SCFHS Saudi Prometric Nursing Exam Nutrition and Therapeutic Diet in Nursing — Questions and Answers
Question 1: A Saudi patient with Stage 4 chronic kidney disease (CKD, GFR 20 mL/min/1.73m²) who is not yet on dialysis is placed on a renal diet. Which dietary restriction is MOST critical at this stage?
- Restrict protein intake to 0.6–0.8 g/kg/day to slow CKD progression (Correct answer)
- Restrict carbohydrates to prevent hyperglycemia
- Increase potassium intake to protect cardiac function
- Restrict calcium intake to prevent hypercalcemia
Correct answer: Restrict protein intake to 0.6–0.8 g/kg/day to slow CKD progression
In pre-dialysis CKD (stages 4–5), low-protein diets (0.6–0.8 g/kg/day) are recommended by KDIGO guidelines and adopted in Saudi MOH renal nutrition protocols to reduce uremic solute load and slow CKD progression. Carbohydrate restriction is a secondary concern if diabetes is present. Potassium must be RESTRICTED (not increased) in advanced CKD to prevent hyperkalemia-induced arrhythmia. Calcium management depends on phosphate and PTH levels.
Question 2: A nurse is initiating nasogastric (NG) tube feeding for a post-stroke patient in a Saudi hospital. Before starting the first feed, what is the MOST reliable method to confirm correct tube placement?
- Chest X-ray confirming the tube tip is below the diaphragm in the stomach (Correct answer)
- Auscultating for air sounds while injecting 20 mL of air via the tube
- Checking that gastric aspirate has a pH of 6 or less using pH paper
- Observing that the patient is not coughing after tube insertion
Correct answer: Chest X-ray confirming the tube tip is below the diaphragm in the stomach
Chest X-ray is the gold standard for confirming NG tube placement, especially before the first feed in a high-risk patient (post-stroke patients have impaired gag reflex and aspiration risk). The auscultation method (whoosh test) is unreliable and no longer recommended. pH testing of aspirate is an acceptable bedside method (pH ≤5.5 confirms gastric placement), but X-ray remains the most reliable method when clinical uncertainty exists.
Question 3: A Saudi patient with Type 2 diabetes mellitus is taught about the glycemic index (GI) of common foods. Which traditional Saudi food has the HIGHEST glycemic index and should be consumed in limited portions?
- White rice (Kabsa) (Correct answer)
- Whole grain bread
- Lentils
- Hummus
Correct answer: White rice (Kabsa)
White rice, a staple of traditional Saudi cuisine including Kabsa, has a high glycemic index (GI ~72–87), causing rapid postprandial blood glucose elevation. Whole grain bread has a moderate GI (~55–70), while lentils (GI ~25–45) and hummus (GI ~6) are low-GI foods that cause gradual glucose rises. Saudi diabetic patients commonly consuming Kabsa should be counseled on portion control and carbohydrate counting.
Question 4: A critically ill patient in a Saudi ICU receiving total parenteral nutrition (TPN) develops a blood glucose of 14 mmol/L. According to Saudi SCCM-aligned protocols, what is the TARGET blood glucose range during TPN administration in ICU patients?
- 7.8–10 mmol/L (Correct answer)
- 3.9–6.1 mmol/L (strict normoglycemia)
- 11–14 mmol/L (permissive hyperglycemia)
- 4–7 mmol/L
Correct answer: 7.8–10 mmol/L
Current Saudi ICU and international critical care guidelines (SCCM/ESPEN) recommend a target blood glucose of 7.8–10 mmol/L for critically ill patients receiving TPN. Strict normoglycemia (3.9–6.1 mmol/L) was associated with higher hypoglycemia-related mortality in landmark NICE-SUGAR trials. Permissive hyperglycemia >10 mmol/L increases infection risk and impairs wound healing. The glucose reading of 14 mmol/L requires insulin intervention.
Question 5: A nurse is providing dietary education to a Saudi cardiac patient newly diagnosed with heart failure. Which dietary modification is the MOST critical to prevent fluid retention and acute decompensation?
- Restrict dietary sodium to less than 2 grams per day (Correct answer)
- Eliminate all dietary fat
- Restrict dietary protein to less than 40 grams per day
- Increase fiber intake to more than 40 grams per day
Correct answer: Restrict dietary sodium to less than 2 grams per day
Sodium restriction to <2 g/day is the cornerstone dietary intervention for heart failure management because excess sodium drives water retention, increasing preload and worsening pulmonary congestion. This recommendation is consistent with Saudi Heart Association guidelines. Eliminating all fat is not recommended; protein restriction is for CKD, not heart failure; increased fiber is beneficial for cardiovascular health generally but does not address acute fluid overload.
Question 6: A Saudi child aged 6 months is brought to a primary health care center and the mother reports exclusive breastfeeding. According to WHO and Saudi MOH infant feeding guidelines, what is the recommended approach at this age?
- Begin introducing complementary foods (pureed fruits, vegetables, iron-rich cereals) while continuing breastfeeding (Correct answer)
- Switch entirely to commercial infant formula to meet increased caloric demands
- Continue exclusive breastfeeding until 12 months with no complementary foods
- Introduce cow's milk to supplement breast milk
Correct answer: Begin introducing complementary foods (pureed fruits, vegetables, iron-rich cereals) while continuing breastfeeding
WHO and Saudi MOH Maternal and Child Health guidelines recommend exclusive breastfeeding for the first 6 months, followed by the introduction of complementary foods (starting with iron-rich foods, pureed vegetables and fruits) at 6 months while continuing breastfeeding until 2 years of age. Switching entirely to formula at 6 months is unnecessary. Exclusive breastfeeding beyond 6 months without complementary foods is inadequate for nutritional needs. Cow's milk is not recommended before 12 months of age.
SCFHS Saudi Prometric Nursing Exam Nutrition and Therapeutic Diet in Nursing
A Saudi patient with Stage 4 chronic kidney disease (CKD, GFR 20 mL/min/1.73m²) who is not yet on dialysis is placed on a renal diet.
Which dietary restriction is MOST critical at this stage?