Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — Growth & Development (Motor/language milestone)
A mother asks why her 15-month-old toddler still isn't using
two-word phrases and mostly points or uses single words.
Which response by the nurse is best?
A. “This is normal — most children don’t use two-word
phrases until after age 2.”
B. “At 15 months we expect several single words; combining
words typically appears between 18–24 months; continue to
encourage talking and read to your child daily.”
C. “Your child should already be speaking in sentences;
schedule a hearing test immediately.”
D. “Stop using gestures — the child will have to learn to
speak without them.”
Correct answer: B
Rationale (correct): At ~15 months many children have
several single words; combining words usually occurs
,between about 18–24 months. The nurse’s response in B
validates parental concern, gives an evidence-based
expectation, and offers a practical intervention (reading,
verbal stimulation). This supports family-centered care and
developmental promotion.
Why the other answers are incorrect:
A. Overly reassuring and inaccurate: two-word phrases
commonly develop sooner than “after age 2”; this statement
may delay monitoring.
C. Alarmist and premature: sentences are not expected at 15
months, so immediate hearing testing is not indicated unless
there are other red flags (no responses to sound, no
babbling).
D. Discouraging gestures is developmentally inappropriate —
gestures are a normal communication bridge for toddlers and
support language acquisition.
2 — Respiratory (Croup / viral laryngotracheobronchitis)
A 2-year-old with inspiratory stridor, a “barking” cough and
low-grade fever is seen in the emergency department. The
child is anxious but oxygen saturation is 96% on room air.
Which immediate nursing action is best?
A. Give oral antibiotics and discharge home.
B. Provide a cool-mist humidifier in the room and encourage
the parents to hold the child upright; prepare to administer
,nebulized epinephrine if respiratory distress increases.
C. Immediately intubate the child because stridor always
progresses to airway obstruction.
D. Administer inhaled corticosteroids and advise home
follow-up.
Correct answer: B
Rationale (correct): Classic viral croup presents with barking
cough and inspiratory stridor. Initial supportive measures
include keeping the child calm, using cool mist or exposure to
cool night air, and positioning upright. Nebulized racemic
epinephrine is indicated if moderate to severe respiratory
distress develops. Continuous assessment for increasing work
of breathing is essential.
Why the other answers are incorrect:
A. Antibiotics are not indicated for viral croup unless bacterial
infection is suspected. Discharging without supportive
measures or education is unsafe.
C. Immediate intubation is excessive when the child has
stable oxygenation (96%) and only mild-moderate symptoms;
intubation is reserved for impending or actual respiratory
failure.
D. Systemic/inhaled corticosteroids (dexamethasone) are
used in croup, but inhaled steroids alone are not standard
immediate treatment in the ED setting — dexamethasone
(single dose) may be given; inhaled steroids do not replace
, supportive measures or racemic epinephrine for moderate
distress.
3 — Cardiac (Congenital heart disease — signs)
An infant with an undiagnosed congenital heart defect is
failing to thrive, sweats with feeds, and has tachypnea. Which
pathophysiologic process most likely explains these signs?
A. Left-to-right shunt causing pulmonary overcirculation and
increased work of breathing.
B. Right-to-left shunt causing immediate cyanosis without
feeding issues.
C. Decreased metabolic demand leads to poor weight gain.
D. Primary gastrointestinal disease causing aspiration.
Correct answer: A
Rationale (correct): Left-to-right shunts (e.g., large VSD)
increase pulmonary blood flow, causing tachypnea, poor
feeding, diaphoresis with feeds, and failure to thrive due to
increased work of breathing and caloric expenditure.
Recognizing these signs prompts assessment for congenital
heart disease.
Why the other answers are incorrect:
B. Right-to-left shunts cause cyanosis (and hypoxemia) often
earlier and do not primarily produce pulmonary
overcirculation or diaphoresis with feeding.
C. Decreased metabolic demand would not explain
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — Growth & Development (Motor/language milestone)
A mother asks why her 15-month-old toddler still isn't using
two-word phrases and mostly points or uses single words.
Which response by the nurse is best?
A. “This is normal — most children don’t use two-word
phrases until after age 2.”
B. “At 15 months we expect several single words; combining
words typically appears between 18–24 months; continue to
encourage talking and read to your child daily.”
C. “Your child should already be speaking in sentences;
schedule a hearing test immediately.”
D. “Stop using gestures — the child will have to learn to
speak without them.”
Correct answer: B
Rationale (correct): At ~15 months many children have
several single words; combining words usually occurs
,between about 18–24 months. The nurse’s response in B
validates parental concern, gives an evidence-based
expectation, and offers a practical intervention (reading,
verbal stimulation). This supports family-centered care and
developmental promotion.
Why the other answers are incorrect:
A. Overly reassuring and inaccurate: two-word phrases
commonly develop sooner than “after age 2”; this statement
may delay monitoring.
C. Alarmist and premature: sentences are not expected at 15
months, so immediate hearing testing is not indicated unless
there are other red flags (no responses to sound, no
babbling).
D. Discouraging gestures is developmentally inappropriate —
gestures are a normal communication bridge for toddlers and
support language acquisition.
2 — Respiratory (Croup / viral laryngotracheobronchitis)
A 2-year-old with inspiratory stridor, a “barking” cough and
low-grade fever is seen in the emergency department. The
child is anxious but oxygen saturation is 96% on room air.
Which immediate nursing action is best?
A. Give oral antibiotics and discharge home.
B. Provide a cool-mist humidifier in the room and encourage
the parents to hold the child upright; prepare to administer
,nebulized epinephrine if respiratory distress increases.
C. Immediately intubate the child because stridor always
progresses to airway obstruction.
D. Administer inhaled corticosteroids and advise home
follow-up.
Correct answer: B
Rationale (correct): Classic viral croup presents with barking
cough and inspiratory stridor. Initial supportive measures
include keeping the child calm, using cool mist or exposure to
cool night air, and positioning upright. Nebulized racemic
epinephrine is indicated if moderate to severe respiratory
distress develops. Continuous assessment for increasing work
of breathing is essential.
Why the other answers are incorrect:
A. Antibiotics are not indicated for viral croup unless bacterial
infection is suspected. Discharging without supportive
measures or education is unsafe.
C. Immediate intubation is excessive when the child has
stable oxygenation (96%) and only mild-moderate symptoms;
intubation is reserved for impending or actual respiratory
failure.
D. Systemic/inhaled corticosteroids (dexamethasone) are
used in croup, but inhaled steroids alone are not standard
immediate treatment in the ED setting — dexamethasone
(single dose) may be given; inhaled steroids do not replace
, supportive measures or racemic epinephrine for moderate
distress.
3 — Cardiac (Congenital heart disease — signs)
An infant with an undiagnosed congenital heart defect is
failing to thrive, sweats with feeds, and has tachypnea. Which
pathophysiologic process most likely explains these signs?
A. Left-to-right shunt causing pulmonary overcirculation and
increased work of breathing.
B. Right-to-left shunt causing immediate cyanosis without
feeding issues.
C. Decreased metabolic demand leads to poor weight gain.
D. Primary gastrointestinal disease causing aspiration.
Correct answer: A
Rationale (correct): Left-to-right shunts (e.g., large VSD)
increase pulmonary blood flow, causing tachypnea, poor
feeding, diaphoresis with feeds, and failure to thrive due to
increased work of breathing and caloric expenditure.
Recognizing these signs prompts assessment for congenital
heart disease.
Why the other answers are incorrect:
B. Right-to-left shunts cause cyanosis (and hypoxemia) often
earlier and do not primarily produce pulmonary
overcirculation or diaphoresis with feeding.
C. Decreased metabolic demand would not explain
