If you walked into any nursing school library in the last decade, the odds are decent you spotted at least one paperback brick on a shared table, dog-eared, sticky-noted, half-coffee-stained. Most likely it was Linda Anne Silvestri's Saunders Comprehensive Review for the NCLEX-RN Examination. The book has earned that wear-and-tear reputation honestly. Now in its 9th edition from Elsevier, the title sells more copies than any other single NCLEX prep resource on the market.
Saunders isn't a quick-hit flashcard system or a cram pamphlet. It's a 1,300-plus-page hybrid review book and question bank, paired with online Evolve access that adds thousands more practice items, audio reviews, and Next Generation NCLEX (NGN) case studies.
For many candidates it functions as the spine of a study plan rather than a supplement. You build everything else — flashcards, QBank subscriptions, study-group sessions, even your exam-day anxiety routine — around what Saunders teaches you in the first three weeks.
This guide walks through what the book actually contains, how to build a 4-to-6-week study plan around it, where it sits versus competitors like UWorld and Archer, and which edition or format (print, digital, used) makes the most sense for your situation. There's also a section on the PN equivalent, the companion Saunders Q&A Review, and the smaller NCLEX-RN Strategies book — three titles people mix up constantly.
One caveat up front. No single book passes the NCLEX for you. Saunders is the chassis. The engine is your NCLEX study plan and the hours of NCLEX-RN practice test work you log alongside it. Buy the book, yes. But also commit to the routine.
Linda Anne Silvestri started as a staff nurse, then moved into education, then started writing review materials for her own students because the available options frustrated her. The first edition of Saunders Comprehensive Review dropped in 1996. Elsevier picked it up and the rest is a long, steady climb through eight more editions.
Why mention this? Because authorship matters in NCLEX prep. Silvestri co-authors with Angela Silvestri, a nurse educator and researcher who specializes in test-item writing. The questions in Saunders read like NCSBN-style items rather than the awkward knock-offs you sometimes hit in cheaper review books. They follow Client Needs categories, integrate the nursing process, and rotate through SATA, ordered response, hot-spot, and the newer NGN bowtie and trend formats.
The result: a book your nursing faculty almost certainly knows, and very possibly recommends from day one. If you've seen the green-and-purple cover propped on a clinical instructor's desk, that wasn't an accident.
Authorship also explains why Saunders updates faster than some competitors. When the NCSBN announced the Next Generation NCLEX format shift in 2021, Elsevier had a fully revised 9th edition on shelves by mid-2022 — well before April 2023, when the new items went live on the actual exam. Smaller publishers were still scrambling six months later.
9th edition (2022): The current version. Adds full Next Generation NCLEX (NGN) coverage, including standalone case studies and the new item types that went live April 1, 2023. If you're testing in 2025 or later, this is the edition to buy.
8th edition (2019): Still useful for content review, but the NGN material is sparse. Skip unless you find one free.
7th and earlier: Outdated. Pharmacology dosages and policy citations don't reflect current practice.
The package splits cleanly into two halves: the print or e-book itself, and the online Evolve companion site. Both come with the purchase — there is no separate Evolve subscription to chase down. Your access lasts for one year from the activation date, which is plenty for almost any reasonable study window.
Inside the print volume you'll find a foundational review unit (test plan, item types, study habits), then content chapters organized by Client Needs category. Each chapter mixes prose, tables, bulleted high-yield points (called "Priority Concepts"), and end-of-chapter practice items with rationales. The print book alone contains roughly 2,400 questions.
The Evolve site adds another 2,800-plus questions. You can run them as study mode (item-by-item with feedback) or quiz mode (timed, full rationale at the end). Crucially, Evolve includes the audio review of pharmacology — a feature that students either ignore completely or build their entire commute around. Try it once. You'll know within ten minutes which group you're in.
The 9th edition also bundles the new NGN case-study generator. It walks you through the unfolding-case format, the matrix items, and the trend items that the NCSBN added in April 2023. Practicing these is non-negotiable — you cannot reason your way through them cold on test day.
A small but useful feature: every chapter ends with a short list of priority concepts. Think of these as the high-yield checklist for that body system or topic. If you only have 20 minutes to skim before clinical, the priority-concepts list is what you read.
Management of care plus safety and infection control — about 25–31% of NCLEX-RN.
Lifespan and prevention content — roughly 6–12% of the exam.
Mental health and coping — about 6–12% of the exam.
The single largest block — 38–62% combined across basic care, pharmacology, reduction of risk, and physiological adaptation.
Silvestri herself suggests 6–8 weeks of structured prep for most candidates. Real-world data from best NCLEX prep surveys lands closer to 4–6 weeks for well-prepared new grads and 8–12 weeks for repeat testers or those out of school for more than a year. The book is built to flex either way.
A workable 5-week pattern looks like this. Week one: read the introductory unit, take the pretest in Evolve, and identify your two weakest Client Needs categories. Weeks two through four: cover one chapter per day during weekdays, drill 75 practice questions per day, and review every rationale — including the rationales for questions you got right. Week five: full-length practice exams, NGN case studies, and targeted re-review of any topic you score below 65% on.
Two warnings. First, do not skip the rationales. Reading a rationale you already "knew" is what locks the reasoning in. Second, do not save NGN items for the last day. Train on them weekly so the format feels routine, not novel, when it counts.
Pace matters more than total hours. Two hours a day for six weeks beats six hours a day for two weeks — every single time. Sustained, mid-intensity practice consolidates memory better than marathon cram sessions, and you'll show up to Pearson VUE rested instead of fried.
Use the Evolve quiz mode to simulate exam conditions at least once a week. Set 75 questions, full time, no breaks. Score yourself afterward. Patterns will emerge by week three: maybe you bomb pharmacology when you're tired, or maybe SATA items are your weak point. Those patterns tell you exactly where to spend the next week's hours.
Best for: Content review and structured first-pass study. Strong if you want a single physical anchor for your prep and an audio companion for pharmacology.
Weaknesses: Questions tend to skew easier than the actual NCLEX. Many candidates pair Saunders content review with a harder QBank for the final two weeks.
Price: Around $70 new with one year of Evolve access included.
Best for: Question-bank training at the difficulty band of the real exam. Detailed rationales with picture-driven explanations.
Weaknesses: Thin on linear content review. You'll want a textbook or Saunders alongside it for foundational gaps.
Price: $129–$399 depending on subscription length. Compare options on the UWorld NCLEX review.
Best for: Predictive readiness assessments and a tight, repeatable QBank loop. Sells itself on "if you pass our readiness exam, you'll pass the NCLEX."
Weaknesses: Less polished content review than Saunders. Some users find the rationales thinner than UWorld's. See the Archer NCLEX writeup for details.
Price: $49–$199 by tier.
Silvestri co-wrote three other titles that often get confused with the comprehensive review. Knowing which one solves which problem saves money and shelf space.
Saunders Q&A Review for the NCLEX-RN. Pure practice questions, no content chapters. Roughly 6,000 items across the book and Evolve. Good as a second QBank in the final two weeks if the comprehensive review's questions started feeling stale. Skip it if you're already using UWorld or another QBank for that purpose.
Saunders Strategies for Test Success. A shorter book — about 500 pages — that focuses on test-taking strategy, item analysis, and prioritization rules. The math calculation chapter alone is worth the cover price. Useful for candidates who have the content but freeze on item structure.
Saunders Comprehensive Review for the NCLEX-PN. Same format as the RN version, mapped to the PN test plan. If you're sitting for the practical-nurse exam instead, this is the right book. The two are not interchangeable — pharmacology depth and scope-of-practice content differ. The NCLEX LPN practice questions guide covers the differences in more detail.
One title that gets recommended a lot but probably isn't on your radar: Saunders Comprehensive Review for the NCLEX-RN Examination — Elsevier eBook on VitalSource. Same content, delivered as a pure digital subscription. Cheaper than the print-plus-Evolve bundle if you genuinely don't want paper. Watch the listing details before you click buy — the bundles look almost identical online.
Saunders Comprehensive Review for the NCLEX-RN (9th edition) lists at $79.99 in print and $74.99 for the e-book. Realistic street prices land between $55 and $75 depending on retailer and season. Amazon, the Elsevier store, and large campus bookstores all carry it; Elsevier occasionally runs 15–20% promotions around the start of fall and spring semesters.
Used copies are tempting but risky. The Evolve access code inside a used book may already be activated, which leaves you with the print volume only and no online practice questions. If you go used, buy from a seller who guarantees an unused code or accept that you're paying about $30 for a 5,200-question book with about 2,400 actually accessible items.
The e-book is delivered via VitalSource or directly through Elsevier and gives you searchable text, highlighting, and side-by-side use with your Evolve account. Choose digital if you study on a tablet, mostly in coffee shops, or want full-text search. Choose print if you annotate heavily, study with a partner, or work better with a physical reference open on the desk.
Returns are restricted on both formats. Print copies must be in resale condition with the Evolve code still sealed; digital purchases are non-refundable once you activate. Decide before you buy whether you're truly going to use the resource, because Elsevier's return window does not cover "I changed my mind" scenarios.
The print-versus-digital debate around Saunders rarely focuses on the right tradeoff. It's not really about preference — it's about which study habit you can actually sustain for six weeks. If you've ever finished a long review session and realized you can't remember a single thing from the last hour, that's the real test.
Print readers retain more on first pass for dense content. That's not opinion — the cognitive-psychology research on linear reading is well-established. Print also lets you write directly on the page, which encodes information more deeply than typed notes. The downside is portability and search: you cannot ctrl-F a paper book at 11 p.m. when you need to confirm a potassium range.
Digital readers gain searchability, weight savings, and the ability to study off a phone in waiting rooms or on the bus. The tradeoff is shallower first-pass retention and the bottomless distraction of every other app on the device. If you go digital, treat your study tablet as a study tablet — turn off notifications, install a focus app, and don't open social media during sessions.
Best of both worlds? Some students buy the e-book for portability, then print specific chapters they're struggling with at the campus library. Cheaper than buying both editions, and you end up with a hand-annotated mini-binder of exactly the topics you actually needed paper for.
The NCLEX-PN is a separate exam with its own test plan. Saunders Comprehensive Review for the NCLEX-PN is the parallel title, structured the same way as the RN edition. It runs about 1,300 pages and ships with roughly 4,500 questions across the book and Evolve.
The PN edition cuts the deeper pharmacology and complex medical-surgical content that LPNs aren't tested on, and adds extended coverage of basic care, comfort, and supervised delegation. A common mistake: candidates buy the RN edition thinking it covers everything on the PN. It does not. The questions are harder than the PN exam in places and miss some PN-specific scope content entirely.
If you're already studying with the NCLEX PN practice test free resources, the PN-specific Saunders is the right paper companion — not the RN version.
For most candidates, no. Saunders is excellent as the content spine of a prep plan, but the consensus among recent test-takers is that you want a second, harder question bank — UWorld, Archer, or the Kaplan QBank — for the last 10–14 days before your test date. The Saunders questions get you to about 75% readiness; the harder QBank closes the last 15–20%.
If your budget is tight, prioritize Saunders 9th edition plus the cheapest readiness assessment you can find. If you have room, Saunders plus a 60-day UWorld subscription is the most common winning combination among the new grads who pass on the first attempt with sub-85-question results.
Worth saying out loud: the candidates who pass are not always the ones who studied the most. They're the ones who studied consistently. Saunders is engineered to support a consistent study habit. The book won't motivate you, but it will reward you the day you sit down and open it.
The single biggest mistake nursing students make with Saunders isn't picking the wrong edition or buying used. It's owning the book without using it. The cover gets photographed for a study group post. The pretest gets taken once. Then the brick sits on a desk for six weeks while the candidate alternates between TikTok review reels and panic.
Treat it like a textbook for a class you're paying tuition for. Open it most days. Write in it. Read the rationales out loud if that helps. Track which Client Needs categories you score below 65% on and re-read those chapters before you do another 75-question drill.
If you follow even a loose 5-week plan around the 9th edition and supplement with one harder QBank in the final fortnight, you'll walk into Pearson VUE having done the work. The exam can still bite — it bites everyone, even the candidates who finish in 75 questions — but Saunders done properly puts you on the right side of that bell curve.
Worth the $70. Worth the shelf space. Worth the late nights. Now go open it.
If you've already taken the NCLEX once and didn't pass, the 9th edition is still your best foundation for a second attempt. Use the diagnostic features in Evolve to identify the specific Client Needs categories where you slipped, then rebuild from there. Repeat testers benefit even more than first-timers from Saunders' structured chapter approach — the comprehensive review format helps you cover gaps you didn't realize you had.
And if you're somewhere in the middle — still in nursing school, planning ahead, eyeing graduation next semester — buying Saunders early and reading two chapters a week through your final year is one of the smartest moves you can make. By the time NCLEX prep starts in earnest, the book already feels familiar. That familiarity is worth a lot when you're under exam pressure.
For many candidates, yes — but the more reliable approach is Saunders plus a harder QBank like UWorld or Archer in the final two weeks. Saunders gives you content review and 5,200+ practice questions; the second QBank trains you on items at the actual NCLEX difficulty band.
The 9th edition (2022). It's the only edition with full Next Generation NCLEX (NGN) case studies and new item types that went live April 1, 2023. Older editions are cheaper but miss roughly 15% of current exam content.
Most new grads need 4–6 weeks of structured study, working through one or two chapters per day plus 75 practice questions. Repeat testers or candidates out of school for over a year often need 8–12 weeks.
One year of online access with about 2,800 additional practice questions beyond the book, audio pharmacology review, NGN case-study generator, and customizable quiz modes. Activation starts your 12-month clock, so don't activate the code until you're ready to study.
New is safer because the Evolve access code is guaranteed unused. Used copies often have already-activated codes, leaving you with print only. If you go used, buy from a seller who guarantees an unused code in writing.
Comprehensive Review is a content textbook plus practice questions — about 1,344 pages of review and 5,200+ items. Q&A Review is questions only, no content chapters, with roughly 6,000 items. Use Comprehensive Review as your primary book; add Q&A only if you need extra question volume late in prep.
Yes — Saunders Comprehensive Review for the NCLEX-PN Examination is the parallel title. It maps to the PN test plan and ships with about 4,500 questions. The RN and PN editions are not interchangeable. Buy the one that matches the exam you're taking.
Saunders is stronger on content review and is structured to be your primary study text. UWorld is stronger as a question bank at NCLEX-level difficulty with detailed rationales. Most successful candidates use both — Saunders for the first 3–4 weeks, then add UWorld for the last 2 weeks before the test.