Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — Growth & Development (Infant)
A 6-month-old infant is being assessed at a well-child visit.
Which of the following findings should the nurse identify as
developmentally appropriate?
A. Sits unsupported for short periods.
B. Pulls self to stand and cruises along furniture.
C. Says 3–4 clear words other than "mama" and "dada."
D. Uses a pincer grasp to pick up small objects.
Correct answer: A
Rationale:
Infants typically sit unsupported by 6 months—this is a gross
motor milestone appropriate for this age. Pulling to stand
and cruising occur closer to 9–12 months (B is incorrect).
Saying 3–4 clear words is more characteristic of 12–15
months; at 6 months vocalizations include babbling and
consonant-vowel sounds (C incorrect). The pincer grasp
,(thumb and forefinger) develops around 9–12 months; at 6
months infants use a palmar grasp (D incorrect).
Developmental knowledge helps nurses identify delays that
require intervention and guides anticipatory guidance to
families (safety principle: home environment should be safe
as gross-motor mobility increases).
2 — Communication with School-Age Child
A 9-year-old child will have a painful procedure. Which
communication approach is best to reduce fear and promote
cooperation?
A. Use simple, concrete explanations and allow them to ask
questions.
B. Avoid details to prevent frightening the child.
C. Use only parents to explain so the child isn't scared.
D. Give only the outcome-focused explanation (e.g., "it will
help you").
Correct answer: A
Rationale:
School-age children (concrete operational stage) need
concrete, factual explanations and the opportunity to ask
questions; this promotes sense of control and reduces
anxiety. Avoiding details (B) creates uncertainty and can
increase fear. Relying solely on parents (C) may not meet the
child's need for direct explanation and can reduce trust.
,Outcome-only statements (D) bypass immediate concerns
(pain, sensations) and may not address the child's questions.
Developmentally appropriate communication respects
autonomy and supports family-centered care.
3 — Respiratory: Asthma Action
A 7-year-old with moderate persistent asthma is brought to
the ED with wheezing and increased work of breathing. The
nurse should anticipate administering which medication first?
A. Inhaled short-acting beta-agonist (albuterol) via nebulizer
with oxygen.
B. Intravenous corticosteroid (methylprednisolone).
C. Subcutaneous epinephrine.
D. Oral leukotriene receptor antagonist (montelukast).
Correct answer: A
Rationale:
For acute bronchospasm, rapid bronchodilation with inhaled
short-acting beta-agonists is the first-line, immediate therapy
to relieve bronchoconstriction and improve airflow (safety:
restores oxygenation). IV steroids (B) are indicated early but
have delayed onset; they are often given after
bronchodilation begins. Subcutaneous epinephrine (C) is
reserved for anaphylaxis or life-threatening bronchospasm
not responsive to inhaled therapy. Montelukast (D) is for
chronic long-term control, not acute rescue. Prioritize
, interventions that rapidly reverse airway obstruction and
correct hypoxia.
Citations for management approach: NCLEX test plan
emphasis on acute care & pharmacologic interventions.
NCSBN
4 — Cardiac: Congenital Heart Disease (Tetralogy of Fallot)
A 4-month-old infant with tetralogy of Fallot is having a "tet"
(hypercyanotic) spell. Which action should the nurse perform
immediately?
A. Place the infant in knee-to-chest (squatting) position and
give oxygen.
B. Give a bolus of normal saline IV and prepare for
intubation.
C. Lay the infant supine and soothe with a pacifier.
D. Administer oral digoxin immediately.
Correct answer: A
Rationale:
Knee-to-chest (or flexing hips and knees) increases systemic
vascular resistance, reducing right-to-left shunting, and is a
classic immediate intervention to relieve hypercyanotic spells
in infants with TOF; administering oxygen also helps. An IV
fluid bolus (B) may be indicated if hypovolemia suspected but
is not the first immediate maneuver; intubation is for
respiratory failure. Laying supine (C) does not increase
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — Growth & Development (Infant)
A 6-month-old infant is being assessed at a well-child visit.
Which of the following findings should the nurse identify as
developmentally appropriate?
A. Sits unsupported for short periods.
B. Pulls self to stand and cruises along furniture.
C. Says 3–4 clear words other than "mama" and "dada."
D. Uses a pincer grasp to pick up small objects.
Correct answer: A
Rationale:
Infants typically sit unsupported by 6 months—this is a gross
motor milestone appropriate for this age. Pulling to stand
and cruising occur closer to 9–12 months (B is incorrect).
Saying 3–4 clear words is more characteristic of 12–15
months; at 6 months vocalizations include babbling and
consonant-vowel sounds (C incorrect). The pincer grasp
,(thumb and forefinger) develops around 9–12 months; at 6
months infants use a palmar grasp (D incorrect).
Developmental knowledge helps nurses identify delays that
require intervention and guides anticipatory guidance to
families (safety principle: home environment should be safe
as gross-motor mobility increases).
2 — Communication with School-Age Child
A 9-year-old child will have a painful procedure. Which
communication approach is best to reduce fear and promote
cooperation?
A. Use simple, concrete explanations and allow them to ask
questions.
B. Avoid details to prevent frightening the child.
C. Use only parents to explain so the child isn't scared.
D. Give only the outcome-focused explanation (e.g., "it will
help you").
Correct answer: A
Rationale:
School-age children (concrete operational stage) need
concrete, factual explanations and the opportunity to ask
questions; this promotes sense of control and reduces
anxiety. Avoiding details (B) creates uncertainty and can
increase fear. Relying solely on parents (C) may not meet the
child's need for direct explanation and can reduce trust.
,Outcome-only statements (D) bypass immediate concerns
(pain, sensations) and may not address the child's questions.
Developmentally appropriate communication respects
autonomy and supports family-centered care.
3 — Respiratory: Asthma Action
A 7-year-old with moderate persistent asthma is brought to
the ED with wheezing and increased work of breathing. The
nurse should anticipate administering which medication first?
A. Inhaled short-acting beta-agonist (albuterol) via nebulizer
with oxygen.
B. Intravenous corticosteroid (methylprednisolone).
C. Subcutaneous epinephrine.
D. Oral leukotriene receptor antagonist (montelukast).
Correct answer: A
Rationale:
For acute bronchospasm, rapid bronchodilation with inhaled
short-acting beta-agonists is the first-line, immediate therapy
to relieve bronchoconstriction and improve airflow (safety:
restores oxygenation). IV steroids (B) are indicated early but
have delayed onset; they are often given after
bronchodilation begins. Subcutaneous epinephrine (C) is
reserved for anaphylaxis or life-threatening bronchospasm
not responsive to inhaled therapy. Montelukast (D) is for
chronic long-term control, not acute rescue. Prioritize
, interventions that rapidly reverse airway obstruction and
correct hypoxia.
Citations for management approach: NCLEX test plan
emphasis on acute care & pharmacologic interventions.
NCSBN
4 — Cardiac: Congenital Heart Disease (Tetralogy of Fallot)
A 4-month-old infant with tetralogy of Fallot is having a "tet"
(hypercyanotic) spell. Which action should the nurse perform
immediately?
A. Place the infant in knee-to-chest (squatting) position and
give oxygen.
B. Give a bolus of normal saline IV and prepare for
intubation.
C. Lay the infant supine and soothe with a pacifier.
D. Administer oral digoxin immediately.
Correct answer: A
Rationale:
Knee-to-chest (or flexing hips and knees) increases systemic
vascular resistance, reducing right-to-left shunting, and is a
classic immediate intervention to relieve hypercyanotic spells
in infants with TOF; administering oxygen also helps. An IV
fluid bolus (B) may be indicated if hypovolemia suspected but
is not the first immediate maneuver; intubation is for
respiratory failure. Laying supine (C) does not increase
