Saudi Prometric Nursing Infection Control and Saudi MOH Regulations 3 — Questions and Answers
Question 1: A patient on a surgical ward develops fever, chills, and hypotension 48 hours after placement of a urinary catheter. The nurse suspects CAUTI. What is the most important immediate nursing action?
- Obtain urine culture and blood cultures, notify physician, and monitor vital signs (Correct answer)
- Change the urinary catheter immediately
- Administer antipyretics and reassess in 4 hours
- Irrigate the bladder with normal saline
Correct answer: Obtain urine culture and blood cultures, notify physician, and monitor vital signs
Suspected CAUTI with systemic signs (fever, chills, hypotension) may indicate urosepsis — a medical emergency. Obtaining cultures (urine and blood) before antibiotics are started provides diagnostic information. Immediate physician notification and hemodynamic monitoring are critical.
Question 2: The nurse is performing surgical hand antisepsis before an operation. What is the minimum recommended duration for this procedure?
- 2–5 minutes using an antimicrobial scrub (or per manufacturer's instructions for alcohol-based formulations) (Correct answer)
- 30 seconds using alcohol-based hand rub
- 1 minute with soap and water
- 10 minutes using povidone-iodine
Correct answer: 2–5 minutes using an antimicrobial scrub (or per manufacturer's instructions for alcohol-based formulations)
Surgical hand antisepsis requires 2–5 minutes (or per the alcohol-based product manufacturer instructions) to remove transient flora and significantly reduce resident flora, achieving the 'clean' state required for surgical procedures. It differs from routine hand hygiene (20–30 sec).
Question 3: Which isolation precaution is required for a patient with active pulmonary tuberculosis?
- Airborne precautions with negative-pressure isolation room and N95 respirator (Correct answer)
- Droplet precautions with surgical mask
- Contact precautions with gown and gloves
- Standard precautions only
Correct answer: Airborne precautions with negative-pressure isolation room and N95 respirator
Pulmonary TB is spread via airborne droplet nuclei (<5 micrometers) that remain suspended in air. Airborne precautions require: negative-pressure (at least 6–12 air changes/hour), N95 or higher respirator for healthcare workers, and door kept closed.
Question 4: A nurse working in the ICU in Saudi Arabia is reviewing the ventilator-associated pneumonia (VAP) prevention bundle. Which intervention has the strongest evidence for VAP reduction?
- Head-of-bed elevation 30–45 degrees and oral care with chlorhexidine (Correct answer)
- Routine ventilator circuit changes every 48 hours
- Prophylactic antibiotics for all ventilated patients
- Daily routine suctioning whether secretions are present or not
Correct answer: Head-of-bed elevation 30–45 degrees and oral care with chlorhexidine
The VAP bundle with strongest evidence includes: head-of-bed elevation 30–45 degrees (prevents aspiration), oral care with 0.12% chlorhexidine (reduces oral colonization), daily sedation vacations, and assessment for extubation. Routine circuit changes increase VAP risk.
Question 5: The Saudi MOH regulations require healthcare workers to report occupational blood or body fluid exposures within what time frame?
- Immediately or as soon as possible — within hours, not days (Correct answer)
- Within 48 hours
- Within 72 hours, before starting PEP
- Within 1 week
Correct answer: Immediately or as soon as possible — within hours, not days
Occupational exposure to blood/body fluids requires immediate reporting to the occupational health department because post-exposure prophylaxis (PEP) for HIV must begin within 2 hours (maximum 72 hours) to be effective. Immediate reporting enables timely decision-making.
Question 6: A nurse notes that a patient's blood culture has grown MRSA. Which precautions should be implemented?
- Contact precautions (gown and gloves) for all patient care activities (Correct answer)
- Airborne precautions only
- Droplet precautions with surgical mask
- No additional precautions beyond standard precautions
Correct answer: Contact precautions (gown and gloves) for all patient care activities
MRSA (methicillin-resistant Staphylococcus aureus) is transmitted primarily through direct skin-to-skin contact and contact with contaminated surfaces. Contact precautions (gown and gloves for all patient contact) are required in addition to standard precautions.
Saudi Prometric Nursing Infection Control and Saudi MOH Regulations 3
A patient on a surgical ward develops fever, chills, and hypotension 48 hours after placement of a urinary catheter.
The nurse suspects CAUTI.
What is the most important immediate nursing action?