,Step-by-Step NCLEX-RN® Review:
Saunders 9th Ed. Chapterwise MCQs &
Rationales
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
,Unit & Chapter Title
– Registration and Authorization to
Test
– 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
,Unit & Chapter Title
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).
Subtopic: The Pyramid to Success
A nursing student wants to maximize retention of
pharmacology facts. According to the Pyramid to Success,
which study behavior is most effective in promoting long-term
learning?
A. Repeated reading of the textbook chapter
B. Cramming with mnemonics the night before the exam
C. Teaching the material to a peer study group
D. Highlighting key sentences during a single review session
Answer: C
Rationale: Teaching others (peer instruction) reinforces
understanding and retrieval pathways (highest tier of the
Pyramid) making it most effective for long-term retention.
A is passive and low on the Pyramid.
B is short-term and leads to rapid forgetting.
D is superficial compared to active teaching.
Subtopic: The Pyramid to Success
A student applies spaced repetition to memorizing lab values.
This strategy aligns with which concept of the Pyramid?
A. First-time learning foundation
B. Active engagement
C. Distributed practice
D. High-stakes test simulation
,Answer: C
Rationale: Distributed (spaced) practice is key for transferring
information from short- to long-term memory.
A refers to initial exposure.
B is active learning but not specific to spacing.
D simulates testing but isn’t spacing content.
Subtopic: The Pyramid to Success
According to the Pyramid, which is an example of elaboration?
A. Copying lecture slides verbatim
B. Creating a concept map linking related concepts
C. Listening to a recording once at normal speed
D. Reading a summary paragraph silently
Answer: B
Rationale: Concept maps require learners to integrate and
connect ideas deeply (elaboration).
A and D are passive.
C lacks depth and active processing.
Subtopic: The Examination Process
During a scheduled exam, the proctor interrupts and says the
testing room temperature will rise. Which right does the
candidate retain?
A. Right to reschedule without penalty
B. Right to request a new test plan
C. Right to standardized testing conditions
D. Right to unlimited breaks
,Answer: C
Rationale: NCLEX regulations mandate standardized conditions
(temperature, noise) to ensure fairness.
A only applies for emergencies.
B is irrelevant to environment.
D is false; breaks are timed and limited.
Subtopic: The Examination Process
A candidate arrives 15 minutes late. The proctor denies entry
and reports them. Which policy does this reflect?
A. Irregular behavior policy
B. Candidate punctuality rule
C. Test center admission policy
D. Break violation rule
Answer: C
Rationale: Testing centers enforce strict admission cutoffs; late
arrivals are not admitted.
A relates to cheating.
B is not an NCLEX policy term.
D concerns exceeding break time.
Subtopic: The Examination Process
If a fire alarm sounds, what does the candidate do according to
the emergency policy?
A. Continue testing until instructed otherwise
B. Stop the test and evacuate, without test data loss
,C. Finish current item then evacuate
D. Submit answers and stay seated
Answer: B
Rationale: Emergency interruptions require evacuation; all
responses are saved and resumed later.
A and D jeopardize safety.
C risks test data integrity.
Subtopic: Computer Adaptive Testing (CAT)
A candidate answers several items correctly; the computer then
selects more difficult items. This illustrates:
A. Item response theory
B. Fixed-form testing
C. Linear question progression
D. Mastery learning
Answer: A
Rationale: CAT uses item response theory to tailor difficulty
based on performance.
B is nonadaptive.
C and D don’t apply to CAT’s dynamic algorithm.
Subtopic: Computer Adaptive Testing (CAT)
The NCLEX uses CAT to determine competence. When does the
exam end?
A. After 75 items regardless of performance
B. When the candidate’s ability is estimated with 95%
confidence above or below the passing standard
, C. When the candidate requests to stop
D. After 265 items even if standard not met
Answer: B
Rationale: CAT ends when statistical confidence is reached that
ability exceeds or falls below the passing cut-score.
A and D misstate item limits.
C only applies if voluntary withdrawal (not typical).
Subtopic: Computer Adaptive Testing (CAT)
A candidate repeatedly answers items incorrectly; the
computer then administers fewer items. Why?
A. To limit test fatigue
B. Confidence interval reached below passing
C. Misinterpretation of performance
D. System error; they must retake
Answer: B
Rationale: CAT stops when it’s confident performance is below
standard, minimizing unnecessary items.
A is secondary.
C and D are incorrect interpretations.
Subtopic: Computer Adaptive Testing (CAT)
Why can’t CAT return to previous items for review?
A. Protects item security
B. Candidate safety
C. Software limitation
D. Reduces testing time
Saunders 9th Ed. Chapterwise MCQs &
Rationales
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
,Unit & Chapter Title
– Registration and Authorization to
Test
– 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
,Unit & Chapter Title
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).
Subtopic: The Pyramid to Success
A nursing student wants to maximize retention of
pharmacology facts. According to the Pyramid to Success,
which study behavior is most effective in promoting long-term
learning?
A. Repeated reading of the textbook chapter
B. Cramming with mnemonics the night before the exam
C. Teaching the material to a peer study group
D. Highlighting key sentences during a single review session
Answer: C
Rationale: Teaching others (peer instruction) reinforces
understanding and retrieval pathways (highest tier of the
Pyramid) making it most effective for long-term retention.
A is passive and low on the Pyramid.
B is short-term and leads to rapid forgetting.
D is superficial compared to active teaching.
Subtopic: The Pyramid to Success
A student applies spaced repetition to memorizing lab values.
This strategy aligns with which concept of the Pyramid?
A. First-time learning foundation
B. Active engagement
C. Distributed practice
D. High-stakes test simulation
,Answer: C
Rationale: Distributed (spaced) practice is key for transferring
information from short- to long-term memory.
A refers to initial exposure.
B is active learning but not specific to spacing.
D simulates testing but isn’t spacing content.
Subtopic: The Pyramid to Success
According to the Pyramid, which is an example of elaboration?
A. Copying lecture slides verbatim
B. Creating a concept map linking related concepts
C. Listening to a recording once at normal speed
D. Reading a summary paragraph silently
Answer: B
Rationale: Concept maps require learners to integrate and
connect ideas deeply (elaboration).
A and D are passive.
C lacks depth and active processing.
Subtopic: The Examination Process
During a scheduled exam, the proctor interrupts and says the
testing room temperature will rise. Which right does the
candidate retain?
A. Right to reschedule without penalty
B. Right to request a new test plan
C. Right to standardized testing conditions
D. Right to unlimited breaks
,Answer: C
Rationale: NCLEX regulations mandate standardized conditions
(temperature, noise) to ensure fairness.
A only applies for emergencies.
B is irrelevant to environment.
D is false; breaks are timed and limited.
Subtopic: The Examination Process
A candidate arrives 15 minutes late. The proctor denies entry
and reports them. Which policy does this reflect?
A. Irregular behavior policy
B. Candidate punctuality rule
C. Test center admission policy
D. Break violation rule
Answer: C
Rationale: Testing centers enforce strict admission cutoffs; late
arrivals are not admitted.
A relates to cheating.
B is not an NCLEX policy term.
D concerns exceeding break time.
Subtopic: The Examination Process
If a fire alarm sounds, what does the candidate do according to
the emergency policy?
A. Continue testing until instructed otherwise
B. Stop the test and evacuate, without test data loss
,C. Finish current item then evacuate
D. Submit answers and stay seated
Answer: B
Rationale: Emergency interruptions require evacuation; all
responses are saved and resumed later.
A and D jeopardize safety.
C risks test data integrity.
Subtopic: Computer Adaptive Testing (CAT)
A candidate answers several items correctly; the computer then
selects more difficult items. This illustrates:
A. Item response theory
B. Fixed-form testing
C. Linear question progression
D. Mastery learning
Answer: A
Rationale: CAT uses item response theory to tailor difficulty
based on performance.
B is nonadaptive.
C and D don’t apply to CAT’s dynamic algorithm.
Subtopic: Computer Adaptive Testing (CAT)
The NCLEX uses CAT to determine competence. When does the
exam end?
A. After 75 items regardless of performance
B. When the candidate’s ability is estimated with 95%
confidence above or below the passing standard
, C. When the candidate requests to stop
D. After 265 items even if standard not met
Answer: B
Rationale: CAT ends when statistical confidence is reached that
ability exceeds or falls below the passing cut-score.
A and D misstate item limits.
C only applies if voluntary withdrawal (not typical).
Subtopic: Computer Adaptive Testing (CAT)
A candidate repeatedly answers items incorrectly; the
computer then administers fewer items. Why?
A. To limit test fatigue
B. Confidence interval reached below passing
C. Misinterpretation of performance
D. System error; they must retake
Answer: B
Rationale: CAT stops when it’s confident performance is below
standard, minimizing unnecessary items.
A is secondary.
C and D are incorrect interpretations.
Subtopic: Computer Adaptive Testing (CAT)
Why can’t CAT return to previous items for review?
A. Protects item security
B. Candidate safety
C. Software limitation
D. Reduces testing time
