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 the Next Generation
NCLEX® (NGN-PN) — Pyramid to Success / Clinical Judgment.
Stem: A practical nursing educator is coaching a PN candidate
on using the Pyramid to Success when approaching NGN case-
based items. Which action best demonstrates applying the
Pyramid framework during an NGN item?
A. Rereading the entire case and immediately choosing the first
option that seems familiar.
B. Identifying and ranking client cues, then linking the top cue
to a PN-level action.
C. Memorizing the sequence of answer choices used for similar
previous items.
,D. Eliminating options containing medical terms the candidate
does not know.
Correct Answer: B
Rationale (correct): Identifying and ranking client cues then
linking them to an appropriate nursing action reflects the
Pyramid’s emphasis on cue recognition and prioritized clinical
judgment; it aligns with NGN expectations for analysis.
Rationale (A): Rereading and choosing the first familiar option
is superficial and risks error; it skips cue ranking and analysis.
Rationale (C): Memorizing answer patterns is a test-taking tactic
rather than applying clinical judgment; NGN evaluates
reasoning, not pattern recall.
Rationale (D): Eliminating options based on unfamiliar terms
risks discarding correct choices and does not represent
prioritization of client cues.
Teaching Point: Prioritize and link client cues to focused nursing
actions.
Citation: Silvestri, L. A., & Silvestri, A. (2025). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Ch. 1.
2.
Reference: Ch. 1 — NGN Test Design — Case scenarios and item
types.
Stem: During NGN-style testing, a PN candidate receives a case
with multiple ordered response prompts (selecting 1st–4th
,actions). The candidate is unsure how to sequence actions.
Which approach most aligns with NGN test design?
A. Sequence actions by which intervention is fastest to perform.
B. Use ABC (airway, breathing, circulation) plus safety to
sequence actions.
C. Sequence actions by which one is most familiar from
textbooks.
D. Order actions alphabetically to avoid bias.
Correct Answer: B
Rationale (correct): NGN items assess prioritization using
clinical frameworks; ABC plus safety provides a valid clinical
ordering strategy consistent with NGN expectations.
Rationale (A): Speed of action is not the priority ordering
principle; fastest is not necessarily most critical.
Rationale (C): Familiarity from texts may not reflect patient
priorities and can misorder emergent needs.
Rationale (D): Alphabetical ordering is nonclinical and irrelevant
to patient safety or NGN scoring.
Teaching Point: Use clinical priority frameworks (e.g., ABCs +
safety) to sequence actions.
Citation: Silvestri, L. A., & Silvestri, A. (2025). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Ch. 1.
3.
, Reference: Ch. 1 — Types of Questions on the Examination and
Scoring — NGN item scoring.
Stem: A PN candidate receives NGN items that require
prioritized responses. Which statement best describes how
these NGN items contribute to pass/fail decisions?
A. Each NGN item is scored only as correct/incorrect with no
partial credit.
B. NGN items use specialized scoring models that evaluate the
clinical reasoning process.
C. NGN items are ignored in pass/fail; only multiple-choice
items count.
D. NGN items count double toward the final score because they
are harder.
Correct Answer: B
Rationale (correct): NGN items are scored using models that
assess elements of clinical reasoning (cue recognition, analysis,
prioritization), not simply right/wrong recall, which informs the
competency judgement.
Rationale (A): Some NGN items permit partial recognition of
reasoning; scoring models are more nuanced than strict binary
scoring.
Rationale (C): NGN items are integral to the exam; they are not
ignored.
Rationale (D): NGN items are not simply “double-weighted”;
they are scored by models assessing reasoning rather than flat
doubling.
Teaching Point: NGN uses reasoning-based scoring, not only
FOR THE NCLEX-PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI;
ANGELA SILVESTRI
TEST BANK
Reference: Ch. 1 — Clinical Judgment and the Next Generation
NCLEX® (NGN-PN) — Pyramid to Success / Clinical Judgment.
Stem: A practical nursing educator is coaching a PN candidate
on using the Pyramid to Success when approaching NGN case-
based items. Which action best demonstrates applying the
Pyramid framework during an NGN item?
A. Rereading the entire case and immediately choosing the first
option that seems familiar.
B. Identifying and ranking client cues, then linking the top cue
to a PN-level action.
C. Memorizing the sequence of answer choices used for similar
previous items.
,D. Eliminating options containing medical terms the candidate
does not know.
Correct Answer: B
Rationale (correct): Identifying and ranking client cues then
linking them to an appropriate nursing action reflects the
Pyramid’s emphasis on cue recognition and prioritized clinical
judgment; it aligns with NGN expectations for analysis.
Rationale (A): Rereading and choosing the first familiar option
is superficial and risks error; it skips cue ranking and analysis.
Rationale (C): Memorizing answer patterns is a test-taking tactic
rather than applying clinical judgment; NGN evaluates
reasoning, not pattern recall.
Rationale (D): Eliminating options based on unfamiliar terms
risks discarding correct choices and does not represent
prioritization of client cues.
Teaching Point: Prioritize and link client cues to focused nursing
actions.
Citation: Silvestri, L. A., & Silvestri, A. (2025). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Ch. 1.
2.
Reference: Ch. 1 — NGN Test Design — Case scenarios and item
types.
Stem: During NGN-style testing, a PN candidate receives a case
with multiple ordered response prompts (selecting 1st–4th
,actions). The candidate is unsure how to sequence actions.
Which approach most aligns with NGN test design?
A. Sequence actions by which intervention is fastest to perform.
B. Use ABC (airway, breathing, circulation) plus safety to
sequence actions.
C. Sequence actions by which one is most familiar from
textbooks.
D. Order actions alphabetically to avoid bias.
Correct Answer: B
Rationale (correct): NGN items assess prioritization using
clinical frameworks; ABC plus safety provides a valid clinical
ordering strategy consistent with NGN expectations.
Rationale (A): Speed of action is not the priority ordering
principle; fastest is not necessarily most critical.
Rationale (C): Familiarity from texts may not reflect patient
priorities and can misorder emergent needs.
Rationale (D): Alphabetical ordering is nonclinical and irrelevant
to patient safety or NGN scoring.
Teaching Point: Use clinical priority frameworks (e.g., ABCs +
safety) to sequence actions.
Citation: Silvestri, L. A., & Silvestri, A. (2025). Saunders
Comprehensive Review for the NCLEX-PN® Examination (9th
ed.). Ch. 1.
3.
, Reference: Ch. 1 — Types of Questions on the Examination and
Scoring — NGN item scoring.
Stem: A PN candidate receives NGN items that require
prioritized responses. Which statement best describes how
these NGN items contribute to pass/fail decisions?
A. Each NGN item is scored only as correct/incorrect with no
partial credit.
B. NGN items use specialized scoring models that evaluate the
clinical reasoning process.
C. NGN items are ignored in pass/fail; only multiple-choice
items count.
D. NGN items count double toward the final score because they
are harder.
Correct Answer: B
Rationale (correct): NGN items are scored using models that
assess elements of clinical reasoning (cue recognition, analysis,
prioritization), not simply right/wrong recall, which informs the
competency judgement.
Rationale (A): Some NGN items permit partial recognition of
reasoning; scoring models are more nuanced than strict binary
scoring.
Rationale (C): NGN items are integral to the exam; they are not
ignored.
Rationale (D): NGN items are not simply “double-weighted”;
they are scored by models assessing reasoning rather than flat
doubling.
Teaching Point: NGN uses reasoning-based scoring, not only
