Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1. A 9-month-old infant is brought to the clinic. Which
developmental milestone is most appropriate to expect for
this age?
A. Uses pincer grasp to pick up small objects.
B. Walks independently.
C. Says three-word phrases.
D. Builds a 6-block tower.
Answer: A
Rationale — Correct (A): At about 9 months infants typically
demonstrate the pincer grasp (index finger and thumb) to
pick up small objects, an important fine motor milestone
related to self-feeding and manipulation. This reflects
sensorimotor development and emerging hand dexterity.
Rationale — Incorrect:
B. Walking independently usually occurs around 12–15
months (gross motor).
,C. Three-word phrases are a toddler/preschool language
milestone (≈24–36 months).
D. Building a 6-block tower is expected closer to 2–3 years;
younger infants may stack 2–3 blocks around 15–18 months.
NCLEX mapping: Health Promotion and Maintenance —
Growth & Development.
2. A 4-year-old with acute asthma is receiving albuterol via
metered-dose inhaler with a spacer. The nurse should
instruct the parent to:
A. Have the child exhale fully, place the spacer mask over the
mouth and nose, deliver a puff, and encourage 5–6 tidal
breaths.
B. Deliver the puff directly into the child's mouth without a
spacer and instruct rapid shallow breaths.
C. Administer two puffs back-to-back without breathing
between puffs.
D. Remove the spacer and shake the inhaler after placing it in
the child's mouth.
Answer: A
Rationale — Correct (A): For young children, a spacer with
mask is recommended. The child should exhale, place the
mask, then after actuation the child should take 5–6 tidal
breaths to ensure medication deposition. This minimizes
coordination issues and maximizes delivery.
,Rationale — Incorrect:
B. Direct MDI without spacer requires coordination; shallow
breaths reduce deposition.
C. Back-to-back puffs without breathing impairs deposition;
follow manufacturer guidance (wait ~20–30 seconds or per
protocol, and have the child take breaths).
D. Shaking before actuation is correct, but removing spacer
defeats its benefit.
NCLEX mapping: Physiological Integrity — Pharmacological &
Respiratory Care.
3. A 2-year-old toddler with suspected otitis media is
prescribed amoxicillin suspension 90 mg/kg/day divided
twice daily. The child weighs 28 lb. What is the dose per
administration? (Round to nearest whole mg and show
calculation.)
A. 350 mg every 12 hours
B. 570 mg every 12 hours
C. 714 mg every 12 hours
D. 1150 mg every 12 hours
Answer: B
Calculation (digit-by-digit):
1. Convert pounds to kilograms: 28 lb ÷ 2.2 =
• 28 ÷ 2 = 14.0; remainder 0.0; now account for 2.2
precisely: 28 ÷ 2.2 = 12.727272... ≈ 12.7 kg.
, (Using precise division: 28 ÷ 2.2 = 12.7272727 → round to
12.73 kg.)
2. Total daily dose = 90 mg × 12.73 kg =
• 90 × 12 = 1080 mg
• 90 × 0.73 = 65.7 mg
• Sum = 1080 + 65.7 = 1145.7 mg/day.
3. Divide by 2 (bid dosing): 1145.7 ÷ 2 = 572.85 mg → round
to 573 mg ≈ 570 mg (closest option).
Rationale — Correct (B): Correct calculation yields ~573 mg
every 12 hours (rounded presentation commonly to 570 mg);
this adheres to weight-based pediatric dosing and safe
rounding practices.
Rationale — Incorrect:
A. 350 mg is too low (would underdose).
C. 714 mg reflects dividing by 1.6 or wrong arithmetic.
D. 1150 mg is the total daily dose, not per administration.
NCLEX mapping: Physiological Integrity — Pharmacological
Therapies; Safe Medication Administration.
4. A 6-year-old is admitted with croup (viral
laryngotracheobronchitis). Which nursing action is most
appropriate in the initial management?
A. Provide cool mist and encourage the parent to expose the
child briefly to cool night air.
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1. A 9-month-old infant is brought to the clinic. Which
developmental milestone is most appropriate to expect for
this age?
A. Uses pincer grasp to pick up small objects.
B. Walks independently.
C. Says three-word phrases.
D. Builds a 6-block tower.
Answer: A
Rationale — Correct (A): At about 9 months infants typically
demonstrate the pincer grasp (index finger and thumb) to
pick up small objects, an important fine motor milestone
related to self-feeding and manipulation. This reflects
sensorimotor development and emerging hand dexterity.
Rationale — Incorrect:
B. Walking independently usually occurs around 12–15
months (gross motor).
,C. Three-word phrases are a toddler/preschool language
milestone (≈24–36 months).
D. Building a 6-block tower is expected closer to 2–3 years;
younger infants may stack 2–3 blocks around 15–18 months.
NCLEX mapping: Health Promotion and Maintenance —
Growth & Development.
2. A 4-year-old with acute asthma is receiving albuterol via
metered-dose inhaler with a spacer. The nurse should
instruct the parent to:
A. Have the child exhale fully, place the spacer mask over the
mouth and nose, deliver a puff, and encourage 5–6 tidal
breaths.
B. Deliver the puff directly into the child's mouth without a
spacer and instruct rapid shallow breaths.
C. Administer two puffs back-to-back without breathing
between puffs.
D. Remove the spacer and shake the inhaler after placing it in
the child's mouth.
Answer: A
Rationale — Correct (A): For young children, a spacer with
mask is recommended. The child should exhale, place the
mask, then after actuation the child should take 5–6 tidal
breaths to ensure medication deposition. This minimizes
coordination issues and maximizes delivery.
,Rationale — Incorrect:
B. Direct MDI without spacer requires coordination; shallow
breaths reduce deposition.
C. Back-to-back puffs without breathing impairs deposition;
follow manufacturer guidance (wait ~20–30 seconds or per
protocol, and have the child take breaths).
D. Shaking before actuation is correct, but removing spacer
defeats its benefit.
NCLEX mapping: Physiological Integrity — Pharmacological &
Respiratory Care.
3. A 2-year-old toddler with suspected otitis media is
prescribed amoxicillin suspension 90 mg/kg/day divided
twice daily. The child weighs 28 lb. What is the dose per
administration? (Round to nearest whole mg and show
calculation.)
A. 350 mg every 12 hours
B. 570 mg every 12 hours
C. 714 mg every 12 hours
D. 1150 mg every 12 hours
Answer: B
Calculation (digit-by-digit):
1. Convert pounds to kilograms: 28 lb ÷ 2.2 =
• 28 ÷ 2 = 14.0; remainder 0.0; now account for 2.2
precisely: 28 ÷ 2.2 = 12.727272... ≈ 12.7 kg.
, (Using precise division: 28 ÷ 2.2 = 12.7272727 → round to
12.73 kg.)
2. Total daily dose = 90 mg × 12.73 kg =
• 90 × 12 = 1080 mg
• 90 × 0.73 = 65.7 mg
• Sum = 1080 + 65.7 = 1145.7 mg/day.
3. Divide by 2 (bid dosing): 1145.7 ÷ 2 = 572.85 mg → round
to 573 mg ≈ 570 mg (closest option).
Rationale — Correct (B): Correct calculation yields ~573 mg
every 12 hours (rounded presentation commonly to 570 mg);
this adheres to weight-based pediatric dosing and safe
rounding practices.
Rationale — Incorrect:
A. 350 mg is too low (would underdose).
C. 714 mg reflects dividing by 1.6 or wrong arithmetic.
D. 1150 mg is the total daily dose, not per administration.
NCLEX mapping: Physiological Integrity — Pharmacological
Therapies; Safe Medication Administration.
4. A 6-year-old is admitted with croup (viral
laryngotracheobronchitis). Which nursing action is most
appropriate in the initial management?
A. Provide cool mist and encourage the parent to expose the
child briefly to cool night air.
