Detailed Review and Analysis of Saunders Comprehensive Review for the NCLEX-RN


Why It's the Best Comprehensive NCLEX Book

Book: Saunders Comprehensive Review for the NCLEX-RN (7th Edition)

Author: Linda Anne Silvestri, PhD, RN

ISBN: 9780323358514

Pub. Date: September 2, 2016

Saunders Comprehensive was my pick as the best comprehensive NCLEX book for these reasons:

Pro: It has the most detailed coverage of nursing knowledge out of any other book.

Pro: The formatting, illustrations, and structure help make this book eaily readable.

Pro: If you buy new, the online area is excellent and well worth it.

It does have drawbacks:

Con: There is so much information, it can make you feel overwhelmed, and a lot of the detailed information is unlikely to show up on your NCLEX exam.

Con: The practice questions in the book are very focused on content and not as high quality as other books.

Verdict: With its detailed content and good readability, Saunders Comprehensive Review is my recommendation for most nursing students.

In most cases, if you went to decent school in the U.S. and recently graduated, Saunders would be a great reference book as you study the NCLEX.

Instead of reading through it line by line, reference it as you study your way through the NCLEX Test Plan - I describe how best to study for the NCLEX here.

However, it's a different story if any of these apply to you:

  • Graduation Date: You graduated from nursing school more than 6 months ago.
  • School Location: You were educated outside of the U.S.
  • School Quality: Graduated from a low-performing nursing school (NCLEX pass rate less than 85%)
  • Repeat Test Taker: If this is not your first NCLEX attempt.
  • Confidence Level: If you feel you haven't retained enough information from nursing school.

The more of those things apply to you, the more useful Saunders will be, since it can help you restore your basic knowledge of nursing content.

So read on and I will tell you a lot more about this very thorough book!

NCLEX Introduction, Study and Strategy

Same as every book, Saunders begins with an introduction to the NCLEX and to basic concepts.

In chapter 1, it reviews (very briefly) the cognitive level of the NCLEX, each of the 8 subcategories on the NCLEX, and each type of alternate format question type on the NCLEX.

There are plenty of examples, but here's the thing:

I just didn't find it as easy to digest, nor as helpful as Kaplan's introduction.

It's just not one of Saunder's strengths.

The chapter reads like a textbook: dry and uninviting.

In chapter 2, Saunders takes an interesting direction:

It's a very detailed plan for staying holistically healthy, keeping sight of your goals, and keeping your motivation high as you prepare for the NCLEX.

When I say detailed, I mean detailed:

It talks about stuff like staying properly hydrated, choosing your study area, making a list, even planning a test drive to the testing center!

There is also a section on "positive pampering."

Anyways, if you've had a lot of setbacks on your NCLEX journey, Saunders tries to address that.

This just reinforces what I truly believe:

Saunders Comprehensive is for students who have had trouble with the NCLEX or have a weak nursing foundation...students who need that extra support.

So, moving on...

Chapter 4: Test Taking Strategies delivers on its promise. It's only about 8 pages long, but each page is a literal wall of text.

There is a lot of information here - but to me it really wasn't easy to read.

A lot of it was just listing obvious stuff, like this:

In multiple-choice questions, multiple-response questions, or questions that require you to arrange nursing interventions or other data in order of priority, read every choice or option presented before answering."

Or repetitive, like this point in "ingredients of a question:"

In a multiple choice question, there will be options and you must select one; read every option carefully and think about the event and the event query as you use the process of elimination."

Don't get me wrong:

There were a lot of useful points here, but Saunders just doesn't describe and develop these concepts as well as Kaplan's book.

In any case, this was not surprising to me, since Saunders' strength really is in its quantity of content. So let's talk about that!

Nursing Content Coverage

Honestly, there's not much to say...but there's a lot I can show.

Now begins a whopping 1000 pages of nursing knowledge.

I'll just highlight some things Saunders does to try to help you process all this information.

Outline Format: Saunders presents this information in outline format. If you're not familiar, this is what it looks like:

List Boxes: Saunders has boxes almost on every page that lists things in a really easy to digest way. I like these!

Critical Thinking Q&A: Saunders has purple boxes that ask an open-ended critical thinking question (usually near the beginning of each section). They then reveal the answer later in the chapter.

Focus on Priority: Saunders has yellow boxes that focus on concepts having to do with priority: triage, choosing which patient to assess first, responding to infection, etc.

Colorful Illustrations and Diagrams: There are plenty of pictures to break up the monotony and help you understand concepts. This is a plus!

For all those reasons, I really like Saunders' presentation of the thousands of facts contained in this book.

Even though there is SO much, the formatting really helps to make it manageable.

That's really all I can think to show you about this section - the rest of the book delivers on Saunders Review's promise of being a very complete review of nursing knowledge..

Quality of the NCLEX Practice Questions

NCLEX Question Difficulty

Difficulty of NCLEX Questions: (Higher % = Higher Difficulty)
Percent I got Wrong 32%

When I sampled 100 questions from this book, I got 32% of them wrong, and the rest correct.

This is a bit on the easier side, though not by much compared to other books if you just look at the percentage.

However, there is one caveat:

I did these questions without reviewing the actual content beforehand, so in fact if I did, I would have gotten even more correct.

Key Takeaway:All in all, the questions are pretty easy and I wouldn't use them as your only source of practice questions for the NCLEX.

NCLEX Question Focus

NCLEX Question Focus:
Nursing Content 54%
Nursing Judgment 36%
Both 20%
Question Focus Rating

Saunders Comprehensive did not really have a balanced focus when it came to its questions.

To be specific, it had 54% content questions, 26% judgment questions, and only 20% questions that required both to get the answer.

This isn't surprising, since its questions are actually meant to test whether you retained the content you read chapter by chapter.

The problem is...

...the NCLEX isn't really like that. The questions on the NCLEX have a lot more judgment required to get them right.

Key Takeaway: Again, don't rely on Saunder's questions to prepare you for the NCLEX. They are useful to reinforce the content taught in the book, however.

As a reminder, my definition of each focus type are as follows:

  • Nursing Content: Requires knowledge of physiology, laboratory, pharmacology, pathophysiology, nursing procedural knowledge, cultural knowledge, or any other medical/nursing factual knowledge/comprehension (above and beyond layman’s knowledge) to answer the question correctly. Good for studying, but can lack dimension and won’t really improve critical thinking or nursing principles.
  • Nursing Judgment: Requires critical thinking, test strategy, or application of nursing principles (least invasive intervention, prioritization, nursing process, health promotion, compliance, ABC’s, delegation principles, legal principles, safety and infection control, therapeutic communication, cultural principles) to answer the question correctly. Good for practice and honing nursing judgment, though will not help with highlighting content weaknesses.
  • Both: Requires both of the above to answer the question correctly. Highly desirable!

NCLEX Question Cognitive Level

Cognitive Level of NCLEX Questions:
Bad Questions 1%
Knowledge 6%
Comprehension 5%
Application or Above 88%
Cognitive Level Rating

Saunders had a generally good mix of cognitive levels.

I found only 1% of bad questions and 11% of the questions were below application level. The rest passed!

Only one book, Kaplan's NCLEX Prep Plus, had a better score.

Key Takeaway: Saunders scores well in this area, but Kaplan is still the clear winner.

As a reminder, here are Bloom's Taxonomy's cognitive levels, plus one I added:

  • Bad Question: This is actually not a Bloom's Taxonomy level. It's when I run across an NCLEX question that's so bad, I have to deduct points from the book somehow. Sometimes its just a wacky topic that no nursing student should expect to know. Other times it's conflicting answers and rationales, or something that's just plain wrong.
  • Knowledge: This is an NCLEX question that only requires you to remember a fact to get it correct. Low cognitive level.
  • Comprehension: This is an NCLEX question that requires you to understand the definition of something or be able to describe something. Also a low cognitive level.
  • Application: These questions require you to use you existing knowledge in NEW situations. These are the winners!


The rationales in this book aren't bad.

Here's an example:

Online Materials

I must say...


Saunders worked really hard to make their online area very useful for students

There's two parts to it:

  • 46 "Animation" videos showing digital animations of body systems, processes, procedures, etc.
  • A program with 5142 NCLEX questions.

The part that really impressed me was the 5142 NCLEX questions.

Not the quantity - though that part is nice.

Here's what really got me:

Saunders categorized each question so well, it's extremely easy to study and practice very specific areas!

For example, you can choose between 12 NCLEX "strategies" and target them one by one:

Or, if you've failed the NCLEX before, you can use the Candidate Performance Report, then use this program to home in on the subcategories you were below the passing standard on.

OR, yet again, you can filter out just all the Select All That Apply questions, for example (they have 562, take a look).

It gets even more specific than that too. I can't even get a screenshot of it, there is such a long list.

Key Takeaway: Get Saunder's Comprehensive Review New rather than Used so you can get the online materials.

Saunders meticulously organized their online question bank to make it extremely easy to target weaknesses and subject areas where you feel you need extra practice. The quantity of the questions included in this bank also make this extremely worth it!

Specifications and Analysis Overview

Overall, Saunders is an excellent content review book, though other books fill other important niches:

I'd say Kaplan has a lot better strategy review, and LaCharity's book has the best NCLEX questions.

But if you feel like your nursing foundation is weak, this book is a must have.

To recap, here's why:

  • You will have a very thorough knowledge base because of how detailed this book is.
  • It's well-formatted and easy to work through.
  • Finally, the online area seems tailor-made to help students struggling with certain areas.

I do recommend this book for most nursing students as a great reference text to use with the Detailed NCLEX Test Plan. Learn more about self-studying using the NCLEX test plan.

But if you don't mind perusing your old textbooks from nursing school, those would do just as well.

I hope this review helped you!

Saunders Comprehensive Review
Verdict: Best Comprehensive
Kevin's Overall Rating (4.0)
Number of Pages 1133 pages
Number of NCLEX Questions Included... Book 996
...Online 5142
Difficulty of NCLEX Questions: (Higher % = Higher Difficulty)
Percent I got Wrong 32%
NCLEX Question Focus:
Nursing Content 54%
Nursing Judgment 36%
Both 20%
Question Focus Rating
Cognitive Level of NCLEX Questions:
Bad Questions 1%
Knowledge 6%
Comprehension 5%
Application or Above 88%
Cognitive Level Rating
NCLEX Content Coverage
Follows NCLEX-RN Detailed Test Plan, Educator's Version No
Avg New $58.15
Avg Used $48.60

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took the NCLEX-RN
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Review for: Saunders Comprehensive Guide to the NCLEX

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I graduated in May of 2013 with my BSN and sat for my NCLEX about 3-4 weeks after graduation, I used a very well know review course to prepare for my NCLEX but I also used more books than I thought possible to try and study as well. I bought both saunders review books and used them more during my final semester and to study for HESI more than for NCLEX after graduation. I was drawn to saunders because they offered practice questions along with rationals and content review, so you are able to answe practice questions whcih are fairly similiar to NCLEX questions, see the rational for the correct and incorrect answers as well as look up and review content that you may not be as strong on. I liked this because it was broken into subjects/content areas so I was able to focus more on the cardiac section and spend more time on it becuase it was one of my weaker areas where Peds/OB was one of my stronger areas so I didn't spend as much time on that. The downside to that is that in NCLEX the subjects are broken up rather mixed together so you never know what you are going to get. I liked using the saunders books for HESI and my final semesters of school versus the actual NCLEX itself. The book is very user friendly and does come with a CD with more practice questions. The price for the book wasn't bad and I was able to sell it to a student a semester below me after I was done with it so I did feel like I got my monies worth out of the book.

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