UNIT I
NCLEX-RN® Exam Preparation
44
,CHAPTER 1
The NCLEX-RN® Examination
http://evolve.elsevier.com/Silvestri/comprehensiveRN/
The Pyramid to Success
Saunders Comprehensive Review for the NCLEX-
RN® Examination
About This Resource and the NCLEX-RN® Examination
Welcome to the Pyramid to Success and Saunders Comprehensive Review for the NCLEX-
RN® Examination. This resource is specially designed to help you begin your
successful journey to the peak of the pyramid, becoming a registered nurse. As you
begin your journey, you will be introduced to all of the important points regarding
the NCLEX-RN examination and the process of testing, and to unique and special
tips regarding how to prepare yourself for this important examination. You will read
what a nursing graduate who recently passed the NCLEX-RN examination has to
say about the test. Important test-taking strategies are detailed. These details will
guide you in selecting the correct option or assist you in making an educated guess if
you are not entirely sure about the correct answer. Each unit in this book begins with
the Pyramid to Success. The Pyramid to Success addresses specific points related to
the NCLEX-RN examination. Client Needs as identified in the test plan framework
for the examination are listed, as are learning objectives for the unit. Pyramid Terms
are key words that are defined in the glossary at the end of the book and set in color
throughout each chapter to direct your attention to significant points for the
examination.
This resource provides you with nursing content review, including the content
identified in the current NCLEX test plan, and practice questions. Throughout each
chapter, you will find Pyramid Point bullets that identify areas most likely to be
tested on the NCLEX-RN examination. Read each chapter, and identify your
strengths and areas that are in need of further review.
The book contains 945 NCLEX-style questions. The Evolve site accompanying this
book contains all of the questions from the book plus additional Evolve questions for
a total of more than 5200 practice questions. The types of practice questions include
multiple choice; fill-in-the-blank; multiple-response; ordered-response (also known
as drag and drop); questions that contain a figure, chart/exhibit, or graphic option
item; audio or video item formats; and case studies (testlets). In addition, the new
Next Generation NCLEX® (NGN) question types are also provided on the
accompanying Evolve site. Examples of question types can be located throughout
this chapter.
Test your strengths and abilities by taking all practice tests provided in this book
and on the accompanying Evolve site. Be sure to read all rationales and test-taking
45
,strategies. The rationale provides you with significant information regarding the
correct and incorrect options. The test-taking strategy provides you with the logical
path to selecting the correct option. reference source and page number are provided
so that you can easily find information you need to review in another Elsevier text.
You may also review in the content review sections of this book. Each question in the
book and on the accompanying Evolve site is coded on the basis of the Level of
Cognitive Ability, the Client Needs category, the Integrated Process, Content Area
being tested, and a Health Problem, if applicable. The Health Problem code allows
you to filter and select questions based on a disease process. For example, if heart
failure is the area of interest, you can select “Adult Health, Cardiovascular, Heart
Failure” on the Evolve site. In addition, two Priority Concepts that relate to the
content of the question are identified. This code is helpful for students specifically
whose curriculum is concept-based. Additionally, information about all of the
special features of this resource and the question types is located in the preface of
this book.
Other Resources in the Saunders Pyramid to Success
There are several other resources in the Saunders Pyramid to Success program.
These include the following: The Saunders Q&A Review for the NCLEX-RN®
Examination, The HESI/Saunders Online Review for the NCLEX-RN® Examination,
Saunders Strategies for Test Success: Passing Nursing School and the NCLEX® Exam,
Saunders Q&A Review Cards for the NCLEX-RN® Exam, and Saunders RNtertainment
for the NCLEX-RN® Exam.
All of these resources in the Saunders Pyramid to Success are described in the
preface of this book and can be obtained online by visiting http://elsevierhealth.com
or by calling 800-545-2522.
Let’s begin our journey through the Pyramid to Success.
Examination Process
An important step in the Pyramid to Success is to become as familiar as possible
with the examination process. Candidates facing the challenge of this examination
can experience significant anxiety. 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. The information contained in this chapter was obtained
from the NCSBN Web site (www.ncsbn.org) and from the NCSBN 2019 test plan for
the NCLEX-RN and includes some procedures related to registering for the exam,
testing procedures, and the answers to the questions most commonly asked by
nursing students and graduates preparing to take the NCLEX. You can obtain
additional information regarding the test and its development by accessing the
NCSBN Web site and clicking on the NCLEX Exam tab or by writing to the National
Council of State Boards of Nursing, 111 East Wacker Drive, Suite 2900, Chicago, IL
60601. You are encouraged to access the NCSBN Web site, because this site provides
you with the most up-to-date and valuable information about the NCLEX and other
resources available to an NCLEX candidate. You are also encouraged to access the
most up-to-date Candidate Bulletin. This document provides you with everything you
need to know about registration procedures and scheduling a test date.
46
, Computer Adaptive Testing
The acronym CAT stands for computer adaptive test, which means that the
examination is created as the test-taker answers each question. All the test questions
are categorized on the basis of the test plan structure and the level of difficulty of the
question. As you answer a question, the computer determines your competency
based on the answer you selected. If you selected a correct answer, the computer
scans the question bank and selects a more difficult question. If you selected an
incorrect answer, the computer scans the question bank and selects an easier
question. This process continues until all test plan requirements are met and a
reliable pass-or-fail decision is made.
When taking a CAT, once an answer is recorded, all subsequent questions
administered depend, to an extent, on the answer selected for that question.
Skipping and returning to earlier questions are not compatible with the logical
methodology of a CAT. The inability to skip questions or go back to change previous
answers will not be a disadvantage to you; you will not fall into that “trap” of
changing a correct answer to an incorrect one with the CAT system.
If you are faced with a question that contains unfamiliar content, you may need to
guess at the answer. There is no penalty for guessing, but you need to make an
educated guess. With most of the questions, the answer will be right there in front of
you. If you need to guess, use your nursing knowledge and clinical experiences to
their fullest extent and all of the test-taking strategies you have practiced in this
review program.
You do not need any computer experience to take this examination. A keyboard
tutorial is provided and administered to all test-takers at the start of the
examination. The tutorial will instruct you on the use of the on-screen optional
calculator, the use of the mouse, and how to record an answer. The tutorial provides
instructions on how to respond to all question types on this examination. This
tutorial is also provided on the NCSBN Web site, and you are encouraged to view
the tutorial when you are preparing for the NCLEX examination. In addition, at the
testing site, a test administrator is present to assist in explaining the use of the
computer to ensure your full understanding of how to proceed.
Development of the Test Plan
The test plan for the NCLEX-RN examination is developed by the NCSBN. The
examination is a national examination; the NCSBN considers the legal scope of
nursing practice as governed by state laws and regulations, including the Nurse
Practice Act, and uses these laws to define the areas on the examination that will
assess the competence of the test-taker for licensure.
The NCSBN also conducts an important study every 3 years, known as a practice
analysis study, that is conducted to link the examination to nursing practice. The
results of this study determine the framework for the test plan for the examination.
The participants in this study include newly licensed registered nurses from all types
of generalist nursing education programs. From a list of nursing care activities
(activity statements) provided, the participants are asked about the applicability,
frequency, and importance of performing these activities in relation to client safety.
A panel of content experts at the NCSBN analyzes the results of the study and makes
47
NCLEX-RN® Exam Preparation
44
,CHAPTER 1
The NCLEX-RN® Examination
http://evolve.elsevier.com/Silvestri/comprehensiveRN/
The Pyramid to Success
Saunders Comprehensive Review for the NCLEX-
RN® Examination
About This Resource and the NCLEX-RN® Examination
Welcome to the Pyramid to Success and Saunders Comprehensive Review for the NCLEX-
RN® Examination. This resource is specially designed to help you begin your
successful journey to the peak of the pyramid, becoming a registered nurse. As you
begin your journey, you will be introduced to all of the important points regarding
the NCLEX-RN examination and the process of testing, and to unique and special
tips regarding how to prepare yourself for this important examination. You will read
what a nursing graduate who recently passed the NCLEX-RN examination has to
say about the test. Important test-taking strategies are detailed. These details will
guide you in selecting the correct option or assist you in making an educated guess if
you are not entirely sure about the correct answer. Each unit in this book begins with
the Pyramid to Success. The Pyramid to Success addresses specific points related to
the NCLEX-RN examination. Client Needs as identified in the test plan framework
for the examination are listed, as are learning objectives for the unit. Pyramid Terms
are key words that are defined in the glossary at the end of the book and set in color
throughout each chapter to direct your attention to significant points for the
examination.
This resource provides you with nursing content review, including the content
identified in the current NCLEX test plan, and practice questions. Throughout each
chapter, you will find Pyramid Point bullets that identify areas most likely to be
tested on the NCLEX-RN examination. Read each chapter, and identify your
strengths and areas that are in need of further review.
The book contains 945 NCLEX-style questions. The Evolve site accompanying this
book contains all of the questions from the book plus additional Evolve questions for
a total of more than 5200 practice questions. The types of practice questions include
multiple choice; fill-in-the-blank; multiple-response; ordered-response (also known
as drag and drop); questions that contain a figure, chart/exhibit, or graphic option
item; audio or video item formats; and case studies (testlets). In addition, the new
Next Generation NCLEX® (NGN) question types are also provided on the
accompanying Evolve site. Examples of question types can be located throughout
this chapter.
Test your strengths and abilities by taking all practice tests provided in this book
and on the accompanying Evolve site. Be sure to read all rationales and test-taking
45
,strategies. The rationale provides you with significant information regarding the
correct and incorrect options. The test-taking strategy provides you with the logical
path to selecting the correct option. reference source and page number are provided
so that you can easily find information you need to review in another Elsevier text.
You may also review in the content review sections of this book. Each question in the
book and on the accompanying Evolve site is coded on the basis of the Level of
Cognitive Ability, the Client Needs category, the Integrated Process, Content Area
being tested, and a Health Problem, if applicable. The Health Problem code allows
you to filter and select questions based on a disease process. For example, if heart
failure is the area of interest, you can select “Adult Health, Cardiovascular, Heart
Failure” on the Evolve site. In addition, two Priority Concepts that relate to the
content of the question are identified. This code is helpful for students specifically
whose curriculum is concept-based. Additionally, information about all of the
special features of this resource and the question types is located in the preface of
this book.
Other Resources in the Saunders Pyramid to Success
There are several other resources in the Saunders Pyramid to Success program.
These include the following: The Saunders Q&A Review for the NCLEX-RN®
Examination, The HESI/Saunders Online Review for the NCLEX-RN® Examination,
Saunders Strategies for Test Success: Passing Nursing School and the NCLEX® Exam,
Saunders Q&A Review Cards for the NCLEX-RN® Exam, and Saunders RNtertainment
for the NCLEX-RN® Exam.
All of these resources in the Saunders Pyramid to Success are described in the
preface of this book and can be obtained online by visiting http://elsevierhealth.com
or by calling 800-545-2522.
Let’s begin our journey through the Pyramid to Success.
Examination Process
An important step in the Pyramid to Success is to become as familiar as possible
with the examination process. Candidates facing the challenge of this examination
can experience significant anxiety. 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. The information contained in this chapter was obtained
from the NCSBN Web site (www.ncsbn.org) and from the NCSBN 2019 test plan for
the NCLEX-RN and includes some procedures related to registering for the exam,
testing procedures, and the answers to the questions most commonly asked by
nursing students and graduates preparing to take the NCLEX. You can obtain
additional information regarding the test and its development by accessing the
NCSBN Web site and clicking on the NCLEX Exam tab or by writing to the National
Council of State Boards of Nursing, 111 East Wacker Drive, Suite 2900, Chicago, IL
60601. You are encouraged to access the NCSBN Web site, because this site provides
you with the most up-to-date and valuable information about the NCLEX and other
resources available to an NCLEX candidate. You are also encouraged to access the
most up-to-date Candidate Bulletin. This document provides you with everything you
need to know about registration procedures and scheduling a test date.
46
, Computer Adaptive Testing
The acronym CAT stands for computer adaptive test, which means that the
examination is created as the test-taker answers each question. All the test questions
are categorized on the basis of the test plan structure and the level of difficulty of the
question. As you answer a question, the computer determines your competency
based on the answer you selected. If you selected a correct answer, the computer
scans the question bank and selects a more difficult question. If you selected an
incorrect answer, the computer scans the question bank and selects an easier
question. This process continues until all test plan requirements are met and a
reliable pass-or-fail decision is made.
When taking a CAT, once an answer is recorded, all subsequent questions
administered depend, to an extent, on the answer selected for that question.
Skipping and returning to earlier questions are not compatible with the logical
methodology of a CAT. The inability to skip questions or go back to change previous
answers will not be a disadvantage to you; you will not fall into that “trap” of
changing a correct answer to an incorrect one with the CAT system.
If you are faced with a question that contains unfamiliar content, you may need to
guess at the answer. There is no penalty for guessing, but you need to make an
educated guess. With most of the questions, the answer will be right there in front of
you. If you need to guess, use your nursing knowledge and clinical experiences to
their fullest extent and all of the test-taking strategies you have practiced in this
review program.
You do not need any computer experience to take this examination. A keyboard
tutorial is provided and administered to all test-takers at the start of the
examination. The tutorial will instruct you on the use of the on-screen optional
calculator, the use of the mouse, and how to record an answer. The tutorial provides
instructions on how to respond to all question types on this examination. This
tutorial is also provided on the NCSBN Web site, and you are encouraged to view
the tutorial when you are preparing for the NCLEX examination. In addition, at the
testing site, a test administrator is present to assist in explaining the use of the
computer to ensure your full understanding of how to proceed.
Development of the Test Plan
The test plan for the NCLEX-RN examination is developed by the NCSBN. The
examination is a national examination; the NCSBN considers the legal scope of
nursing practice as governed by state laws and regulations, including the Nurse
Practice Act, and uses these laws to define the areas on the examination that will
assess the competence of the test-taker for licensure.
The NCSBN also conducts an important study every 3 years, known as a practice
analysis study, that is conducted to link the examination to nursing practice. The
results of this study determine the framework for the test plan for the examination.
The participants in this study include newly licensed registered nurses from all types
of generalist nursing education programs. From a list of nursing care activities
(activity statements) provided, the participants are asked about the applicability,
frequency, and importance of performing these activities in relation to client safety.
A panel of content experts at the NCSBN analyzes the results of the study and makes
47
