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 has begun pulling to stand and pincer
grasp is emerging. Which parental observation indicates
expected development for this age?
A. Uses a spoon independently at most meals.
B. Says two-word phrases such as “more milk.”
C. Transfers objects from one hand to the other.
D. Rides a tricycle without assistance.
Answer: C
Rationale:
Correct — C: At about 6–9 months infants begin transferring
objects between hands (midline crossing → bilateral
coordination) as fine-motor control improves; pincer grasp
emergence fits this timeline. Developmental principle: motor
skills progress from gross to fine, midline orientation to
bilateral use.
,A — Incorrect: Self-feeding with a spoon independently is
usually later (around 12–15+ months with messy assistance
earlier).
B — Incorrect: Two-word phrases are typically seen around
18–24 months; at 9 months babbling and first words may
appear but not two-word phrases.
D — Incorrect: Riding a tricycle requires coordinated pedaling
and balance and appears around 3 years.
NCLEX alignment: Health Promotion and Maintenance —
Growth & Development; Cognitive level: Application.
2. A 4-year-old with asthma is prescribed a bronchodilator via
metered-dose inhaler (MDI). Which action by the parent
best promotes correct delivery?
A. Have the child take several quick, shallow breaths after
actuation.
B. Place a spacer between the MDI and the child’s mouth.
C. Encourage the child to swallow saliva before inhalation.
D. Shake the inhaler only if it is labeled “shake well.”
Answer: B
Rationale:
Correct — B: A spacer improves drug deposition in the lungs
in young children who cannot coordinate inhalation with
actuation; it reduces oropharyngeal deposition and increases
efficacy and safety. Safety principle: match device to
developmental ability.
,A — Incorrect: Quick, shallow breaths reduce lung
deposition; a slow, deep inhalation or tidal breathing with a
spacer is preferred in young children.
C — Incorrect: Swallowing saliva is irrelevant and may delay
inhalation; inhalation technique matters for pulmonary
delivery.
D — Incorrect: Most MDIs require shaking (to suspend
propellant/medication); relying on label alone is not best
practice — provider teaching should include shaking per
manufacturer instructions.
NCLEX alignment: Physiological Integrity — Pharmacological
and Parenteral Therapies; Cognitive level: Application.
3. A 2-year-old toddler presents with sudden onset high fever
and barking cough at night; inspiratory stridor is present.
The nurse suspects croup (laryngotracheobronchitis).
Which immediate action is most appropriate?
A. Give oral amoxicillin and discharge home.
B. Place the child in a cold air environment or humidified
mist and administer nebulized epinephrine if severe.
C. Perform throat cultures and start oral corticosteroids
immediately.
D. Intubate immediately in the ED.
Answer: B
Rationale:
Correct — B: Mild to moderate croup responds to humidified
, air (or cool night air) and nebulized racemic epinephrine if
moderate to severe stridor; systemic corticosteroids
(dexamethasone) are also indicated but humidified air and
nebulized epinephrine can be immediate symptomatic
interventions. Safety: airway assessment and interventions
prioritized.
A — Incorrect: Croup is usually viral; antibiotics are not
indicated unless bacterial infection is documented.
C — Incorrect: Throat cultures are not indicated acutely and
corticosteroids are usually given (often IM/PO
dexamethasone), but pending airway support, humidified air
and epinephrine are immediate.
D — Incorrect: Intubation is reserved for impending
respiratory failure; not first-line for most croup cases.
NCLEX alignment: Physiological Integrity — Reduction of Risk
Potential (respiratory); Cognitive level: Analysis.
4. A parent asks why the pediatric nurse uses atraumatic
communication (simple words, play) when educating a 5-
year-old preparing for a blood draw. The nurse’s best
explanation is:
A. “Young children don’t understand words, so play is
faster.”
B. “Children have limited attention and concrete thinking;
play reduces anxiety and improves cooperation.”
C. “Play is for distraction only and has no educational
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1. A 9-month-old infant has begun pulling to stand and pincer
grasp is emerging. Which parental observation indicates
expected development for this age?
A. Uses a spoon independently at most meals.
B. Says two-word phrases such as “more milk.”
C. Transfers objects from one hand to the other.
D. Rides a tricycle without assistance.
Answer: C
Rationale:
Correct — C: At about 6–9 months infants begin transferring
objects between hands (midline crossing → bilateral
coordination) as fine-motor control improves; pincer grasp
emergence fits this timeline. Developmental principle: motor
skills progress from gross to fine, midline orientation to
bilateral use.
,A — Incorrect: Self-feeding with a spoon independently is
usually later (around 12–15+ months with messy assistance
earlier).
B — Incorrect: Two-word phrases are typically seen around
18–24 months; at 9 months babbling and first words may
appear but not two-word phrases.
D — Incorrect: Riding a tricycle requires coordinated pedaling
and balance and appears around 3 years.
NCLEX alignment: Health Promotion and Maintenance —
Growth & Development; Cognitive level: Application.
2. A 4-year-old with asthma is prescribed a bronchodilator via
metered-dose inhaler (MDI). Which action by the parent
best promotes correct delivery?
A. Have the child take several quick, shallow breaths after
actuation.
B. Place a spacer between the MDI and the child’s mouth.
C. Encourage the child to swallow saliva before inhalation.
D. Shake the inhaler only if it is labeled “shake well.”
Answer: B
Rationale:
Correct — B: A spacer improves drug deposition in the lungs
in young children who cannot coordinate inhalation with
actuation; it reduces oropharyngeal deposition and increases
efficacy and safety. Safety principle: match device to
developmental ability.
,A — Incorrect: Quick, shallow breaths reduce lung
deposition; a slow, deep inhalation or tidal breathing with a
spacer is preferred in young children.
C — Incorrect: Swallowing saliva is irrelevant and may delay
inhalation; inhalation technique matters for pulmonary
delivery.
D — Incorrect: Most MDIs require shaking (to suspend
propellant/medication); relying on label alone is not best
practice — provider teaching should include shaking per
manufacturer instructions.
NCLEX alignment: Physiological Integrity — Pharmacological
and Parenteral Therapies; Cognitive level: Application.
3. A 2-year-old toddler presents with sudden onset high fever
and barking cough at night; inspiratory stridor is present.
The nurse suspects croup (laryngotracheobronchitis).
Which immediate action is most appropriate?
A. Give oral amoxicillin and discharge home.
B. Place the child in a cold air environment or humidified
mist and administer nebulized epinephrine if severe.
C. Perform throat cultures and start oral corticosteroids
immediately.
D. Intubate immediately in the ED.
Answer: B
Rationale:
Correct — B: Mild to moderate croup responds to humidified
, air (or cool night air) and nebulized racemic epinephrine if
moderate to severe stridor; systemic corticosteroids
(dexamethasone) are also indicated but humidified air and
nebulized epinephrine can be immediate symptomatic
interventions. Safety: airway assessment and interventions
prioritized.
A — Incorrect: Croup is usually viral; antibiotics are not
indicated unless bacterial infection is documented.
C — Incorrect: Throat cultures are not indicated acutely and
corticosteroids are usually given (often IM/PO
dexamethasone), but pending airway support, humidified air
and epinephrine are immediate.
D — Incorrect: Intubation is reserved for impending
respiratory failure; not first-line for most croup cases.
NCLEX alignment: Physiological Integrity — Reduction of Risk
Potential (respiratory); Cognitive level: Analysis.
4. A parent asks why the pediatric nurse uses atraumatic
communication (simple words, play) when educating a 5-
year-old preparing for a blood draw. The nurse’s best
explanation is:
A. “Young children don’t understand words, so play is
faster.”
B. “Children have limited attention and concrete thinking;
play reduces anxiety and improves cooperation.”
C. “Play is for distraction only and has no educational
