Mixed Deck — All SAUDI PROMETRIC NURSING Topics Flashcards

A patient with schizophrenia tells the nurse that the television is sending special messages only to them. This symptom is an example of:

Answer: Idea of reference

An idea of reference is a delusional belief that external events (TV, radio, strangers' conversations) have special personal relevance or messages directed specifically at the patient. It is a positive symptom of schizophrenia.

A nurse in a Saudi MOH hospital is caring for a patient with chronic liver disease who develops hepatic encephalopathy Grade III. The physician orders lactulose 30 mL orally every 2 hours. After 6 hours, the patient has had 5 loose stools and arterial ammonia is 180 µmol/L (normal <50 µmol/L). The patient's sodium is 128 mEq/L. Which nursing intervention takes HIGHEST priority at this point?

Answer: Hold lactulose and notify physician of hyponatremia with risk of osmotic demyelination syndrome

While lactulose is first-line for hepatic encephalopathy, the patient now has significant hyponatremia (Na 128 mEq/L). Continued aggressive lactulose-induced diarrhea can worsen hyponatremia through free water and electrolyte losses. In cirrhotic patients, hyponatremia is often dilutional; rapid correction with isotonic saline risks osmotic demyelination syndrome (ODS). The nurse must hold the lactulose and escalate to the physician to reassess the regimen, potentially adding rifaximin (approved in Saudi MOH formularies) and addressing electrolyte balance before continuing. Normal saline bolus (option D) is dangerous in dilutional hyponatremia with fluid overload.

The nurse is administering IV calcium gluconate. What medication must be available at the bedside as an antidote?

Answer: Sodium bicarbonate and cardiac monitoring equipment

Calcium gluconate is used to treat hypocalcemia and to protect the heart in hyperkalemia. However, rapid administration can cause bradycardia and cardiac arrest. ECG monitoring and resuscitation equipment (including sodium bicarbonate to manage arrhythmias) should be available.

A 10-month-old infant presents with high fever and a generalized macular rash that appears as the fever breaks. What condition does the nurse suspect?

Answer: Roseola infantum (Sixth disease)

Roseola (HHV-6) classically presents in infants 6–24 months old with 3–5 days of high fever (up to 40°C), followed by the appearance of a generalized rose-pink macular rash as the fever breaks. This sequence — fever first, rash after — is the hallmark.

A patient is admitted involuntarily to a psychiatric unit. The nurse explains that the patient retains which right?

Answer: The right to refuse specific medications (with capacity assessment)

Involuntary psychiatric admission restricts freedom of movement but does not eliminate all rights. Patients retain rights including: confidentiality, humane treatment, communication with an attorney, and the right to refuse medications in most jurisdictions (unless capacity is deemed absent by a court).

A community health nurse in Al-Qassim region — where Brucellosis is endemic — confirms a case of Brucella melitensis in a 40-year-old goat farmer following laboratory testing. The patient is referred for antibiotic treatment. What is the nurse's PRIMARY next action under Saudi MOH communicable disease control regulations?

Answer: Notify the Regional Health Affairs Directorate through the official reporting system and conduct a source investigation to identify the animal reservoir and raw dairy exposure

Brucellosis is a Category B notifiable disease in Saudi Arabia requiring mandatory reporting to the Regional Health Affairs Directorate. The community health nurse's primary public health role beyond clinical referral is official notification AND source investigation — identifying the animal reservoir (goats, camels, cattle), raw milk or unpasteurized cheese consumption, and occupational exposure routes. Household quarantine is not indicated; Brucellosis is not transmitted person-to-person. Prophylactic antibiotics are not routinely indicated for contacts without occupational exposure. Veterinary coordination through the Ministry of Environment, Water, and Agriculture is also triggered, but this is a secondary referral — the nurse's first duty is MOH notification and epidemiological investigation.

A nurse is implementing a surgical site infection (SSI) prevention bundle pre-operatively. Which intervention has the strongest evidence for reducing SSI?

Answer: Chlorhexidine-alcohol skin preparation and appropriate perioperative antibiotic prophylaxis

Evidence-based SSI prevention: chlorhexidine-alcohol skin antisepsis (superior to povidone-iodine), timely antibiotic prophylaxis (within 60 min of incision), maintaining normothermia and glucose control, and avoiding hair shaving (clippers if needed, just before surgery). Prophylactic antibiotics should not extend beyond 24 hours routinely.

A 68-year-old Saudi male with chronic kidney disease (CrCl 22 mL/min) is prescribed metformin 1000 mg twice daily by a new resident for Type 2 diabetes. As the primary nurse, your priority concern regarding this prescription is:

Answer: Lactic acidosis risk, because metformin accumulates in renal impairment and inhibits hepatic lactate clearance

Metformin is contraindicated when CrCl < 30 mL/min (Saudi MOH and SFDA guidelines align with international standards). In renal impairment, metformin accumulates because it is renally cleared. This leads to mitochondrial inhibition of Complex I, reducing hepatic gluconeogenesis from lactate and causing life-threatening lactic acidosis. Metformin does not stimulate insulin secretion (it's not a secretagogue), does not cause hyperkalemia, and has no QT effect. The nurse must flag this as a critical prescribing error and withhold the dose pending physician review.

A psychiatric nurse in Jeddah is caring for a patient with Bipolar I Disorder who is 7 months pregnant and experiencing a severe manic episode with psychotic features. The team is considering pharmacological intervention. Which of the following medication choices presents the GREATEST teratogenic risk that the nurse must prioritize flagging to the treating team?

Answer: Valproate sodium at mood-stabilizing doses

Valproate (sodium valproate) carries a Category X-equivalent teratogenic profile and is explicitly contraindicated in pregnancy due to a high risk of neural tube defects (spina bifida), fetal valproate syndrome, and long-term neurodevelopmental impairment in the child. At 7 months gestation, the CNS is still maturing, and valproate remains harmful throughout pregnancy. The SCFHS maternal-psychiatric nursing guidelines and WHO recommendations strongly advise against valproate in pregnant women. While quetiapine, haloperidol, and lorazepam each carry their own perinatal risks, valproate represents the highest absolute teratogenic risk among these options and requires urgent flagging.

A critically ill patient has a serum potassium of 6.8 mEq/L with peaked T-waves on ECG. Which intervention takes priority?

Answer: Administer IV calcium gluconate

Calcium gluconate stabilizes the cardiac membrane and is the first-line emergency treatment for severe hyperkalemia with ECG changes.

The public health nurse is interpreting a sensitivity of 95% for a screening test. What does this mean?

Answer: 95% of people with the disease will test positive (true positive rate)

Sensitivity = true positives / (true positives + false negatives). A sensitivity of 95% means the test correctly identifies 95% of people who truly have the disease. High sensitivity = low false negative rate, making it good for ruling out disease (negative result = unlikely to have disease).

According to WHO hand hygiene guidelines, which of the 'Five Moments for Hand Hygiene' requires hand hygiene BEFORE the moment?

Answer: Before touching a patient and before aseptic procedures

The WHO Five Moments are: (1) before touching a patient, (2) before aseptic/clean procedures, (3) after body fluid exposure, (4) after touching a patient, (5) after touching patient surroundings. Moments 1 and 2 are 'before' moments that protect the patient.

A 67-year-old male admitted to a Saudi MOH ICU following a massive ischemic stroke develops fever (39.8°C), hypertension (BP 195/110 mmHg), bradycardia (HR 44 bpm), and irregular respirations. CT head shows significant cerebral edema with midline shift of 8 mm. Intracranial pressure (ICP) monitoring shows ICP 32 mmHg and cerebral perfusion pressure (CPP) of 55 mmHg. Per SCFHS neurocritical care guidelines, which intervention should be PRIORITIZED FIRST?

Answer: Administer 23.4% hypertonic saline 30 mL IV bolus to acutely lower ICP

The patient has Cushing's triad (hypertension, bradycardia, irregular respirations) indicating critically elevated ICP with impending herniation, and ICP of 32 mmHg with CPP of only 55 mmHg (target is ≥60 mmHg). The immediate priority is to acutely reduce ICP. In refractory or acute ICP crisis, 23.4% hypertonic saline (30 mL bolus) provides rapid osmotic reduction of cerebral edema and is the most potent acute pharmacological ICP-lowering agent, superior to mannitol in this context. Therapeutic hypothermia (option B) is not first-line for ischemic stroke. Lowering MAP with labetalol (option C) would dangerously reduce CPP further (CPP = MAP − ICP). Hemicraniectomy (option D) is a surgical option but not the immediate first priority before medical management is maximized.

A primigravida at 38 weeks gestation presents with BP 158/104, severe headache, and 3+ proteinuria. What condition should the nurse suspect?

Answer: Severe preeclampsia

Severe preeclampsia is characterized by BP ≥160/110, severe headache, visual changes, epigastric pain, and significant proteinuria. This patient's BP of 158/104 with symptoms crosses into severe range. HELLP involves hemolysis, elevated liver enzymes, and low platelets.

A nurse is preparing a Saudi patient with bipolar I disorder and stage 3 chronic kidney disease (CKD) for discharge on a mood stabilizer regimen. The psychiatrist has prescribed lithium. Which nursing action reflects the HIGHEST level of patient safety advocacy in this specific clinical context?

Answer: Immediately clarify the prescription with the psychiatrist and flag the renal contraindication, recommending consideration of valproate or lamotrigine

Lithium is primarily renally excreted and is relatively contraindicated in stage 3+ CKD due to the high risk of accumulation and toxicity. The nurse's highest advocacy role is to proactively flag this pharmacological risk to the prescribing psychiatrist before the medication is dispensed—not after. While lithium can occasionally be used with extreme caution and adjusted dosing in mild-moderate CKD under specialist oversight, the nurse must initiate the safety conversation. Alternatives such as valproate (with liver monitoring) or lamotrigine are commonly preferred in renal impairment. Substituting medications independently without physician order would exceed the nurse's scope of practice.

The nurse is preparing to give a subcutaneous injection of insulin. At what angle should the needle be inserted?

Answer: 45–90 degrees depending on body fat

Subcutaneous injections are given at 45–90 degrees. The angle depends on the patient's body fat: 90 degrees for patients with adequate subcutaneous tissue, 45 degrees for thin patients to avoid injecting into muscle.

The nurse is administering oxytocin to augment labor. Which finding requires the nurse to stop the infusion and notify the physician?

Answer: Uterine contractions lasting more than 90 seconds occurring every 1 minute (tachysystole)

Uterine tachysystole (contractions >5 in 10 minutes) or prolonged contractions (>90 seconds) with oxytocin can cause fetal hypoxia. The infusion must be stopped and the patient repositioned, given oxygen, and the physician notified.

A patient is admitted with diabetic ketoacidosis (DKA). Which arterial blood gas result is expected?

Answer: pH 7.28, PaCO2 28, HCO3 14 (metabolic acidosis with respiratory compensation)

DKA causes metabolic acidosis from ketone accumulation. Expected ABG findings are low pH (<7.35), low HCO3 (<18), and low PaCO2 due to compensatory hyperventilation (Kussmaul respirations), which attempts to blow off CO2 to raise pH.

The nurse is performing a physical assessment and notices the patient has clubbing of the fingers. This finding is most commonly associated with:

Answer: Chronic hypoxia

Digital clubbing is associated with chronic hypoxia, most commonly due to chronic lung diseases (e.g., COPD, cystic fibrosis) or cyanotic heart disease. The mechanism involves chronic tissue hypoxia causing soft tissue proliferation.

A patient is prescribed metoprolol. What is the most important assessment before administering a beta-blocker?

Answer: Heart rate and blood pressure

Before administering any beta-blocker, the nurse must assess heart rate and blood pressure. Beta-blockers slow heart rate and reduce blood pressure. They should be withheld if HR <60 bpm or systolic BP <90 mmHg (per institutional parameters or physician orders).