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 — Infant milestone identification (2 months)
A 2-month-old infant is brought to the clinic. Which milestone
would be most important for the nurse to document as age-
appropriate at this visit?
A. Pulls to standing and cruises along furniture.
B. Laughs aloud, follows a face, and coos.
C. Uses 2–3 word combinations and draws a circle.
D. Rides a tricycle and hops on one foot.
Answer: B
Rationale — Correct (B): At about 2 months infants typically
demonstrate social smile, cooing/vocalizes, and visually
tracks/follows faces. These are standard 2-month
social/communication and visual tracking milestones per
,CDC/AAP milestone guidance; documenting these supports
normal early developmental screening. CDC+1
Rationale — Incorrect (A, C, D):
• A (pulls to stand, cruises) describes gross motor skills
closer to 9–12 months, not 2 months. Documenting such
an advanced skill for a 2-month old would be unexpected.
• C (2–3 word combinations) is typical of a toddler (≈2 years)
and drawing a circle occurs around 3–4 years.
• D (rides tricycle, hops) is preschool motor skills (~3–4
years). Selecting a distractor that belongs to older ages
could delay recognition of developmental delay — a safety
issue because early identification enables prompt referral.
Nursing teaching point: Use developmental screening at
routine well visits (9, 18, 30 months per AAP guidance) and
counsel caregivers when milestones are not met. AAP
2 — 6-month old feeding readiness and safety
A 6-month-old infant who has started solids is brought for a
well visit. Which caregiver statement indicates the nurse must
provide immediate safety teaching?
A. “We give small pieces of soft, mashed banana and supervise
meals.”
B. “We allow the baby to have whole grapes and hot dogs when
we cut them lengthwise.”
,C. “We always stay with the baby during feeding and keep small
objects out of reach.”
D. “We offer iron-fortified cereal and mashed vegetables after
we offer breastmilk first.”
Answer: B
Rationale — Correct (B): Whole grapes and hot dogs are
choking hazards. If given, they must be altered to be both cut
and prepared in a safe shape (e.g., cut lengthwise and
quartered/cut into small pieces). The statement as written
implies whole grapes/hot dogs are being given — immediate
safety teaching is required. This is a developmental safety issue:
infants (~6 months) are still developing oral motor control and
are at high risk for choking.
Rationale — Incorrect (A, C, D):
• A is appropriate (soft mashed foods and supervision).
• C is safe (active supervision and environmental safety).
• D is consistent with recommended early complementary
feeding (iron-rich foods) while continuing
breastmilk/formula. CDC
Nursing teaching point: Reinforce appropriate textures, how to
cut foods, and choking prevention. Provide CPR/choking first-
aid resources for caregivers.
3 — 9-month safety & stranger anxiety
, A 9-month-old admitted for observation clings to the parent
and cries when the nurse enters; the infant is inconsolable for
several minutes after the parent leaves. Which developmental
explanation best matches this behavior?
A. This is separation anxiety and stranger anxiety —
developmentally typical.
B. This is regression indicating an attachment disorder that
requires immediate psychiatric hospitalization.
C. This is evidence of neurocognitive impairment and lack of
object permanence.
D. This is normal only for toddlers older than 3 years; 9-month-
olds should be indifferent.
Answer: A
Rationale — Correct (A): Around 6–9 months infants develop
object permanence and attachment; stranger
anxiety/separation anxiety commonly begins in this age range.
The behavior is developmentally typical and expected.
Recognizing typical developmental responses informs
supportive care (e.g., allow parental presence for procedures;
use soothing strategies). CDC
Rationale — Incorrect (B, C, D):
• B overpathologizes a normal developmental stage —
psychiatric hospitalization is not indicated.
• C misinterprets the behavior — object permanence is
developing (not absent).
PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
PEDIATRIC NURSING (CHILD HEALTH & DEVELOPMENTAL
DISORDERS) TEST BANK
1 — Infant milestone identification (2 months)
A 2-month-old infant is brought to the clinic. Which milestone
would be most important for the nurse to document as age-
appropriate at this visit?
A. Pulls to standing and cruises along furniture.
B. Laughs aloud, follows a face, and coos.
C. Uses 2–3 word combinations and draws a circle.
D. Rides a tricycle and hops on one foot.
Answer: B
Rationale — Correct (B): At about 2 months infants typically
demonstrate social smile, cooing/vocalizes, and visually
tracks/follows faces. These are standard 2-month
social/communication and visual tracking milestones per
,CDC/AAP milestone guidance; documenting these supports
normal early developmental screening. CDC+1
Rationale — Incorrect (A, C, D):
• A (pulls to stand, cruises) describes gross motor skills
closer to 9–12 months, not 2 months. Documenting such
an advanced skill for a 2-month old would be unexpected.
• C (2–3 word combinations) is typical of a toddler (≈2 years)
and drawing a circle occurs around 3–4 years.
• D (rides tricycle, hops) is preschool motor skills (~3–4
years). Selecting a distractor that belongs to older ages
could delay recognition of developmental delay — a safety
issue because early identification enables prompt referral.
Nursing teaching point: Use developmental screening at
routine well visits (9, 18, 30 months per AAP guidance) and
counsel caregivers when milestones are not met. AAP
2 — 6-month old feeding readiness and safety
A 6-month-old infant who has started solids is brought for a
well visit. Which caregiver statement indicates the nurse must
provide immediate safety teaching?
A. “We give small pieces of soft, mashed banana and supervise
meals.”
B. “We allow the baby to have whole grapes and hot dogs when
we cut them lengthwise.”
,C. “We always stay with the baby during feeding and keep small
objects out of reach.”
D. “We offer iron-fortified cereal and mashed vegetables after
we offer breastmilk first.”
Answer: B
Rationale — Correct (B): Whole grapes and hot dogs are
choking hazards. If given, they must be altered to be both cut
and prepared in a safe shape (e.g., cut lengthwise and
quartered/cut into small pieces). The statement as written
implies whole grapes/hot dogs are being given — immediate
safety teaching is required. This is a developmental safety issue:
infants (~6 months) are still developing oral motor control and
are at high risk for choking.
Rationale — Incorrect (A, C, D):
• A is appropriate (soft mashed foods and supervision).
• C is safe (active supervision and environmental safety).
• D is consistent with recommended early complementary
feeding (iron-rich foods) while continuing
breastmilk/formula. CDC
Nursing teaching point: Reinforce appropriate textures, how to
cut foods, and choking prevention. Provide CPR/choking first-
aid resources for caregivers.
3 — 9-month safety & stranger anxiety
, A 9-month-old admitted for observation clings to the parent
and cries when the nurse enters; the infant is inconsolable for
several minutes after the parent leaves. Which developmental
explanation best matches this behavior?
A. This is separation anxiety and stranger anxiety —
developmentally typical.
B. This is regression indicating an attachment disorder that
requires immediate psychiatric hospitalization.
C. This is evidence of neurocognitive impairment and lack of
object permanence.
D. This is normal only for toddlers older than 3 years; 9-month-
olds should be indifferent.
Answer: A
Rationale — Correct (A): Around 6–9 months infants develop
object permanence and attachment; stranger
anxiety/separation anxiety commonly begins in this age range.
The behavior is developmentally typical and expected.
Recognizing typical developmental responses informs
supportive care (e.g., allow parental presence for procedures;
use soothing strategies). CDC
Rationale — Incorrect (B, C, D):
• B overpathologizes a normal developmental stage —
psychiatric hospitalization is not indicated.
• C misinterprets the behavior — object permanence is
developing (not absent).
