Saunders Comprehensive Review for the NCLEX-RN Examination

1. Master the NCLEX-RN Exam Structure & Process

Knowing what the examination is all about and knowing what you will encounter during the process of testing will assist in alleviating fear and anxiety.

Understand the format. The NCLEX-RN is a Computer Adaptive Test (CAT), meaning the difficulty of questions adjusts based on your performance. It draws from a large pool of questions categorized by the Client Needs framework (Safe and Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, Physiological Integrity) and Integrated Processes (Caring, Communication, Nursing Process, etc.). The test plan is updated regularly based on practice analysis studies to reflect current nursing practice.

Know the logistics. Familiarize yourself with the registration process, including obtaining your Authorization to Test (ATT) form and scheduling your appointment. Arrive early on the day of the exam, bring required identification, and understand the testing center rules regarding personal belongings and breaks. Testing accommodations are available for those who qualify, but must be arranged in advance through the state board of nursing.

Computer adaptive testing. The CAT system aims to determine your competency level efficiently. It continues presenting questions until it is 95% certain you are above or below the passing standard, or until the maximum number of questions (265) or time (6 hours) is reached. You cannot skip questions or go back to change answers once submitted.

2. Embrace the Pyramid to Success Framework

Saunders Comprehensive Review for the NCLEX-RN® Examination is especially designed to help you with your successful journey to the peak of the Saunders Pyramid to Success: becoming a registered nurse!

Structured preparation journey. The "Pyramid to Success" framework outlines a step-by-step approach to preparing for the NCLEX-RN, using various Saunders resources. This book serves as a foundational step, providing comprehensive content review and practice questions aligned with the exam blueprint.

Building blocks for success. The pyramid suggests a logical progression through different types of study materials.

• Base: Test-taking strategies (covered in this book and a dedicated resource).
• Mid-levels: Comprehensive content review (this book) and extensive practice questions (Q&A review books/sites).
• Peak: Online review courses for integrated, interactive practice.

Holistic approach. The framework emphasizes not just content mastery but also developing effective test-taking skills and maintaining a positive mindset, recognizing that success on the NCLEX requires a multifaceted approach. It encourages using the resources in a way that builds upon each step, leading towards the ultimate goal of licensure.

3. Cultivate a Winning Mindset and Preparation Plan

A strong positive attitude, a structured plan for preparation, and maintaining control in your pathway to success ensure reaching the peak of the Pyramid to Success.

Mindset matters. Anxiety about the NCLEX is normal, but a strong positive attitude and belief in your ability to succeed are crucial for overcoming fear and maintaining control. Reflect on your past accomplishments and visualize your success as a registered nurse.

Strategic planning. Develop a realistic study plan and schedule that balances your personal and work obligations. Determine your preferred study environment (alone or group) and stick to your schedule consistently. Communicate your needs to family and friends to gain their support and minimize distractions.

Prioritize self-care. Maintaining physical and mental well-being is essential for sustained focus and positive momentum.

• Plan time for exercise and enjoyable activities.
• Establish healthy eating habits and stay hydrated.
• Ensure adequate rest and sleep.
• Engage in activities that provide positive mental stimulation.

Final preparation involves trusting your preparation, visualizing success, and allowing for rest before the exam day.

4. Conquer the NCLEX Test-Taking Strategies

Strategic words focus your attention on a critical point to consider when answering the question and will assist you in eliminating the incorrect options.

Beyond content knowledge. Success on the NCLEX requires not just knowing the material but also mastering test-taking strategies to analyze questions and select the best answer. These strategies help you navigate complex scenarios and prioritize nursing actions.

Key strategic approaches:

• Focus only on the data provided; avoid reading into the question.
• Identify strategic words (e.g., first, initial, priority, best) that indicate the need to prioritize or assess.
• Use the process of elimination by identifying comparable or alike options and eliminating options with closed-ended words (e.g., all, always, never).
• Look for umbrella options that encompass other choices.

Prioritization frameworks. Many questions require prioritizing care. Utilize established frameworks:

• ABCs (Airway, Breathing, Circulation) - Airway is always the first priority (except in CAB for CPR).
• Maslow's Hierarchy of Needs (Physiological needs first).
• The Nursing Process (Assessment is the first step).

Applying these strategies consistently, especially when practicing questions, is vital for improving performance and increasing confidence.

5. Navigate the Comprehensive Nursing Content Review

This text will provide you with a comprehensive review of all nursing content areas specifically related to the new 2019 test plan for the NCLEX-RN examination...

Exam blueprint coverage. The book is organized into units and chapters covering the breadth of nursing content tested on the NCLEX-RN, aligning with the Client Needs categories and Integrated Processes outlined in the test plan. This ensures a systematic review of essential knowledge.

Key content areas include:

• Professional Standards (Ethics, Legal, Prioritization)
• Foundations of Care (Fluids, Electrolytes, Acid-Base, Vital Signs, Nutrition, Safety, Calculations, Perioperative)
• Growth and Development
• Maternity and Pediatric Nursing
• Adult Health (covering all major body systems and associated problems)
• Mental Health
• Complex Care

Focused review. Each unit and chapter highlights key concepts, learning objectives, and important points (Pyramid Points, Pyramid Alerts) to guide your study and focus on content most likely to appear on the exam. This structure helps you identify areas of strength and those needing further review.

6. Prepare for Next Generation NCLEX (NGN) Questions

These new item types are intended to evaluate a candidate’s ability to utilize the dynamic skill of clinical judgment, rather than knowledge or recall alone.

Evolving exam format. The NCLEX is evolving to better assess clinical judgment, introducing new item types known as Next Generation NCLEX (NGN) questions. While some may currently be research items, practicing these formats is crucial for future readiness and developing essential critical thinking skills.

NGN item types include:

• Enhanced Multiple Response (Select all that apply from a longer list)
• Enhanced Hot Spots (Highlighting specific information in text or images)
• Extended Drag and Drop (Ordering steps or matching items)
• CLOZE items (Fill-in-the-blank using dropdown menus)
• Constructed Response (Short text answers)
• Matrix items (Categorizing information in a table)
• Case Studies (Testlets) with multiple questions related to a single client scenario.

Clinical judgment focus. These formats move beyond simple recall, requiring you to analyze client data, prioritize actions, and make clinical decisions based on complex information, mirroring real-world nursing practice. Practice with these types helps build the critical thinking skills necessary for safe and competent care.

7. Leverage Practice Questions and Rationales

While preparing for the NCLEX-RN examination, it is crucial for students to practice taking test questions.

Essential practice. The book and accompanying online resources provide a vast collection of NCLEX-style practice questions, including multiple-choice and various alternate item formats, totaling over 5200 questions online. Regularly taking these questions is vital for familiarizing yourself with the exam format and question styles.

Learn from mistakes. Each practice question includes a detailed rationale explaining why the correct answer is right and why the incorrect options are wrong. This is a powerful learning tool, helping you understand the underlying nursing principles and reinforce your knowledge.

Strategy application. Rationales also often include a specific test-taking strategy used to arrive at the correct answer. Reviewing these strategies in context helps you apply them effectively during the actual exam, especially when faced with challenging questions. Consistent practice with rationales is key to improving both content knowledge and test-taking skills.

8. Utilize the Book's Special Features and Online Resources

Saunders Pyramid to Success products provide you with everything that you need to ready yourself for the NCLEX-RN examination.

Enhanced learning tools. The book incorporates special features designed to highlight important information and aid in retention.

• Pyramid Terms: Bold green terms indicating important concepts.
• Priority Concepts: Two key concepts identified for each chapter.
• Pyramid Points: Bullet points highlighting content likely to be tested.
• Pyramid Alerts: Red text emphasizing critical nursing concepts.

Interactive online platform. The accompanying Evolve site offers valuable digital resources:

• A pretest to assess strengths and weaknesses and generate a personalized study calendar.
• Additional practice questions, including NGN item types.
• Audio and video questions.
• Case studies (Testlets).
• Audio review summaries for challenging topics like Pharmacology and Fluids/Electrolytes.

These features, combined with the comprehensive content and practice questions, provide a robust system for NCLEX preparation.

Last updated: May 11, 2025