Saudi Nursing Licensure Exam — Questions and Answers

Question 1: What is the nurse's priority when caring for a child with acute otitis media (ear infection)?

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

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

Hypoglycemia
Hyperthyroidism
A persistent dry cough (Correct answer)
Diarrhea

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

Only fluid
Potassium, phosphorus, and sodium (Correct answer)
Only protein
Only sodium

Correct answer: Potassium, phosphorus, and sodium

CKD patients require restriction of potassium (to prevent hyperkalemia and cardiac arrhythmias), phosphorus (to prevent renal osteodystrophy), and sodium (to control fluid retention and hypertension). Protein and fluid may also be restricted.

Question 4: A child with meningitis is placed in a darkened room. Which symptom explains this intervention?

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

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

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

Correct answer: Confirming the patient’s identity, procedure, site, and consent.

The Saudi Ministry of Health, in alignment with international standards like the WHO Surgical Safety Checklist, mandates a 'Sign In' phase before the induction of anaesthesia. A critical component of this phase is for the nurse and anaesthetist to verbally confirm with the patient their identity, the specific surgical procedure, the surgical site, and that the consent form has been correctly signed. Prophylactic antibiotics are typically given within 60 minutes before the incision, not four hours.

Question 6: A patient taking SSRIs is prescribed tramadol for pain. What interaction should the nurse be aware of?

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

Correct answer: Serotonin syndrome — a potentially life-threatening excess of serotonergic activity

Both SSRIs and tramadol increase serotonergic activity. Combining them can cause serotonin syndrome: hyperthermia, agitation, tremor, clonus, hyperreflexia, and diaphoresis. Severe cases include rhabdomyolysis and death. The combination should be avoided or used with extreme caution.

Question 7: Which vitamin is primarily synthesized in the skin upon exposure to ultraviolet sunlight?

Vitamin D (Correct answer)
Vitamin K
Vitamin A
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 8: How should a nurse administer an intramuscular injection to an infant?

In the gluteal muscle
In the vastus lateralis (anterolateral thigh) using a 25-gauge, 5/8 to 1-inch needle (Correct answer)
In the dorsal gluteal site
In the deltoid 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 9: 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 10: What is the correct method for obtaining a mid-stream urine specimen?

Collect the first stream only
Collect the entire void in a sterile container
Clean the urethral area, discard first stream, collect midstream, stop before end of stream (Correct answer)
Insert a catheter for every urine culture

Correct answer: Clean the urethral area, discard first stream, collect midstream, stop before end of stream

Mid-stream collection reduces contamination from periurethral flora. Cleaning the area, discarding the first stream, then collecting the middle portion provides the most accurate representation of bladder urine.

Question 11: 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 12: Which body is responsible for licensing nurses in Saudi Arabia?

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

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 13: A postpartum patient develops a fever of 38.5°C on day 3 with a tender, red area on her right breast. What condition is this?

Breast engorgement
Mastitis (Correct answer)
Normal lactation changes
Breast abscess

Correct answer: Mastitis

Mastitis is breast infection (most commonly Staphylococcus aureus) presenting with localized redness, warmth, tenderness, fever, and flu-like symptoms, typically on days 3–4 postpartum. Treatment includes antibiotics and continued breastfeeding or pumping.

Question 14: A nurse is caring for a 2-day-old newborn in Riyadh. A heel prick blood sample is collected as part of the mandatory National Newborn Screening Program. Which of the following conditions is included in this screening panel?

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

Correct answer: Congenital Hypothyroidism

The Kingdom of Saudi Arabia's National Newborn Screening Program mandates screening for several conditions, including endocrine disorders like Congenital Hypothyroidism and Congenital Adrenal Hyperplasia, as well as various inborn errors of metabolism. Early detection and treatment of Congenital Hypothyroidism are crucial to prevent severe intellectual disability.

Question 15: What is the purpose of a nursing care plan?

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

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 16: Which communicable disease is targeted for eradication in Saudi Arabia through the Expanded Program on Immunization?

Measles
Hepatitis C
Poliomyelitis (Correct answer)
Malaria

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

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

Correct answer: Platelet count of 45,000/mm³

A platelet count of 45,000/mm³ is significantly below the normal range (150,000–400,000/mm³), indicating thrombocytopenia. Low platelets impair clot formation, increasing bleeding risk. The other values are within normal limits.

Question 18: Adequate postoperative protein intake is most critical for which physiological purpose?

Providing energy substrate for early ambulation
Supporting wound healing and maintaining immune function (Correct answer)
Preventing postoperative constipation
Stabilizing blood glucose levels

Correct answer: Supporting wound healing and maintaining immune function

Protein is the primary substrate for collagen synthesis during wound healing and for immunoglobulin production, both essential for postoperative recovery.

Question 19: A nurse is caring for a patient suspected of having Middle East Respiratory Syndrome (MERS-CoV) in a hospital in Al-Ahsa. According to Saudi Ministry of Health and WHO guidelines, which combination of personal protective equipment (PPE) is required when providing routine care for this patient?

Surgical mask and gloves only.
Gown, gloves, eye protection, and a surgical mask. (Correct answer)
Gown, gloves, and an N95 respirator.
Shoe covers, gown, and a surgical mask.

Correct answer: Gown, gloves, eye protection, and a surgical mask.

For routine care of a suspected or confirmed MERS-CoV patient, standard, contact, and droplet precautions are required. This includes wearing a gown, gloves, eye protection (goggles or face shield), and a medical/surgical mask. An N95 respirator is specifically required during aerosol-generating procedures. Since its initial identification in Saudi Arabia in 2012, stringent infection control protocols have been a cornerstone of managing MERS-CoV outbreaks in healthcare facilities across the Kingdom.

Question 20: A patient with type 2 diabetes has a fasting blood glucose of 320 mg/dL. Which symptom is most likely present?

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

Correct answer: Polyuria, polydipsia, and polyphagia

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

Question 21: When performing a bed bath, in which order should body parts be washed?

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

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

Perform a cervical exam immediately
Assess fetal heart rate and check for cord prolapse (Correct answer)
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 23: A patient is admitted with suspected myocardial infarction. Which laboratory marker is most specific for cardiac muscle damage?

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

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

More than 500 mL
More than 200–250 mL (Correct answer)
More than 100 mL
More than 50 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 25: What is the most accurate method for calculating medication doses for pediatric patients?

Using the adult dose divided by 2
Body weight in kilograms (mg/kg) or body surface area (BSA) calculation (Correct answer)
Estimating by the child's age
Using the same dose as adults for children over 5

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 26: 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
Drink large amounts of fluids during meals to dilute food
Increase dietary fiber intake significantly
Eat small, frequent meals and avoid simple sugars (Correct answer)

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

Use of generic medications only
Use of five or more medications simultaneously, increasing risk of drug interactions, adverse effects, and non-adherence (Correct answer)
Simultaneous use of two medications
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 28: What is the primary goal of discharge planning?

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

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 29: What is the scope of practice for a registered nurse in Saudi Arabia?

Defined by SCFHS guidelines: patient assessment, care planning, medication administration, patient education, and documentation within the nurse's competency level (Correct answer)
Nurses can practice independently without limitations
Only providing basic hygiene care
Only following physician orders

Correct answer: Defined by SCFHS guidelines: patient assessment, care planning, medication administration, patient education, and documentation within the nurse's competency level

Saudi RN scope of practice includes: comprehensive patient assessment, nursing diagnosis, care planning, implementing nursing interventions, medication administration, patient/family education, documentation, delegation to unlicensed personnel, and participation in quality improvement. Practice must stay within competency boundaries.

Question 30: What is the function of the Saudi Patient Safety Center?

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

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 31: What is the most important measure to prevent ventilator-associated pneumonia (VAP)?

Maintain head of bed at 30–45 degrees, perform oral care with chlorhexidine, and assess readiness to extubate daily (Correct answer)
Change the ventilator circuit daily
Keep the patient supine
Administer prophylactic antibiotics to all ventilated patients

Correct answer: Maintain head of bed at 30–45 degrees, perform oral care with chlorhexidine, and assess readiness to extubate daily

The VAP bundle includes: head of bed elevation 30–45° (reduces aspiration), oral decontamination with chlorhexidine (reduces oropharyngeal bacteria), daily sedation vacation and spontaneous breathing trials (to minimize ventilator days), and cuff pressure maintenance. Routine ventilator circuit changes are not recommended.

Question 32: How should a nurse manage a patient with an arterial line?

No special monitoring needed
Remove if the patient moves
Only check blood pressure readings
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 33: What is the purpose of an 'allergy band' on a patient?

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

Correct answer: To alert all healthcare providers of documented drug, food, or environmental allergies to prevent accidental exposure

Allergy identification bands provide a universal, immediate visual alert at the point of care — particularly at medication administration, procedures, and emergencies — to prevent exposure to documented allergens. This is a patient safety redundancy that complements electronic allergy records.

Question 34: What are the signs of cardiac tamponade?

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

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 35: What is the priority nursing intervention for a patient experiencing a tonic-clonic seizure?

Restrain limbs to prevent injury
Insert a tongue blade to protect the tongue
Protect the patient from injury, maintain airway, do not restrain (Correct answer)
Leave the patient and call for help immediately

Correct answer: Protect the patient from injury, maintain airway, do not restrain

The priority during a seizure is patient safety: lower to the floor if possible, cushion the head, clear the environment, and turn to the side after convulsive activity stops to maintain airway. Never restrain or insert objects in the mouth.

Question 36: Which medication is the first-line mood stabilizer for bipolar disorder?

Lithium carbonate (Correct answer)
Clonazepam
Haloperidol
Fluoxetine

Correct answer: Lithium carbonate

Lithium is the gold standard mood stabilizer for bipolar disorder with strong evidence for preventing both manic and depressive episodes and reducing suicide risk. It requires regular serum level monitoring (therapeutic range: 0.6–1.2 mEq/L for maintenance).

Question 37: Which dietary instruction is most important for a patient taking warfarin?

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

Correct answer: Maintain consistent vitamin K intake and avoid drastic dietary changes

Warfarin works by inhibiting vitamin K-dependent clotting factors. Sudden large increases in vitamin K intake (from leafy greens) antagonize warfarin and reduce anticoagulation. Consistency is more important than elimination.

Question 38: A patient's blood pressure is 150/95 mmHg. How should this reading be documented?

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

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 39: A nurse prepares to administer insulin. Which type of insulin is clear in appearance?

Regular (soluble) insulin and insulin analogues (lispro, aspart, glargine) (Correct answer)
Premixed insulin 70/30
NPH insulin
All insulin types are clear

Correct answer: Regular (soluble) insulin and insulin analogues (lispro, aspart, glargine)

Regular (soluble) insulin and most insulin analogues (lispro, aspart, glargine, detemir) are clear solutions. NPH (Neutral Protamine Hagedorn) insulin appears cloudy/turbid due to the protamine suspension. Premixed insulins (70% NPH/30% regular) are cloudy.

Question 40: What is antibiotic stewardship?

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

Correct answer: A systematic approach to optimizing antibiotic selection, dose, and duration to improve outcomes and reduce resistance

Antibiotic stewardship programs (ASPs) promote appropriate antibiotic use: right drug, right dose, right duration, and right route. Goals include improving patient outcomes, preventing C. difficile, and reducing antibiotic resistance — a global health threat. Nurses play a key role in culture collection before antibiotic administration.

Question 41: What are the signs of dehydration in an infant?

Increased wet diapers
Sunken fontanelle, dry mucous membranes, decreased tears, decreased urine output, and poor skin turgor (Correct answer)
Weight gain
Bulging fontanelle

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

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

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

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

Correct answer: Biological indicators (Geobacillus stearothermophilus spore strips)

Biological indicators using Geobacillus stearothermophilus spore strips are the gold standard for autoclave validation. These are the most heat-resistant organisms; if they are killed, sterilization was achieved. Chemical indicators (Bowie-Dick test, color-change tape) confirm exposure to steam/heat but do not confirm sterilization.

Question 44: What is the normal expected weight loss for a newborn in the first few days of life?

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

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 45: What is akathisia?

Severe muscle rigidity caused by antipsychotics
Involuntary repetitive movements of the face and tongue
Sudden loss of muscle tone
A subjective feeling of motor restlessness and inability to remain still, caused by antipsychotics (Correct answer)

Correct answer: A subjective feeling of motor restlessness and inability to remain still, caused by antipsychotics

Akathisia is an extrapyramidal side effect of antipsychotics characterized by inner restlessness and a compelling need to move. Patients pace, shift weight, and cannot sit still. It is often mistaken for anxiety and is a common cause of medication non-adherence.

Question 46: What is the correct technique when inserting a urinary catheter in a female patient?

Use sterile technique, cleanse from front to back, insert into urethral meatus (Correct answer)
Insert into the largest visible opening
Cleanse from back to front, use non-sterile gloves
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 47: What does the term 'gravida 3, para 2' mean?

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

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 48: 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?

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

Correct answer: Providing aggressive intravenous hydration and pain management.

The management of a sickle cell vaso-occlusive crisis prioritizes hydration and analgesia. Intravenous fluids help to reduce blood viscosity and sickling, while adequate pain control is essential for patient comfort and to reduce physiological stress. The Eastern and Southwestern regions of Saudi Arabia have the highest prevalence of SCD. While oxygen may be used if the patient is hypoxic, it is not the primary intervention for all crises. Antibiotics are for treating infection, and splenectomy is not an emergency treatment for a typical pain crisis.

Question 49: What is the nurse's responsibility in patient advocacy?

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

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

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

Question 50: A patient develops sudden confusion, tachycardia, and fever of 39.5°C on post-operative day 2. What should the nurse suspect?

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

Correct answer: Infection or sepsis

New onset confusion, fever >38°C, and tachycardia are components of systemic inflammatory response syndrome (SIRS), suggesting early sepsis. Post-operative infection typically manifests day 2–5. Immediate assessment and physician notification are required.

Question 51: A patient on gentamicin therapy requires monitoring of which parameters?

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

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 52: What does a hemodynamic reading of CVP 2 mmHg indicate?

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

Correct answer: Hypovolemia (low intravascular volume) requiring fluid resuscitation

Central Venous Pressure (CVP) normal range is 2-8 mmHg. CVP of 2 mmHg (at the low end/below normal) suggests hypovolemia — decreased intravascular volume. The nurse should anticipate fluid resuscitation orders and assess for signs of dehydration and poor perfusion.

Question 53: What does 'half-life' mean in pharmacology?

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

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

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

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

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

Correct answer: 12–20 breaths per minute

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

Question 56: Which level of Maslow's hierarchy must be met before safety needs can be addressed?

Esteem needs
Self-actualization
Physiological needs (food, water, shelter, air) (Correct answer)
Social needs

Correct answer: Physiological needs (food, water, shelter, air)

Maslow's hierarchy places physiological needs (oxygen, water, food, warmth, sleep) at the base. These must be met before safety, love/belonging, esteem, and self-actualization needs can be effectively addressed in nursing care planning.

Question 57: Which intervention is most effective in preventing hospital-acquired infections?

Routine antibiotic prophylaxis for all patients
Consistent hand hygiene (Correct answer)
Wearing gloves without hand hygiene
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 58: What is the recommended position for a laboring patient with umbilical cord prolapse?

Supine position
Trendelenburg or knee-chest position (Correct answer)
High Fowler's position
Left lateral position

Correct answer: Trendelenburg or knee-chest position

Cord prolapse is an obstetric emergency. The knee-chest or Trendelenburg position uses gravity to shift the presenting part away from the cord, relieving compression. The nurse manually holds the presenting part off the cord while preparing for emergency cesarean section.

Question 59: A patient is diagnosed with deep vein thrombosis (DVT). Which nursing intervention is contraindicated?

Massaging the affected leg (Correct answer)
Administering anticoagulants as prescribed
Elevating the affected extremity
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 60: 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.
Start Vitamin D supplementation only after 6 months of age.
Administer 400 IU of Vitamin D daily, starting in the first few days of life. (Correct answer)
Rely on the Vitamin D content from the mother's breast milk only.

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

Infiltration (Correct answer)
Septicemia
Phlebitis
Air embolism

Correct answer: Infiltration

Infiltration occurs when IV fluid leaks into surrounding tissue instead of the vein. Signs include local swelling, pallor, coolness, and pain. The IV should be discontinued and the site assessed for treatment.

Question 62: What is the nurse's responsibility regarding advance directives in Saudi healthcare?

Only follow advance directives if the physician agrees
Ignore advance directives as they have no legal standing
Never discuss advance directives with patients
Document the existence of advance directives, ensure they are accessible in the medical record, and communicate their content to the care team (Correct answer)

Correct answer: Document the existence of advance directives, ensure they are accessible in the medical record, and communicate their content to the care team

Advance directives (patient instructions for future healthcare decisions if they lose capacity) must be documented, filed prominently in the medical record, communicated to all team members, and honored. In Saudi Arabia, these documents guide surrogate decision-making and must align with Islamic legal principles.

Question 63: 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 64: What is the most common complication following coronary artery bypass graft (CABG) surgery?

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

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 65: A patient has a blood urea nitrogen (BUN) of 45 mg/dL and creatinine of 3.2 mg/dL. What condition does this suggest?

Normal kidney function
Renal impairment (Correct answer)
Dehydration alone
Liver failure

Correct answer: Renal impairment

Elevated BUN and creatinine indicate impaired renal filtration. BUN normal range is 7–20 mg/dL and creatinine 0.6–1.2 mg/dL. Both elevated together strongly suggest acute kidney injury or chronic kidney disease.

Question 66: What are the 'five moments for hand hygiene' according to the WHO?

Before and after every procedure only
Before meals, after toileting, before surgery, after wound care, before medication administration
Before patient contact, before aseptic tasks, after body fluid exposure, after patient contact, after contact with patient surroundings (Correct answer)
After contact with body fluids only

Correct answer: Before patient contact, before aseptic tasks, after body fluid exposure, after patient contact, after contact with patient surroundings

WHO's '5 Moments' are: 1) Before touching a patient, 2) Before clean/aseptic procedures, 3) After body fluid exposure risk, 4) After touching a patient, 5) After touching patient surroundings. This framework targets all critical transmission points in patient care.

Question 67: Which environmental health issue is a significant public health concern in Saudi Arabia?

Extreme cold exposure
Waterborne diseases from flooding
Extreme heat and air pollution from sand storms and industrial sources (Correct answer)
Radiation from nuclear plants

Correct answer: Extreme heat and air pollution from sand storms and industrial sources

Saudi Arabia's extreme heat (heat stroke risk, especially for outdoor workers and Hajj pilgrims), sandstorm-generated particulate air pollution, and petrochemical industrial emissions are significant environmental health concerns. Heat-related illness prevention is a major public health intervention.

Question 68: A mother asks when her baby's anterior fontanelle should close. What is the correct response?

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

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

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

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 70: What is the primary goal of primary prevention in community health?

Detect disease early through screening
Reduce the impact of established disease
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 71: Which anthropometric measurement is used to estimate stature in elderly or bedridden patients when standing height cannot be obtained?

Mid-upper arm circumference
Waist 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 72: Which vital sign change is an early indicator of hypovolemic shock?

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

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

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

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 74: Which assessment finding requires immediate nursing intervention?

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

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 75: 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 76: What is the nurse's role in managing a child with asthma exacerbation?

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)
Restrict fluid intake
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 77: Which assessment is most important when a patient is receiving a blood transfusion?

Blood glucose monitoring
Vital signs every 15 minutes for the first hour (Correct answer)
Urine output only
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 78: What is the appropriate first response when a child is found in respiratory arrest?

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

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

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

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

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

Question 80: At what gestational age is a pregnancy considered full term?

39–40 weeks (Correct answer)
37–38 weeks
41–42 weeks
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 81: Which immunization is specifically contraindicated in a child with severe combined immunodeficiency (SCID)?

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

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 82: Which drug is used to reverse opioid overdose?

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

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 83: 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 84: Which surface disinfectant is effective against C. difficile spores?

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

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

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

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

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

Correct answer: Life-threatening organ dysfunction caused by dysregulated host response to infection — monitor for SIRS criteria, lactate levels, and organ dysfunction

Sepsis recognition (qSOFA): altered mental status, respiratory rate ≥22, systolic BP ≤100 mmHg. Nursing priorities: early recognition, obtain blood cultures BEFORE antibiotics, administer broad-spectrum antibiotics within 1 hour, aggressive fluid resuscitation (30 mL/kg crystalloid), monitor lactate, and assess organ function.

Question 87: Which vaccine is recommended for all newborns within 24 hours of birth according to the Saudi immunization schedule?

Varicella vaccine
MMR vaccine
Hepatitis B vaccine (Correct answer)
BCG vaccine

Correct answer: Hepatitis B vaccine

The Hepatitis B vaccine is given at birth (within 24 hours) to prevent vertical transmission from infected mothers and to establish early immunity. BCG is also given at birth in Saudi Arabia for tuberculosis prevention.

Question 88: What are the requirements for blood product administration under Saudi health regulations?

Two-nurse verification, informed consent, pretransfusion compatibility testing, and monitoring during transfusion (Correct answer)
Verbal consent only is required
No formal process is required for blood products
One nurse verification is sufficient

Correct answer: Two-nurse verification, informed consent, pretransfusion compatibility testing, and monitoring during transfusion

Saudi health standards require: written informed consent for transfusion, pre-transfusion compatibility testing (cross-match), two-nurse verification of product labels against patient ID, vital sign monitoring, and documentation. These multiple steps reduce the risk of transfusion errors and reactions.

Question 89: Which finding indicates that a patient's nasogastric tube is properly placed in the stomach?

Air bubbling in water when tube end is submerged
Bubbling sounds on chest auscultation
Aspiration of gastric contents with pH 1–5 and confirmation by X-ray (Correct answer)
Clear aspirate without pH testing

Correct answer: Aspiration of gastric contents with pH 1–5 and confirmation by X-ray

X-ray remains the gold standard for initial NG tube placement verification. Aspirating gastric contents and checking pH (gastric pH typically 1–5) is used for ongoing verification. Auscultation alone is unreliable.

Question 90: Which antibiotics are absolutely contraindicated in children under 8 years?

Tetracyclines (Correct answer)
Cephalosporins
Macrolides
Penicillins

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

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

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 92: What is the correct order for donning (putting on) PPE?

Eye protection, gloves, mask, gown
Gloves, gown, mask, eye protection
Mask, gloves, gown, eye protection
Gown, mask/respirator, eye protection, gloves (Correct answer)

Correct answer: Gown, mask/respirator, eye protection, gloves

CDC recommended donning order: 1) Gown (protects clothing), 2) Mask/respirator (protects airway), 3) Eye protection (protects mucous membranes), 4) Gloves (protect hands and seal gown cuffs). This sequence minimizes self-contamination during application.

Question 93: What is the 'cold chain' in immunization?

A method of vaccine preparation
The system maintaining vaccines at required temperatures from manufacture to administration (Correct answer)
The process of administering vaccines in cold climates
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 94: What does the nurse assess using the Richmond Agitation-Sedation Scale (RASS)?

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

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 95: 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 96: A patient with iron-deficiency anemia should consume iron-rich foods alongside which substance to maximize absorption?

Vitamin C (Correct answer)
Phytates
Tannins
Calcium

Correct answer: Vitamin C

Vitamin C (ascorbic acid) enhances non-heme iron absorption by converting iron to its more absorbable ferrous form.

Question 97: Which Saudi MOH initiative aims to reduce hospital-acquired infections?

No formal national program exists
The National Infection Prevention and Control Program (NICP) with mandatory surveillance, reporting, and bundle implementation (Correct answer)
Treating all HAIs with broad-spectrum antibiotics
Reducing hospital bed numbers

Correct answer: The National Infection Prevention and Control Program (NICP) with mandatory surveillance, reporting, and bundle implementation

Saudi MOH's National Infection Prevention and Control Program mandates HAI surveillance, reporting of rates to MOH, implementation of evidence-based prevention bundles (CLABSI, CAUTI, VAP, SSI), and regular staff training. Facilities must meet benchmark rates or implement corrective action plans.

Question 98: What does the term 'herd immunity' mean?

Sufficient community vaccination coverage that protects even unvaccinated individuals by interrupting transmission (Correct answer)
Vaccination of only high-risk individuals
Immunity that lasts only in herds of animals
Natural immunity acquired through disease

Correct answer: Sufficient community vaccination coverage that protects even unvaccinated individuals by interrupting transmission

Herd immunity (community immunity) occurs when a high enough proportion of the population is immune (through vaccination or prior infection) that the pathogen cannot sustain transmission, indirectly protecting those who cannot be vaccinated (immunocompromised, infants).

Question 99: What is the correct angle for intramuscular injection in the vastus lateralis muscle?

15 degrees
90 degrees (Correct answer)
60 degrees
45 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 100: What is the Tawakkalna application's role in Saudi health?

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

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

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

Question 101: What is the correct approach to contact tracing for a newly diagnosed HIV patient?

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

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

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

Question 102: What does the Saudi Blood Transfusion Center regulate?

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

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

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

Question 103: A patient's wound culture reveals MRSA. What precautions are required?

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

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

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

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

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

Correct answer: Contractions that increase in frequency, duration, and intensity with cervical change

True labor is characterized by regular contractions that progressively increase in frequency, duration, and intensity, accompanied by cervical effacement and dilation. Braxton Hicks contractions are irregular, do not increase in intensity, and do not cause cervical change.

Question 106: What is the correct site for intramuscular injection in infants under 12 months?

Deltoid muscle
Dorsogluteal muscle
Vastus lateralis (anterolateral thigh) (Correct answer)
Ventrogluteal 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 107: Which assessment is critical before administering digoxin?

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

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

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

Correct answer: IV bisphosphonates (zoledronic acid, pamidronate)

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

Question 109: 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)
Restrain the patient to prevent injury
Administer antipsychotic medication
Leave the patient in a quiet room alone

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 110: What is the 'chain of infection' in infection control?

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

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

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

Question 111: What does 'NPO' mean in a clinical context?

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

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

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

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

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

Correct answer: Building long-term healthy behaviors and health literacy in children and adolescents

School-based health education targets children at a formative age when health behaviors and attitudes are being established. Programs addressing nutrition, physical activity, hygiene, mental health, and substance use prevention create lifelong health literacy and behavior patterns.

Question 114: 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.
Early mobilization and physiotherapy on post-operative day 1. (Correct answer)
Bed rest for the first 48 hours post-operatively.

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 115: 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 boost the immune system
To stimulate growth
To prevent jaundice

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

High Fowler's position (60–90 degrees) (Correct answer)
Trendelenburg position
Supine position
Lithotomy 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 117: What does 'MDROs' stand for and why are they significant?

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

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

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

Question 118: A patient is prescribed erythromycin. What should the nurse teach about administration?

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

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

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

Question 119: Which vaccine is mandatory for pilgrims traveling to Saudi Arabia for Hajj and Umrah?

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

Correct answer: Meningococcal vaccine (ACWY)

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

Question 120: 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 121: Which indicators are used to measure maternal health in a population?

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

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

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

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

Moderate protein restriction with emphasis on branched-chain amino acids (Correct answer)
High-fat diet to spare protein
High-protein diet to support liver regeneration
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 124: Which observation indicates a toddler is experiencing normal separation anxiety?

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

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 125: Which finding indicates a newborn has adequate hydration?

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

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

Excretion
Metabolism (biotransformation) (Correct answer)
Distribution
Absorption

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 127: A nurse observes a colleague making a medication error but not reporting it. What is the appropriate action?

Encourage the colleague to report the error and report it yourself if they do not (Correct answer)
Do nothing to avoid conflict
Report only to the unit manager in secret
Ignore it as it is not your responsibility

Correct answer: Encourage the colleague to report the error and report it yourself if they do not

Nurses have an ethical and professional obligation to ensure patient safety. Encouraging peer reporting first respects professional relationships, but the nurse must independently report if the colleague fails to do so.

Question 128: A patient with bipolar disorder is in a manic phase. Which nursing intervention is the priority?

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

Correct answer: Ensure safety, provide a low-stimulation environment, and meet physical needs

During mania, patients are at risk for injury (from impulsivity and poor judgment), dehydration (forgetting to eat/drink), and exhaustion. A low-stimulation environment reduces escalation. Safety and physical needs are the priority.

Question 129: What is the priority nursing intervention for a child in status epilepticus?

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

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 130: A patient with peripheral arterial disease reports leg pain that worsens with walking and improves with rest. This is called:

Deep vein thrombosis
Intermittent claudication (Correct answer)
Peripheral neuropathy
Restless leg syndrome

Correct answer: Intermittent claudication

Intermittent claudication is the hallmark symptom of peripheral arterial disease — cramping or aching pain in the legs during walking (exercise increases oxygen demand beyond supply) that reliably resolves with rest (decreased demand).

Question 131: What is the significance of elevated lactate levels in a critically ill patient?

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

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 132: Which macronutrient provides 4 kilocalories per gram?

Water
Carbohydrate (Correct answer)
Alcohol
Fat

Correct answer: Carbohydrate

Carbohydrates provide 4 kcal/g; fats provide 9 kcal/g and alcohol provides 7 kcal/g.

Question 133: 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
Monitor blood glucose regularly and adjust medications under physician guidance (Correct answer)
Discontinue all diabetes medications during the fasting period

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 134: 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?

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

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

20-30 breaths/minute
12-20 breaths/minute
30-60 breaths/minute (Correct answer)
60-80 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 136: Which infectious disease is required to be reported to Saudi public health authorities?

Only COVID-19
All notifiable diseases including tuberculosis, hepatitis, meningitis, and foodborne outbreaks (Correct answer)
Only sexually transmitted infections
Any disease the nurse thinks is unusual

Correct answer: All notifiable diseases including tuberculosis, hepatitis, meningitis, and foodborne outbreaks

Saudi Arabia's Ministry of Health maintains a list of notifiable diseases including TB, hepatitis A/B/C, meningococcal disease, typhoid, foodborne outbreaks, sexually transmitted infections, and others. Mandatory reporting enables outbreak detection, contact tracing, and public health response.

Question 137: A healthcare worker sustains a needlestick injury from an HIV-positive patient. What is the immediate action?

Wash the wound with soap and water, report to occupational health, assess HIV exposure and start PEP within 72 hours (Correct answer)
Apply antibiotic ointment and cover with a bandage
Squeeze the wound to remove blood, apply iodine, return to work
No action needed as the risk is very low

Correct answer: Wash the wound with soap and water, report to occupational health, assess HIV exposure and start PEP within 72 hours

Needlestick response: immediately wash with soap and water (do not squeeze), report to occupational health or emergency department, assess source patient HIV status, and start HIV post-exposure prophylaxis (PEP) within 72 hours (ideally <2 hours) — a 28-day antiretroviral course.

Question 138: What is the correct procedure when a nurse receives a verbal medication order?

Refuse all verbal orders
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
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 139: What type of therapy is most evidence-based for PTSD?

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

Correct answer: Trauma-focused cognitive behavioral therapy (TF-CBT) and EMDR

Trauma-focused CBT and Eye Movement Desensitization and Reprocessing (EMDR) have the strongest evidence base for PTSD treatment. They help patients process traumatic memories, modify negative thought patterns, and reduce hyperarousal and avoidance behaviors.

Question 140: What personal protective equipment is required when preparing cytotoxic chemotherapy drugs?

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

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

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

Question 141: Which sign/symptom indicates a fluid volume deficit (dehydration)?

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

Correct answer: Decreased skin turgor and dry mucous membranes

Decreased skin turgor and dry mucous membranes are classic signs of dehydration due to reduced extracellular fluid. Bounding pulse, hypertension, periorbital edema, and distended neck veins indicate fluid excess.

Question 142: A nurse in a medical ward is reviewing the lab results of an adult Saudi male patient. The complete blood count (CBC) shows a haemoglobin (Hb) level of 110 g/L. How should the nurse interpret this finding based on reference intervals for the adult Saudi population?

Within the normal reference range.
Below the normal reference range, indicating mild anaemia. (Correct answer)
Indicative of severe anaemia.
Above the normal reference range, indicating polycythaemia.

Correct answer: Below the normal reference range, indicating mild anaemia.

Based on studies establishing haematological reference intervals for the Saudi population, the normal haemoglobin range for adult males is typically 130-170 g/L or higher, with a mean often around 149 g/L. A value of 110 g/L is below this lower limit. According to general clinical guidelines used in the Kingdom, anaemia is often defined as Hb < 120 g/L in females and < 130 g/L in males. Therefore, 110 g/L indicates mild anaemia.

Question 143: What is the primary goal of nasogastric tube decompression after abdominal surgery?

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

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

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

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

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

Question 145: What is the nurse's priority action when a patient's ventilator alarm sounds 'High Pressure'?

Remove the patient from the ventilator
Increase the tidal volume
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 146: A patient is prescribed morphine for pain. Which side effect requires the most immediate intervention?

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

Correct answer: Respiratory depression with rate <10 breaths/min

Respiratory depression is the most life-threatening opioid side effect. A respiratory rate below 10 breaths/min requires immediate intervention with naloxone (opioid antagonist) and supportive airway measures. Other side effects, while uncomfortable, are not immediately life-threatening.

Question 147: What is the role of the Saudi Bioethics Committee in healthcare?

To manage hospital finances
To hire medical staff
To provide guidance on complex ethical issues in patient care, research, and clinical practice (Correct answer)
To manage pharmaceutical contracts

Correct answer: To provide guidance on complex ethical issues in patient care, research, and clinical practice

Bioethics committees review ethically complex cases (end-of-life decisions, informed consent disputes, resource allocation), provide clinical ethics consultations, develop institutional policies on ethical issues, and oversee ethical conduct of clinical research in Saudi healthcare institutions.

Question 148: What is the recommended frequency for repositioning bedridden patients to prevent pressure ulcers?

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

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

Recommend vitamin C supplementation only
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

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

Secondary intention
Delayed primary closure
Primary intention (Correct answer)
Tertiary intention

Correct answer: Primary intention

Healing by primary intention occurs when wound edges are approximated (sutured, stapled, or taped closed), allowing healing with minimal scarring. This is the most efficient healing method with lowest infection risk.

Question 151: 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)
Increase simple carbohydrates in the diet
Drink large amounts of fluid with meals

Correct answer: Eat small, frequent meals; avoid fluids with meals; lie down after eating

Dumping syndrome occurs when food moves too quickly into the small intestine. Small, frequent, low-carbohydrate meals, avoiding fluids during meals, and lying down after eating slow gastric emptying and reduce symptoms.

Question 152: What does 'incidence rate' measure in epidemiology?

Number of hospitalizations per year
New cases of a disease in a population at risk over a specified time period (Correct answer)
Death rates from a specific disease
Total cases of a disease at a point in time

Correct answer: New cases of a disease in a population at risk over a specified time period

Incidence rate measures new cases occurring in a disease-free (at-risk) population during a defined period. It reflects the risk of developing a disease. Prevalence measures all existing cases (both new and old) at a specific time.

Question 153: What is the nurse's role in end-of-life care in the Saudi ICU?

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
Only provide technical care
Withdraw all medications

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 154: How many continuing education hours are required for SCFHS license renewal?

50 hours per month
Only a written exam for renewal
A specified number of Continuing Medical Education (CME) hours determined by SCFHS category requirements (Correct answer)
No continuing education is required

Correct answer: A specified number of Continuing Medical Education (CME) hours determined by SCFHS category requirements

SCFHS requires healthcare professionals including nurses to complete mandatory CME/CPD (Continuing Professional Development) hours for license renewal. The specific number depends on the professional category and classification level. The aim is to maintain and update competency throughout a career.

Question 155: Which assessment finding is most characteristic of left-sided heart failure?

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

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

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

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 157: 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 158: What is the correct compression-to-ventilation ratio for single-rescuer infant CPR?

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

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

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

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

Sublingual
Intravenous (IV) (Correct answer)
Intramuscular
Oral

Correct answer: Intravenous (IV)

IV administration delivers drugs directly into the bloodstream, providing immediate bioavailability (100%) and the fastest onset of action. This is why emergency drugs (epinephrine, adenosine, naloxone in arrest) are given IV. Sublingual is next fastest as it bypasses first-pass metabolism.

Question 161: What is the nurse's role in quality improvement initiatives in Saudi healthcare?

Only report errors
Only follow existing policies
Participate in data collection, identify areas for improvement, implement evidence-based changes, and monitor outcomes using PDSA cycles (Correct answer)
Quality improvement is only administration's responsibility

Correct answer: Participate in data collection, identify areas for improvement, implement evidence-based changes, and monitor outcomes using PDSA cycles

Nurses contribute to quality improvement by: collecting quality indicator data, participating in root cause analysis, implementing Plan-Do-Study-Act (PDSA) improvement cycles, monitoring patient outcomes, participating in accreditation preparation (CBAHI/JCI), and championing best practices.

Question 162: What is the mechanism of action of proton pump inhibitors (PPIs)?

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

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 163: Under Saudi regulations, what are the requirements for nursing overtime and duty hours?

Nurses must work unlimited hours as required
Overtime is mandatory without additional compensation
Duty hours and overtime are regulated by the Ministry of Human Resources; excessive hours that impair patient safety must be reported (Correct answer)
No regulations exist for nursing duty hours in Saudi Arabia

Correct answer: Duty hours and overtime are regulated by the Ministry of Human Resources; excessive hours that impair patient safety must be reported

Saudi labor regulations (Ministry of Human Resources and Social Development) govern maximum working hours. Healthcare employers must comply with duty hour regulations. Nurses are professionally obligated to report excessive fatigue that could impair safe patient care, consistent with patient safety principles.

Question 164: What is the most important risk factor for non-communicable disease prevention that community nurses should address?

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

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

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

Question 165: A patient taking corticosteroids long-term should be monitored for which complication?

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

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

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

Question 166: What is the correct technique for removing soiled gloves to prevent self-contamination?

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
Pull both gloves off at the fingertips together
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 167: What nursing assessments are important for a child with suspected meningitis?

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

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 168: A patient with a hip fracture is being assessed for fat embolism syndrome. Which triad of findings is classic?

Bradycardia, hypertension, and confusion
Fever, cough, and chest pain
Tachycardia, hypotension, and cyanosis
Hypoxia, neurological changes, and petechial rash (Correct answer)

Correct answer: Hypoxia, neurological changes, and petechial rash

Fat embolism syndrome classically presents with the triad of hypoxemia (from lung fat emboli), neurological deterioration (confusion, decreased consciousness), and petechial rash (from fat emboli in dermal capillaries), typically 24–72 hours after long-bone fracture.

Question 169: 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 sun protection
Safety guidance isn't needed until the child walks
Only car seat usage

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

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

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 171: A child weighing 20 kg has a fever. Using weight-based dosing, the correct dose of acetaminophen (15 mg/kg) is:

400 mg
300 mg (Correct answer)
200 mg
150 mg

Correct answer: 300 mg

Dose = 15 mg/kg × 20 kg = 300 mg. Accurate weight-based dosing in pediatrics is critical to avoid under-dosing (ineffective) or overdosing (hepatotoxic with acetaminophen).

Question 172: When administering oxygen via a simple face mask, what is the minimum flow rate to prevent CO₂ rebreathing?

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

Correct answer: 5 L/min

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

Question 173: 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?

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

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

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

Correct answer: Examining the throat with a tongue depressor

Examining the throat with a tongue depressor in suspected epiglottitis can precipitate complete airway obstruction from laryngospasm. The child should never be forced into a supine position. Emergency airway equipment must be at the bedside.

Question 175: What is the antidote for acetaminophen (paracetamol) overdose?

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

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

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

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

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

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

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

Question 178: What differentiates delirium from dementia?

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

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

Hypercalcemia
Hypernatremia
Hyperkalemia
Hypophosphatemia (Correct answer)

Correct answer: Hypophosphatemia

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

Question 180: Which drug class can cause hyperkalemia?

Loop diuretics
Thiazide 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 181: Which finding in a postpartum patient requires immediate nursing attention?

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

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 182: 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 3-year-old with temperature of 38.5°C and runny nose
A 5-year-old with temperature of 39°C after vaccination

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 183: Which nutritional deficiency disease is caused by inadequate intake of thiamine (Vitamin B1)?

Scurvy
Beriberi (Correct answer)
Rickets
Pellagra

Correct answer: Beriberi

Beriberi results from thiamine deficiency; pellagra is caused by niacin deficiency, scurvy by Vitamin C deficiency, and rickets by Vitamin D deficiency.

Question 184: Which nursing intervention is the highest priority when a patient develops sudden severe chest pain?

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

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

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

Correct answer: Ideas of reference

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

Question 186: What is the correct nursing response when a patient experiencing command hallucinations says the voices are telling them to hurt someone?

Document it for the next shift only
Tell the patient to ignore the voices
Ensure immediate safety, remove potential weapons, notify the treatment team immediately (Correct answer)
Continue the current care plan without changes

Correct answer: Ensure immediate safety, remove potential weapons, notify the treatment team immediately

Command hallucinations with violent content represent an imminent safety risk to the patient and others. Immediate safety measures (environmental safety, 1:1 observation), notification of the treatment team, and potentially initiating involuntary hold procedures are required.

Question 187: Which action correctly identifies a patient before medication administration?

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

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

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)
Only check the machine once per shift

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 189: Which screening test is recommended for cervical cancer in Saudi Arabia?

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

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

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

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 191: 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
Advise the patient to increase activity
Schedule a routine follow-up appointment

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

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

Question 192: Which Saudi regulation addresses the rights of patients with mental illness?

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

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

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

Correct answer: BMI 30 and above

A BMI of 30 or above is classified as obesity by the World Health Organization; BMI 25–29.9 is overweight.

Question 194: What is the nursing management for a patient with acute respiratory distress syndrome (ARDS)?

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

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 195: What continuing education requirements must Saudi nurses fulfill to maintain licensure?

Only attend one conference per year
Continuing education is optional
Accumulate required Continuing Medical Education (CME) hours during the license period as specified by SCFHS (Correct answer)
No continuing education required

Correct answer: Accumulate required Continuing Medical Education (CME) hours during the license period as specified by SCFHS

SCFHS requires nurses to accumulate a specified number of CME credit hours during each license renewal period. Activities include: accredited conferences, workshops, online courses, research participation, and publications. This ensures nurses maintain and update their professional competency.

Question 196: A patient is prescribed warfarin. Which food significantly increases bleeding risk?

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

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 197: Which assessment tool is used to screen for alcohol use disorder?

MMSE
PHQ-9
CAGE questionnaire (Correct answer)
GAD-7

Correct answer: CAGE questionnaire

The CAGE questionnaire (Cut down, Annoyed, Guilty, Eye-opener) is a validated 4-question screening tool for alcohol use disorder. A score of 2 or more positive responses suggests a problematic drinking pattern requiring further assessment.

Question 198: What is the priority nursing assessment for a patient admitted with suicidal ideation?

Administer medication first
Assess the lethality of the plan, means, intent, and timeline (Correct answer)
Leave the patient alone to calm down
Check vital signs only

Correct answer: Assess the lethality of the plan, means, intent, and timeline

Suicide risk assessment must include plan (is there a specific method?), means (access to the method), intent (determination to carry it out), and timeline (when). Higher lethality, accessible means, and clear intent indicate imminent risk requiring immediate intervention.

Question 199: What is the correct action if a nurse makes a medication error?

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

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

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

Question 200: What is the correct order of the nursing process?

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

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.

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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