetastasis.x(A)xisxunnecessary,xandxthisxactionxcouldxtraumatizexthextumorxinxthexsamexmannerxas
xp
alpation.x(BxandxC)xarexincorrectxsincexthexabdomenxisxnotxdiscoloredxandxcoldxcompressesxarexnotxindic
at
ed.
,x
Atx8xa.m.xthexunlicensedxassistivexpersonnelx(UAP)xinformsxthexchargexnursexthatxaxfemalexadolescentxcli
e
ntxwithxacute
170/88. xglomerulonephritis
xThexclient xreportsxtoxthexxhas
UAPxaxxthat
blood xpressure
xshe xof
xisxupset x210/110.
xbecause xThe
xher x4xa.m.xxblood
xboyfriend xpressure
didxnot xreading
xvisitxlastxnight.xw
asWha
txactionxshouldxthexnursextakexfirst?
Givexthexclientxherx9xa.m.xprescriptionxforxanxoralxdiureticxearly.
AdministerxPRNxprescriptionxofxnifedipinex(Procardia)xsublingually.
Notifyxthexhealthcarexproviderxandxinformxthexnursingxsupervisorxofxthexclient'sxcondition
.
Attemptxtoxcalmxthexclientxandxretakexthexbloodxpressurexinxthirtyxminutes.x-
xcorrectxanswer-
AdministerxPRNxprescriptionxofxnifedipinex(Procardia)xsublingually.
SublingualxProcardiax(B)xlowersxbloodxpressurexveryxquickly,xandxthisxshouldxbexdonexfirst.x(A)xmayxalsox
be
done,xbutxoralxdiureticsxdoxnotxworkxasxrapidlyxasxthexsublingualxantihypertensive.xWhenxnotifyingxthexh
ea
lthcarexprovider,xthexfirstxthingxhe/shexwillxwantxtoxknowxisxifxthexPRNxantihypertensivexhasxbeenxadmini
st
eredx(C).x(D)xdoesxnotxconsiderxthexseriousnessxofxthisxfinding.xThexnursexshouldxstayxwithxthexclientxunti
lThe
xt
xnursexisxassessingxanx8-month-
he
oldxxblood pressure
childxxwho xisxreduced.
xhasxaxmedicalxdiagnosisxofxTetrologyxofxFallot.xWhichxsymptomxisxthisxclientxmostxlikelyxto
xex
hibit?
Bradycardia.
Machineryxmurmur.
Weakxpedalxpulses.
Clubbedxfingers.x-xcorrectxanswer-Clubbedxfingers.
TetrologyxofxFallot,xaxcyanoticxheartxdefect,xcausesxclubbingxofxfingersxandxtoesx(D)xduextoxtissuexhypoxia
.xT
achycardia,xnotx(A),xisxaxmanifestationxofxcongenitalxheartxdisease.x(B)xisxaxclassicxsignxofxventricularxsept
al
defect.x(C)xisxcharacteristicxofxcoarctationxofxthexaorta.
Surgeryxisxbeingxdelayedxforxanxinfantxwithxundescendedxtestes.xInxcollaborationxwithxthexhealthcarexpro
vi
derxandxthexfamily,xwhichxprescriptionxshouldxthexnursexanticipate?
Axtrialxofxadrenocorticotrophicxhormonexinjections.
Frequentxstimulationxofxthexcremastericxreflex.
