SAUNDERS COMPREHENSIVE REVIEW
FOR THE NCLEX-PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI;
ANGELA SILVESTRI
TEST BANK
1
Reference: Ch. 1 — Clinical Judgment and the Next Generation
NCLEX (NGN)-PN® Examination — Pyramid to Success
Stem: As a PN instructor preparing a review workshop, you plan
activities that strengthen observation, analysis, and safety-
based decision making from the Pyramid to Success. Which
activity best aligns with the Pyramid to Success for improving
students’ clinical judgment?
A. Giving students a large set of isolated facts to memorize
before practice scenarios
B. Having students practice sorting patient cues, identifying
problems, and selecting safe actions in short case prompts
,C. Administering timed multiple-choice recall quizzes with
instant right/wrong feedback
D. Requiring students to write long essays explaining
pathophysiology for every NCLEX topic
Correct answer: B
Rationales:
• Correct (B): Sorting cues and selecting safe actions
practices the layered skills in the Pyramid to Success
(recognition, interpretation, prioritization) and builds NGN
clinical judgment.
• A: Memorization alone doesn’t build the applied cue-
interpretation and decision skills emphasized by the
Pyramid.
• C: Timed recall quizzes assess memory, not the analytic
cue-to-action steps NGN requires.
• D: Long essays on pathophysiology are deep learning but
do not train rapid cue recognition and action selection
under PN exam conditions.
Teaching point: Practice cue sorting → interpret → choose
safe action (Pyramid sequence).
Citation: Silvestri, L. A., & Silvestri, A. (2025). Saunders
Comprehensive Review for the NCLEX-PN® Examination
(9th ed.). Ch. 1.
2
,Reference: Ch. 1 — Clinical Judgment and NGN — Clinical
Judgment and Next Generation NCLEX® Items
Stem: A PN candidate sees a Next Generation item that
presents a short scenario with multiple patient cues and asks
which cue is the highest priority to report. Which cognitive skill
is the NGN primarily testing?
A. Factual recall of textbook data
B. Ability to prioritize and interpret clinical cues
C. Simple procedural memory of drug dosages
D. Memorization of test-center rules
Correct answer: B
Rationales:
• Correct (B): NGN items emphasize recognizing,
interpreting, and prioritizing cues to make safe clinical
decisions — core clinical judgment skills.
• A: Factual recall is low-level and not the NGN focus.
• C: Procedural memory for dosages is not the central NGN
skill in cue-based items.
• D: Test-center rules are irrelevant to NGN clinical judgment
items.
Teaching point: NGN focuses on interpreting and
prioritizing clinical cues, not rote recall.
Citation: Silvestri & Silvestri (2025). Ch. 1.
3
, Reference: Ch. 1 — Examination Process — Computer Adaptive
Testing (CAT)
Stem: A candidate asks why some NCLEX-PN exams stop after
fewer than the maximum number of items. What best explains
how CAT determines when to stop testing?
A. The test stops when the candidate completes all possible
questions in the bank
B. The test stops when the computer estimates the candidate’s
ability with enough precision to make a pass/fail decision
C. The test stops only if the candidate requests to end the exam
early
D. The test stops when the candidate answers 75 consecutive
questions correctly
Correct answer: B
Rationales:
• Correct (B): CAT continues until it estimates ability level
precisely enough to make a reliable pass/fail decision.
• A: Candidates rarely see all items; CAT selects items
adaptively, not exhaustively.
• C: Candidates cannot end for score reasons; the system
controls stopping rules.
• D: There is no rule about 75 consecutive correct answers
causing stop; stopping is statistical.
Teaching point: CAT stops when ability is statistically
estimated sufficiently for pass/fail.
Citation: Silvestri & Silvestri (2025). Ch. 1.
FOR THE NCLEX-PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI;
ANGELA SILVESTRI
TEST BANK
1
Reference: Ch. 1 — Clinical Judgment and the Next Generation
NCLEX (NGN)-PN® Examination — Pyramid to Success
Stem: As a PN instructor preparing a review workshop, you plan
activities that strengthen observation, analysis, and safety-
based decision making from the Pyramid to Success. Which
activity best aligns with the Pyramid to Success for improving
students’ clinical judgment?
A. Giving students a large set of isolated facts to memorize
before practice scenarios
B. Having students practice sorting patient cues, identifying
problems, and selecting safe actions in short case prompts
,C. Administering timed multiple-choice recall quizzes with
instant right/wrong feedback
D. Requiring students to write long essays explaining
pathophysiology for every NCLEX topic
Correct answer: B
Rationales:
• Correct (B): Sorting cues and selecting safe actions
practices the layered skills in the Pyramid to Success
(recognition, interpretation, prioritization) and builds NGN
clinical judgment.
• A: Memorization alone doesn’t build the applied cue-
interpretation and decision skills emphasized by the
Pyramid.
• C: Timed recall quizzes assess memory, not the analytic
cue-to-action steps NGN requires.
• D: Long essays on pathophysiology are deep learning but
do not train rapid cue recognition and action selection
under PN exam conditions.
Teaching point: Practice cue sorting → interpret → choose
safe action (Pyramid sequence).
Citation: Silvestri, L. A., & Silvestri, A. (2025). Saunders
Comprehensive Review for the NCLEX-PN® Examination
(9th ed.). Ch. 1.
2
,Reference: Ch. 1 — Clinical Judgment and NGN — Clinical
Judgment and Next Generation NCLEX® Items
Stem: A PN candidate sees a Next Generation item that
presents a short scenario with multiple patient cues and asks
which cue is the highest priority to report. Which cognitive skill
is the NGN primarily testing?
A. Factual recall of textbook data
B. Ability to prioritize and interpret clinical cues
C. Simple procedural memory of drug dosages
D. Memorization of test-center rules
Correct answer: B
Rationales:
• Correct (B): NGN items emphasize recognizing,
interpreting, and prioritizing cues to make safe clinical
decisions — core clinical judgment skills.
• A: Factual recall is low-level and not the NGN focus.
• C: Procedural memory for dosages is not the central NGN
skill in cue-based items.
• D: Test-center rules are irrelevant to NGN clinical judgment
items.
Teaching point: NGN focuses on interpreting and
prioritizing clinical cues, not rote recall.
Citation: Silvestri & Silvestri (2025). Ch. 1.
3
, Reference: Ch. 1 — Examination Process — Computer Adaptive
Testing (CAT)
Stem: A candidate asks why some NCLEX-PN exams stop after
fewer than the maximum number of items. What best explains
how CAT determines when to stop testing?
A. The test stops when the candidate completes all possible
questions in the bank
B. The test stops when the computer estimates the candidate’s
ability with enough precision to make a pass/fail decision
C. The test stops only if the candidate requests to end the exam
early
D. The test stops when the candidate answers 75 consecutive
questions correctly
Correct answer: B
Rationales:
• Correct (B): CAT continues until it estimates ability level
precisely enough to make a reliable pass/fail decision.
• A: Candidates rarely see all items; CAT selects items
adaptively, not exhaustively.
• C: Candidates cannot end for score reasons; the system
controls stopping rules.
• D: There is no rule about 75 consecutive correct answers
causing stop; stopping is statistical.
Teaching point: CAT stops when ability is statistically
estimated sufficiently for pass/fail.
Citation: Silvestri & Silvestri (2025). Ch. 1.
