SNLE Exam Flashcards

Q: How is the SNLE structured?

The SNLE has 200 multiple-choice questions delivered in two parts of 100 questions each, with 120 minutes allotted per part and a scheduled break between parts. Up to 10% may be unscored pilot items. The exam is computer-based through Prometric test centers.

Q: What is the SNLE passing score?

The passing standard is a scaled score of 500 on a reporting scale of 200 to 800, set by a panel of Saudi nursing experts through standard-setting. Raw percent correct is not reported; focus on blueprint-weighted preparation rather than memorizing a fixed percentage.

Q: What topics does the SNLE blueprint emphasize?

Adult Nursing is 40%, Maternal-Child Nursing 30%, Nursing Fundamentals 20%, and Nursing Management and Leadership 10%. Domain weights may vary by up to plus or minus 5%. Patient safety themes are integrated across all domains.

Q: Who administers the SNLE?

SCFHS owns the exam content and licensure requirements. Registration flows through the Mumaris Plus portal. Prometric delivers the computer-based test at authorized centers. DataFlow credential verification and SCFHS classification fees are separate from the Prometric sitting fee.

Q: How should I weight SNLE flashcard review?

Spend the most time on adult and maternal-child nursing together (70% of the blueprint). Drill fundamentals such as infection control, dosage calculation, and pharmacology because they underpin safety questions in every domain. Add leadership cards for prioritization, delegation, and ethics scenarios.

Q: What clinical judgment skills does the SNLE test?

Beyond recall, items test interpretation of assessment data, prioritization of nursing actions, safe medication administration, and culturally appropriate patient education. Practice applied vignettes alongside terminology flashcards to match exam-style decision-making.

Question 1

Acute myocardial infarction — first medication for ischemic chest pain when BP allows

Accepted Answer

Sublingual nitroglycerin dilates coronary arteries and reduces preload, lowering myocardial oxygen demand. Given after airway and oxygen if systolic blood pressure is adequate. Aspirin and anticoagulants follow per ACS protocol but do not primarily relieve pain.

Question 2

Left-sided heart failure — classic lung assessment finding

Accepted Answer

Crackles at lung bases from pulmonary congestion as blood backs up into pulmonary circulation. Also expect dyspnea, orthopnea, and frothy sputum. JVD, peripheral edema, and hepatomegaly suggest right-sided failure instead.

Question 3

Heparin overdose with bleeding — specific reversal agent

Accepted Answer

Protamine sulfate binds heparin and neutralizes anticoagulation rapidly. Vitamin K reverses warfarin over hours to days, not heparin. Monitor aPTT and bleeding sites; stop infusion and notify provider per protocol.

Question 4

COPD patient starting oxygen — safest initial delivery

Accepted Answer

Low-flow nasal cannula (often 1-2 L/min) targeting saturations around 88-92% preserves hypoxic respiratory drive in chronic retainers. High-flow masks risk suppressing drive and worsening hypercapnia.

Question 5

Serum potassium 6.8 mmol/L — earliest life-threatening ECG change

Accepted Answer

Peaked (tall, tented) T waves signal hyperkalemia before QRS widening and sine-wave patterns. Treat with cardiac membrane stabilization (calcium), insulin and glucose, beta-agonists, and removal therapy per severity.

Question 6

Diabetic ketoacidosis — hallmark labs and priority intervention

Accepted Answer

Hyperglycemia, metabolic acidosis, ketonuria, and dehydration. Priority is IV fluids then insulin after potassium is verified adequate (insulin drives K intracellularly). Monitor glucose, electrolytes, and mental status hourly early in treatment.

Question 7

Tension pneumothorax — immediate nursing action

Accepted Answer

Prepare for emergent needle decompression: tracheal deviation, absent breath sounds on affected side, hypotension, and distended neck veins. Do not delay for chest X-ray if clinical picture is classic. High-flow oxygen while awaiting intervention.

Question 8

Stroke FAST assessment — what each letter represents

Accepted Answer

Face drooping, Arm weakness, Speech difficulty, Time to call emergency services. Time last known well guides thrombolytic eligibility. Maintain airway, check glucose, and avoid unnecessary BP lowering unless extreme.

Question 9

Sepsis bundle — first-hour priorities

Accepted Answer

Obtain blood cultures before antibiotics when possible, administer broad-spectrum antibiotics, measure lactate, and begin 30 mL/kg crystalloid for hypotension or lactate 4 mmol/L or higher. Frequent reassessment of perfusion and urine output.

Question 10

Active tuberculosis — airborne isolation requirements

Accepted Answer

Negative-pressure airborne infection isolation room, N95 respirator for staff, patient wears surgical mask during transport. Continue until three consecutive negative sputum smears or physician de-isolation order per local policy.

Question 11

Major depression with suicidal ideation — priority nursing action

Accepted Answer

Ensure immediate safety: constant observation per protocol, remove harmful objects, and do not leave patient alone. Complete suicide risk assessment and notify provider. Therapeutic communication follows once environment is secure.

Question 12

Digoxin toxicity — common precipitant and early sign

Accepted Answer

Hypokalemia increases digoxin binding and toxicity risk. Early symptoms include nausea, vision changes (yellow halos), and bradycardia with arrhythmias. Hold digoxin, check potassium and digoxin level, and treat per protocol.

Question 13

Upper GI bleed — pre-endoscopy nursing care

Accepted Answer

Two large-bore IV lines, type and crossmatch, monitor hemoglobin and vital signs, keep NPO, and assess for orthostatic changes. Avoid unnecessary sedatives that mask neurologic decline. Prepare for possible transfusion.

Question 14

Spinal cord injury — autonomic dysreflexia trigger and first response

Accepted Answer

Noxious stimulus below injury level (often blocked bladder or bowel) causes severe hypertension, headache, and bradycardia. Sit patient upright, loosen clothing, check catheter and rectum, and treat hypertension per protocol. Common in T6 and above injuries.

Question 15

Burn fluid resuscitation — Parkland formula purpose

Accepted Answer

Estimates first 24-hour crystalloid needs from burn size and weight to replace capillary leak losses. Half given in first 8 hours from burn time. Monitor urine output (typically 0.5 mL/kg/h adult) to titrate fluids.

Question 16

Post-op deep vein thrombosis prevention — early ambulation rationale

Accepted Answer

Muscle pump activity reduces venous stasis. Combine with mechanical prophylaxis and pharmacologic anticoagulation when ordered. Leg pain, unilateral swelling, or warmth warrants further evaluation.

Question 17

Chronic kidney disease — dietary phosphorus restriction goal

Accepted Answer

Limit high-phosphorus foods (dairy, nuts, colas) and take phosphate binders with meals when prescribed. Rising phosphorus contributes to bone disease and cardiovascular calcification. Patient education includes reading food labels.

Question 18

Hypoglycemia in conscious patient — first treatment

Accepted Answer

Give 15 g fast-acting carbohydrate (glucose tablets, juice), recheck in 15 minutes, repeat if still under 70 mg/dL. Follow with snack if next meal is delayed. Unconscious patients need IV dextrose or glucagon, not oral sugar.

Question 19

Pulmonary embolism — classic triad (not always present)

Accepted Answer

Sudden dyspnea, pleuritic chest pain, and tachycardia. May have hypoxia, hemoptysis, or leg swelling. High clinical suspicion warrants immediate evaluation; anticoagulation after stability confirmed.

Question 20

Endotracheal tube cuff pressure — why monitor

Accepted Answer

Target typically 20-30 cm H2O to prevent aspiration leak while avoiding tracheal mucosal ischemia and stenosis. Overinflation impairs perfusion; underinflation increases aspiration risk. Check per unit policy with manometer.

Question 21

Labor stages — when does the active phase of Stage 1 begin?

Accepted Answer

Stage 1 is latent then active labor; active phase traditionally begins at 6 cm cervical dilation with regular contractions. Full dilation (10 cm) ends Stage 1. Stage 2 is pushing until birth; Stage 3 is placenta delivery; Stage 4 is immediate recovery.

Question 22

APGAR scoring — five components at 1 and 5 minutes

Accepted Answer

Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), Respiration. Each 0-2 points; 7-10 is reassuring, 4-6 moderate assistance, 0-3 requires immediate resuscitation. Score at 1 and 5 minutes routinely.

Question 23

Postpartum hemorrhage — primary nursing action

Accepted Answer

Massage fundus to stimulate contraction, ensure bladder empty, count pads, and establish large-bore IV access while calling for help. Oxytocin and other uterotonics per order. Early recognition prevents shock.

Question 24

Preeclampsia severe features — blood pressure threshold

Accepted Answer

Systolic 160 mmHg or higher or diastolic 110 mmHg or higher on two occasions, plus symptoms such as headache, visual changes, epigastric pain, or thrombocytopenia. Requires urgent evaluation and often magnesium sulfate for seizure prophylaxis.

Question 25

Magnesium sulfate toxicity — antidote and early sign

Accepted Answer

Calcium gluconate is the antidote for respiratory depression or cardiac effects. Loss of deep tendon reflexes is an early clinical sign. Monitor respiratory rate, urine output, and magnesium level per protocol.

Question 26

Newborn thermoregulation — why heat loss is rapid

Accepted Answer

Large surface-area-to-weight ratio, thin skin, and limited subcutaneous fat cause rapid heat loss by conduction, convection, radiation, and evaporation. Dry immediately, skin-to-skin or radiant warmer, and monitor axillary temperature.

Question 27

Breastfeeding engorgement — teaching for effective latch

Accepted Answer

Feed on demand, ensure asymmetric latch with wide mouth and chin touching breast, and hand-express briefly before latch if areola is too firm. Avoid scheduled long gaps early postpartum. Report cracked nipples with signs of mastitis.

Question 28

Pediatric dehydration — skin turgor and fontanel assessment

Accepted Answer

Delayed skin tenting and sunken anterior fontanel (infants) indicate moderate dehydration. Dry mucous membranes, decreased tears, and oliguria support diagnosis. Shock signs (weak pulses, lethargy) need urgent fluid resuscitation.

Question 29

Croup (laryngotracheobronchitis) — characteristic cough and stridor

Accepted Answer

Barking seal-like cough and inspiratory stridor, often worse at night. Mild cases: cool mist and comfort. Severe distress, drooling, or fatigue suggests epiglottitis or severe obstruction — keep child calm and prepare for advanced airway support.

Question 30

Febrile seizure in child — parent teaching priority

Accepted Answer

Turn child on side, protect from injury, do not put objects in mouth, and time the event. Most are brief and benign. Seek emergency care if seizure lasts over 5 minutes, child is under 6 months, or neurologic deficit persists after.

Question 31

Contraceptive teaching — combined oral contraceptives contraindication

Accepted Answer

Avoid in smokers over 35, history of thromboembolism, migraine with aura, uncontrolled hypertension, and certain liver disease. Estrogen increases thrombotic risk. Progestin-only methods may be alternatives when estrogen is contraindicated.

Question 32

Neonatal jaundice — phototherapy nursing care

Accepted Answer

Maximize skin exposure per device instructions, protect eyes, monitor bilirubin trends, and maintain hydration and feeding frequency. Phototherapy converts bilirubin to water-soluble isomers for excretion. Watch for bronze baby syndrome with certain conditions.

Question 33

Child abuse suspicion — documentation priority

Accepted Answer

Objective factual description of injuries (size, shape, location, color), child statements in quotes, and behaviors. Do not confront alleged perpetrator in front of child. Follow mandatory reporting laws and facility policy immediately.

Question 34

Immunization schedule concept — live vaccine precautions

Accepted Answer

Live attenuated vaccines (MMR, varicella, nasal flu in some formulations) are contraindicated in severe immunocompromise and pregnancy. Separate live vaccines by at least 28 days if not given same day. Document lot number and site.

Question 35

Ectopic pregnancy — classic presentation

Accepted Answer

Amenorrhea, unilateral pelvic pain, and vaginal bleeding; positive pregnancy test. Rupture causes shoulder pain (referred), hypotension, and shock. Do not delay surgical or medical management once diagnosed.

Question 36

Chain of infection — six links

Accepted Answer

Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Breaking any link prevents spread. Standard precautions apply to all patients regardless of known diagnosis.

Question 37

Surgical asepsis vs medical asepsis

Accepted Answer

Surgical (sterile) technique eliminates all microorganisms and spores from objects and fields — required for invasive procedures. Medical asepsis (clean technique) reduces number and spread of pathogens — used for routine care and clean dressing changes.

Question 38

Rights of medication administration

Accepted Answer

Right patient, drug, dose, route, time, documentation, reason, response, and form (plus facility-specific rights). Two identifiers before every dose. Independent double-check for high-alert medications per policy.

Question 39

IV infiltration vs extravasation

Accepted Answer

Infiltration: non-vesicant fluid leaks into tissue causing swelling and coolness — stop infusion, elevate, warm compress per policy. Extravasation: vesicant causes tissue necrosis — stop immediately, aspirate if protocol allows, and apply antidote per drug.

Question 40

Dosage calculation — mg/kg/day divided doses

Accepted Answer

Multiply patient weight in kg by ordered mg/kg/day for 24-hour total, then divide by number of doses per day. Verify concentration when converting to mL. Always have second nurse check high-risk calculations when policy requires.

Question 41

Nursing process order

Accepted Answer

Assessment, diagnosis, planning, implementation, and evaluation (ADPIE). Assessment must precede interventions; evaluation determines whether plan continues or changes. Documentation reflects each step.

Question 42

Maslow hierarchy — prioritize physiological needs

Accepted Answer

Airway, breathing, circulation, and homeostasis come before safety, belonging, esteem, and self-actualization in acute care prioritization. A patient with airway compromise is addressed before psychosocial concerns.

Question 43

Informed consent — nurse role

Accepted Answer

Witness signature and confirm patient received information in understandable language; nurse does not explain surgical risks (provider duty). Ensure voluntary decision without coercion. Consent must be obtained before sedation when possible.

Question 44

Pressure injury Stage 3 — tissue involvement

Accepted Answer

Full-thickness skin loss with visible subcutaneous fat; bone, tendon, or muscle not exposed. Slough or eschar may be present. Requires pressure redistribution, moisture management, and wound care per interprofessional plan.

Question 45

Enteral feeding residual check — action for high residual

Accepted Answer

Hold feeding and reassess abdomen if gastric residual exceeds facility threshold (often 200-500 mL depending on policy). High residuals risk aspiration. Verify tube placement and consider prokinetics or post-pyloric feeding per provider.

Question 46

Delegation — five rights framework

Accepted Answer

Right task, circumstance, person, direction/communication, and supervision/evaluation. RN retains accountability for outcome. Tasks requiring nursing judgment are not delegated to unlicensed assistive personnel.

Question 47

RN vs LPN scope — what LPN typically cannot do independently

Accepted Answer

Initial assessment, care planning, teaching that requires RN judgment, and triage decisions remain RN responsibilities. LPNs administer medications and perform assigned procedures under RN supervision per licensure law and facility policy.

Question 48

SBAR communication — components

Accepted Answer

Situation (concise problem), Background (relevant history), Assessment (your findings), Recommendation (requested action). Standardizes handoffs and provider calls to reduce errors during transitions of care.

Question 49

Root cause analysis vs incident report

Accepted Answer

Incident report documents event for risk management without admitting fault; it is not part of the medical record. Root cause analysis is a systems-focused review after serious events to identify process failures and prevent recurrence.

Question 50

Ethical principle — autonomy in competent adult refusal

Accepted Answer

Competent patients may refuse treatment even if refusal leads to harm or death. Ensure informed decision, assess decision-making capacity, and document discussion. Beneficence does not override valid autonomous refusal.

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