Free SNLE practice questions

Correct answer: C

• A. Place the patient in a flat supine position with legs extended.

  Placing the patient flat with extended legs increases tension on the abdominal muscles and the incision, which can worsen the evisceration. The patient should instead be placed in a low Fowler's position with the knees flexed.

• B. Gently reinsert the protruding bowel into the abdominal cavity.

  Gently reinserting the bowel is strictly contraindicated as it can cause mechanical trauma to the tissue, impair blood supply leading to ischemia, and introduce severe infection into the peritoneal cavity.

• C. Cover the protruding bowel with sterile, saline-soaked dressings.

  According to the Nursing Process, while assessment is usually the first step, immediate intervention takes priority when a life- or organ-threatening emergency is visually identified. Evisceration is a surgical emergency. The nurse must immediately cover the exposed bowel with sterile, saline-soaked dressings to prevent tissue necrosis and severe infection before notifying the surgeon.

• D. Obtain a complete set of vital signs to assess for shock.

  Obtaining vital signs delays critical intervention. Under the Nursing Process, routine assessment is deferred until the immediate physical threat to the exposed organ is managed with a protective dressing.

Association of periOperative Registered Nurses (AORN) Guidelines for Perioperative Practice · Postoperative Patient Care: Management of Surgical Complications (checked 15 August 2026)

Correct answer: C

• A. "All of your future children will be carriers of the trait and will not develop the disease."

  Incorrect. Inheritance probabilities apply independently to each pregnancy. There is a 25% chance a child will not carry the trait at all (HbAA) and a 25% chance they will have the disease (HbSS).

• B. "There is a 50% chance with each pregnancy that your child will have sickle cell disease."

  Incorrect. A 50% chance represents the probability of the child being a carrier of the trait (HbAS), not having the active disease (HbSS).

• C. "There is a 25% chance with each pregnancy that your child will have sickle cell disease."

  Correct. Sickle cell disease follows an autosomal recessive inheritance pattern. When both parents are carriers (trait), there is a 25% risk with each pregnancy that the child will inherit two defective genes and have the disease.

• D. "None of your children will get the disease because you both only carry the trait without symptoms."

  Incorrect. Although both parents are asymptomatic carriers, they each possess one recessive gene for the disease. If both pass the recessive gene to the offspring, the child will develop sickle cell disease.

Saudi Ministry of Health (MOH) Premarital Screening Program Guidelines · Genetic Counseling for Hemoglobinopathies (checked 15 August 2026)

Correct answer: D

• A. Reassure the patient by explaining that the voices are not real.

  Arguing with or logically dismissing a patient's hallucinations is non-therapeutic and damages trust; it also fails to assess the immediate safety risk.

• B. Administer the prescribed as-needed (PRN) antipsychotic medication.

  While medication may help manage psychotic symptoms, the nursing process dictates that a thorough assessment of the immediate safety threat must precede pharmacological intervention.

• C. Escort the patient to a quiet room to decrease sensory stimulation.

  Decreasing environmental stimuli is a valid intervention for agitation, but it does not address the priority need to assess the specific safety risk posed by the command hallucinations.

• D. Ask the patient directly what the voices are telling him to do.

  Under the nursing process framework (assessment before intervention) and Maslow's hierarchy of needs (safety), the nurse must first assess the nature of command hallucinations to determine if the patient is at immediate risk of self-harm or harming others.

American Nurses Association (ANA), Psychiatric-Mental Health Nursing: Scope and Standards of Practice · Standard 1: Assessment - Evaluating risk to self or others (checked 15 August 2026)

Correct answer: A

• A. Auscultate the abdomen for bowel sounds in all four quadrants.

  Correct. According to the Nursing Process (Assessment), the standard sequence for examining the abdomen is Inspection, Auscultation, Percussion, and Palpation (IAPP). Auscultation must be performed immediately after inspection, before percussion and palpation, to prevent altering bowel motility and producing false bowel sounds.

• B. Percuss the abdomen to assess for tympany and dullness.

  Incorrect. Percussion involves tapping the abdomen, which can alter normal bowel sounds and motility if done before auscultation.

• C. Ask the patient to sit up to assess for abdominal symmetry.

  Incorrect. The abdomen is typically inspected for contour and symmetry while the patient is in a supine position, not sitting up, and the inspection phase has already been completed.

• D. Palpate the abdomen lightly to identify areas of tenderness.

  Incorrect. Palpation is performed last in the abdominal assessment sequence because manipulating the intestines can stimulate peristalsis, creating false bowel sounds, or cause pain that makes further assessment difficult.

Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th Edition · Chapter 38: Assessment of Digestive and Gastrointestinal Function (checked 15 August 2026)

Correct answer: C

• A. Palpate peripheral pulses and measure capillary refill.

  Assessing circulation (pulses and capillary refill) is the 'C' in the ABCDE framework. It must be performed immediately after establishing that the airway is clear and breathing is adequate, not before.

• B. Assess the level of consciousness using the Glasgow Coma Scale.

  Assessing neurological status is the 'D' (Disability) in the ABCDE framework. While restlessness may indicate a head injury, the airway and breathing must be secured first to reverse potential hypoxia and prevent secondary brain injury.

• C. Evaluate airway patency and respiratory effort.

  According to the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) prioritization framework, the nurse must first assess and secure the airway and evaluate breathing. Chest bruising and restlessness strongly indicate potential airway or respiratory compromise (such as hypoxia), making this the absolute immediate priority.

• D. Auscultate the abdomen for bowel sounds.

  Abdominal assessment is part of the secondary survey. Life-threatening issues related to airway, breathing, and circulation must be entirely ruled out or treated before moving to regional assessments like the abdomen.

Emergency Nurses Association (ENA), Trauma Nursing Core Course (TNCC) Provider Manual · 9th Edition, Chapter 4: Initial Assessment (checked 15 August 2026)

Correct answer: D

• A. Stop the transfusion, flush the existing blood tubing with normal saline, and notify the rapid response team.

  While stopping the transfusion is correct, flushing the existing blood tubing with normal saline is contraindicated. This action would forcefully push the remaining incompatible blood inside the tubing into the patient's circulation, worsening the life-threatening hemolytic reaction.

• B. Slow the transfusion rate, apply oxygen via nasal cannula, and notify the physician immediately.

  Slowing the rate might be considered for mild circulatory overload, but it is absolutely contraindicated for a suspected hemolytic reaction. The transfusion must be stopped completely and immediately to prevent further administration of incompatible cells.

• C. Stop the transfusion, administer a prescribed antipyretic, and collect a urine sample to check for hemoglobinuria.

  While administering antipyretics and collecting a urine sample for hemoglobinuria are required steps in managing and investigating a transfusion reaction, they are secondary interventions. Under the ABCDE framework, maintaining circulation by securing IV access with normal saline takes immediate priority over obtaining diagnostic samples or treating fever.

• D. Stop the transfusion, disconnect the blood tubing at the IV hub, and infuse normal saline using new IV tubing.

  Under the ABCDE framework, the patient is exhibiting signs of an acute hemolytic transfusion reaction with circulatory compromise (hypotension). The priority is to remove the offending agent (Circulation/Exposure) by stopping the transfusion and maintaining venous access for resuscitation. Disconnecting at the IV hub and using entirely new tubing is critical to prevent infusing the remaining incompatible blood in the old line into the patient.

Infusion Nurses Society (INS) - Infusion Therapy Standards of Practice · Standard: Transfusion Therapy - Management of Transfusion Reactions (checked 15 August 2026)

Correct answer: D

• A. Apply a barrier cream to the infant's perianal area.

  Incorrect. Maintaining skin integrity is an important nursing intervention for infants with severe diarrhea, but it is not a life-saving priority compared to treating hypovolemic shock.

• B. Educate the parents on preparing oral rehydration salts.

  Incorrect. Patient education is essential for discharge planning or managing mild dehydration, but it is inappropriate to prioritize over immediate resuscitation in a severely dehydrated, lethargic infant.

• C. Obtain a stool specimen for viral and bacterial studies.

  Incorrect. While identifying the causative pathogen is part of the medical management plan, obtaining diagnostic samples is a lower priority than stabilizing a hemodynamically unstable patient.

• D. Establish intravenous access for fluid resuscitation.

  Correct. Under the ABCDE priority framework, this infant is exhibiting signs of severe dehydration and hypovolemic shock (Circulation compromise indicated by lethargy, tachycardia, hypotension, and delayed capillary refill). The immediate life-saving priority is restoring intravascular volume through rapid intravenous fluid administration.

WHO Pocket Book of Hospital Care for Children · Chapter 5: Diarrhoea, Section 5.2: Severe dehydration (checked 15 August 2026)

Correct answer: A

• A. Place the patient in a supine position with legs elevated and notify the physician immediately.

  Under the ABCDE priority framework, this patient is exhibiting unambiguous signs of hypovolemic shock (tachycardia, hypotension, oliguria, dizziness) likely due to internal hemorrhage. The priority is to support Circulation. Placing the patient in a modified Trendelenburg position (supine with legs elevated) promotes venous return to vital organs. Immediate escalation to the physician is required for urgent surgical or medical intervention.

• B. Assess the perineal pad for the amount of vaginal bleeding.

  Under the nursing process, assessment is usually the first step. However, under the ABCDE framework, when a patient exhibits unambiguous signs of circulatory failure (hypovolemic shock), immediate life-saving intervention and escalation supersede secondary assessments. Checking the pad delays critical interventions.

• C. Administer the prescribed intravenous morphine for the severe abdominal pain.

  Administering morphine is contraindicated at this time. While the patient is in severe pain, opioids cause vasodilation and can further lower blood pressure, worsening the hypovolemic shock. Circulation must be stabilized first.

• D. Encourage the patient to perform deep breathing exercises to improve oxygenation.

  The patient's oxygen saturation is 95% on room air, indicating that Airway and Breathing are currently adequate. The primary life-threatening issue is Circulation, making breathing exercises a lower priority.

American Society of PeriAnesthesia Nurses (ASPAN) Standards for Perianesthesia Nursing Practice · Standard IV: Care of the Patient with Postoperative Hemorrhage and Shock (checked 15 August 2026)

Correct answer: A

• A. Medical social worker

  Based on the nursing process for discharge planning, identifying barriers to care (such as financial constraints) requires prompt coordination with the appropriate resource. The medical social worker specializes in assessing financial needs, navigating healthcare coverage, and coordinating community or charitable resources to secure necessary medical equipment.

• B. Patient relations officer

  The patient relations officer primarily addresses patient rights, grievances, and satisfaction during the hospital stay, rather than managing post-discharge resource planning and financial aid.

• C. Home health care nurse

  The home health care nurse provides ongoing clinical assessment and care in the home setting, but they do not typically manage the financial procurement of equipment prior to the patient's discharge.

• D. Respiratory therapist

  The respiratory therapist is essential for educating the patient and family on the correct and safe clinical use of the oxygen equipment, but they do not address the financial barrier to obtaining it.

American Nurses Association (ANA), Nursing: Scope and Standards of Practice · Standard 16: Resource Stewardship (checked 15 August 2026)

Correct answer: D

• A. Document the privacy breach in the nursing notes of the patient's electronic health record.

  This is incorrect. Incident reports and privacy breaches involving staff or students are documented in administrative risk management systems, not in the patient's clinical medical record, as they do not reflect the patient's clinical care.

• B. Verify that the student obscures the patient's identifying information before the presentation.

  This is incorrect because storing unencrypted Protected Health Information (PHI) on a personal device is already a legally actionable security breach, regardless of whether the student plans to de-identify the image later.

• C. Confiscate the student's smartphone and submit it to the hospital's security department.

  This is incorrect. Confiscating a student's personal property falls outside the nurse's legal scope of practice and authority. The correct approach is verbal instruction and leadership escalation.

• D. Instruct the student to delete the photograph immediately and notify the unit manager.

  Under the framework of ethical and legal nursing practice (patient rights and safety), maintaining patient confidentiality is a primary professional responsibility. Capturing Protected Health Information (PHI) on an unauthorized personal device is a direct violation of privacy laws and informatics security policies. The nurse's first priority is to mitigate the immediate risk by having the unauthorized data destroyed, followed by escalating the incident to nursing leadership for formal risk management reporting.

American Nurses Association (ANA), Nursing: Scope and Standards of Practice, 4th Edition · Standard 7: Ethics (Maintaining patient confidentiality and privacy) (checked 15 August 2026)