Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1) Growth & Development — Motor Milestones
A 9-month-old infant is brought to clinic. Which finding
should the nurse identify as developmentally appropriate for
this age?
A. Uses a pincer grasp to pick up small objects.
B. Says several single words (e.g., “mama,” “dada”) and links
two words.
C. Cruises (walks holding onto furniture) and pulls to stand.
D. Walks independently and begins to run.
Correct: C — Cruises and pulls to stand.
Rationale (correct): By about 9 months most infants pull to
stand and cruise along furniture as part of gross motor
development. This reflects increasing trunk and leg strength
and is an expected milestone.
Why A is incorrect: The pincer grasp typically refines around
,9–12 months; a precise pincer (thumb and index) is more
reliably present by 10–12 months — 9 months may show a
crude pincer.
Why B is incorrect: Saying “mama/dada” is expected earlier,
but linking two words (two-word phrases) usually emerges
around 18–24 months.
Why D is incorrect: Independent walking typically occurs
near 12 months; running usually appears later (15–18
months+).
2) Respiratory — Asthma action/med administration
A 6-year-old with moderate persistent asthma uses a
metered-dose inhaler (MDI) with a spacer. Which instruction
should the nurse reinforce to the parent?
A. “Give 10 puffs at once when your child feels short of
breath.”
B. “Have the child take slow, deep inhalations and hold
breath for about 5–10 seconds after each puff.”
C. “Remove the spacer immediately after each puff so the
next dose is stronger.”
D. “Only use the spacer for rescue inhalers; controller
inhalers don’t need one.”
Correct: B — Slow, deep inhalations and breath-hold for 5–10
seconds.
,Rationale (correct): Spacers improve medication deposition
in the lungs; instructing slow, deep inhalation and a short
breath hold (about 5–10 seconds) optimizes delivery. For a
child this age a spacer with a mask (if needed) and coaching
on breath-hold is appropriate for both rescue and some
controller inhalers as directed.
Why A is incorrect: Giving 10 puffs at once is unsafe and
unnecessary; doses are prescribed (e.g., 1–2 puffs) —
overdosing risks systemic side effects.
Why C is incorrect: Removing the spacer after each puff is
irrelevant and may increase medication loss; spacer should
remain attached for the prescribed number of puffs.
Why D is incorrect: Spacers may be recommended for both
rescue and some controllers depending on formulation and
age; blanket statement is false.
3) Cardiac — Congenital heart defect recognition
A 2-month-old infant presents with poor weight gain,
tachypnea, and hepatomegaly. Which congenital heart defect
is most likely?
A. Ventricular septal defect (VSD) causing left-to-right shunt.
B. Tetralogy of Fallot with cyanotic spells.
C. Patent ductus arteriosus (PDA) in the absence of other
lesions.
D. Transposition of the great arteries (TGA) with immediate
cyanosis.
, Correct: A — VSD with left-to-right shunt.
Rationale (correct): Large left-to-right shunts (like VSDs)
cause increased pulmonary blood flow → tachypnea,
difficulty feeding, failure to thrive, and hepatic congestion
(hepatomegaly) from heart failure in early infancy.
Why B is incorrect: Tetralogy of Fallot produces cyanosis and
“tet” spells; infants with TOF typically have cyanotic rather
than signs of volume overload and hepatomegaly.
Why C is incorrect: PDA can cause similar symptoms if large,
but isolated PDA is more common in preterm infants; VSD is a
classic cause of early heart failure signs at 2 months.
Why D is incorrect: TGA causes profound cyanosis soon after
birth; presentation with failure to thrive and hepatomegaly at
2 months without cyanosis is less consistent.
4) Infection — Group A streptococcal pharyngitis teaching
A child has been prescribed penicillin V for streptococcal
pharyngitis. Which statement by the parent indicates correct
understanding?
A. “I can stop the antibiotics once my child feels better,
usually within 24–48 hours.”
B. “I should complete the full prescribed course even if
symptoms improve.”
C. “It’s safe to give the medication only on weekdays to save
doses.”
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1) Growth & Development — Motor Milestones
A 9-month-old infant is brought to clinic. Which finding
should the nurse identify as developmentally appropriate for
this age?
A. Uses a pincer grasp to pick up small objects.
B. Says several single words (e.g., “mama,” “dada”) and links
two words.
C. Cruises (walks holding onto furniture) and pulls to stand.
D. Walks independently and begins to run.
Correct: C — Cruises and pulls to stand.
Rationale (correct): By about 9 months most infants pull to
stand and cruise along furniture as part of gross motor
development. This reflects increasing trunk and leg strength
and is an expected milestone.
Why A is incorrect: The pincer grasp typically refines around
,9–12 months; a precise pincer (thumb and index) is more
reliably present by 10–12 months — 9 months may show a
crude pincer.
Why B is incorrect: Saying “mama/dada” is expected earlier,
but linking two words (two-word phrases) usually emerges
around 18–24 months.
Why D is incorrect: Independent walking typically occurs
near 12 months; running usually appears later (15–18
months+).
2) Respiratory — Asthma action/med administration
A 6-year-old with moderate persistent asthma uses a
metered-dose inhaler (MDI) with a spacer. Which instruction
should the nurse reinforce to the parent?
A. “Give 10 puffs at once when your child feels short of
breath.”
B. “Have the child take slow, deep inhalations and hold
breath for about 5–10 seconds after each puff.”
C. “Remove the spacer immediately after each puff so the
next dose is stronger.”
D. “Only use the spacer for rescue inhalers; controller
inhalers don’t need one.”
Correct: B — Slow, deep inhalations and breath-hold for 5–10
seconds.
,Rationale (correct): Spacers improve medication deposition
in the lungs; instructing slow, deep inhalation and a short
breath hold (about 5–10 seconds) optimizes delivery. For a
child this age a spacer with a mask (if needed) and coaching
on breath-hold is appropriate for both rescue and some
controller inhalers as directed.
Why A is incorrect: Giving 10 puffs at once is unsafe and
unnecessary; doses are prescribed (e.g., 1–2 puffs) —
overdosing risks systemic side effects.
Why C is incorrect: Removing the spacer after each puff is
irrelevant and may increase medication loss; spacer should
remain attached for the prescribed number of puffs.
Why D is incorrect: Spacers may be recommended for both
rescue and some controllers depending on formulation and
age; blanket statement is false.
3) Cardiac — Congenital heart defect recognition
A 2-month-old infant presents with poor weight gain,
tachypnea, and hepatomegaly. Which congenital heart defect
is most likely?
A. Ventricular septal defect (VSD) causing left-to-right shunt.
B. Tetralogy of Fallot with cyanotic spells.
C. Patent ductus arteriosus (PDA) in the absence of other
lesions.
D. Transposition of the great arteries (TGA) with immediate
cyanosis.
, Correct: A — VSD with left-to-right shunt.
Rationale (correct): Large left-to-right shunts (like VSDs)
cause increased pulmonary blood flow → tachypnea,
difficulty feeding, failure to thrive, and hepatic congestion
(hepatomegaly) from heart failure in early infancy.
Why B is incorrect: Tetralogy of Fallot produces cyanosis and
“tet” spells; infants with TOF typically have cyanotic rather
than signs of volume overload and hepatomegaly.
Why C is incorrect: PDA can cause similar symptoms if large,
but isolated PDA is more common in preterm infants; VSD is a
classic cause of early heart failure signs at 2 months.
Why D is incorrect: TGA causes profound cyanosis soon after
birth; presentation with failure to thrive and hepatomegaly at
2 months without cyanosis is less consistent.
4) Infection — Group A streptococcal pharyngitis teaching
A child has been prescribed penicillin V for streptococcal
pharyngitis. Which statement by the parent indicates correct
understanding?
A. “I can stop the antibiotics once my child feels better,
usually within 24–48 hours.”
B. “I should complete the full prescribed course even if
symptoms improve.”
C. “It’s safe to give the medication only on weekdays to save
doses.”
