SAUNDERS COMPREHENSIVE REVIEW FOR THE NCLEX-
PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
PEDIATRIC NURSING (CHILD HEALTH & DEVELOPMENTAL
DISORDERS) TEST BANK
1) 2-month developmental check
A 2-month-old is brought for a well-child visit. Which finding
would the nurse expect as an age-appropriate milestone?
A. Sits unsupported for 30 seconds.
B. Coos and turns head to voice.
C. Says single clear words (e.g., “mama”).
D. Runs without falling.
Correct answer: B
Rationale: By 2 months, social smile and vocalization (cooing)
and turning toward voices are expected early communication
milestones. Sitting unsupported and running are gross motor
milestones seen much later (sitting unsupported typically
around 6 months; running by ~18–24 months). Single clear
words (mama/dada consistently) typically by ~9–12 months.
,Choosing B demonstrates knowledge of age-appropriate
language and social development and supports anticipatory
guidance (safe prone/playtime, TUMMY time) to promote
motor skills. (CDC milestone guidance used for age
expectations.) CDC
2) 6-month fine motor and feeding
A 6-month-old infant is being introduced to solids. Which
caregiver teaching should the nurse prioritize to promote safe
oral motor development?
A. Offer whole almonds to encourage chewing.
B. Tighten the straps on the high-chair harness and present
mashed/soft finger foods.
C. Allow the infant to feed themselves with large round gummy
snacks.
D. Wait until 18 months to introduce any solids.
Correct answer: B
Rationale: At ~6 months infants begin to sit with support, bring
objects to mouth, and can handle mashed/soft finger foods;
caregiver safety measures include secure seating (harness) and
offering appropriately textured foods to reduce aspiration risk.
Whole nuts/gummies are choking hazards for infants. Waiting
until 18 months delays normal progression; early introduction
of appropriately textured solids under supervision is
,recommended. This item tests developmental knowledge and
safety (aspiration prevention).
3) 15-month milestone and screening
A 15-month-old toddler is not yet walking independently and is
not using single words. The nurse’s best initial action is to:
A. Reassure the parent that this is within normal limits and
discharge without referral.
B. Document findings and schedule routine visitation in 6
months.
C. Perform a brief developmental screening and refer for early
intervention if concerns persist.
D. Advise immediate genetic testing.
Correct answer: C
Rationale: At 15 months, most children walk and use some
words; delays warrant screening. The CDC recommends
developmental surveillance and screening and early referral for
services if delays are identified. Immediate genetic testing is not
the first step unless other signs suggest a syndrome.
Reassurance without screening risks missing early intervention
opportunities. This reflects NCLEX focus on screening, timely
referral, and safety/advocacy.
4) Asthma — spacer vs. nebulizer
, An 8-year-old with moderate persistent asthma is prescribed
inhaled albuterol via a metered-dose inhaler (MDI) with spacer.
The parent asks why a spacer is needed. The nurse’s best
explanation is:
A. A spacer increases oropharyngeal deposition to help prevent
cough.
B. A spacer decreases medication reaching the lungs so side
effects are avoided.
C. A spacer allows more medication to reach the lower airways
and coordinates with the child’s inhalation.
D. Spacers are only cosmetic and have no clinical effect.
Correct answer: C
Rationale: Spacers reduce need for hand-breath coordination
and deliver more medication to lower airways; this improves
bronchodilation and reduces oropharyngeal deposition and
systemic side effects. Option A is wrong because a spacer
decreases oropharyngeal deposition (not increases). B is
incorrect—spacers increase pulmonary delivery, not decrease
lung delivery. D is incorrect. Teaching caregivers about spacer
use improves medication efficacy and safety (less systemic
absorption, improved symptom control).
5) Bronchiolitis (RSV) — nursing priority
A 3-month-old with bronchiolitis is admitted with increased
work of breathing and poor oral intake. Which is the highest
PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
PEDIATRIC NURSING (CHILD HEALTH & DEVELOPMENTAL
DISORDERS) TEST BANK
1) 2-month developmental check
A 2-month-old is brought for a well-child visit. Which finding
would the nurse expect as an age-appropriate milestone?
A. Sits unsupported for 30 seconds.
B. Coos and turns head to voice.
C. Says single clear words (e.g., “mama”).
D. Runs without falling.
Correct answer: B
Rationale: By 2 months, social smile and vocalization (cooing)
and turning toward voices are expected early communication
milestones. Sitting unsupported and running are gross motor
milestones seen much later (sitting unsupported typically
around 6 months; running by ~18–24 months). Single clear
words (mama/dada consistently) typically by ~9–12 months.
,Choosing B demonstrates knowledge of age-appropriate
language and social development and supports anticipatory
guidance (safe prone/playtime, TUMMY time) to promote
motor skills. (CDC milestone guidance used for age
expectations.) CDC
2) 6-month fine motor and feeding
A 6-month-old infant is being introduced to solids. Which
caregiver teaching should the nurse prioritize to promote safe
oral motor development?
A. Offer whole almonds to encourage chewing.
B. Tighten the straps on the high-chair harness and present
mashed/soft finger foods.
C. Allow the infant to feed themselves with large round gummy
snacks.
D. Wait until 18 months to introduce any solids.
Correct answer: B
Rationale: At ~6 months infants begin to sit with support, bring
objects to mouth, and can handle mashed/soft finger foods;
caregiver safety measures include secure seating (harness) and
offering appropriately textured foods to reduce aspiration risk.
Whole nuts/gummies are choking hazards for infants. Waiting
until 18 months delays normal progression; early introduction
of appropriately textured solids under supervision is
,recommended. This item tests developmental knowledge and
safety (aspiration prevention).
3) 15-month milestone and screening
A 15-month-old toddler is not yet walking independently and is
not using single words. The nurse’s best initial action is to:
A. Reassure the parent that this is within normal limits and
discharge without referral.
B. Document findings and schedule routine visitation in 6
months.
C. Perform a brief developmental screening and refer for early
intervention if concerns persist.
D. Advise immediate genetic testing.
Correct answer: C
Rationale: At 15 months, most children walk and use some
words; delays warrant screening. The CDC recommends
developmental surveillance and screening and early referral for
services if delays are identified. Immediate genetic testing is not
the first step unless other signs suggest a syndrome.
Reassurance without screening risks missing early intervention
opportunities. This reflects NCLEX focus on screening, timely
referral, and safety/advocacy.
4) Asthma — spacer vs. nebulizer
, An 8-year-old with moderate persistent asthma is prescribed
inhaled albuterol via a metered-dose inhaler (MDI) with spacer.
The parent asks why a spacer is needed. The nurse’s best
explanation is:
A. A spacer increases oropharyngeal deposition to help prevent
cough.
B. A spacer decreases medication reaching the lungs so side
effects are avoided.
C. A spacer allows more medication to reach the lower airways
and coordinates with the child’s inhalation.
D. Spacers are only cosmetic and have no clinical effect.
Correct answer: C
Rationale: Spacers reduce need for hand-breath coordination
and deliver more medication to lower airways; this improves
bronchodilation and reduces oropharyngeal deposition and
systemic side effects. Option A is wrong because a spacer
decreases oropharyngeal deposition (not increases). B is
incorrect—spacers increase pulmonary delivery, not decrease
lung delivery. D is incorrect. Teaching caregivers about spacer
use improves medication efficacy and safety (less systemic
absorption, improved symptom control).
5) Bronchiolitis (RSV) — nursing priority
A 3-month-old with bronchiolitis is admitted with increased
work of breathing and poor oral intake. Which is the highest
