Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
Question 1 — Growth & Development (cognitive)
A 2-year-old toddler is brought to the clinic. The parent
reports the child uses two- to four-word phrases, follows
simple two-step commands, and points to pictures in a book.
Which developmental domain and expected milestone is
being described?
A. Fine motor — pincer grasp
B. Language/communication — combining words into short
phrases
C. Gross motor — runs well and hops on one foot
D. Social/emotional — plays cooperatively with peers
Correct answer: B
Rationale — Correct (B): Using two- to four-word phrases
and following two-step commands are
language/communication milestones typical of toddlers
,around 2 years. This aligns with CDC/AAP milestone guidance
for ages 2–3 years. CDC+1
Rationale — Incorrect:
• A: Pincer grasp is a fine motor milestone of infancy (around
9–12 months), not 2 years.
• C: Running well/hopping on one foot are gross motor skills
usually appearing later (running by 18–24 months;
hopping on one foot closer to 4 years).
• D: Cooperative play with peers is a social skill that typically
develops later (preschool age ~3–4 years).
Question 2 — Developmental screening / priority
A nurse in a pediatric clinic is performing developmental
surveillance at a 9-month well visit. Which observation
should prompt immediate further developmental screening?
A. The infant pulls to stand and cruises along furniture.
B. The infant does not respond to loud sounds and fails to
babble.
C. The infant transfers objects from hand to hand.
D. The infant uses pincer grasp to pick up small objects.
Correct answer: B
Rationale — Correct (B): Lack of response to loud sounds and
absent babbling at 9 months suggests possible hearing
impairment or communication delay and should prompt
,immediate screening/referral. CDC/AAP recommend acting
early when auditory or communication milestones are
missing. CDC+1
Rationale — Incorrect:
• A: Pulling to stand and cruising are appropriate gross
motor milestones at ~9–12 months.
• C: Transferring objects hand-to-hand is typical by 6
months.
• D: Pincer grasp appears around 9–12 months and would
not by itself prompt immediate concern.
Question 3 — Respiratory (croup)
A 3-year-old child arrives with a barking cough and
inspiratory stridor at rest. The child is anxious but has good
oxygen saturation and no drooling. Which intervention
should the nurse anticipate next?
A. Immediate intubation in the ED.
B. Inhaled racemic epinephrine and a single dose of oral
dexamethasone.
C. Give oral antibiotics for presumed bacterial tracheitis.
D. Place the child supine and provide oxygen by facemask.
Correct answer: B
Rationale — Correct (B): Classic viral croup (barking cough,
inspiratory stridor, no drooling) is treated with corticosteroids
, (dexamethasone) and, for moderate to severe stridor,
nebulized epinephrine (racemic or L-epinephrine). This
reduces subglottic edema and improves airway patency.
Oxygen only if hypoxic. Intubation is reserved for impending
respiratory failure. Elsevier Health
Rationale — Incorrect:
• A: Intubation is not first-line unless the child is in
respiratory failure or becoming fatigued.
• C: Bacterial tracheitis often presents with high fever,
toxicity, and ineffective airway—antibiotics only if bacterial
infection confirmed.
• D: Supine positioning may worsen airway obstruction in an
anxious child; oxygen is only indicated if hypoxemia is
present.
Question 4 — Cardiac (congenital heart disease — VSD)
A 5-month-old infant with a moderate ventricular septal
defect (VSD) is being assessed. Which clinical finding is most
consistent with congestive heart failure in this age group?
A. Failure to thrive, tachypnea, and hepatomegaly.
B. Bradycardia and decreased activity.
C. Dry skin and decreased urine output.
D. Hyperthermia and mucous membrane dryness.
Correct answer: A
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
Question 1 — Growth & Development (cognitive)
A 2-year-old toddler is brought to the clinic. The parent
reports the child uses two- to four-word phrases, follows
simple two-step commands, and points to pictures in a book.
Which developmental domain and expected milestone is
being described?
A. Fine motor — pincer grasp
B. Language/communication — combining words into short
phrases
C. Gross motor — runs well and hops on one foot
D. Social/emotional — plays cooperatively with peers
Correct answer: B
Rationale — Correct (B): Using two- to four-word phrases
and following two-step commands are
language/communication milestones typical of toddlers
,around 2 years. This aligns with CDC/AAP milestone guidance
for ages 2–3 years. CDC+1
Rationale — Incorrect:
• A: Pincer grasp is a fine motor milestone of infancy (around
9–12 months), not 2 years.
• C: Running well/hopping on one foot are gross motor skills
usually appearing later (running by 18–24 months;
hopping on one foot closer to 4 years).
• D: Cooperative play with peers is a social skill that typically
develops later (preschool age ~3–4 years).
Question 2 — Developmental screening / priority
A nurse in a pediatric clinic is performing developmental
surveillance at a 9-month well visit. Which observation
should prompt immediate further developmental screening?
A. The infant pulls to stand and cruises along furniture.
B. The infant does not respond to loud sounds and fails to
babble.
C. The infant transfers objects from hand to hand.
D. The infant uses pincer grasp to pick up small objects.
Correct answer: B
Rationale — Correct (B): Lack of response to loud sounds and
absent babbling at 9 months suggests possible hearing
impairment or communication delay and should prompt
,immediate screening/referral. CDC/AAP recommend acting
early when auditory or communication milestones are
missing. CDC+1
Rationale — Incorrect:
• A: Pulling to stand and cruising are appropriate gross
motor milestones at ~9–12 months.
• C: Transferring objects hand-to-hand is typical by 6
months.
• D: Pincer grasp appears around 9–12 months and would
not by itself prompt immediate concern.
Question 3 — Respiratory (croup)
A 3-year-old child arrives with a barking cough and
inspiratory stridor at rest. The child is anxious but has good
oxygen saturation and no drooling. Which intervention
should the nurse anticipate next?
A. Immediate intubation in the ED.
B. Inhaled racemic epinephrine and a single dose of oral
dexamethasone.
C. Give oral antibiotics for presumed bacterial tracheitis.
D. Place the child supine and provide oxygen by facemask.
Correct answer: B
Rationale — Correct (B): Classic viral croup (barking cough,
inspiratory stridor, no drooling) is treated with corticosteroids
, (dexamethasone) and, for moderate to severe stridor,
nebulized epinephrine (racemic or L-epinephrine). This
reduces subglottic edema and improves airway patency.
Oxygen only if hypoxic. Intubation is reserved for impending
respiratory failure. Elsevier Health
Rationale — Incorrect:
• A: Intubation is not first-line unless the child is in
respiratory failure or becoming fatigued.
• C: Bacterial tracheitis often presents with high fever,
toxicity, and ineffective airway—antibiotics only if bacterial
infection confirmed.
• D: Supine positioning may worsen airway obstruction in an
anxious child; oxygen is only indicated if hypoxemia is
present.
Question 4 — Cardiac (congenital heart disease — VSD)
A 5-month-old infant with a moderate ventricular septal
defect (VSD) is being assessed. Which clinical finding is most
consistent with congestive heart failure in this age group?
A. Failure to thrive, tachypnea, and hepatomegaly.
B. Bradycardia and decreased activity.
C. Dry skin and decreased urine output.
D. Hyperthermia and mucous membrane dryness.
Correct answer: A
