SNLE - Saudi Nursing Licensing Adult Medical-Surgical Nursing Questions and Answers — Questions and Answers
Question 1: A 45-year-old male patient with a known history of Type 2 Diabetes Mellitus presents to a primary health clinic in Riyadh. His latest HbA1c is 8.5%. According to the Saudi Ministry of Health (MOH) guidelines for diabetes management, which of the following is the most appropriate initial action for the nurse to anticipate?
- Recommending immediate initiation of insulin therapy.
- Reinforcing education on lifestyle modifications and assessing medication adherence. (Correct answer)
- Scheduling the patient for a consultation with a nephrologist.
- Advising the patient to double his current oral hypoglycaemic dose.
Correct answer: Reinforcing education on lifestyle modifications and assessing medication adherence.
According to the National Saudi Diabetic Guidelines for Primary Health Care, the target for most diabetic patients is an HbA1c of less than 7%. When a patient's HbA1c is elevated, the initial step involves a thorough assessment of their current regimen, including adherence to diet, exercise, and prescribed medications. Before escalating pharmacological treatment, it is crucial to reinforce education and identify any barriers to self-management. Immediate insulin initiation is typically reserved for patients with significantly higher HbA1c levels or signs of catabolism.
Question 2: 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.
- Confirming the patient’s identity, procedure, site, and consent. (Correct answer)
- Verifying that the patient's family members are present in the waiting area.
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 3: A 28-year-old female from the Eastern Province is admitted with a painful vaso-occlusive crisis. Given the high prevalence of Sickle Cell Disease (SCD) in this region of Saudi Arabia, what is the priority nursing intervention?
- Administering high-flow oxygen via a non-rebreather mask.
- Providing aggressive intravenous hydration and pain management. (Correct answer)
- Initiating prophylactic antibiotic therapy.
- Preparing the patient for an emergency splenectomy.
Correct answer: Providing aggressive intravenous hydration and pain management.
The management of a sickle cell vaso-occlusive crisis prioritizes hydration and analgesia. Intravenous fluids help to reduce blood viscosity and sickling, while adequate pain control is essential for patient comfort and to reduce physiological stress. The Eastern and Southwestern regions of Saudi Arabia have the highest prevalence of SCD. While oxygen may be used if the patient is hypoxic, it is not the primary intervention for all crises. Antibiotics are for treating infection, and splenectomy is not an emergency treatment for a typical pain crisis.
Question 4: 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, and an N95 respirator.
- Gown, gloves, eye protection, and a surgical mask. (Correct answer)
- Shoe covers, gown, and a surgical mask.
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 5: 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?
- Bed rest for the first 48 hours post-operatively.
- Nil per os (NPO) until bowel sounds return.
- Early mobilization and physiotherapy on post-operative day 1. (Correct answer)
- Routine administration of opioid analgesics every 4 hours.
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 6: A nurse in a medical ward is reviewing the lab results of an adult Saudi male patient. The complete blood count (CBC) shows a haemoglobin (Hb) level of 110 g/L. How should the nurse interpret this finding based on reference intervals for the adult Saudi population?
- Within the normal reference range.
- Indicative of severe anaemia.
- Below the normal reference range, indicating mild anaemia. (Correct answer)
- Above the normal reference range, indicating polycythaemia.
Correct answer: Below the normal reference range, indicating mild anaemia.
Based on studies establishing haematological reference intervals for the Saudi population, the normal haemoglobin range for adult males is typically 130-170 g/L or higher, with a mean often around 149 g/L. A value of 110 g/L is below this lower limit. According to general clinical guidelines used in the Kingdom, anaemia is often defined as Hb < 120 g/L in females and < 130 g/L in males. Therefore, 110 g/L indicates mild anaemia.
SNLE - Saudi Nursing Licensing Adult Medical-Surgical Nursing Questions and Answers
A 45-year-old male patient with a known history of Type 2 Diabetes Mellitus presents to a primary health clinic in Riyadh.
His latest HbA1c is 8.5%.
According to the Saudi Ministry of Health (MOH) guidelines for diabetes management, which of the following is the most appropriate initial action for the nurse to anticipate?