Saudi Nursing Licensure Exam — Questions and Answers

Question 1: Which child with fever should be referred to the emergency department immediately?

A 2-year-old with temperature of 38°C and mild cough
A 3-week-old infant with temperature of 38°C (Correct answer)
A 5-year-old with temperature of 39°C after vaccination
A 3-year-old with temperature of 38.5°C and runny nose

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 2: What is the correct technique when inserting a urinary catheter in a female patient?

Cleanse from back to front, use non-sterile gloves
Use sterile technique, cleanse from front to back, insert into urethral meatus (Correct answer)
Insert into the largest visible opening
Use clean technique and insert into the vaginal opening

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 3: What is the normal fetal heart rate range?

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

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 4: 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?

Nil per os (NPO) until bowel sounds return.
Routine administration of opioid analgesics every 4 hours.
Bed rest for the first 48 hours post-operatively.
Early mobilization and physiotherapy on post-operative day 1. (Correct answer)

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

150/95 mmHg (Correct answer)
Systolic 150, diastolic 95 mmHg
Elevated BP
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 6: Which communicable disease is targeted for eradication in Saudi Arabia through the Expanded Program on Immunization?

Malaria
Measles
Hepatitis C
Poliomyelitis (Correct answer)

Correct answer: Poliomyelitis

Polio eradication is a global WHO goal. Saudi Arabia maintains high polio vaccination coverage (OPV/IPV) and participates in global eradication efforts. Saudi Arabia has been polio-free and maintains surveillance at borders due to high pilgrim traffic during Hajj.

Question 7: What is the correct site for intramuscular injection in infants under 12 months?

Deltoid muscle
Vastus lateralis (anterolateral thigh) (Correct answer)
Ventrogluteal muscle
Dorsogluteal muscle

Correct answer: Vastus lateralis (anterolateral thigh)

The vastus lateralis (anterolateral thigh) is the preferred IM injection site for infants and children under 3 years because the deltoid and gluteal muscles are underdeveloped. The dorsogluteal site is avoided in all ages due to proximity to the sciatic nerve.

Question 8: What is the normal respiratory rate for a newborn?

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

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

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

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 10: Which finding in a postpartum patient requires immediate nursing attention?

Mild perineal discomfort
Lochia rubra on day 2
Breast engorgement
Uterine fundus soft and deviated to the right with excessive bleeding (Correct answer)

Correct answer: Uterine fundus soft and deviated to the right with excessive bleeding

A soft (boggy), displaced uterine fundus indicates uterine atony — the leading cause of postpartum hemorrhage. The bladder is likely full, displacing the uterus. Interventions: empty the bladder and perform uterine massage, then reassess.

Question 11: What does 'half-life' mean in pharmacology?

The time to reach peak plasma level
The time required for the plasma concentration of a drug to decrease by 50% (Correct answer)
The time for complete elimination
The duration of drug action

Correct answer: The time required for the plasma concentration of a drug to decrease by 50%

Half-life (t½) is the time required for drug plasma concentration to fall by 50%. It determines dosing frequency (steady state reached at ~5 half-lives, drug essentially eliminated in ~5 half-lives). Drugs with long half-lives require less frequent dosing.

Question 12: What is the nursing management for a patient with acute respiratory distress syndrome (ARDS)?

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

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 13: Which type of enteral feeding formula is most appropriate for a patient with poorly controlled diabetes mellitus?

Diabetic-specific formula with reduced carbohydrate content (Correct answer)
High-protein formula without carbohydrate modification
Elemental formula with simple sugars
High-carbohydrate standard formula

Correct answer: Diabetic-specific formula with reduced carbohydrate content

Diabetic-specific enteral formulas contain modified carbohydrates and higher fat/fiber to reduce postprandial glucose excursions.

Question 14: What is the normal range for adult serum sodium?

120–130 mEq/L
145–155 mEq/L
135–145 mEq/L (Correct answer)
125–135 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 15: What does the Saudi Patient Rights Charter include?

Right to free private room for all patients
Right to refuse all medical care without any documentation
Right to information, informed consent, dignity, privacy, emergency care, and complaint filing (Correct answer)
Right to choose the treating physician's specialty always

Correct answer: Right to information, informed consent, dignity, privacy, emergency care, and complaint filing

The Saudi Patient Rights Charter (MOH) guarantees patients: the right to information about their condition and treatment, informed consent, respectful and dignified care, privacy and confidentiality, access to emergency care, the right to file complaints, and the right to refuse treatment with documentation.

Question 16: Which Saudi health regulation governs the safe disposal of medical waste?

All medical waste must be incinerated on-site always
Only sharps require special disposal
Medical waste must be segregated, labeled, and disposed of according to Saudi MOH regulations and international standards (Correct answer)
Medical waste can be placed in regular trash bins

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

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

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

41–42 weeks
37–38 weeks
39–40 weeks (Correct answer)
34–36 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 19: Under Saudi health regulations, when can a Do Not Resuscitate (DNR) order be implemented?

Automatically for all patients over 70
With documented informed consent from the patient or legal guardian, and in accordance with hospital policy and medical ethics guidelines (Correct answer)
Nurses can implement DNR independently without physician order
By physician decision alone without consent

Correct answer: With documented informed consent from the patient or legal guardian, and in accordance with hospital policy and medical ethics guidelines

In Saudi Arabia, DNR orders require informed consent (from a competent patient) or surrogate decision-making (for incapacitated patients), physician documentation, and compliance with hospital policy and Islamic ethical principles. Sharia principles regarding preservation of life guide these complex decisions.

Question 20: What does the Saudi 'Seha' digital health platform provide?

Virtual healthcare consultations, appointment booking, prescription management, and health records access (Correct answer)
Laboratory testing only
Only physical therapy services
In-person emergency care only

Correct answer: Virtual healthcare consultations, appointment booking, prescription management, and health records access

Seha Virtual Hospital is a MOH initiative delivering telemedicine services including virtual outpatient consultations, remote specialist referrals, digital prescriptions, and integrated health records access. It represents Saudi Arabia's expansion of digital health infrastructure under Vision 2030.

Question 21: What is the nurse's role in managing a child with asthma exacerbation?

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

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

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

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 23: 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 adult dose divided by 2
Using the same dose as adults for children over 5
Estimating by the child's age

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 24: Which finding should the nurse report immediately in a patient who had a carotid endarterectomy?

Heart rate of 72 bpm
Blood pressure of 130/80 mmHg
Sudden neck swelling and difficulty breathing (Correct answer)
Mild incisional pain

Correct answer: Sudden neck swelling and difficulty breathing

After carotid endarterectomy, neck hematoma can rapidly compress the airway, causing life-threatening airway obstruction. Sudden swelling with stridor or dyspnea is a surgical emergency requiring immediate intervention.

Question 25: What is the correct action when a patient reports a new rash after receiving a medication?

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

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 26: What is the correct angle for intramuscular injection in the vastus lateralis muscle?

60 degrees
45 degrees
90 degrees (Correct answer)
15 degrees

Correct answer: 90 degrees

Intramuscular injections are administered at a 90-degree angle to ensure the medication reaches muscle tissue rather than subcutaneous fat. The vastus lateralis is a common IM site for adults and infants.

Question 27: What is the nurse's priority when caring for a child with acute otitis media (ear infection)?

Apply cold compresses to the ear
Administer IV antibiotics immediately
Manage pain (analgesics), assess tympanic membrane, administer oral antibiotics if prescribed, and educate parents on proper medication administration (Correct answer)
Restrict all fluids

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 28: How should a nurse manage a patient with an arterial line?

Only check blood pressure readings
Remove if the patient moves
No special monitoring needed
Zero and level the transducer at the phlebostatic axis, monitor waveform, assess the site for bleeding/infection, and perform Allen's test before insertion (Correct answer)

Correct answer: Zero and level the transducer at the phlebostatic axis, monitor waveform, assess the site for bleeding/infection, and perform Allen's test before insertion

Arterial line nursing care: zero/level transducer at phlebostatic axis (4th ICS, mid-axillary), verify waveform quality, maintain continuous flush system, assess insertion site (bleeding, infection, circulation distal to site), perform Allen's test before radial insertion, and never flush rapidly (risk of retrograde cerebral embolism).

Question 29: A patient with hyperthyroidism is preparing for a thyroidectomy. Which pre-operative medication is given to reduce thyroid vascularity?

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

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

Administer antibiotics
Place the child in a supine position
Restrict fluids
Keep the child calm, provide cool mist humidity, administer nebulized epinephrine for severe cases, and monitor for airway obstruction (Correct answer)

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

Atelectasis
Pleural effusion
Pneumonia
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 32: Which drug is used to reverse opioid overdose?

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

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 33: What is the purpose of an autoclave in healthcare?

To clean instruments with soap and water
To store sterile supplies
To sterilize heat-resistant instruments using pressurized steam at high temperature (Correct answer)
To disinfect surfaces

Correct answer: To sterilize heat-resistant instruments using pressurized steam at high temperature

Autoclaves use pressurized saturated steam (typically 121°C at 15 psi for 15–20 minutes, or 134°C for faster cycles) to achieve sterilization by denaturation of microbial proteins. It is the gold standard for sterilizing heat/moisture-stable instruments.

Question 34: What does the term 'gravida 3, para 2' mean?

Three pregnancies, two deliveries after 20 weeks (Correct answer)
Three living children, two miscarriages
Three deliveries, two pregnancies
Two pregnancies, three deliveries

Correct answer: Three pregnancies, two deliveries after 20 weeks

Gravida refers to the total number of pregnancies regardless of outcome. Para refers to the number of deliveries after 20 weeks gestation (viable). Gravida 3, para 2 means the patient has been pregnant three times and delivered twice.

Question 35: Which dietary factor is most strongly linked to the high prevalence of type 2 diabetes in Saudi Arabia?

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

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.

Question 36: What is the significance of elevated lactate levels in a critically ill patient?

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

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 37: 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
Platelet count of 45,000/mm³ (Correct answer)
Sodium of 138 mEq/L

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

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

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 39: What action should a nurse take when discovering a patient has fallen?

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

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 40: Which level of Maslow's hierarchy must be met before safety needs can be addressed?

Physiological needs (food, water, shelter, air) (Correct answer)
Social needs
Self-actualization
Esteem 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 41: A 45-year-old male patient with a known history of Type 2 Diabetes Mellitus presents to a primary health clinic in Riyadh. His latest HbA1c is 8.5%. According to the Saudi Ministry of Health (MOH) guidelines for diabetes management, which of the following is the most appropriate initial action for the nurse to anticipate?

Scheduling the patient for a consultation with a nephrologist.
Advising the patient to double his current oral hypoglycaemic dose.
Reinforcing education on lifestyle modifications and assessing medication adherence. (Correct answer)
Recommending immediate initiation of insulin therapy.

Correct answer: Reinforcing education on lifestyle modifications and assessing medication adherence.

According to the National Saudi Diabetic Guidelines for Primary Health Care, the target for most diabetic patients is an HbA1c of less than 7%. When a patient's HbA1c is elevated, the initial step involves a thorough assessment of their current regimen, including adherence to diet, exercise, and prescribed medications. Before escalating pharmacological treatment, it is crucial to reinforce education and identify any barriers to self-management. Immediate insulin initiation is typically reserved for patients with significantly higher HbA1c levels or signs of catabolism.

Question 42: What is the nurse's priority action when a patient's ventilator alarm sounds 'High Pressure'?

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

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 43: Which action correctly identifies a patient before medication administration?

Check two identifiers: name and date of birth or medical record number (Correct answer)
Ask the patient their room number
Ask a family member the patient's name
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 44: 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)
Reassure the patient that it is normal
Schedule a routine follow-up appointment
Advise the patient to increase activity

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 45: What is the antidote for acetaminophen (paracetamol) overdose?

Activated charcoal only
Flumazenil
N-acetylcysteine (NAC) (Correct answer)
Naloxone

Correct answer: N-acetylcysteine (NAC)

N-acetylcysteine (NAC) is the specific antidote for acetaminophen toxicity. Acetaminophen overdose depletes glutathione, allowing the toxic metabolite NAPQI to cause hepatic necrosis. NAC replenishes glutathione and detoxifies NAPQI. It must be given within 8–10 hours for maximum efficacy.

Question 46: A patient is exhibiting escalating agitation on the psychiatric unit. What is the least restrictive first intervention?

Immediate chemical restraint
Immediate physical restraint
Verbal de-escalation: calm voice, non-threatening posture, offer choices (Correct answer)
Seclusion

Correct answer: Verbal de-escalation: calm voice, non-threatening posture, offer choices

The hierarchy of least to most restrictive interventions starts with verbal de-escalation (preferred), followed by medication (chemical restraint), seclusion, and finally physical restraint as a last resort. Least restrictive intervention must always be tried first.

Question 47: A diabetic patient in Saudi Arabia planning to observe Ramadan fasting should be counseled to:

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

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 48: What is 'bioavailability' of a drug?

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

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

To prevent Rh sensitization in Rh-negative mothers (Correct answer)
To prevent preeclampsia
To stimulate fetal lung maturity
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 50: Which indicators are used to measure maternal health in a population?

Life expectancy at birth
Number of hospitals per capita
Infant vaccination rates
Maternal mortality ratio, antenatal care coverage, and skilled birth attendance (Correct answer)

Correct answer: Maternal mortality ratio, antenatal care coverage, and skilled birth attendance

Maternal health is measured by: maternal mortality ratio (deaths per 100,000 live births), antenatal care coverage (% of women receiving ANC), proportion of births attended by skilled health personnel, and contraceptive prevalence rate.

Question 51: What is the nurse's role in end-of-life care in the Saudi ICU?

Only provide technical care
Withdraw all medications
Provide comfort measures, manage symptoms, support family communication, respect cultural/religious practices, and coordinate with the palliative care team (Correct answer)
End-of-life discussions are not the nurse's responsibility

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 52: Which intervention is most effective in preventing hospital-acquired infections?

Wearing gloves without hand hygiene
Routine antibiotic prophylaxis for all patients
Consistent hand hygiene (Correct answer)
Isolation of all patients

Correct answer: Consistent hand hygiene

Hand hygiene is the single most effective measure to prevent healthcare-associated infections. The WHO '5 Moments for Hand Hygiene' framework identifies key moments that break the chain of transmission.

Question 53: According to WHO classification, which body mass index (BMI) value indicates obesity?

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

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 54: What is the nursing role in disaster preparedness?

Participate in planning, train in triage and emergency response, and educate communities (Correct answer)
Only respond when a disaster occurs
Treat only non-urgent conditions during disasters
Leave disaster management to emergency services

Correct answer: Participate in planning, train in triage and emergency response, and educate communities

Nurses play critical roles before (planning, training, community education), during (triage, emergency care, mass casualty management), and after (continuity of care, mental health support, rehabilitation) disasters. Preparedness requires advance training and planning.

Question 55: Which body is responsible for licensing nurses in Saudi Arabia?

Saudi Commission for Health Specialties (SCFHS) (Correct answer)
Saudi Ministry of Interior
General Authority of Health
Saudi Board of Medical Specialties

Correct answer: Saudi Commission for Health Specialties (SCFHS)

The Saudi Commission for Health Specialties (SCFHS) is the government authority responsible for licensing, credentialing, and regulating all health professionals in Saudi Arabia, including nurses. The SNLE (Saudi Nursing Licensing Exam) is administered by the SCFHS.

Question 56: A patient is prescribed furosemide (a loop diuretic). What electrolyte should be monitored?

Potassium (risk of hypokalemia) (Correct answer)
Calcium (risk of hypercalcemia)
Magnesium (risk of hypermagnesemia)
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 57: Which phase of pharmacokinetics describes the breakdown of a drug into metabolites?

Metabolism (biotransformation) (Correct answer)
Distribution
Absorption
Excretion

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 58: A nurse is preparing to administer blood. Which action is most important before beginning the transfusion?

Administer diphenhydramine to all patients prophylactically
Start the transfusion as quickly as possible to save time
Verify blood type and cross-match with two nurses at the bedside (Correct answer)
Prime the tubing with dextrose solution

Correct answer: Verify blood type and cross-match with two nurses at the bedside

Two-nurse verification of blood product labels against the patient's identification and compatibility report is mandatory to prevent ABO-incompatible transfusion reactions, which can be fatal.

Question 59: 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.
Rely on the Vitamin D content from the mother's breast milk only.
Administer 400 IU of Vitamin D daily, starting in the first few days of life. (Correct answer)
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 60: How should a nurse administer an intramuscular injection to an infant?

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

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

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

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 62: A nurse is about to give a patient 1000 mg of a drug. The available preparation is 250 mg/5 mL. How many mL should be given?

5 mL
10 mL
25 mL
20 mL (Correct answer)

Correct answer: 20 mL

Calculation: Required dose ÷ Available dose × Volume = 1000 mg ÷ 250 mg × 5 mL = 4 × 5 mL = 20 mL. Careful dose calculation is essential to prevent medication errors, particularly with liquid preparations in pediatrics and high-risk medications.

Question 63: What is the correct procedure when a nurse receives a verbal medication order?

Write the order down, read it back to confirm, have it cosigned by the prescriber as soon as possible (Correct answer)
Record the order only at the end of the shift
Refuse all verbal orders
Administer the medication immediately without documentation

Correct answer: Write the order down, read it back to confirm, have it cosigned by the prescriber as soon as possible

Read-back (RSVP) verification is mandatory for verbal and telephone orders: receive, record (write it down), read back (read the complete order aloud), receive confirmation. The prescriber must cosign the verbal order within the facility's policy timeframe (typically 24 hours).

Question 64: Which statement by a patient taking MAO inhibitors requires immediate intervention?

'I took my medication with water this morning.'
'I had red wine and cheese with dinner tonight.' (Correct answer)
'I have been sleeping better since I started this medication.'
'I feel less sad this week.'

Correct answer: 'I had red wine and cheese with dinner tonight.'

MAO inhibitors combined with tyramine-rich foods (aged cheese, red wine, cured meats, fermented foods) cause hypertensive crisis — a dangerous, potentially fatal surge in blood pressure. Patients must strictly avoid all tyramine-containing foods.

Question 65: What is the Saudi Commission for Health Specialties (SCFHS) classification for registered nurses?

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

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 66: What does 'epidemiology' study?

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

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 67: What is the appropriate first response when a child is found in respiratory arrest?

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

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

Albumin
Globulin
Casein
Gluten (Correct answer)

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 69: What is the correct order of the nursing process?

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

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 70: Which observation indicates a toddler is experiencing normal separation anxiety?

Refusing to eat for more than 24 hours
High fever when separated from parents
Crying when the parent leaves but calming with a substitute caregiver (Correct answer)
Inability to be comforted by any caregiver

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 71: What does 'isolation' precautions for immunocompromised patients include?

Contact isolation to protect other patients
Airborne precautions
Standard precautions only
Protective (reverse) isolation: restricting pathogens from entering the patient's environment (Correct answer)

Correct answer: Protective (reverse) isolation: restricting pathogens from entering the patient's environment

Immunocompromised patients (post-BMT, severe neutropenia) require protective (reverse) isolation: HEPA-filtered rooms, restricted visitors, no fresh flowers or plants, careful food safety, and cohorting staff to reduce exposure from external pathogens that could be fatal in a patient with no immune defenses.

Question 72: Which nursing intervention is most important in caring for a patient with active psychosis?

Engage in lengthy discussions about the content of delusions
Isolate the patient from all social contact
Agree with the patient's delusional beliefs to reduce distress
Establish a calm, consistent, trusting relationship and maintain reality orientation (Correct answer)

Correct answer: Establish a calm, consistent, trusting relationship and maintain reality orientation

A consistent, trustworthy therapeutic relationship is the foundation of psychiatric nursing. Engaging in the content of delusions reinforces them; isolation increases paranoia. Brief, clear, reality-oriented communication in a calm environment is most therapeutic.

Question 73: What is the most common complication following coronary artery bypass graft (CABG) surgery?

Deep vein thrombosis
Renal failure
Dysrhythmias, particularly atrial fibrillation (Correct answer)
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 74: 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 75: Which screening test is recommended for cervical cancer in Saudi Arabia?

Colonoscopy for cervical cancer
Monthly self-breast exam only
Annual mammography for all women
Pap smear (cervical cytology) and/or HPV testing every 3–5 years for women aged 25–65 (Correct answer)

Correct answer: Pap smear (cervical cytology) and/or HPV testing every 3–5 years for women aged 25–65

Cervical cancer screening in Saudi Arabia follows WHO guidelines: Pap smear every 3 years (or HPV co-testing every 5 years) for women aged 25–65. HPV vaccination (bivalent/quadrivalent) is also part of the national immunization program for girls.

Question 76: What is the DOTS strategy for tuberculosis control?

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

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 77: What is the purpose of the Hajj health operations in Saudi Arabia?

To provide dental care only
To screen pilgrims for chronic diseases only
To prevent disease transmission and provide healthcare to millions of pilgrims from diverse countries (Correct answer)
To administer visas

Correct answer: To prevent disease transmission and provide healthcare to millions of pilgrims from diverse countries

Hajj is the world's largest annual mass gathering. Saudi health operations aim to prevent infectious disease transmission (meningococcal meningitis, respiratory infections, foodborne illness), manage chronic conditions, provide emergency care, and monitor for global health threats through enhanced surveillance.

Question 78: A patient describes hearing voices that comment on their actions throughout the day. This is:

Auditory hallucinations — a positive symptom of schizophrenia (Correct answer)
A delusion
A normal stress response
Negative symptom of schizophrenia

Correct answer: Auditory hallucinations — a positive symptom of schizophrenia

Auditory hallucinations — hearing sounds, voices, or commands without an external stimulus — are positive (added) symptoms of schizophrenia. Running commentary type hallucinations are a classic first-rank (Schneiderian) symptom of schizophrenia.

Question 79: What is the purpose of a nursing care plan?

To schedule nursing shifts
To provide individualized, goal-directed care and guide interventions (Correct answer)
To record billing information
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 80: What does 'case fatality rate' measure?

The proportion of diagnosed cases of a disease who die from it (Correct answer)
Total deaths in a population
Deaths per 100,000 population
The risk of developing a disease

Correct answer: The proportion of diagnosed cases of a disease who die from it

Case fatality rate (CFR) = (deaths from disease / confirmed cases of disease) × 100%. It measures the severity/lethality of a disease and is different from mortality rate (deaths per population). A high CFR indicates a highly deadly disease.

Question 81: What is the purpose of biofilm in healthcare-associated infections?

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

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 82: What is the Saudi MOH protocol for managing a mass casualty incident (MCI)?

Activate the hospital incident command system (HICS), implement START triage, and surge capacity protocols (Correct answer)
Treat patients on a first-come, first-served basis
Only treat patients brought by ambulance
Call the Ministry of Interior only

Correct answer: Activate the hospital incident command system (HICS), implement START triage, and surge capacity protocols

Saudi hospitals follow incident command structures (HICS) in MCIs. START (Simple Triage and Rapid Treatment) triage categorizes casualties by survivability (red: immediate, yellow: delayed, green: minor, black: deceased/expectant). Surge capacity protocols expand hospital capacity for mass casualties.

Question 83: Which term describes a patient's inability to feel pleasure in activities they previously enjoyed?

Agoraphobia
Anhedonia (Correct answer)
Anergia
Aphasia

Correct answer: Anhedonia

Anhedonia is the inability to experience pleasure from previously enjoyable activities and is a core symptom of major depressive disorder and a negative symptom of schizophrenia. Anergia is lack of energy; aphasia is language impairment; agoraphobia is fear of open spaces.

Question 84: What is the primary concern when administering IV aminophylline?

Severe hypoglycemia
Cardiac arrhythmias and seizures from rapid administration (Correct answer)
Respiratory depression
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 85: Which term describes a patient's false belief that is firmly held despite evidence to the contrary?

Confabulation
Illusion
Hallucination
Delusion (Correct answer)

Correct answer: Delusion

A delusion is a fixed, false belief not consistent with cultural norms, maintained despite clear evidence to the contrary. Hallucinations are sensory perceptions without external stimuli. Illusions are misinterpretations of real stimuli. Confabulation is unconscious fabrication of memories.

Question 86: What is the mechanism of action of proton pump inhibitors (PPIs)?

Irreversibly inhibit the H+/K+-ATPase pump in gastric parietal cells, reducing acid secretion (Correct answer)
Coat the stomach lining
Block histamine H2 receptors
Neutralize stomach acid

Correct answer: Irreversibly inhibit the H+/K+-ATPase pump in gastric parietal cells, reducing acid secretion

PPIs (omeprazole, pantoprazole, esomeprazole) irreversibly block the proton pump (H+/K+-ATPase) in gastric parietal cells, producing the most potent and long-lasting reduction in gastric acid secretion. They are first-line for peptic ulcer disease and GERD.

Question 87: What is the recommended approach for tuberculosis contact investigation?

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

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

Allowing the child to sit in a position of comfort
Preparing for possible intubation
Examining the throat with a tongue depressor (Correct answer)
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 89: Which immunization schedule is given at 2 months in Saudi Arabia?

BCG and Hepatitis B
DTaP, IPV, Hib, Hepatitis B, PCV, and Rotavirus (Correct answer)
MMR and varicella
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 90: Which vital sign change is an early indicator of hypovolemic shock?

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

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 91: What are the signs of cardiac tamponade?

High urine output
Peripheral edema only
Hypertension and bradycardia
Beck's triad: hypotension, distended neck veins, and muffled heart sounds (Correct answer)

Correct answer: Beck's triad: hypotension, distended neck veins, and muffled heart sounds

Cardiac tamponade presents with Beck's triad: hypotension (low cardiac output), distended jugular veins (impaired venous return), and muffled/distant heart sounds (fluid around heart). Additional signs: pulsus paradoxus (>10 mmHg BP drop during inspiration), tachycardia, and narrowed pulse pressure.

Question 92: When performing a bed bath, in which order should body parts be washed?

Face, neck, arms, chest, abdomen, legs, back, perineum (Correct answer)
Perineum, legs, abdomen, chest, arms, neck, face
Feet, legs, abdomen, arms, face, perineum
Back, face, arms, chest, abdomen, perineum, legs

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

Hypernatremia
Hypokalemia (low potassium) (Correct answer)
Hyperkalemia
Hypercalcemia

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

To certify that the hospital meets international patient safety and quality standards (Correct answer)
To provide financial audits
To manage hospital administration
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 95: What is the correct compression-to-ventilation ratio for adult CPR?

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

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 96: A patient develops sudden confusion, tachycardia, and fever of 39.5°C on post-operative day 2. What should the nurse suspect?

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

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 97: What is the purpose of peak and trough drug level monitoring?

To assess patient compliance only
To determine the drug's mechanism of action
To ensure drug levels stay within the therapeutic window �� peak confirms efficacy, trough confirms safety (Correct answer)
To check if the patient took their medication

Correct answer: To ensure drug levels stay within the therapeutic window �� peak confirms efficacy, trough confirms safety

Peak levels (drawn at maximum drug concentration, typically 30–60 min post-dose for IV) confirm the drug reached therapeutic levels. Trough levels (drawn just before the next dose) confirm the drug has not accumulated to toxic levels. This is essential for aminoglycosides and vancomycin.

Question 98: What differentiates delirium from dementia?

They have identical presentations
Delirium only occurs in elderly patients
Delirium is always permanent; dementia is reversible
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 99: What is the primary nursing role in a school health program?

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

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 100: Which assessment finding is most characteristic of left-sided heart failure?

Pulmonary congestion with dyspnea and crackles (Correct answer)
Ascites
Hepatomegaly
Peripheral edema and jugular venous distension

Correct answer: Pulmonary congestion with dyspnea and crackles

The left ventricle pumps blood to the systemic circulation. When it fails, blood backs up into the pulmonary circulation, causing pulmonary edema, dyspnea, orthopnea, and crackles on auscultation.

Question 101: A mother asks when her baby's anterior fontanelle should close. What is the correct response?

3–6 months
12–18 months (Correct answer)
24–36 months
At birth

Correct answer: 12–18 months

The anterior fontanelle (the 'soft spot' at the top of the head) normally closes between 12 and 18 months as the skull bones fuse. Early closure (craniosynostosis) and delayed closure both warrant medical evaluation.

Question 102: Which assessment finding requires immediate nursing intervention?

Respiratory rate of 16 breaths/min
Temperature of 37.2°C
Blood pressure of 130/80 mmHg
Oxygen saturation of 88% on room air (Correct answer)

Correct answer: Oxygen saturation of 88% on room air

An oxygen saturation of 88% indicates significant hypoxemia, which can cause tissue hypoxia and organ damage. Immediate supplemental oxygen and physician notification are required. The other values are within normal limits.

Question 103: What are the components of the 'CLABSI bundle' to prevent central line infections?

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

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 104: Which serum protein is the best indicator of chronic, long-standing malnutrition due to its prolonged half-life?

Prealbumin (half-life 2–3 days)
C-reactive protein (acute phase marker)
Transferrin (half-life 8–10 days)
Albumin (half-life 21 days) (Correct answer)

Correct answer: Albumin (half-life 21 days)

Albumin's 21-day half-life means its serum level reflects nutritional status over the past several weeks, making it an indicator of chronic malnutrition.

Question 105: A patient has a nasogastric tube. Before administering medication, what must the nurse confirm?

That the patient is sitting upright only
Patient food preferences
Tube color and length
Tube placement in the stomach (Correct answer)

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

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

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

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

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

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

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

Only temperature check
Only appetite changes
Only blood pressure
Assess for nuchal rigidity, Kernig's and Brudzinski's signs, photophobia, petechial rash, altered consciousness, and bulging fontanelle in infants (Correct answer)

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 110: Which approach best describes 'health promotion' according to the Ottawa Charter?

Prescribing medications for prevention
Treating illness after it occurs
Providing health services in hospitals only
Enabling people to increase control over and improve their health (Correct answer)

Correct answer: Enabling people to increase control over and improve their health

The Ottawa Charter (1986) defines health promotion as the process of enabling people to increase control over their health. It encompasses building healthy public policies, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services.

Question 111: 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 50-gram, 1-hour Glucose Challenge Test (GCT) (Correct answer)
A 100-gram, 4-hour Oral Glucose Tolerance Test (OGTT)
A fasting plasma glucose (FPG) test only

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 112: What is the most common cause of respiratory distress in premature newborns?

Respiratory distress syndrome (RDS) from surfactant deficiency (Correct answer)
Pneumonia
Meconium aspiration
Congenital heart disease

Correct answer: Respiratory distress syndrome (RDS) from surfactant deficiency

Surfactant, produced by type II pneumocytes, reduces alveolar surface tension and prevents alveolar collapse. Premature infants (<37 weeks) lack adequate surfactant, causing RDS (hyaline membrane disease). Treatment includes exogenous surfactant and respiratory support.

Question 113: What is required when a Saudi nurse is asked to perform a task outside their scope of practice?

Always comply with physician requests regardless of scope
Only decline if the patient objects
Decline respectfully, explain why it is outside scope, and refer to an appropriately qualified professional (Correct answer)
Perform the task to help the team

Correct answer: Decline respectfully, explain why it is outside scope, and refer to an appropriately qualified professional

Practicing outside one's scope of practice is a professional, legal, and patient safety issue. Saudi nurses are required to practice within their competence and SCFHS-defined scope. Declining an out-of-scope task, explaining why, and facilitating appropriate referral is the correct professional response.

Question 114: According to the Saudi Ministry of Health (MOH) National Immunization Schedule, which two vaccines are mandatory for a healthy newborn within the first 24 hours of life?

IPV (Inactivated Polio Vaccine) and Hib
BCG (Bacillus Calmette-Guérin) and Hepatitis B (HBV) (Correct answer)
Rotavirus and DTaP
MMR and Varicella

Correct answer: BCG (Bacillus Calmette-Guérin) and Hepatitis B (HBV)

The Saudi Ministry of Health's National Immunization Schedule mandates the administration of the first dose of the Hepatitis B vaccine (HBV) and the BCG vaccine at birth, typically within the first 24 hours, to protect against hepatitis B and tuberculosis, respectively.

Question 115: Which drug class can cause hyperkalemia?

Thiazide diuretics
Loop diuretics
Calcium channel blockers
ACE inhibitors and potassium-sparing diuretics (Correct answer)

Correct answer: ACE inhibitors and potassium-sparing diuretics

ACE inhibitors reduce aldosterone production, decreasing potassium excretion. Potassium-sparing diuretics (spironolactone, triamterene, amiloride) directly prevent potassium secretion in the distal nephron. Combining these two classes significantly increases hyperkalemia risk.

Question 116: What does 'NPO' mean in a clinical context?

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

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 117: What is the purpose of administering vitamin K to a newborn at birth?

To prevent hemorrhagic disease of the newborn due to vitamin K deficiency (Correct answer)
To stimulate growth
To prevent jaundice
To boost the immune system

Correct answer: To prevent hemorrhagic disease of the newborn due to vitamin K deficiency

Newborns have low vitamin K levels because it does not cross the placenta well and gut bacteria (which produce vitamin K) are not yet established. Without supplementation, they are at risk for vitamin K deficiency bleeding (hemorrhagic disease of the newborn).

Question 118: What is the primary purpose of the nursing diagnosis in the nursing process?

To schedule nursing assignments
To assign patient acuity scores
To document physician-prescribed treatments
To identify actual or potential patient health problems that nurses can treat (Correct answer)

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 119: What are the legal implications of nursing negligence in Saudi Arabia?

Only the hospital is liable
Only verbal warnings
Nurses can face administrative sanctions, civil liability for damages, and criminal charges under Saudi health practice law (Correct answer)
No legal consequences for nurses

Correct answer: Nurses can face administrative sanctions, civil liability for damages, and criminal charges under Saudi health practice law

Nursing negligence in Saudi Arabia can result in: SCFHS administrative action (license suspension/revocation), civil liability (compensation for damages through medical malpractice committees), and criminal charges for gross negligence. The Saudi Health Practice Law establishes accountability for healthcare professionals.

Question 120: A patient is in pain and rates it 8/10. Which action should the nurse take first?

Perform a comprehensive pain assessment (Correct answer)
Reassess pain in one hour
Administer the maximum analgesic dose
Tell the patient to rest quietly

Correct answer: Perform a comprehensive pain assessment

A comprehensive pain assessment (location, quality, duration, aggravating/relieving factors) must precede any intervention to ensure appropriate and safe management. Assessment drives the intervention choice.

Question 121: What is the Saudi Ministry of Health's policy on patient confidentiality?

Family members automatically have access to all patient information
Patient information can be shared freely among healthcare workers
Patient information must be kept confidential except in legally defined circumstances such as public health reporting (Correct answer)
Confidentiality only applies to HIV-positive patients

Correct answer: Patient information must be kept confidential except in legally defined circumstances such as public health reporting

Saudi health regulations and Islamic ethical principles uphold patient confidentiality. Information may only be disclosed with patient consent, by legal obligation (notifiable diseases, court orders), in medical emergencies involving risk to life, or to protect public health — with minimum necessary disclosure.

Question 122: What is 'polypharmacy' and why is it a nursing concern in elderly patients?

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 generic medications only
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 123: 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?

Patient complains of moderate uterine cramping, especially during breastfeeding.
Fundus is boggy and deviated to the right, 3 cm above the umbilicus. (Correct answer)
Lochia rubra is present, with one saturated perineal pad in 2 hours.
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 124: What is the function of the Saudi Patient Safety Center?

To manage nursing education curricula
To provide patient financial assistance
To license medical devices
To lead national initiatives to reduce medical errors and improve patient safety across the Saudi health system (Correct answer)

Correct answer: To lead national initiatives to reduce medical errors and improve patient safety across the Saudi health system

The Saudi Patient Safety Center (SPSC), part of the MOH, develops national patient safety programs, standards, and initiatives: medication safety, infection control standards, surgical safety, fall prevention, and adverse event reporting systems — working to systematically reduce preventable harm.

Question 125: When administering oxygen via a simple face mask, what is the minimum flow rate to prevent CO₂ rebreathing?

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

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 126: A nurse is conducting a home visit for a patient with hypertension. Which finding requires immediate referral?

Irregular sleep schedule
Blood pressure of 140/90 mmHg without symptoms
Blood pressure of 200/120 mmHg with severe headache (Correct answer)
Mild ankle edema

Correct answer: Blood pressure of 200/120 mmHg with severe headache

BP of 200/120 mmHg with severe headache is a hypertensive emergency (possible end-organ damage — stroke, encephalopathy, renal failure). Immediate emergency referral is required. Hypertensive urgency is severe BP without end-organ damage; emergency involves damage.

Question 127: A patient is prescribed warfarin. Which food significantly increases bleeding risk?

Vitamin K-rich foods
High-protein foods
Calcium-rich dairy products
Excessive consumption of cranberry juice (Correct answer)

Correct answer: Excessive consumption of cranberry juice

Cranberry juice contains compounds that inhibit CYP2C9, the enzyme that metabolizes warfarin, leading to increased warfarin levels and INR elevation. This significantly increases bleeding risk. Vitamin K-rich foods (green leafy vegetables) actually reduce warfarin's anticoagulant effect.

Question 128: What does 'primary healthcare' mean according to the Alma-Ata Declaration?

Specialist medical services
Emergency care
Hospital care only
Essential, accessible, community-based care that is the first point of contact with the health system (Correct answer)

Correct answer: Essential, accessible, community-based care that is the first point of contact with the health system

The Alma-Ata Declaration (1978) defined primary healthcare as essential, evidence-based, accessible, affordable, and community-participatory health services serving as the first contact with the health system. It emphasized equity, community participation, intersectoral action, and appropriate technology.

Question 129: A Saudi nurse counseling a mother with an exclusively breastfed newborn should recommend which supplement starting within the first few days of life?

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

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 130: 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 131: What is a key sign of developmental dysplasia of the hip (DDH) in an infant?

Normal gait by 12 months
Asymmetric gluteal folds and positive Ortolani test (Correct answer)
Leg length equality
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 132: Which immunization is specifically contraindicated in a child with severe combined immunodeficiency (SCID)?

Live vaccines such as MMR and varicella (Correct answer)
Inactivated vaccines such as IPV
Hepatitis B vaccine
Pneumococcal 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 133: Which position is most appropriate for a patient experiencing respiratory distress?

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

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 134: 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 135: What are the classic signs of intussusception in an infant?

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

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 136: Which finding indicates a newborn has adequate hydration?

6 or more wet diapers per day after day 4 (Correct answer)
No wet diapers in 12 hours
Concentrated yellow urine
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 137: What is the primary goal of primary prevention in community health?

Reduce the impact of established disease
Detect disease early through screening
Rehabilitate individuals after illness
Prevent disease before it occurs through health promotion and risk reduction (Correct answer)

Correct answer: Prevent disease before it occurs through health promotion and risk reduction

Primary prevention targets healthy individuals to prevent disease onset. Examples include immunizations, health education, tobacco cessation, and sanitation. Secondary prevention is early detection (screening); tertiary prevention is reducing disability from established disease.

Question 138: What is the correct technique for removing soiled gloves to prevent self-contamination?

Pull both gloves off at the fingertips together
Grasp outside of first glove at the wrist and peel off, then insert fingers inside second glove and peel off (Correct answer)
Cut the gloves off with scissors
Remove gloves from the fingertips using the other gloved hand

Correct answer: Grasp outside of first glove at the wrist and peel off, then insert fingers inside second glove and peel off

The safe glove removal technique: 1) Grasp the outside of one glove at the wrist (avoiding bare skin contact), peel it inside out and hold it, 2) Slide the finger under the wrist of the second glove and peel it inside out over the first. Both gloves end up inside out, containing contamination.

Question 139: What is the primary nursing concern for a patient with liver cirrhosis and ascites?

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

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

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

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

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

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 142: Which drug class is used to treat acute extrapyramidal side effects (EPS) caused by antipsychotics?

Benzodiazepines
Beta-blockers
Anticholinergic agents such as benztropine (Cogentin) (Correct answer)
SSRIs

Correct answer: Anticholinergic agents such as benztropine (Cogentin)

Acute EPS (dystonia, akathisia, parkinsonism) from antipsychotic dopamine blockade are treated with anticholinergic agents (benztropine, diphenhydramine) which restore the dopamine-acetylcholine balance in the extrapyramidal system.

Question 143: A patient on gentamicin therapy requires monitoring of which parameters?

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

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 144: What is the primary purpose of a health needs assessment in community nursing?

To allocate nursing staff schedules
To evaluate individual patient outcomes
To identify health priorities and gaps in services in a community (Correct answer)
To audit hospital records

Correct answer: To identify health priorities and gaps in services in a community

A community health needs assessment identifies the population's health status, risk factors, existing resources, service gaps, and priorities. It uses data from surveys, vital statistics, and community input to guide evidence-based public health planning.

Question 145: The Malnutrition Universal Screening Tool (MUST) evaluates a patient based on which three components?

Hemoglobin, appetite score, and functional status
Dietary intake, hydration status, and wound healing
Serum albumin, dietary recall, and muscle strength
BMI, unintentional weight loss, and acute disease effect on intake (Correct answer)

Correct answer: BMI, unintentional weight loss, and acute disease effect on intake

MUST uses BMI, percentage of unintentional weight loss over 3–6 months, and acute disease effect on nutritional intake to score malnutrition risk.

Question 146: What is the correct compression-to-ventilation ratio for single-rescuer infant CPR?

30:2 (Correct answer)
5:1
15:2
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 147: 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)
High-flow oxygen without limit
5 L/min via simple face mask
10–15 L/min via non-rebreather mask

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 148: How should soiled linen be handled in the hospital?

Roll tightly and place in a designated linen bag without shaking; avoid contact with uniform (Correct answer)
Carry soiled linen against the uniform to contain it
Leave in the patient room until the end of the shift
Shake the linen to remove debris before bagging

Correct answer: Roll tightly and place in a designated linen bag without shaking; avoid contact with uniform

Soiled linen is handled by: holding away from the body and uniform, rolling (not shaking — shaking disperses microorganisms into the air), placing directly in a color-coded linen bag, and transporting in a covered trolley. Never sort or rinse soiled linen in patient rooms.

Question 149: A patient's wound culture reveals MRSA. What precautions are required?

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

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 150: Which surface disinfectant is effective against C. difficile spores?

Iodine-based disinfectants
Quaternary ammonium compounds
Isopropyl alcohol
Hypochlorite (bleach) solution (Correct answer)

Correct answer: Hypochlorite (bleach) solution

C. difficile spores are extremely resistant. The CDC recommends EPA-registered sporicidal disinfectants, primarily diluted sodium hypochlorite (bleach, 1:10 dilution), for environmental cleaning in rooms of C. difficile patients. Alcohol and quaternary ammonium compounds are ineffective against spores.

Question 151: A patient is diagnosed with deep vein thrombosis (DVT). Which nursing intervention is contraindicated?

Administering anticoagulants as prescribed
Elevating the affected extremity
Massaging the affected leg (Correct answer)
Applying warm compresses as ordered

Correct answer: Massaging the affected leg

Massaging a limb with known or suspected DVT is contraindicated because it can dislodge the thrombus, causing a potentially fatal pulmonary embolism. Elevation, warmth, and anticoagulation are appropriate interventions.

Question 152: What is the 'first-pass effect' in pharmacology?

The initial drug distribution phase
The first dose being more effective than subsequent doses
Significant drug metabolism by the liver before reaching systemic circulation after oral administration (Correct answer)
The first sign of drug toxicity

Correct answer: Significant drug metabolism by the liver before reaching systemic circulation after oral administration

After oral ingestion, drugs absorbed from the gut pass through the portal circulation to the liver where they may be extensively metabolized before reaching systemic circulation. This reduces bioavailability (e.g., nitrates, morphine, propranolol have high first-pass effect and require higher oral doses or alternative routes).

Question 153: 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
Immediately stop the TPN infusion
Check the blood glucose level (Correct answer)

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

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

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

Stay with the patient, speak calmly, guide slow controlled breathing, reassure they are safe (Correct answer)
Administer antipsychotic medication
Leave the patient in a quiet room alone
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 156: What is the normal range for adult body temperature measured orally?

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

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 157: What is the priority assessment for a patient with a cervical spinal cord injury?

Skin integrity
Pain level
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 158: 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 159: A nurse working in a surgical unit in Jeddah is preparing a patient for an elective cholecystectomy. Which of the following actions is a mandatory part of the pre-operative verification process according to the surgical safety checklist endorsed by the Saudi Ministry of Health?

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

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 160: What does the nursing term 'diaphoresis' mean?

Excessive urination
Difficulty breathing
Profuse sweating (Correct answer)
Abnormal thirst

Correct answer: Profuse sweating

Diaphoresis means profuse or excessive sweating. It is a clinical sign associated with conditions such as hypoglycemia, myocardial infarction, fever, pain, and anxiety, and warrants further assessment.

Question 161: Which position is contraindicated for a patient who has just had a lumbar puncture?

Sitting upright immediately after the procedure (Correct answer)
Lying flat for 4–8 hours post-procedure
Side-lying position
Prone position

Correct answer: Sitting upright immediately after the procedure

After lumbar puncture, patients typically lie flat for 4–8 hours to reduce the risk of post-lumbar puncture headache caused by CSF leakage. Sitting upright too soon increases intracranial pressure gradient and worsens CSF leakage.

Question 162: What is the normal expected weight loss for a newborn in the first few days of life?

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

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 163: A patient is admitted with suspected myocardial infarction. Which laboratory marker is most specific for cardiac muscle damage?

Troponin I or Troponin T (Correct answer)
Lactate dehydrogenase (LDH)
Creatine kinase (total CK)
C-reactive protein (CRP)

Correct answer: Troponin I or Troponin T

Cardiac troponins (troponin I and T) are highly specific biomarkers for myocardial cell injury. They rise within 3–6 hours of infarction, peak at 12–24 hours, and remain elevated for 7–10 days, making them the gold standard diagnostic marker.

Question 164: What is the 'cold chain' in immunization?

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

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 165: Which vitamin is primarily synthesized in the skin upon exposure to ultraviolet sunlight?

Vitamin A
Vitamin D (Correct answer)
Vitamin K
Vitamin B12

Correct answer: Vitamin D

Vitamin D is synthesized in the skin when 7-dehydrocholesterol is converted upon UV-B exposure; deficiency is common in covered populations.

Question 166: Which electrolyte imbalance most commonly causes muscle cramps and tetany?

Hypernatremia
Hyponatremia
Hypocalcemia (Correct answer)
Hyperkalemia

Correct answer: Hypocalcemia

Hypocalcemia causes increased neuromuscular excitability, manifesting as muscle cramps, tetany, positive Trousseau's and Chvostek's signs, and in severe cases, laryngospasm and seizures. Calcium is essential for normal muscle and nerve function.

Question 167: What is the purpose of the Saudi Health Information Exchange (HIE)?

To manage hospital finances
To allow secure sharing of patient health information across different healthcare providers and facilities (Correct answer)
To store only laboratory results
To restrict access to patient records

Correct answer: To allow secure sharing of patient health information across different healthcare providers and facilities

The Saudi HIE enables interoperable electronic exchange of patient health information between hospitals, primary care centers, pharmacies, and laboratories — improving care coordination, reducing duplicate testing, enabling continuity of care, and supporting evidence-based decision-making across the health system.

Question 168: Which assessment is critical before administering digoxin?

Measure blood glucose
Check blood pressure first
Check the apical pulse for a full minute — hold if <60 bpm (Correct answer)
Assess urine output

Correct answer: Check the apical pulse for a full minute — hold if <60 bpm

Digoxin slows heart rate. The apical pulse must be assessed for a full minute before each dose. If the rate is below 60 bpm (adults), the dose is withheld and the prescriber notified. Digoxin level and electrolytes (especially potassium) should also be monitored.

Question 169: A new father in Al-Khobar approaches the nurse and expresses his wish for a respected elder to perform 'Tahneek' for his newborn. What is the nurse's most culturally competent and safe response?

Document the request and inform the physician, recommending against the practice.
Allow the family to perform the ritual using a minuscule amount of a softened date, ensuring aseptic technique and observing the infant for any adverse reaction. (Correct answer)
Inform the father that no outside food or substances are allowed for the newborn.
Provide the family with a honey-based gel from the hospital pharmacy to use instead.

Correct answer: Allow the family to perform the ritual using a minuscule amount of a softened date, ensuring aseptic technique and observing the infant for any adverse reaction.

Tahneek is an important Islamic cultural and religious practice involving rubbing a small amount of a softened date or honey on a newborn's palate. A culturally competent nurse should respect this practice while ensuring safety. The best approach is to facilitate the ritual in a safe manner, using a tiny particle to minimize any risk of choking or infection, and ensuring proper hand hygiene is performed by the person conducting the Tahneek.

Question 170: At what age should children receive the MMR vaccine according to the Saudi MOH immunization schedule?

12 months (with second dose at 18 months) (Correct answer)
6 months
3 years
At birth

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 171: A patient with chronic kidney disease (CKD) who is NOT yet on dialysis should generally follow which dietary protein guideline?

High protein intake (>1.5 g/kg/day) to compensate for urinary losses
Unrestricted protein with increased phosphorus
Protein restriction to approximately 0.6–0.8 g/kg/day (Correct answer)
High-potassium diet to support kidney perfusion

Correct answer: Protein restriction to approximately 0.6–0.8 g/kg/day

Restricting dietary protein to 0.6–0.8 g/kg/day in pre-dialysis CKD reduces nitrogenous waste accumulation and may slow disease progression.

Question 172: A patient is prescribed phenytoin for seizure control. Which adverse effect is specific to this drug?

Gingival hyperplasia (gum overgrowth) (Correct answer)
Pulmonary fibrosis
Severe weight gain
Renal calculi

Correct answer: Gingival hyperplasia (gum overgrowth)

Gingival hyperplasia (gum overgrowth) is a characteristic adverse effect of phenytoin, occurring in up to 50% of patients. Good oral hygiene reduces severity. Other phenytoin adverse effects include nystagmus, ataxia, diplopia, and teratogenicity (fetal hydantoin syndrome).

Question 173: A primigravida at 36 weeks reports a sudden gush of fluid from the vagina. What is the priority nursing action?

Assess fetal heart rate and check for cord prolapse (Correct answer)
Perform a cervical exam immediately
Prepare the patient for immediate delivery
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 174: What is the primary goal of nasogastric tube decompression after abdominal surgery?

Provide enteral nutrition
Monitor gastric pH
Administer oral medications
Remove gas and fluids to prevent abdominal distension and vomiting (Correct answer)

Correct answer: Remove gas and fluids to prevent abdominal distension and vomiting

Postoperative ileus causes accumulation of gas and secretions in the stomach and intestines. NG decompression removes these contents, reducing distension, nausea, vomiting, and risk of aspiration.

Question 175: Which medication requires a daily weight to be taken and reported?

Vitamin supplements
Antibiotics
Digoxin and diuretics (Correct answer)
Antipsychotics

Correct answer: Digoxin and diuretics

Daily weight monitoring is essential for patients on digoxin (to detect fluid retention from heart failure) and diuretics (to monitor fluid balance — rapid weight gain indicates fluid retention; rapid loss indicates over-diuresis). A weight gain of >1 kg/day should be reported.

Question 176: A nurse is performing hand hygiene. According to WHO guidelines, how long should alcohol-based handrub be applied?

10–15 seconds
60–90 seconds
20–30 seconds (Correct answer)
5–10 seconds

Correct answer: 20–30 seconds

WHO guidelines specify that alcohol-based handrub should be applied for 20–30 seconds covering all surfaces until hands are dry. This duration ensures effective microbial reduction.

Question 177: What personal protective equipment is required when preparing cytotoxic chemotherapy drugs?

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

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 178: A patient has been prescribed ACE inhibitors for hypertension. What side effect should the nurse teach the patient to expect?

Diarrhea
Hypoglycemia
Hyperthyroidism
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 179: What is 'healthcare-associated infection' (HAI)?

An infection acquired in a healthcare setting, not present on admission, occurring after 48 hours (Correct answer)
Any infection in a hospital patient
An infection acquired in the community
An infection caused by antibiotic-resistant organisms only

Correct answer: An infection acquired in a healthcare setting, not present on admission, occurring after 48 hours

HAIs (nosocomial infections) are infections not present or incubating at admission, typically developing ≥48 hours after admission or within 30 days of healthcare exposure. Common HAIs include CLABSI, CAUTI, VAP, SSI. They are largely preventable through evidence-based bundles.

Question 180: What is the recommended frequency for repositioning bedridden patients to prevent pressure ulcers?

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

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 181: Which sign/symptom indicates a fluid volume deficit (dehydration)?

Distended neck veins
Bounding pulse and hypertension
Periorbital edema
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 182: Which type of isolation precaution is required for a patient with pulmonary tuberculosis?

Standard precautions only
Droplet precautions
Contact precautions
Airborne precautions (Correct answer)

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 183: 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 184: Which antibiotics are absolutely contraindicated in children under 8 years?

Macrolides
Penicillins
Cephalosporins
Tetracyclines (Correct answer)

Correct answer: Tetracyclines

Tetracyclines bind to calcium in developing bones and teeth, causing permanent dental staining (brown-grey discoloration) and impaired bone growth when given to children under 8 years or during pregnancy. They are absolutely contraindicated in these populations.

Question 185: At what gastric residual volume should a nurse typically pause nasogastric tube feeding and notify the physician?

More than 200–250 mL (Correct answer)
More than 100 mL
More than 50 mL
More than 500 mL

Correct answer: More than 200–250 mL

Most clinical guidelines recommend withholding enteral feeding when gastric residual volume exceeds 200–250 mL to reduce aspiration risk.

Question 186: What does the acronym 'SBAR' stand for in nursing communication?

Safety, Background, Action, Report
Situation, Background, Assessment, Recommendation (Correct answer)
Standard, Background, Assessment, Response
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 187: Which developmental milestone is expected for a 12-month-old child?

Riding a tricycle
Reading simple words
Taking first independent steps and saying 1–3 words (Correct answer)
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 188: Which action prevents dumping syndrome in a post-gastrectomy patient?

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
Increase simple carbohydrates in the diet

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

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

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 190: What is the priority nursing intervention for a child in status epilepticus?

Restrain the child
Leave the child alone until the seizure stops
Put something in the child's mouth
Ensure airway patency, place in side-lying position, protect from injury, administer benzodiazepines as ordered, and monitor oxygen saturation (Correct answer)

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 191: 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.
Preparing the patient for an emergency splenectomy.
Administering high-flow oxygen via a non-rebreather mask.
Providing aggressive intravenous hydration and pain management. (Correct answer)

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 192: What are the signs of dehydration in an infant?

Increased wet diapers
Bulging fontanelle
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 193: Which medication requires regular monitoring of white blood cell count?

Haloperidol (Haldol)
Clozapine (Clozaril) (Correct answer)
Fluoxetine (Prozac)
Lithium

Correct answer: Clozapine (Clozaril)

Clozapine carries a risk of agranulocytosis (dangerous reduction in white blood cells) in approximately 1% of patients. Mandatory WBC and absolute neutrophil count (ANC) monitoring is required weekly for 6 months, then bi-weekly, then monthly.

Question 194: 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 free up hospital beds quickly
To reduce hospital costs only
To document patient preferences

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

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

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 196: Which dietary modification is most appropriate for a patient with hepatic encephalopathy?

High-protein diet to support liver regeneration
High-fat diet to spare protein
Moderate protein restriction with emphasis on branched-chain amino acids (Correct answer)
Sodium supplementation to maintain osmolarity

Correct answer: Moderate protein restriction with emphasis on branched-chain amino acids

Hepatic encephalopathy management involves moderating protein intake and preferring branched-chain amino acids to reduce ammonia production.

Question 197: A community nurse identifies a cluster of measles cases in one school. What is the immediate priority action?

Wait and monitor for more cases before acting
Report to public health authorities and ensure immunization status of all contacts is reviewed (Correct answer)
Treat all affected children with antibiotics
Recommend vitamin C supplementation only

Correct answer: Report to public health authorities and ensure immunization status of all contacts is reviewed

A disease cluster requires immediate mandatory reporting to public health authorities who will investigate the outbreak, verify diagnoses, identify the source, and implement control measures (vaccination of susceptibles, exclusion of cases). Measles has no specific antiviral treatment.

Question 198: Which nursing intervention is the highest priority when a patient develops sudden severe chest pain?

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

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 199: What does the APGAR score assess in the newborn?

Airway, Pulse, Grunting, Arousal, Respiration
Appearance, Pain, Growth, Alertness, Respirations
Appearance, Pulse, Grimace, Activity, Respiration (Correct answer)
Alertness, Pulse, Growth, Activity, Reflexes

Correct answer: Appearance, Pulse, Grimace, Activity, Respiration

The APGAR score assesses five criteria at 1 and 5 minutes of life: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. Each is scored 0–2; total 7–10 is normal.

Question 200: A nurse observes another nurse reusing a single-use medical device. What is the appropriate action?

Report only if a patient develops an infection
Document it only
Immediately intervene to stop the practice and report to the charge nurse and infection control (Correct answer)
Do nothing to avoid conflict

Correct answer: Immediately intervene to stop the practice and report to the charge nurse and infection control

Reusing single-use devices risks transmission of bloodborne pathogens and other infections, and compromises device integrity. This is a patient safety issue requiring immediate intervention to stop the practice, followed by mandatory reporting to the charge nurse and infection control for investigation and corrective action.

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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