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 items) — Q1–Q15
(Items cover Basic Care, Safety/Mgmt, health promotion)
Q1 — Single best answer
A postop client returns from PACU after abdominal surgery. The
nurse finds the client lying still, respirations 6/min, O₂ sat 84%
on room air, and snoring respirations. What is the nurse’s best
immediate action?
A. Call the surgeon.
B. Stimulate and reposition the client’s airway, provide oxygen.
,C. Increase room lights and assess incision.
D. Encourage deep breathing and coughing.
Domain: Safe & Effective Care Environment — Safety &
Infection Control.
Answer: B.
Rationales:
A. Not immediate — airway problem needs immediate
intervention.
B. Correct — snoring and low RR/O₂ indicate airway obstruction
and hypoventilation; reposition/stimulate and give oxygen.
C. Lights/incision irrelevant; delays airway treatment.
D. C&B appropriate later but not with RR 6 and sat 84%.
Q2 — SATA
Which of the following are appropriate interventions to prevent
catheter-associated urinary tract infection (CAUTI)? (Select all
that apply.)
A. Use aseptic technique during catheter insertion.
B. Irrigate the catheter daily with sterile saline.
C. Keep drainage bag below bladder level.
D. Replace catheter on a routine fixed schedule (every 7 days).
E. Maintain a closed drainage system.
Domain: Safe & Effective Care Environment — Safety &
Infection Control.
,Answers: A, C, E.
Rationales:
A. Correct — aseptic insertion reduces infection risk.
B. Incorrect — routine irrigation increases infection risk unless
ordered.
C. Correct — prevents reflux of urine.
D. Incorrect — routine replacement not recommended; change
only for indications.
E. Correct — closed system reduces contamination.
Q3 — Single best answer
A nurse delegates ambulation of a stable postop client to a
nursing assistant. Which task outcome requires the nurse to
intervene?
A. Assistant performs a pre-ambulation pain check and reports
pain 7/10.
B. Client ambulated with assistive device and uses gait belt.
C. Assistant documents ambulation distance and tolerance.
D. Assistant obtains vital signs after ambulation as instructed.
Domain: Safe & Effective Care Environment — Management of
Care.
Answer: A.
Rationales:
A. Correct — pain 7/10 requires nurse assessment and pain
management before ambulation.
, B. Appropriate.
C. Appropriate.
D. Appropriate.
Q4 — Matrix (match)
Match each normal adult vital sign range (left) with the
expected value (right). Provide the letter mapping (1–4).
1. Normal adult RR
2. Normal adult HR
3. Normal adult BP (systolic)
4. Normal adult oral temp (°C)
A. 12–20 breaths/min
B. 36.5–37.5 °C
C. 60–100 bpm
D. 90–120 mm Hg
Domain: Safe & Effective Care Environment — Management of
Care.
Answers: 1→A; 2→C; 3→D; 4→B.
Rationales: Brief facts: adult RR 12–20; HR 60–100; SBP
approximate 90–120; oral temp ~36.5–37.5°C.
Q5 — Single best answer (NGN-style short case)
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 items) — Q1–Q15
(Items cover Basic Care, Safety/Mgmt, health promotion)
Q1 — Single best answer
A postop client returns from PACU after abdominal surgery. The
nurse finds the client lying still, respirations 6/min, O₂ sat 84%
on room air, and snoring respirations. What is the nurse’s best
immediate action?
A. Call the surgeon.
B. Stimulate and reposition the client’s airway, provide oxygen.
,C. Increase room lights and assess incision.
D. Encourage deep breathing and coughing.
Domain: Safe & Effective Care Environment — Safety &
Infection Control.
Answer: B.
Rationales:
A. Not immediate — airway problem needs immediate
intervention.
B. Correct — snoring and low RR/O₂ indicate airway obstruction
and hypoventilation; reposition/stimulate and give oxygen.
C. Lights/incision irrelevant; delays airway treatment.
D. C&B appropriate later but not with RR 6 and sat 84%.
Q2 — SATA
Which of the following are appropriate interventions to prevent
catheter-associated urinary tract infection (CAUTI)? (Select all
that apply.)
A. Use aseptic technique during catheter insertion.
B. Irrigate the catheter daily with sterile saline.
C. Keep drainage bag below bladder level.
D. Replace catheter on a routine fixed schedule (every 7 days).
E. Maintain a closed drainage system.
Domain: Safe & Effective Care Environment — Safety &
Infection Control.
,Answers: A, C, E.
Rationales:
A. Correct — aseptic insertion reduces infection risk.
B. Incorrect — routine irrigation increases infection risk unless
ordered.
C. Correct — prevents reflux of urine.
D. Incorrect — routine replacement not recommended; change
only for indications.
E. Correct — closed system reduces contamination.
Q3 — Single best answer
A nurse delegates ambulation of a stable postop client to a
nursing assistant. Which task outcome requires the nurse to
intervene?
A. Assistant performs a pre-ambulation pain check and reports
pain 7/10.
B. Client ambulated with assistive device and uses gait belt.
C. Assistant documents ambulation distance and tolerance.
D. Assistant obtains vital signs after ambulation as instructed.
Domain: Safe & Effective Care Environment — Management of
Care.
Answer: A.
Rationales:
A. Correct — pain 7/10 requires nurse assessment and pain
management before ambulation.
, B. Appropriate.
C. Appropriate.
D. Appropriate.
Q4 — Matrix (match)
Match each normal adult vital sign range (left) with the
expected value (right). Provide the letter mapping (1–4).
1. Normal adult RR
2. Normal adult HR
3. Normal adult BP (systolic)
4. Normal adult oral temp (°C)
A. 12–20 breaths/min
B. 36.5–37.5 °C
C. 60–100 bpm
D. 90–120 mm Hg
Domain: Safe & Effective Care Environment — Management of
Care.
Answers: 1→A; 2→C; 3→D; 4→B.
Rationales: Brief facts: adult RR 12–20; HR 60–100; SBP
approximate 90–120; oral temp ~36.5–37.5°C.
Q5 — Single best answer (NGN-style short case)
