SAUNDERS COMPREHENSIVE REVIEW FOR THE NCLEX-
PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
PEDIATRIC NURSING (CHILD HEALTH & DEVELOPMENTAL
DISORDERS) TEST BANK
1 (Knowledge — Growth & Development)
A 9-month-old infant is brought to well child clinic. Which of the
following developmental milestones is most appropriate to
expect for this age?
A. Uses a 2-word phrase ("more milk")
B. Pulls to stand and cruises along furniture; uses a pincer grasp
to pick up small objects
C. Copies a circle with a pencil and stands on one foot for a few
seconds
D. Rides a tricycle and dresses self with minimal assistance
Correct answer: B
Rationale — Correct (B): At about 9 months, infants commonly
pull to stand, cruise along furniture, and begin to develop a
pincer grasp (thumb and index finger) for small objects. These
,are gross and fine motor milestones appropriate for this age.
Recognizing expected milestones supports safe anticipatory
guidance and helps detect developmental delays early (safety:
early referral).
Rationale — Incorrect:
• A: Using 2-word phrases appears later (around 2 years). At
9 months, babbling and imitating sounds are expected, not
2-word phrases.
• C: Copying a circle and standing on one foot are
preschool/school-age skills (~3–4 years).
• D: Riding a tricycle and independent dressing occur around
3 years; not expected at 9 months.
2 (Application — Communication / Family Teaching)
A 14-year-old adolescent with newly diagnosed type 1 diabetes
and their parents ask how insulin dosing will be determined.
Which explanation by the nurse is most appropriate?
A. “We’ll start a standard fixed dose that everyone your age
uses; it won’t change unless you’re very ill.”
B. “Insulin doses are calculated according to weight, blood
glucose patterns, and carbohydrate intake; we’ll teach you how
to adjust doses safely.”
C. “You’ll only need short-acting insulin before meals, so carb
counting is unnecessary.”
,D. “Insulin is always given in the same amount in the morning
and at night to avoid confusion.”
Correct answer: B
Rationale — Correct (B): Insulin regimens for adolescents with
type 1 diabetes are individualized based on weight, glucose
patterns, insulin sensitivity, and carbohydrate intake; teaching
includes carb counting and dose adjustment (safety: prevent
hypo/hyperglycemia). This explanation encourages shared
decision-making and caregiver/adolescent competence.
Rationale — Incorrect:
• A: There is no standard fixed dose for all adolescents; fixed
dosing risks inappropriate glycemic control and safety
issues.
• C: Short-acting insulin alone is often insufficient; most
regimens include basal and bolus insulin and require carb
counting for mealtime dosing.
• D: Insulin doses frequently vary by time of day and meals;
fixed dosing disregards glucose variability and food intake.
3 (Analysis — Respiratory: Asthma — Priority)
A 6-year-old with known asthma arrives in the ED with
increased work of breathing, audible wheeze, suprasternal
retractions, and an oxygen saturation of 89% on room air.
Which action should the nurse perform first?
, A. Administer oral prednisone ordered stat
B. Place the child on oxygen and prepare for nebulized short-
acting β2 agonist (albuterol) therapy
C. Obtain a detailed history from the parents about medication
adherence
D. Administer a dose of inhaled cromolyn sodium
Correct answer: B
Rationale — Correct (B): The child has signs of moderate to
severe respiratory distress and hypoxemia (SpO₂ 89%). The first
priority is to establish adequate oxygenation and administer a
short-acting bronchodilator (nebulized albuterol) to relieve
bronchospasm. This aligns with airway/breathing priority and
NCLEX safety concepts.
Rationale — Incorrect:
• A: Oral prednisone may be indicated but is not the
immediate first action — it takes effect over hours. Airway
and oxygenation come first.
• C: A history is important but should not delay emergent
interventions for hypoxemia.
• D: Cromolyn is not a rescue medication and is not
appropriate for acute management.
4 (Application — Bronchiolitis / Infant Safety)
PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
PEDIATRIC NURSING (CHILD HEALTH & DEVELOPMENTAL
DISORDERS) TEST BANK
1 (Knowledge — Growth & Development)
A 9-month-old infant is brought to well child clinic. Which of the
following developmental milestones is most appropriate to
expect for this age?
A. Uses a 2-word phrase ("more milk")
B. Pulls to stand and cruises along furniture; uses a pincer grasp
to pick up small objects
C. Copies a circle with a pencil and stands on one foot for a few
seconds
D. Rides a tricycle and dresses self with minimal assistance
Correct answer: B
Rationale — Correct (B): At about 9 months, infants commonly
pull to stand, cruise along furniture, and begin to develop a
pincer grasp (thumb and index finger) for small objects. These
,are gross and fine motor milestones appropriate for this age.
Recognizing expected milestones supports safe anticipatory
guidance and helps detect developmental delays early (safety:
early referral).
Rationale — Incorrect:
• A: Using 2-word phrases appears later (around 2 years). At
9 months, babbling and imitating sounds are expected, not
2-word phrases.
• C: Copying a circle and standing on one foot are
preschool/school-age skills (~3–4 years).
• D: Riding a tricycle and independent dressing occur around
3 years; not expected at 9 months.
2 (Application — Communication / Family Teaching)
A 14-year-old adolescent with newly diagnosed type 1 diabetes
and their parents ask how insulin dosing will be determined.
Which explanation by the nurse is most appropriate?
A. “We’ll start a standard fixed dose that everyone your age
uses; it won’t change unless you’re very ill.”
B. “Insulin doses are calculated according to weight, blood
glucose patterns, and carbohydrate intake; we’ll teach you how
to adjust doses safely.”
C. “You’ll only need short-acting insulin before meals, so carb
counting is unnecessary.”
,D. “Insulin is always given in the same amount in the morning
and at night to avoid confusion.”
Correct answer: B
Rationale — Correct (B): Insulin regimens for adolescents with
type 1 diabetes are individualized based on weight, glucose
patterns, insulin sensitivity, and carbohydrate intake; teaching
includes carb counting and dose adjustment (safety: prevent
hypo/hyperglycemia). This explanation encourages shared
decision-making and caregiver/adolescent competence.
Rationale — Incorrect:
• A: There is no standard fixed dose for all adolescents; fixed
dosing risks inappropriate glycemic control and safety
issues.
• C: Short-acting insulin alone is often insufficient; most
regimens include basal and bolus insulin and require carb
counting for mealtime dosing.
• D: Insulin doses frequently vary by time of day and meals;
fixed dosing disregards glucose variability and food intake.
3 (Analysis — Respiratory: Asthma — Priority)
A 6-year-old with known asthma arrives in the ED with
increased work of breathing, audible wheeze, suprasternal
retractions, and an oxygen saturation of 89% on room air.
Which action should the nurse perform first?
, A. Administer oral prednisone ordered stat
B. Place the child on oxygen and prepare for nebulized short-
acting β2 agonist (albuterol) therapy
C. Obtain a detailed history from the parents about medication
adherence
D. Administer a dose of inhaled cromolyn sodium
Correct answer: B
Rationale — Correct (B): The child has signs of moderate to
severe respiratory distress and hypoxemia (SpO₂ 89%). The first
priority is to establish adequate oxygenation and administer a
short-acting bronchodilator (nebulized albuterol) to relieve
bronchospasm. This aligns with airway/breathing priority and
NCLEX safety concepts.
Rationale — Incorrect:
• A: Oral prednisone may be indicated but is not the
immediate first action — it takes effect over hours. Airway
and oxygenation come first.
• C: A history is important but should not delay emergent
interventions for hypoxemia.
• D: Cromolyn is not a rescue medication and is not
appropriate for acute management.
4 (Application — Bronchiolitis / Infant Safety)
