SAUNDERS COMPREHENSIVE REVIEW
FOR THE NCLEX-PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI;
ANGELA SILVESTRI
TEST BANK
Reference: Ch. 1 — Clinical Judgment and NGN-PN®
Examination — The Pyramid to Success
Stem: A practical nursing candidate is creating a weekly study
plan to prepare for NGN-PN items that emphasize clinical
judgment. Which study activity best aligns with the Pyramid to
Success for improving clinical judgment?
A. Memorizing definitions of diseases from a high-yield facts
list.
B. Practicing case-based scenarios that require recognizing cues
and prioritizing actions.
C. Re-reading the same textbook chapter repeatedly until
,content feels familiar.
D. Taking only practice multiple-choice recall quizzes.
Correct answer: B
Rationale — Correct: Practicing case-based scenarios targets
application and analysis—recognizing cues and making
decisions—core to the Pyramid to Success. It builds clinical
judgment rather than simple recall.
Rationale — A: Memorization supports knowledge but does not
develop higher-order clinical judgment required by NGN-PN
items.
Rationale — C: Rereading may increase familiarity but is passive
and less effective for application/analysis skill development.
Rationale — D: Simple recall quizzes test memory, not the
scenario analysis and prioritization emphasized by the Pyramid
to Success.
Teaching point: Use case-based practice to build clinical
judgment, not rote memorization.
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-PN®
Examination — Clinical Judgment and Next Generation NCLEX®
Items
,Stem: During an NGN-style case, a client’s respiratory rate
increases from 16 to 28 breaths/min and oxygen saturation
drops to 90% on room air. Which PN action best demonstrates
appropriate clinical judgment?
A. Continue routine monitoring and document the change in
the chart.
B. Administer a PRN opioid analgesic to calm the client.
C. Administer oxygen per standing order and notify the RN or
provider.
D. Place the client in Trendelenburg position and reassess in 30
minutes.
Correct answer: C
Rationale — Correct: Increasing RR and SaO₂ drop indicate
respiratory compromise; administering oxygen per standing
order and notifying the RN/provider is a timely, appropriate PN
action within scope and prioritizes oxygenation and reporting.
Rationale — A: Passive documentation delays intervention for a
deteriorating client and is unsafe.
Rationale — B: Opioids can depress respiration and worsen the
situation; not appropriate for tachypnea and hypoxia.
Rationale — D: Trendelenburg is inappropriate for respiratory
distress and may worsen breathing.
Teaching point: For respiratory deterioration, prioritize
oxygenation and escalate care promptly.
Citation: Silvestri, L. A., & Silvestri, A. (2025). Saunders
, Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Ch. 1.
3.
Reference: Ch. 1 — Examination Process — Registering to Take
the Examination
Stem: A PN candidate calls the testing vendor because she lost
the Authorization to Test (ATT) email and her scheduled
appointment is in 4 days. What is the nurse educator’s best
instruction?
A. Tell the candidate to go to the testing center without the ATT;
they will allow entry.
B. Advise the candidate to contact the licensing board
immediately to request a replacement ATT.
C. Recommend the candidate reschedule for a later date
without contacting anyone.
D. Suggest the candidate attempt to log into the testing
vendor’s website; resending the ATT may be possible.
Correct answer: D
Rationale — Correct: The testing vendor’s website often allows
ATT retrieval or resending; instructing the candidate to log in is
the quickest practical step.
Rationale — A: Testing centers require authorization and ID;
attempting to enter without ATT is unsafe and unlikely to be
permitted.
FOR THE NCLEX-PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI;
ANGELA SILVESTRI
TEST BANK
Reference: Ch. 1 — Clinical Judgment and NGN-PN®
Examination — The Pyramid to Success
Stem: A practical nursing candidate is creating a weekly study
plan to prepare for NGN-PN items that emphasize clinical
judgment. Which study activity best aligns with the Pyramid to
Success for improving clinical judgment?
A. Memorizing definitions of diseases from a high-yield facts
list.
B. Practicing case-based scenarios that require recognizing cues
and prioritizing actions.
C. Re-reading the same textbook chapter repeatedly until
,content feels familiar.
D. Taking only practice multiple-choice recall quizzes.
Correct answer: B
Rationale — Correct: Practicing case-based scenarios targets
application and analysis—recognizing cues and making
decisions—core to the Pyramid to Success. It builds clinical
judgment rather than simple recall.
Rationale — A: Memorization supports knowledge but does not
develop higher-order clinical judgment required by NGN-PN
items.
Rationale — C: Rereading may increase familiarity but is passive
and less effective for application/analysis skill development.
Rationale — D: Simple recall quizzes test memory, not the
scenario analysis and prioritization emphasized by the Pyramid
to Success.
Teaching point: Use case-based practice to build clinical
judgment, not rote memorization.
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-PN®
Examination — Clinical Judgment and Next Generation NCLEX®
Items
,Stem: During an NGN-style case, a client’s respiratory rate
increases from 16 to 28 breaths/min and oxygen saturation
drops to 90% on room air. Which PN action best demonstrates
appropriate clinical judgment?
A. Continue routine monitoring and document the change in
the chart.
B. Administer a PRN opioid analgesic to calm the client.
C. Administer oxygen per standing order and notify the RN or
provider.
D. Place the client in Trendelenburg position and reassess in 30
minutes.
Correct answer: C
Rationale — Correct: Increasing RR and SaO₂ drop indicate
respiratory compromise; administering oxygen per standing
order and notifying the RN/provider is a timely, appropriate PN
action within scope and prioritizes oxygenation and reporting.
Rationale — A: Passive documentation delays intervention for a
deteriorating client and is unsafe.
Rationale — B: Opioids can depress respiration and worsen the
situation; not appropriate for tachypnea and hypoxia.
Rationale — D: Trendelenburg is inappropriate for respiratory
distress and may worsen breathing.
Teaching point: For respiratory deterioration, prioritize
oxygenation and escalate care promptly.
Citation: Silvestri, L. A., & Silvestri, A. (2025). Saunders
, Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Ch. 1.
3.
Reference: Ch. 1 — Examination Process — Registering to Take
the Examination
Stem: A PN candidate calls the testing vendor because she lost
the Authorization to Test (ATT) email and her scheduled
appointment is in 4 days. What is the nurse educator’s best
instruction?
A. Tell the candidate to go to the testing center without the ATT;
they will allow entry.
B. Advise the candidate to contact the licensing board
immediately to request a replacement ATT.
C. Recommend the candidate reschedule for a later date
without contacting anyone.
D. Suggest the candidate attempt to log into the testing
vendor’s website; resending the ATT may be possible.
Correct answer: D
Rationale — Correct: The testing vendor’s website often allows
ATT retrieval or resending; instructing the candidate to log in is
the quickest practical step.
Rationale — A: Testing centers require authorization and ID;
attempting to enter without ATT is unsafe and unlikely to be
permitted.
