Worth 30% of the Saudi Nursing Licensure Examination — around 60 of the 200 items you sit. 61 original questions here, each with an explanation for all four options — 10 to answer now, and the full set to read below.
Pregnancy, labour and the postpartum period, gynaecology, newborn care, and paediatric medical and surgical nursing — two populations whose normal values differ from the adult ones.
How to work it
Age and gestation change what counts as normal. Fix the expected range for the patient in front of you before deciding whether a finding is reassuring, then read the question again.
Where marks go
Applying adult vital-sign ranges to a neonate or a child. A respiratory rate that would alarm you in an adult can be unremarkable in an infant, and the reverse.
Thirty minutes after a vaginal delivery, a nurse finds that a woman has saturated one perineal pad within the past 15 minutes. The fundus is boggy and palpable above the umbilicus, deviated to the right. What is the nurse's first action?
10 sample maternal-child nursing questions
Every question below, with the reasoning for all four options. Try to answer before you open one.
Maternity nursing · medium
Thirty minutes after a vaginal delivery, a nurse finds that a woman has saturated one perineal pad within the past 15 minutes. The fundus is boggy and palpable above the umbilicus, deviated to the right. What is the nurse's first action?
AApply firm continuous pressure to the perineum with a sterile pad
BMassage the fundus until it becomes firm
CAssist the woman to empty her bladder before doing anything else
DPlace the woman in Trendelenburg position
Show the answer and why the others fail
Answer: B. Massage the fundus until it becomes firm
A
Perineal pressure addresses bleeding from a superficial laceration; it cannot control hemorrhage arising from the placental site inside an atonic uterus.
B — correct
A boggy fundus with excessive bleeding calls for immediate fundal massage, which mechanically stimulates the myometrium to contract and compress the open placental site. It is instantaneous, requires no equipment, and slows blood loss while the nurse arranges the next steps — emptying the bladder and notifying the provider.
C
The high, laterally deviated fundus does indicate bladder distension, which displaces the uterus upward and sideways and prevents it from contracting down effectively. Emptying the bladder is necessary, but it takes several minutes, so it follows the massage that stops bleeding now.
D
Head-down positioning does nothing to restore uterine tone and is not a priority intervention for postpartum hemorrhage; it can also hinder assessment and ventilation.
TakeawayFor a boggy fundus with heavy bleeding, massage the uterus first — it is the fastest way to restore tone. Then empty the distended bladder, which displaces the uterus and keeps it from contracting effectively.
Pediatric medical · medium
A nurse is teaching parents of a healthy 2-month-old infant about safe sleep. Which statement by a parent indicates that teaching has been effective?
AI will use a soft quilt and a wedge to keep my baby comfortable and in position
BI will let my baby sleep in our bed so I can feed him more easily at night
CI will put my baby to sleep on his side so he does not choke if he spits up
DI will place my baby on his back on a firm flat surface with no pillows or bumpers
Show the answer and why the others fail
Answer: D. I will place my baby on his back on a firm flat surface with no pillows or bumpers
A
Soft bedding and positioning devices are associated with suffocation and are specifically advised against.
B
Bed-sharing increases risk of suffocation and sudden infant death. Room-sharing on a separate sleep surface is the recommended alternative.
C
Side sleeping is unstable and increases the risk of rolling prone. Healthy infants have intact airway protective reflexes when supine and do not have increased aspiration risk.
D — correct
Supine positioning on a firm, flat, separate sleep surface free of soft bedding is the evidence-based recommendation to reduce sudden infant death syndrome risk.
TakeawaySafe infant sleep: supine, firm flat separate surface, nothing soft in the sleep space, room-share but do not bed-share.
Pediatric medical · hard
A 4-year-old is admitted with epiglottitis. The child is sitting upright, leaning forward, drooling, and has inspiratory stridor. Which action must the nurse avoid?
AAdministering humidified oxygen without upsetting the child
BInspecting the throat with a tongue depressor to visualize the epiglottis
CEnsuring emergency airway equipment is immediately available at the bedside
DKeeping the child in the position of comfort on the parent's lap
Show the answer and why the others fail
Answer: B. Inspecting the throat with a tongue depressor to visualize the epiglottis
A
This is appropriate supportive care, provided it does not agitate the child.
B — correct
Examining the pharynx in suspected epiglottitis can trigger laryngospasm and complete airway obstruction. Direct visualization is performed only by skilled personnel in a setting prepared for immediate intubation.
C
This is essential preparation, since these children can obstruct abruptly.
D
This is correct care — the upright tripod position maximizes airway patency, and keeping the child calm with a parent prevents agitation-induced obstruction.
TakeawayNever inspect the throat or place anything in the mouth of a child with suspected epiglottitis — keep them calm, upright, and near airway equipment.
Maternity nursing · medium
A 28-year-old primigravida delivered a 3.8 kg infant vaginally 30 minutes ago. The nurse notes heavy vaginal bleeding with large clots and a boggy uterus on palpation. Which of the following medications should the nurse anticipate administering first?
ACarboprost tromethamine 250 mcg intramuscularly
BOxytocin 10 units intravenously
CMethylergonovine 0.2 mg intramuscularly
DMisoprostol 800 mcg sublingually
Show the answer and why the others fail
Answer: B. Oxytocin 10 units intravenously
A
Carboprost is a second-line prostaglandin F2α analog, reserved for refractory atony and contraindicated in patients with asthma; it is not given first.
B — correct
Oxytocin is the first-line pharmacological agent for postpartum hemorrhage due to uterine atony; intravenous administration provides rapid onset of action to control active bleeding.
C
Methylergonovine is a second-line uterotonic and is contraindicated in patients with hypertension; it is not the first choice for initial management of uterine atony.
D
Misoprostol is a prostaglandin E1 analog used when oxytocin is ineffective or unavailable; it is not the initial drug of choice for uterine atony.
TakeawayOxytocin is the first-line uterotonic for postpartum hemorrhage due to uterine atony, and intravenous administration is recommended for active hemorrhage to achieve rapid uterine contraction.
Neonatal nursing · medium
A community health nurse is conducting a home visit for a 2-day-old infant and the mother. The infant was born at 38 weeks gestation via uncomplicated vaginal delivery and was discharged home 24 hours after birth. The mother is breastfeeding. Which assessment finding requires immediate intervention?
AInfant's axillary temperature is 36.0°C (96.8°F).
BInfant has a small, flat, bluish discoloration on the lower back.
CInfant has lost 5% of birth weight since delivery.
DInfant has had 4 wet diapers in the past 24 hours.
Show the answer and why the others fail
Answer: A. Infant's axillary temperature is 36.0°C (96.8°F).
A — correct
An axillary temperature of 36.0°C (96.8°F) is below the normal newborn range and indicates cold stress, which can lead to hypoglycemia and metabolic acidosis; immediate intervention is required.
B
A small, flat, bluish discoloration on the lower back is a typical Mongolian spot, a benign congenital finding that does not require intervention.
C
A weight loss of up to 7% from birth weight is expected in the first few days for breastfed infants; 5% is within normal limits and does not require immediate intervention.
D
By day 2 of life, an infant should have at least 2–3 wet diapers per day; 4 wet diapers indicates adequate hydration and is a normal finding.
TakeawayAn axillary temperature of 36.0°C (96.8°F) in a newborn indicates cold stress, which can lead to hypoglycemia and metabolic acidosis; immediate warming and further evaluation are necessary.
Gynecology · medium
A 32-year-old woman presents with severe dysmenorrhea, deep dyspareunia, and chronic pelvic pain. She has been trying to conceive for 18 months without success. Pelvic examination reveals a fixed, retroverted uterus and tender nodules in the posterior cul-de-sac. Which of the following is the most appropriate next step to confirm the suspected diagnosis?
AAbdominal CT scan
BDiagnostic laparoscopy with biopsy
CPelvic MRI
DTransvaginal ultrasound
Show the answer and why the others fail
Answer: B. Diagnostic laparoscopy with biopsy
A
CT imaging has poor sensitivity for detecting endometrial implants and is not recommended for the diagnosis of endometriosis; it is more useful for evaluating other pelvic pathology.
B — correct
Laparoscopy with direct visualization and histological confirmation is the gold standard for diagnosing endometriosis, especially in the presence of infertility and classic examination findings.
C
MRI can identify deep infiltrating endometriosis and endometriomas, but it is not the first-line confirmatory test; laparoscopy remains the definitive diagnostic procedure.
D
Transvaginal ultrasound can detect endometriomas (chocolate cysts) but has limited sensitivity for peritoneal implants and adhesions, making it insufficient to definitively confirm endometriosis.
TakeawayLaparoscopy with biopsy is the gold standard for diagnosing endometriosis, particularly in patients with infertility and classic physical examination findings.
Gynecology · medium
A 35-year-old woman presents with a 6-month history of heavy menstrual bleeding and pelvic pressure. She reports soaking through a pad every hour for 2 days each cycle, but denies intermenstrual bleeding. Vital signs are stable. Urine pregnancy test is negative and hemoglobin is 12.5 g/dL. Bimanual examination reveals an enlarged, mobile, non-tender uterus. Which of the following is the most appropriate initial diagnostic test?
AEndometrial biopsy
BTransvaginal ultrasound
CMagnetic resonance imaging (MRI)
DAbdominal ultrasound
Show the answer and why the others fail
Answer: B. Transvaginal ultrasound
A
Endometrial biopsy is indicated for women ≥45 years with abnormal uterine bleeding to evaluate for hyperplasia or cancer; in a 35-year-old without risk factors, it is not indicated as an initial test.
B — correct
Transvaginal ultrasound is the first-line imaging study for evaluating abnormal uterine bleeding and suspected uterine fibroids, providing detailed visualization of the endometrium and myometrium.
C
MRI is reserved for cases where ultrasound findings are inconclusive or when detailed mapping is needed before surgical intervention; it is not the initial diagnostic test.
D
Abdominal ultrasound is less sensitive than transvaginal ultrasound for uterine pathology and is not the preferred initial imaging modality when transvaginal ultrasound is available and not contraindicated.
TakeawayAfter ruling out pregnancy and significant anemia, transvaginal ultrasound is the first-line imaging modality for evaluating abnormal uterine bleeding and suspected structural abnormalities such as uterine fibroids.
Neonatal nursing · medium
A nurse is assessing a 2-hour-old newborn who was born at 39 weeks' gestation weighing 4,200 g to a mother with gestational diabetes. The newborn is jittery and has a weak cry. Which action should the nurse take first?
APlace the newborn under a radiant warmer for thermoregulation.
BObtain a capillary blood glucose level.
CInitiate phototherapy for hyperbilirubinemia.
DAdminister 10% dextrose in water intravenously.
Show the answer and why the others fail
Answer: B. Obtain a capillary blood glucose level.
A
While thermoregulation is important and cold stress can worsen hypoglycemia, the immediate priority is to assess blood glucose to confirm and treat the likely cause of the symptoms. Thermoregulation can be addressed concurrently but does not replace the need for glucose assessment.
B — correct
Jitteriness and weak cry are classic signs of neonatal hypoglycemia. Given the risk factor of maternal diabetes and large size, checking blood glucose is the priority to confirm and guide immediate treatment.
C
Jitteriness and weak cry are not signs of hyperbilirubinemia; they are classic indicators of hypoglycemia. Jaundice appearing within the first 24 hours is pathological, but this newborn is not described as jaundiced, so phototherapy is not indicated.
D
Intravenous dextrose may be needed if hypoglycemia is confirmed, but it is not the first action. The nurse must first assess the blood glucose level to determine if intervention is required.
TakeawayIn newborns with risk factors for hypoglycemia (e.g., maternal diabetes, LGA), signs such as jitteriness, weak cry, or lethargy warrant immediate blood glucose assessment to confirm and treat hypoglycemia promptly.
Pediatric medical · medium
A 6-year-old child with a history of asthma is brought to the emergency department with increased work of breathing. The nurse assesses the child. Which finding indicates the child is in the early stage of respiratory distress?
ACyanosis of the lips and nail beds
BBradycardia and hypotension
CDecreased breath sounds and silent chest
DTachypnea and wheezing without retractions
Show the answer and why the others fail
Answer: D. Tachypnea and wheezing without retractions
A
Cyanosis is a late sign of hypoxemia and indicates severe respiratory compromise.
B
Bradycardia and hypotension are late, pre-arrest signs; early respiratory distress typically presents with tachycardia due to sympathetic stimulation.
C
Decreased breath sounds and silent chest are late signs indicating severe airway obstruction and impending respiratory failure.
D — correct
Tachypnea and wheezing without accessory muscle use are early signs of mild respiratory distress, reflecting increased work of breathing to overcome airway resistance and maintain ventilation.
TakeawayEarly signs of respiratory distress in children include tachypnea and wheezing; retractions, nasal flaring, and grunting indicate moderate distress, while cyanosis, decreased breath sounds, and bradycardia are late signs.
Maternity nursing · medium
A nurse is caring for a client who delivered a 4.1 kg infant vaginally 30 minutes ago. The client's fundus is firm, midline, and at the umbilicus. The nurse notes continuous trickling of bright red blood from the vagina. Vital signs: blood pressure 100/60 mm Hg, heart rate 110/min. Which of the following actions should the nurse take first?
AInspect the perineum for lacerations
BNotify the healthcare provider of the findings
CPerform fundal massage to promote uterine contraction
DAdminister oxytocin 10 units intramuscularly
Show the answer and why the others fail
Answer: A. Inspect the perineum for lacerations
A — correct
A firm fundus with continuous bright red bleeding suggests a genital tract laceration; the nurse should inspect the perineum and apply direct pressure as a temporary measure to control bleeding until the provider can repair the laceration.
B
The provider should be notified, but the nurse must first assess the perineum for lacerations, as immediate inspection and temporary pressure can control bleeding.
C
Fundal massage is indicated for a boggy uterus to promote contraction; massaging a firm fundus is contraindicated because it can cause uterine relaxation (iatrogenic atony) and increased pain.
D
Oxytocin is used to treat uterine atony, but the fundus is firm, indicating that atony is not the cause of bleeding; this intervention is not indicated.
TakeawayWhen the uterus is firm but bleeding persists, suspect a genital tract laceration; the nurse should first inspect the perineum and apply direct pressure as a temporary measure to control bleeding, then notify the provider.
The full set is split by topic above — each sub-section page carries all of its questions with rationales.