Saudi Nursing Licensure Exam — Questions and Answers

Question 1: What is the recommended frequency for repositioning bedridden patients to prevent pressure ulcers?

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

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 2: A patient taking corticosteroids long-term should be monitored for which complication?

Hypotension
Bradycardia
Hyperglycemia, hypertension, osteoporosis, and adrenal suppression (Correct answer)
Hypoglycemia only

Correct answer: Hyperglycemia, hypertension, osteoporosis, and adrenal suppression

Long-term corticosteroid use causes multiple side effects: hyperglycemia (impaired glucose metabolism), hypertension (sodium/water retention), osteoporosis (reduced calcium absorption), weight gain (Cushing's syndrome), immunosuppression, and hypothalamic-pituitary-adrenal axis suppression.

Question 3: Saudi Arabia's Vision 2030 health goals include which nursing-relevant objective?

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

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 4: A nurse is teaching a new mother about breastfeeding. How often should a newborn feed?

Once per night only
Every 6–8 hours
On a strict 4-hour schedule
Every 2–3 hours, 8–12 times per day (Correct answer)

Correct answer: Every 2–3 hours, 8–12 times per day

Newborns have small stomachs and high nutritional needs. Feeding every 2–3 hours (8–12 times in 24 hours) establishes milk supply through frequent stimulation, prevents hypoglycemia, and supports adequate newborn weight gain.

Question 5: 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?

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

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 6: 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?

Expose the infant to direct sunlight for 30 minutes daily.
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.
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 7: A patient has a nasogastric tube. Before administering medication, what must the nurse confirm?

That the patient is sitting upright only
Tube color and length
Tube placement in the stomach (Correct answer)
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 8: A diabetic patient in Saudi Arabia planning to observe Ramadan fasting should be counseled to:

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

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 9: What is the normal respiratory rate for a newborn?

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

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 10: What is antibiotic stewardship?

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

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 11: What is the purpose of Rho(D) immune globulin (RhoGAM)?

To stimulate fetal lung maturity
To prevent Rh sensitization in Rh-negative mothers (Correct answer)
To prevent preeclampsia
To treat existing Rh hemolytic disease

Correct answer: To prevent Rh sensitization in Rh-negative mothers

RhoGAM is given to Rh-negative mothers at 28 weeks gestation and within 72 hours after delivery, miscarriage, amniocentesis, or trauma. It provides passive immunity that prevents the mother from forming anti-Rh antibodies that would affect future pregnancies.

Question 12: A patient with COPD is receiving oxygen therapy. What is the safest initial oxygen flow rate?

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

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

Hypokalemia (low potassium) (Correct answer)
Hypernatremia
Hypercalcemia
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 14: A nurse is caring for a patient with chronic renal failure. Which dietary modification is most critical?

Increase dietary protein
Encourage high fluid intake
Increase sodium intake
Restrict potassium and phosphorus (Correct answer)

Correct answer: Restrict potassium and phosphorus

Renal failure impairs excretion of potassium and phosphorus, requiring dietary restriction to prevent life-threatening hyperkalemia and hyperphosphatemia.

Question 15: What does 'MDROs' stand for and why are they significant?

Minimum dose required for organisms
Multi-drug resistant organisms — pathogens resistant to multiple antibiotics, limiting treatment options (Correct answer)
Medical diagnostic reporting orders
Mild drug reactions in organisms

Correct answer: Multi-drug resistant organisms — pathogens resistant to multiple antibiotics, limiting treatment options

MDROs (MRSA, VRE, ESBL-producing organisms, CRE, CRAB) have resistance to multiple antibiotic classes, leaving few or no treatment options. They spread readily in healthcare settings. Prevention requires contact precautions, antibiotic stewardship, and strict infection control.

Question 16: What is the normal range for adult serum sodium?

135–145 mEq/L (Correct answer)
125–135 mEq/L
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 17: When administering oxygen via a simple face mask, what is the minimum flow rate to prevent CO₂ rebreathing?

1–2 L/min
10 L/min
5 L/min (Correct answer)
15 L/min

Correct answer: 5 L/min

A minimum flow rate of 5 L/min is required with a simple face mask to flush exhaled CO₂ from the mask reservoir. Lower flow rates allow CO₂ accumulation and rebreathing, potentially worsening respiratory status.

Question 18: What does 'drug antagonism' mean?

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

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

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

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 20: What is the purpose of well-baby clinics in Saudi community health?

Providing hospital-level care in the community
Monitoring growth and development, providing immunizations, and educating parents (Correct answer)
Emergency pediatric care
Treating acute illness

Correct answer: Monitoring growth and development, providing immunizations, and educating parents

Well-baby clinics provide preventive pediatric services: routine growth and development monitoring, immunizations according to the national schedule, nutritional counseling, parental education, and early identification of developmental problems — all in a primary care setting.

Question 21: Which laboratory value indicates the patient may be at risk for bleeding?

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

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 22: What is the most important risk factor for non-communicable disease prevention that community nurses should address?

Genetic factors only
Tobacco use, physical inactivity, unhealthy diet, and harmful alcohol use (Correct answer)
Environmental pollution exclusively
Access to specialist hospitals

Correct answer: Tobacco use, physical inactivity, unhealthy diet, and harmful alcohol use

WHO identifies four shared modifiable risk factors responsible for 80% of premature NCD deaths: tobacco use, physical inactivity, unhealthy diet (high salt, saturated fat, sugar), and harmful alcohol use. Community nurses can address all four through education and behavioral change support.

Question 23: What is the purpose of a nursing care plan?

To schedule nursing shifts
To record billing information
To provide individualized, goal-directed care and guide interventions (Correct answer)
To document physician orders only

Correct answer: To provide individualized, goal-directed care and guide interventions

A nursing care plan individualizes care based on patient-specific nursing diagnoses and goals. It guides nursing interventions, promotes continuity of care, and provides a framework for evaluation.

Question 24: Which type of wound healing occurs when a wound is sutured closed?

Secondary intention
Tertiary intention
Primary intention (Correct answer)
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 25: Which observation indicates a toddler is experiencing normal separation anxiety?

Refusing to eat for more than 24 hours
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)

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 26: 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?

Initiating prophylactic antibiotic therapy.
Providing aggressive intravenous hydration and pain management. (Correct answer)
Preparing the patient for an emergency splenectomy.
Administering high-flow oxygen via a non-rebreather mask.

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 27: What is the Saudi Commission for Health Specialties (SCFHS) classification for registered nurses?

Classification only applies to physicians
Nurses are classified in the Nursing track with levels from Practitioner to Consultant based on education and experience (Correct answer)
All nurses hold the same classification
Nurses are classified under Allied Health only

Correct answer: Nurses are classified in the Nursing track with levels from Practitioner to Consultant based on education and experience

SCFHS classifies healthcare professionals including nurses in professional tracks with levels (Technician, Practitioner, Specialist, Consultant) based on qualifications, experience, and examination. Classification determines licensing scope, scope of practice, and salary grades.

Question 28: A patient with type 2 diabetes has a fasting blood glucose of 320 mg/dL. Which symptom is most likely present?

Bradypnea and confusion alone
Hypotension and bradycardia
Polyuria, polydipsia, and polyphagia (Correct answer)
Hypothermia and pallor

Correct answer: Polyuria, polydipsia, and polyphagia

The classic triad of hyperglycemia is polyuria (excess urination), polydipsia (excess thirst), and polyphagia (excess hunger). At 320 mg/dL the osmotic diuretic effect of glucose spills into urine, driving fluid loss and thirst.

Question 29: Which immunization is specifically contraindicated in a child with severe combined immunodeficiency (SCID)?

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

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 30: What is the Tawakkalna application's role in Saudi health?

A government digital health platform for COVID-19 status, vaccination records, and health service access (Correct answer)
A pharmaceutical database
A nursing licensing portal only
A hospital admission booking system only

Correct answer: A government digital health platform for COVID-19 status, vaccination records, and health service access

Tawakkalna is the Saudi government's digital health and services app. It served as the primary COVID-19 health passport (vaccination status, test results, quarantine status) and continues to integrate health services, appointment booking, and digital ID, reflecting Saudi Arabia's digital health transformation under Vision 2030.

Question 31: What is the correct approach to contact tracing for a newly diagnosed HIV patient?

Publicly announce the patient's diagnosis
Confidentially notify sexual and needle-sharing partners of potential exposure (Correct answer)
Notify only family members
No notification is required due to confidentiality

Correct answer: Confidentially notify sexual and needle-sharing partners of potential exposure

Partner notification (contact tracing) for HIV is a critical public health intervention to interrupt transmission. It is conducted confidentially, often by health departments, to inform contacts of potential exposure without disclosing the index patient's identity, enabling testing and treatment.

Question 32: Which method is used to test whether an autoclave has achieved sterilization?

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

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

To schedule nursing assignments
To assign patient acuity scores
To identify actual or potential patient health problems that nurses can treat (Correct answer)
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 34: What is the correct order of the nursing process?

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

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 35: A patient recovering from gastric bypass surgery experiences flushing, tachycardia, and diarrhea shortly after eating. The nurse should advise the patient to:

Drink large amounts of fluids during meals to dilute food
Increase dietary fiber intake significantly
Eat small, frequent meals and avoid simple sugars (Correct answer)
Eat large, infrequent meals to reduce meal frequency

Correct answer: Eat small, frequent meals and avoid simple sugars

Dumping syndrome follows rapid gastric emptying; small frequent meals and avoiding simple sugars slow gastric transit and reduce symptoms.

Question 36: What is sepsis and what are the nursing priorities for early recognition?

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

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 37: Which Saudi regulation addresses nurses' right to refuse assignment on moral grounds?

Conscientious objection is not recognized in Saudi healthcare
Nurses may exercise conscientious objection to specific procedures conflicting with personal beliefs, provided patient care is not abandoned and alternative arrangements are made (Correct answer)
Nurses must perform all assigned tasks regardless of beliefs
Only physicians may exercise conscientious objection

Correct answer: Nurses may exercise conscientious objection to specific procedures conflicting with personal beliefs, provided patient care is not abandoned and alternative arrangements are made

Saudi healthcare standards recognize conscientious objection for nurses when a procedure conflicts with deeply held moral or religious beliefs. However, the nurse must ensure the patient's care needs are met by arranging alternative care, notifying the supervisor, and never abandoning a patient in an emergency.

Question 38: What is the normal expected weight loss for a newborn in the first few days of life?

5% maximum
Up to 20% of birth weight
Up to 10% of birth weight (Correct answer)
No weight loss is normal

Correct answer: Up to 10% of birth weight

Newborns normally lose up to 10% of their birth weight in the first 3–4 days due to meconium passage, urine output, and limited fluid intake. Birth weight should be regained by 10–14 days. Loss >10% warrants evaluation for feeding problems.

Question 39: Under Saudi health regulations, what must a nurse do before performing any invasive procedure?

Obtain consent from a colleague
No consent is required for nursing procedures
Obtain informed consent from the patient or legal guardian (Correct answer)
Proceed without consent in all cases

Correct answer: Obtain informed consent from the patient or legal guardian

Saudi health regulations, consistent with international standards, require informed consent before invasive procedures. The patient (or legal guardian if the patient lacks capacity) must receive clear information about the procedure, risks, benefits, and alternatives before providing voluntary consent.

Question 40: What is the purpose of an 'allergy band' on a patient?

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

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

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 3-week-old infant with temperature of 38°C (Correct answer)
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 42: A patient develops sudden confusion, tachycardia, and fever of 39.5°C on post-operative day 2. What should the nurse suspect?

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

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

Use of generic medications only
Simultaneous use of two medications
Use of five or more medications simultaneously, increasing risk of drug interactions, adverse effects, and non-adherence (Correct answer)
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 44: A patient has been prescribed ACE inhibitors for hypertension. What side effect should the nurse teach the patient to expect?

Diarrhea
Hyperthyroidism
Hypoglycemia
A persistent dry cough (Correct answer)

Correct answer: A persistent dry cough

ACE inhibitors (e.g., enalapril, lisinopril) block bradykinin breakdown, causing bradykinin accumulation in the lungs. This produces a persistent dry, non-productive cough in 10–20% of patients, which is the most common reason for switching to an ARB.

Question 45: What is a key sign of developmental dysplasia of the hip (DDH) in an infant?

Leg length equality
Normal gait by 12 months
Asymmetric gluteal folds and positive Ortolani test (Correct answer)
Symmetrical hip abduction

Correct answer: Asymmetric gluteal folds and positive Ortolani test

DDH signs include asymmetric gluteal and thigh skin folds, limited hip abduction, and positive Ortolani (click or clunk felt when reducing a dislocated hip) and Barlow (dislocation provoked) tests. Early detection allows brace treatment; delayed diagnosis requires surgery.

Question 46: What is the correct nursing response to a patient experiencing a panic attack?

Administer antipsychotic medication
Leave the patient in a quiet room alone
Stay with the patient, speak calmly, guide slow controlled breathing, reassure they are safe (Correct answer)
Restrain the patient to prevent injury

Correct answer: Stay with the patient, speak calmly, guide slow controlled breathing, reassure they are safe

During a panic attack, the nurse's presence, calm demeanor, and controlled breathing guidance reduce sympathetic stimulation. Reassurance that the symptoms are the panic attack itself (not a heart attack) and that it will pass helps de-escalate the physiological response.

Question 47: What is the most accurate method for calculating medication doses for pediatric patients?

Body weight in kilograms (mg/kg) or body surface area (BSA) calculation (Correct answer)
Using the same dose as adults for children over 5
Estimating by the child's age
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 48: A patient is prescribed metformin for type 2 diabetes. What is the most serious adverse effect to monitor for?

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

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

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

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

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

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 51: 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
Intermittent claudication (Correct answer)
Deep vein thrombosis

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 52: A patient receiving total parenteral nutrition (TPN) develops sudden diaphoresis, tremor, and confusion. What is the nurse's priority action?

Administer an insulin bolus
Notify the physician first
Check the blood glucose level (Correct answer)
Immediately stop the TPN infusion

Correct answer: Check the blood glucose level

These symptoms suggest hypoglycemia; checking blood glucose is the priority assessment before any intervention to confirm the cause.

Question 53: At what age should children receive the MMR vaccine according to the Saudi MOH immunization schedule?

At birth
6 months
3 years
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 54: What is the appropriate first response when a child is found in respiratory arrest?

Administer epinephrine
Call for help before starting any intervention
Open the airway with head-tilt–chin-lift and give 2 rescue breaths (Correct answer)
Start chest compressions immediately

Correct answer: Open the airway with head-tilt–chin-lift and give 2 rescue breaths

For pediatric respiratory arrest without cardiac arrest, the priority is restoring ventilation. Open the airway, give 2 rescue breaths, and check for a pulse. Chest compressions are added if there is no pulse or HR <60 with signs of poor perfusion.

Question 55: Which finding indicates a newborn has adequate hydration?

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

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

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

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

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

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

Varicella vaccine
MMR vaccine
BCG 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 59: Which level of Maslow's hierarchy must be met before safety needs can be addressed?

Self-actualization
Physiological needs (food, water, shelter, air) (Correct answer)
Esteem needs
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 60: Which assessment is most important when a patient is receiving a blood transfusion?

Blood glucose monitoring
Urine output only
Vital signs every 15 minutes for the first hour (Correct answer)
Pain assessment at each hour

Correct answer: Vital signs every 15 minutes for the first hour

Transfusion reactions can occur within the first 15 minutes. Vital signs (temperature, BP, pulse, respiratory rate) are monitored every 15 minutes during the first hour to detect early signs of hemolytic or febrile reactions.

Question 61: What is the primary concern when administering IV aminophylline?

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

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 62: A child with asthma is having a severe attack. Which medication is given first?

Oral leukotriene antagonist
Short-acting beta-2 agonist (salbutamol/albuterol) via nebulizer (Correct answer)
Long-acting beta agonist
Inhaled corticosteroid

Correct answer: Short-acting beta-2 agonist (salbutamol/albuterol) via nebulizer

Short-acting beta-2 agonists (SABAs) such as salbutamol (albuterol) cause rapid bronchodilation by relaxing bronchial smooth muscle and are the first-line rescue medication for acute asthma attacks. Systemic corticosteroids are added for moderate to severe attacks.

Question 63: What does the acronym 'SBAR' stand for in nursing communication?

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

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

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

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

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

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 66: 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 67: A patient taking warfarin has an INR of 5.8 with minor bleeding. What is the appropriate intervention?

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

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

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

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 69: What does the term 'herd immunity' mean?

Natural immunity acquired through disease
Sufficient community vaccination coverage that protects even unvaccinated individuals by interrupting transmission (Correct answer)
Vaccination of only high-risk individuals
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 70: What is the correct order for donning (putting on) PPE?

Gown, mask/respirator, eye protection, gloves (Correct answer)
Mask, gloves, gown, eye protection
Gloves, gown, mask, eye protection
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 71: What is the priority assessment for a patient with a cervical spinal cord injury?

Pain level
Skin integrity
Bladder and bowel function
Airway patency and respiratory function (Correct answer)

Correct answer: Airway patency and respiratory function

Cervical spinal cord injuries at C3–C5 can impair or eliminate phrenic nerve function, causing diaphragmatic paralysis and respiratory failure. Airway and breathing assessment is the absolute priority (ABCs).

Question 72: A patient is prescribed morphine for pain. Which side effect requires the most immediate intervention?

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

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

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)
Only report errors
Only follow existing policies

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 74: A patient with schizophrenia states 'The TV is sending me secret messages.' This is an example of:

Auditory hallucinations
Thought insertion
Delusion of grandeur
Ideas of reference (Correct answer)

Correct answer: Ideas of reference

Ideas of reference are a type of delusion in which the patient believes that external events or objects (TV, radio, strangers) are specifically directed at them with special meaning. This is a positive symptom of schizophrenia.

Question 75: Which dietary instruction is most important for a patient taking warfarin?

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

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 76: A patient diagnosed with celiac disease must strictly avoid which dietary protein?

Albumin
Globulin
Gluten (Correct answer)
Casein

Correct answer: Gluten

Celiac disease is an autoimmune condition triggered by gluten, a protein found in wheat, barley, and rye that causes intestinal villous atrophy.

Question 77: What is the primary nursing concern for a patient with liver cirrhosis and ascites?

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

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 78: What does 'NPO' mean in a clinical context?

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

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

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

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 80: What is the meaning of 'therapeutic index'?

The duration of drug action
The route of drug administration
The speed of drug absorption
The ratio between the toxic dose and the therapeutic dose of a drug (Correct answer)

Correct answer: The ratio between the toxic dose and the therapeutic dose of a drug

The therapeutic index (TI) = TD50/ED50 (toxic dose in 50% / effective dose in 50%). A narrow TI means the difference between effective and toxic doses is small, requiring careful monitoring (e.g., lithium, digoxin, warfarin, aminoglycosides).

Question 81: What type of therapy is most evidence-based for PTSD?

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

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 82: What differentiates delirium from dementia?

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

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 83: 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)
Administer IV antibiotics immediately
Restrict all fluids
Apply cold compresses to the ear

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 84: What is 'bioavailability' of a drug?

The speed of drug absorption
The volume of distribution
The half-life of a drug
The fraction of an administered dose that reaches systemic circulation unchanged (Correct answer)

Correct answer: The fraction of an administered dose that reaches systemic circulation unchanged

Bioavailability is the proportion of drug that reaches systemic circulation in an active form. IV administration has 100% bioavailability. Oral bioavailability is reduced by first-pass metabolism, poor absorption, and chemical instability. It affects dosing route and amount.

Question 85: What personal protective equipment is required when preparing cytotoxic chemotherapy drugs?

Surgical mask only
Standard gloves only
Double gloves, chemotherapy-rated gown, eye/face protection, and a biological safety cabinet (Correct answer)
No special equipment needed

Correct answer: Double gloves, chemotherapy-rated gown, eye/face protection, and a biological safety cabinet

Cytotoxic drugs are hazardous materials. Preparation requires: double chemotherapy-tested gloves, a closed-front chemo-rated gown (not a regular isolation gown), eye/face protection, and preparation in a biological safety cabinet (Class II, Type B2) to protect the preparer from aerosolized drug.

Question 86: How should sharps (needles, scalpels) be disposed of after use?

Immediately in a puncture-resistant sharps container without recapping (Correct answer)
Recap the needle before disposal
Leave on the tray for someone else to collect
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 87: A patient is receiving total parenteral nutrition (TPN). What is the most important nursing action?

Infuse through a peripheral IV
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)
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 88: 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 89: Which sign/symptom indicates a fluid volume deficit (dehydration)?

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

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

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

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 91: A Saudi nurse discovers a colleague practicing while intoxicated. What is the correct action?

Ignore it and hope the colleague improves
Only report if a patient is harmed
Confront the colleague privately and take no further action
Report immediately to the charge nurse or supervisor to protect patient safety (Correct answer)

Correct answer: Report immediately to the charge nurse or supervisor to protect patient safety

A nurse practicing while intoxicated poses an immediate patient safety risk. Immediate reporting to the supervisor is required regardless of personal relationships. Saudi MOH and SCFHS codes of conduct require nurses to safeguard patients and report colleagues whose fitness to practice is impaired.

Question 92: What is the nurse's role in end-of-life care in the Saudi ICU?

Only provide technical care
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)

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 93: What is the nursing management for a patient with acute respiratory distress syndrome (ARDS)?

Immediate extubation
High tidal volume ventilation
Low tidal volume ventilation (6 mL/kg), prone positioning, PEEP optimization, and conservative fluid management (Correct answer)
No ventilator support needed

Correct answer: Low tidal volume ventilation (6 mL/kg), prone positioning, PEEP optimization, and conservative fluid management

ARDS management: lung-protective ventilation (low tidal volume 6 mL/kg ideal body weight), appropriate PEEP to maintain oxygenation, prone positioning (12-16 hours/day improves oxygenation), conservative fluid management, sedation management, and monitoring for barotrauma.

Question 94: What is the primary nursing role in a school health program?

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

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 95: Which Saudi regulation addresses the rights of patients with mental illness?

Mental health regulations only apply in Riyadh
No specific laws apply to psychiatric patients
Psychiatric patients have no rights to consent or information
Mental Health Law requiring voluntary or involuntary admission criteria, patient rights, and periodic review (Correct answer)

Correct answer: Mental Health Law requiring voluntary or involuntary admission criteria, patient rights, and periodic review

Saudi Arabia's mental health legislation establishes criteria for voluntary and compulsory (involuntary) admission, patient rights during psychiatric hospitalization (dignity, information, legal representation, periodic review), and the obligation to use the least restrictive appropriate treatment.

Question 96: What is the 'cold chain' in immunization?

The process of administering vaccines in cold climates
The transport of vaccines on ice from the factory
A method of vaccine preparation
The system maintaining vaccines at required temperatures from manufacture to administration (Correct answer)

Correct answer: The system maintaining vaccines at required temperatures from manufacture to administration

The cold chain is the end-to-end temperature-controlled supply chain (typically 2–8°C for most vaccines) that preserves vaccine potency from manufacturing through storage, transport, and administration. Cold chain breaks render vaccines ineffective.

Question 97: What regulation governs nursing documentation standards in Saudi healthcare facilities?

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

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 98: What is the primary goal of discharge planning?

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

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 99: What is the normal range for adult respiratory rate?

20–30 breaths per minute
6–10 breaths per minute
12–20 breaths per minute (Correct answer)
8–12 breaths per minute

Correct answer: 12–20 breaths per minute

The normal adult respiratory rate is 12–20 breaths per minute. Values below 12 (bradypnea) or above 20 (tachypnea) may indicate respiratory compromise and require further assessment.

Question 100: How should a nurse administer an intramuscular injection to an infant?

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

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

Administer adenosine
Initiate CPR and prepare for immediate defibrillation (Correct answer)
Wait for the rhythm to convert spontaneously
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 102: Under Saudi MOH guidelines, what is the nurse-to-patient ratio in the ICU?

1:1 or 1:2 for critically ill patients requiring intensive monitoring (Correct answer)
No specific ratio exists
5:1 nurse to patient in ICU
1:10 in the ICU

Correct answer: 1:1 or 1:2 for critically ill patients requiring intensive monitoring

Saudi MOH and JCI standards require ICU nurse-to-patient ratios of 1:1 for the most critically ill patients or 1:2 for stable ICU patients. These ratios ensure adequate monitoring, timely intervention, and safe administration of complex medications and interventions.

Question 103: What nursing considerations apply when caring for a patient on continuous renal replacement therapy (CRRT)?

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

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

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

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

Choking prevention (small objects), fall prevention (never leave on elevated surfaces), water safety, proper car seat use, and safe sleep environment (Correct answer)
Only car seat usage
Safety guidance isn't needed until the child walks
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 106: 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 random blood sugar and HbA1c test
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)

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

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

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

Normal physiological jaundice
Pathological jaundice requiring immediate evaluation (Correct answer)
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 109: What are the components of the 'CLABSI bundle' to prevent central line infections?

Weekly dressing changes
Antibiotic-coated catheters only
Simple hand washing before insertion
Hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal site selection, daily line review (Correct answer)

Correct answer: Hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal site selection, daily line review

The CLABSI prevention bundle (from the Institute for Healthcare Improvement): hand hygiene, maximal sterile barrier precautions during insertion (cap, mask, gown, gloves, large sterile drape), chlorhexidine 2% skin preparation, optimal catheter site selection (subclavian preferred), and daily assessment of line necessity with prompt removal.

Question 110: What nursing assessments are important for a child with suspected meningitis?

Only appetite changes
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

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

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

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 112: A patient on gentamicin therapy requires monitoring of which parameters?

Liver enzymes only
Renal function (creatinine, BUN) and hearing (ototoxicity) (Correct answer)
Coagulation studies
Blood glucose

Correct answer: Renal function (creatinine, BUN) and hearing (ototoxicity)

Aminoglycosides (gentamicin, tobramycin, amikacin) are nephrotoxic (damage renal tubular cells) and ototoxic (damage cochlear and vestibular hair cells). Peak and trough drug levels, creatinine, BUN, urine output, and audiologic testing are required during therapy.

Question 113: A patient has been involuntarily admitted to a psychiatric unit. Which right is retained?

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 leave the hospital at will
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 114: A pregnant patient is 38 weeks gestation and has a blood pressure of 158/105 mmHg with 3+ proteinuria. What condition does this indicate?

Chronic hypertension
HELLP syndrome
Severe preeclampsia (Correct answer)
Gestational 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 115: What does ESBL stand for and what is the clinical significance?

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

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

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

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

Face, neck, arms, chest, abdomen, legs, back, perineum (Correct answer)
Feet, legs, abdomen, arms, face, perineum
Back, face, arms, chest, abdomen, perineum, legs
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 118: What is the therapeutic serum level of lithium for maintenance therapy?

0.1–0.5 mEq/L
1.5–2.0 mEq/L
0.6–1.2 mEq/L (Correct answer)
2.0–2.5 mEq/L

Correct answer: 0.6–1.2 mEq/L

Therapeutic lithium levels for maintenance are 0.6–1.2 mEq/L. During acute mania, levels of 0.8–1.2 mEq/L are targeted. Toxicity begins around 1.5 mEq/L and is life-threatening above 2.0 mEq/L. Signs of toxicity include tremor, ataxia, nausea, and confusion.

Question 119: What is the normal range for adult body temperature measured orally?

38.0–39.0°C (100.4–102.2°F)
35.0–36.0°C (95.0–96.8°F)
37.5–38.5°C (99.5–101.3°F)
36.5–37.5°C (97.7–99.5°F) (Correct answer)

Correct answer: 36.5–37.5°C (97.7–99.5°F)

Normal adult oral temperature ranges from 36.5–37.5°C. Values above 38°C are defined as fever (pyrexia). Temperature varies slightly by site: rectal is highest, axillary is lowest, and tympanic approximates core temperature.

Question 120: What is the correct action if a nurse makes a medication error?

Assess the patient, report to the charge nurse and physician, complete an incident report (Correct answer)
Say nothing and hope there are no consequences
Ask another nurse to handle it
Tell only the charge nurse and make no written record

Correct answer: Assess the patient, report to the charge nurse and physician, complete an incident report

After a medication error, patient assessment and safety are the first priority, followed by immediate notification of the charge nurse and prescribing physician. An incident report documents the event for quality improvement without punitive intent.

Question 121: Which anthropometric measurement is used to estimate stature in elderly or bedridden patients when standing height cannot be obtained?

Waist circumference
Mid-upper arm circumference
Knee height (Correct answer)
Head circumference

Correct answer: Knee height

Knee height measurement, using a knee-height caliper, reliably estimates stature in patients who cannot stand upright.

Question 122: Which action correctly identifies a patient before medication administration?

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

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 123: Which drug is used to reverse opioid overdose?

N-acetylcysteine
Flumazenil
Naloxone (Narcan) (Correct answer)
Atropine

Correct answer: Naloxone (Narcan)

Naloxone is a competitive opioid receptor antagonist that rapidly reverses opioid-induced respiratory depression, sedation, and miosis. It has a short duration (30–90 minutes) — shorter than most opioids — so repeated doses or infusion may be needed.

Question 124: What is the purpose of using a draw sheet when repositioning a patient?

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

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 125: A patient is prescribed erythromycin. What should the nurse teach about administration?

Take with food to reduce gastrointestinal side effects; avoid macrolide-drug interactions (Correct answer)
Take only at bedtime
Take on an empty stomach
Avoid all dairy products

Correct answer: Take with food to reduce gastrointestinal side effects; avoid macrolide-drug interactions

Erythromycin frequently causes GI side effects (nausea, vomiting, abdominal cramping) due to its motilin agonist properties accelerating gut motility. Taking with food reduces GI irritation. Erythromycin inhibits CYP3A4 — important drug-drug interaction to check.

Question 126: What is the role of the Joint Commission International (JCI) accreditation in Saudi hospitals?

To provide financial audits
To manage hospital administration
To certify that the hospital meets international patient safety and quality standards (Correct answer)
To license individual nurses

Correct answer: To certify that the hospital meets international patient safety and quality standards

JCI accreditation is a voluntary international quality standard. Saudi hospitals seek JCI accreditation to demonstrate compliance with international patient safety goals, quality standards, and best practices. It involves rigorous evaluation of patient care processes, safety systems, and hospital governance.

Question 127: Which electrolyte disturbance is most characteristic of refeeding syndrome when nutrition is reintroduced to a severely malnourished patient?

Hypophosphatemia (Correct answer)
Hyperkalemia
Hypercalcemia
Hypernatremia

Correct answer: Hypophosphatemia

Refeeding syndrome is defined by severe hypophosphatemia as cellular uptake of phosphate surges with insulin release during carbohydrate reintroduction.

Question 128: A patient with anorexia nervosa is admitted with a weight of 35 kg at 165 cm height (BMI 12.9). What is the immediate priority?

Psychotherapy sessions immediately
Family therapy only
Discharge to outpatient care
Medical stabilization: electrolyte management and nutritional rehabilitation (Correct answer)

Correct answer: Medical stabilization: electrolyte management and nutritional rehabilitation

Severe anorexia (BMI <15) is a medical emergency. Life-threatening complications include cardiac arrhythmias (from hypokalemia and hypomagnesemia), refeeding syndrome, and multi-organ failure. Medical stabilization, electrolyte monitoring, and controlled nutritional rehabilitation precede psychological interventions.

Question 129: Which immunization schedule is given at 2 months in Saudi Arabia?

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

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 130: What is the nurse's role in tobacco cessation counseling?

Assess tobacco use at every visit, provide brief advice, refer to cessation programs, and follow up (Correct answer)
Prescribe nicotine replacement therapy independently
Ignore tobacco use as it is a personal choice
Only intervene if the patient asks

Correct answer: Assess tobacco use at every visit, provide brief advice, refer to cessation programs, and follow up

Evidence-based tobacco cessation follows the 5 A's framework: Ask (assess use), Advise (counsel to quit), Assess (readiness to quit), Assist (provide resources, medications), and Arrange (follow-up). This brief intervention by nurses is proven to increase quit rates.

Question 131: A nurse in a primary health center is conducting a hypertension screening day. Which blood pressure reading requires physician referral for same-day evaluation?

120/70 mmHg
130/80 mmHg
140/90 mmHg in a known hypertensive on medication
185/115 mmHg in an asymptomatic individual (Correct answer)

Correct answer: 185/115 mmHg in an asymptomatic individual

Stage 3 hypertension (BP ≥180/110 mmHg) even without symptoms requires same-day physician evaluation due to the risk of hypertensive urgency or emergency. While not all cases require emergency room care, same-day medical review is essential.

Question 132: A nurse working in an occupational health setting assesses a factory worker with hearing loss. What type of prevention is provided by ear protection?

Tertiary prevention
Primordial prevention
Primary prevention (Correct answer)
Secondary prevention

Correct answer: Primary prevention

Providing ear protection to prevent noise-induced hearing loss before it occurs is primary prevention. Secondary prevention would be audiometric screening to detect early hearing loss; tertiary prevention would be hearing rehabilitation after loss has occurred.

Question 133: What is the 'chain of infection' in infection control?

Infectious agent → reservoir → portal of exit → transmission → portal of entry → susceptible host (Correct answer)
Bacteria → virus → fungus → parasite → prion
Patient → nurse → hospital → community
Contact → droplet → airborne → vehicle → vector

Correct answer: Infectious agent → reservoir → portal of exit → transmission → portal of entry → susceptible host

The chain of infection describes the six links required for infection transmission: infectious agent, reservoir (where it lives), portal of exit, mode of transmission, portal of entry, and susceptible host. Breaking any link prevents infection.

Question 134: A patient with major depressive disorder refuses to get out of bed and states 'What is the point?' Which nursing diagnosis is the priority?

Impaired physical mobility
Ineffective health maintenance
Deficient knowledge
Risk for self-directed violence related to hopelessness (Correct answer)

Correct answer: Risk for self-directed violence related to hopelessness

Hopelessness is a significant risk factor for suicidal ideation. 'What is the point?' may indicate passive suicidal ideation. Safety assessment and risk for self-directed violence are the priority nursing concerns before addressing mobility or other issues.

Question 135: Which route of administration provides the fastest drug action in an emergency?

Oral
Intravenous (IV) (Correct answer)
Sublingual
Intramuscular

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

Moon face, central obesity, and purple striae (Correct answer)
Exophthalmos and heat intolerance
Dry skin and bradycardia
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 137: What are the classic signs of intussusception in an infant?

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

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 138: A pregnant patient reports decreased fetal movement. What is the initial nursing intervention?

Perform a non-stress test (NST) and notify the physician (Correct answer)
Advise the patient to increase activity
Reassure the patient that it is normal
Schedule a routine follow-up appointment

Correct answer: Perform a non-stress test (NST) and notify the physician

Decreased fetal movement can signal fetal compromise. The initial assessment tool is the non-stress test (NST), which evaluates fetal heart rate reactivity as an indicator of fetal well-being. The physician must be notified promptly.

Question 139: A nurse is assessing a woman who is 12 hours postpartum after a vaginal delivery. Which finding requires immediate notification of the charge nurse or physician?

Lochia rubra is present, with one saturated perineal pad in 2 hours.
Patient complains of moderate uterine cramping, especially during breastfeeding.
Fundus is boggy and deviated to the right, 3 cm above the umbilicus. (Correct answer)
Fundus is firm, at the level of the umbilicus.

Correct answer: Fundus is boggy and deviated to the right, 3 cm above the umbilicus.

A boggy (soft) fundus that is deviated from the midline and located above the umbilicus is a classic sign of uterine atony and a full bladder. This places the patient at high risk for postpartum hemorrhage, which is a medical emergency. The other findings are normal for this postpartum period. This is a universal standard of care, applicable in Saudi Arabia and internationally.

Question 140: Which finding suggests neuroleptic malignant syndrome (NMS) in a patient taking antipsychotics?

High fever, muscle rigidity, altered consciousness, and autonomic instability (Correct answer)
Hypotension, bradycardia, and hypothermia
Rash, angioedema, and bronchospasm
Low-grade fever, mild tremor, and increased appetite

Correct answer: High fever, muscle rigidity, altered consciousness, and autonomic instability

NMS is a rare, potentially fatal reaction to antipsychotics characterized by the tetrad: hyperthermia (often >40°C), severe muscle rigidity ('lead-pipe' rigidity), altered consciousness, and autonomic instability (diaphoresis, tachycardia, BP fluctuations). Immediate discontinuation and supportive treatment are required.

Question 141: What is the normal fetal heart rate range?

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

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

90–100% alcohol
10–15% alcohol
60–80% alcohol (ethanol or isopropanol) (Correct answer)
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 143: A patient with dementia becomes confused and agitated every evening. This is called:

Sundowning syndrome (Correct answer)
Depression
Delirium
Normal aging

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 144: What does the Saudi Blood Transfusion Center regulate?

Regulation of IV fluids
Plasma pharmaceutical production only
Blood donation, testing, storage, and distribution standards across Saudi healthcare facilities (Correct answer)
Blood pressure medication distribution

Correct answer: Blood donation, testing, storage, and distribution standards across Saudi healthcare facilities

The Saudi National Blood Transfusion and Research Center oversees the national blood banking system: donor recruitment and screening, mandatory testing for HIV, Hepatitis B/C, syphilis, and other infectious agents, component preparation, storage, and distribution to hospitals — ensuring a safe, adequate blood supply.

Question 145: 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 146: What action should a nurse take when discovering a patient has fallen?

Apply ice to all extremities as a precaution
Document the fall and continue with other tasks
Assess the patient for injuries, stay with the patient, and notify the physician (Correct answer)
Move the patient back to bed immediately without assessment

Correct answer: Assess the patient for injuries, stay with the patient, and notify the physician

After a patient fall, the nurse must first assess for injuries (head, spine, fractures) before moving the patient to avoid worsening any injuries. Staying with the patient ensures safety while help is summoned.

Question 147: A community health nurse is conducting a needs assessment. Which data source provides the most comprehensive population health information?

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

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

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

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

Phlebitis
Septicemia
Air embolism
Infiltration (Correct answer)

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 150: What is the purpose of using sterile technique for wound care?

To maintain patient comfort
To save time
To comply with aesthetic standards only
To prevent introduction of microorganisms that could cause surgical site or wound infection (Correct answer)

Correct answer: To prevent introduction of microorganisms that could cause surgical site or wound infection

Wounds expose normally protected internal tissues to potential contamination. Sterile technique during wound care (sterile gloves, sterile dressings, sterile irrigating solutions) prevents introducing new pathogens that could cause local infection, delayed healing, bacteremia, or sepsis.

Question 151: What is the most common complication following coronary artery bypass graft (CABG) surgery?

Deep vein thrombosis
Dysrhythmias, particularly atrial fibrillation (Correct answer)
Renal failure
Stroke

Correct answer: Dysrhythmias, particularly atrial fibrillation

Atrial fibrillation occurs in 20–40% of patients after CABG, typically on post-operative day 2–4. It results from pericardial inflammation, electrolyte imbalances, and sympathetic stimulation from surgery.

Question 152: Which position is most appropriate for a patient experiencing respiratory distress?

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

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

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

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

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

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 155: A patient with a new colostomy expresses disgust and refuses to look at the stoma. Which nursing response is most therapeutic?

Tell the patient they will feel better soon
Insist the patient look at the stoma immediately
Acknowledge the patient's feelings and gradually involve them in ostomy care (Correct answer)
Perform all care without discussing it with the patient

Correct answer: Acknowledge the patient's feelings and gradually involve them in ostomy care

Altered body image is a major psychosocial concern after ostomy formation. Therapeutic nursing involves acknowledging feelings as valid, normalizing the emotional response, and gradually building the patient's confidence and self-efficacy in self-care.

Question 156: What is the difference between quarantine and isolation in public health?

Quarantine is only for animals
Quarantine is for confirmed cases; isolation is for exposed individuals
They mean the same thing
Quarantine separates exposed (possibly incubating) people; isolation separates confirmed cases (Correct answer)

Correct answer: Quarantine separates exposed (possibly incubating) people; isolation separates confirmed cases

Isolation applies to confirmed infectious cases to prevent transmission. Quarantine applies to individuals who have been exposed and may be incubating the disease but are not yet confirmed to be infectious. Both prevent further spread.

Question 157: What is the recommended approach for tuberculosis contact investigation?

Screen only symptomatic contacts
Treat all contacts with full TB therapy
Screen all close contacts with TST or IGRA and treat latent TB infection in high-risk individuals (Correct answer)
No action needed unless contacts develop symptoms

Correct answer: Screen all close contacts with TST or IGRA and treat latent TB infection in high-risk individuals

TB contact investigation identifies recently infected individuals who can progress to active TB. All close contacts receive tuberculin skin test (TST) or interferon-gamma release assay (IGRA). Positive test with no active disease = latent TB treated with isoniazid to prevent activation.

Question 158: What is the mechanism of action of beta-blocker medications?

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

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 159: 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 160: 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
Renal impairment (Correct answer)
Dehydration alone
Liver failure

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

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

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

Restrict fluids
Place the child in a supine position
Keep the child calm, provide cool mist humidity, administer nebulized epinephrine for severe cases, and monitor for airway obstruction (Correct answer)
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 163: Which nursing assessment is most important for a patient receiving heparin therapy?

Check urine specific gravity
Monitor blood glucose levels
Monitor for signs of bleeding and check aPTT values (Correct answer)
Assess skin turgor

Correct answer: Monitor for signs of bleeding and check aPTT values

Heparin is an anticoagulant that increases bleeding risk. Monitoring aPTT (target 1.5–2.5 times control), observing for hematuria, melena, petechiae, and excessive bruising are essential safety assessments.

Question 164: What is the DOTS strategy for tuberculosis control?

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

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

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

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 166: What is the nurse's responsibility in patient advocacy?

Only advocating for salary increases
Always agree with the physician
Protecting patient rights, ensuring informed consent, communicating patient concerns to the healthcare team, and supporting patient decision-making (Correct answer)
Advocacy is only for social workers

Correct answer: Protecting patient rights, ensuring informed consent, communicating patient concerns to the healthcare team, and supporting patient decision-making

Nurse as patient advocate: ensure informed consent, respect patient autonomy, communicate patient wishes to the team, protect vulnerable patients (children, elderly, cognitively impaired), facilitate access to resources, support patient participation in care decisions, and report safety concerns.

Question 167: Which vital sign change is an early indicator of hypovolemic shock?

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

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

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

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 169: Which vaccine is mandatory for pilgrims traveling to Saudi Arabia for Hajj and Umrah?

Typhoid vaccine
Meningococcal vaccine (ACWY) (Correct answer)
Yellow fever vaccine
Hepatitis B vaccine

Correct answer: Meningococcal vaccine (ACWY)

Saudi Arabia requires proof of meningococcal (ACWY) vaccination for all Hajj and Umrah pilgrims due to historical outbreaks of meningococcal meningitis at mass gatherings. Additional recommended vaccines include influenza, hepatitis A, and typhoid depending on country of origin.

Question 170: A patient is prescribed furosemide (a loop diuretic). What electrolyte should be monitored?

Magnesium (risk of hypermagnesemia)
Potassium (risk of hypokalemia) (Correct answer)
Calcium (risk of hypercalcemia)
Phosphate (risk of hyperphosphatemia)

Correct answer: Potassium (risk of hypokalemia)

Loop diuretics inhibit Na-K-2Cl transport in the loop of Henle, causing loss of sodium, potassium, chloride, magnesium, and calcium. Hypokalemia is the most clinically significant electrolyte disturbance, increasing the risk of cardiac arrhythmias.

Question 171: A child with marasmus, a form of severe acute malnutrition, would present with which characteristic clinical finding?

Generalized pitting edema and distended abdomen
Skin dermatitis, hair depigmentation, and edema
Severe wasting of muscle and fat with relatively preserved serum proteins (Correct answer)
Normal weight with isolated micronutrient deficiencies

Correct answer: Severe wasting of muscle and fat with relatively preserved serum proteins

Marasmus results from severe caloric deprivation, producing marked wasting but relatively preserved albumin, unlike kwashiorkor which features edema and hypoalbuminemia.

Question 172: What is the key nursing consideration when administering benzodiazepines to an elderly patient?

Increase the dose to ensure adequate sedation
Use lowest effective dose, monitor for excessive sedation and fall risk (Correct answer)
No special considerations in elderly patients
Administer intramuscularly only

Correct answer: Use lowest effective dose, monitor for excessive sedation and fall risk

Elderly patients have reduced hepatic metabolism and increased CNS sensitivity to benzodiazepines, leading to prolonged sedation, cognitive impairment, and fall risk. The Beers Criteria identifies benzodiazepines as potentially inappropriate medications in elderly patients.

Question 173: Which medication is used to treat hypercalcemia caused by malignancy?

IV bisphosphonates (zoledronic acid, pamidronate) (Correct answer)
Furosemide alone
Calcium gluconate IV
Vitamin D supplements

Correct answer: IV bisphosphonates (zoledronic acid, pamidronate)

Bisphosphonates are the cornerstone of malignancy-associated hypercalcemia treatment. They inhibit osteoclast activity, reducing calcium release from bone. IV administration provides rapid effect. Hydration with normal saline and furosemide are supportive measures.

Question 174: 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)
Put something in the child's mouth
Restrain the child
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 175: A patient's wound culture reveals MRSA. What precautions are required?

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

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

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

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 177: What is the primary nursing concern when oxytocin (Pitocin) is being used for labor induction?

Monitor urine output every 8 hours
Ensure adequate pain relief only
Monitor for maternal hypoglycemia
Monitor for uterine hyperstimulation and fetal heart rate changes (Correct answer)

Correct answer: Monitor for uterine hyperstimulation and fetal heart rate changes

Oxytocin can cause uterine hyperstimulation (more than 5 contractions in 10 minutes or contractions >90 seconds), which reduces uteroplacental blood flow and causes fetal hypoxia. Continuous fetal monitoring is mandatory during induction.

Question 178: A patient with chronic kidney disease is placed on a renal diet. Which nutrient is most commonly restricted?

Potassium, phosphorus, and sodium (Correct answer)
Only fluid
Only sodium
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 179: 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.
Routine administration of opioid analgesics every 4 hours.
Early mobilization and physiotherapy on post-operative day 1. (Correct answer)
Nil per os (NPO) until bowel sounds return.

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

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

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 181: What does 'epidemiology' study?

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

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 182: When should a nurse change gloves during patient care?

Once per shift
Only when touching bodily fluids
Between different body sites on the same patient, between tasks with different contamination risk, and between patients (Correct answer)
Only when gloves are visibly torn

Correct answer: Between different body sites on the same patient, between tasks with different contamination risk, and between patients

Gloves must be changed: when moving from a contaminated body site to a clean one on the same patient, between different care tasks with different contamination levels, and always between patients. Gloves are not a substitute for hand hygiene.

Question 183: A Saudi nurse counseling a mother with an exclusively breastfed newborn should recommend which supplement starting within the first few days of life?

Iron drops starting at birth
Calcium supplement
Vitamin C supplement
Vitamin D drops starting within the first few days (Correct answer)

Correct answer: Vitamin D drops starting within the first few days

Breast milk is low in Vitamin D; the WHO and Saudi MOH recommend Vitamin D supplementation for exclusively breastfed infants from early life.

Question 184: Which sign differentiates true labor from false labor (Braxton Hicks contractions)?

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

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

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

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

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

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

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

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

37–38 weeks
34–36 weeks
39–40 weeks (Correct answer)
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 189: 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?

Gown, gloves, eye protection, and a surgical mask. (Correct answer)
Shoe covers, gown, and a surgical mask.
Surgical mask and gloves only.
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 190: 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 191: What does a hemodynamic reading of CVP 2 mmHg indicate?

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

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

Pneumonia
Pleural effusion
Atelectasis
Pulmonary embolism (Correct answer)

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

Absorption
Excretion
Distribution
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 194: Which action prevents dumping syndrome in a post-gastrectomy patient?

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

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 195: Which developmental milestone is expected for a 12-month-old child?

Taking first independent steps and saying 1–3 words (Correct answer)
Reading simple words
Riding a tricycle
Running and speaking in sentences

Correct answer: Taking first independent steps and saying 1–3 words

By 12 months, most children can pull to stand and take a few independent steps, and say 1–3 meaningful words (mama, dada). Running typically develops around 18–24 months, and sentences at 2 years.

Question 196: What are a nurse's legal obligations regarding a patient who refuses a life-saving treatment?

Force the treatment regardless of refusal
Ensure the patient is competent, document their informed refusal, continue supportive care, notify the physician, and escalate if patient capacity is in question (Correct answer)
Report the patient to authorities
Accept the refusal without documentation

Correct answer: Ensure the patient is competent, document their informed refusal, continue supportive care, notify the physician, and escalate if patient capacity is in question

Competent adult patients have the legal right to refuse any treatment in Saudi Arabia, consistent with Islamic principles of personal autonomy. The nurse's obligations are: assess competence, provide complete information, document the refusal clearly (preferably signed), notify the physician, and ensure ongoing supportive care continues.

Question 197: 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 198: What does the nurse assess using the Richmond Agitation-Sedation Scale (RASS)?

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

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 199: 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?

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

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 200: Which dietary factor is most strongly linked to the high prevalence of type 2 diabetes in Saudi Arabia?

High protein intake
Low fat diet
High vegetable consumption
High consumption of refined carbohydrates, sugar-sweetened beverages, and sedentary lifestyle (Correct answer)

Correct answer: High consumption of refined carbohydrates, sugar-sweetened beverages, and sedentary lifestyle

Saudi Arabia has one of the world's highest diabetes prevalence rates (over 18%). Contributing factors include rapid dietary westernization (high-calorie, refined carbohydrate diets), sugar-sweetened beverage consumption, physical inactivity, and obesity — all modifiable risk factors.

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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