Worth 10% of the Saudi Nursing Licensure Examination — around 20 of the 200 items you sit. 34 original questions here, each with an explanation for all four options — 10 to answer now, and the full set to read below.
How care is organised rather than delivered: coordinating resources, frontline quality and safety, working across professions, nursing informatics, and evidence-based practice.
How to work it
These items are about scope and accountability. Ask who is permitted to do the task, who stays responsible for it afterwards, and what the nurse must document or escalate.
Where marks go
Delegating the assessment along with the task. Delegation moves the doing; it never moves the judgement or the accountability.
In the emergency department, four patients arrive simultaneously. Applying the ABC (airway, breathing, circulation) priority framework, which patient should the nurse assess first?
10 sample nursing management and leadership questions
Every question below, with the reasoning for all four options. Try to answer before you open one.
Resources to support and coordinate patient care · medium
In the emergency department, four patients arrive simultaneously. Applying the ABC (airway, breathing, circulation) priority framework, which patient should the nurse assess first?
AA 68-year-old with a two-day history of dysuria and low-grade fever
BA 30-year-old with a closed forearm fracture and intact distal pulses
CA 22-year-old with a 4 cm superficial laceration and controlled bleeding
DA 45-year-old with an audible stridor and increasing facial swelling after eating shellfish
Show the answer and why the others fail
Answer: D. A 45-year-old with an audible stridor and increasing facial swelling after eating shellfish
A
No airway, breathing, or circulatory compromise is reported for this patient, so under the ABC framework the presentation ranks below airway obstruction. This does not make the patient low priority overall — older adults with urinary symptoms and fever require prompt vital signs and mental status assessment, because urosepsis is easily missed in this group.
B
A closed fracture with intact neurovascular status is urgent but stable and can safely wait.
C
Controlled bleeding from a superficial wound poses no immediate threat to life.
D — correct
Stridor with rapidly progressing facial swelling signals impending airway obstruction from anaphylaxis. Airway compromise always takes highest priority and requires immediate intramuscular epinephrine.
TakeawayTriage follows airway, breathing, circulation — stridor with progressing angioedema outranks every stable injury in the queue.
Quality and safe patient care at the frontline · medium
A nurse is about to administer an intravenous medication. The patient's identification band lists a name and medical record number. Which patient identification practice meets safety standards?
AConfirm the patient's room number and bed number match the assignment sheet
BAsk the patient "Are you Mr. Ahmed?" and proceed if he nods yes
CVerify the full name and medical record number against the medication record
DRely on visual recognition since the nurse has cared for the patient all week
Show the answer and why the others fail
Answer: C. Verify the full name and medical record number against the medication record
A
Location-based identifiers are explicitly prohibited because patients are frequently moved between rooms and beds.
B
A leading yes-or-no question invites false confirmation, particularly from confused, sedated, or hearing-impaired patients.
C — correct
International patient safety goals require at least two patient-specific identifiers, neither of which is the room or bed number, checked against the order before any medication or procedure.
D
Familiarity is a well-documented source of identification error and does not satisfy the two-identifier requirement.
TakeawayAlways use two patient-specific identifiers — never room or bed number — and ask open-ended identifying questions.
Resources to support and coordinate patient care · medium
A charge nurse on a medical-surgical unit is planning assignments for the next shift. The team consists of one registered nurse (RN), one licensed practical nurse (LPN), and one unlicensed assistive personnel (UAP). Which of the following patients is most appropriate to assign to the LPN?
AA patient with newly diagnosed diabetes who needs comprehensive education on insulin self-injection.
BA patient who was admitted 2 hours ago with acute chest pain and is awaiting cardiac enzyme results.
CA patient with a stage 2 pressure injury who requires a dressing change and oral antibiotic administration.
DA patient who is 2 days post-operative after a hip replacement and needs assistance with bathing and ambulation.
Show the answer and why the others fail
Answer: C. A patient with a stage 2 pressure injury who requires a dressing change and oral antibiotic administration.
A
Initial teaching and complex patient education are the responsibility of the RN, not the LPN.
B
This patient is newly admitted and potentially unstable, requiring initial and ongoing assessment by an RN.
C — correct
The patient is stable with predictable outcomes; wound care and oral medication administration are within the LPN's scope of practice.
D
Assistance with activities of daily living can be delegated to the UAP; assigning this patient to the LPN is not the most effective use of the LPN's skills.
TakeawayAssign stable patients with predictable outcomes to LPNs, while reserving RNs for initial assessments, unstable patients, and complex education.
Research and Evidence Based Practice · medium
A nurse manager on a medical-surgical unit is reviewing current evidence to update the unit's protocol for preventing catheter-associated urinary tract infections (CAUTI). The manager wants to base the new protocol on the strongest available evidence. Which type of research evidence should the manager prioritize?
AA single randomized controlled trial with a large sample size
BA quasi-experimental study with a control group
CA qualitative study exploring nurses' perceptions of CAUTI prevention
DA systematic review of multiple randomized controlled trials
Show the answer and why the others fail
Answer: D. A systematic review of multiple randomized controlled trials
A
While a well-designed RCT provides strong evidence, a single study is not as robust as a synthesis of multiple RCTs. Individual studies may have limitations or conflicting results.
B
Quasi-experimental studies lack randomization, which increases the risk of selection bias. They provide a lower level of evidence than RCTs or systematic reviews.
C
Qualitative research provides valuable insights into experiences and barriers but does not establish cause-and-effect relationships or measure intervention effectiveness, making it a lower level of evidence for practice change.
D — correct
Systematic reviews of RCTs are considered the highest level of evidence because they critically appraise and synthesize results from multiple studies, reducing bias and increasing generalizability.
TakeawayIn evidence-based practice, systematic reviews of randomized controlled trials (RCTs) represent the highest level of evidence for evaluating intervention effectiveness, as they synthesize findings from multiple studies to provide more reliable conclusions than single studies.
Nursing informatics for safe and legal delivery of patient care · medium
A nurse documents a patient's pain assessment in the electronic health record (EHR) but later realizes that the pain score was entered as 8/10 instead of the actual 3/10 reported by the patient. What is the most appropriate action to correct this error?
ALeave the incorrect entry unchanged and document the correct pain score in a new progress note without referencing the error.
BDelete the incorrect entry and create a new note with the correct pain score.
CCreate an addendum noting the error, the correct pain score, and the date and time of the correction.
DAsk the information technology (IT) department to delete the erroneous entry from the system permanently.
Show the answer and why the others fail
Answer: C. Create an addendum noting the error, the correct pain score, and the date and time of the correction.
A
Failing to correct the error could lead to clinical decisions based on inaccurate data and creates a discrepancy in the record. The correction must be clearly linked to the original entry to ensure clarity and legal defensibility.
B
Deleting an entry compromises the integrity of the medical record and removes the audit trail, which is a legal and professional violation. EHR systems are designed to prevent deletion of authenticated entries.
C — correct
An addendum preserves the original entry for legal and clinical audit purposes while clearly documenting the correction. This aligns with informatics principles for safe, legal documentation and maintains data integrity.
D
IT departments do not have the authority to delete clinical entries, as this would destroy the legal record. The nurse is responsible for correcting their own documentation following proper procedures.
TakeawayIn electronic health records, never delete or alter original entries. Use an addendum to make corrections, clearly noting the error, the correct information, and the date/time of the correction to maintain a complete, legal audit trail.
Quality and safe patient care at the frontline · medium
A nurse is preparing to administer a medication and notices that the tablet in the package appears different from the usual form. Upon checking, the nurse finds that the pharmacy dispensed a higher-dose tablet. The nurse returns the medication and obtains the correct dose. The patient receives the correct medication without harm. How should this event be classified in the facility's safety reporting system?
ANo harm event
BAdverse event
CNear miss
DSentinel event
Show the answer and why the others fail
Answer: C. Near miss
A
A no harm event is an error that reaches the patient but does not cause harm. Here, the error was intercepted before reaching the patient, making it a near miss rather than a no harm event.
B
An adverse event involves harm to the patient. The error was identified and corrected before reaching the patient, so no harm occurred.
C — correct
A near miss (or close call) is a safety event that did not reach the patient because it was intercepted before administration. The error was caught and corrected, so no harm resulted.
D
A sentinel event is a patient safety event that results in death, permanent harm, or severe temporary harm. No harm occurred in this scenario.
TakeawayA near miss is a patient safety event that did not reach the patient and is a valuable opportunity for system improvement without patient harm.
Resources to support and coordinate patient care · medium
A charge nurse on a medical-surgical unit is planning care for the day shift. The team includes one registered nurse (RN), one licensed practical nurse (LPN), and one unlicensed assistive personnel (UAP). Which of the following patient care activities should the charge nurse delegate to the UAP?
AA patient with a chest tube who requires assessment of the insertion site and drainage system.
BA patient 2 days after total hip replacement who is stable and needs assistance ambulating to the bathroom.
CA patient newly diagnosed with diabetes who needs instruction on self-injection of insulin.
DA patient receiving total parenteral nutrition (TPN) who needs a new intravenous tubing set-up.
Show the answer and why the others fail
Answer: B. A patient 2 days after total hip replacement who is stable and needs assistance ambulating to the bathroom.
A
Assessment of a chest tube site and drainage requires clinical judgment to detect complications, which is a nursing responsibility and cannot be delegated to UAP.
B — correct
Assisting a stable patient with ambulation is a routine task that can be delegated to UAP after the nurse has assessed the patient and confirmed the UAP understands any necessary precautions.
C
Patient teaching requires assessment of learning needs and evaluation of understanding, which are within the RN scope of practice and cannot be delegated to UAP.
D
Changing IV tubing for TPN requires aseptic technique and knowledge of IV therapy, which is outside the UAP scope of practice.
TakeawayUAP can be delegated routine tasks for stable patients, such as assisting with ambulation, after the nurse has assessed the patient and confirmed the UAP's competence. Tasks requiring assessment, teaching, or aseptic technique must be performed by licensed nurses.
Quality and safe patient care at the frontline · medium
A staff nurse notices that an intravenous (IV) bag prepared by pharmacy is labeled for a different patient. The nurse immediately stops the administration and reports the near miss to the charge nurse. According to a just culture approach, what is the most appropriate next step?
AFile an incident report detailing the near-miss event.
BDocument the near miss in the patient's medical record.
CNo further action is needed because the patient was not harmed.
DNotify the pharmacy manager to discipline the staff involved.
Show the answer and why the others fail
Answer: A. File an incident report detailing the near-miss event.
A — correct
In a just culture, near misses are reported through incident reporting systems to identify system vulnerabilities and prevent future errors, without immediate blame.
B
The medical record is used to document clinical care and assessments. While the clinical facts of the event (e.g., that the IV was stopped due to a labeling discrepancy) should be documented for continuity of care, the near miss event itself is reported through the incident reporting system, not entered as an event in the patient's chart. This option incorrectly suggests documenting the near miss rather than the relevant clinical details.
C
Near misses are valuable learning opportunities. Failing to report them undermines safety culture and allows system flaws to persist.
D
Just culture focuses on system improvement rather than individual punishment unless reckless behavior is evident. The first step is reporting, not discipline.
TakeawayIn a just culture, near-miss events are reported through incident reporting systems to analyze system vulnerabilities and prevent future errors, without immediate blame.
Nursing teams and interprofessional relations · medium
A staff nurse reports to the nurse manager that a physician frequently yells at her in front of patients and other team members, causing her significant distress. What is the nurse manager's best initial action?
AEncourage the nurse to directly confront the physician about the impact of the yelling.
BSchedule a private meeting with the physician to discuss the reported behavior immediately.
CAcknowledge the nurse's concerns and initiate the facility's process for addressing disruptive behavior.
DAdvise the nurse to avoid the physician whenever possible to minimize further distress.
Show the answer and why the others fail
Answer: C. Acknowledge the nurse's concerns and initiate the facility's process for addressing disruptive behavior.
A
Placing the burden of confrontation on the distressed nurse is inappropriate and may escalate the conflict; the manager should facilitate a structured resolution process.
B
While addressing the physician is necessary, the initial step is to support the nurse and follow organizational policy, which typically includes documentation and investigation before direct intervention.
C — correct
The manager's first priority is to support the nurse and activate the organization's established policy for reporting and managing disruptive conduct, ensuring a structured, safe, and consistent response.
D
Avoidance does not resolve the underlying behavior and may compromise patient care by impeding essential communication between the nurse and physician.
TakeawayWhen a nurse reports disruptive behavior, the manager's first action is to provide support and follow the facility's established process for reporting and addressing such behavior, rather than avoiding the issue, expecting the nurse to confront the individual, or immediately confronting the physician without due process.
Nursing informatics for safe and legal delivery of patient care · medium
A nurse realizes that she inadvertently documented a pain assessment under the wrong patient's electronic health record. Which of the following actions should the nurse take?
ADelete the erroneous entry, document the assessment in the correct chart, and notify the supervisor.
BRequest that health information management delete the erroneous entry, document the assessment in the correct chart, and notify the supervisor.
CMark the erroneous entry as 'entered in error,' document the assessment in the correct chart, and notify the supervisor.
DLeave the erroneous entry unchanged, document the assessment in the correct chart, and notify the supervisor.
Show the answer and why the others fail
Answer: C. Mark the erroneous entry as 'entered in error,' document the assessment in the correct chart, and notify the supervisor.
A
Deleting an entry compromises the integrity of the medical record and may be considered falsification. EHR systems typically restrict deletion of finalized entries; the proper correction is to mark the entry as erroneous.
B
Deletion of an entry, even by health information management, is not the standard correction method; the entry should be marked as erroneous to maintain an audit trail. While HIM may assist with record integrity, the nurse who made the error is responsible for initiating the proper correction.
C — correct
This action preserves the original entry for audit purposes while clearly indicating it is invalid, ensures the correct information is placed in the intended patient's record, and addresses the potential privacy breach by informing the supervisor, who can follow facility policy for further steps.
D
Leaving the erroneous entry unchanged in the wrong chart can lead to incorrect clinical decisions based on false data and constitutes a HIPAA violation because protected health information remains in an unauthorized record. The entry must be corrected, not simply left as is.
TakeawayWhen a documentation error involves the wrong patient, the nurse must correct the erroneous entry in the wrong chart by marking it as 'entered in error' (or per facility policy) to preserve audit integrity and prevent clinical misuse, then document the information in the correct chart, and notify a supervisor or privacy officer to address the potential breach of protected health information.
The full set is split by topic above — each sub-section page carries all of its questions with rationales.