NCLEX-RN® Test Bank | Saunders 9th Ed. | Silvestri & Silvestri | Updated 2025
TEST BANK
FOR
Saunders Comprehensive Review
for the NCLEX-RN® Examination
9th Edition
By Linda Anne Silvestri & Angela Silvestri
Complete Questions and Answers with Detailed Rationales
✅ 100 Questions 📋 Full Rationales 🎓 Updated 2025
PASS GUARANTEED | NCLEX-RN® Exam Prep
All NCLEX-RN® client need categories covered: Safe & Effective Care Environment | Health Promotion |
Psychosocial Integrity | Physiological Integrity
© 2025 | Pass Guaranteed | Updated 2025
,NCLEX-RN® Test Bank | Saunders 9th Ed. | Silvestri & Silvestri | Updated 2025
📖 HOW TO USE THIS TEST BANK
About This Test Bank
This comprehensive test bank is designed to accompany Saunders Comprehensive Review for the
NCLEX-RN® Examination, 9th Edition by Linda Anne Silvestri and Angela Silvestri. It covers all major
content areas tested on the NCLEX-RN® examination using the latest NCSBN test plan framework.
Study Strategy Guide
Step 1: Build Your Foundation
Complete all questions in each unit sequentially. Review the rationale for every question — both correct
and incorrect answers. Understanding WHY an answer is wrong is as important as knowing the right
answer.
Step 2: Apply the NCLEX-RN® Framework
Use the NCLEX-RN® priority frameworks when approaching questions: ABC (Airway, Breathing,
Circulation), Maslow's Hierarchy of Needs, and the Nursing Process (ADPIE). Safety and life-threatening
concerns always take priority.
Step 3: Focus on High-Yield Topics
Prioritize pharmacology (especially high-alert medications), fluid/electrolyte imbalances, acid-base
disorders, maternal-newborn complications, and psychiatric emergencies — these appear frequently on
the NCLEX-RN®.
Step 4: Practice Test-Taking Strategies
Eliminate obvious distractors first. When two answers seem similar, look for the ONE that is most
immediate, most critical, or addresses the root cause. Remember: assess before intervening (unless a
life-threatening situation demands immediate action).
NCLEX-RN® Client Need Category % of NCLEX-RN® Exam (2025)
Safe & Effective Care Environment 21–33%
Health Promotion & Maintenance 6–12%
Psychosocial Integrity 6–12%
Physiological Integrity 38–62%
© 2025 | Pass Guaranteed | Updated 2025
,NCLEX-RN® Test Bank | Saunders 9th Ed. | Silvestri & Silvestri | Updated 2025
UNIT 1: SAFE AND EFFECTIVE CARE ENVIRONMENT
Chapter 1: Prioritization, Delegation, and Assignment
1. A nurse is caring for four clients. Which client should the nurse assess first?
A. A client with stable angina who reports chest pressure rated 3/10
B. A postoperative client 2 hours post-appendectomy with a urine output of 20 mL/hour ✓
C. A client with COPD whose oxygen saturation is 91% on 2L nasal cannula
D. A client with type 2 diabetes whose fasting blood glucose is 180 mg/dL
Rationale: A urine output of 20 mL/hour (less than 30 mL/hr) indicates oliguria, a
potential sign of hypovolemia or renal failure post-surgery. This is an immediate life-
ANS: B
threatening concern requiring priority assessment. The other options represent stable or
expected findings.
2. Which task is appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP)?
A. Assessing a client's incision for signs of infection
B. Administering a nasogastric tube feeding to a stable client
C. Measuring and recording urine output for a client with a urinary catheter ✓
D. Performing a wound irrigation using sterile technique
Rationale: Measuring and recording urine output is a non-invasive, observational task
ANS: C that falls within the UAP scope of practice. Assessment, medication administration, and
sterile procedures require nursing licensure and cannot be delegated.
3. A charge nurse is making client assignments. Which client is most appropriate to assign to a
newly graduated nurse?
A. A client with septic shock requiring vasopressor titration
B. A client 1 day post-hip replacement who is ambulating with assistance ✓
C. A client with acute respiratory failure on mechanical ventilation
D. A client awaiting emergent cardiac catheterization
Rationale: A client who is 1 day post-hip replacement and ambulating is considered
ANS: B stable and appropriate for a newly licensed nurse. The other clients have complex,
unstable conditions requiring experienced nursing judgment.
4. The nurse receives a SBAR report about a client with a potassium level of 2.9 mEq/L. Which
intervention is the priority?
A. Document the finding and reassess in 2 hours
B. Notify the healthcare provider immediately
C. Encourage oral intake of potassium-rich foods
D. Place the client on a cardiac monitor and notify the provider ✓
© 2025 | Pass Guaranteed | Updated 2025
, NCLEX-RN® Test Bank | Saunders 9th Ed. | Silvestri & Silvestri | Updated 2025
Rationale: A potassium level of 2.9 mEq/L is hypokalemia and can cause life-
ANS: D threatening cardiac dysrhythmias. The nurse should place the client on a cardiac monitor
and notify the provider simultaneously per protocol.
5. When applying the ABC (Airway, Breathing, Circulation) prioritization model, which client takes
priority?
A. A client reporting pain 6/10 following knee surgery
B. A client with a new tracheostomy who is demonstrating respiratory stridor ✓
C. A client awaiting discharge instructions for hypertension management
D. A client with moderate confusion post-general anesthesia
Rationale: Stridor following tracheostomy indicates partial airway obstruction — an
ANS: B immediate life-threatening emergency. Airway takes highest priority in the ABC model.
The other clients have lower acuity needs.
Chapter 2: Infection Control and Standard Precautions
6. A nurse is caring for a client diagnosed with active pulmonary tuberculosis (TB). Which type of
isolation precautions should the nurse implement?
A. Contact precautions only
B. Droplet precautions
C. Airborne precautions ✓
D. Protective (reverse) isolation
Rationale: Tuberculosis is transmitted via airborne particles (droplet nuclei). Airborne
ANS: C precautions include a negative pressure room and N95 respirator. Droplet precautions
are for larger respiratory droplets and are insufficient for TB.
7. The nurse is caring for clients with various infections. Which client should be placed in a private
room with negative air pressure?
A. A client with Clostridium difficile (C. diff) diarrhea
B. A client with methicillin-resistant Staphylococcus aureus (MRSA) wound infection
C. A client with confirmed varicella (chickenpox) ✓
D. A client with influenza type A
Rationale: Varicella is transmitted via airborne route and requires a negative pressure
ANS: C room with airborne precautions. MRSA and C. diff require contact precautions. Influenza
requires droplet precautions (standard room).
8. A nurse sustains a needlestick injury after administering an injection to an HIV-positive client.
What is the priority nursing action?
© 2025 | Pass Guaranteed | Updated 2025
TEST BANK
FOR
Saunders Comprehensive Review
for the NCLEX-RN® Examination
9th Edition
By Linda Anne Silvestri & Angela Silvestri
Complete Questions and Answers with Detailed Rationales
✅ 100 Questions 📋 Full Rationales 🎓 Updated 2025
PASS GUARANTEED | NCLEX-RN® Exam Prep
All NCLEX-RN® client need categories covered: Safe & Effective Care Environment | Health Promotion |
Psychosocial Integrity | Physiological Integrity
© 2025 | Pass Guaranteed | Updated 2025
,NCLEX-RN® Test Bank | Saunders 9th Ed. | Silvestri & Silvestri | Updated 2025
📖 HOW TO USE THIS TEST BANK
About This Test Bank
This comprehensive test bank is designed to accompany Saunders Comprehensive Review for the
NCLEX-RN® Examination, 9th Edition by Linda Anne Silvestri and Angela Silvestri. It covers all major
content areas tested on the NCLEX-RN® examination using the latest NCSBN test plan framework.
Study Strategy Guide
Step 1: Build Your Foundation
Complete all questions in each unit sequentially. Review the rationale for every question — both correct
and incorrect answers. Understanding WHY an answer is wrong is as important as knowing the right
answer.
Step 2: Apply the NCLEX-RN® Framework
Use the NCLEX-RN® priority frameworks when approaching questions: ABC (Airway, Breathing,
Circulation), Maslow's Hierarchy of Needs, and the Nursing Process (ADPIE). Safety and life-threatening
concerns always take priority.
Step 3: Focus on High-Yield Topics
Prioritize pharmacology (especially high-alert medications), fluid/electrolyte imbalances, acid-base
disorders, maternal-newborn complications, and psychiatric emergencies — these appear frequently on
the NCLEX-RN®.
Step 4: Practice Test-Taking Strategies
Eliminate obvious distractors first. When two answers seem similar, look for the ONE that is most
immediate, most critical, or addresses the root cause. Remember: assess before intervening (unless a
life-threatening situation demands immediate action).
NCLEX-RN® Client Need Category % of NCLEX-RN® Exam (2025)
Safe & Effective Care Environment 21–33%
Health Promotion & Maintenance 6–12%
Psychosocial Integrity 6–12%
Physiological Integrity 38–62%
© 2025 | Pass Guaranteed | Updated 2025
,NCLEX-RN® Test Bank | Saunders 9th Ed. | Silvestri & Silvestri | Updated 2025
UNIT 1: SAFE AND EFFECTIVE CARE ENVIRONMENT
Chapter 1: Prioritization, Delegation, and Assignment
1. A nurse is caring for four clients. Which client should the nurse assess first?
A. A client with stable angina who reports chest pressure rated 3/10
B. A postoperative client 2 hours post-appendectomy with a urine output of 20 mL/hour ✓
C. A client with COPD whose oxygen saturation is 91% on 2L nasal cannula
D. A client with type 2 diabetes whose fasting blood glucose is 180 mg/dL
Rationale: A urine output of 20 mL/hour (less than 30 mL/hr) indicates oliguria, a
potential sign of hypovolemia or renal failure post-surgery. This is an immediate life-
ANS: B
threatening concern requiring priority assessment. The other options represent stable or
expected findings.
2. Which task is appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP)?
A. Assessing a client's incision for signs of infection
B. Administering a nasogastric tube feeding to a stable client
C. Measuring and recording urine output for a client with a urinary catheter ✓
D. Performing a wound irrigation using sterile technique
Rationale: Measuring and recording urine output is a non-invasive, observational task
ANS: C that falls within the UAP scope of practice. Assessment, medication administration, and
sterile procedures require nursing licensure and cannot be delegated.
3. A charge nurse is making client assignments. Which client is most appropriate to assign to a
newly graduated nurse?
A. A client with septic shock requiring vasopressor titration
B. A client 1 day post-hip replacement who is ambulating with assistance ✓
C. A client with acute respiratory failure on mechanical ventilation
D. A client awaiting emergent cardiac catheterization
Rationale: A client who is 1 day post-hip replacement and ambulating is considered
ANS: B stable and appropriate for a newly licensed nurse. The other clients have complex,
unstable conditions requiring experienced nursing judgment.
4. The nurse receives a SBAR report about a client with a potassium level of 2.9 mEq/L. Which
intervention is the priority?
A. Document the finding and reassess in 2 hours
B. Notify the healthcare provider immediately
C. Encourage oral intake of potassium-rich foods
D. Place the client on a cardiac monitor and notify the provider ✓
© 2025 | Pass Guaranteed | Updated 2025
, NCLEX-RN® Test Bank | Saunders 9th Ed. | Silvestri & Silvestri | Updated 2025
Rationale: A potassium level of 2.9 mEq/L is hypokalemia and can cause life-
ANS: D threatening cardiac dysrhythmias. The nurse should place the client on a cardiac monitor
and notify the provider simultaneously per protocol.
5. When applying the ABC (Airway, Breathing, Circulation) prioritization model, which client takes
priority?
A. A client reporting pain 6/10 following knee surgery
B. A client with a new tracheostomy who is demonstrating respiratory stridor ✓
C. A client awaiting discharge instructions for hypertension management
D. A client with moderate confusion post-general anesthesia
Rationale: Stridor following tracheostomy indicates partial airway obstruction — an
ANS: B immediate life-threatening emergency. Airway takes highest priority in the ABC model.
The other clients have lower acuity needs.
Chapter 2: Infection Control and Standard Precautions
6. A nurse is caring for a client diagnosed with active pulmonary tuberculosis (TB). Which type of
isolation precautions should the nurse implement?
A. Contact precautions only
B. Droplet precautions
C. Airborne precautions ✓
D. Protective (reverse) isolation
Rationale: Tuberculosis is transmitted via airborne particles (droplet nuclei). Airborne
ANS: C precautions include a negative pressure room and N95 respirator. Droplet precautions
are for larger respiratory droplets and are insufficient for TB.
7. The nurse is caring for clients with various infections. Which client should be placed in a private
room with negative air pressure?
A. A client with Clostridium difficile (C. diff) diarrhea
B. A client with methicillin-resistant Staphylococcus aureus (MRSA) wound infection
C. A client with confirmed varicella (chickenpox) ✓
D. A client with influenza type A
Rationale: Varicella is transmitted via airborne route and requires a negative pressure
ANS: C room with airborne precautions. MRSA and C. diff require contact precautions. Influenza
requires droplet precautions (standard room).
8. A nurse sustains a needlestick injury after administering an injection to an HIV-positive client.
What is the priority nursing action?
© 2025 | Pass Guaranteed | Updated 2025
