Saudi Nursing Licensure Exam — Questions and Answers

Question 1: A patient is prescribed morphine for pain. Which side effect requires the most immediate intervention?

Drowsiness
Respiratory depression with rate <10 breaths/min (Correct answer)
Constipation
Nausea

Correct answer: Respiratory depression with rate <10 breaths/min

Respiratory depression is the most life-threatening opioid side effect. A respiratory rate below 10 breaths/min requires immediate intervention with naloxone (opioid antagonist) and supportive airway measures. Other side effects, while uncomfortable, are not immediately life-threatening.

Question 2: What is antibiotic stewardship?

A systematic approach to optimizing antibiotic selection, dose, and duration to improve outcomes and reduce resistance (Correct answer)
Using antibiotics only for viral infections
Limiting all antibiotic use
Prescribing the most expensive antibiotics available

Correct answer: A systematic approach to optimizing antibiotic selection, dose, and duration to improve outcomes and reduce resistance

Antibiotic stewardship programs (ASPs) promote appropriate antibiotic use: right drug, right dose, right duration, and right route. Goals include improving patient outcomes, preventing C. difficile, and reducing antibiotic resistance — a global health threat. Nurses play a key role in culture collection before antibiotic administration.

Question 3: A patient describes hearing voices that comment on their actions throughout the day. This is:

A delusion
A normal stress response
Auditory hallucinations — a positive symptom of schizophrenia (Correct answer)
Negative symptom of schizophrenia

Correct answer: Auditory hallucinations — a positive symptom of schizophrenia

Auditory hallucinations — hearing sounds, voices, or commands without an external stimulus — are positive (added) symptoms of schizophrenia. Running commentary type hallucinations are a classic first-rank (Schneiderian) symptom of schizophrenia.

Question 4: What is the correct compression-to-ventilation ratio for adult CPR?

5:1
30:2 (Correct answer)
15:1
15:2

Correct answer: 30:2

Current AHA/Saudi Heart Association guidelines: 30 chest compressions to 2 ventilations for adult CPR (single or two rescuers with advanced airway). Compressions should be at least 5 cm deep, at a rate of 100-120/min, with full chest recoil. Minimize interruptions (<10 seconds).

Question 5: What is the priority nursing intervention for a child in status epilepticus?

Ensure airway patency, place in side-lying position, protect from injury, administer benzodiazepines as ordered, and monitor oxygen saturation (Correct answer)
Restrain the child
Put something in the child's mouth
Leave the child alone until the seizure stops

Correct answer: Ensure airway patency, place in side-lying position, protect from injury, administer benzodiazepines as ordered, and monitor oxygen saturation

Status epilepticus (seizure >5 minutes) is a neurological emergency. Priority: maintain airway (suction as needed), position on side (prevents aspiration), protect from injury (padding), administer IV lorazepam/diazepam as ordered, monitor SpO2, and time the seizure duration.

Question 6: Which surface disinfectant is effective against C. difficile spores?

Iodine-based disinfectants
Hypochlorite (bleach) solution (Correct answer)
Isopropyl alcohol
Quaternary ammonium compounds

Correct answer: Hypochlorite (bleach) solution

C. difficile spores are extremely resistant. The CDC recommends EPA-registered sporicidal disinfectants, primarily diluted sodium hypochlorite (bleach, 1:10 dilution), for environmental cleaning in rooms of C. difficile patients. Alcohol and quaternary ammonium compounds are ineffective against spores.

Question 7: A nurse enters a patient's room and notices the patient is coughing with blood-tinged sputum and has not been put on isolation. What should the nurse do?

Initiate airborne precautions immediately, put on N95 mask, and notify the physician and infection control (Correct answer)
Continue care with standard precautions only
Wait for blood culture results before taking action
Simply open the window

Correct answer: Initiate airborne precautions immediately, put on N95 mask, and notify the physician and infection control

Hemoptysis with respiratory symptoms raises the concern of active pulmonary TB or other airborne pathogen. Precautions should be initiated based on clinical suspicion rather than waiting for culture results. Early isolation prevents nosocomial transmission.

Question 8: Which nursing intervention is most important in caring for a patient with active psychosis?

Establish a calm, consistent, trusting relationship and maintain reality orientation (Correct answer)
Isolate the patient from all social contact
Engage in lengthy discussions about the content of delusions
Agree with the patient's delusional beliefs to reduce distress

Correct answer: Establish a calm, consistent, trusting relationship and maintain reality orientation

A consistent, trustworthy therapeutic relationship is the foundation of psychiatric nursing. Engaging in the content of delusions reinforces them; isolation increases paranoia. Brief, clear, reality-oriented communication in a calm environment is most therapeutic.

Question 9: What is the primary concern when administering IV aminophylline?

Renal failure
Respiratory depression
Severe hypoglycemia
Cardiac arrhythmias and seizures from rapid administration (Correct answer)

Correct answer: Cardiac arrhythmias and seizures from rapid administration

Aminophylline (theophylline) has a narrow therapeutic index. Rapid IV administration can cause severe cardiac arrhythmias (tachycardia, ventricular arrhythmias) and seizures due to CNS stimulation. It must be given as a slow infusion with cardiac monitoring and serum level monitoring.

Question 10: A nurse working in a surgical unit in Jeddah is preparing a patient for an elective cholecystectomy. Which of the following actions is a mandatory part of the pre-operative verification process according to the surgical safety checklist endorsed by the Saudi Ministry of Health?

Ensuring the patient has arranged for post-discharge transportation.
Administering a prophylactic dose of a broad-spectrum antibiotic 4 hours before incision.
Verifying that the patient's family members are present in the waiting area.
Confirming the patient’s identity, procedure, site, and consent. (Correct answer)

Correct answer: Confirming the patient’s identity, procedure, site, and consent.

The Saudi Ministry of Health, in alignment with international standards like the WHO Surgical Safety Checklist, mandates a 'Sign In' phase before the induction of anaesthesia. A critical component of this phase is for the nurse and anaesthetist to verbally confirm with the patient their identity, the specific surgical procedure, the surgical site, and that the consent form has been correctly signed. Prophylactic antibiotics are typically given within 60 minutes before the incision, not four hours.

Question 11: What type of therapy is most evidence-based for PTSD?

Trauma-focused cognitive behavioral therapy (TF-CBT) and EMDR (Correct answer)
Psychoanalytic therapy only
Medication alone without psychotherapy
Group exercise therapy

Correct answer: Trauma-focused cognitive behavioral therapy (TF-CBT) and EMDR

Trauma-focused CBT and Eye Movement Desensitization and Reprocessing (EMDR) have the strongest evidence base for PTSD treatment. They help patients process traumatic memories, modify negative thought patterns, and reduce hyperarousal and avoidance behaviors.

Question 12: What is the correct order for donning (putting on) PPE?

Mask, gloves, gown, eye protection
Gloves, gown, mask, eye protection
Gown, mask/respirator, eye protection, gloves (Correct answer)
Eye protection, gloves, mask, gown

Correct answer: Gown, mask/respirator, eye protection, gloves

CDC recommended donning order: 1) Gown (protects clothing), 2) Mask/respirator (protects airway), 3) Eye protection (protects mucous membranes), 4) Gloves (protect hands and seal gown cuffs). This sequence minimizes self-contamination during application.

Question 13: Which vital sign change is an early indicator of hypovolemic shock?

Increased blood pressure
Decreased heart rate (bradycardia)
Increased heart rate (tachycardia) (Correct answer)
Decreased respiratory rate

Correct answer: Increased heart rate (tachycardia)

Tachycardia is the earliest compensatory response to hypovolemia, as the body increases heart rate to maintain cardiac output when blood volume is reduced. Blood pressure typically falls later.

Question 14: Which medication requires a daily weight to be taken and reported?

Digoxin and diuretics (Correct answer)
Vitamin supplements
Antibiotics
Antipsychotics

Correct answer: Digoxin and diuretics

Daily weight monitoring is essential for patients on digoxin (to detect fluid retention from heart failure) and diuretics (to monitor fluid balance — rapid weight gain indicates fluid retention; rapid loss indicates over-diuresis). A weight gain of >1 kg/day should be reported.

Question 15: A nurse is conducting a home visit for a patient with hypertension. Which finding requires immediate referral?

Blood pressure of 200/120 mmHg with severe headache (Correct answer)
Irregular sleep schedule
Mild ankle edema
Blood pressure of 140/90 mmHg without symptoms

Correct answer: Blood pressure of 200/120 mmHg with severe headache

BP of 200/120 mmHg with severe headache is a hypertensive emergency (possible end-organ damage — stroke, encephalopathy, renal failure). Immediate emergency referral is required. Hypertensive urgency is severe BP without end-organ damage; emergency involves damage.

Question 16: What is the correct procedure when a nurse receives a verbal medication order?

Refuse all verbal orders
Administer the medication immediately without documentation
Write the order down, read it back to confirm, have it cosigned by the prescriber as soon as possible (Correct answer)
Record the order only at the end of the shift

Correct answer: Write the order down, read it back to confirm, have it cosigned by the prescriber as soon as possible

Read-back (RSVP) verification is mandatory for verbal and telephone orders: receive, record (write it down), read back (read the complete order aloud), receive confirmation. The prescriber must cosign the verbal order within the facility's policy timeframe (typically 24 hours).

Question 17: According to WHO classification, which body mass index (BMI) value indicates obesity?

BMI 18.5–24.9
BMI 30 and above (Correct answer)
BMI 17.5 and below
BMI 25–29.9

Correct answer: BMI 30 and above

A BMI of 30 or above is classified as obesity by the World Health Organization; BMI 25–29.9 is overweight.

Question 18: Saudi Arabia's Vision 2030 health goals include which nursing-relevant objective?

Outsourcing all healthcare to the private sector
Reducing the nursing workforce
Eliminating all hospitals
Increasing preventive care, reducing non-communicable diseases, and expanding primary healthcare access (Correct answer)

Correct answer: Increasing preventive care, reducing non-communicable diseases, and expanding primary healthcare access

Vision 2030's health objectives include expanding primary healthcare services, increasing preventive care emphasis (screening programs, chronic disease management), reducing NCD burden (diabetes, cardiovascular disease, obesity), and improving healthcare quality and access across the Kingdom.

Question 19: Which Saudi health regulation governs the safe disposal of medical waste?

Medical waste must be segregated, labeled, and disposed of according to Saudi MOH regulations and international standards (Correct answer)
Only sharps require special disposal
Medical waste can be placed in regular trash bins
All medical waste must be incinerated on-site always

Correct answer: Medical waste must be segregated, labeled, and disposed of according to Saudi MOH regulations and international standards

Saudi medical waste management follows MOH regulations aligned with WHO standards: color-coded segregation (yellow for infectious, red for sharps, black for general), proper labeling, secure transport, and treatment (incineration, autoclave, chemical treatment) before final disposal. Incorrect disposal risks environmental and public health harm.

Question 20: What does 'epidemiology' study?

Individual patient care
Surgical techniques
Pharmacological treatments
The distribution and determinants of health and disease in populations (Correct answer)

Correct answer: The distribution and determinants of health and disease in populations

Epidemiology studies the frequency, distribution (who gets disease, where, when), and determinants (why — risk factors, causes) of health conditions in populations. This data drives public health policy, disease prevention, and control strategies.

Question 21: A child with meningitis is placed in a darkened room. Which symptom explains this intervention?

Photophobia (sensitivity to light) (Correct answer)
Conjunctivitis
Increased ICP causing vision loss
Visual impairment

Correct answer: Photophobia (sensitivity to light)

Photophobia (extreme sensitivity to light) is a classic sign of meningitis caused by meningeal irritation. A darkened, quiet environment reduces stimulation that worsens headache and discomfort in patients with meningeal inflammation.

Question 22: Which observation indicates a toddler is experiencing normal separation anxiety?

High fever when separated from parents
Inability to be comforted by any caregiver
Crying when the parent leaves but calming with a substitute caregiver (Correct answer)
Refusing to eat for more than 24 hours

Correct answer: Crying when the parent leaves but calming with a substitute caregiver

Separation anxiety is developmentally normal between 6 months and 2 years. Normal anxiety includes protest at separation but eventual consolation by a trusted alternative caregiver. Inconsolable distress or physical symptoms suggest abnormal anxiety.

Question 23: A patient is admitted with suspected myocardial infarction. Which laboratory marker is most specific for cardiac muscle damage?

C-reactive protein (CRP)
Creatine kinase (total CK)
Lactate dehydrogenase (LDH)
Troponin I or Troponin T (Correct answer)

Correct answer: Troponin I or Troponin T

Cardiac troponins (troponin I and T) are highly specific biomarkers for myocardial cell injury. They rise within 3–6 hours of infarction, peak at 12–24 hours, and remain elevated for 7–10 days, making them the gold standard diagnostic marker.

Question 24: How should sharps (needles, scalpels) be disposed of after use?

Immediately in a puncture-resistant sharps container without recapping (Correct answer)
Leave on the tray for someone else to collect
Recap the needle before disposal
Dispose in regular trash bag

Correct answer: Immediately in a puncture-resistant sharps container without recapping

Sharps must be placed immediately in a designated puncture-resistant, leak-proof sharps container. Never recap needles (recapping is the most common cause of needlestick injuries). Never leave sharps on trays or in open containers.

Question 25: A pregnant patient is 38 weeks gestation and has a blood pressure of 158/105 mmHg with 3+ proteinuria. What condition does this indicate?

Gestational hypertension
Severe preeclampsia (Correct answer)
HELLP syndrome
Chronic hypertension

Correct answer: Severe preeclampsia

Severe preeclampsia is diagnosed when BP ≥160/110 mmHg with significant proteinuria after 20 weeks gestation. Gestational hypertension has no proteinuria; HELLP syndrome includes hemolysis, elevated liver enzymes, and low platelets.

Question 26: A patient's wound culture reveals MRSA. What precautions are required?

Contact precautions: gloves and gown for all patient contact (Correct answer)
Droplet precautions with surgical mask
Standard precautions only
Airborne precautions with N95 mask

Correct answer: Contact precautions: gloves and gown for all patient contact

MRSA (methicillin-resistant Staphylococcus aureus) is transmitted via direct contact with the patient or contaminated surfaces. Contact precautions (gloves and gown) are required to prevent spread to other patients.

Question 27: A patient is receiving total parenteral nutrition (TPN). What is the most important nursing action?

Discontinue if blood glucose exceeds 140 mg/dL
Monitor blood glucose every 4–6 hours and assess for infection at the catheter site (Correct answer)
Infuse through a peripheral IV
Add all medications directly to the TPN bag

Correct answer: Monitor blood glucose every 4–6 hours and assess for infection at the catheter site

TPN is glucose-rich and delivered through a central line, creating dual risks: hyperglycemia (requiring regular glucose monitoring) and catheter-related bloodstream infection (requiring strict aseptic technique and site assessment).

Question 28: A patient taking SSRIs is prescribed tramadol for pain. What interaction should the nurse be aware of?

No significant interaction
Increased sedation only
Decreased pain relief
Serotonin syndrome — a potentially life-threatening excess of serotonergic activity (Correct answer)

Correct answer: Serotonin syndrome — a potentially life-threatening excess of serotonergic activity

Both SSRIs and tramadol increase serotonergic activity. Combining them can cause serotonin syndrome: hyperthermia, agitation, tremor, clonus, hyperreflexia, and diaphoresis. Severe cases include rhabdomyolysis and death. The combination should be avoided or used with extreme caution.

Question 29: A patient has been involuntarily admitted to a psychiatric unit. Which right is retained?

The right to leave the hospital at will
The right to be treated with dignity and to communicate with an attorney (Correct answer)
The right to refuse all treatments indefinitely
The right to have medications withheld

Correct answer: The right to be treated with dignity and to communicate with an attorney

Involuntary commitment restricts the right to leave but does not remove all rights. Patients retain rights to dignity, least restrictive treatment, communication with legal counsel, and informed consent for most procedures. Forced treatment generally requires a separate court order.

Question 30: A 4-year-old is admitted with suspected epiglottitis. Which action is contraindicated?

Administering humidified oxygen
Allowing the child to sit in a position of comfort
Preparing for possible intubation
Examining the throat with a tongue depressor (Correct answer)

Correct answer: Examining the throat with a tongue depressor

Examining the throat with a tongue depressor in suspected epiglottitis can precipitate complete airway obstruction from laryngospasm. The child should never be forced into a supine position. Emergency airway equipment must be at the bedside.

Question 31: What is the normal range for adult serum sodium?

125–135 mEq/L
135–145 mEq/L (Correct answer)
145–155 mEq/L
120–130 mEq/L

Correct answer: 135–145 mEq/L

Normal serum sodium is 135–145 mEq/L. Hyponatremia (<135) causes neurological symptoms from cerebral edema, while hypernatremia (>145) causes cellular dehydration and neurological dysfunction from brain cell shrinkage.

Question 32: Which therapeutic communication technique is most appropriate when a patient states 'I feel like nobody cares about me'?

Reflect feelings: 'It sounds like you are feeling very alone right now.' (Correct answer)
Change the subject to distract the patient.
Minimize: 'I am sure that is not true.'
Offer advice: 'You should talk to your family.'

Correct answer: Reflect feelings: 'It sounds like you are feeling very alone right now.'

Reflecting feelings validates the patient's emotional experience and encourages them to explore their feelings further. Offering unsolicited advice, minimizing, or changing the subject are non-therapeutic techniques that block communication.

Question 33: What is the normal fetal heart rate range?

160–200 beats per minute
60–100 beats per minute
80–110 beats per minute
110–160 beats per minute (Correct answer)

Correct answer: 110–160 beats per minute

Normal fetal heart rate is 110–160 bpm. Bradycardia (<110 bpm) may indicate fetal hypoxia or cord compression. Tachycardia (>160 bpm) may suggest maternal fever, fetal infection, or fetal distress.

Question 34: What is the most effective way to prevent the spread of contact-transmitted infections in healthcare?

Restricting patient movement
Closing the hospital ward
Routine use of antibiotics
Consistent hand hygiene and appropriate use of PPE (gloves and gown) during patient contact (Correct answer)

Correct answer: Consistent hand hygiene and appropriate use of PPE (gloves and gown) during patient contact

Hand hygiene (before and after patient contact, even when gloves are worn) combined with appropriate PPE use is the most effective and evidence-based method to break contact transmission. No other single intervention has greater impact on HAI reduction.

Question 35: Which position is most appropriate for a patient experiencing respiratory distress?

Lithotomy position
Supine position
High Fowler's position (60–90 degrees) (Correct answer)
Trendelenburg position

Correct answer: High Fowler's position (60–90 degrees)

High Fowler's position (60–90 degrees) allows maximum lung expansion by using gravity to lower the diaphragm, improving ventilation. It is the first-line positioning intervention for respiratory distress.

Question 36: What is the primary complication of Rh incompatibility in pregnancy?

Placenta previa
Gestational diabetes
Premature labor
Hemolytic disease of the newborn (erythroblastosis fetalis) (Correct answer)

Correct answer: Hemolytic disease of the newborn (erythroblastosis fetalis)

When an Rh-negative mother carries an Rh-positive fetus, maternal anti-Rh antibodies cross the placenta in subsequent pregnancies, destroying fetal red blood cells. This causes hemolytic anemia, hydrops fetalis, and neonatal jaundice. Rho(D) immune globulin (RhoGAM) prevents sensitization.

Question 37: What does the APGAR score assess in the newborn?

Alertness, Pulse, Growth, Activity, Reflexes
Airway, Pulse, Grunting, Arousal, Respiration
Appearance, Pulse, Grimace, Activity, Respiration (Correct answer)
Appearance, Pain, Growth, Alertness, Respirations

Correct answer: Appearance, Pulse, Grimace, Activity, Respiration

The APGAR score assesses five criteria at 1 and 5 minutes of life: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. Each is scored 0–2; total 7–10 is normal.

Question 38: Which route of administration provides the fastest drug action in an emergency?

Oral
Intramuscular
Intravenous (IV) (Correct answer)
Sublingual

Correct answer: Intravenous (IV)

IV administration delivers drugs directly into the bloodstream, providing immediate bioavailability (100%) and the fastest onset of action. This is why emergency drugs (epinephrine, adenosine, naloxone in arrest) are given IV. Sublingual is next fastest as it bypasses first-pass metabolism.

Question 39: A patient with COPD is receiving oxygen therapy. What is the safest initial oxygen flow rate?

High-flow oxygen without limit
5 L/min via simple face mask
10–15 L/min via non-rebreather mask
1–2 L/min via nasal cannula (Correct answer)

Correct answer: 1–2 L/min via nasal cannula

Patients with COPD may rely on hypoxic drive to breathe. High-flow oxygen can suppress this drive and cause respiratory depression. Low-flow oxygen (1–2 L/min) targeting SpO2 of 88–92% is the safe starting point.

Question 40: Which vaccine is recommended for all newborns within 24 hours of birth according to the Saudi immunization schedule?

MMR vaccine
BCG vaccine
Varicella vaccine
Hepatitis B vaccine (Correct answer)

Correct answer: Hepatitis B vaccine

The Hepatitis B vaccine is given at birth (within 24 hours) to prevent vertical transmission from infected mothers and to establish early immunity. BCG is also given at birth in Saudi Arabia for tuberculosis prevention.

Question 41: At what age should children receive the MMR vaccine according to the Saudi MOH immunization schedule?

3 years
At birth
6 months
12 months (with second dose at 18 months) (Correct answer)

Correct answer: 12 months (with second dose at 18 months)

The Saudi MOH immunization schedule recommends the first MMR (measles, mumps, rubella) vaccine at 12 months of age, with a second dose at 18 months. Earlier vaccination may be given during outbreaks but doesn't count toward the routine schedule.

Question 42: A patient with chronic kidney disease is placed on a renal diet. Which nutrient is most commonly restricted?

Only fluid
Only sodium
Potassium, phosphorus, and sodium (Correct answer)
Only protein

Correct answer: Potassium, phosphorus, and sodium

CKD patients require restriction of potassium (to prevent hyperkalemia and cardiac arrhythmias), phosphorus (to prevent renal osteodystrophy), and sodium (to control fluid retention and hypertension). Protein and fluid may also be restricted.

Question 43: What does 'incidence rate' measure in epidemiology?

New cases of a disease in a population at risk over a specified time period (Correct answer)
Death rates from a specific disease
Number of hospitalizations per year
Total cases of a disease at a point in time

Correct answer: New cases of a disease in a population at risk over a specified time period

Incidence rate measures new cases occurring in a disease-free (at-risk) population during a defined period. It reflects the risk of developing a disease. Prevalence measures all existing cases (both new and old) at a specific time.

Question 44: What is the mechanism of action of beta-blocker medications?

Dilate peripheral blood vessels only
Block beta-adrenergic receptors, reducing heart rate, contractility, and blood pressure (Correct answer)
Block calcium channels in cardiac cells
Increase heart rate and contractility

Correct answer: Block beta-adrenergic receptors, reducing heart rate, contractility, and blood pressure

Beta-blockers competitively block beta-1 receptors in the heart (reducing heart rate and contractility) and beta-2 receptors in bronchi and blood vessels. They reduce cardiac oxygen demand and blood pressure. Used for hypertension, angina, heart failure, and dysrhythmias.

Question 45: Which intervention is most effective in preventing hospital-acquired infections?

Isolation of all patients
Wearing gloves without hand hygiene
Consistent hand hygiene (Correct answer)
Routine antibiotic prophylaxis for all patients

Correct answer: Consistent hand hygiene

Hand hygiene is the single most effective measure to prevent healthcare-associated infections. The WHO '5 Moments for Hand Hygiene' framework identifies key moments that break the chain of transmission.

Question 46: What does 'therapeutic milieu' mean in a psychiatric setting?

A safe, structured environment designed to promote therapeutic change through social interactions (Correct answer)
Medication management only
Isolation of patients with behavioral problems
A reward-and-punishment behavior modification system

Correct answer: A safe, structured environment designed to promote therapeutic change through social interactions

Therapeutic milieu refers to the planned, structured, safe environment of a psychiatric unit where all aspects — physical layout, rules, staff interactions, group activities — are used as therapeutic tools to promote healing and behavioral change.

Question 47: What anticipatory guidance should a nurse provide to parents of a 6-month-old regarding safety?

Safety guidance isn't needed until the child walks
Only car seat usage
Choking prevention (small objects), fall prevention (never leave on elevated surfaces), water safety, proper car seat use, and safe sleep environment (Correct answer)
Only sun protection

Correct answer: Choking prevention (small objects), fall prevention (never leave on elevated surfaces), water safety, proper car seat use, and safe sleep environment

At 6 months, safety guidance includes: choking hazards (no small objects, cut food appropriately), fall prevention (never leave unattended on beds/changing tables), water safety (never leave alone in bath), rear-facing car seat, safe sleep (alone, on back, in crib), and poison prevention.

Question 48: How should a nurse manage a patient with an arterial line?

Zero and level the transducer at the phlebostatic axis, monitor waveform, assess the site for bleeding/infection, and perform Allen's test before insertion (Correct answer)
Remove if the patient moves
No special monitoring needed
Only check blood pressure readings

Correct answer: Zero and level the transducer at the phlebostatic axis, monitor waveform, assess the site for bleeding/infection, and perform Allen's test before insertion

Arterial line nursing care: zero/level transducer at phlebostatic axis (4th ICS, mid-axillary), verify waveform quality, maintain continuous flush system, assess insertion site (bleeding, infection, circulation distal to site), perform Allen's test before radial insertion, and never flush rapidly (risk of retrograde cerebral embolism).

Question 49: A diabetic patient in Saudi Arabia planning to observe Ramadan fasting should be counseled to:

Discontinue all diabetes medications during the fasting period
Avoid all physical activity throughout the month
Significantly increase carbohydrate intake at Suhoor to sustain energy
Monitor blood glucose regularly and adjust medications under physician guidance (Correct answer)

Correct answer: Monitor blood glucose regularly and adjust medications under physician guidance

Diabetic patients observing Ramadan require individualized medical supervision, regular glucose monitoring, and medication adjustments to prevent hypoglycemia or hyperglycemia.

Question 50: Which environmental health issue is a significant public health concern in Saudi Arabia?

Waterborne diseases from flooding
Radiation from nuclear plants
Extreme heat and air pollution from sand storms and industrial sources (Correct answer)
Extreme cold exposure

Correct answer: Extreme heat and air pollution from sand storms and industrial sources

Saudi Arabia's extreme heat (heat stroke risk, especially for outdoor workers and Hajj pilgrims), sandstorm-generated particulate air pollution, and petrochemical industrial emissions are significant environmental health concerns. Heat-related illness prevention is a major public health intervention.

Question 51: Which nursing intervention is the highest priority when a patient develops sudden severe chest pain?

Assess the patient and notify the physician immediately (Correct answer)
Reassure the patient that it will pass
Administer prescribed analgesics
Document the complaint and continue monitoring

Correct answer: Assess the patient and notify the physician immediately

Sudden severe chest pain can indicate a life-threatening condition such as myocardial infarction. The priority is immediate assessment and physician notification to initiate rapid diagnostic and treatment protocols.

Question 52: A nurse is providing discharge education to a new mother. Due to the high prevalence of Vitamin D deficiency in Saudi Arabia, what is the standard recommendation for a healthy, exclusively breastfed infant?

Administer 400 IU of Vitamin D daily, starting in the first few days of life. (Correct answer)
Rely on the Vitamin D content from the mother's breast milk only.
Expose the infant to direct sunlight for 30 minutes daily.
Start Vitamin D supplementation only after 6 months of age.

Correct answer: Administer 400 IU of Vitamin D daily, starting in the first few days of life.

Due to factors like limited sun exposure and low levels of Vitamin D in breast milk, deficiency is highly prevalent in Saudi Arabia. Health authorities and experts recommend that all infants, especially those who are breastfed, receive a daily supplement of 400 IU of Vitamin D, starting shortly after birth, to prevent rickets and support healthy bone development.

Question 53: What does the nurse assess using the Richmond Agitation-Sedation Scale (RASS)?

Level of sedation or agitation in critically ill patients, ranging from -5 (unarousable) to +4 (combative) (Correct answer)
Respiratory function
Pain level
Cardiac rhythm

Correct answer: Level of sedation or agitation in critically ill patients, ranging from -5 (unarousable) to +4 (combative)

RASS rates sedation/agitation: +4 combative, +3 very agitated, +2 agitated, +1 restless, 0 alert and calm, -1 drowsy, -2 light sedation, -3 moderate sedation, -4 deep sedation, -5 unarousable. Target is typically 0 to -2 in ICU patients, adjusted to clinical needs.

Question 54: What is the CBAHI (Central Board for Accreditation of Healthcare Institutions) and its significance?

A hospital ranking system
A pharmaceutical company
Saudi Arabia's national healthcare accreditation body that sets standards for patient safety, quality, and organizational management (Correct answer)
An insurance company

Correct answer: Saudi Arabia's national healthcare accreditation body that sets standards for patient safety, quality, and organizational management

CBAHI is Saudi Arabia's national accreditation program, equivalent to JCI internationally. It evaluates healthcare facilities against standards covering: patient rights, patient safety, clinical care, infection control, facility management, and governance. Accreditation is mandatory for MOH facilities.

Question 55: Which electrolyte imbalance most commonly causes muscle cramps and tetany?

Hypernatremia
Hypocalcemia (Correct answer)
Hyperkalemia
Hyponatremia

Correct answer: Hypocalcemia

Hypocalcemia causes increased neuromuscular excitability, manifesting as muscle cramps, tetany, positive Trousseau's and Chvostek's signs, and in severe cases, laryngospasm and seizures. Calcium is essential for normal muscle and nerve function.

Question 56: Under Saudi health regulations, when can a Do Not Resuscitate (DNR) order be implemented?

With documented informed consent from the patient or legal guardian, and in accordance with hospital policy and medical ethics guidelines (Correct answer)
By physician decision alone without consent
Automatically for all patients over 70
Nurses can implement DNR independently without physician order

Correct answer: With documented informed consent from the patient or legal guardian, and in accordance with hospital policy and medical ethics guidelines

In Saudi Arabia, DNR orders require informed consent (from a competent patient) or surrogate decision-making (for incapacitated patients), physician documentation, and compliance with hospital policy and Islamic ethical principles. Sharia principles regarding preservation of life guide these complex decisions.

Question 57: Which action prevents dumping syndrome in a post-gastrectomy patient?

Drink large amounts of fluid with meals
Eat small, frequent meals; avoid fluids with meals; lie down after eating (Correct answer)
Increase simple carbohydrates in the diet
Eat large meals three times daily

Correct answer: Eat small, frequent meals; avoid fluids with meals; lie down after eating

Dumping syndrome occurs when food moves too quickly into the small intestine. Small, frequent, low-carbohydrate meals, avoiding fluids during meals, and lying down after eating slow gastric emptying and reduce symptoms.

Question 58: A nurse prepares to administer insulin. Which type of insulin is clear in appearance?

Regular (soluble) insulin and insulin analogues (lispro, aspart, glargine) (Correct answer)
NPH insulin
Premixed insulin 70/30
All insulin types are clear

Correct answer: Regular (soluble) insulin and insulin analogues (lispro, aspart, glargine)

Regular (soluble) insulin and most insulin analogues (lispro, aspart, glargine, detemir) are clear solutions. NPH (Neutral Protamine Hagedorn) insulin appears cloudy/turbid due to the protamine suspension. Premixed insulins (70% NPH/30% regular) are cloudy.

Question 59: What is the correct reconstitution principle for IV antibiotics?

Reconstitution can be done hours before administration without refrigeration
Use any available diluent at any volume
Follow manufacturer instructions for diluent type, volume, concentration, and infusion time (Correct answer)
Always use dextrose for all antibiotics

Correct answer: Follow manufacturer instructions for diluent type, volume, concentration, and infusion time

IV antibiotics must be reconstituted with the correct diluent (normal saline vs. dextrose — some antibiotics are incompatible with certain solutions), correct concentration, and administered within the stability window. Incorrect preparation affects potency, stability, and safety.

Question 60: What is the primary purpose of the nursing diagnosis in the nursing process?

To identify actual or potential patient health problems that nurses can treat (Correct answer)
To schedule nursing assignments
To assign patient acuity scores
To document physician-prescribed treatments

Correct answer: To identify actual or potential patient health problems that nurses can treat

Nursing diagnoses identify actual or potential health problems within the nurse's independent scope of practice. They differ from medical diagnoses by focusing on human responses to illness rather than disease labels.

Question 61: What are the signs of dehydration in an infant?

Bulging fontanelle
Increased wet diapers
Sunken fontanelle, dry mucous membranes, decreased tears, decreased urine output, and poor skin turgor (Correct answer)
Weight gain

Correct answer: Sunken fontanelle, dry mucous membranes, decreased tears, decreased urine output, and poor skin turgor

Infant dehydration signs: sunken anterior fontanelle, dry mucous membranes, absent tears when crying, decreased urine output (<6 wet diapers/day), poor skin turgor (tenting), tachycardia, lethargy, and sunken eyes. Severe dehydration is a medical emergency in infants.

Question 62: What is the nurse's role in quality improvement initiatives in Saudi healthcare?

Only report errors
Only follow existing policies
Quality improvement is only administration's responsibility
Participate in data collection, identify areas for improvement, implement evidence-based changes, and monitor outcomes using PDSA cycles (Correct answer)

Correct answer: Participate in data collection, identify areas for improvement, implement evidence-based changes, and monitor outcomes using PDSA cycles

Nurses contribute to quality improvement by: collecting quality indicator data, participating in root cause analysis, implementing Plan-Do-Study-Act (PDSA) improvement cycles, monitoring patient outcomes, participating in accreditation preparation (CBAHI/JCI), and championing best practices.

Question 63: According to the Saudi Ministry of Health (MOH) National Immunization Schedule, which two vaccines are mandatory for a healthy newborn within the first 24 hours of life?

Rotavirus and DTaP
MMR and Varicella
IPV (Inactivated Polio Vaccine) and Hib
BCG (Bacillus Calmette-Guérin) and Hepatitis B (HBV) (Correct answer)

Correct answer: BCG (Bacillus Calmette-Guérin) and Hepatitis B (HBV)

The Saudi Ministry of Health's National Immunization Schedule mandates the administration of the first dose of the Hepatitis B vaccine (HBV) and the BCG vaccine at birth, typically within the first 24 hours, to protect against hepatitis B and tuberculosis, respectively.

Question 64: Which sign/symptom indicates a fluid volume deficit (dehydration)?

Bounding pulse and hypertension
Decreased skin turgor and dry mucous membranes (Correct answer)
Distended neck veins
Periorbital edema

Correct answer: Decreased skin turgor and dry mucous membranes

Decreased skin turgor and dry mucous membranes are classic signs of dehydration due to reduced extracellular fluid. Bounding pulse, hypertension, periorbital edema, and distended neck veins indicate fluid excess.

Question 65: Which sign differentiates true labor from false labor (Braxton Hicks contractions)?

Contractions felt only in the lower abdomen
Contractions that increase in frequency, duration, and intensity with cervical change (Correct answer)
Contractions that ease with a warm bath
Irregular contractions that stop with walking

Correct answer: Contractions that increase in frequency, duration, and intensity with cervical change

True labor is characterized by regular contractions that progressively increase in frequency, duration, and intensity, accompanied by cervical effacement and dilation. Braxton Hicks contractions are irregular, do not increase in intensity, and do not cause cervical change.

Question 66: A patient with a hip fracture is being assessed for fat embolism syndrome. Which triad of findings is classic?

Tachycardia, hypotension, and cyanosis
Bradycardia, hypertension, and confusion
Hypoxia, neurological changes, and petechial rash (Correct answer)
Fever, cough, and chest pain

Correct answer: Hypoxia, neurological changes, and petechial rash

Fat embolism syndrome classically presents with the triad of hypoxemia (from lung fat emboli), neurological deterioration (confusion, decreased consciousness), and petechial rash (from fat emboli in dermal capillaries), typically 24–72 hours after long-bone fracture.

Question 67: Which vitamin is primarily synthesized in the skin upon exposure to ultraviolet sunlight?

Vitamin K
Vitamin B12
Vitamin D (Correct answer)
Vitamin A

Correct answer: Vitamin D

Vitamin D is synthesized in the skin when 7-dehydrocholesterol is converted upon UV-B exposure; deficiency is common in covered populations.

Question 68: Which finding indicates a newborn has adequate hydration?

Concentrated yellow urine
No wet diapers in 12 hours
Only 2 wet diapers per day
6 or more wet diapers per day after day 4 (Correct answer)

Correct answer: 6 or more wet diapers per day after day 4

After the first 3–4 days, a well-hydrated newborn should produce at least 6 wet diapers per day. Fewer wet diapers, concentrated urine, or dry mucous membranes suggest inadequate fluid intake and possible feeding difficulties.

Question 69: A nurse is about to give a patient 1000 mg of a drug. The available preparation is 250 mg/5 mL. How many mL should be given?

20 mL (Correct answer)
10 mL
25 mL
5 mL

Correct answer: 20 mL

Calculation: Required dose ÷ Available dose × Volume = 1000 mg ÷ 250 mg × 5 mL = 4 × 5 mL = 20 mL. Careful dose calculation is essential to prevent medication errors, particularly with liquid preparations in pediatrics and high-risk medications.

Question 70: What concentration of alcohol-based handrub is effective against most healthcare pathogens?

90–100% alcohol
60–80% alcohol (ethanol or isopropanol) (Correct answer)
10–15% alcohol
20–30% alcohol

Correct answer: 60–80% alcohol (ethanol or isopropanol)

WHO and CDC recommend alcohol concentrations of 60–80% for maximal antimicrobial activity. Concentrations below 60% are less effective; above 80%, the evaporation is too rapid for adequate denaturing time, and the formulation becomes less effective. The sweet spot is 60–80%.

Question 71: What is the priority nursing action during a cardiac arrest when the rhythm shows ventricular fibrillation?

Initiate CPR and prepare for immediate defibrillation (Correct answer)
Wait for the rhythm to convert spontaneously
Administer adenosine
Administer atropine

Correct answer: Initiate CPR and prepare for immediate defibrillation

Ventricular fibrillation (VF) is a shockable rhythm. Priority: immediate high-quality CPR, defibrillate as soon as possible (120-200J biphasic), resume CPR immediately after shock for 2 minutes, administer epinephrine after 2nd shock, and amiodarone after 3rd shock per ACLS protocol.

Question 72: Which screening test is recommended for cervical cancer in Saudi Arabia?

Annual mammography for all women
Colonoscopy for cervical cancer
Pap smear (cervical cytology) and/or HPV testing every 3–5 years for women aged 25–65 (Correct answer)
Monthly self-breast exam only

Correct answer: Pap smear (cervical cytology) and/or HPV testing every 3–5 years for women aged 25–65

Cervical cancer screening in Saudi Arabia follows WHO guidelines: Pap smear every 3 years (or HPV co-testing every 5 years) for women aged 25–65. HPV vaccination (bivalent/quadrivalent) is also part of the national immunization program for girls.

Question 73: How should a nurse administer an intramuscular injection to an infant?

In the dorsal gluteal site
In the vastus lateralis (anterolateral thigh) using a 25-gauge, 5/8 to 1-inch needle (Correct answer)
In the gluteal muscle
In the deltoid muscle

Correct answer: In the vastus lateralis (anterolateral thigh) using a 25-gauge, 5/8 to 1-inch needle

For infants, the vastus lateralis (anterolateral thigh) is the preferred IM injection site due to its well-developed muscle mass. The deltoid is too small, and gluteal muscles are not fully developed (risk of sciatic nerve injury). Use a 25-gauge needle, 5/8 to 1 inch length.

Question 74: A patient with peripheral arterial disease reports leg pain that worsens with walking and improves with rest. This is called:

Restless leg syndrome
Peripheral neuropathy
Deep vein thrombosis
Intermittent claudication (Correct answer)

Correct answer: Intermittent claudication

Intermittent claudication is the hallmark symptom of peripheral arterial disease — cramping or aching pain in the legs during walking (exercise increases oxygen demand beyond supply) that reliably resolves with rest (decreased demand).

Question 75: What is the primary nursing concern for a patient with liver cirrhosis and ascites?

Risk of pulmonary embolism
Risk of cardiac tamponade
Risk of spontaneous bacterial peritonitis and fluid/electrolyte imbalance (Correct answer)
Risk of hyperthyroidism

Correct answer: Risk of spontaneous bacterial peritonitis and fluid/electrolyte imbalance

Ascites in cirrhosis creates a large reservoir of stagnant fluid at risk for bacterial infection (spontaneous bacterial peritonitis). Additionally, portal hypertension causes sodium/water retention and electrolyte imbalances, particularly hyponatremia and hypokalemia.

Question 76: A patient with iron-deficiency anemia should consume iron-rich foods alongside which substance to maximize absorption?

Tannins
Vitamin C (Correct answer)
Calcium
Phytates

Correct answer: Vitamin C

Vitamin C (ascorbic acid) enhances non-heme iron absorption by converting iron to its more absorbable ferrous form.

Question 77: What is the function of the Saudi Patient Safety Center?

To manage nursing education curricula
To provide patient financial assistance
To license medical devices
To lead national initiatives to reduce medical errors and improve patient safety across the Saudi health system (Correct answer)

Correct answer: To lead national initiatives to reduce medical errors and improve patient safety across the Saudi health system

The Saudi Patient Safety Center (SPSC), part of the MOH, develops national patient safety programs, standards, and initiatives: medication safety, infection control standards, surgical safety, fall prevention, and adverse event reporting systems — working to systematically reduce preventable harm.

Question 78: Which medication is the first-line mood stabilizer for bipolar disorder?

Lithium carbonate (Correct answer)
Fluoxetine
Haloperidol
Clonazepam

Correct answer: Lithium carbonate

Lithium is the gold standard mood stabilizer for bipolar disorder with strong evidence for preventing both manic and depressive episodes and reducing suicide risk. It requires regular serum level monitoring (therapeutic range: 0.6–1.2 mEq/L for maintenance).

Question 79: What is the correct process for a Saudi nurse to report a near-miss incident?

Discuss only at the next staff meeting without formal documentation
Report only to the physician involved
Complete an incident report and submit to the quality or risk management department for learning and prevention (Correct answer)
Do nothing since no patient was harmed

Correct answer: Complete an incident report and submit to the quality or risk management department for learning and prevention

Near-miss reporting is a critical safety culture practice. Near-miss events (unsafe conditions that nearly caused harm) are reported through the hospital's incident reporting system to the quality/risk management department for root cause analysis and system improvement — preventing future actual harm.

Question 80: Which assessment finding is most characteristic of left-sided heart failure?

Hepatomegaly
Peripheral edema and jugular venous distension
Ascites
Pulmonary congestion with dyspnea and crackles (Correct answer)

Correct answer: Pulmonary congestion with dyspnea and crackles

The left ventricle pumps blood to the systemic circulation. When it fails, blood backs up into the pulmonary circulation, causing pulmonary edema, dyspnea, orthopnea, and crackles on auscultation.

Question 81: What are the requirements for blood product administration under Saudi health regulations?

Verbal consent only is required
One nurse verification is sufficient
No formal process is required for blood products
Two-nurse verification, informed consent, pretransfusion compatibility testing, and monitoring during transfusion (Correct answer)

Correct answer: Two-nurse verification, informed consent, pretransfusion compatibility testing, and monitoring during transfusion

Saudi health standards require: written informed consent for transfusion, pre-transfusion compatibility testing (cross-match), two-nurse verification of product labels against patient ID, vital sign monitoring, and documentation. These multiple steps reduce the risk of transfusion errors and reactions.

Question 82: What does the acronym 'SBAR' stand for in nursing communication?

Situation, Brief, Assessment, Review
Situation, Background, Assessment, Recommendation (Correct answer)
Safety, Background, Action, Report
Standard, Background, Assessment, Response

Correct answer: Situation, Background, Assessment, Recommendation

SBAR stands for Situation, Background, Assessment, Recommendation. It is a standardized communication framework used in healthcare to convey critical patient information clearly and concisely.

Question 83: What nursing assessments are important for a child with suspected meningitis?

Assess for nuchal rigidity, Kernig's and Brudzinski's signs, photophobia, petechial rash, altered consciousness, and bulging fontanelle in infants (Correct answer)
Only temperature check
Only blood pressure
Only appetite changes

Correct answer: Assess for nuchal rigidity, Kernig's and Brudzinski's signs, photophobia, petechial rash, altered consciousness, and bulging fontanelle in infants

Meningitis assessment: nuchal rigidity (stiff neck), positive Kernig's sign (resistance to knee extension with hip flexed), positive Brudzinski's sign (flexion of hips/knees with neck flexion), photophobia, petechial/purpuric rash (meningococcal), irritability, bulging fontanelle (infants), and altered consciousness.

Question 84: What is the purpose of surveillance cultures in ICU patients?

To diagnose active infections only
To detect silent colonization with MDROs before they cause infection, enabling targeted precautions (Correct answer)
To monitor antibiotic effectiveness only
To replace clinical cultures

Correct answer: To detect silent colonization with MDROs before they cause infection, enabling targeted precautions

Active surveillance cultures (nasal swabs for MRSA, rectal swabs for VRE/ESBL/CRE) in high-risk ICU patients identify asymptomatic colonization. This allows targeted contact precautions to be implemented before infection occurs, reducing transmission to other vulnerable patients.

Question 85: A primigravida at 36 weeks reports a sudden gush of fluid from the vagina. What is the priority nursing action?

Perform a cervical exam immediately
Administer oxytocin
Assess fetal heart rate and check for cord prolapse (Correct answer)
Prepare the patient for immediate delivery

Correct answer: Assess fetal heart rate and check for cord prolapse

A sudden gush of fluid suggests premature rupture of membranes (PROM). The immediate priority is fetal heart rate assessment and visual inspection for cord prolapse at the vaginal introitus. Cord prolapse is a life-threatening emergency requiring urgent intervention.

Question 86: What does 'NPO' mean in a clinical context?

Non-priority observation
Nothing by mouth (nil per os) (Correct answer)
Normal physiological output
No procedure ordered

Correct answer: Nothing by mouth (nil per os)

NPO stands for 'nil per os,' a Latin phrase meaning nothing by mouth. It is ordered before procedures, surgery, or when oral intake is contraindicated to prevent aspiration or gastrointestinal complications.

Question 87: Which infectious disease is required to be reported to Saudi public health authorities?

Any disease the nurse thinks is unusual
Only sexually transmitted infections
All notifiable diseases including tuberculosis, hepatitis, meningitis, and foodborne outbreaks (Correct answer)
Only COVID-19

Correct answer: All notifiable diseases including tuberculosis, hepatitis, meningitis, and foodborne outbreaks

Saudi Arabia's Ministry of Health maintains a list of notifiable diseases including TB, hepatitis A/B/C, meningococcal disease, typhoid, foodborne outbreaks, sexually transmitted infections, and others. Mandatory reporting enables outbreak detection, contact tracing, and public health response.

Question 88: A nurse observes a colleague making a medication error but not reporting it. What is the appropriate action?

Ignore it as it is not your responsibility
Encourage the colleague to report the error and report it yourself if they do not (Correct answer)
Report only to the unit manager in secret
Do nothing to avoid conflict

Correct answer: Encourage the colleague to report the error and report it yourself if they do not

Nurses have an ethical and professional obligation to ensure patient safety. Encouraging peer reporting first respects professional relationships, but the nurse must independently report if the colleague fails to do so.

Question 89: A newborn has a yellow tinge to the skin and eyes at 18 hours of life. What type of jaundice is this?

Pathological jaundice requiring immediate evaluation (Correct answer)
Normal physiological jaundice
Crigler-Najjar syndrome
Breast milk jaundice

Correct answer: Pathological jaundice requiring immediate evaluation

Jaundice appearing within the first 24 hours of life is always considered pathological and requires immediate evaluation. Causes include hemolytic disease (Rh or ABO incompatibility) or serious infection. Physiological jaundice appears after 24 hours.

Question 90: What is the primary nursing role in a school health program?

Health promotion, early identification of problems, and provision of first aid (Correct answer)
Treating all medical conditions on-site
Prescribing medications
Replacing pediatricians

Correct answer: Health promotion, early identification of problems, and provision of first aid

School nurses focus on health promotion (nutrition, mental health, hygiene education), screening (vision, hearing, scoliosis), early identification of health problems, first aid for acute injuries, and managing chronic conditions (asthma, diabetes, epilepsy) in the school setting.

Question 91: What continuing education requirements must Saudi nurses fulfill to maintain licensure?

Continuing education is optional
No continuing education required
Accumulate required Continuing Medical Education (CME) hours during the license period as specified by SCFHS (Correct answer)
Only attend one conference per year

Correct answer: Accumulate required Continuing Medical Education (CME) hours during the license period as specified by SCFHS

SCFHS requires nurses to accumulate a specified number of CME credit hours during each license renewal period. Activities include: accredited conferences, workshops, online courses, research participation, and publications. This ensures nurses maintain and update their professional competency.

Question 92: What is the nursing priority for a child with croup (laryngotracheobronchitis)?

Keep the child calm, provide cool mist humidity, administer nebulized epinephrine for severe cases, and monitor for airway obstruction (Correct answer)
Place the child in a supine position
Restrict fluids
Administer antibiotics

Correct answer: Keep the child calm, provide cool mist humidity, administer nebulized epinephrine for severe cases, and monitor for airway obstruction

Croup management: keep the child calm (crying worsens obstruction), cool mist/humidified air, oral or nebulized corticosteroids (dexamethasone), nebulized racemic epinephrine for moderate-severe stridor, monitor respiratory status, and prepare for intubation if severe obstruction.

Question 93: A patient with bipolar disorder is in a manic phase. Which nursing intervention is the priority?

Allow the patient to make all decisions independently
Encourage social activities to channel excess energy
Ensure safety, provide a low-stimulation environment, and meet physical needs (Correct answer)
Engage the patient in lengthy discussions

Correct answer: Ensure safety, provide a low-stimulation environment, and meet physical needs

During mania, patients are at risk for injury (from impulsivity and poor judgment), dehydration (forgetting to eat/drink), and exhaustion. A low-stimulation environment reduces escalation. Safety and physical needs are the priority.

Question 94: Which drug class is used to treat acute extrapyramidal side effects (EPS) caused by antipsychotics?

Benzodiazepines
SSRIs
Beta-blockers
Anticholinergic agents such as benztropine (Cogentin) (Correct answer)

Correct answer: Anticholinergic agents such as benztropine (Cogentin)

Acute EPS (dystonia, akathisia, parkinsonism) from antipsychotic dopamine blockade are treated with anticholinergic agents (benztropine, diphenhydramine) which restore the dopamine-acetylcholine balance in the extrapyramidal system.

Question 95: What personal protective equipment is required for standard precautions when there is a risk of blood splash?

Gloves, gown, mask, and eye protection (Correct answer)
Surgical mask only
Gloves only
N95 respirator always

Correct answer: Gloves, gown, mask, and eye protection

Standard precautions require: gloves when touching blood, body fluids, mucous membranes, or non-intact skin; mask and eye protection (goggles or face shield) when splash or spray of blood/body fluids is anticipated; gown when clothing may be soiled.

Question 96: What is the nurse's role in managing a child with asthma exacerbation?

Apply cold compresses to the chest
Administer bronchodilators (albuterol) via nebulizer, position upright, monitor SpO2, administer corticosteroids as ordered, and assess respiratory status frequently (Correct answer)
Encourage vigorous physical activity
Restrict fluid intake

Correct answer: Administer bronchodilators (albuterol) via nebulizer, position upright, monitor SpO2, administer corticosteroids as ordered, and assess respiratory status frequently

Asthma exacerbation management: immediate bronchodilator (albuterol nebulizer), upright position (Fowler's/tripod), continuous SpO2 monitoring, supplemental oxygen if needed, systemic corticosteroids (oral prednisolone or IV methylprednisolone), frequent respiratory assessment, and keep the child calm.

Question 97: What is the most important nursing consideration when administering potassium chloride IV?

It can be given as a rapid IV bolus if the patient is hypokalemic
Never give undiluted IV push; always dilute and administer slowly (Correct answer)
Concentration does not matter if given through a central line
IV push is acceptable in emergencies

Correct answer: Never give undiluted IV push; always dilute and administer slowly

IV potassium must always be diluted (maximum 10 mEq/hr peripherally, 20 mEq/hr centrally) and never given as an IV push. Rapid potassium administration causes fatal cardiac dysrhythmias.

Question 98: A new father in Al-Khobar approaches the nurse and expresses his wish for a respected elder to perform 'Tahneek' for his newborn. What is the nurse's most culturally competent and safe response?

Allow the family to perform the ritual using a minuscule amount of a softened date, ensuring aseptic technique and observing the infant for any adverse reaction. (Correct answer)
Inform the father that no outside food or substances are allowed for the newborn.
Document the request and inform the physician, recommending against the practice.
Provide the family with a honey-based gel from the hospital pharmacy to use instead.

Correct answer: Allow the family to perform the ritual using a minuscule amount of a softened date, ensuring aseptic technique and observing the infant for any adverse reaction.

Tahneek is an important Islamic cultural and religious practice involving rubbing a small amount of a softened date or honey on a newborn's palate. A culturally competent nurse should respect this practice while ensuring safety. The best approach is to facilitate the ritual in a safe manner, using a tiny particle to minimize any risk of choking or infection, and ensuring proper hand hygiene is performed by the person conducting the Tahneek.

Question 99: What is the purpose of using a draw sheet when repositioning a patient?

To keep the patient warm
To reduce friction and shear on the skin during repositioning (Correct answer)
To measure urine output
To secure IV lines

Correct answer: To reduce friction and shear on the skin during repositioning

A draw sheet reduces friction and shear forces on vulnerable skin during repositioning, protecting against pressure injury formation. Friction and shear are major contributing factors to skin breakdown in immobile patients.

Question 100: A patient taking warfarin has an INR of 5.8 with minor bleeding. What is the appropriate intervention?

No intervention needed as INR <6
Hold warfarin, administer vitamin K as ordered, monitor closely, notify physician (Correct answer)
Discharge the patient immediately
Give extra doses of warfarin

Correct answer: Hold warfarin, administer vitamin K as ordered, monitor closely, notify physician

INR >4–5 with any bleeding requires immediate intervention. Warfarin is held, and vitamin K (phytomenadione) is given to reverse anticoagulation. The dose and route of vitamin K depend on severity: oral for non-urgent reversal, IV for urgent reversal. Fresh frozen plasma or 4-factor PCC is used for life-threatening bleeding.

Question 101: What is the primary goal of electroconvulsive therapy (ECT)?

To treat severe treatment-resistant depression and reduce suicide risk (Correct answer)
To treat all psychiatric conditions universally
To punish patients for dangerous behavior
To sedate patients long-term

Correct answer: To treat severe treatment-resistant depression and reduce suicide risk

ECT is indicated for severe, treatment-resistant depression, especially with high suicide risk, psychotic features, or when rapid response is needed. It induces a controlled seizure under general anesthesia, producing neurobiological changes that rapidly alleviate depression.

Question 102: A community health nurse is conducting a needs assessment. Which data source provides the most comprehensive population health information?

National health surveys, vital statistics, and census data combined (Correct answer)
Hospital discharge records only
Social media posts
Patient interviews alone

Correct answer: National health surveys, vital statistics, and census data combined

Comprehensive needs assessments combine multiple data sources: national health surveys (burden of disease, risk factors), vital statistics (birth/death rates, mortality causes), census data (demographics, socioeconomic factors), and community input for a complete picture.

Question 103: What is the purpose of an 'allergy band' on a patient?

To indicate dietary restrictions
To identify the patient's blood type
To alert all healthcare providers of documented drug, food, or environmental allergies to prevent accidental exposure (Correct answer)
To show the patient's preferred medications

Correct answer: To alert all healthcare providers of documented drug, food, or environmental allergies to prevent accidental exposure

Allergy identification bands provide a universal, immediate visual alert at the point of care — particularly at medication administration, procedures, and emergencies — to prevent exposure to documented allergens. This is a patient safety redundancy that complements electronic allergy records.

Question 104: Which insulin type has the longest duration of action?

Regular insulin
Glargine (Lantus) (Correct answer)
Lispro (Humalog)
NPH insulin

Correct answer: Glargine (Lantus)

Insulin glargine (Lantus) is a long-acting basal insulin with duration of approximately 20–24 hours and no pronounced peak, providing steady background insulin coverage. It is given once daily.

Question 105: Which type of isolation precaution is required for a patient with pulmonary tuberculosis?

Airborne precautions (Correct answer)
Contact precautions
Droplet precautions
Standard precautions only

Correct answer: Airborne precautions

Pulmonary tuberculosis is transmitted via airborne droplet nuclei (particles <5 microns) that remain suspended in the air. Airborne precautions require a negative-pressure room and N95 respirators.

Question 106: What nursing considerations apply when caring for a patient on continuous renal replacement therapy (CRRT)?

Only check the machine once per shift
CRRT requires no anticoagulation
Monitor hemodynamic stability, manage anticoagulation of the circuit, assess fluid balance hourly, monitor electrolytes, and troubleshoot alarms (Correct answer)
No special nursing care needed

Correct answer: Monitor hemodynamic stability, manage anticoagulation of the circuit, assess fluid balance hourly, monitor electrolytes, and troubleshoot alarms

CRRT nursing care: continuous hemodynamic monitoring (hypotension risk), circuit anticoagulation management (citrate or heparin), hourly fluid balance assessment, frequent electrolyte monitoring (especially calcium with citrate), catheter site assessment, temperature monitoring (heat loss), and filter/circuit lifespan tracking.

Question 107: What is the purpose of the Hajj health operations in Saudi Arabia?

To administer visas
To prevent disease transmission and provide healthcare to millions of pilgrims from diverse countries (Correct answer)
To screen pilgrims for chronic diseases only
To provide dental care only

Correct answer: To prevent disease transmission and provide healthcare to millions of pilgrims from diverse countries

Hajj is the world's largest annual mass gathering. Saudi health operations aim to prevent infectious disease transmission (meningococcal meningitis, respiratory infections, foodborne illness), manage chronic conditions, provide emergency care, and monitor for global health threats through enhanced surveillance.

Question 108: A child weighing 20 kg has a fever. Using weight-based dosing, the correct dose of acetaminophen (15 mg/kg) is:

150 mg
200 mg
300 mg (Correct answer)
400 mg

Correct answer: 300 mg

Dose = 15 mg/kg × 20 kg = 300 mg. Accurate weight-based dosing in pediatrics is critical to avoid under-dosing (ineffective) or overdosing (hepatotoxic with acetaminophen).

Question 109: A patient is prescribed metformin for type 2 diabetes. What is the most serious adverse effect to monitor for?

Lactic acidosis, particularly in renal impairment (Correct answer)
Weight gain
Sodium retention
Hypoglycemia

Correct answer: Lactic acidosis, particularly in renal impairment

Metformin-associated lactic acidosis (MALA) is rare but life-threatening, occurring when metformin accumulates due to renal impairment (reduced excretion). Metformin is contraindicated in significant renal failure (eGFR <30 mL/min). Hypoglycemia is rare with metformin alone.

Question 110: What is 'polypharmacy' and why is it a nursing concern in elderly patients?

Use of five or more medications simultaneously, increasing risk of drug interactions, adverse effects, and non-adherence (Correct answer)
Use of generic medications only
Simultaneous use of two medications
Use of any medication after age 65

Correct answer: Use of five or more medications simultaneously, increasing risk of drug interactions, adverse effects, and non-adherence

Polypharmacy (typically ≥5 medications) is particularly dangerous in the elderly due to: reduced renal/hepatic clearance, altered drug distribution, increased CNS sensitivity, high risk of drug-drug interactions, and difficulty managing complex regimens leading to non-adherence.

Question 111: A patient with dementia becomes confused and agitated every evening. This is called:

Delirium
Normal aging
Depression
Sundowning syndrome (Correct answer)

Correct answer: Sundowning syndrome

Sundowning is a pattern of increased confusion, agitation, wandering, and behavioral disturbance in the late afternoon and evening hours, common in dementia. Contributing factors include fatigue, reduced light, and disrupted circadian rhythm.

Question 112: Which nutritional deficiency disease is caused by inadequate intake of thiamine (Vitamin B1)?

Rickets
Beriberi (Correct answer)
Pellagra
Scurvy

Correct answer: Beriberi

Beriberi results from thiamine deficiency; pellagra is caused by niacin deficiency, scurvy by Vitamin C deficiency, and rickets by Vitamin D deficiency.

Question 113: A nurse is reviewing the post-operative orders for a 60-year-old patient who underwent a total knee replacement. To align with the Enhanced Recovery After Surgery (ERAS) principles being adopted in many Saudi hospitals, which order should the nurse prioritize and encourage?

Routine administration of opioid analgesics every 4 hours.
Nil per os (NPO) until bowel sounds return.
Early mobilization and physiotherapy on post-operative day 1. (Correct answer)
Bed rest for the first 48 hours post-operatively.

Correct answer: Early mobilization and physiotherapy on post-operative day 1.

Enhanced Recovery After Surgery (ERAS) protocols, which are increasingly being implemented in Saudi Arabia, emphasize multimodal pain management, early feeding, and, crucially, early mobilization to reduce complications and shorten hospital stays. For a patient after knee replacement, initiating mobilization with physiotherapy on the first post-operative day is a key component of the ERAS pathway, helping to prevent deep vein thrombosis and improve functional recovery.

Question 114: A patient's blood pressure is 150/95 mmHg. How should this reading be documented?

Systolic 150, diastolic 95 mmHg
Elevated BP
150 over 95
150/95 mmHg (Correct answer)

Correct answer: 150/95 mmHg

Blood pressure is documented numerically as systolic/diastolic in mmHg format (e.g., 150/95 mmHg). This standardized format ensures clarity and consistency across healthcare records.

Question 115: What is the significance of elevated lactate levels in a critically ill patient?

It is normal in ICU patients
It indicates adequate oxygenation
Elevated lactate (>2 mmol/L) indicates tissue hypoperfusion and is a marker of shock severity and mortality risk (Correct answer)
It only indicates liver disease

Correct answer: Elevated lactate (>2 mmol/L) indicates tissue hypoperfusion and is a marker of shock severity and mortality risk

Elevated lactate indicates anaerobic metabolism due to tissue hypoperfusion (inadequate oxygen delivery). Lactate >2 mmol/L is concerning; >4 mmol/L indicates severe shock with high mortality risk. Serial lactate monitoring guides resuscitation adequacy — lactate clearance of >10% per hour is the goal.

Question 116: What is the primary goal of nasogastric tube decompression after abdominal surgery?

Monitor gastric pH
Administer oral medications
Remove gas and fluids to prevent abdominal distension and vomiting (Correct answer)
Provide enteral nutrition

Correct answer: Remove gas and fluids to prevent abdominal distension and vomiting

Postoperative ileus causes accumulation of gas and secretions in the stomach and intestines. NG decompression removes these contents, reducing distension, nausea, vomiting, and risk of aspiration.

Question 117: Which position is contraindicated for a patient who has just had a lumbar puncture?

Lying flat for 4–8 hours post-procedure
Side-lying position
Prone position
Sitting upright immediately after the procedure (Correct answer)

Correct answer: Sitting upright immediately after the procedure

After lumbar puncture, patients typically lie flat for 4–8 hours to reduce the risk of post-lumbar puncture headache caused by CSF leakage. Sitting upright too soon increases intracranial pressure gradient and worsens CSF leakage.

Question 118: Which child with fever should be referred to the emergency department immediately?

A 3-week-old infant with temperature of 38°C (Correct answer)
A 3-year-old with temperature of 38.5°C and runny nose
A 5-year-old with temperature of 39°C after vaccination
A 2-year-old with temperature of 38°C and mild cough

Correct answer: A 3-week-old infant with temperature of 38°C

Fever in a neonate under 3 months is a medical emergency. The neonatal immune system cannot reliably contain bacterial infection, and serious bacterial infection (meningitis, sepsis, UTI) cannot be excluded without full septic workup including lumbar puncture.

Question 119: What does the term 'herd immunity' mean?

Sufficient community vaccination coverage that protects even unvaccinated individuals by interrupting transmission (Correct answer)
Vaccination of only high-risk individuals
Natural immunity acquired through disease
Immunity that lasts only in herds of animals

Correct answer: Sufficient community vaccination coverage that protects even unvaccinated individuals by interrupting transmission

Herd immunity (community immunity) occurs when a high enough proportion of the population is immune (through vaccination or prior infection) that the pathogen cannot sustain transmission, indirectly protecting those who cannot be vaccinated (immunocompromised, infants).

Question 120: What are the professional boundaries that Saudi nurses must maintain?

Maintaining therapeutic relationships, avoiding dual relationships, not accepting gifts beyond nominal value, protecting confidentiality, and maintaining appropriate physical/emotional boundaries (Correct answer)
Boundaries only apply to male nurses
No specific boundaries are required
Only financial boundaries matter

Correct answer: Maintaining therapeutic relationships, avoiding dual relationships, not accepting gifts beyond nominal value, protecting confidentiality, and maintaining appropriate physical/emotional boundaries

Professional boundaries include: maintaining therapeutic (not personal) relationships, avoiding dual relationships, appropriate gift policies, maintaining confidentiality, appropriate physical contact, avoiding favoritism, not sharing personal problems with patients, and following Saudi cultural norms for professional interaction.

Question 121: A patient is taking digoxin. Which electrolyte imbalance increases the risk of digoxin toxicity?

Hypercalcemia
Hypokalemia (low potassium) (Correct answer)
Hypernatremia
Hyperkalemia

Correct answer: Hypokalemia (low potassium)

Hypokalemia increases digoxin toxicity by increasing the drug's binding to the Na+/K+-ATPase pump (same site as potassium). Low potassium and digoxin compete for the same receptor — with less potassium, digoxin binds more and exerts a more potent (toxic) effect.

Question 122: What is the nurse's priority when caring for a child with acute otitis media (ear infection)?

Manage pain (analgesics), assess tympanic membrane, administer oral antibiotics if prescribed, and educate parents on proper medication administration (Correct answer)
Apply cold compresses to the ear
Restrict all fluids
Administer IV antibiotics immediately

Correct answer: Manage pain (analgesics), assess tympanic membrane, administer oral antibiotics if prescribed, and educate parents on proper medication administration

Acute otitis media nursing care: pain management (acetaminophen/ibuprofen, warm compresses), administer prescribed antibiotics (amoxicillin is first-line), educate parents on completing the full antibiotic course, assess for complications (hearing loss, mastoiditis), and teach preventive measures.

Question 123: A patient has a blood urea nitrogen (BUN) of 45 mg/dL and creatinine of 3.2 mg/dL. What condition does this suggest?

Normal kidney function
Liver failure
Renal impairment (Correct answer)
Dehydration alone

Correct answer: Renal impairment

Elevated BUN and creatinine indicate impaired renal filtration. BUN normal range is 7–20 mg/dL and creatinine 0.6–1.2 mg/dL. Both elevated together strongly suggest acute kidney injury or chronic kidney disease.

Question 124: What does 'drug antagonism' mean?

A drug that is excreted unchanged
One drug decreases or blocks the effect of another drug (Correct answer)
A drug that produces its own effect independently
Two drugs with additive effects

Correct answer: One drug decreases or blocks the effect of another drug

Drug antagonism occurs when one drug reduces or blocks the pharmacological effect of another. Competitive antagonists compete for the same receptor (naloxone-opioids); non-competitive antagonists block elsewhere in the pathway. This is the basis for many antidotes.

Question 125: What does 'half-life' mean in pharmacology?

The time for complete elimination
The time to reach peak plasma level
The duration of drug action
The time required for the plasma concentration of a drug to decrease by 50% (Correct answer)

Correct answer: The time required for the plasma concentration of a drug to decrease by 50%

Half-life (t½) is the time required for drug plasma concentration to fall by 50%. It determines dosing frequency (steady state reached at ~5 half-lives, drug essentially eliminated in ~5 half-lives). Drugs with long half-lives require less frequent dosing.

Question 126: What are the classic signs of intussusception in an infant?

Gradual weight loss only
Chronic diarrhea
Sudden episodic severe abdominal pain (drawing legs up), 'currant jelly' stools (blood and mucus), and a sausage-shaped mass in the abdomen (Correct answer)
Constant mild discomfort

Correct answer: Sudden episodic severe abdominal pain (drawing legs up), 'currant jelly' stools (blood and mucus), and a sausage-shaped mass in the abdomen

Intussusception presents with: sudden severe colicky abdominal pain (infant draws up legs, screams), followed by calm intervals, 'currant jelly' stools (mixture of blood and mucus), palpable sausage-shaped mass (usually right upper quadrant), and vomiting. This is a pediatric surgical emergency.

Question 127: What does the Saudi MOH 'Nitaqat' system mean for expatriate nurses working in Saudi Arabia?

It is a Saudization program requiring healthcare employers to maintain minimum percentages of Saudi nationals in the workforce (Correct answer)
It is a patient satisfaction measurement tool
It is a salary standardization system
It is a nursing training program

Correct answer: It is a Saudization program requiring healthcare employers to maintain minimum percentages of Saudi nationals in the workforce

Nitaqat is Saudi Arabia's nationalization (Saudization) program. It requires companies including healthcare providers to employ minimum percentages of Saudi nationals. This affects hiring, visa quotas, and compliance requirements for expatriate nurses working in the Kingdom.

Question 128: A patient with obsessive-compulsive disorder (OCD) insists on washing their hands 50 times per day. What is the most therapeutic nursing approach?

Mock the behavior to highlight its irrationality
Allow the ritual initially while building therapeutic alliance, then gradually work on reducing it (Correct answer)
Ignore the behavior entirely
Prevent the ritual immediately and completely

Correct answer: Allow the ritual initially while building therapeutic alliance, then gradually work on reducing it

Abruptly stopping OCD rituals causes extreme anxiety. The therapeutic approach involves building trust, psychoeducation, and gradually implementing exposure and response prevention (ERP) therapy. Forcing immediate cessation is counterproductive and harmful.

Question 129: Which body is responsible for licensing nurses in Saudi Arabia?

Saudi Board of Medical Specialties
General Authority of Health
Saudi Ministry of Interior
Saudi Commission for Health Specialties (SCFHS) (Correct answer)

Correct answer: Saudi Commission for Health Specialties (SCFHS)

The Saudi Commission for Health Specialties (SCFHS) is the government authority responsible for licensing, credentialing, and regulating all health professionals in Saudi Arabia, including nurses. The SNLE (Saudi Nursing Licensing Exam) is administered by the SCFHS.

Question 130: What is the main goal of school-based health education programs?

Building long-term healthy behaviors and health literacy in children and adolescents (Correct answer)
Increasing academic performance only
Replacing parental health guidance
Providing medical treatment in schools

Correct answer: Building long-term healthy behaviors and health literacy in children and adolescents

School-based health education targets children at a formative age when health behaviors and attitudes are being established. Programs addressing nutrition, physical activity, hygiene, mental health, and substance use prevention create lifelong health literacy and behavior patterns.

Question 131: A nurse is preparing to administer blood. Which action is most important before beginning the transfusion?

Administer diphenhydramine to all patients prophylactically
Start the transfusion as quickly as possible to save time
Prime the tubing with dextrose solution
Verify blood type and cross-match with two nurses at the bedside (Correct answer)

Correct answer: Verify blood type and cross-match with two nurses at the bedside

Two-nurse verification of blood product labels against the patient's identification and compatibility report is mandatory to prevent ABO-incompatible transfusion reactions, which can be fatal.

Question 132: Which level of Maslow's hierarchy must be met before safety needs can be addressed?

Esteem needs
Physiological needs (food, water, shelter, air) (Correct answer)
Self-actualization
Social needs

Correct answer: Physiological needs (food, water, shelter, air)

Maslow's hierarchy places physiological needs (oxygen, water, food, warmth, sleep) at the base. These must be met before safety, love/belonging, esteem, and self-actualization needs can be effectively addressed in nursing care planning.

Question 133: What does 'case fatality rate' measure?

Total deaths in a population
Deaths per 100,000 population
The risk of developing a disease
The proportion of diagnosed cases of a disease who die from it (Correct answer)

Correct answer: The proportion of diagnosed cases of a disease who die from it

Case fatality rate (CFR) = (deaths from disease / confirmed cases of disease) × 100%. It measures the severity/lethality of a disease and is different from mortality rate (deaths per population). A high CFR indicates a highly deadly disease.

Question 134: A nurse is caring for a patient suspected of having Middle East Respiratory Syndrome (MERS-CoV) in a hospital in Al-Ahsa. According to Saudi Ministry of Health and WHO guidelines, which combination of personal protective equipment (PPE) is required when providing routine care for this patient?

Surgical mask and gloves only.
Gown, gloves, eye protection, and a surgical mask. (Correct answer)
Shoe covers, gown, and a surgical mask.
Gown, gloves, and an N95 respirator.

Correct answer: Gown, gloves, eye protection, and a surgical mask.

For routine care of a suspected or confirmed MERS-CoV patient, standard, contact, and droplet precautions are required. This includes wearing a gown, gloves, eye protection (goggles or face shield), and a medical/surgical mask. An N95 respirator is specifically required during aerosol-generating procedures. Since its initial identification in Saudi Arabia in 2012, stringent infection control protocols have been a cornerstone of managing MERS-CoV outbreaks in healthcare facilities across the Kingdom.

Question 135: When performing a bed bath, in which order should body parts be washed?

Feet, legs, abdomen, arms, face, perineum
Back, face, arms, chest, abdomen, perineum, legs
Face, neck, arms, chest, abdomen, legs, back, perineum (Correct answer)
Perineum, legs, abdomen, chest, arms, neck, face

Correct answer: Face, neck, arms, chest, abdomen, legs, back, perineum

The correct order moves from cleanest to dirtiest areas: face and neck first, then arms, chest, abdomen, legs, back, and perineum last. This prevents transferring microorganisms from dirty to clean areas.

Question 136: A postpartum patient develops a fever of 38.5°C on day 3 with a tender, red area on her right breast. What condition is this?

Breast engorgement
Mastitis (Correct answer)
Breast abscess
Normal lactation changes

Correct answer: Mastitis

Mastitis is breast infection (most commonly Staphylococcus aureus) presenting with localized redness, warmth, tenderness, fever, and flu-like symptoms, typically on days 3–4 postpartum. Treatment includes antibiotics and continued breastfeeding or pumping.

Question 137: What is the antidote for acetaminophen (paracetamol) overdose?

N-acetylcysteine (NAC) (Correct answer)
Naloxone
Activated charcoal only
Flumazenil

Correct answer: N-acetylcysteine (NAC)

N-acetylcysteine (NAC) is the specific antidote for acetaminophen toxicity. Acetaminophen overdose depletes glutathione, allowing the toxic metabolite NAPQI to cause hepatic necrosis. NAC replenishes glutathione and detoxifies NAPQI. It must be given within 8–10 hours for maximum efficacy.

Question 138: Which phase of pharmacokinetics describes the breakdown of a drug into metabolites?

Distribution
Excretion
Absorption
Metabolism (biotransformation) (Correct answer)

Correct answer: Metabolism (biotransformation)

Metabolism (biotransformation) involves enzymatic conversion of drugs into metabolites, primarily in the liver via cytochrome P450 enzymes. Metabolites may be active or inactive. Drug-drug interactions often occur at this phase. Absorption: drug enters bloodstream; distribution: drug spreads to tissues; excretion: drug leaves the body.

Question 139: What is the normal respiratory rate for a newborn?

60-80 breaths/minute
30-60 breaths/minute (Correct answer)
20-30 breaths/minute
12-20 breaths/minute

Correct answer: 30-60 breaths/minute

Normal newborn respiratory rate is 30-60 breaths per minute. Rates above 60 (tachypnea) may indicate respiratory distress, while periodic breathing (brief pauses <10 seconds) is normal in newborns. Always count for a full 60 seconds in infants.

Question 140: A patient has been diagnosed with Cushing's syndrome. Which assessment finding is expected?

Moon face, central obesity, and purple striae (Correct answer)
Dry skin and bradycardia
Exophthalmos and heat intolerance
Extreme weight loss and hypotension

Correct answer: Moon face, central obesity, and purple striae

Cushing's syndrome results from chronic cortisol excess. Classic findings include moon-shaped face (fat redistribution), central obesity with thin limbs, buffalo hump, purple striae (stretch marks from skin fragility), hypertension, and hyperglycemia.

Question 141: Which term describes a patient's inability to feel pleasure in activities they previously enjoyed?

Agoraphobia
Anhedonia (Correct answer)
Anergia
Aphasia

Correct answer: Anhedonia

Anhedonia is the inability to experience pleasure from previously enjoyable activities and is a core symptom of major depressive disorder and a negative symptom of schizophrenia. Anergia is lack of energy; aphasia is language impairment; agoraphobia is fear of open spaces.

Question 142: A nurse is caring for a 2-day-old newborn in Riyadh. A heel prick blood sample is collected as part of the mandatory National Newborn Screening Program. Which of the following conditions is included in this screening panel?

Type 1 Diabetes
Developmental Dysplasia of the Hip
Congenital Hypothyroidism (Correct answer)
Retinopathy of Prematurity

Correct answer: Congenital Hypothyroidism

The Kingdom of Saudi Arabia's National Newborn Screening Program mandates screening for several conditions, including endocrine disorders like Congenital Hypothyroidism and Congenital Adrenal Hyperplasia, as well as various inborn errors of metabolism. Early detection and treatment of Congenital Hypothyroidism are crucial to prevent severe intellectual disability.

Question 143: Which macronutrient provides 4 kilocalories per gram?

Carbohydrate (Correct answer)
Water
Fat
Alcohol

Correct answer: Carbohydrate

Carbohydrates provide 4 kcal/g; fats provide 9 kcal/g and alcohol provides 7 kcal/g.

Question 144: What is the DOTS strategy for tuberculosis control?

A dietary supplement program
A vaccine program for TB prevention
Daily oral treatment at home without supervision
Directly Observed Therapy Short-course: supervised medication-taking to ensure adherence (Correct answer)

Correct answer: Directly Observed Therapy Short-course: supervised medication-taking to ensure adherence

DOTS (Directly Observed Therapy Short-course) is the WHO-recommended TB control strategy. A healthcare worker or trained observer watches the patient swallow each dose, ensuring adherence and preventing drug resistance. Treatment is 6 months minimum.

Question 145: A mother asks when her baby's anterior fontanelle should close. What is the correct response?

3–6 months
At birth
12–18 months (Correct answer)
24–36 months

Correct answer: 12–18 months

The anterior fontanelle (the 'soft spot' at the top of the head) normally closes between 12 and 18 months as the skull bones fuse. Early closure (craniosynostosis) and delayed closure both warrant medical evaluation.

Question 146: Which finding indicates that a patient's nasogastric tube is properly placed in the stomach?

Clear aspirate without pH testing
Bubbling sounds on chest auscultation
Aspiration of gastric contents with pH 1–5 and confirmation by X-ray (Correct answer)
Air bubbling in water when tube end is submerged

Correct answer: Aspiration of gastric contents with pH 1–5 and confirmation by X-ray

X-ray remains the gold standard for initial NG tube placement verification. Aspirating gastric contents and checking pH (gastric pH typically 1–5) is used for ongoing verification. Auscultation alone is unreliable.

Question 147: Which dietary instruction is most important for a patient taking warfarin?

Avoid protein-rich foods
Eat as many leafy greens as possible
Maintain consistent vitamin K intake and avoid drastic dietary changes (Correct answer)
Eliminate all vitamin K from the diet

Correct answer: Maintain consistent vitamin K intake and avoid drastic dietary changes

Warfarin works by inhibiting vitamin K-dependent clotting factors. Sudden large increases in vitamin K intake (from leafy greens) antagonize warfarin and reduce anticoagulation. Consistency is more important than elimination.

Question 148: A patient is in pain and rates it 8/10. Which action should the nurse take first?

Reassess pain in one hour
Administer the maximum analgesic dose
Tell the patient to rest quietly
Perform a comprehensive pain assessment (Correct answer)

Correct answer: Perform a comprehensive pain assessment

A comprehensive pain assessment (location, quality, duration, aggravating/relieving factors) must precede any intervention to ensure appropriate and safe management. Assessment drives the intervention choice.

Question 149: A patient has a nasogastric tube. Before administering medication, what must the nurse confirm?

Tube color and length
Tube placement in the stomach (Correct answer)
That the patient is sitting upright only
Patient food preferences

Correct answer: Tube placement in the stomach

Confirming NG tube placement before each use prevents aspiration pneumonia from accidental pulmonary medication instillation. Methods include pH testing of aspirate, X-ray confirmation, or auscultation.

Question 150: At what gestational age is a pregnancy considered full term?

34–36 weeks
39–40 weeks (Correct answer)
37–38 weeks
41–42 weeks

Correct answer: 39–40 weeks

Full term is defined as 39 0/7 to 40 6/7 weeks gestation. Early term is 37–38 weeks, late term is 41 weeks, and postterm is 42 weeks or beyond. Full-term infants have the best outcomes compared to early-term deliveries.

Question 151: What is sepsis and what are the nursing priorities for early recognition?

Life-threatening organ dysfunction caused by dysregulated host response to infection — monitor for SIRS criteria, lactate levels, and organ dysfunction (Correct answer)
A localized infection with no systemic effects
A chronic condition with no urgency
A type of surgical procedure

Correct answer: Life-threatening organ dysfunction caused by dysregulated host response to infection — monitor for SIRS criteria, lactate levels, and organ dysfunction

Sepsis recognition (qSOFA): altered mental status, respiratory rate ≥22, systolic BP ≤100 mmHg. Nursing priorities: early recognition, obtain blood cultures BEFORE antibiotics, administer broad-spectrum antibiotics within 1 hour, aggressive fluid resuscitation (30 mL/kg crystalloid), monitor lactate, and assess organ function.

Question 152: What is the primary goal of discharge planning?

To reduce hospital costs only
To free up hospital beds quickly
To ensure continuity of care and safe transition to the next level of care (Correct answer)
To document patient preferences

Correct answer: To ensure continuity of care and safe transition to the next level of care

Discharge planning aims to ensure safe, continuous care as the patient moves from hospital to home or another care setting. It involves patient education, follow-up arrangements, and coordination of community resources.

Question 153: What is the correct technique when inserting a urinary catheter in a female patient?

Use clean technique and insert into the vaginal opening
Cleanse from back to front, use non-sterile gloves
Insert into the largest visible opening
Use sterile technique, cleanse from front to back, insert into urethral meatus (Correct answer)

Correct answer: Use sterile technique, cleanse from front to back, insert into urethral meatus

Female urinary catheterization requires sterile technique. The urethral meatus is cleaned with antiseptic solution using front-to-back strokes to prevent introducing vaginal or rectal flora into the urethra.

Question 154: Which communicable disease is targeted for eradication in Saudi Arabia through the Expanded Program on Immunization?

Hepatitis C
Measles
Poliomyelitis (Correct answer)
Malaria

Correct answer: Poliomyelitis

Polio eradication is a global WHO goal. Saudi Arabia maintains high polio vaccination coverage (OPV/IPV) and participates in global eradication efforts. Saudi Arabia has been polio-free and maintains surveillance at borders due to high pilgrim traffic during Hajj.

Question 155: What does the nursing term 'diaphoresis' mean?

Excessive urination
Profuse sweating (Correct answer)
Difficulty breathing
Abnormal thirst

Correct answer: Profuse sweating

Diaphoresis means profuse or excessive sweating. It is a clinical sign associated with conditions such as hypoglycemia, myocardial infarction, fever, pain, and anxiety, and warrants further assessment.

Question 156: What regulation governs nursing documentation standards in Saudi healthcare facilities?

MOH documentation standards requiring accurate, timely, legible, and legally defensible medical records (Correct answer)
No formal documentation standards exist
Documentation only required for surgical patients
Documentation is optional if verbal communication is used

Correct answer: MOH documentation standards requiring accurate, timely, legible, and legally defensible medical records

Saudi MOH standards mandate that all nursing documentation be accurate (factual), complete, timely (contemporaneous), legible, signed, and legally defensible. Medical records are legal documents. Falsification, omission of critical information, and late documentation create legal and professional liability.

Question 157: A patient receiving IV fluid develops swelling and coolness around the IV site. What complication has occurred?

Air embolism
Phlebitis
Infiltration (Correct answer)
Septicemia

Correct answer: Infiltration

Infiltration occurs when IV fluid leaks into surrounding tissue instead of the vein. Signs include local swelling, pallor, coolness, and pain. The IV should be discontinued and the site assessed for treatment.

Question 158: Which drug class can cause hyperkalemia?

Calcium channel blockers
ACE inhibitors and potassium-sparing diuretics (Correct answer)
Loop diuretics
Thiazide diuretics

Correct answer: ACE inhibitors and potassium-sparing diuretics

ACE inhibitors reduce aldosterone production, decreasing potassium excretion. Potassium-sparing diuretics (spironolactone, triamterene, amiloride) directly prevent potassium secretion in the distal nephron. Combining these two classes significantly increases hyperkalemia risk.

Question 159: What is the purpose of administering vitamin K to a newborn at birth?

To stimulate growth
To prevent jaundice
To prevent hemorrhagic disease of the newborn due to vitamin K deficiency (Correct answer)
To boost the immune system

Correct answer: To prevent hemorrhagic disease of the newborn due to vitamin K deficiency

Newborns have low vitamin K levels because it does not cross the placenta well and gut bacteria (which produce vitamin K) are not yet established. Without supplementation, they are at risk for vitamin K deficiency bleeding (hemorrhagic disease of the newborn).

Question 160: What are the 'five moments for hand hygiene' according to the WHO?

Before patient contact, before aseptic tasks, after body fluid exposure, after patient contact, after contact with patient surroundings (Correct answer)
Before and after every procedure only
After contact with body fluids only
Before meals, after toileting, before surgery, after wound care, before medication administration

Correct answer: Before patient contact, before aseptic tasks, after body fluid exposure, after patient contact, after contact with patient surroundings

WHO's '5 Moments' are: 1) Before touching a patient, 2) Before clean/aseptic procedures, 3) After body fluid exposure risk, 4) After touching a patient, 5) After touching patient surroundings. This framework targets all critical transmission points in patient care.

Question 161: What is the correct compression-to-ventilation ratio for single-rescuer infant CPR?

15:2
5:1
15:1
30:2 (Correct answer)

Correct answer: 30:2

Single-rescuer infant and child CPR uses a 30:2 ratio (30 compressions to 2 breaths), the same as adult CPR. Two-rescuer pediatric CPR uses a 15:2 ratio to allow more frequent compressions in children with higher respiratory rates.

Question 162: A 26-year-old pregnant woman at 26 weeks of gestation undergoes screening for Gestational Diabetes Mellitus (GDM) at a primary health clinic in Jeddah. According to common protocols in Saudi Arabia, what is the initial screening test performed?

A 100-gram, 4-hour Oral Glucose Tolerance Test (OGTT)
A fasting plasma glucose (FPG) test only
A 50-gram, 1-hour Glucose Challenge Test (GCT) (Correct answer)
A random blood sugar and HbA1c test

Correct answer: A 50-gram, 1-hour Glucose Challenge Test (GCT)

Standard practice for GDM screening in Saudi Arabia, typically between 24-28 weeks of gestation, involves an initial 50-gram, 1-hour Glucose Challenge Test (GCT). If the result of this non-fasting test is above the threshold, a diagnostic 75-g or 100-g Oral Glucose Tolerance Test (OGTT) is then performed to confirm the diagnosis of GDM.

Question 163: What is the purpose of the Saudi Arabia 'Mumaris Plus' system?

A pharmaceutical approval database
A patient appointment system
The SCFHS digital portal for health professional registration, licensing, exam booking, and credential verification (Correct answer)
A hospital accreditation tool

Correct answer: The SCFHS digital portal for health professional registration, licensing, exam booking, and credential verification

Mumaris Plus is the SCFHS online platform for all professional registration activities: license applications, renewals, exam registration, credential evaluation, classification upgrades, and verification of healthcare professional licenses. All Saudi-licensed health workers must maintain an active Mumaris Plus profile.

Question 164: Under Saudi healthcare regulations, what must happen if a medication error causes patient harm?

Only document in internal records without patient disclosure
Complete incident report, disclose to the patient and family, provide appropriate treatment, and conduct root cause analysis (Correct answer)
Blame the dispensing pharmacist without investigation
Keep the error confidential

Correct answer: Complete incident report, disclose to the patient and family, provide appropriate treatment, and conduct root cause analysis

Saudi MOH standards require: immediate clinical management of any harm, mandatory incident reporting, disclosure to the patient/family (consistent with the Patient Rights Charter's right to information), and root cause analysis to identify system failures and prevent recurrence.

Question 165: Which statement by a patient taking MAO inhibitors requires immediate intervention?

'I had red wine and cheese with dinner tonight.' (Correct answer)
'I have been sleeping better since I started this medication.'
'I feel less sad this week.'
'I took my medication with water this morning.'

Correct answer: 'I had red wine and cheese with dinner tonight.'

MAO inhibitors combined with tyramine-rich foods (aged cheese, red wine, cured meats, fermented foods) cause hypertensive crisis — a dangerous, potentially fatal surge in blood pressure. Patients must strictly avoid all tyramine-containing foods.

Question 166: What is the purpose of the 'I PASS' communication tool in nursing handoffs?

A medication reconciliation checklist only
Illness severity, Patient summary, Action list, Situation awareness/contingency planning, Synthesis by receiver — to ensure safe handoff (Correct answer)
Only to document the physician's plan
A billing and coding tool

Correct answer: Illness severity, Patient summary, Action list, Situation awareness/contingency planning, Synthesis by receiver — to ensure safe handoff

I-PASS is an evidence-based handoff communication framework that reduces handoff-related adverse events. Components: Illness severity (stable/watcher/unstable), Patient summary (key history and findings), Action list (to-do items), Situation awareness (what could go wrong), Synthesis (receiver reads back understanding).

Question 167: A patient has a serum potassium of 2.8 mEq/L. Which ECG finding is expected?

Peaked T waves
Shortened PR interval
Widened QRS complex with tall peaked T waves
Flattened T waves and U waves (Correct answer)

Correct answer: Flattened T waves and U waves

Hypokalemia (K+ <3.5 mEq/L) causes flattened or inverted T waves and the appearance of U waves (a positive deflection after the T wave) on ECG. Severe hypokalemia can lead to life-threatening dysrhythmias.

Question 168: A patient with hyperthyroidism is preparing for a thyroidectomy. Which pre-operative medication is given to reduce thyroid vascularity?

Propylthiouracil
Lugol's iodine solution (Correct answer)
Propranolol
Levothyroxine

Correct answer: Lugol's iodine solution

Lugol's iodine solution (potassium iodide) is given 10–14 days pre-operatively to reduce thyroid vascularity and gland size, decreasing intraoperative hemorrhage risk. Propylthiouracil blocks hormone synthesis, and propranolol controls tachycardia.

Question 169: What does a hemodynamic reading of CVP 2 mmHg indicate?

Hypovolemia (low intravascular volume) requiring fluid resuscitation (Correct answer)
Normal fluid status
Right heart failure
Fluid overload

Correct answer: Hypovolemia (low intravascular volume) requiring fluid resuscitation

Central Venous Pressure (CVP) normal range is 2-8 mmHg. CVP of 2 mmHg (at the low end/below normal) suggests hypovolemia — decreased intravascular volume. The nurse should anticipate fluid resuscitation orders and assess for signs of dehydration and poor perfusion.

Question 170: Which immunization is specifically contraindicated in a child with severe combined immunodeficiency (SCID)?

Hepatitis B vaccine
Pneumococcal vaccine
Inactivated vaccines such as IPV
Live vaccines such as MMR and varicella (Correct answer)

Correct answer: Live vaccines such as MMR and varicella

Live attenuated vaccines (MMR, varicella, oral rotavirus, BCG) are absolutely contraindicated in children with SCID or severe immunodeficiency because the live virus can cause disseminated infection and death in an immune-compromised host.

Question 171: What is the nurse's priority action when a patient's ventilator alarm sounds 'High Pressure'?

Silence the alarm and continue monitoring
Remove the patient from the ventilator
Increase the tidal volume
Assess the patient immediately for secretions, kinking, biting, pneumothorax, or bronchospasm (Correct answer)

Correct answer: Assess the patient immediately for secretions, kinking, biting, pneumothorax, or bronchospasm

High pressure alarm means increased resistance to airflow. Causes: secretions (suction needed), kinked/compressed tubing, patient biting tube (insert bite block), bronchospasm (administer bronchodilator), tension pneumothorax (emergency), or decreased lung compliance. Assess patient before the ventilator.

Question 172: Which immunization schedule is given at 2 months in Saudi Arabia?

DTaP, IPV, Hib, Hepatitis B, PCV, and Rotavirus (Correct answer)
BCG and Hepatitis B
Influenza and meningococcal vaccines
MMR and varicella

Correct answer: DTaP, IPV, Hib, Hepatitis B, PCV, and Rotavirus

Saudi Arabia's expanded immunization program at 2 months includes DTaP (diphtheria, tetanus, pertussis), IPV (inactivated polio), Hib (Haemophilus influenzae type b), Hepatitis B (second dose), PCV13 (pneumococcal), and oral rotavirus vaccine.

Question 173: Which indicators are used to measure maternal health in a population?

Maternal mortality ratio, antenatal care coverage, and skilled birth attendance (Correct answer)
Infant vaccination rates
Life expectancy at birth
Number of hospitals per capita

Correct answer: Maternal mortality ratio, antenatal care coverage, and skilled birth attendance

Maternal health is measured by: maternal mortality ratio (deaths per 100,000 live births), antenatal care coverage (% of women receiving ANC), proportion of births attended by skilled health personnel, and contraceptive prevalence rate.

Question 174: What differentiates delirium from dementia?

Delirium has acute onset and fluctuating consciousness; dementia is gradual and progressive (Correct answer)
Delirium only occurs in elderly patients
They have identical presentations
Delirium is always permanent; dementia is reversible

Correct answer: Delirium has acute onset and fluctuating consciousness; dementia is gradual and progressive

Delirium is characterized by acute onset (hours to days), fluctuating level of consciousness, and is often reversible when the underlying cause is treated. Dementia develops gradually over months to years with preserved consciousness until late stages.

Question 175: Which type of wound healing occurs when a wound is sutured closed?

Primary intention (Correct answer)
Tertiary intention
Secondary intention
Delayed primary closure

Correct answer: Primary intention

Healing by primary intention occurs when wound edges are approximated (sutured, stapled, or taped closed), allowing healing with minimal scarring. This is the most efficient healing method with lowest infection risk.

Question 176: A patient reports feeling nervous, having a pounding heart, and sweating every time they go to a shopping mall. This is most consistent with:

Somatization disorder
Acute psychosis
Generalized anxiety disorder
Specific phobia or agoraphobia with panic (Correct answer)

Correct answer: Specific phobia or agoraphobia with panic

Situational panic symptoms (palpitations, diaphoresis, anxiety) triggered specifically and consistently by a particular place (shopping mall) are consistent with a specific phobia or agoraphobia. Generalized anxiety disorder is not limited to specific situations.

Question 177: What is the correct action when a patient reports a new rash after receiving a medication?

Reduce the dose and observe
Stop the medication, assess severity, notify the physician, and document the reaction as an allergy (Correct answer)
Apply topical steroid without reporting
Continue the medication and document the rash

Correct answer: Stop the medication, assess severity, notify the physician, and document the reaction as an allergy

A new rash after drug administration may represent an allergic reaction ranging from mild to anaphylactic. The drug should be held, severity assessed (mild urticaria vs. angioedema, bronchospasm, hypotension suggesting anaphylaxis), the physician notified, and the reaction documented as an allergy in the medical record.

Question 178: Which action correctly identifies a patient before medication administration?

Ask the patient their room number
Check the name on the bed nameplate only
Ask a family member the patient's name
Check two identifiers: name and date of birth or medical record number (Correct answer)

Correct answer: Check two identifiers: name and date of birth or medical record number

Two patient identifiers (name plus date of birth or medical record number) are required before medication administration per international patient safety standards. Room number and bed labels are not reliable identifiers.

Question 179: What is 'surgical asepsis' versus 'medical asepsis'?

Surgical asepsis only applies in the operating room
Medical asepsis is more stringent than surgical asepsis
Surgical asepsis means completely sterile technique; medical asepsis reduces microbial numbers to safe levels (clean technique) (Correct answer)
They are interchangeable terms

Correct answer: Surgical asepsis means completely sterile technique; medical asepsis reduces microbial numbers to safe levels (clean technique)

Medical asepsis (clean technique) reduces microbial count and prevents spread (handwashing, clean environment). Surgical asepsis (sterile technique) aims to eliminate all microorganisms from objects and areas. Surgical asepsis is required for invasive procedures, wound care, and any entry into sterile body cavities.

Question 180: What is the most common cause of respiratory distress in premature newborns?

Pneumonia
Congenital heart disease
Meconium aspiration
Respiratory distress syndrome (RDS) from surfactant deficiency (Correct answer)

Correct answer: Respiratory distress syndrome (RDS) from surfactant deficiency

Surfactant, produced by type II pneumocytes, reduces alveolar surface tension and prevents alveolar collapse. Premature infants (<37 weeks) lack adequate surfactant, causing RDS (hyaline membrane disease). Treatment includes exogenous surfactant and respiratory support.

Question 181: A patient develops sudden confusion, tachycardia, and fever of 39.5°C on post-operative day 2. What should the nurse suspect?

Dehydration only
Adverse medication reaction requiring no action
Normal post-operative reaction
Infection or sepsis (Correct answer)

Correct answer: Infection or sepsis

New onset confusion, fever >38°C, and tachycardia are components of systemic inflammatory response syndrome (SIRS), suggesting early sepsis. Post-operative infection typically manifests day 2–5. Immediate assessment and physician notification are required.

Question 182: Which laboratory value indicates the patient may be at risk for bleeding?

White blood cell count of 8,000/mm³
Sodium of 138 mEq/L
Platelet count of 45,000/mm³ (Correct answer)
Hemoglobin of 12 g/dL

Correct answer: Platelet count of 45,000/mm³

A platelet count of 45,000/mm³ is significantly below the normal range (150,000–400,000/mm³), indicating thrombocytopenia. Low platelets impair clot formation, increasing bleeding risk. The other values are within normal limits.

Question 183: Which approach best describes 'health promotion' according to the Ottawa Charter?

Enabling people to increase control over and improve their health (Correct answer)
Treating illness after it occurs
Providing health services in hospitals only
Prescribing medications for prevention

Correct answer: Enabling people to increase control over and improve their health

The Ottawa Charter (1986) defines health promotion as the process of enabling people to increase control over their health. It encompasses building healthy public policies, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services.

Question 184: Which method is used to test whether an autoclave has achieved sterilization?

Temperature gauge reading only
Biological indicators (Geobacillus stearothermophilus spore strips) (Correct answer)
Visual inspection of instruments
Chemical indicators alone

Correct answer: Biological indicators (Geobacillus stearothermophilus spore strips)

Biological indicators using Geobacillus stearothermophilus spore strips are the gold standard for autoclave validation. These are the most heat-resistant organisms; if they are killed, sterilization was achieved. Chemical indicators (Bowie-Dick test, color-change tape) confirm exposure to steam/heat but do not confirm sterilization.

Question 185: What is the correct order of the nursing process?

Assessment, Planning, Diagnosis, Implementation, Evaluation
Planning, Assessment, Diagnosis, Implementation, Evaluation
Diagnosis, Assessment, Planning, Evaluation, Implementation
Assessment, Diagnosis, Planning, Implementation, Evaluation (Correct answer)

Correct answer: Assessment, Diagnosis, Planning, Implementation, Evaluation

The nursing process follows the sequence: Assessment (collect data), Diagnosis (identify problems), Planning (set goals), Implementation (carry out interventions), and Evaluation (assess outcomes). This ADPIE sequence is universally accepted.

Question 186: A healthcare worker sustains a needlestick injury from an HIV-positive patient. What is the immediate action?

Wash the wound with soap and water, report to occupational health, assess HIV exposure and start PEP within 72 hours (Correct answer)
Squeeze the wound to remove blood, apply iodine, return to work
Apply antibiotic ointment and cover with a bandage
No action needed as the risk is very low

Correct answer: Wash the wound with soap and water, report to occupational health, assess HIV exposure and start PEP within 72 hours

Needlestick response: immediately wash with soap and water (do not squeeze), report to occupational health or emergency department, assess source patient HIV status, and start HIV post-exposure prophylaxis (PEP) within 72 hours (ideally <2 hours) — a 28-day antiretroviral course.

Question 187: What does ESBL stand for and what is the clinical significance?

Extended safety biomarker level
Enhanced sterile barrier laboratory
Extended-spectrum beta-lactamase — enzymes that break down most penicillins and cephalosporins, leaving few treatment options (Correct answer)
Extra-stable bacterial layer

Correct answer: Extended-spectrum beta-lactamase — enzymes that break down most penicillins and cephalosporins, leaving few treatment options

ESBL-producing bacteria (commonly E. coli, Klebsiella) produce enzymes that hydrolyze most beta-lactam antibiotics including third-generation cephalosporins. Carbapenems (meropenem, imipenem) are often the last-resort treatment. ESBLs spread via contact transmission and are a major healthcare infection challenge.

Question 188: Which reflex is normal in a healthy newborn?

All newborn reflexes are abnormal
Stepping reflex disappears at birth
Babinski reflex disappears at birth
Moro (startle) reflex (Correct answer)

Correct answer: Moro (startle) reflex

The Moro reflex (startle response to sudden movement — arms abduct then adduct) is a normal primitive reflex present at birth. Absence suggests neurological impairment. It disappears by 3–6 months as the nervous system matures.

Question 189: What is the most accurate method for calculating medication doses for pediatric patients?

Using the same dose as adults for children over 5
Estimating by the child's age
Body weight in kilograms (mg/kg) or body surface area (BSA) calculation (Correct answer)
Using the adult dose divided by 2

Correct answer: Body weight in kilograms (mg/kg) or body surface area (BSA) calculation

Pediatric dosing is calculated by mg/kg body weight for most medications, with BSA (m²) used for critical drugs like chemotherapy. Weight must be measured accurately (not estimated) and doses must not exceed maximum adult doses. Double-check calculations are standard practice.

Question 190: A post-operative patient reports sudden onset of chest pain and dyspnea on day 3. What should the nurse suspect first?

Pleural effusion
Pulmonary embolism (Correct answer)
Atelectasis
Pneumonia

Correct answer: Pulmonary embolism

Sudden pleuritic chest pain and dyspnea in a post-operative patient on day 2–5 is a classic presentation of pulmonary embolism from deep vein thrombosis. Immobility, surgery, and hypercoagulable state (Virchow's triad) are risk factors.

Question 191: Which term describes a patient's false belief that is firmly held despite evidence to the contrary?

Confabulation
Hallucination
Delusion (Correct answer)
Illusion

Correct answer: Delusion

A delusion is a fixed, false belief not consistent with cultural norms, maintained despite clear evidence to the contrary. Hallucinations are sensory perceptions without external stimuli. Illusions are misinterpretations of real stimuli. Confabulation is unconscious fabrication of memories.

Question 192: Which assessment finding requires immediate nursing intervention?

Temperature of 37.2°C
Respiratory rate of 16 breaths/min
Blood pressure of 130/80 mmHg
Oxygen saturation of 88% on room air (Correct answer)

Correct answer: Oxygen saturation of 88% on room air

An oxygen saturation of 88% indicates significant hypoxemia, which can cause tissue hypoxia and organ damage. Immediate supplemental oxygen and physician notification are required. The other values are within normal limits.

Question 193: What is the priority nursing intervention for a patient experiencing a tonic-clonic seizure?

Restrain limbs to prevent injury
Leave the patient and call for help immediately
Insert a tongue blade to protect the tongue
Protect the patient from injury, maintain airway, do not restrain (Correct answer)

Correct answer: Protect the patient from injury, maintain airway, do not restrain

The priority during a seizure is patient safety: lower to the floor if possible, cushion the head, clear the environment, and turn to the side after convulsive activity stops to maintain airway. Never restrain or insert objects in the mouth.

Question 194: What is the recommended frequency for repositioning bedridden patients to prevent pressure ulcers?

Every 2 hours (Correct answer)
Every 4 hours
Every 30 minutes
Every 6 hours

Correct answer: Every 2 hours

Evidence-based guidelines recommend repositioning immobile patients every 2 hours to relieve sustained pressure on bony prominences, restore tissue perfusion, and prevent pressure ulcer formation.

Question 195: What is the nurse's role in end-of-life care in the Saudi ICU?

End-of-life discussions are not the nurse's responsibility
Withdraw all medications
Provide comfort measures, manage symptoms, support family communication, respect cultural/religious practices, and coordinate with the palliative care team (Correct answer)
Only provide technical care

Correct answer: Provide comfort measures, manage symptoms, support family communication, respect cultural/religious practices, and coordinate with the palliative care team

ICU end-of-life nursing: provide dignified comfort care, manage pain and symptoms, support family (facilitate visits, communication with physicians), respect Islamic end-of-life practices (facing Qibla, Quran recitation), ensure Do Not Resuscitate orders are clear, and coordinate with palliative care and chaplaincy services.

Question 196: What is the correct technique for measuring blood pressure manually?

Place the cuff over clothing, inflate to 300 mmHg always
Position the arm above heart level
Deflate the cuff as quickly as possible
Position the cuff 2–3 cm above the antecubital fossa, inflate 30 mmHg above estimated systolic, deflate at 2–3 mmHg/sec (Correct answer)

Correct answer: Position the cuff 2–3 cm above the antecubital fossa, inflate 30 mmHg above estimated systolic, deflate at 2–3 mmHg/sec

The cuff should be placed 2–3 cm above the antecubital fossa over the brachial artery, inflated 30 mmHg above the estimated systolic pressure, and slowly deflated at 2–3 mmHg/second to accurately identify Korotkoff sounds.

Question 197: What is the purpose of biofilm in healthcare-associated infections?

Biofilm prevents infection formation
Biofilm is only a problem on environmental surfaces
Biofilm is a natural protective substance produced by the body
Bacteria within biofilm are protected from antibiotics and immune cells, making infections very difficult to treat (Correct answer)

Correct answer: Bacteria within biofilm are protected from antibiotics and immune cells, making infections very difficult to treat

Biofilms are structured communities of bacteria encased in a self-produced polysaccharide matrix, forming on urinary catheters, central lines, prosthetic joints, and chronic wounds. Bacteria within biofilm are up to 1000 times more resistant to antibiotics and evade immune defenses.

Question 198: A patient is diagnosed with deep vein thrombosis (DVT). Which nursing intervention is contraindicated?

Applying warm compresses as ordered
Massaging the affected leg (Correct answer)
Administering anticoagulants as prescribed
Elevating the affected extremity

Correct answer: Massaging the affected leg

Massaging a limb with known or suspected DVT is contraindicated because it can dislodge the thrombus, causing a potentially fatal pulmonary embolism. Elevation, warmth, and anticoagulation are appropriate interventions.

Question 199: What is the importance of cultural competence in Saudi nursing practice?

Only relates to language translation
Only important when treating non-Saudi patients
Understanding and respecting diverse cultural beliefs, communication styles, and health practices of the diverse patient population in Saudi Arabia (Correct answer)
Cultural competence is not relevant

Correct answer: Understanding and respecting diverse cultural beliefs, communication styles, and health practices of the diverse patient population in Saudi Arabia

Saudi Arabia's diverse population (citizens and expatriates from many countries) requires cultural competence: understanding Islamic health practices, respecting modesty requirements, accommodating language differences, recognizing cultural health beliefs, providing gender-appropriate care, and adapting communication styles.

Question 200: What is the correct method for obtaining a mid-stream urine specimen?

Collect the first stream only
Insert a catheter for every urine culture
Collect the entire void in a sterile container
Clean the urethral area, discard first stream, collect midstream, stop before end of stream (Correct answer)

Correct answer: Clean the urethral area, discard first stream, collect midstream, stop before end of stream

Mid-stream collection reduces contamination from periurethral flora. Cleaning the area, discarding the first stream, then collecting the middle portion provides the most accurate representation of bladder urine.

Saudi Nursing Licensure Exam

The SNLE is administered by the Saudi Commission for Health Specialties (SCFHS) to assess nursing competency for licensure in Saudi Arabia, covering adult health, maternal-child, community, pharmacology, and professional standards.

200

Questions

240 min

Time Limit

63%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

proscheduler.prometric.com — Score release · verified Oct 2026
scfhs.org.sa — Retake policy, test delivery, eligibility, exam format, passing score, registration · verified Oct 2026