HESI Exit Pediatrics

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Sample questions from HESI Exit Pediatrics

This material has 150 questions with answers and rationales. Here are the first 5.

1. 1.In the pediatric emergency department, a 5-month-old with bronchiolitis has copious nasal secretions, mild subcostal retractions, and an oxygen saturation of 92% on room air. The infant becomes too fatigued to coordinate sucking during a feeding. Which action should the nurse take first?

   • A.Administer an antitussive medication.
   • B.Request an order for a nasogastric feeding.
   • C.Offer smaller, more frequent oral feedings while the infant is upright.
   • D.Suction the nares with a bulb syringe or suction device.

   Rationale: Clearing nasal secretions can reduce airway obstruction and improve the infant's ability to breathe and feed, so suctioning is the immediate priority. Smaller feedings may be appropriate after breathing and feeding coordination improve, while tube feeding requires further assessment and a prescription. Antitussives are not routinely used for infants with bronchiolitis and can impair protective coughing.

2. 2.At change of shift on a pediatric medical unit, which child should the nurse assess first?

   • A.A 10-year-old with a ventricular septal defect who is newly restless, has cool extremities, and has a capillary refill of 4 seconds.
   • B.A 9-year-old with cystic fibrosis who has a temperature of 38.1 C and thick green sputum.
   • C.A 7-year-old with sickle cell disease who reports pain of 8/10 and has an oxygen saturation of 97% on room air.
   • D.An 8-year-old with nephrotic syndrome whose urine output has decreased from 1.2 to 0.8 mL/kg/hr over 4 hours.

   Rationale: New restlessness, cool extremities, and delayed capillary refill suggest impaired perfusion and possible decreased cardiac output, requiring immediate assessment. Severe sickle cell pain needs timely analgesia, but the stated oxygenation is stable and no acute respiratory findings are described. The urine output change and fever with sputum warrant follow-up, but neither takes priority over signs of possible circulatory compromise.

3. 3.Refer to the client's chart. Which actions should the nurse take now for the child experiencing an asthma exacerbation? Select all that apply.

   • A.Encourage the child to drink a large glass of water before treatment.
   • B.Delay reassessment until the full medication schedule is completed.
   • C.Prepare to escalate care because the child is becoming drowsy and air movement is decreasing.
   • D.Position the child upright and minimize exertion.
   • E.Apply oxygen and titrate it to the prescribed saturation goal.
   • F.Administer the prescribed inhaled short-acting bronchodilator.

   Rationale: The chart shows worsening retractions and a falling oxygen saturation, so upright positioning, prompt bronchodilator administration, and oxygen support are appropriate. Drowsiness with decreasing air movement at 1015 is an ominous change that can signal impending respiratory failure and requires escalation rather than waiting. Oral fluids do not treat acute bronchospasm and may increase aspiration risk when breathing is labored, while reassessment must occur promptly after interventions.

4. 4.A child with type 1 diabetes is receiving an insulin infusion for diabetic ketoacidosis. Two hours after treatment begins, the serum glucose has fallen from 520 to 240 mg/dL, but the anion gap remains elevated. Which prescription should the nurse anticipate?

   • A.Restrict fluids until the anion gap returns to the reference range.
   • B.Add dextrose to the IV fluid while continuing insulin as prescribed.
   • C.Administer a rapid-acting insulin dose subcutaneously and discontinue IV fluids.
   • D.Stop the insulin infusion because the glucose is below 250 mg/dL.

   Answer and rationale are in the full material.

5. 5.The parent of a 4-year-old with acute otitis media reports that the child developed hives and lip swelling after the first dose of amoxicillin. Which instruction is most important?

   • A.Hold the next dose and schedule a routine appointment in 1 week.
   • B.Give an antihistamine and continue the antibiotic if the rash fades.
   • C.Stop the medication and seek emergency care for the swelling and hives.
   • D.Give the next dose with food and observe for a milder reaction.

   Answer and rationale are in the full material.