Worth 40% of the Saudi Nursing Licensure Examination — around 80 of the 200 items you sit. 124 original questions here, each with an explanation for all four options — 10 to answer now, and the full set to read below.
The largest section, spanning medical and surgical wards, critical care, community practice and mental health — adult patients across every setting a nurse is likely to be placed in.
How to work it
Most items give you a patient whose numbers are already abnormal and ask what to do first. Work from what threatens airway, breathing and circulation soonest, then from what a nurse can act on without waiting for an order.
Where marks go
Choosing the intervention that treats the diagnosis over the one that addresses the immediate risk. A correct treatment given in the wrong order is still the wrong answer.
A 62-year-old patient with type 2 diabetes presents with a serum glucose of 640 mg/dL, serum osmolality of 330 mOsm/kg, pH 7.36, and negative serum ketones. Which nursing intervention should the nurse anticipate as the initial priority?
10 sample adult nursing questions
Every question below, with the reasoning for all four options. Try to answer before you open one.
Medical nursing · medium
A 62-year-old patient with type 2 diabetes presents with a serum glucose of 640 mg/dL, serum osmolality of 330 mOsm/kg, pH 7.36, and negative serum ketones. Which nursing intervention should the nurse anticipate as the initial priority?
ABegin isotonic intravenous fluid resuscitation
BAdminister a subcutaneous rapid-acting insulin sliding scale dose
CAdminister intravenous sodium bicarbonate
DRestrict oral fluids and monitor hourly blood glucose only
Show the answer and why the others fail
Answer: A. Begin isotonic intravenous fluid resuscitation
A — correct
Hyperosmolar hyperglycemic state produces profound osmotic diuresis and severe volume depletion. Aggressive isotonic fluid replacement is the first-line treatment and by itself lowers glucose substantially before insulin infusion is titrated.
B
Subcutaneous absorption is unreliable in a dehydrated, poorly perfused patient; a controlled intravenous insulin infusion is used, and only after fluid resuscitation is underway.
C
There is no significant acidosis (pH 7.36) and bicarbonate is not indicated; this picture is hyperosmolar hyperglycemic state, not ketoacidosis.
D
Fluid restriction worsens the underlying hypovolemia and hyperosmolality; monitoring alone does not treat the emergency.
TakeawayIn hyperosmolar hyperglycemic state, fluid resuscitation comes before insulin — the patient's core problem is profound dehydration.
Medical nursing · medium
A patient is admitted with an acute exacerbation of chronic obstructive pulmonary disease. Arterial blood gas on room air shows pH 7.31, PaCO2 62 mmHg, HCO3 30 mEq/L, PaO2 52 mmHg. Which oxygen therapy approach is most appropriate?
AApply a non-rebreather mask at 15 L/min
BTarget an oxygen saturation of 98 to 100 percent with a simple face mask
CTitrate controlled oxygen to a target saturation of 88 to 92 percent
DWithhold oxygen to avoid suppressing the hypoxic respiratory drive
Show the answer and why the others fail
Answer: C. Titrate controlled oxygen to a target saturation of 88 to 92 percent
A
High-flow uncontrolled oxygen in a chronically hypercapnic patient can worsen CO2 retention through ventilation-perfusion mismatch and the Haldane effect.
B
Overshooting saturation in COPD increases the risk of worsening hypercapnia and acidosis, and confers no benefit.
C — correct
Patients at risk of hypercapnic respiratory failure are managed with a target SpO2 of 88 to 92 percent, which corrects dangerous hypoxemia while minimizing CO2 retention. This is the current standard for COPD exacerbation.
D
Withholding oxygen from a hypoxemic patient is dangerous. Hypoxia kills faster than hypercapnia; oxygen is given, but titrated.
TakeawayIn COPD with hypercapnic respiratory failure risk, give oxygen but titrate it to SpO2 88 to 92 percent — never withhold it entirely.
Surgical nursing · hard
Two days after a total thyroidectomy, a patient reports tingling around the mouth and in the fingertips. On assessment, carpal spasm occurs when the blood pressure cuff is inflated. Which action should the nurse take first?
AReassure the patient that paresthesia is an expected postoperative finding
BEncourage deep breathing into a paper bag to correct respiratory alkalosis
CNotify the physician and prepare to administer intravenous calcium gluconate
DAdminister the scheduled levothyroxine dose several hours early
Show the answer and why the others fail
Answer: C. Notify the physician and prepare to administer intravenous calcium gluconate
A
These are not benign findings; dismissing them delays treatment of a potentially life-threatening electrolyte emergency.
B
This addresses hyperventilation-induced symptoms, which is not the mechanism here; the post-thyroidectomy context points strongly to true hypocalcemia.
C — correct
Perioral and digital paresthesia with a positive Trousseau sign indicates acute hypocalcemia from inadvertent parathyroid injury or removal. This can progress to laryngospasm and tetany, so urgent calcium replacement is required.
D
Levothyroxine replaces thyroid hormone and has no effect on serum calcium; it does not treat this emergency.
TakeawayPerioral tingling plus Trousseau or Chvostek sign after thyroidectomy signals hypocalcemia from parathyroid injury — anticipate IV calcium and watch for laryngospasm.
Mental/psychiatric nursing · medium
A patient tells the nurse, "I have been thinking that everyone would be better off without me. I have my father's pistol at home." What is the nurse's most appropriate response?
A"Let's talk about something more positive to take your mind off this."
B"I will keep this between us so you feel safe talking to me."
C"You have so much to live for — think about how your family would feel."
D"Are you thinking about killing yourself, and do you have a plan?"
Show the answer and why the others fail
Answer: D. "Are you thinking about killing yourself, and do you have a plan?"
A
Changing the subject is avoidance; it invalidates the patient and forfeits critical assessment information.
B
Confidentiality cannot be promised when there is risk of serious harm; the nurse has a duty to involve the treatment team.
C
Reassurance and guilt-inducing appeals shut down disclosure and do not address immediate lethality.
D — correct
Direct, explicit questioning about suicidal intent and plan is the evidence-based approach. It does not increase risk, and it is required to assess lethality — access to a firearm makes this a high-risk situation demanding immediate safety measures.
TakeawayAsk about suicide directly and specifically — asking does not plant the idea, and plan plus means access defines the level of risk.
Mental/psychiatric nursing · easy
A patient experiencing a panic attack is hyperventilating, trembling, and says "I am going to die." Which nursing intervention is most appropriate?
ALeave the patient alone in a quiet room until the symptoms subside
BStay with the patient and use short, simple directions in a calm voice
CEncourage the patient to explore childhood causes of the anxiety now
DExplain in detail the physiology of the fight-or-flight response
Show the answer and why the others fail
Answer: B. Stay with the patient and use short, simple directions in a calm voice
A
Abandonment during panic intensifies terror; the patient needs a calm presence.
B — correct
During panic, attention and information processing are severely narrowed. A calm presence with brief, concrete directions provides external structure and helps the patient regain control.
C
Insight-oriented exploration during acute panic increases distress; it belongs in later therapeutic work.
D
Complex teaching cannot be processed during panic-level anxiety; education is done after the episode resolves.
TakeawayIn panic-level anxiety, stay with the patient and give short simple directions — teaching and insight work come only after the acute episode.
Critical care nursing · medium
A nurse finds an unresponsive adult in a hospital corridor with no normal breathing and no pulse after a 10-second check. A colleague has activated the emergency response and is bringing the defibrillator. What should the nurse do next?
ABegin chest compressions at 100 to 120 per minute with full recoil
BOpen the airway and give two rescue breaths before compressions
CWait for the defibrillator to arrive before starting compressions
DInsert an oropharyngeal airway and ventilate before compressions
Show the answer and why the others fail
Answer: A. Begin chest compressions at 100 to 120 per minute with full recoil
A — correct
High-quality chest compressions are started immediately once pulselessness is confirmed. Rate 100 to 120/min, depth 5 to 6 cm in adults, full chest recoil, and minimal interruptions are the parameters most strongly linked to survival.
B
Current resuscitation guidance begins with compressions rather than breaths, to minimize any delay in generating circulation.
C
Any pause without compressions reduces coronary and cerebral perfusion; compressions continue until the pads are placed and the rhythm analyzed.
D
Advanced airway placement must not delay compressions; airway management is layered in without interrupting chest compressions.
TakeawayConfirmed cardiac arrest means immediate high-quality compressions — rate 100 to 120/min, depth 5 to 6 cm, full recoil, minimal interruptions.
Critical care nursing · hard
A mechanically ventilated patient suddenly becomes agitated with SpO2 falling to 82%, absent breath sounds on the right, tracheal deviation to the left, distended neck veins, and blood pressure 78/40 mmHg. What should the nurse anticipate?
AObtaining a portable chest radiograph before any intervention
BImmediate needle decompression of the right chest followed by chest tube insertion
CAdministering a fluid bolus and a sedative for ventilator dyssynchrony
DIncreasing the positive end-expiratory pressure to improve oxygenation
Show the answer and why the others fail
Answer: B. Immediate needle decompression of the right chest followed by chest tube insertion
A
Waiting for imaging in tension pneumothorax risks cardiac arrest; decompression must not be delayed.
B — correct
Absent unilateral breath sounds with contralateral tracheal deviation, distended neck veins, and hypotension is tension pneumothorax — an obstructive shock state. It is a clinical diagnosis requiring immediate decompression, before imaging.
C
Sedation masks a life-threatening mechanical problem, and fluids cannot overcome obstruction of venous return.
D
Raising PEEP forces more air into the pleural space and worsens the tension physiology.
TakeawayTension pneumothorax is a clinical diagnosis — decompress immediately rather than waiting for a chest radiograph.
Community nursing · medium
A community health nurse organizes a program that screens adults over 40 for hypertension and elevated blood glucose at a local mosque. This activity is best classified as which level of prevention?
AQuaternary prevention
BTertiary prevention
CPrimary prevention
DSecondary prevention
Show the answer and why the others fail
Answer: D. Secondary prevention
A
Quaternary prevention aims to protect patients from over-medicalization and unnecessary intervention; it does not describe screening for undetected disease.
B
Tertiary prevention limits disability and rehabilitates people with established disease, such as a cardiac rehabilitation program.
C
Primary prevention acts before disease occurs — for example health education, immunization, or dietary counselling to prevent onset.
D — correct
Secondary prevention detects existing but asymptomatic disease early so treatment can begin before complications develop. Population screening for hypertension and diabetes is the classic example.
TakeawayScreening asymptomatic populations for early disease is secondary prevention — primary prevents onset, tertiary limits disability.
Community nursing · hard
During an outbreak investigation of foodborne illness at a community event, the nurse calculates that 45 of 150 people who ate the rice dish became ill, while 5 of 100 who did not eat it became ill. Which epidemiological conclusion is best supported?
AThe exposed attack rate of 30 percent far exceeds the unexposed rate of 5 percent
BThe data prove that the rice dish caused the illness in this outbreak
CThe attack rate among those who ate the rice dish is 45 percent
DBecause some unexposed people became ill, the rice can be excluded as a source
Show the answer and why the others fail
Answer: A. The exposed attack rate of 30 percent far exceeds the unexposed rate of 5 percent
A — correct
Attack rate equals ill divided by total at risk in that group: 45/150 equals 30 percent exposed versus 5/100 equals 5 percent unexposed. A markedly higher attack rate in the exposed group identifies a probable vehicle warranting further investigation.
B
An epidemiological association identifies a likely vehicle but does not by itself establish causation; laboratory confirmation and other criteria are needed.
C
This confuses the number of cases with a rate; 45 is the case count, and the denominator of 150 must be applied.
D
Background cases and secondary transmission are expected in the unexposed group and do not rule out a vehicle with a much higher attack rate.
TakeawayAttack rate equals cases divided by the population at risk in that group; comparing exposed and unexposed attack rates points to the likely vehicle.
Community nursing · easy
A community nurse is conducting a home visit for an older adult living alone who has had two recent falls. Which intervention should the nurse prioritize?
ARemove loose rugs and clutter, improve lighting, and install grab bars in the bathroom
BRecommend the patient limit walking within the home to reduce fall opportunities
CProvide a written fall-prevention leaflet and plan to review it at the next visit in three months
DAdvise the patient to wear loose slippers indoors for comfort
Show the answer and why the others fail
Answer: A. Remove loose rugs and clutter, improve lighting, and install grab bars in the bathroom
A — correct
Home hazard modification is a proven component of multifactorial fall prevention. Loose rugs, poor lighting, and unsupported bathroom transfers are among the most common modifiable causes of falls in older adults.
B
Restricting mobility causes deconditioning and muscle weakness, which increases rather than decreases future fall risk.
C
Written education alone has little effect on fall rates and leaves every hazard in the home untouched for another three months. Education is a useful adjunct, but for someone who has already fallen twice it cannot substitute for acting on the hazards during this visit.
D
Loose, backless footwear is associated with increased fall risk; well-fitting non-slip shoes are recommended.
TakeawayFall prevention in older adults combines home hazard removal, strength and balance exercise, and review of fall-risk medications — never mobility restriction.
The full set is split by topic above — each sub-section page carries all of its questions with rationales.