Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1
A 9-month-old infant is brought to the clinic for a well check.
Which of the following is the most appropriate expected
developmental milestone for this age?
A. Begins to use a spoon independently
B. Sits unsupported and pulls to stand; uses a pincer grasp to
pick up small objects
C. Runs well and kicks a ball forward
D. Uses 3- to 4-word sentences
Answer: B
Rationale (correct — B): At about 9 months infants typically
sit unsupported, may pull to stand, and develop a pincer
grasp (fine motor) for picking up small objects. This aligns
with expected gross and fine motor milestones for that age
and informs anticipatory guidance and safety (e.g., choking
risk).
,Rationale (A): Using a spoon independently is expected later
(around 12–18 months, with more self-feeding by 2 years).
Not correct for 9 months.
Rationale (C): Running well and coordinated kicking are
toddler skills (≈18–24 months and beyond).
Rationale (D): 3–4 word sentences occur much later (≈2–3
years).
2
A toddler (18 months) in the clinic is anxious and will not
cooperate with an exam. The nurse’s BEST approach to gain
cooperation is to:
A. Physically restrain the toddler to complete the assessment
quickly
B. Use a parental presence and allow the toddler to handle
safe equipment first (e.g., stethoscope)
C. Ask the toddler to sit quietly and explain the exam step-by-
step using medical terms
D. Tell the parent to leave the room so the toddler will calm
down
Answer: B
Rationale (correct — B): Family-centered care and
developmental communication: toddlers respond best when
a parent is present and when given simple, concrete choices
and time to explore safe objects. Allowing the child to handle
,equipment reduces fear and increases cooperation.
Rationale (A): Physical restraint should be avoided except
when necessary for safety; coercion increases distress and is
not a first-line approach.
Rationale (C): Toddlers do not respond to complex medical
explanations; using age-appropriate language and
demonstration is preferred.
Rationale (D): Removing the parent can increase toddler
anxiety and reduce cooperation.
3
A 3-year-old with barking cough and inspiratory stridor is
diagnosed with viral croup (laryngotracheobronchitis). Which
intervention is the MOST appropriate initial nursing action?
A. Administer nebulized epinephrine and observe for
improvement
B. Begin broad-spectrum IV antibiotics immediately
C. Give oral dexamethasone and provide a cool-mist
environment or exposure to cool night air
D. Intubate immediately
Answer: C
Rationale (correct — C): For mild to moderate viral croup, a
dose of oral or IM dexamethasone reduces airway
inflammation. Noninvasive measures (cool mist or cool air)
can help. Nebulized epinephrine (A) is used for moderate to
, severe stridor with respiratory distress — but
dexamethasone + supportive care is appropriate initial action
in many cases.
Rationale (A): Nebulized epinephrine is effective for severe
stridor/respiratory distress; not always first action if child is
stable. If used, monitor for rebound.
Rationale (B): Viral croup is usually viral—antibiotics are not
indicated unless bacterial superinfection suspected.
Rationale (D): Intubation is reserved for impending
respiratory failure; not an initial action.
4
A 6-year-old child with asthma is prescribed an inhaled short-
acting beta-agonist (albuterol) via metered-dose inhaler
(MDI). The nurse should instruct the child (and caregiver) to:
A. Use the inhaler only when wheezing is severe; avoid
spacer use because it decreases medication delivery
B. Shake the MDI, use a spacer with a mask or mouthpiece
appropriate for the child, exhale fully, actuate while the child
inhales slowly, and hold breath for 5–10 seconds afterward
C. Administer the inhaler and then immediately administer a
corticosteroid inhaler (without waiting) to boost effect
D. Use the inhaler before exercise only; do not use for acute
symptoms
Answer: B
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1
A 9-month-old infant is brought to the clinic for a well check.
Which of the following is the most appropriate expected
developmental milestone for this age?
A. Begins to use a spoon independently
B. Sits unsupported and pulls to stand; uses a pincer grasp to
pick up small objects
C. Runs well and kicks a ball forward
D. Uses 3- to 4-word sentences
Answer: B
Rationale (correct — B): At about 9 months infants typically
sit unsupported, may pull to stand, and develop a pincer
grasp (fine motor) for picking up small objects. This aligns
with expected gross and fine motor milestones for that age
and informs anticipatory guidance and safety (e.g., choking
risk).
,Rationale (A): Using a spoon independently is expected later
(around 12–18 months, with more self-feeding by 2 years).
Not correct for 9 months.
Rationale (C): Running well and coordinated kicking are
toddler skills (≈18–24 months and beyond).
Rationale (D): 3–4 word sentences occur much later (≈2–3
years).
2
A toddler (18 months) in the clinic is anxious and will not
cooperate with an exam. The nurse’s BEST approach to gain
cooperation is to:
A. Physically restrain the toddler to complete the assessment
quickly
B. Use a parental presence and allow the toddler to handle
safe equipment first (e.g., stethoscope)
C. Ask the toddler to sit quietly and explain the exam step-by-
step using medical terms
D. Tell the parent to leave the room so the toddler will calm
down
Answer: B
Rationale (correct — B): Family-centered care and
developmental communication: toddlers respond best when
a parent is present and when given simple, concrete choices
and time to explore safe objects. Allowing the child to handle
,equipment reduces fear and increases cooperation.
Rationale (A): Physical restraint should be avoided except
when necessary for safety; coercion increases distress and is
not a first-line approach.
Rationale (C): Toddlers do not respond to complex medical
explanations; using age-appropriate language and
demonstration is preferred.
Rationale (D): Removing the parent can increase toddler
anxiety and reduce cooperation.
3
A 3-year-old with barking cough and inspiratory stridor is
diagnosed with viral croup (laryngotracheobronchitis). Which
intervention is the MOST appropriate initial nursing action?
A. Administer nebulized epinephrine and observe for
improvement
B. Begin broad-spectrum IV antibiotics immediately
C. Give oral dexamethasone and provide a cool-mist
environment or exposure to cool night air
D. Intubate immediately
Answer: C
Rationale (correct — C): For mild to moderate viral croup, a
dose of oral or IM dexamethasone reduces airway
inflammation. Noninvasive measures (cool mist or cool air)
can help. Nebulized epinephrine (A) is used for moderate to
, severe stridor with respiratory distress — but
dexamethasone + supportive care is appropriate initial action
in many cases.
Rationale (A): Nebulized epinephrine is effective for severe
stridor/respiratory distress; not always first action if child is
stable. If used, monitor for rebound.
Rationale (B): Viral croup is usually viral—antibiotics are not
indicated unless bacterial superinfection suspected.
Rationale (D): Intubation is reserved for impending
respiratory failure; not an initial action.
4
A 6-year-old child with asthma is prescribed an inhaled short-
acting beta-agonist (albuterol) via metered-dose inhaler
(MDI). The nurse should instruct the child (and caregiver) to:
A. Use the inhaler only when wheezing is severe; avoid
spacer use because it decreases medication delivery
B. Shake the MDI, use a spacer with a mask or mouthpiece
appropriate for the child, exhale fully, actuate while the child
inhales slowly, and hold breath for 5–10 seconds afterward
C. Administer the inhaler and then immediately administer a
corticosteroid inhaler (without waiting) to boost effect
D. Use the inhaler before exercise only; do not use for acute
symptoms
Answer: B
