Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1. A 15-month-old is brought to the clinic. Which
developmental milestone would the nurse expect at this
age?
A. Uses a 3-word sentence
B. Walks independently and begins to run
C. Copies a triangle with a pencil
D. Performs parallel play with peers
Answer: B
Rationale — Why B is correct: By about 12–18 months
toddlers typically walk independently and begin to run
unsteadily. This reflects gross motor progression from
standing/walking to increasing ambulatory mobility,
important for safety teaching (fall risk, supervision).
Why A is incorrect: 3-word sentences emerge later (≈2–3
years).
Why C is incorrect: Copying a triangle is a preschool/school-
,age fine motor/visual-motor skill (≈4–5 years).
Why D is incorrect: Parallel play is typical of toddlers age 2–3,
but the descriptor “performs parallel play with peers” is less
specific for 15 months than gross motor milestones.
2. A 4-year-old hospitalized after a fracture is fearful of being
separated from parents. Which statement reflects Erikson’s
psychosocial stage for this age and best nursing approach?
A. "Industry vs. inferiority" — encourage competitive tasks.
B. "Autonomy vs. shame/doubt" — allow independent
dressing.
C. "Initiative vs. guilt" — provide opportunities for choice
and play.
D. "Trust vs. mistrust" — maintain constant physical
holding.
Answer: C
Rationale — Why C is correct: Preschoolers (≈3–5 years) are
in Erikson’s Initiative vs. Guilt stage; they develop purpose
and initiative through play and choices. Offering age-
appropriate choices and therapeutic play reduces anxiety and
supports coping.
Why A is incorrect: Industry vs. inferiority applies to school-
age children (≈6–12 years).
Why B is incorrect: Autonomy vs. shame/doubt is typical of
toddlers (≈1–3 years). While encouraging independence is
,important overall, initiative/choice is more developmentally
appropriate for a 4-year-old.
Why D is incorrect: Trust vs. mistrust describes infancy (0–1
year); constant holding is not developmentally required for a
preschooler and may limit autonomy.
3. A child demonstrates symbolic play, egocentrism, and
difficulty with conservation tasks. Which Piagetian stage
does this describe?
A. Sensorimotor
B. Preoperational
C. Concrete operational
D. Formal operational
Answer: B
Rationale — Why B is correct: The preoperational stage (≈2–
7 years) is characterized by symbolic play, egocentrism, and
inability to conserve (volume/number). Recognizing cognitive
level guides education (use concrete, visual teaching and
simple explanations).
Why A is incorrect: Sensorimotor (0–2 years) is object
permanence and sensorimotor exploration.
Why C is incorrect: Concrete operational (≈7–11 years)
involves logical thought and conservation.
Why D is incorrect: Formal operational (≈11 years and up)
involves abstract reasoning.
, 4. A 2-year-old presents with barking cough and inspiratory
stridor at night. Which is the nurse’s priority intervention?
A. Give oral antibiotics immediately.
B. Administer nebulized epinephrine and corticosteroid per
protocol.
C. Place the child supine and restrict fluids.
D. Begin chest physiotherapy.
Answer: B
Rationale — Why B is correct: Classic viral croup
(laryngotracheobronchitis) presents with barking cough and
inspiratory stridor. Nebulized epinephrine reduces airway
edema quickly; a single dose of corticosteroid (e.g.,
dexamethasone) reduces inflammation. These are priority
interventions to relieve upper airway obstruction and prevent
respiratory compromise.
Why A is incorrect: Antibiotics are not indicated for viral
croup unless bacterial infection is suspected.
Why C is incorrect: Supine positioning may worsen
respiratory distress; maintain comfortable position (often
upright) and avoid fluid restriction unless indicated by airway
compromise.
Why D is incorrect: Chest physiotherapy is not effective for
upper airway obstruction from croup.
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1. A 15-month-old is brought to the clinic. Which
developmental milestone would the nurse expect at this
age?
A. Uses a 3-word sentence
B. Walks independently and begins to run
C. Copies a triangle with a pencil
D. Performs parallel play with peers
Answer: B
Rationale — Why B is correct: By about 12–18 months
toddlers typically walk independently and begin to run
unsteadily. This reflects gross motor progression from
standing/walking to increasing ambulatory mobility,
important for safety teaching (fall risk, supervision).
Why A is incorrect: 3-word sentences emerge later (≈2–3
years).
Why C is incorrect: Copying a triangle is a preschool/school-
,age fine motor/visual-motor skill (≈4–5 years).
Why D is incorrect: Parallel play is typical of toddlers age 2–3,
but the descriptor “performs parallel play with peers” is less
specific for 15 months than gross motor milestones.
2. A 4-year-old hospitalized after a fracture is fearful of being
separated from parents. Which statement reflects Erikson’s
psychosocial stage for this age and best nursing approach?
A. "Industry vs. inferiority" — encourage competitive tasks.
B. "Autonomy vs. shame/doubt" — allow independent
dressing.
C. "Initiative vs. guilt" — provide opportunities for choice
and play.
D. "Trust vs. mistrust" — maintain constant physical
holding.
Answer: C
Rationale — Why C is correct: Preschoolers (≈3–5 years) are
in Erikson’s Initiative vs. Guilt stage; they develop purpose
and initiative through play and choices. Offering age-
appropriate choices and therapeutic play reduces anxiety and
supports coping.
Why A is incorrect: Industry vs. inferiority applies to school-
age children (≈6–12 years).
Why B is incorrect: Autonomy vs. shame/doubt is typical of
toddlers (≈1–3 years). While encouraging independence is
,important overall, initiative/choice is more developmentally
appropriate for a 4-year-old.
Why D is incorrect: Trust vs. mistrust describes infancy (0–1
year); constant holding is not developmentally required for a
preschooler and may limit autonomy.
3. A child demonstrates symbolic play, egocentrism, and
difficulty with conservation tasks. Which Piagetian stage
does this describe?
A. Sensorimotor
B. Preoperational
C. Concrete operational
D. Formal operational
Answer: B
Rationale — Why B is correct: The preoperational stage (≈2–
7 years) is characterized by symbolic play, egocentrism, and
inability to conserve (volume/number). Recognizing cognitive
level guides education (use concrete, visual teaching and
simple explanations).
Why A is incorrect: Sensorimotor (0–2 years) is object
permanence and sensorimotor exploration.
Why C is incorrect: Concrete operational (≈7–11 years)
involves logical thought and conservation.
Why D is incorrect: Formal operational (≈11 years and up)
involves abstract reasoning.
, 4. A 2-year-old presents with barking cough and inspiratory
stridor at night. Which is the nurse’s priority intervention?
A. Give oral antibiotics immediately.
B. Administer nebulized epinephrine and corticosteroid per
protocol.
C. Place the child supine and restrict fluids.
D. Begin chest physiotherapy.
Answer: B
Rationale — Why B is correct: Classic viral croup
(laryngotracheobronchitis) presents with barking cough and
inspiratory stridor. Nebulized epinephrine reduces airway
edema quickly; a single dose of corticosteroid (e.g.,
dexamethasone) reduces inflammation. These are priority
interventions to relieve upper airway obstruction and prevent
respiratory compromise.
Why A is incorrect: Antibiotics are not indicated for viral
croup unless bacterial infection is suspected.
Why C is incorrect: Supine positioning may worsen
respiratory distress; maintain comfortable position (often
upright) and avoid fluid restriction unless indicated by airway
compromise.
Why D is incorrect: Chest physiotherapy is not effective for
upper airway obstruction from croup.
