Worth 20% of the Saudi Nursing Licensure Examination — around 40 of the 200 items you sit. 37 original questions here, each with an explanation for all four options — 10 to answer now, and the full set to read below.
The base the rest of the exam rests on — core nursing practice, physical assessment, pharmacology and the basic sciences behind them.
How to work it
Pharmacology and calculation items are the ones you can get fully right or fully wrong on arithmetic alone, so they repay careful checking more than any other part of the exam.
Where marks go
Recognising a drug but not its nursing implication. Knowing what a medicine does is separate from knowing what to monitor, what to hold it for, and what to teach.
A nurse is preparing to reposition a 78-year-old bedbound patient who has a Braden Scale score of 12. Which nursing action best prevents pressure injury development over the sacrum?
10 sample nursing fundamentals questions
Every question below, with the reasoning for all four options. Try to answer before you open one.
Fundamentals of nursing · easy
A nurse is preparing to reposition a 78-year-old bedbound patient who has a Braden Scale score of 12. Which nursing action best prevents pressure injury development over the sacrum?
APlace a ring-shaped (donut) foam cushion under the sacrum
BMassage the sacral area vigorously to stimulate circulation
CElevate the head of the bed to 60 degrees continuously for comfort
DReposition the patient onto a 30-degree lateral tilt position
Show the answer and why the others fail
Answer: D. Reposition the patient onto a 30-degree lateral tilt position
A
Donut devices concentrate pressure on the surrounding tissue ring and impair venous return; they are no longer recommended.
B
Vigorous massage over bony prominences is contraindicated; it can shear deep tissue and damage capillaries rather than improving perfusion, and it is no longer part of any prevention protocol.
C
Head elevation above 30 degrees increases shear and friction over the sacrum and coccyx, so it is avoided unless medically indicated (for example, aspiration prevention during enteral feeding or mechanical ventilation), and it is never maintained continuously for comfort alone.
D — correct
A 30-degree lateral tilt offloads the sacrum and greater trochanter, keeping interface pressure off the bony prominence. It is the recommended repositioning standard for a patient in the high-risk Braden band of 10 to 12, alongside a pressure-redistributing support surface.
TakeawayPressure injury prevention relies on offloading (30-degree tilt), support surfaces, and moisture control — never massage over bony prominences and never use donut devices.
Physical assessment · medium
A nurse measures the vital signs of an adult patient who weighs 70 kg: BP 88/54 mmHg, pulse 118/min, respirations 24/min, temperature 38.9°C. Urine output has been 15 mL/hr for the last three hours. Which of these findings most directly measures perfusion of an end organ?
APulse of 118/min
BRespiratory rate of 24/min
CUrine output of 15 mL/hr
DTemperature of 38.9°C
Show the answer and why the others fail
Answer: C. Urine output of 15 mL/hr
A
Tachycardia is a compensatory response that defends cardiac output; it warns of a problem but says nothing about whether any specific organ is still being perfused.
B
Tachypnea is a significant finding — a rate of 22/min or above is one of the qSOFA criteria and, alongside this patient's hypotension, points toward sepsis — but it reflects respiratory compensation rather than measuring perfusion of an end organ.
C — correct
For this 70 kg patient, 15 mL/hr equals roughly 0.21 mL/kg/hr, far below the 0.5 mL/kg/hr threshold. Reduced urine formation is the direct bedside consequence of inadequate renal perfusion, making it the only listed finding that measures an end organ's blood supply rather than the body's compensatory effort.
D
Fever signals an inflammatory or infectious process and raises metabolic demand, but it is not itself a direct measure of tissue perfusion.
TakeawayUrine output below 0.5 mL/kg/hr is a direct marker of end-organ hypoperfusion, unlike compensatory changes in heart rate or respiratory rate. Three hours of oliguria is a perfusion warning, not an acute kidney injury stage — KDIGO stage 1 requires that low output be sustained for at least 6 hours.
Fundamentals of nursing · hard
A patient receiving continuous nasogastric enteral feeding suddenly develops coughing, dyspnea, and oxygen saturation falling from 97% to 88%. What is the nurse's first action?
AStop the feeding at once and reposition the patient to protect the airway
BObtain a stat chest radiograph to confirm aspiration before acting
CFlush the feeding tube with 30 mL of water to confirm correct placement
DCheck the gastric residual volume before deciding whether to continue
Show the answer and why the others fail
Answer: A. Stop the feeding at once and reposition the patient to protect the airway
A — correct
Halting the infusion removes the source of ongoing airway soilage, which no other listed action does. Repositioning — turning the patient to the side with the head of the bed raised — lets gastric contents drain away from the trachea, and suctioning follows immediately as part of the same airway-protective sequence, along with supplemental oxygen.
B
Imaging documents the injury but leaves formula entering the airway while the patient waits; radiography follows stabilization rather than preceding it.
C
If the tube has migrated into the airway, flushing instils additional fluid directly into the lungs; patency testing is never a response to acute desaturation.
D
This offers no benefit during an acute event, and current ASPEN/SCCM guidance recommends against routine gastric residual volume monitoring altogether, since it does not reduce aspiration or pneumonia and causes needless interruption of nutrition.
TakeawayIn suspected aspiration during enteral feeding, stop the feed first, then protect the airway with side-lying positioning, suction, and oxygen — remove the source of harm before any diagnostic step.
Pharmacology · medium
A patient receiving intravenous vancomycin develops flushing and erythema of the face, neck, and upper torso 20 minutes into the infusion. Blood pressure is 96/58 mmHg. What is the nurse's most appropriate immediate action?
AAdminister intramuscular epinephrine and call the rapid response team
BPermanently document vancomycin as a drug allergy in the record
CStop the infusion, give an antihistamine, and resume at a slower rate
DContinue the infusion at the same rate and document the reaction
Show the answer and why the others fail
Answer: C. Stop the infusion, give an antihistamine, and resume at a slower rate
A
Epinephrine is reserved for true anaphylaxis with airway compromise or shock. This rate-related histamine reaction resolves with slowing the infusion and antihistamines.
B
Labelling this an allergy is inaccurate — it is not IgE-mediated — and wrongly removes an important antibiotic from the patient's future options.
C — correct
This is vancomycin infusion reaction (formerly red man syndrome), a rate-related non-IgE histamine release. Stopping the infusion, treating with an antihistamine, and resuming more slowly (typically over at least 60 minutes or longer) is the correct management.
D
Continuing at the same rate allows the histamine release to worsen and the hypotension to deepen; the infusion rate is the modifiable cause.
TakeawayVancomycin infusion reaction is rate-dependent histamine release, not a true allergy — stop, treat with antihistamine, then infuse more slowly.
Pharmacology · easy
A physician orders 250 mg of an antibiotic to be given orally. The pharmacy supplies a suspension labeled 125 mg per 5 mL. How many milliliters should the nurse administer?
A5 mL
B10 mL
C2.5 mL
D12.5 mL
Show the answer and why the others fail
Answer: B. 10 mL
A
5 mL delivers only 125 mg, which is half the ordered dose.
B — correct
Using desired over available times quantity: 250 divided by 125, multiplied by 5 mL, equals 10 mL. This delivers exactly the ordered 250 mg.
C
2.5 mL delivers only 62.5 mg, one quarter of the ordered dose; this inverts the calculation.
D
12.5 mL would deliver 312.5 mg, an overdose; this results from misapplying the ratio.
TakeawayDose calculation: (desired dose / available dose) x volume on hand — always double-check the units on the supplied concentration.
Pharmacology · hard
A patient stabilized on warfarin for atrial fibrillation has an INR of 6.5 with no bleeding. Which action should the nurse anticipate?
AAdminister protamine sulfate to reverse the anticoagulation
BWithhold the warfarin doses and recheck the INR
CAdminister intravenous vitamin K 10 mg immediately
DContinue the usual warfarin dose and recheck the INR in one week
Show the answer and why the others fail
Answer: B. Withhold the warfarin doses and recheck the INR
A
Protamine reverses heparin, not warfarin. It has no meaningful effect on vitamin K-dependent clotting factor depletion.
B — correct
For an INR between 4.5 and 10 with no bleeding, guidelines direct the nurse to simply omit doses and recheck the INR, allowing it to drift down as clotting factors are regenerated. Routine vitamin K is specifically advised against in this range because it adds no reduction in bleeding events and risks over-correction.
C
High-dose IV vitamin K belongs to the management of major or life-threatening bleeding, where it is given together with four-factor prothrombin complex concentrate — the PCC provides the rapid factor replacement, while vitamin K alone takes hours and cannot achieve urgent reversal. In a non-bleeding patient it also produces prolonged warfarin resistance.
D
Continuing the dose at an INR of 6.5 leaves the patient at substantial risk of spontaneous major bleeding for another week.
TakeawayAn INR of 4.5 to 10 without bleeding is managed by holding warfarin and rechecking the INR, not by giving vitamin K. Low-dose oral vitamin K is considered once the INR exceeds 10, and four-factor PCC plus IV vitamin K is reserved for major bleeding.
Physical assessment · medium
A nurse is preparing to measure the blood pressure of a patient who has a left arm arteriovenous fistula for hemodialysis. Which of the following actions should the nurse take?
AObtain the blood pressure measurement using the right arm.
BPlace the cuff on the left thigh to avoid both arms entirely.
CApply the cuff to the left arm directly over the fistula site.
DPosition the cuff on the left forearm below the fistula.
Show the answer and why the others fail
Answer: A. Obtain the blood pressure measurement using the right arm.
A — correct
The arm with the fistula should never be used for blood pressure measurement. The opposite arm is the preferred site to ensure patient safety and preserve the fistula.
B
While the thigh is an alternative site, it is not the first choice when a healthy opposite arm is available. Thigh measurements also require a larger cuff and may be less accurate.
C
Applying pressure over an arteriovenous fistula can cause thrombosis, damage the fistula, and compromise vascular access for dialysis.
D
The entire limb with the fistula should be avoided for blood pressure measurement to prevent compromised circulation, inaccurate readings, and potential fistula damage.
TakeawayNever measure blood pressure on an arm with an arteriovenous fistula; use the opposite arm to prevent thrombosis and preserve vascular access.
Fundamentals of nursing · medium
A nurse is caring for a patient with a surgical wound infection. After removing the soiled dressing, the nurse notes that her hands are visibly contaminated with wound drainage. Which action should the nurse take next?
AApply an alcohol-based hand rub.
BUse an antiseptic hand wipe.
CPut on a clean pair of gloves.
DWash hands with soap and water.
Show the answer and why the others fail
Answer: D. Wash hands with soap and water.
A
Alcohol-based hand rubs are not effective when hands are visibly soiled; they are appropriate for routine decontamination when hands are not visibly dirty.
B
Antiseptic hand wipes are not a standard method for hand hygiene in clinical settings and may not adequately remove visible soil or pathogens.
C
Gloves are not a substitute for hand hygiene; hands must be cleaned before donning new gloves to prevent contamination.
D — correct
When hands are visibly soiled, the CDC and WHO guidelines recommend handwashing with soap and water to effectively remove organic material and microorganisms.
TakeawayWhen hands are visibly soiled, wash with soap and water rather than using alcohol-based hand rub.
Fundamentals of nursing · medium
A nurse is providing care for a patient with a confirmed Clostridioides difficile infection. After removing gloves following direct patient contact, which hand hygiene method should the nurse use?
AApply an alcohol-based hand rub to all surfaces of the hands.
BUse an antiseptic hand wash containing chlorhexidine gluconate.
CWash hands with soap and water using friction for at least 20 seconds.
DRinse hands with water only and dry thoroughly with a paper towel.
Show the answer and why the others fail
Answer: C. Wash hands with soap and water using friction for at least 20 seconds.
A
Alcohol-based hand rubs are not effective against C. difficile spores, which can persist on hands and contribute to transmission.
B
Chlorhexidine gluconate is not sporicidal and does not reliably eliminate C. difficile spores from hands.
C — correct
Soap and water mechanically remove C. difficile spores from hands, which is the recommended practice by infection control guidelines.
D
Rinsing with water alone is insufficient to remove C. difficile spores; soap and mechanical friction are required.
TakeawayHand washing with soap and water is essential after caring for patients with C. difficile infection because alcohol-based hand rubs do not kill spores.
Fundamentals of nursing · easy
A nurse is preparing to perform a sterile wound dressing change for a patient with a surgical incision. Which of the following actions should the nurse take first?
APerform hand hygiene.
BRemove the old dressing.
COpen the sterile dressing kit.
DApply sterile gloves.
Show the answer and why the others fail
Answer: A. Perform hand hygiene.
A — correct
Hand hygiene is the most fundamental infection control measure and must be performed before any patient contact or sterile procedure. It is the first action to prevent healthcare-associated infections.
B
Removing the old dressing is a necessary step, but it is performed after hand hygiene and before establishing the sterile field to minimize the time the sterile field is exposed to potential contamination.
C
Opening the sterile kit is part of setting up the sterile field, but it should be done after hand hygiene and after removing the soiled dressing to keep the sterile items from being exposed to contamination.
D
Applying sterile gloves is necessary to maintain asepsis during the procedure, but it is not the first step. The nurse must first perform hand hygiene to reduce the risk of transferring microorganisms to the patient or the sterile field.
TakeawayHand hygiene is the single most important practice to reduce the transmission of infectious agents in healthcare settings and must be performed before and after every patient contact or procedure.
The full set is split by topic above — each sub-section page carries all of its questions with rationales.