SAUNDERS COMPREHENSIVE REVIEW
FOR THE NCLEX-PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI;
ANGELA SILVESTRI
TEST BANK
Reference: Ch. 1 — Clinical Judgment & NGN — The Pyramid to
Success
Stem: A PN student preparing for the NGN reviews the Pyramid
to Success which emphasizes recognizing cues before making
judgments. During a clinical skills lab, which action best
demonstrates the student is applying the Pyramid framework?
A. Memorizing all possible diagnoses for common
presentations.
B. Listing vital-sign trends and focused assessment findings
before planning care.
C. Reading the instructor’s answers before answering clinical
questions.
,D. Practicing psychomotor skills only until they feel automatic.
Correct Answer: B
Rationales:
• Correct (B): Listing trends and focused assessment findings
reflects cue recognition and organization, key first steps in
the Pyramid to Success and clinical judgment.
• A: Memorization of diagnoses is recall-focused and
bypasses cue interpretation required for NGN-style
judgment.
• C: Relying on instructor answers prevents independent cue
analysis and judgment development.
• D: Psychomotor practice is important but does not
demonstrate the cognitive step of recognizing and
interpreting cues.
Teaching Point: Start with cue recognition (data trends)
before planning 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 — Clinical Judgment & NGN — Clinical
Judgment and Next Generation NCLEX® Items
Stem: A PN candidate encounters an NGN-style case requiring
identification of client cues. Which nurse action best shows
,appropriate application-level clinical judgment?
A. Choosing the intervention that worked last time for a similar
diagnosis.
B. Identifying abnormal findings and their likely implications
before selecting an action.
C. Selecting the most aggressive treatment to correct all
abnormalities.
D. Waiting for the provider’s order for every abnormal cue.
Correct Answer: B
Rationales:
• Correct (B): Identifying abnormal findings and implications
reflects analysis and aligns with NGN requirements to
recognize and interpret cues.
• A: Using past success without evaluating current cues risks
inappropriate care—overgeneralization.
• C: Choosing aggressive treatments without interpretation
may be unsafe and outside PN scope.
• D: Waiting for orders for every cue delays necessary basic
nursing actions and fails to prioritize PN responsibilities.
Teaching Point: Interpret cues first; select nursing actions
based on analysis.
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 — Computer Adaptive
Testing (CAT)
Stem: A practical nurse candidate is taking the NCLEX-PN and
receives mostly moderate-difficulty items early in testing.
Which interpretation best fits how CAT adjusts the exam?
A. The test will end immediately because the candidate
answered all questions.
B. The computer will select harder or easier items based on
current performance to estimate ability.
C. The candidate’s final score will be the average of item
difficulties seen.
D. The candidate can choose to skip and return to items to
improve their score.
Correct Answer: B
Rationales:
• Correct (B): CAT tailors item difficulty in real time based on
performance to estimate ability accurately.
• A: The exam does not end simply for answering moderate
items; end relies on ability estimation and other
termination criteria.
• C: Final score isn't a simple average of item difficulties; it’s
based on measurement of ability against the passing
standard.
FOR THE NCLEX-PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI;
ANGELA SILVESTRI
TEST BANK
Reference: Ch. 1 — Clinical Judgment & NGN — The Pyramid to
Success
Stem: A PN student preparing for the NGN reviews the Pyramid
to Success which emphasizes recognizing cues before making
judgments. During a clinical skills lab, which action best
demonstrates the student is applying the Pyramid framework?
A. Memorizing all possible diagnoses for common
presentations.
B. Listing vital-sign trends and focused assessment findings
before planning care.
C. Reading the instructor’s answers before answering clinical
questions.
,D. Practicing psychomotor skills only until they feel automatic.
Correct Answer: B
Rationales:
• Correct (B): Listing trends and focused assessment findings
reflects cue recognition and organization, key first steps in
the Pyramid to Success and clinical judgment.
• A: Memorization of diagnoses is recall-focused and
bypasses cue interpretation required for NGN-style
judgment.
• C: Relying on instructor answers prevents independent cue
analysis and judgment development.
• D: Psychomotor practice is important but does not
demonstrate the cognitive step of recognizing and
interpreting cues.
Teaching Point: Start with cue recognition (data trends)
before planning 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 — Clinical Judgment & NGN — Clinical
Judgment and Next Generation NCLEX® Items
Stem: A PN candidate encounters an NGN-style case requiring
identification of client cues. Which nurse action best shows
,appropriate application-level clinical judgment?
A. Choosing the intervention that worked last time for a similar
diagnosis.
B. Identifying abnormal findings and their likely implications
before selecting an action.
C. Selecting the most aggressive treatment to correct all
abnormalities.
D. Waiting for the provider’s order for every abnormal cue.
Correct Answer: B
Rationales:
• Correct (B): Identifying abnormal findings and implications
reflects analysis and aligns with NGN requirements to
recognize and interpret cues.
• A: Using past success without evaluating current cues risks
inappropriate care—overgeneralization.
• C: Choosing aggressive treatments without interpretation
may be unsafe and outside PN scope.
• D: Waiting for orders for every cue delays necessary basic
nursing actions and fails to prioritize PN responsibilities.
Teaching Point: Interpret cues first; select nursing actions
based on analysis.
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 — Computer Adaptive
Testing (CAT)
Stem: A practical nurse candidate is taking the NCLEX-PN and
receives mostly moderate-difficulty items early in testing.
Which interpretation best fits how CAT adjusts the exam?
A. The test will end immediately because the candidate
answered all questions.
B. The computer will select harder or easier items based on
current performance to estimate ability.
C. The candidate’s final score will be the average of item
difficulties seen.
D. The candidate can choose to skip and return to items to
improve their score.
Correct Answer: B
Rationales:
• Correct (B): CAT tailors item difficulty in real time based on
performance to estimate ability accurately.
• A: The exam does not end simply for answering moderate
items; end relies on ability estimation and other
termination criteria.
• C: Final score isn't a simple average of item difficulties; it’s
based on measurement of ability against the passing
standard.
