Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1. Growth & Development — Toddler behavior
A 2-year-old toddler is being observed in the playroom.
Which behavior is most developmentally appropriate for
this age?
A. Cooperative, rule-based play with peers.
B. Parallel play with other children (playing near but not
directly with others).
C. Dramatic, role-playing with complex rules (imaginary
scenarios).
D. Prefers solitary play and shows little interest in people.
Answer: B
Rationale — Correct (B): Parallel play — playing alongside
other children without full cooperation — is characteristic of
toddlers (about 1–3 years). It reflects their emerging
autonomy while social skills are still developing.
,Rationale — Incorrect:
A. Cooperative, rule-based play is more characteristic of
school-age children (≈6–12 years).
C. Complex role-playing with rules is typical of older
preschool and school-age children.
D. Persistent solitary play with little interest in people may
indicate social/emotional concerns; not developmentally
typical for a healthy toddler.
2. Communication — Adolescent confidentiality
A 15-year-old asks the nurse to keep discussion about
sexual activity confidential. The adolescent reports no
danger and no abuse. Which is the nurse’s best response?
A. “I can’t keep that private — I must tell your parents.”
B. “I will keep it confidential unless I’m worried about your
safety; we can talk about protection and testing.”
C. “Tell me everything, and I’ll call your parents to arrange
contraception.”
D. “I won’t ask any more questions if you don’t want to tell
me.”
Answer: B
Rationale — Correct (B): For adolescents, confidentiality
encourages disclosure and appropriate care. Nurses should
explain limits of confidentiality (e.g., harm to self/others,
abuse) and provide necessary counseling/treatment (e.g., STI
,testing, contraception) while respecting autonomy and
legal/regulatory rules. This aligns with family-centered care
that respects adolescent rights.
Rationale — Incorrect:
A. Absolute refusal undermines trust; it’s not correct unless
there’s imminent risk or local law requires disclosure.
C. Involving parents without consent breaches confidentiality
and may deter care.
D. Avoiding questions ignores duty to assess risk and provide
appropriate education/care.
3. Respiratory — Croup (acute laryngotracheobronchitis)
A 3-year-old with barking cough and inspiratory stridor is
brought to the ED. The child is alert, sitting upright, and has
mild retractions. Which is the most appropriate initial
nursing action?
A. Prepare for immediate intubation.
B. Administer cool-mist humidified air and keep the child
calm.
C. Start broad-spectrum IV antibiotics.
D. Position supine and start chest physiotherapy.
Answer: B
Rationale — Correct (B): Mild croup is often managed by
keeping the child calm and providing cool humidified air or
exposure to cool outdoor air. Anxiety can worsen airway
, obstruction; calming measures are critical. Nebulized
epinephrine and corticosteroids are indicated when there is
moderate to severe stridor or respiratory distress.
Rationale — Incorrect:
A. Immediate intubation is reserved for impending
respiratory failure; not appropriate for a stable, alert child.
C. Croup is usually viral; antibiotics are not indicated unless
bacterial infection is suspected.
D. Supine positioning and chest physiotherapy are not helpful
and can increase distress.
4. Respiratory — Asthma priority action in acute
exacerbation
A 6-year-old with audible wheezes, tachypnea, and
accessory muscle use arrives. Which intervention should the
nurse initiate first?
A. Give a short-acting β₂-agonist (nebulized albuterol).
B. Begin systemic corticosteroids orally.
C. Administer inhaled cromolyn sodium.
D. Start IV antibiotics.
Answer: A
Rationale — Correct (A): In an acute pediatric asthma
exacerbation, rapid bronchodilation with a short-acting β₂-
agonist (e.g., nebulized albuterol) is the priority to relieve
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1. Growth & Development — Toddler behavior
A 2-year-old toddler is being observed in the playroom.
Which behavior is most developmentally appropriate for
this age?
A. Cooperative, rule-based play with peers.
B. Parallel play with other children (playing near but not
directly with others).
C. Dramatic, role-playing with complex rules (imaginary
scenarios).
D. Prefers solitary play and shows little interest in people.
Answer: B
Rationale — Correct (B): Parallel play — playing alongside
other children without full cooperation — is characteristic of
toddlers (about 1–3 years). It reflects their emerging
autonomy while social skills are still developing.
,Rationale — Incorrect:
A. Cooperative, rule-based play is more characteristic of
school-age children (≈6–12 years).
C. Complex role-playing with rules is typical of older
preschool and school-age children.
D. Persistent solitary play with little interest in people may
indicate social/emotional concerns; not developmentally
typical for a healthy toddler.
2. Communication — Adolescent confidentiality
A 15-year-old asks the nurse to keep discussion about
sexual activity confidential. The adolescent reports no
danger and no abuse. Which is the nurse’s best response?
A. “I can’t keep that private — I must tell your parents.”
B. “I will keep it confidential unless I’m worried about your
safety; we can talk about protection and testing.”
C. “Tell me everything, and I’ll call your parents to arrange
contraception.”
D. “I won’t ask any more questions if you don’t want to tell
me.”
Answer: B
Rationale — Correct (B): For adolescents, confidentiality
encourages disclosure and appropriate care. Nurses should
explain limits of confidentiality (e.g., harm to self/others,
abuse) and provide necessary counseling/treatment (e.g., STI
,testing, contraception) while respecting autonomy and
legal/regulatory rules. This aligns with family-centered care
that respects adolescent rights.
Rationale — Incorrect:
A. Absolute refusal undermines trust; it’s not correct unless
there’s imminent risk or local law requires disclosure.
C. Involving parents without consent breaches confidentiality
and may deter care.
D. Avoiding questions ignores duty to assess risk and provide
appropriate education/care.
3. Respiratory — Croup (acute laryngotracheobronchitis)
A 3-year-old with barking cough and inspiratory stridor is
brought to the ED. The child is alert, sitting upright, and has
mild retractions. Which is the most appropriate initial
nursing action?
A. Prepare for immediate intubation.
B. Administer cool-mist humidified air and keep the child
calm.
C. Start broad-spectrum IV antibiotics.
D. Position supine and start chest physiotherapy.
Answer: B
Rationale — Correct (B): Mild croup is often managed by
keeping the child calm and providing cool humidified air or
exposure to cool outdoor air. Anxiety can worsen airway
, obstruction; calming measures are critical. Nebulized
epinephrine and corticosteroids are indicated when there is
moderate to severe stridor or respiratory distress.
Rationale — Incorrect:
A. Immediate intubation is reserved for impending
respiratory failure; not appropriate for a stable, alert child.
C. Croup is usually viral; antibiotics are not indicated unless
bacterial infection is suspected.
D. Supine positioning and chest physiotherapy are not helpful
and can increase distress.
4. Respiratory — Asthma priority action in acute
exacerbation
A 6-year-old with audible wheezes, tachypnea, and
accessory muscle use arrives. Which intervention should the
nurse initiate first?
A. Give a short-acting β₂-agonist (nebulized albuterol).
B. Begin systemic corticosteroids orally.
C. Administer inhaled cromolyn sodium.
D. Start IV antibiotics.
Answer: A
Rationale — Correct (A): In an acute pediatric asthma
exacerbation, rapid bronchodilation with a short-acting β₂-
agonist (e.g., nebulized albuterol) is the priority to relieve
