SAUNDERS COMPREHENSIVE REVIEW
FOR THE NCLEX-RN® EXAMINATION
9TH EDITION 2026
Elsevier items and derived items © 2011, 2008, 2005, 2002 by Saunders, an imprint of Elsevier Inc.
, Test Bank 2
Silvestri: saunders comprehensive review for the nclex-rn®
examination, 9th edition
Fundamentals and issues of nursing
Test bank
Multiple choice
1. The nurse has a prescription to give ear drops to a 2-year-old child. The nurse
positions the child’s ear properly by pulling the pinna of the ear:
1. Upward and outward
2. Downward and outward
3. Downward and backward
4. Upward and backward
Ans: 3
Rationale: to administer ear drops properly to a child who is younger than 3
years old, the pinna of the ear should be pulled downward and backward. When
giving ear drops to a child older than 3 years, the pinna is pulled upward and
backward (“upward and backward”). The other options are incorrect.
Test-taking strategy: use basic principles of administering otic medications to
answer this question. Note the age of the child to direct you to the correct option.
Remember in a child who is younger than 3 years old, the pinna of the ear should
be pulled downward and backward. If this question was difficult, review the
procedure for administering ear drops to children.
Pts: 1
Dif: level of cognitive ability: applying
Ref: perry, s., hockenberry, m., lowdermilk, d., & wilson, d. (2010). Maternal
child nursing care (4th ed.). St. Louis: mosby.
Obj: client needs: physiological integrity
Top: content area: fundamentals
Msc: integrated process: nursing process—implementation
2. A client who was receiving enteral feedings in the hospital has been started on a
regular diet and is almost ready for discharge. The client will be
self-administering supplemental tube feedings between meals for a short time
after discharge. When the client expresses concern about his or her ability to
perform this procedure at home, the nurse would best respond with which of the
following?
1. “tell me more about your concerns about going home.”
2. “do you want to stay in the hospital a few more days?”
3. “maybe a friend will do the feeding for you.”
4. “have you discussed your feelings with your family and doctor?”
Elsevier items and derived items © 2011, 2008, 2005, 2002 by Saunders, an imprint of Elsevier Inc.
, Test Bank 3
Ans: 1
Rationale: a client often has fears about leaving the secure environment of a
health care facility. This client has a specific fear about not being able to handle
tube feedings at home. An open communication statement such as “tell me more
about...” Often leads to valuable information about the client and his or her
concerns. “maybe a friend will do the feeding for you.” And “have you discussed
your feelings with your family and doctor?” Are nontherapeutic responses
because they place the client’s issues on hold. “do you want to stay in the hospital
a few more days?” Is beyond the scope of practice for the nurse to implement and
may not be necessary.
Test-taking strategy: use therapeutic communication techniques to answer the
question. “tell me more about your concerns about going home.” Focuses on the
client’s feelings. Remember to address the client’s feelings first. Review
therapeutic communication techniques if you had difficulty with this question.
Pts: 1
Dif: level of cognitive ability: applying
Ref: ignatavicius, d., & workman, m. (2010). Medical-surgical nursing:
patient-centered collaborative care (6th ed.). St. Louis: saunders. | potter, p., &
perry, a. (2009). Fundamentals of nursing (7th ed.). St. Louis: mosby.
Obj: client needs: psychosocial integrity
Top: content area: fundamentals
Msc: integrated process: communication and documentation
3. The nurse is administering enteral feedings via a nasogastric (ng) tube. The nurse
should do which of the following when caring for this client to maintain client
safety?
1. Keep the client in a supine position.
2. Change the ng tube with every other feeding.
3. Check for tube placement and residual amount at least every 4 hours.
4. Increase the rate of the feeding if the infusion falls behind schedule.
Ans: 3
Rationale: ng tube feedings are beneficial but present possible complications
such as diarrhea, lactose intolerance, dumping syndrome, or excess fluid volume.
The most common complication is aspiration pneumonia caused by regurgitation
of formula contents from the stomach into the respiratory tract. This risk can be
minimized by checking the tube placement; the ph and color of aspirate and
residual amount; and by keeping the head of the bed elevated to 30 degrees at all
times. Problems with diarrhea may be caused by infusing a formula that is cold,
contaminated, or of the wrong consistency or by infusing a formula too rapidly.
Nasogastric tubes may be left in place from weeks to months, depending on the
type of tube inserted. The feeding bag itself should be changed daily.
Elsevier items and derived items © 2011, 2008, 2005, 2002 by Saunders, an imprint of Elsevier Inc.
, Test Bank 4
Test-taking strategy: use the process of elimination to assist in answering the
question. Eliminate “change the ng tube with every other feeding” first because
nasogastric tubes may be left in place from weeks to months, depending on the
type of tube inserted. Eliminate “keep the client in a supine position” next
because a supine position could cause aspiration pneumonia. Choose “check for
tube placement and residual amount at least every 4 hours” over “increase the
rate of the feeding if the infusion falls behind schedule” because it is a definitive
action that it helps protect the client from aspiration. Review the care of a client
receiving ng tube feedings if you had difficulty with this question.
Pts: 1
Dif: level of cognitive ability: applying
Ref: potter, p., & perry, a. (2009). Fundamentals of nursing (7th ed.). St. Louis:
mosby.
Obj: client needs: physiological integrity
Top: content area: fundamentals
Msc: integrated process: nursing process—implementation
4. The client with pancreatitis is being weaned from parenteral nutrition (pn). The
client asks the nurse why the pn cannot just be stopped. The nurse includes in a
response to the client that which of the following complications could occur with
sudden termination of pn formula?
1. Dehydration
2. Hypokalemia
3. Hypernatremia
4. Rebound hypoglycemia
Ans: 4
Rationale: clients receiving pn are receiving high concentrations of glucose. To
give the pancreas time to adjust to decreasing glucose loads, the infusion rates are
tapered down. Prior to discontinuing the pn, the body must adjust to the lowered
glucose level. If the pn were suddenly withdrawn, the client could have rebound
hypoglycemia. Although the other options are potential complications, they are
not risks associated with discontinuing pn abruptly.
Test-taking strategy: use the process of elimination to answer the question.
Recall that pn solutions contain high concentrations of glucose; this will easily
direct you to “rebound hypoglycemia.” Review the components of a pn solution
and the considerations related to weaning if you had difficulty with this question.
Pts: 1
Dif: level of cognitive ability: applying
Ref: gahart, b., & nazareno, a. (2010). 2010 intravenous medications: a
handbook for nurses and health professionals (26th ed.). St. Louis: mosby. |
ignatavicius, d., & workman, m. (2010). Medical-surgical nursing: patient-centered
collaborative care (6th ed.). St. Louis: saunders.
Obj: client needs: physiological integrity
Elsevier items and derived items © 2011, 2008, 2005, 2002 by Saunders, an imprint of Elsevier Inc.
FOR THE NCLEX-RN® EXAMINATION
9TH EDITION 2026
Elsevier items and derived items © 2011, 2008, 2005, 2002 by Saunders, an imprint of Elsevier Inc.
, Test Bank 2
Silvestri: saunders comprehensive review for the nclex-rn®
examination, 9th edition
Fundamentals and issues of nursing
Test bank
Multiple choice
1. The nurse has a prescription to give ear drops to a 2-year-old child. The nurse
positions the child’s ear properly by pulling the pinna of the ear:
1. Upward and outward
2. Downward and outward
3. Downward and backward
4. Upward and backward
Ans: 3
Rationale: to administer ear drops properly to a child who is younger than 3
years old, the pinna of the ear should be pulled downward and backward. When
giving ear drops to a child older than 3 years, the pinna is pulled upward and
backward (“upward and backward”). The other options are incorrect.
Test-taking strategy: use basic principles of administering otic medications to
answer this question. Note the age of the child to direct you to the correct option.
Remember in a child who is younger than 3 years old, the pinna of the ear should
be pulled downward and backward. If this question was difficult, review the
procedure for administering ear drops to children.
Pts: 1
Dif: level of cognitive ability: applying
Ref: perry, s., hockenberry, m., lowdermilk, d., & wilson, d. (2010). Maternal
child nursing care (4th ed.). St. Louis: mosby.
Obj: client needs: physiological integrity
Top: content area: fundamentals
Msc: integrated process: nursing process—implementation
2. A client who was receiving enteral feedings in the hospital has been started on a
regular diet and is almost ready for discharge. The client will be
self-administering supplemental tube feedings between meals for a short time
after discharge. When the client expresses concern about his or her ability to
perform this procedure at home, the nurse would best respond with which of the
following?
1. “tell me more about your concerns about going home.”
2. “do you want to stay in the hospital a few more days?”
3. “maybe a friend will do the feeding for you.”
4. “have you discussed your feelings with your family and doctor?”
Elsevier items and derived items © 2011, 2008, 2005, 2002 by Saunders, an imprint of Elsevier Inc.
, Test Bank 3
Ans: 1
Rationale: a client often has fears about leaving the secure environment of a
health care facility. This client has a specific fear about not being able to handle
tube feedings at home. An open communication statement such as “tell me more
about...” Often leads to valuable information about the client and his or her
concerns. “maybe a friend will do the feeding for you.” And “have you discussed
your feelings with your family and doctor?” Are nontherapeutic responses
because they place the client’s issues on hold. “do you want to stay in the hospital
a few more days?” Is beyond the scope of practice for the nurse to implement and
may not be necessary.
Test-taking strategy: use therapeutic communication techniques to answer the
question. “tell me more about your concerns about going home.” Focuses on the
client’s feelings. Remember to address the client’s feelings first. Review
therapeutic communication techniques if you had difficulty with this question.
Pts: 1
Dif: level of cognitive ability: applying
Ref: ignatavicius, d., & workman, m. (2010). Medical-surgical nursing:
patient-centered collaborative care (6th ed.). St. Louis: saunders. | potter, p., &
perry, a. (2009). Fundamentals of nursing (7th ed.). St. Louis: mosby.
Obj: client needs: psychosocial integrity
Top: content area: fundamentals
Msc: integrated process: communication and documentation
3. The nurse is administering enteral feedings via a nasogastric (ng) tube. The nurse
should do which of the following when caring for this client to maintain client
safety?
1. Keep the client in a supine position.
2. Change the ng tube with every other feeding.
3. Check for tube placement and residual amount at least every 4 hours.
4. Increase the rate of the feeding if the infusion falls behind schedule.
Ans: 3
Rationale: ng tube feedings are beneficial but present possible complications
such as diarrhea, lactose intolerance, dumping syndrome, or excess fluid volume.
The most common complication is aspiration pneumonia caused by regurgitation
of formula contents from the stomach into the respiratory tract. This risk can be
minimized by checking the tube placement; the ph and color of aspirate and
residual amount; and by keeping the head of the bed elevated to 30 degrees at all
times. Problems with diarrhea may be caused by infusing a formula that is cold,
contaminated, or of the wrong consistency or by infusing a formula too rapidly.
Nasogastric tubes may be left in place from weeks to months, depending on the
type of tube inserted. The feeding bag itself should be changed daily.
Elsevier items and derived items © 2011, 2008, 2005, 2002 by Saunders, an imprint of Elsevier Inc.
, Test Bank 4
Test-taking strategy: use the process of elimination to assist in answering the
question. Eliminate “change the ng tube with every other feeding” first because
nasogastric tubes may be left in place from weeks to months, depending on the
type of tube inserted. Eliminate “keep the client in a supine position” next
because a supine position could cause aspiration pneumonia. Choose “check for
tube placement and residual amount at least every 4 hours” over “increase the
rate of the feeding if the infusion falls behind schedule” because it is a definitive
action that it helps protect the client from aspiration. Review the care of a client
receiving ng tube feedings if you had difficulty with this question.
Pts: 1
Dif: level of cognitive ability: applying
Ref: potter, p., & perry, a. (2009). Fundamentals of nursing (7th ed.). St. Louis:
mosby.
Obj: client needs: physiological integrity
Top: content area: fundamentals
Msc: integrated process: nursing process—implementation
4. The client with pancreatitis is being weaned from parenteral nutrition (pn). The
client asks the nurse why the pn cannot just be stopped. The nurse includes in a
response to the client that which of the following complications could occur with
sudden termination of pn formula?
1. Dehydration
2. Hypokalemia
3. Hypernatremia
4. Rebound hypoglycemia
Ans: 4
Rationale: clients receiving pn are receiving high concentrations of glucose. To
give the pancreas time to adjust to decreasing glucose loads, the infusion rates are
tapered down. Prior to discontinuing the pn, the body must adjust to the lowered
glucose level. If the pn were suddenly withdrawn, the client could have rebound
hypoglycemia. Although the other options are potential complications, they are
not risks associated with discontinuing pn abruptly.
Test-taking strategy: use the process of elimination to answer the question.
Recall that pn solutions contain high concentrations of glucose; this will easily
direct you to “rebound hypoglycemia.” Review the components of a pn solution
and the considerations related to weaning if you had difficulty with this question.
Pts: 1
Dif: level of cognitive ability: applying
Ref: gahart, b., & nazareno, a. (2010). 2010 intravenous medications: a
handbook for nurses and health professionals (26th ed.). St. Louis: mosby. |
ignatavicius, d., & workman, m. (2010). Medical-surgical nursing: patient-centered
collaborative care (6th ed.). St. Louis: saunders.
Obj: client needs: physiological integrity
Elsevier items and derived items © 2011, 2008, 2005, 2002 by Saunders, an imprint of Elsevier Inc.
