10 original SNLE questions on fundamentals of nursing, each with an explanation for all four options. Part of Nursing Fundamentals, worth 20% of the Saudi Nursing Licensure Examination.
Q01 / 10easy0 correct
Nursing Fundamentalseasyq001
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?
All 10 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
BElevate the head of the bed to 60 degrees continuously for comfort
CMassage the sacral area vigorously to stimulate circulation
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
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.
C
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.
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.
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
BCheck the gastric residual volume before deciding whether to continue
CObtain a stat chest radiograph to confirm aspiration before acting
DFlush the feeding tube with 30 mL of water to confirm correct placement
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
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.
C
Imaging documents the injury but leaves formula entering the airway while the patient waits; radiography follows stabilization rather than preceding it.
D
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.
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.
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?
AWash hands with soap and water.
BApply an alcohol-based hand rub.
CUse an antiseptic hand wipe.
DPut on a clean pair of gloves.
Show the answer and why the others fail
Answer: A. Wash hands with soap and water.
A — correct
When hands are visibly soiled, the CDC and WHO guidelines recommend handwashing with soap and water to effectively remove organic material and microorganisms.
B
Alcohol-based hand rubs are not effective when hands are visibly soiled; they are appropriate for routine decontamination when hands are not visibly dirty.
C
Antiseptic hand wipes are not a standard method for hand hygiene in clinical settings and may not adequately remove visible soil or pathogens.
D
Gloves are not a substitute for hand hygiene; hands must be cleaned before donning new gloves to prevent contamination.
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?
AWash hands with soap and water using friction for at least 20 seconds.
BRinse hands with water only and dry thoroughly with a paper towel.
CUse an antiseptic hand wash containing chlorhexidine gluconate.
DApply an alcohol-based hand rub to all surfaces of the hands.
Show the answer and why the others fail
Answer: A. Wash hands with soap and water using friction for at least 20 seconds.
A — correct
Soap and water mechanically remove C. difficile spores from hands, which is the recommended practice by infection control guidelines.
B
Rinsing with water alone is insufficient to remove C. difficile spores; soap and mechanical friction are required.
C
Chlorhexidine gluconate is not sporicidal and does not reliably eliminate C. difficile spores from hands.
D
Alcohol-based hand rubs are not effective against C. difficile spores, which can persist on hands and contribute to transmission.
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?
AApply sterile gloves.
BPerform hand hygiene.
COpen the sterile dressing kit.
DRemove the old dressing.
Show the answer and why the others fail
Answer: B. Perform hand hygiene.
A
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.
B — 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.
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
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.
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.
Fundamentals of nursing · medium
A 45-year-old patient is admitted to the medical unit with a persistent cough, night sweats, and hemoptysis. The chest X-ray shows cavitary lesions in the upper lobes. The nurse suspects pulmonary tuberculosis. Which infection control precaution should the nurse implement immediately?
APlace the patient in a private room and wear gloves and a gown for all patient contact.
BPlace the patient in a negative-pressure room and wear an N95 respirator when entering the room.
CPlace the patient in a private room with the door open and wear a surgical mask when within 3 feet of the patient.
DPlace the patient in a standard room and wear a surgical mask only during aerosol-generating procedures.
Show the answer and why the others fail
Answer: B. Place the patient in a negative-pressure room and wear an N95 respirator when entering the room.
A
This describes contact precautions, which are used for pathogens spread by direct or indirect contact (e.g., MRSA, C. difficile). Tuberculosis is not transmitted by contact; airborne precautions are required.
B — correct
Pulmonary tuberculosis is transmitted via airborne droplet nuclei. Airborne precautions require a negative-pressure isolation room with a minimum of 12 air changes per hour (existing facilities) and use of a fit-tested N95 respirator by all healthcare personnel entering the room.
C
This describes droplet precautions, which are used for pathogens transmitted via large respiratory droplets (e.g., influenza, pertussis). Tuberculosis requires airborne precautions because the infectious particles are smaller and remain suspended in the air for long periods.
D
Standard precautions alone are insufficient for suspected pulmonary tuberculosis. Airborne precautions, including a negative-pressure room and N95 respirator, must be initiated immediately to prevent transmission of airborne infectious particles.
TakeawaySuspected or confirmed pulmonary tuberculosis requires immediate airborne precautions: a negative-pressure isolation room with ≥12 air changes per hour (existing facilities) and use of a fit-tested N95 respirator for all healthcare personnel entering the room.
Fundamentals of nursing · medium
A nurse is preparing to perform a sterile dressing change for a patient with a surgical wound. Which of the following actions by the nurse indicates a need for further education regarding infection control?
APerforms hand hygiene before donning sterile gloves
BOpens the sterile dressing kit by first opening the flap farthest from the body, then the side flaps, and finally the flap nearest to the body
CPlaces the sterile glove package on a clean, dry surface before opening it
DPlaces sterile items on the 1-inch border of the sterile field
Show the answer and why the others fail
Answer: D. Places sterile items on the 1-inch border of the sterile field
A
Hand hygiene is always performed before donning sterile gloves to reduce the risk of contamination; this action is correct.
B
This sequence prevents the nurse from reaching over the sterile field, maintaining asepsis; the action is correct.
C
A clean, dry surface provides a stable base and prevents contamination of the inner sterile wrapper; this action is correct.
D — correct
The 1-inch border of a sterile field is considered unsterile. Placing sterile items there risks contamination and indicates a need for further education.
TakeawayThe 1-inch border of a sterile field is considered unsterile. Sterile items must be placed only on the sterile area to maintain asepsis.
Fundamentals of nursing · medium
A nurse is changing the dressing of a patient with a surgical wound infection. After removing the soiled dressing and discarding it in the appropriate bin, the nurse removes gloves and performs hand hygiene. Which of the WHO '5 Moments for Hand Hygiene' indicates the need for this action?
AAfter touching patient surroundings
BAfter body fluid exposure risk
CAfter touching a patient
DBefore touching a patient
Show the answer and why the others fail
Answer: B. After body fluid exposure risk
A
This moment applies after contact with objects in the patient's immediate environment (e.g., bed rails, overbed table) without touching the patient. The nurse handled a soiled dressing, which is considered a body fluid exposure, not merely contact with patient surroundings.
B — correct
Handling a soiled wound dressing involves potential exposure to blood or body fluids. The WHO moment 'after body fluid exposure risk' requires hand hygiene immediately after such a task, even if gloves were worn, to prevent transmission of microorganisms.
C
This moment applies after any direct contact with a patient, such as after taking a pulse or blood pressure. However, when the contact involves exposure to body fluids, the 'after body fluid exposure risk' moment takes priority. In this scenario, the nurse handled a soiled dressing, so the correct indication is Moment 3, not Moment 4.
D
This moment applies before any direct contact with the patient, such as before assisting with personal care or performing a physical examination. The scenario describes an action after patient contact and after exposure to body fluids, so this moment is not indicated.
TakeawayHand hygiene after contact with wound dressings or other potentially infectious materials is classified as 'after body fluid exposure risk,' even if gloves were worn, to prevent cross-contamination.
Fundamentals of nursing · medium
A nurse is preparing to administer the first enteral feeding through a newly inserted nasogastric (NG) tube. Which action should the nurse take to confirm correct tube placement before starting the feeding?
AObtain an abdominal x-ray to visualize tube tip location.
BMark and record the external tube length at the naris.
CMeasure the pH of gastric aspirate obtained from the tube.
DInject 10 mL of air while auscultating over the epigastrium.
Show the answer and why the others fail
Answer: A. Obtain an abdominal x-ray to visualize tube tip location.
A — correct
Radiographic confirmation is the gold standard for verifying correct nasogastric tube placement before administering the first feeding, as it provides definitive evidence of tip location in the stomach.
B
Marking and measuring external tube length is a secondary check to detect tube migration, but it does not confirm internal tip position and cannot replace radiographic verification for initial use.
C
pH testing is useful for ongoing verification after initial placement has been confirmed, but it is not sufficient as the sole method for the first feeding because pH values can overlap between gastric and respiratory secretions.
D
Auscultation of injected air is an unreliable method that can produce misleading sounds even when the tube is misplaced in the lungs or esophagus; it is no longer recommended as a primary verification technique.
TakeawayAbdominal x-ray is the most reliable method to confirm initial nasogastric tube placement before first use; auscultation and pH testing alone are insufficient.
Fundamentals of nursing · medium
A nurse is caring for a patient with a known seizure disorder. The patient suddenly begins to have a generalized tonic-clonic seizure. Which action should the nurse take first?
AInsert a padded tongue blade into the patient's mouth to prevent tongue injury.
BAdminister the prescribed intravenous antiepileptic medication immediately.
CProtect the patient's head and clear the immediate area of hazardous objects.
DRestrain the patient's arms and legs to prevent injury from flailing.
Show the answer and why the others fail
Answer: C. Protect the patient's head and clear the immediate area of hazardous objects.
A
Inserting any object into the mouth of a seizing patient is contraindicated; it can cause dental damage, oral injury, or airway obstruction, and does not prevent tongue biting.
B
Medication administration is not the first action during an active seizure; ensuring safety and maintaining a patent airway take precedence, and IV access may be difficult to obtain during convulsions.
C — correct
The first priority during an active seizure is to prevent physical injury. Protecting the head and removing nearby hazards are immediate safety measures that can be performed without interfering with the seizure.
D
Restraining a patient during a seizure can lead to musculoskeletal injury and does not stop the seizure; the nurse should protect the patient from environmental hazards without restricting movement.
TakeawayDuring a generalized tonic-clonic seizure, the nurse's first priority is to protect the patient from physical injury by clearing the area of hazards and protecting the head, rather than inserting objects into the mouth, restraining, or administering medication.