Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1. (Growth & Development — Milestones)
A 9-month-old infant is brought to clinic. Which finding, if
present, would be most consistent with expected
development for a 9-month-old?
A. Uses a pincer grasp to pick up a small crumb.
B. Speaks a 3-word sentence.
C. Walks independently.
D. Shows no stranger anxiety.
Answer: A. Uses a pincer grasp to pick up a small crumb.
Rationale — Correct (A): By about 9 months most infants
demonstrate a pincer (inferior pincer) grasp (thumb and
index finger) and can pick up small objects — an expected
fine motor milestone. This reflects typical sensorimotor
development and is safety-relevant when anticipating oral
exploration.
,Rationale — Incorrect:
B: 3-word sentences are typical of toddlers around 2 years; a
9-month-old may say "mama/dada" nonspecific and babble
but not form multiword sentences.
C: Independent walking usually occurs around 12 months
(range ~9–15 months); expecting walking at 9 months risks
labeling a normal infant as delayed.
D: Stranger anxiety commonly increases around 6–9 months;
absence of stranger anxiety at 9 months is not the most
expected finding and may warrant assessment of
social/emotional cues but is not as typical as the pincer
grasp.
2. (Growth & Development — Nutrition)
A parent of a 14-month-old asks when to introduce cow’s
milk as the primary beverage. The nurse’s best response is:
A. “You can begin whole cow’s milk now as the primary
drink.”
B. “Give only skim milk until age 2 to avoid high fat intake.”
C. “Use soy milk instead of cow’s milk until age 5.”
D. “Continue exclusive breastfeeding until the child is 2 years
old.”
Answer: A. “You can begin whole cow’s milk now as the
primary drink.”
,Rationale — Correct (A): Current pediatric guidance supports
introducing pasteurized whole cow’s milk as the main milk
source after 12 months (to provide needed fat for brain
growth). Whole milk is typically recommended through 24
months unless there are specific medical concerns. This is a
developmental nutrition safety principle.
Rationale — Incorrect:
B: Skim/low-fat milks are generally not recommended for
children <2 years because dietary fat supports neurological
development.
C: Soy or alternative milks are not routinely recommended as
first-line substitutes unless contraindicated (e.g., cow’s milk
protein allergy) and may lack nutrients unless fortified.
D: Exclusive breastfeeding to 2 years is not recommended;
complementary foods should be introduced by 6 months,
and continuing breastfeeding beyond 12 months is optional
but not exclusive.
3. (Safety — Poisoning prevention)
A nurse is teaching parents about toddler safety. Which
statement by the parent indicates the best understanding of
safe medication storage?
A. “I’ll keep the child’s cough syrup on the counter to remind
myself to give it at night.”
B. “I’ll put all medications in a locked cabinet up and away
from the child’s reach.”
, C. “I’ll leave vitamins in their chews on the kitchen table for
convenience.”
D. “We don’t need childproof caps since we watch our child
closely.”
Answer: B. “I’ll put all medications in a locked cabinet up
and away from the child’s reach.”
Rationale — Correct (B): Safe storage — locked, out of sight
and reach — is a primary prevention strategy for accidental
pediatric poisonings. It addresses developmental curiosity
and mobility typical of toddlers.
Rationale — Incorrect:
A: Leaving medications on counters creates easy access
during moments of inattention — unsafe.
C: Chewables (vitamins) are attractive to children and must
be stored securely; leaving them out is hazardous.
D: Childproof caps reduce but do not eliminate risk;
supervision alone is insufficient due to rapid toddler mobility.
4. (Growth & Development — Cognitive)
Which play activity is most appropriate to assess for a 4-year-
old’s developmental level?
A. Stacking 6–8 blocks to build a tower.
B. Solving a simple two-piece puzzle.
C. Engaging in cooperative pretend play with peers.
D. Following a three-step unrelated command.
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1. (Growth & Development — Milestones)
A 9-month-old infant is brought to clinic. Which finding, if
present, would be most consistent with expected
development for a 9-month-old?
A. Uses a pincer grasp to pick up a small crumb.
B. Speaks a 3-word sentence.
C. Walks independently.
D. Shows no stranger anxiety.
Answer: A. Uses a pincer grasp to pick up a small crumb.
Rationale — Correct (A): By about 9 months most infants
demonstrate a pincer (inferior pincer) grasp (thumb and
index finger) and can pick up small objects — an expected
fine motor milestone. This reflects typical sensorimotor
development and is safety-relevant when anticipating oral
exploration.
,Rationale — Incorrect:
B: 3-word sentences are typical of toddlers around 2 years; a
9-month-old may say "mama/dada" nonspecific and babble
but not form multiword sentences.
C: Independent walking usually occurs around 12 months
(range ~9–15 months); expecting walking at 9 months risks
labeling a normal infant as delayed.
D: Stranger anxiety commonly increases around 6–9 months;
absence of stranger anxiety at 9 months is not the most
expected finding and may warrant assessment of
social/emotional cues but is not as typical as the pincer
grasp.
2. (Growth & Development — Nutrition)
A parent of a 14-month-old asks when to introduce cow’s
milk as the primary beverage. The nurse’s best response is:
A. “You can begin whole cow’s milk now as the primary
drink.”
B. “Give only skim milk until age 2 to avoid high fat intake.”
C. “Use soy milk instead of cow’s milk until age 5.”
D. “Continue exclusive breastfeeding until the child is 2 years
old.”
Answer: A. “You can begin whole cow’s milk now as the
primary drink.”
,Rationale — Correct (A): Current pediatric guidance supports
introducing pasteurized whole cow’s milk as the main milk
source after 12 months (to provide needed fat for brain
growth). Whole milk is typically recommended through 24
months unless there are specific medical concerns. This is a
developmental nutrition safety principle.
Rationale — Incorrect:
B: Skim/low-fat milks are generally not recommended for
children <2 years because dietary fat supports neurological
development.
C: Soy or alternative milks are not routinely recommended as
first-line substitutes unless contraindicated (e.g., cow’s milk
protein allergy) and may lack nutrients unless fortified.
D: Exclusive breastfeeding to 2 years is not recommended;
complementary foods should be introduced by 6 months,
and continuing breastfeeding beyond 12 months is optional
but not exclusive.
3. (Safety — Poisoning prevention)
A nurse is teaching parents about toddler safety. Which
statement by the parent indicates the best understanding of
safe medication storage?
A. “I’ll keep the child’s cough syrup on the counter to remind
myself to give it at night.”
B. “I’ll put all medications in a locked cabinet up and away
from the child’s reach.”
, C. “I’ll leave vitamins in their chews on the kitchen table for
convenience.”
D. “We don’t need childproof caps since we watch our child
closely.”
Answer: B. “I’ll put all medications in a locked cabinet up
and away from the child’s reach.”
Rationale — Correct (B): Safe storage — locked, out of sight
and reach — is a primary prevention strategy for accidental
pediatric poisonings. It addresses developmental curiosity
and mobility typical of toddlers.
Rationale — Incorrect:
A: Leaving medications on counters creates easy access
during moments of inattention — unsafe.
C: Chewables (vitamins) are attractive to children and must
be stored securely; leaving them out is hazardous.
D: Childproof caps reduce but do not eliminate risk;
supervision alone is insufficient due to rapid toddler mobility.
4. (Growth & Development — Cognitive)
Which play activity is most appropriate to assess for a 4-year-
old’s developmental level?
A. Stacking 6–8 blocks to build a tower.
B. Solving a simple two-piece puzzle.
C. Engaging in cooperative pretend play with peers.
D. Following a three-step unrelated command.
