,NCLEX-RN® Core Review by Saunders:
Chapter-Specific MCQs for Guaranteed
Retention
Table of Contents
📘 NCLEX-RN® Preparation – Table of Contents
Unit & Chapter Title
UNIT I: NCLEX-RN®
Preparation
Clinical Judgment and the NCLEX-RN®
Chapter 1
Examination
– The Pyramid to Success
– The Examination Process
– Computer Adaptive Testing
– Development of the Test Plan
– The Test Plan
– Types of Questions and Scoring
– Registration and Authorization to
Test
,Unit & Chapter Title
– Changing Your Appointment
– Day of Examination & Testing
Accommodations
– Testing Center & NGN Test Design
– Pass-or-Fail Decisions & Results
– Candidate Performance Report
– Nurse Licensure Compact &
International Nurse
Chapter 2 Self-Efficacy and Profiles to Success
– Pyramid to Success
– Increasing Self-Efficacy
– Developing Control
– Building Confidence
The NCLEX-RN® Examination: A
Chapter 3
Graduate’s Perspective
– NGN Reflections by Madison Drew
Mahon, BSN, RN
Clinical Judgment and Test-Taking
Chapter 4
Strategies
,| UNIT II: Client Needs | |
| Chapter 5 | Client Needs and the NCLEX-RN® Test Plan |
| | – Physiological Integrity |
| | – Safe and Effective Care Environment |
| | – Health Promotion and Maintenance |
| | – Psychosocial Integrity |
| Chapter 6 | Physiological Integrity Practice Questions |
| Chapter 7 | Safe and Effective Care Environment Practice
Questions |
| Chapter 8 | Health Promotion and Maintenance Practice
Questions |
| Chapter 9 | Psychosocial Integrity Practice Questions |
| UNIT III: Integrated Processes | |
| Chapter 10 | Integrated Processes and the NCLEX-RN® Test
Plan |
| | – Caring |
| | – Clinical Judgment |
| | – Communication and Documentation |
| | – Culture and Spirituality |
| | – Nursing Process |
| | – Teaching and Learning |
| Chapter 11 | Integrated Processes Practice Questions |
| | – Caring |
| | – Communication and Documentation |
| | – Culture and Spirituality |
| | – Teaching and Learning |
| | – Nursing Process: Assessment |
,| | – Nursing Process: Analysis |
| | – Nursing Process: Planning |
| | – Nursing Process: Implementation |
| | – Nursing Process: Evaluation |
,Chapter 1: Clinical Judgment and the NCLEX-RN® Examination
(Saunders Q&A Review, 9th Ed., 2025).
1–7. The Pyramid to Success
1. A nursing student is reviewing the Pyramid to Success model
to guide exam preparation. Which level of the pyramid
emphasizes practicing test-taking strategies such as
prioritization, delegation, and management of care?
A. Foundational knowledge
B. Critical thinking skills
C. Test-taking strategies
D. Clinical judgment application
Answer: C. Test-taking strategies
Rationale:
C is correct because the third tier of the Pyramid focuses
on test-taking strategies (e.g., prioritization, delegation)
that optimize performance under exam conditions.
A is incorrect—foundational knowledge is the base level
(tier 1).
B is incorrect—critical thinking skills are the second tier.
D is incorrect—clinical judgment application is the apex
(tier 4) of the pyramid.
2. According to the Pyramid to Success, which tier directly
precedes the development of clinical judgment application?
,A. Foundational knowledge
B. Test-taking strategies
C. Critical thinking skills
D. Evaluation of outcomes
Answer: C. Critical thinking skills
Rationale:
C is correct because critical thinking skills (tier 2) build on
foundational knowledge and pave the way for test-taking
strategies (tier 3) before applying clinical judgment (tier 4).
A is incorrect—that’s tier 1.
B is incorrect—that’s tier 3, which follows critical thinking.
D is incorrect—not part of the pyramid levels.
3. A graduate nurse wants to ensure mastery of foundational
knowledge before advancing. Which action best reflects tier 1
of the Pyramid to Success?
A. Practicing NCLEX-style questions under timed conditions
B. Reviewing pathophysiology, pharmacology, and nursing
fundamentals
C. Engaging in reflective journaling about clinical experiences
D. Developing a study schedule that includes breaks
Answer: B. Reviewing pathophysiology, pharmacology, and
nursing fundamentals
Rationale:
, B is correct—tier 1 is all about solidifying foundational
content knowledge.
A is incorrect—timed practice questions are tier 3,
test-taking strategies.
C is incorrect—that relates more to reflective practice and
clinical judgment.
D is incorrect—while valuable, scheduling is a study skill
rather than content mastery.
4. During a study session, the student practices delegating tasks
in a simulated scenario to improve exam preparedness. This
activity corresponds to which component of the Pyramid?
A. Tier 1: Foundational knowledge
B. Tier 2: Critical thinking skills
C. Tier 3: Test-taking strategies
D. Tier 4: Clinical judgment application
Answer: C. Tier 3: Test-taking strategies
Rationale:
C is correct—delegation exercises are a core part of
test-taking strategies under tier 3.
A is incorrect—that tier focuses on content.
B is incorrect—that focuses on analysis and reasoning.
D is incorrect—that tier emphasizes synthesizing and
applying judgment in new situations.
,5. The apex of the Pyramid to Success emphasizes:
A. Prioritization of test questions
B. Integration of content knowledge and critical thinking into
client care decisions
C. Memorization of key facts
D. Creation of a detailed study timetable
Answer: B. Integration of content knowledge and critical
thinking into client care decisions
Rationale:
B is correct—the apex (tier 4) focuses on clinical judgment:
synthesizing knowledge and critical thinking for safe
nursing decisions.
A is incorrect—that’s a test-taking strategy (tier 3).
C is incorrect—that’s foundational knowledge (tier 1) but
incomplete without application.
D is incorrect—time management is supportive but not the
apex.
6. A student recognizes that simply memorizing drug names
(tier 1) won’t guarantee success on the NCLEX. According to the
Pyramid, which additional tier is MOST critical for answering
“select all that apply” questions?
A. Tier 1 only
, B. Tier 2: Critical thinking skills
C. Tier 3: Test-taking strategies
D. Tier 4: Clinical judgment application
Answer: C. Tier 3: Test-taking strategies
Rationale:
C is correct—select-all-that-apply questions require
strategies like eliminating distractors and recognizing
objective cues, hallmarks of tier 3.
A is incorrect—tier 1 is necessary but insufficient.
B is incorrect—critical thinking helps but must be paired
with specific strategies.
D is incorrect—clinical judgment is essential but built on
strategic knowledge of question formats.
7. Which study activity best illustrates movement from tier 2 to
tier 3 of the Pyramid?
A. Recalling diagnostic criteria for heart failure
B. Analyzing lab values to determine fluid status
C. Practicing prioritization frameworks on sample NCLEX
questions
D. Creating flashcards of normal vital sign ranges
Answer: C. Practicing prioritization frameworks on sample
NCLEX questions
Rationale:
Chapter-Specific MCQs for Guaranteed
Retention
Table of Contents
📘 NCLEX-RN® Preparation – Table of Contents
Unit & Chapter Title
UNIT I: NCLEX-RN®
Preparation
Clinical Judgment and the NCLEX-RN®
Chapter 1
Examination
– The Pyramid to Success
– The Examination Process
– Computer Adaptive Testing
– Development of the Test Plan
– The Test Plan
– Types of Questions and Scoring
– Registration and Authorization to
Test
,Unit & Chapter Title
– Changing Your Appointment
– Day of Examination & Testing
Accommodations
– Testing Center & NGN Test Design
– Pass-or-Fail Decisions & Results
– Candidate Performance Report
– Nurse Licensure Compact &
International Nurse
Chapter 2 Self-Efficacy and Profiles to Success
– Pyramid to Success
– Increasing Self-Efficacy
– Developing Control
– Building Confidence
The NCLEX-RN® Examination: A
Chapter 3
Graduate’s Perspective
– NGN Reflections by Madison Drew
Mahon, BSN, RN
Clinical Judgment and Test-Taking
Chapter 4
Strategies
,| UNIT II: Client Needs | |
| Chapter 5 | Client Needs and the NCLEX-RN® Test Plan |
| | – Physiological Integrity |
| | – Safe and Effective Care Environment |
| | – Health Promotion and Maintenance |
| | – Psychosocial Integrity |
| Chapter 6 | Physiological Integrity Practice Questions |
| Chapter 7 | Safe and Effective Care Environment Practice
Questions |
| Chapter 8 | Health Promotion and Maintenance Practice
Questions |
| Chapter 9 | Psychosocial Integrity Practice Questions |
| UNIT III: Integrated Processes | |
| Chapter 10 | Integrated Processes and the NCLEX-RN® Test
Plan |
| | – Caring |
| | – Clinical Judgment |
| | – Communication and Documentation |
| | – Culture and Spirituality |
| | – Nursing Process |
| | – Teaching and Learning |
| Chapter 11 | Integrated Processes Practice Questions |
| | – Caring |
| | – Communication and Documentation |
| | – Culture and Spirituality |
| | – Teaching and Learning |
| | – Nursing Process: Assessment |
,| | – Nursing Process: Analysis |
| | – Nursing Process: Planning |
| | – Nursing Process: Implementation |
| | – Nursing Process: Evaluation |
,Chapter 1: Clinical Judgment and the NCLEX-RN® Examination
(Saunders Q&A Review, 9th Ed., 2025).
1–7. The Pyramid to Success
1. A nursing student is reviewing the Pyramid to Success model
to guide exam preparation. Which level of the pyramid
emphasizes practicing test-taking strategies such as
prioritization, delegation, and management of care?
A. Foundational knowledge
B. Critical thinking skills
C. Test-taking strategies
D. Clinical judgment application
Answer: C. Test-taking strategies
Rationale:
C is correct because the third tier of the Pyramid focuses
on test-taking strategies (e.g., prioritization, delegation)
that optimize performance under exam conditions.
A is incorrect—foundational knowledge is the base level
(tier 1).
B is incorrect—critical thinking skills are the second tier.
D is incorrect—clinical judgment application is the apex
(tier 4) of the pyramid.
2. According to the Pyramid to Success, which tier directly
precedes the development of clinical judgment application?
,A. Foundational knowledge
B. Test-taking strategies
C. Critical thinking skills
D. Evaluation of outcomes
Answer: C. Critical thinking skills
Rationale:
C is correct because critical thinking skills (tier 2) build on
foundational knowledge and pave the way for test-taking
strategies (tier 3) before applying clinical judgment (tier 4).
A is incorrect—that’s tier 1.
B is incorrect—that’s tier 3, which follows critical thinking.
D is incorrect—not part of the pyramid levels.
3. A graduate nurse wants to ensure mastery of foundational
knowledge before advancing. Which action best reflects tier 1
of the Pyramid to Success?
A. Practicing NCLEX-style questions under timed conditions
B. Reviewing pathophysiology, pharmacology, and nursing
fundamentals
C. Engaging in reflective journaling about clinical experiences
D. Developing a study schedule that includes breaks
Answer: B. Reviewing pathophysiology, pharmacology, and
nursing fundamentals
Rationale:
, B is correct—tier 1 is all about solidifying foundational
content knowledge.
A is incorrect—timed practice questions are tier 3,
test-taking strategies.
C is incorrect—that relates more to reflective practice and
clinical judgment.
D is incorrect—while valuable, scheduling is a study skill
rather than content mastery.
4. During a study session, the student practices delegating tasks
in a simulated scenario to improve exam preparedness. This
activity corresponds to which component of the Pyramid?
A. Tier 1: Foundational knowledge
B. Tier 2: Critical thinking skills
C. Tier 3: Test-taking strategies
D. Tier 4: Clinical judgment application
Answer: C. Tier 3: Test-taking strategies
Rationale:
C is correct—delegation exercises are a core part of
test-taking strategies under tier 3.
A is incorrect—that tier focuses on content.
B is incorrect—that focuses on analysis and reasoning.
D is incorrect—that tier emphasizes synthesizing and
applying judgment in new situations.
,5. The apex of the Pyramid to Success emphasizes:
A. Prioritization of test questions
B. Integration of content knowledge and critical thinking into
client care decisions
C. Memorization of key facts
D. Creation of a detailed study timetable
Answer: B. Integration of content knowledge and critical
thinking into client care decisions
Rationale:
B is correct—the apex (tier 4) focuses on clinical judgment:
synthesizing knowledge and critical thinking for safe
nursing decisions.
A is incorrect—that’s a test-taking strategy (tier 3).
C is incorrect—that’s foundational knowledge (tier 1) but
incomplete without application.
D is incorrect—time management is supportive but not the
apex.
6. A student recognizes that simply memorizing drug names
(tier 1) won’t guarantee success on the NCLEX. According to the
Pyramid, which additional tier is MOST critical for answering
“select all that apply” questions?
A. Tier 1 only
, B. Tier 2: Critical thinking skills
C. Tier 3: Test-taking strategies
D. Tier 4: Clinical judgment application
Answer: C. Tier 3: Test-taking strategies
Rationale:
C is correct—select-all-that-apply questions require
strategies like eliminating distractors and recognizing
objective cues, hallmarks of tier 3.
A is incorrect—tier 1 is necessary but insufficient.
B is incorrect—critical thinking helps but must be paired
with specific strategies.
D is incorrect—clinical judgment is essential but built on
strategic knowledge of question formats.
7. Which study activity best illustrates movement from tier 2 to
tier 3 of the Pyramid?
A. Recalling diagnostic criteria for heart failure
B. Analyzing lab values to determine fluid status
C. Practicing prioritization frameworks on sample NCLEX
questions
D. Creating flashcards of normal vital sign ranges
Answer: C. Practicing prioritization frameworks on sample
NCLEX questions
Rationale:
