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
Questions
1 — Developmental milestone (6 months)
A 6-month-old infant is brought to the clinic. Which milestone
should the nurse expect as developmentally appropriate at this
age?
A. Walks with assistance.
B. Uses a pincer grasp to pick up small objects.
C. Sits unsupported.
D. Says three-word sentences.
Answer: C. Sits unsupported.
Rationale (correct): By about 6 months most infants can sit
unsupported — an important gross motor milestone. Nursing
,assessment should note age-appropriate motor control for
feeding and safety (e.g., preventing falls).
Why others are incorrect:
A — Walking with assistance typically appears closer to 9–12
months.
B — Mature pincer grasp (using thumb and forefinger) emerges
around 9–12 months; at 6 months infants use raking grasp.
D — Three-word sentences are much later (≈3 years).
Assessments should use age-appropriate expectations to guide
anticipatory guidance and referrals.
2 — Infant respiratory (bronchiolitis)
An 8-month-old infant diagnosed with viral bronchiolitis (RSV
positive) has increased work of breathing and oxygen saturation
90% on room air. Which nursing action has the highest priority?
A. Offer oral fluids every 2 hours.
B. Begin supplemental oxygen to keep SpO₂ ≥ 92% and monitor.
C. Encourage supine positioning with a pillow under the head.
D. Administer oral acetaminophen for fever.
Answer: B. Begin supplemental oxygen to keep SpO₂ ≥ 92% and
monitor.
Rationale (correct): Infants with bronchiolitis can develop
hypoxemia; maintaining adequate oxygenation is the highest
priority for tissue perfusion and preventing respiratory failure.
The NCLEX/NGN priority principle: airway/oxygenation >
,hydration/comfort.
Why others are incorrect:
A — Hydration is important but not before correcting
hypoxemia. Oral fluids may be contraindicated if respiratory
distress progresses.
C — Supine positioning is better for airway patency; placing a
pillow under the head may obstruct airway or be unsafe for
infants — avoid loose pillows.
D — Treating fever provides comfort but does not address
hypoxemia.
3 — Asthma: home teaching and triggers
A school-age child with moderate persistent asthma has an
individualized asthma action plan. Which parent statement
indicates the teaching was effective?
A. “I’ll give the rescue inhaler (albuterol) every day, even if she
feels fine.”
B. “We’ll limit daily physical activity so she never breathes
hard.”
C. “We’ll use the daily controller inhaler as prescribed and keep
the rescue inhaler for sudden symptoms.”
D. “If she uses the rescue inhaler more than once a month, it’s
fine.”
Answer: C. “We’ll use the daily controller inhaler as prescribed
and keep the rescue inhaler for sudden symptoms.”
, Rationale (correct): Controller (anti-inflammatory) medications
are for daily use to prevent exacerbations; rescue
bronchodilators are for quick relief of symptoms. Proper use
decreases morbidity and improves safety.
Why others are incorrect:
A — Overuse of rescue inhaler without controller therapy
indicates poor control and risks tachycardia/side effects.
B — Exercise should be encouraged with pre-exercise
medication when needed; avoid unnecessary activity restriction
that impairs development/socialization.
D — Using rescue inhaler more than twice weekly (for
symptoms, excluding pre-exercise) suggests inadequate control
and need to adjust therapy.
4 — Congenital heart disease (cyanotic CHD)
A 3-month-old infant with tetralogy of Fallot is brought for a
“tet” spell (sudden cyanosis, crying, and limpness). Which
nursing intervention is the priority during the spell?
A. Place the infant in a knee-to-chest position (or bring knees to
chest) and administer oxygen.
B. Offer a bottle to calm the infant.
C. Start IV antibiotics.
D. Give acetaminophen for discomfort.
Answer: A. Place the infant in a knee-to-chest position (or bring
knees to chest) and administer oxygen.
PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
PEDIATRIC NURSING (CHILD HEALTH & DEVELOPMENTAL
DISORDERS) TEST BANK
Questions
1 — Developmental milestone (6 months)
A 6-month-old infant is brought to the clinic. Which milestone
should the nurse expect as developmentally appropriate at this
age?
A. Walks with assistance.
B. Uses a pincer grasp to pick up small objects.
C. Sits unsupported.
D. Says three-word sentences.
Answer: C. Sits unsupported.
Rationale (correct): By about 6 months most infants can sit
unsupported — an important gross motor milestone. Nursing
,assessment should note age-appropriate motor control for
feeding and safety (e.g., preventing falls).
Why others are incorrect:
A — Walking with assistance typically appears closer to 9–12
months.
B — Mature pincer grasp (using thumb and forefinger) emerges
around 9–12 months; at 6 months infants use raking grasp.
D — Three-word sentences are much later (≈3 years).
Assessments should use age-appropriate expectations to guide
anticipatory guidance and referrals.
2 — Infant respiratory (bronchiolitis)
An 8-month-old infant diagnosed with viral bronchiolitis (RSV
positive) has increased work of breathing and oxygen saturation
90% on room air. Which nursing action has the highest priority?
A. Offer oral fluids every 2 hours.
B. Begin supplemental oxygen to keep SpO₂ ≥ 92% and monitor.
C. Encourage supine positioning with a pillow under the head.
D. Administer oral acetaminophen for fever.
Answer: B. Begin supplemental oxygen to keep SpO₂ ≥ 92% and
monitor.
Rationale (correct): Infants with bronchiolitis can develop
hypoxemia; maintaining adequate oxygenation is the highest
priority for tissue perfusion and preventing respiratory failure.
The NCLEX/NGN priority principle: airway/oxygenation >
,hydration/comfort.
Why others are incorrect:
A — Hydration is important but not before correcting
hypoxemia. Oral fluids may be contraindicated if respiratory
distress progresses.
C — Supine positioning is better for airway patency; placing a
pillow under the head may obstruct airway or be unsafe for
infants — avoid loose pillows.
D — Treating fever provides comfort but does not address
hypoxemia.
3 — Asthma: home teaching and triggers
A school-age child with moderate persistent asthma has an
individualized asthma action plan. Which parent statement
indicates the teaching was effective?
A. “I’ll give the rescue inhaler (albuterol) every day, even if she
feels fine.”
B. “We’ll limit daily physical activity so she never breathes
hard.”
C. “We’ll use the daily controller inhaler as prescribed and keep
the rescue inhaler for sudden symptoms.”
D. “If she uses the rescue inhaler more than once a month, it’s
fine.”
Answer: C. “We’ll use the daily controller inhaler as prescribed
and keep the rescue inhaler for sudden symptoms.”
, Rationale (correct): Controller (anti-inflammatory) medications
are for daily use to prevent exacerbations; rescue
bronchodilators are for quick relief of symptoms. Proper use
decreases morbidity and improves safety.
Why others are incorrect:
A — Overuse of rescue inhaler without controller therapy
indicates poor control and risks tachycardia/side effects.
B — Exercise should be encouraged with pre-exercise
medication when needed; avoid unnecessary activity restriction
that impairs development/socialization.
D — Using rescue inhaler more than twice weekly (for
symptoms, excluding pre-exercise) suggests inadequate control
and need to adjust therapy.
4 — Congenital heart disease (cyanotic CHD)
A 3-month-old infant with tetralogy of Fallot is brought for a
“tet” spell (sudden cyanosis, crying, and limpness). Which
nursing intervention is the priority during the spell?
A. Place the infant in a knee-to-chest position (or bring knees to
chest) and administer oxygen.
B. Offer a bottle to calm the infant.
C. Start IV antibiotics.
D. Give acetaminophen for discomfort.
Answer: A. Place the infant in a knee-to-chest position (or bring
knees to chest) and administer oxygen.
