Saudi Nursing License (SNLE) Complete Review Guide 2026–2027

4. Hypertension: focus on correct measurement (patient seated and rested, arm at heart level, correct cuff size) and on its complications (stroke, heart failure, kidney failure).
5. Ischemic stroke: FAST signs (face, arm, speech, time). The window for clot-dissolving treatment is short, so record when symptoms started. Check swallowing before any food.
6. Asthma is reversible narrowing, while COPD is linked to smoking and mostly irreversible. Give the rapid bronchodilator first in an acute asthma attack.
7. Arterial blood gases: pH 7.35 to 7.45, PaCO2 35 to 45, HCO3 22 to 26 mEq/L. Respiratory acidosis: low pH and high CO2. Metabolic acidosis: low pH and low HCO3.
8. Normal fasting glucose is about 70 to 99 mg/dL. Hypoglycemia is below 70. For an alert patient: 15 g fast carbohydrate, then recheck in 15 minutes (the 15-15 rule).
9. Chronic kidney disease: restrict potassium, phosphorus, sodium and fluids as ordered. For hemodialysis access, check thrill and bruit and never take blood pressure or draw blood from that arm.
10. Before surgery: fast as instructed, consent signed before sedatives, document vital signs and allergies. After surgery: assess airway, breathing, circulation, pain and wound.
11. Postoperative complications: atelectasis (first 48 hours) is treated with deep breathing and coughing. Deep vein thrombosis is prevented with movement, stockings and anticoagulants. Wound dehiscence or evisceration: cover with a sterile saline-moist dressing and call the surgeon.
12. Burns: the Rule of Nines estimates surface area, and electrical burns need cardiac monitoring. The first priority in burns is the airway (inhalation injury).
13. Adult resuscitation: check safety and response, call for help, check pulse for no more than 10 seconds, start compressions at once, and pause only for rhythm analysis or the shock. Resume compressions right after the shock.
14. Glasgow Coma Scale: eye 4, verbal 5, motor 6, total 3 to 15. A score of 8 or less means the airway is at risk.
15. Levels of prevention: primary (immunization, education) prevents disease, secondary (early screening such as mammography) detects it early, tertiary (rehabilitation) limits disability.
16. Chain of infection: pathogen, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host. The best break is hand hygiene, then standard precautions, then isolation by transmission route (contact, droplet, airborne).
17. Disaster triage: red is immediate and likely to survive with care, yellow is delayed, green is minor, black is deceased or expectant. Treat airway and breathing threats before minor injuries.
18. Therapeutic communication means active listening, open-ended questions and reflecting feelings. Avoid empty reassurance and quick advice.
19. Lithium: keep fluid and salt intake steady and monitor blood levels. The therapeutic range is about 0.6 to 1.2 mEq/L. Toxicity shows as coarse tremor, vomiting, diarrhea and confusion.

Common mistakes in this chapter

• ✕ Pain is not the priority by default. The life-threatening problem comes first: airway, then breathing, then circulation.
• ✕ Waiting for low blood pressure to identify shock. It is a late sign. Tachycardia, low urine output and altered consciousness appear earlier.
• ✕ Giving high-flow oxygen to every COPD patient. These patients need low-flow oxygen with saturation monitoring, because their drive to breathe can fall.
• ✕ Mixing up hypoglycemia and DKA. Cool, clammy skin with shaking means low glucose. Dry, warm skin with deep rapid breathing means high glucose.
• ✕ Forgetting that the first checks after surgery are airway, breathing and bleeding, not pain or diet. If a dressing soaks through, reinforce it and call. Do not remove it.
• ✕ Shocking asystole or pulseless electrical activity. Neither is shockable. Shock only ventricular fibrillation and pulseless ventricular tachycardia.
• ✕ Arguing with a psychotic patient about hallucinations. Acknowledge the feeling, say you do not hear what they hear, and redirect to reality.
• ✕ Believing that asking a depressed patient about suicide plants the idea. Asking directly is correct and is part of assessment.