Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
INTEGRATED REVIEW — COMPREHENSIVE NCLEX
PRACTICE PACK [FUNDAMENTALS,
PHARMACOLOGY, MEDICAL-SURGICAL,
MATERNITY, PEDIATRIC, EMERGENCY, AND
SPECIALTY SYSTEMS] TEST BANK
Practice Test — Questions 1–100
Fundamentals (Q1–Q15)
1 (SBA). A nurse is preparing to administer a medication to a
confused older adult who refuses it. The best initial action is to:
A. Force the medication by oral swallowing.
B. Document the refusal and leave.
C. Assess the reasons for refusal and re-explain the medication’s
,purpose.
D. Tell the family to instruct the client to take it.
Answer: C
Cognitive level: Application
NCLEX category: Psychosocial Integrity (also Safe & Effective
Care)
Rationales:
• A: Incorrect — forcing violates autonomy and may be
assault; seek alternatives.
• B: Incorrect — documenting refusal is required but
problem solving should be attempted first.
• C: Correct — assessing underlying causes (pain, fear,
misunderstanding) is priority for informed consent and
safe care.
• D: Incorrect — family cannot coerce; nurse must address
client’s concerns directly.
2 (SBA). A client has an indwelling urinary catheter. Which
nursing action best reduces catheter-associated urinary tract
infections (CAUTI)?
A. Irrigate catheter daily with sterile saline.
B. Use a closed drainage system and maintain below bladder
level.
C. Change catheter every 48 hours prophylactically.
D. Flush with antiseptic solution via tubing once daily.
,Answer: B
Cognitive level: Application
NCLEX category: Safe & Effective Care Environment — Safety &
Infection Control
Rationales:
• A: Incorrect — routine irrigation increases infection risk
unless obstruction present.
• B: Correct — closed system and gravity drainage are
evidence-based to reduce CAUTI.
• C: Incorrect — routine scheduled changes increase trauma
and infection risk.
• D: Incorrect — antiseptic flushing is not recommended for
prevention and risks complications.
3 (SATA). Which interventions are appropriate when moving a
patient up in bed? (Select all that apply.)
A. Use a draw sheet and two caregivers.
B. Flex knees and use leg muscles to lift.
C. Ask the patient to push with feet if able.
D. Lift the patient with your back straight and trunk rotation.
E. Use friction-reducing device or sheet.
Answer: A, B, C, E
Cognitive level: Application
NCLEX category: Safe & Effective Care Environment —
, Management of Care / Safety
Rationales:
• A: Correct — draw sheet and adequate staffing reduce
injury.
• B: Correct — flexing knees and using leg muscles follows
body mechanics.
• C: Correct — using patient participation when possible
reduces caregiver load.
• D: Incorrect — lifting with back and rotating increases risk
of injury.
• E: Correct — friction-reducing devices are recommended
to decrease force required.
4 (SBA). A patient with early stage Alzheimer’s becomes
agitated at sundown. The most appropriate nursing strategy is
to:
A. Give a sedative at sundown nightly.
B. Reorient and provide a quiet, structured routine before
evening.
C. Restrain the patient during evenings to prevent wandering.
D. Encourage the family to visit continually in evening hours.
Answer: B
Cognitive level: Application
PN® Examination
9th Edition
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
INTEGRATED REVIEW — COMPREHENSIVE NCLEX
PRACTICE PACK [FUNDAMENTALS,
PHARMACOLOGY, MEDICAL-SURGICAL,
MATERNITY, PEDIATRIC, EMERGENCY, AND
SPECIALTY SYSTEMS] TEST BANK
Practice Test — Questions 1–100
Fundamentals (Q1–Q15)
1 (SBA). A nurse is preparing to administer a medication to a
confused older adult who refuses it. The best initial action is to:
A. Force the medication by oral swallowing.
B. Document the refusal and leave.
C. Assess the reasons for refusal and re-explain the medication’s
,purpose.
D. Tell the family to instruct the client to take it.
Answer: C
Cognitive level: Application
NCLEX category: Psychosocial Integrity (also Safe & Effective
Care)
Rationales:
• A: Incorrect — forcing violates autonomy and may be
assault; seek alternatives.
• B: Incorrect — documenting refusal is required but
problem solving should be attempted first.
• C: Correct — assessing underlying causes (pain, fear,
misunderstanding) is priority for informed consent and
safe care.
• D: Incorrect — family cannot coerce; nurse must address
client’s concerns directly.
2 (SBA). A client has an indwelling urinary catheter. Which
nursing action best reduces catheter-associated urinary tract
infections (CAUTI)?
A. Irrigate catheter daily with sterile saline.
B. Use a closed drainage system and maintain below bladder
level.
C. Change catheter every 48 hours prophylactically.
D. Flush with antiseptic solution via tubing once daily.
,Answer: B
Cognitive level: Application
NCLEX category: Safe & Effective Care Environment — Safety &
Infection Control
Rationales:
• A: Incorrect — routine irrigation increases infection risk
unless obstruction present.
• B: Correct — closed system and gravity drainage are
evidence-based to reduce CAUTI.
• C: Incorrect — routine scheduled changes increase trauma
and infection risk.
• D: Incorrect — antiseptic flushing is not recommended for
prevention and risks complications.
3 (SATA). Which interventions are appropriate when moving a
patient up in bed? (Select all that apply.)
A. Use a draw sheet and two caregivers.
B. Flex knees and use leg muscles to lift.
C. Ask the patient to push with feet if able.
D. Lift the patient with your back straight and trunk rotation.
E. Use friction-reducing device or sheet.
Answer: A, B, C, E
Cognitive level: Application
NCLEX category: Safe & Effective Care Environment —
, Management of Care / Safety
Rationales:
• A: Correct — draw sheet and adequate staffing reduce
injury.
• B: Correct — flexing knees and using leg muscles follows
body mechanics.
• C: Correct — using patient participation when possible
reduces caregiver load.
• D: Incorrect — lifting with back and rotating increases risk
of injury.
• E: Correct — friction-reducing devices are recommended
to decrease force required.
4 (SBA). A patient with early stage Alzheimer’s becomes
agitated at sundown. The most appropriate nursing strategy is
to:
A. Give a sedative at sundown nightly.
B. Reorient and provide a quiet, structured routine before
evening.
C. Restrain the patient during evenings to prevent wandering.
D. Encourage the family to visit continually in evening hours.
Answer: B
Cognitive level: Application
