SAUNDERS COMPREHENSIVE REVIEW FOR THE NCLEX-
PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
PEDIATRIC NURSING (CHILD HEALTH & DEVELOPMENTAL
DISORDERS) TEST BANK
Item 1 — Developmental screening (1-year check)
A 12-month-old infant is brought for a well visit. Which
milestone would most concern the nurse and prompt
immediate developmental screening?
A. Uses pincer grasp to pick up small objects.
B. Says “mama” and “dada” specifically and says one additional
word.
C. Does not pull to stand or attempt to cruise.
D. Waves bye-bye on request.
Correct answer: C
Rationale — correct (C): By 12 months most infants pull to
stand and may cruise or take first steps. Failure to pull to stand
or show any attempt at standing raises concern for gross motor
,delay and warrants developmental screening/referral (safety:
early detection reduces later morbidity). CDC
Rationale — incorrect:
A: Pincer grasp is expected by ~9–12 months — not concerning.
B: Specific “mama/dada” and another word is within expected
language for 12 months.
D: Waving bye-bye is a typical social/communication milestone
by ~9–12 months.
Item 2 — Toddler safety / separation
A 20-month-old toddler is hospitalized for dehydration. The
parent is present and asks the nurse whether brief separation
will harm the child’s development. The nurse’s best reply is:
A. “Children this age don’t notice short separations.”
B. “Brief separations are OK; I’ll help your child stay comforted.”
C. “You must stay with your child at all times to prevent
developmental setbacks.”
D. “Separation never affects development if you call frequently.”
Correct answer: B
Rationale — correct (B): Toddlers (≈1–3 yrs) have emerging
autonomy and strong parent attachment; brief separations can
be managed safely if the nurse provides comfort, consistent
routine, and parental involvement when possible. This response
reassures and offers a safety plan (reduces anxiety, supports
attachment). CDC
,Rationale — incorrect:
A: Incorrect — toddlers do notice separations and may
experience distress.
C: Overly prescriptive and not feasible; promotes dependency.
D: Misleading — phone contact helps but in-person comforting
matters more for toddlers.
Item 3 — Asthma acute exacerbation (school-age)
A 9-year-old with moderate persistent asthma presents with
increased wheeze, accessory muscle use, and peak expiratory
flow (PEF) 60% of personal best. Which is the nurse’s priority
intervention?
A. Begin a short-acting beta-agonist (albuterol) via nebulizer
immediately.
B. Start oral corticosteroids at home and discharge.
C. Teach the child to perform pursed-lip breathing.
D. Obtain a chest x-ray before treatment.
Correct answer: A
Rationale — correct (A): For an acute asthma exacerbation with
respiratory distress and PEF 60% (moderate), immediate
bronchodilation with a short-acting beta-agonist is priority to
relieve bronchospasm and improve ventilation (safety: timely
treatment prevents respiratory failure). NGN-style priority =
address immediate physiologic instability first. Evolve
, Rationale — incorrect:
B: Oral corticosteroids may be indicated but are adjunctive —
they do not reverse bronchospasm immediately and should not
delay bronchodilator therapy.
C: Breathing techniques can be supportive but not first-line in
active moderate distress.
D: Chest x-ray is not required before initiating treatment for
typical asthma exacerbation and would delay critical therapy.
Item 4 — Bronchiolitis assessment (infant)
An 8-month-old infant is admitted with bronchiolitis (likely RSV).
Which finding most indicates a need for close monitoring and
possible transfer to higher level care?
A. Mild subcostal retractions with normal feeding.
B. Respiratory rate (RR) 55 breaths/min with nasal flaring and
poor oral intake.
C. Clear lung sounds with occasional cough.
D. Oxygen saturation (SpO₂) 97% on room air.
Correct answer: B
Rationale — correct (B): Infants with bronchiolitis who show
tachypnea, nasal flaring, retractions, and poor oral intake are at
risk of respiratory failure and dehydration; poor feeding is a red
flag in infants and requires close monitoring and possible
escalation to IV fluids or higher support. Safety: infants have
limited reserves. Evolve
PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
PEDIATRIC NURSING (CHILD HEALTH & DEVELOPMENTAL
DISORDERS) TEST BANK
Item 1 — Developmental screening (1-year check)
A 12-month-old infant is brought for a well visit. Which
milestone would most concern the nurse and prompt
immediate developmental screening?
A. Uses pincer grasp to pick up small objects.
B. Says “mama” and “dada” specifically and says one additional
word.
C. Does not pull to stand or attempt to cruise.
D. Waves bye-bye on request.
Correct answer: C
Rationale — correct (C): By 12 months most infants pull to
stand and may cruise or take first steps. Failure to pull to stand
or show any attempt at standing raises concern for gross motor
,delay and warrants developmental screening/referral (safety:
early detection reduces later morbidity). CDC
Rationale — incorrect:
A: Pincer grasp is expected by ~9–12 months — not concerning.
B: Specific “mama/dada” and another word is within expected
language for 12 months.
D: Waving bye-bye is a typical social/communication milestone
by ~9–12 months.
Item 2 — Toddler safety / separation
A 20-month-old toddler is hospitalized for dehydration. The
parent is present and asks the nurse whether brief separation
will harm the child’s development. The nurse’s best reply is:
A. “Children this age don’t notice short separations.”
B. “Brief separations are OK; I’ll help your child stay comforted.”
C. “You must stay with your child at all times to prevent
developmental setbacks.”
D. “Separation never affects development if you call frequently.”
Correct answer: B
Rationale — correct (B): Toddlers (≈1–3 yrs) have emerging
autonomy and strong parent attachment; brief separations can
be managed safely if the nurse provides comfort, consistent
routine, and parental involvement when possible. This response
reassures and offers a safety plan (reduces anxiety, supports
attachment). CDC
,Rationale — incorrect:
A: Incorrect — toddlers do notice separations and may
experience distress.
C: Overly prescriptive and not feasible; promotes dependency.
D: Misleading — phone contact helps but in-person comforting
matters more for toddlers.
Item 3 — Asthma acute exacerbation (school-age)
A 9-year-old with moderate persistent asthma presents with
increased wheeze, accessory muscle use, and peak expiratory
flow (PEF) 60% of personal best. Which is the nurse’s priority
intervention?
A. Begin a short-acting beta-agonist (albuterol) via nebulizer
immediately.
B. Start oral corticosteroids at home and discharge.
C. Teach the child to perform pursed-lip breathing.
D. Obtain a chest x-ray before treatment.
Correct answer: A
Rationale — correct (A): For an acute asthma exacerbation with
respiratory distress and PEF 60% (moderate), immediate
bronchodilation with a short-acting beta-agonist is priority to
relieve bronchospasm and improve ventilation (safety: timely
treatment prevents respiratory failure). NGN-style priority =
address immediate physiologic instability first. Evolve
, Rationale — incorrect:
B: Oral corticosteroids may be indicated but are adjunctive —
they do not reverse bronchospasm immediately and should not
delay bronchodilator therapy.
C: Breathing techniques can be supportive but not first-line in
active moderate distress.
D: Chest x-ray is not required before initiating treatment for
typical asthma exacerbation and would delay critical therapy.
Item 4 — Bronchiolitis assessment (infant)
An 8-month-old infant is admitted with bronchiolitis (likely RSV).
Which finding most indicates a need for close monitoring and
possible transfer to higher level care?
A. Mild subcostal retractions with normal feeding.
B. Respiratory rate (RR) 55 breaths/min with nasal flaring and
poor oral intake.
C. Clear lung sounds with occasional cough.
D. Oxygen saturation (SpO₂) 97% on room air.
Correct answer: B
Rationale — correct (B): Infants with bronchiolitis who show
tachypnea, nasal flaring, retractions, and poor oral intake are at
risk of respiratory failure and dehydration; poor feeding is a red
flag in infants and requires close monitoring and possible
escalation to IV fluids or higher support. Safety: infants have
limited reserves. Evolve
