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.
,5. A 7-year-old with asthma uses albuterol MDI PRN and
fluticasone daily. Which statement indicates correct
understanding of medication types?
A. "Albuterol is a controller medicine I use every day."
B. "Fluticasone is a rescue inhaler to stop an attack."
C. "Albuterol is a short-acting bronchodilator used for
quick relief."
D. "I should stop fluticasone when symptoms improve."
Answer: C
Rationale — Why C is correct: Albuterol is a short-acting β2-
agonist (SABA) used for quick relief of bronchospasm.
Fluticasone is an inhaled corticosteroid (controller) for daily
use. Knowing rescue versus controller reduces exacerbation
risk and guides teaching for action plans.
Why A is incorrect: Albuterol is a rescue (not daily controller)
med.
Why B is incorrect: Fluticasone is a controller, not for acute
symptom relief.
Why D is incorrect: Stopping controller inhaled steroids when
symptoms improve can lead to loss of control; therapy is
typically continued per provider instructions.
6. An infant with a large ventricular septal defect (VSD)
demonstrates poor weight gain and tachypnea. Which
pathophysiologic explanation is most accurate?
, A. Decreased pulmonary blood flow causes cyanosis and
weight loss.
B. Left-to-right shunt increases pulmonary blood flow
causing tachypnea and poor feeding.
C. Right-to-left shunt causes increased systemic perfusion
and poor weight gain.
D. VSD reduces preload and leads to muscle wasting.
Answer: B
Rationale — Why B is correct: A VSD commonly produces a
left-to-right shunt: oxygenated blood returns to pulmonary
circulation increasing pulmonary blood flow, causing
tachypnea, increased work of breathing, and poor oral
intake/weight gain due to fatigue and increased metabolic
demand.
Why A is incorrect: Decreased pulmonary blood flow is
typical of some cyanotic defects, not VSD with left-to-right
shunt.
Why C is incorrect: Right-to-left shunt causes cyanosis; VSD
often initially causes left-to-right.
Why D is incorrect: VSD leads to volume overload not
reduced preload; muscle wasting is secondary to chronic
increased work of breathing and poor intake.
7. A 9-month-old with Tetralogy of Fallot has a sudden deep
cyanotic spell. Which immediate nursing action is
, indicated?
A. Place the infant supine and elevate the legs.
B. Administer aspirin and observe.
C. Place the infant in a knee-to-chest position and
administer oxygen if ordered.
D. Begin chest compressions.
Answer: C
Rationale — Why C is correct: During a "Tet spell"
(hypercyanotic event) increasing systemic vascular resistance
and reducing right-to-left shunting helps — knee-to-chest
position increases systemic vascular resistance, improving
pulmonary blood flow. Administer oxygen and provide calm
measures; prompt provider notification and interventions
(morphine, fluids) follow per protocol.
Why A is incorrect: Supine with leg elevation does not
produce the physiologic benefits of knee-to-chest and may
not reduce shunting.
Why B is incorrect: Aspirin is not used for acute cyanotic
spells.
Why D is incorrect: Chest compressions are indicated only for
cardiac arrest.
8. A 10-month-old hospitalized with RSV bronchiolitis has
increased work of breathing and difficulty feeding. Which
intervention is highest priority?
, A. Start empiric antibiotics.
B. Frequent nasal suctioning and maintain hydration.
C. Chest physiotherapy and postural drainage.
D. Routine bronchodilator nebulizations every 4 hours.
Answer: B
Rationale — Why B is correct: RSV bronchiolitis causes upper
airway secretions and small airway obstruction; suctioning
the nares improves breathing and feeding. Hydration is
crucial because tachypnea increases fluid needs. Supportive
care is the mainstay; bronchodilators and antibiotics are not
routinely recommended.
Why A is incorrect: Antibiotics are not indicated unless
bacterial coinfection is suspected.
Why C is incorrect: Chest physiotherapy/postural drainage
have limited benefit in bronchiolitis.
Why D is incorrect: Routine bronchodilators lack consistent
benefit; may be tried in select patients but not routinely.
9. A school-age child is admitted with suspected
meningococcal meningitis. Which isolation precaution
should the nurse implement immediately?
A. Standard precautions only.
B. Contact precautions only.
C. Droplet precautions, private room with mask for visitors.
D. Airborne precautions with negative pressure room.
,Answer: C
Rationale — Why C is correct: Neisseria meningitidis is
spread by large respiratory droplets; droplet precautions
(mask within 3–6 feet, private room) are indicated until 24
hours after effective antibiotic therapy. Implementing droplet
precautions protects staff and other patients.
Why A is incorrect: Standard precautions are insufficient for
droplet-spread pathogens.
Why B is incorrect: Contact precautions alone do not address
droplet transmission.
Why D is incorrect: Airborne precautions (negative pressure,
N95) are used for smaller droplet nuclei (e.g., TB, measles,
varicella) and are not required for meningococcal meningitis.
10. A 10-year-old with Type 1 diabetes and vomiting at
home calls the clinic. Which instruction is most important
for sick-day management?
A. Stop insulin while vomiting to avoid hypoglycemia.
B. Continue basal/short-acting insulin and monitor blood
glucose and ketones closely.
C. Double the usual insulin dose because of illness.
D. Avoid fluids to reduce vomiting episodes.
Answer: B
Rationale — Why B is correct: During illness (even with
decreased intake), continued insulin is essential to prevent
, ketosis and diabetic ketoacidosis (DKA). Frequent glucose and
ketone monitoring, small frequent fluids (oral or IV if
needed), and contacting provider for persistent vomiting are
critical sick-day measures.
Why A is incorrect: Stopping insulin increases risk of
hyperglycemia and DKA.
Why C is incorrect: Doubling insulin without guidance risks
hypoglycemia; dosing adjustments should be provider-
directed.
Why D is incorrect: Maintaining hydration is essential during
illness to prevent dehydration and DKA.
11. A nurse is preparing oral acetaminophen for an 18-kg
toddler. The order: acetaminophen 15 mg/kg PO now. The
oral suspension is 160 mg/5 mL. How many mL should the
nurse administer? (Give answer to one decimal place.)
A. 5.0 mL
B. 8.4 mL
C. 10.5 mL
D. 12.0 mL
Answer: B
Rationale — Calculation (digit-by-digit):
Ordered dose = 15 mg/kg × 18 kg = 15 × 18 = 270 mg.
Concentration = 160 mg per 5 mL → 160 mg : 5 mL. Solve for
mL = (270 mg × 5 mL) ÷ 160 mg. Numerator = 270 × 5 =
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.
,5. A 7-year-old with asthma uses albuterol MDI PRN and
fluticasone daily. Which statement indicates correct
understanding of medication types?
A. "Albuterol is a controller medicine I use every day."
B. "Fluticasone is a rescue inhaler to stop an attack."
C. "Albuterol is a short-acting bronchodilator used for
quick relief."
D. "I should stop fluticasone when symptoms improve."
Answer: C
Rationale — Why C is correct: Albuterol is a short-acting β2-
agonist (SABA) used for quick relief of bronchospasm.
Fluticasone is an inhaled corticosteroid (controller) for daily
use. Knowing rescue versus controller reduces exacerbation
risk and guides teaching for action plans.
Why A is incorrect: Albuterol is a rescue (not daily controller)
med.
Why B is incorrect: Fluticasone is a controller, not for acute
symptom relief.
Why D is incorrect: Stopping controller inhaled steroids when
symptoms improve can lead to loss of control; therapy is
typically continued per provider instructions.
6. An infant with a large ventricular septal defect (VSD)
demonstrates poor weight gain and tachypnea. Which
pathophysiologic explanation is most accurate?
, A. Decreased pulmonary blood flow causes cyanosis and
weight loss.
B. Left-to-right shunt increases pulmonary blood flow
causing tachypnea and poor feeding.
C. Right-to-left shunt causes increased systemic perfusion
and poor weight gain.
D. VSD reduces preload and leads to muscle wasting.
Answer: B
Rationale — Why B is correct: A VSD commonly produces a
left-to-right shunt: oxygenated blood returns to pulmonary
circulation increasing pulmonary blood flow, causing
tachypnea, increased work of breathing, and poor oral
intake/weight gain due to fatigue and increased metabolic
demand.
Why A is incorrect: Decreased pulmonary blood flow is
typical of some cyanotic defects, not VSD with left-to-right
shunt.
Why C is incorrect: Right-to-left shunt causes cyanosis; VSD
often initially causes left-to-right.
Why D is incorrect: VSD leads to volume overload not
reduced preload; muscle wasting is secondary to chronic
increased work of breathing and poor intake.
7. A 9-month-old with Tetralogy of Fallot has a sudden deep
cyanotic spell. Which immediate nursing action is
, indicated?
A. Place the infant supine and elevate the legs.
B. Administer aspirin and observe.
C. Place the infant in a knee-to-chest position and
administer oxygen if ordered.
D. Begin chest compressions.
Answer: C
Rationale — Why C is correct: During a "Tet spell"
(hypercyanotic event) increasing systemic vascular resistance
and reducing right-to-left shunting helps — knee-to-chest
position increases systemic vascular resistance, improving
pulmonary blood flow. Administer oxygen and provide calm
measures; prompt provider notification and interventions
(morphine, fluids) follow per protocol.
Why A is incorrect: Supine with leg elevation does not
produce the physiologic benefits of knee-to-chest and may
not reduce shunting.
Why B is incorrect: Aspirin is not used for acute cyanotic
spells.
Why D is incorrect: Chest compressions are indicated only for
cardiac arrest.
8. A 10-month-old hospitalized with RSV bronchiolitis has
increased work of breathing and difficulty feeding. Which
intervention is highest priority?
, A. Start empiric antibiotics.
B. Frequent nasal suctioning and maintain hydration.
C. Chest physiotherapy and postural drainage.
D. Routine bronchodilator nebulizations every 4 hours.
Answer: B
Rationale — Why B is correct: RSV bronchiolitis causes upper
airway secretions and small airway obstruction; suctioning
the nares improves breathing and feeding. Hydration is
crucial because tachypnea increases fluid needs. Supportive
care is the mainstay; bronchodilators and antibiotics are not
routinely recommended.
Why A is incorrect: Antibiotics are not indicated unless
bacterial coinfection is suspected.
Why C is incorrect: Chest physiotherapy/postural drainage
have limited benefit in bronchiolitis.
Why D is incorrect: Routine bronchodilators lack consistent
benefit; may be tried in select patients but not routinely.
9. A school-age child is admitted with suspected
meningococcal meningitis. Which isolation precaution
should the nurse implement immediately?
A. Standard precautions only.
B. Contact precautions only.
C. Droplet precautions, private room with mask for visitors.
D. Airborne precautions with negative pressure room.
,Answer: C
Rationale — Why C is correct: Neisseria meningitidis is
spread by large respiratory droplets; droplet precautions
(mask within 3–6 feet, private room) are indicated until 24
hours after effective antibiotic therapy. Implementing droplet
precautions protects staff and other patients.
Why A is incorrect: Standard precautions are insufficient for
droplet-spread pathogens.
Why B is incorrect: Contact precautions alone do not address
droplet transmission.
Why D is incorrect: Airborne precautions (negative pressure,
N95) are used for smaller droplet nuclei (e.g., TB, measles,
varicella) and are not required for meningococcal meningitis.
10. A 10-year-old with Type 1 diabetes and vomiting at
home calls the clinic. Which instruction is most important
for sick-day management?
A. Stop insulin while vomiting to avoid hypoglycemia.
B. Continue basal/short-acting insulin and monitor blood
glucose and ketones closely.
C. Double the usual insulin dose because of illness.
D. Avoid fluids to reduce vomiting episodes.
Answer: B
Rationale — Why B is correct: During illness (even with
decreased intake), continued insulin is essential to prevent
, ketosis and diabetic ketoacidosis (DKA). Frequent glucose and
ketone monitoring, small frequent fluids (oral or IV if
needed), and contacting provider for persistent vomiting are
critical sick-day measures.
Why A is incorrect: Stopping insulin increases risk of
hyperglycemia and DKA.
Why C is incorrect: Doubling insulin without guidance risks
hypoglycemia; dosing adjustments should be provider-
directed.
Why D is incorrect: Maintaining hydration is essential during
illness to prevent dehydration and DKA.
11. A nurse is preparing oral acetaminophen for an 18-kg
toddler. The order: acetaminophen 15 mg/kg PO now. The
oral suspension is 160 mg/5 mL. How many mL should the
nurse administer? (Give answer to one decimal place.)
A. 5.0 mL
B. 8.4 mL
C. 10.5 mL
D. 12.0 mL
Answer: B
Rationale — Calculation (digit-by-digit):
Ordered dose = 15 mg/kg × 18 kg = 15 × 18 = 270 mg.
Concentration = 160 mg per 5 mL → 160 mg : 5 mL. Solve for
mL = (270 mg × 5 mL) ÷ 160 mg. Numerator = 270 × 5 =
