SAUNDERS COMPREHENSIVE REVIEW
FOR THE NCLEX-PN® EXAMINATION
9TH EDITION
AUTHOR(S)LINDA ANNE SILVESTRI;
ANGELA SILVESTRI
TEST BANK
Question 1
Reference: Clinical Judgment and the Next Generation NCLEX
(NGN)-PN® Examination; The Pyramid to Success
Clinical Scenario: A practical nursing student is reviewing the
"Pyramid to Success" model presented in their NCLEX-PN®
review book. The student understands that the foundation of
this pyramid is crucial for building safe and effective clinical
judgments. On which of the following components should the
student focus as the base of the Pyramid to Success?
,Options: A. Nursing interventions and procedures B.
Prioritization, delegation, and assignment C. Knowledge of
pathophysiology and pharmacology D. The nursing process and
clinical judgment
Correct Answer: D. The nursing process and clinical judgment
Rationales: Correct Answer: The foundation of the Pyramid
to Success is the nursing process and clinical judgment. This
foundational level ensures that the nurse uses a systematic
approach to provide safe client care. The nursing process serves
as a blueprint for all critical thinking and clinical decisions made
by the nurse. Option A: Nursing interventions and
procedures are higher-level skills that are built upon the
foundation of the nursing process and clinical judgment; they
are not the base itself. Option B: Prioritization, delegation,
and assignment are complex skills that are also built upon the
foundational knowledge and cognitive skills of the nursing
process and clinical judgment. Option C: Knowledge of
pathophysiology and pharmacology is essential but represents
the knowledge base that feeds into the nursing process, not the
foundational thinking framework itself.
Teaching Point: The nursing process and clinical judgment form
the essential foundation for safe, client-centered care and all
NCLEX-PN® success strategies.
,Citation: Silvestri, L. A., & Silvestri, A. (2026). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Chapter 1.
Question 2
Reference: Clinical Judgment and the Next Generation NCLEX
(NGN)-PN® Examination; Clinical Judgment and Next
Generation NCLEX® Items
Clinical Scenario: The nursing instructor is explaining the NGN-
PN® test design to a group of practical nursing students. The
instructor emphasizes that the new test design focuses heavily
on a specific cognitive skill. Which cognitive skill is most
essential for the NGN-PN® examination as it requires the nurse
to synthesize and evaluate data to make decisions?
Options: A. Memory B. Comprehension C. Application D.
Clinical judgment
Correct Answer: D. Clinical judgment
Rationales: Correct Answer: Clinical judgment is the
cognitive skill most essential for the NGN-PN® examination. It
requires the nurse to observe, think, prioritize, plan, act, and
evaluate, synthesizing all available data to make a safe and
effective decision. The NGN test design is specifically built to
evaluate this higher-level thinking. Option A: Memory is a
,lower-level cognitive skill that involves recalling facts and is not
the primary focus of the NGN-PN® examination. Option B:
Comprehension involves understanding the meaning of
information but does not require the synthesis and evaluation
needed for clinical judgment. Option C: Application involves
using knowledge in a specific situation, but clinical judgment
goes a step further by requiring interpretation, analysis, and
evaluation of the outcomes.
Teaching Point: The NGN-PN® is designed to test clinical
judgment, moving beyond simple recall to evaluate a nurse's
ability to make safe decisions.
Citation: Silvestri, L. A., & Silvestri, A. (2026). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Chapter 1.
Question 3
Reference: Clinical Judgment and the Next Generation NCLEX
(NGN)-PN® Examination; Examination Process; Computer
Adaptive Testing
Clinical Scenario: A practical nursing student is preparing for
the NCLEX-PN® examination. The student is reviewing how the
computerized adaptive testing (CAT) format works. Which
,statement best describes the CAT process the student will
experience during the examination?
Options: A. The computer selects a specific set of questions for
each candidate based on their state of residence. B. The
computer presents questions that become progressively easier
as the candidate answers correctly. C. The computer selects
questions based on the candidate's previous answers to
determine the next question. D. The computer presents a
random set of questions from a fixed pool, regardless of the
candidate's performance.
Correct Answer: C. The computer selects questions based on
the candidate's previous answers to determine the next
question.
Rationales: Correct Answer: Computer adaptive testing
(CAT) selects questions based on the candidate's previous
answers. The computer estimates the candidate's ability level
and administers questions at or near that level, making the test
individualized. Option A: The computer does not select
questions based on the candidate's state of residence; it selects
them based on the candidate's performance on previous items.
Option B: Questions become more difficult as the
candidate answers correctly, not easier. The test is designed to
challenge the candidate at their current ability level. Option
D: The questions are not random; they are specifically selected
,by the computer algorithm based on the candidate's
performance to pinpoint their ability level.
Teaching Point: CAT uses your previous answers to tailor the
exam to your ability level, selecting questions that are neither
too easy nor too hard.
Citation: Silvestri, L. A., & Silvestri, A. (2026). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Chapter 1.
Question 4
Reference: Clinical Judgment and the Next Generation NCLEX
(NGN)-PN® Examination; Development of the Test Plan; Test
Plan
Clinical Scenario: The practical nurse is reviewing the
components of the NCLEX-PN® Test Plan to focus their study
efforts. The nurse understands that the test plan is based on a
framework that includes all of the following components to
ensure entry-level competence, EXCEPT:
Options: A. Client Needs B. Integrated Processes C. The Nursing
Process D. Levels of Cognitive Ability
Correct Answer: C. The Nursing Process
,Rationales: Correct Answer: While the nursing process is a
fundamental part of nursing practice, the NCLEX-PN® Test Plan
is organized around four major components: Client Needs,
Integrated Processes, and Levels of Cognitive Ability. The
Nursing Process is not a separate, distinct component of the
test plan but rather is integrated throughout the framework as
a method for organizing thought. Option A: Client Needs is
a major category in the NCLEX-PN® Test Plan, detailing the
specific needs of clients that nurses address. Option B:
Integrated Processes are a component of the test plan and
include processes like the nursing process, communication, and
teaching/learning. Option D: Levels of Cognitive Ability is a
component of the test plan and categorizes the complexity of
the thinking required for each question.
Teaching Point: The NCLEX-PN® Test Plan is organized by Client
Needs, Integrated Processes, and Levels of Cognitive Ability, not
solely by the Nursing Process.
Citation: Silvestri, L. A., & Silvestri, A. (2026). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Chapter 1.
Question 5
,Reference: Clinical Judgment and the Next Generation NCLEX
(NGN)-PN® Examination; Development of the Test Plan; Level of
Cognitive Ability
Clinical Scenario: The nursing instructor is creating a practice
test for the students. The instructor is writing a question that
requires the student to interpret a client's laboratory results
and determine the most appropriate nursing action. This type
of question is assessing which level of cognitive ability?
Options: A. Recall B. Comprehension C. Analysis D. Application
Correct Answer: C. Analysis
Rationales: Correct Answer: Analysis involves breaking
down information into its component parts and examining the
relationships to determine the best course of action.
Interpreting lab results and determining a nursing action
requires the student to analyze the data, see patterns, and
make a clinical decision. Option A: Recall is the simplest
level of cognitive ability, involving only the memorization of
facts. Option B: Comprehension involves understanding the
meaning of information, but not necessarily breaking it down
into component parts to make a decision. Option D:
Application involves using knowledge in a specific situation, but
analysis goes a step further by requiring the examination and
interpretation of complex data.
,Teaching Point: Analysis requires interpreting data and making
decisions, a key skill for safe practical nursing practice.
Citation: Silvestri, L. A., & Silvestri, A. (2026). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Chapter 1.
Question 6
Reference: Clinical Judgment and the Next Generation NCLEX
(NGN)-PN® Examination; Development of the Test Plan; Client
Needs
Clinical Scenario: A practical nursing student is reviewing the
Client Needs categories for the NCLEX-PN®. The student is
focusing on the category that addresses the nurse's role in
providing a safe environment. Which Client Needs category is
the student reviewing?
Options: A. Health Promotion and Maintenance B. Psychosocial
Integrity C. Safe and Effective Care Environment D.
Physiological Integrity
Correct Answer: C. Safe and Effective Care Environment
Rationales: Correct Answer: The Safe and Effective Care
Environment client need category encompasses nursing actions
and responsibilities related to providing a safe environment and
, managing client care. This includes areas such as safety and
infection control, as well as management of care. Option A:
Health Promotion and Maintenance focuses on assisting clients
to maintain or improve their health. Option B: Psychosocial
Integrity focuses on the client's mental, emotional, and social
well-being. Option D: Physiological Integrity focuses on the
client's physical health and the promotion of physical wellness.
Teaching Point: Safe and Effective Care Environment is the
Client Needs category directly related to safety, infection
control, and care management.
Citation: Silvestri, L. A., & Silvestri, A. (2026). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Chapter 1.
Question 7
Reference: Clinical Judgment and the Next Generation NCLEX
(NGN)-PN® Examination; Development of the Test Plan;
Integrated Processes
Clinical Scenario: The nursing instructor is teaching about the
integrated processes that are foundational to nursing practice.
The instructor explains that these processes are woven
throughout all areas of the NCLEX-PN®. Which of the following
FOR THE NCLEX-PN® EXAMINATION
9TH EDITION
AUTHOR(S)LINDA ANNE SILVESTRI;
ANGELA SILVESTRI
TEST BANK
Question 1
Reference: Clinical Judgment and the Next Generation NCLEX
(NGN)-PN® Examination; The Pyramid to Success
Clinical Scenario: A practical nursing student is reviewing the
"Pyramid to Success" model presented in their NCLEX-PN®
review book. The student understands that the foundation of
this pyramid is crucial for building safe and effective clinical
judgments. On which of the following components should the
student focus as the base of the Pyramid to Success?
,Options: A. Nursing interventions and procedures B.
Prioritization, delegation, and assignment C. Knowledge of
pathophysiology and pharmacology D. The nursing process and
clinical judgment
Correct Answer: D. The nursing process and clinical judgment
Rationales: Correct Answer: The foundation of the Pyramid
to Success is the nursing process and clinical judgment. This
foundational level ensures that the nurse uses a systematic
approach to provide safe client care. The nursing process serves
as a blueprint for all critical thinking and clinical decisions made
by the nurse. Option A: Nursing interventions and
procedures are higher-level skills that are built upon the
foundation of the nursing process and clinical judgment; they
are not the base itself. Option B: Prioritization, delegation,
and assignment are complex skills that are also built upon the
foundational knowledge and cognitive skills of the nursing
process and clinical judgment. Option C: Knowledge of
pathophysiology and pharmacology is essential but represents
the knowledge base that feeds into the nursing process, not the
foundational thinking framework itself.
Teaching Point: The nursing process and clinical judgment form
the essential foundation for safe, client-centered care and all
NCLEX-PN® success strategies.
,Citation: Silvestri, L. A., & Silvestri, A. (2026). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Chapter 1.
Question 2
Reference: Clinical Judgment and the Next Generation NCLEX
(NGN)-PN® Examination; Clinical Judgment and Next
Generation NCLEX® Items
Clinical Scenario: The nursing instructor is explaining the NGN-
PN® test design to a group of practical nursing students. The
instructor emphasizes that the new test design focuses heavily
on a specific cognitive skill. Which cognitive skill is most
essential for the NGN-PN® examination as it requires the nurse
to synthesize and evaluate data to make decisions?
Options: A. Memory B. Comprehension C. Application D.
Clinical judgment
Correct Answer: D. Clinical judgment
Rationales: Correct Answer: Clinical judgment is the
cognitive skill most essential for the NGN-PN® examination. It
requires the nurse to observe, think, prioritize, plan, act, and
evaluate, synthesizing all available data to make a safe and
effective decision. The NGN test design is specifically built to
evaluate this higher-level thinking. Option A: Memory is a
,lower-level cognitive skill that involves recalling facts and is not
the primary focus of the NGN-PN® examination. Option B:
Comprehension involves understanding the meaning of
information but does not require the synthesis and evaluation
needed for clinical judgment. Option C: Application involves
using knowledge in a specific situation, but clinical judgment
goes a step further by requiring interpretation, analysis, and
evaluation of the outcomes.
Teaching Point: The NGN-PN® is designed to test clinical
judgment, moving beyond simple recall to evaluate a nurse's
ability to make safe decisions.
Citation: Silvestri, L. A., & Silvestri, A. (2026). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Chapter 1.
Question 3
Reference: Clinical Judgment and the Next Generation NCLEX
(NGN)-PN® Examination; Examination Process; Computer
Adaptive Testing
Clinical Scenario: A practical nursing student is preparing for
the NCLEX-PN® examination. The student is reviewing how the
computerized adaptive testing (CAT) format works. Which
,statement best describes the CAT process the student will
experience during the examination?
Options: A. The computer selects a specific set of questions for
each candidate based on their state of residence. B. The
computer presents questions that become progressively easier
as the candidate answers correctly. C. The computer selects
questions based on the candidate's previous answers to
determine the next question. D. The computer presents a
random set of questions from a fixed pool, regardless of the
candidate's performance.
Correct Answer: C. The computer selects questions based on
the candidate's previous answers to determine the next
question.
Rationales: Correct Answer: Computer adaptive testing
(CAT) selects questions based on the candidate's previous
answers. The computer estimates the candidate's ability level
and administers questions at or near that level, making the test
individualized. Option A: The computer does not select
questions based on the candidate's state of residence; it selects
them based on the candidate's performance on previous items.
Option B: Questions become more difficult as the
candidate answers correctly, not easier. The test is designed to
challenge the candidate at their current ability level. Option
D: The questions are not random; they are specifically selected
,by the computer algorithm based on the candidate's
performance to pinpoint their ability level.
Teaching Point: CAT uses your previous answers to tailor the
exam to your ability level, selecting questions that are neither
too easy nor too hard.
Citation: Silvestri, L. A., & Silvestri, A. (2026). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Chapter 1.
Question 4
Reference: Clinical Judgment and the Next Generation NCLEX
(NGN)-PN® Examination; Development of the Test Plan; Test
Plan
Clinical Scenario: The practical nurse is reviewing the
components of the NCLEX-PN® Test Plan to focus their study
efforts. The nurse understands that the test plan is based on a
framework that includes all of the following components to
ensure entry-level competence, EXCEPT:
Options: A. Client Needs B. Integrated Processes C. The Nursing
Process D. Levels of Cognitive Ability
Correct Answer: C. The Nursing Process
,Rationales: Correct Answer: While the nursing process is a
fundamental part of nursing practice, the NCLEX-PN® Test Plan
is organized around four major components: Client Needs,
Integrated Processes, and Levels of Cognitive Ability. The
Nursing Process is not a separate, distinct component of the
test plan but rather is integrated throughout the framework as
a method for organizing thought. Option A: Client Needs is
a major category in the NCLEX-PN® Test Plan, detailing the
specific needs of clients that nurses address. Option B:
Integrated Processes are a component of the test plan and
include processes like the nursing process, communication, and
teaching/learning. Option D: Levels of Cognitive Ability is a
component of the test plan and categorizes the complexity of
the thinking required for each question.
Teaching Point: The NCLEX-PN® Test Plan is organized by Client
Needs, Integrated Processes, and Levels of Cognitive Ability, not
solely by the Nursing Process.
Citation: Silvestri, L. A., & Silvestri, A. (2026). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Chapter 1.
Question 5
,Reference: Clinical Judgment and the Next Generation NCLEX
(NGN)-PN® Examination; Development of the Test Plan; Level of
Cognitive Ability
Clinical Scenario: The nursing instructor is creating a practice
test for the students. The instructor is writing a question that
requires the student to interpret a client's laboratory results
and determine the most appropriate nursing action. This type
of question is assessing which level of cognitive ability?
Options: A. Recall B. Comprehension C. Analysis D. Application
Correct Answer: C. Analysis
Rationales: Correct Answer: Analysis involves breaking
down information into its component parts and examining the
relationships to determine the best course of action.
Interpreting lab results and determining a nursing action
requires the student to analyze the data, see patterns, and
make a clinical decision. Option A: Recall is the simplest
level of cognitive ability, involving only the memorization of
facts. Option B: Comprehension involves understanding the
meaning of information, but not necessarily breaking it down
into component parts to make a decision. Option D:
Application involves using knowledge in a specific situation, but
analysis goes a step further by requiring the examination and
interpretation of complex data.
,Teaching Point: Analysis requires interpreting data and making
decisions, a key skill for safe practical nursing practice.
Citation: Silvestri, L. A., & Silvestri, A. (2026). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Chapter 1.
Question 6
Reference: Clinical Judgment and the Next Generation NCLEX
(NGN)-PN® Examination; Development of the Test Plan; Client
Needs
Clinical Scenario: A practical nursing student is reviewing the
Client Needs categories for the NCLEX-PN®. The student is
focusing on the category that addresses the nurse's role in
providing a safe environment. Which Client Needs category is
the student reviewing?
Options: A. Health Promotion and Maintenance B. Psychosocial
Integrity C. Safe and Effective Care Environment D.
Physiological Integrity
Correct Answer: C. Safe and Effective Care Environment
Rationales: Correct Answer: The Safe and Effective Care
Environment client need category encompasses nursing actions
and responsibilities related to providing a safe environment and
, managing client care. This includes areas such as safety and
infection control, as well as management of care. Option A:
Health Promotion and Maintenance focuses on assisting clients
to maintain or improve their health. Option B: Psychosocial
Integrity focuses on the client's mental, emotional, and social
well-being. Option D: Physiological Integrity focuses on the
client's physical health and the promotion of physical wellness.
Teaching Point: Safe and Effective Care Environment is the
Client Needs category directly related to safety, infection
control, and care management.
Citation: Silvestri, L. A., & Silvestri, A. (2026). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Chapter 1.
Question 7
Reference: Clinical Judgment and the Next Generation NCLEX
(NGN)-PN® Examination; Development of the Test Plan;
Integrated Processes
Clinical Scenario: The nursing instructor is teaching about the
integrated processes that are foundational to nursing practice.
The instructor explains that these processes are woven
throughout all areas of the NCLEX-PN®. Which of the following
