Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — Growth & Development (Infant cognitive / social)
A 9-month-old infant exhibits brief separation from the
parent in the clinic without crying, but becomes distressed
when a nurse they don’t know approaches with a syringe.
Which behavior is most developmentally appropriate and
expected for a 9-month-old?
A. The infant should show no reaction to unfamiliar adults.
B. The infant shows stranger anxiety and may cry when
approached by an unfamiliar adult.
C. The infant should be able to verbally ask for the parent.
D. The infant should prefer the nurse to the parent.
Answer: B.
Rationale (correct): Stranger anxiety commonly appears
around 6–9 months as object permanence develops and
infants distinguish familiar from unfamiliar people; distress
,when approached by strangers is expected and
developmentally appropriate. This reflects normal
attachment and cognitive milestone development.
Rationale (incorrect): A — Infants typically do react to
unfamiliar adults by wariness or distress at this age. C —
Verbal requests for the parent are beyond typical expressive
language for most 9-month-olds. D — Preference for the
parent over unfamiliar staff at this age is typical, so preferring
the nurse would be unexpected.
2 — Growth & Development (Toddlers / Erikson)
A toddler (2 years old) is hospitalized and refuses to let
parents leave. Which nursing intervention best supports
Erikson’s stage (autonomy vs shame/doubt) and
developmental needs?
A. Leave the child alone to encourage independence.
B. Provide brief goodbyes, allow parents to stay with play
materials, and offer choices for small tasks.
C. Enforce a rigid schedule without parental presence.
D. Discourage parental involvement to prevent separation
anxiety.
Answer: B.
Rationale (correct): Toddlers are developing autonomy;
offering choices (e.g., which toy) supports independence
while parental presence and brief, consistent goodbyes
reduce anxiety and promote trust. Family-centered
,approaches that permit parental involvement are
developmentally appropriate.
Rationale (incorrect): A & C & D — Leaving the toddler alone,
enforcing rigid separation, or discouraging parents increase
shame/doubt and distress; they do not support autonomy or
family-centered care.
3 — Respiratory (Croup vs Epiglottitis)
A 3-year-old presents with a barking cough, inspiratory
stridor that improves with humidified air, and low-grade
fever. Which is the most likely diagnosis?
A. Bacterial epiglottitis
B. Foreign body aspiration
C. Viral croup (laryngotracheobronchitis)
D. Asthma exacerbation
Answer: C.
Rationale (correct): Barking cough and inspiratory stridor in a
toddler, often worse at night and improving with humidity,
are classic for viral croup. Clinical management emphasizes
maintaining airway, using humidified air and nebulized
epinephrine for severe cases.
Rationale (incorrect): A — Epiglottitis typically has high fever,
drooling, muffled voice, and rapid progression; do not
attempt throat exam in severe epiglottitis. B — Foreign body
aspiration often has sudden onset and unilateral findings;
, history is key. D — Asthma typically causes expiratory wheeze
and prolonged expiration rather than a barky cough/stridor.
4 — Cardiac (Congenital cyanotic defect)
A 2-month-old infant with tetralogy of Fallot (TOF) is at risk
for “tet” spells (hypercyanotic spells). Which immediate
action should the nurse implement during an acute “tet”
spell?
A. Place the infant supine and administer a diuretic.
B. Knee-to-chest position (or informal squatting position if
age appropriate), administer oxygen, and call for help.
C. Give a high-volume feed to calm the infant.
D. Begin chest compressions immediately.
Answer: B.
Rationale (correct): Knee-to-chest (in infants, holding
hips/bringing knees to chest) increases systemic vascular
resistance, reducing right-to-left shunt and improving
oxygenation. Administering oxygen and calling for immediate
assistance are essential. This is standard emergency response
for hypercyanotic spells.
Rationale (incorrect): A — Supine positioning and diuretics
are not first-line for a “tet” spell. C — Feeding may worsen
hypoxia. D — Chest compressions are not indicated unless
there is cardiopulmonary arrest.
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — Growth & Development (Infant cognitive / social)
A 9-month-old infant exhibits brief separation from the
parent in the clinic without crying, but becomes distressed
when a nurse they don’t know approaches with a syringe.
Which behavior is most developmentally appropriate and
expected for a 9-month-old?
A. The infant should show no reaction to unfamiliar adults.
B. The infant shows stranger anxiety and may cry when
approached by an unfamiliar adult.
C. The infant should be able to verbally ask for the parent.
D. The infant should prefer the nurse to the parent.
Answer: B.
Rationale (correct): Stranger anxiety commonly appears
around 6–9 months as object permanence develops and
infants distinguish familiar from unfamiliar people; distress
,when approached by strangers is expected and
developmentally appropriate. This reflects normal
attachment and cognitive milestone development.
Rationale (incorrect): A — Infants typically do react to
unfamiliar adults by wariness or distress at this age. C —
Verbal requests for the parent are beyond typical expressive
language for most 9-month-olds. D — Preference for the
parent over unfamiliar staff at this age is typical, so preferring
the nurse would be unexpected.
2 — Growth & Development (Toddlers / Erikson)
A toddler (2 years old) is hospitalized and refuses to let
parents leave. Which nursing intervention best supports
Erikson’s stage (autonomy vs shame/doubt) and
developmental needs?
A. Leave the child alone to encourage independence.
B. Provide brief goodbyes, allow parents to stay with play
materials, and offer choices for small tasks.
C. Enforce a rigid schedule without parental presence.
D. Discourage parental involvement to prevent separation
anxiety.
Answer: B.
Rationale (correct): Toddlers are developing autonomy;
offering choices (e.g., which toy) supports independence
while parental presence and brief, consistent goodbyes
reduce anxiety and promote trust. Family-centered
,approaches that permit parental involvement are
developmentally appropriate.
Rationale (incorrect): A & C & D — Leaving the toddler alone,
enforcing rigid separation, or discouraging parents increase
shame/doubt and distress; they do not support autonomy or
family-centered care.
3 — Respiratory (Croup vs Epiglottitis)
A 3-year-old presents with a barking cough, inspiratory
stridor that improves with humidified air, and low-grade
fever. Which is the most likely diagnosis?
A. Bacterial epiglottitis
B. Foreign body aspiration
C. Viral croup (laryngotracheobronchitis)
D. Asthma exacerbation
Answer: C.
Rationale (correct): Barking cough and inspiratory stridor in a
toddler, often worse at night and improving with humidity,
are classic for viral croup. Clinical management emphasizes
maintaining airway, using humidified air and nebulized
epinephrine for severe cases.
Rationale (incorrect): A — Epiglottitis typically has high fever,
drooling, muffled voice, and rapid progression; do not
attempt throat exam in severe epiglottitis. B — Foreign body
aspiration often has sudden onset and unilateral findings;
, history is key. D — Asthma typically causes expiratory wheeze
and prolonged expiration rather than a barky cough/stridor.
4 — Cardiac (Congenital cyanotic defect)
A 2-month-old infant with tetralogy of Fallot (TOF) is at risk
for “tet” spells (hypercyanotic spells). Which immediate
action should the nurse implement during an acute “tet”
spell?
A. Place the infant supine and administer a diuretic.
B. Knee-to-chest position (or informal squatting position if
age appropriate), administer oxygen, and call for help.
C. Give a high-volume feed to calm the infant.
D. Begin chest compressions immediately.
Answer: B.
Rationale (correct): Knee-to-chest (in infants, holding
hips/bringing knees to chest) increases systemic vascular
resistance, reducing right-to-left shunt and improving
oxygenation. Administering oxygen and calling for immediate
assistance are essential. This is standard emergency response
for hypercyanotic spells.
Rationale (incorrect): A — Supine positioning and diuretics
are not first-line for a “tet” spell. C — Feeding may worsen
hypoxia. D — Chest compressions are not indicated unless
there is cardiopulmonary arrest.
