Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
INTEGRATED REVIEW — COMPREHENSIVE NCLEX
PRACTICE PACK [FUNDAMENTALS,
PHARMACOLOGY, MEDICAL-SURGICAL,
MATERNITY, PEDIATRIC, EMERGENCY, AND
SPECIALTY SYSTEMS] TEST BANK
Fundamentals (15 questions)
1. (Fundamentals → Safe & Effective Care) — SBA
A nurse plans morning care for a newly admitted patient who
arrived at 0200 and is wearing an identification bracelet. Which
action is the highest priority?
A. Provide a detailed admission assessment.
B. Verify identity by comparing the bracelet with the chart.
C. Orient the patient to the room and call light.
D. Offer pain medication for reported pain.
,Answer: B. Verify identity by comparing the bracelet with the
chart.
Rationale: Verifying identity prevents misidentification errors
(highest safety priority). A: Assessment is important but occurs
after identity confirmed. C: Orientation is important but
secondary. D: Pain management important, but only after
confirming identity and assessment.
2. (Fundamentals → Physiological Integrity) — SATA
Select all actions that help prevent pressure injury in an
immobile older adult.
A. Reposition every 2 hours.
B. Keep skin moist with emollient after every bathing.
C. Use a specialty mattress if high risk.
D. Massage red areas to restore circulation.
E. Encourage protein-rich meals and supplements.
Answers: A, C, E.
Rationale:
A: Correct — regular repositioning relieves pressure.
C: Correct — specialty surfaces reduce pressure risk.
E: Correct — nutrition supports tissue integrity.
B: Incorrect — excessive moisture increases maceration risk;
maintain skin dry/clean.
D: Incorrect — massaging reddened bony prominence may
damage tissue and is not recommended.
,3. (Fundamentals → Safe & Effective Care) — SBA
A client refuses an invasive procedure. The nurse should:
A. Document refusal and notify the provider.
B. Tell the client the risks and insist they consent.
C. Obtain the signature of a family member agreeing to
procedure.
D. Ask the provider to coerce consent.
Answer: A. Document refusal and notify the provider.
Rationale: Patient autonomy — document refusal and inform
provider. B & D: Coercion violates autonomy. C: Family cannot
consent for competent adult.
4. (Fundamentals → Psychosocial Integrity) — SBA
A hospitalized adolescent appears withdrawn and refuses
visitors. Best nursing response:
A. Tell them friends will leave if they isolate.
B. Explore reasons for withdrawal and offer support.
C. Insist they have at least one daily visitor.
D. Ignore behavior to avoid embarrassment.
Answer: B. Explore reasons for withdrawal and offer support.
Rationale: Therapeutic approach: assess underlying issues. A &
C: Confrontational and not therapeutic. D: Neglects patient
needs.
, 5. (Fundamentals → Safe & Effective Care) — SBA
Correct method to remove sterile gloves after a sterile
procedure:
A. Pull glove off both hands simultaneously.
B. Grasp outside of one glove with other gloved hand, remove;
slip fingers under cuff of remaining glove and remove.
C. Peel both gloves toward fingertips and discard.
D. Rinse gloves with antiseptic and remove.
Answer: B. Grasp outside of one glove with other gloved hand,
remove; slip fingers under cuff of remaining glove and remove.
Rationale: This preserves sterility and prevents contamination.
A & C: Incorrect technique risking contamination. D: Not
standard practice.
6. (Fundamentals → Health Promotion) — SBA
A community nurse is teaching safe infant sleep. Which
instruction is correct?
A. Place infant on stomach to sleep to prevent choking.
B. Use soft pillows and blankets to keep infant warm.
C. Place infant on back on a firm mattress with no loose
bedding.
D. Let infant sleep in an adult bed to keep warm.
Answer: C. Place infant on back on a firm mattress with no
loose bedding.
PN® Examination
9th Edition
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
INTEGRATED REVIEW — COMPREHENSIVE NCLEX
PRACTICE PACK [FUNDAMENTALS,
PHARMACOLOGY, MEDICAL-SURGICAL,
MATERNITY, PEDIATRIC, EMERGENCY, AND
SPECIALTY SYSTEMS] TEST BANK
Fundamentals (15 questions)
1. (Fundamentals → Safe & Effective Care) — SBA
A nurse plans morning care for a newly admitted patient who
arrived at 0200 and is wearing an identification bracelet. Which
action is the highest priority?
A. Provide a detailed admission assessment.
B. Verify identity by comparing the bracelet with the chart.
C. Orient the patient to the room and call light.
D. Offer pain medication for reported pain.
,Answer: B. Verify identity by comparing the bracelet with the
chart.
Rationale: Verifying identity prevents misidentification errors
(highest safety priority). A: Assessment is important but occurs
after identity confirmed. C: Orientation is important but
secondary. D: Pain management important, but only after
confirming identity and assessment.
2. (Fundamentals → Physiological Integrity) — SATA
Select all actions that help prevent pressure injury in an
immobile older adult.
A. Reposition every 2 hours.
B. Keep skin moist with emollient after every bathing.
C. Use a specialty mattress if high risk.
D. Massage red areas to restore circulation.
E. Encourage protein-rich meals and supplements.
Answers: A, C, E.
Rationale:
A: Correct — regular repositioning relieves pressure.
C: Correct — specialty surfaces reduce pressure risk.
E: Correct — nutrition supports tissue integrity.
B: Incorrect — excessive moisture increases maceration risk;
maintain skin dry/clean.
D: Incorrect — massaging reddened bony prominence may
damage tissue and is not recommended.
,3. (Fundamentals → Safe & Effective Care) — SBA
A client refuses an invasive procedure. The nurse should:
A. Document refusal and notify the provider.
B. Tell the client the risks and insist they consent.
C. Obtain the signature of a family member agreeing to
procedure.
D. Ask the provider to coerce consent.
Answer: A. Document refusal and notify the provider.
Rationale: Patient autonomy — document refusal and inform
provider. B & D: Coercion violates autonomy. C: Family cannot
consent for competent adult.
4. (Fundamentals → Psychosocial Integrity) — SBA
A hospitalized adolescent appears withdrawn and refuses
visitors. Best nursing response:
A. Tell them friends will leave if they isolate.
B. Explore reasons for withdrawal and offer support.
C. Insist they have at least one daily visitor.
D. Ignore behavior to avoid embarrassment.
Answer: B. Explore reasons for withdrawal and offer support.
Rationale: Therapeutic approach: assess underlying issues. A &
C: Confrontational and not therapeutic. D: Neglects patient
needs.
, 5. (Fundamentals → Safe & Effective Care) — SBA
Correct method to remove sterile gloves after a sterile
procedure:
A. Pull glove off both hands simultaneously.
B. Grasp outside of one glove with other gloved hand, remove;
slip fingers under cuff of remaining glove and remove.
C. Peel both gloves toward fingertips and discard.
D. Rinse gloves with antiseptic and remove.
Answer: B. Grasp outside of one glove with other gloved hand,
remove; slip fingers under cuff of remaining glove and remove.
Rationale: This preserves sterility and prevents contamination.
A & C: Incorrect technique risking contamination. D: Not
standard practice.
6. (Fundamentals → Health Promotion) — SBA
A community nurse is teaching safe infant sleep. Which
instruction is correct?
A. Place infant on stomach to sleep to prevent choking.
B. Use soft pillows and blankets to keep infant warm.
C. Place infant on back on a firm mattress with no loose
bedding.
D. Let infant sleep in an adult bed to keep warm.
Answer: C. Place infant on back on a firm mattress with no
loose bedding.
