,Saunders NCLEX-RN® Mastery 2025:
Chapter-by-Chapter MCQs with Verified
Answers and 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
– 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).
Subtopic 1: The Pyramid to Success
1. A newly graduated nurse is preparing to study for the
NCLEX. Which level of the Pyramid to Success focuses on
integrating knowledge, experience, and intuition into
decision-making?
A. Foundational thinking
B. Sound clinical judgment
C. Application of knowledge
D. Outcome evaluation
Answer: B
Rationale:
o B is correct: Sound clinical judgment represents the
apex where knowledge, experience, and intuition
combine to guide safe care.
o A is incorrect: Foundational thinking is the base level
(knowledge acquisition).
o C is incorrect: Application of knowledge is
intermediate, applying facts to situations.
o D is incorrect: Outcome evaluation is assessing
results, not the integrative process.
2. On which tier of the Pyramid to Success would learning
pathophysiology and pharmacology best belong?
, A. Foundational thinking
B. Application of knowledge
C. Sound clinical judgment
D. Self-evaluation
Answer: A
Rationale:
o A is correct: Foundational thinking includes
acquisition of core nursing science and content.
o B is incorrect: Application of knowledge uses those
principles in practice.
o C is incorrect: Sound clinical judgment integrates
knowledge and experience.
o D is incorrect: Self-evaluation is reflecting on one’s
performance.
3. A student uses practice questions to identify gaps in
content mastery. This best represents which Pyramid
level?
A. Application of knowledge
B. Outcome evaluation
C. Self-evaluation
D. Foundational thinking
Answer: C
Rationale:
, o C is correct: Self-evaluation is reflecting on strengths
and weaknesses to guide study.
o A is incorrect: Application is practicing knowledge
use, not reflecting on deficits.
o B is incorrect: Outcome evaluation reviews patient
results, not study progress.
o D is incorrect: Foundational is content learning, not
gap analysis.
4. Integrating case studies into review sessions primarily
enhances which level of the Pyramid?
A. Foundational thinking
B. Application of knowledge
C. Sound clinical judgment
D. Outcome evaluation
Answer: B
Rationale:
o B is correct: Case studies facilitate applying
knowledge to clinical scenarios.
o A is incorrect: Foundational is pure knowledge
accumulation.
o C is incorrect: Judgment integration is more advanced
than case practice.
o D is incorrect: Outcome evaluation focuses on
evaluating care results.
,5. Which study strategy best promotes development of
sound clinical judgment?
A. Memorizing drug side effects
B. Repeating flashcards of lab values
C. Simulating patient care scenarios
D. Writing definitions in a notebook
Answer: C
Rationale:
o C is correct: Simulations engage integration of
knowledge, experience, and critical thinking.
o A and B are incorrect: These build foundational
knowledge but not judgment.
o D is incorrect: Writing definitions is rote
memorization, not judgment development.
6. A nurse uses reflective journaling after practice exams to
identify thinking errors. What Pyramid component is
this?
A. Outcome evaluation
B. Application of knowledge
C. Self-evaluation
D. Foundational thinking
Answer: C
Rationale:
, o C is correct: Reflective journaling is self-assessment to
improve performance.
o A is incorrect: Outcome evaluation concerns patient
outcomes.
o B is incorrect: Application is practice of content.
o D is incorrect: Foundational is knowledge gathering.
7. Which describes the purpose of the Pyramid’s Outcome
Evaluation level?
A. Assessing patient care results to refine judgment
B. Testing foundational knowledge with flashcards
C. Applying theory in simulated settings
D. Reflecting on test-taking skills only
Answer: A
Rationale:
o A is correct: Outcome evaluation involves analyzing
clinical results to improve care.
o B is incorrect: Flashcards address foundational
knowledge.
o C is incorrect: Simulation is application, not outcome
review.
o D is incorrect: Outcome evaluation is broader,
covering clinical outcomes.
Chapter-by-Chapter MCQs with Verified
Answers and 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
– 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).
Subtopic 1: The Pyramid to Success
1. A newly graduated nurse is preparing to study for the
NCLEX. Which level of the Pyramid to Success focuses on
integrating knowledge, experience, and intuition into
decision-making?
A. Foundational thinking
B. Sound clinical judgment
C. Application of knowledge
D. Outcome evaluation
Answer: B
Rationale:
o B is correct: Sound clinical judgment represents the
apex where knowledge, experience, and intuition
combine to guide safe care.
o A is incorrect: Foundational thinking is the base level
(knowledge acquisition).
o C is incorrect: Application of knowledge is
intermediate, applying facts to situations.
o D is incorrect: Outcome evaluation is assessing
results, not the integrative process.
2. On which tier of the Pyramid to Success would learning
pathophysiology and pharmacology best belong?
, A. Foundational thinking
B. Application of knowledge
C. Sound clinical judgment
D. Self-evaluation
Answer: A
Rationale:
o A is correct: Foundational thinking includes
acquisition of core nursing science and content.
o B is incorrect: Application of knowledge uses those
principles in practice.
o C is incorrect: Sound clinical judgment integrates
knowledge and experience.
o D is incorrect: Self-evaluation is reflecting on one’s
performance.
3. A student uses practice questions to identify gaps in
content mastery. This best represents which Pyramid
level?
A. Application of knowledge
B. Outcome evaluation
C. Self-evaluation
D. Foundational thinking
Answer: C
Rationale:
, o C is correct: Self-evaluation is reflecting on strengths
and weaknesses to guide study.
o A is incorrect: Application is practicing knowledge
use, not reflecting on deficits.
o B is incorrect: Outcome evaluation reviews patient
results, not study progress.
o D is incorrect: Foundational is content learning, not
gap analysis.
4. Integrating case studies into review sessions primarily
enhances which level of the Pyramid?
A. Foundational thinking
B. Application of knowledge
C. Sound clinical judgment
D. Outcome evaluation
Answer: B
Rationale:
o B is correct: Case studies facilitate applying
knowledge to clinical scenarios.
o A is incorrect: Foundational is pure knowledge
accumulation.
o C is incorrect: Judgment integration is more advanced
than case practice.
o D is incorrect: Outcome evaluation focuses on
evaluating care results.
,5. Which study strategy best promotes development of
sound clinical judgment?
A. Memorizing drug side effects
B. Repeating flashcards of lab values
C. Simulating patient care scenarios
D. Writing definitions in a notebook
Answer: C
Rationale:
o C is correct: Simulations engage integration of
knowledge, experience, and critical thinking.
o A and B are incorrect: These build foundational
knowledge but not judgment.
o D is incorrect: Writing definitions is rote
memorization, not judgment development.
6. A nurse uses reflective journaling after practice exams to
identify thinking errors. What Pyramid component is
this?
A. Outcome evaluation
B. Application of knowledge
C. Self-evaluation
D. Foundational thinking
Answer: C
Rationale:
, o C is correct: Reflective journaling is self-assessment to
improve performance.
o A is incorrect: Outcome evaluation concerns patient
outcomes.
o B is incorrect: Application is practice of content.
o D is incorrect: Foundational is knowledge gathering.
7. Which describes the purpose of the Pyramid’s Outcome
Evaluation level?
A. Assessing patient care results to refine judgment
B. Testing foundational knowledge with flashcards
C. Applying theory in simulated settings
D. Reflecting on test-taking skills only
Answer: A
Rationale:
o A is correct: Outcome evaluation involves analyzing
clinical results to improve care.
o B is incorrect: Flashcards address foundational
knowledge.
o C is incorrect: Simulation is application, not outcome
review.
o D is incorrect: Outcome evaluation is broader,
covering clinical outcomes.
