SNLE exam: free questions, blueprint and pass score

Results: A scaled score on a 200-800 reporting scale, with a statement of results and a feedback report comparing you with other test takers - announced 2-6 weeks after the test window closes.

Attempts: You may sit each licensure exam up to four times a year, counted from your first attempt, until you pass. You cannot sit twice in the same testing window - the second sitting counts as an attempt and its result is void. Arriving more than 30 minutes late also counts as an attempt unless SCFHS accepts a documented reason. After passing, you get two further attempts to improve your score, for residency selection.

1. Question 1Nursing Fundamentalseasy

   A nurse adjusts a patient's IV pump settings and straightens the bed linen, without touching the patient, and then leaves the room. Which of the WHO five moments for hand hygiene applies?

   1. ABefore touching a patient
   2. BBefore a clean or aseptic procedure
   3. CAfter touching patient surroundings
   4. DAfter body fluid exposure risk
   Show answer and explanation▾

   Answer: C. After touching patient surroundings

   Touching objects in the patient's immediate surroundings, such as the bed, pump or linen, without touching the patient is moment 5: after touching patient surroundings. The other moments apply to direct patient contact, aseptic tasks or body fluid exposure.

   Reference: WHO Guidelines on Hand Hygiene in Health Care (2009)

2. Question 2Nursing Fundamentalseasy

   On a patient's sacrum, a nurse finds a shallow open wound with a moist pink wound bed. There is no slough, no visible fat and no tunnelling. How should this pressure injury be staged?

   1. AStage 1
   2. BStage 2
   3. CStage 3
   4. DUnstageable
   Show answer and explanation▾

   Answer: B. Stage 2

   Stage 2 is partial-thickness skin loss with exposed dermis: a pink or red, moist wound bed without slough or visible fat. Stage 1 is intact skin with non-blanchable redness. Stage 3 shows full-thickness loss with visible fat, and unstageable wounds are obscured by slough or eschar.

   Reference: NPIAP Pressure Injury Stages (2016)

3. Question 3Nursing Fundamentalseasy

   A patient in diabetic ketoacidosis needs a continuous IV insulin infusion. Which insulin can the nurse prepare for intravenous use?

   1. AInsulin glargine
   2. BNPH (isophane) insulin
   3. CRegular (soluble) human insulin
   4. DInsulin detemir
   Show answer and explanation▾

   Answer: C. Regular (soluble) human insulin

   Regular (soluble) insulin is clear and short-acting and can be given intravenously. NPH is a suspension and must never be given IV, and long-acting analogues such as glargine and detemir are for subcutaneous use only.

   Reference: McCuistion, Pharmacology: A Patient-Centered Nursing Process Approach, 9th ed. (2017)

4. Question 4Adult Nursingmedium

   Twelve hours after a total thyroidectomy, a patient reports tingling around the mouth and in the fingertips. Tapping over the facial nerve causes the corner of the mouth to twitch. What should the nurse prepare for?

   1. AIV calcium gluconate
   2. BIV potassium chloride
   3. COral levothyroxine
   4. DEmergency tracheostomy
   Show answer and explanation▾

   Answer: A. IV calcium gluconate

   Perioral tingling and a positive Chvostek sign after thyroidectomy suggest hypocalcaemia from parathyroid injury or removal. IV calcium gluconate should be ready. Potassium and levothyroxine do not treat it, and tracheostomy is for airway obstruction such as from a neck haematoma.

   Reference: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. (2018)

5. Question 5Adult Nursingmedium

   A nurse checks a patient's chest drain and sees continuous bubbling in the water-seal chamber. What does this most likely indicate?

   1. ANormal functioning of the system
   2. BAn air leak in the patient or the drainage system
   3. CFull re-expansion of the lung
   4. DAn obstructed drain tube
   Show answer and explanation▾

   Answer: B. An air leak in the patient or the drainage system

   Continuous bubbling in the water-seal chamber means air is entering the system, from the pleural space or from a loose connection, so the nurse checks the system from the patient outwards. Gentle rise and fall with breathing (tidalling) is normal, and tidalling that stops can mean lung re-expansion or a blocked tube.

   Reference: Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 11th ed. (2020)

6. Question 6Adult Nursingeasy

   Twenty minutes into a red cell transfusion, a patient develops chills, a temperature rise of 1.5 °C and lower back pain. What is the nurse's first action?

   1. ASlow the transfusion rate and recheck in 15 minutes
   2. BStop the transfusion and keep the IV line open with 0.9% saline
   3. CGive paracetamol and continue the transfusion
   4. DSend the blood bag back to the laboratory once the unit is finished
   Show answer and explanation▾

   Answer: B. Stop the transfusion and keep the IV line open with 0.9% saline

   Fever, chills and back pain can signal an acute haemolytic reaction. Stop the transfusion immediately, keep venous access with saline through new tubing, check vital signs, inform the doctor and return the bag and giving set to the blood bank. Slowing or continuing the transfusion risks giving more incompatible blood.

   Reference: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. (2018)

7. Question 7Adult Nursingeasy

   A patient with type 2 diabetes is sweaty and shaky, with a capillary glucose of 3.2 mmol/L (58 mg/dL). She is alert and able to swallow. What should the nurse do first?

   1. AGive 15-20 g of fast-acting oral carbohydrate and recheck glucose in 15 minutes
   2. BGive IV 50% dextrose
   3. CGive intramuscular glucagon
   4. DGive her usual dose of insulin with a meal
   Show answer and explanation▾

   Answer: A. Give 15-20 g of fast-acting oral carbohydrate and recheck glucose in 15 minutes

   A conscious patient who can swallow should be given 15-20 g of fast-acting glucose, with glucose rechecked after 15 minutes and treatment repeated if it is still low. IV dextrose and glucagon are for patients who cannot take oral treatment, and insulin would worsen hypoglycaemia.

   Reference: ADA Standards of Care in Diabetes: Glycemic Goals and Hypoglycemia (2024)

8. Question 8Adult Nursingmedium

   After a head injury, a patient opens his eyes only to a painful stimulus, makes incomprehensible sounds and withdraws his arm from pain. What is his Glasgow Coma Scale score?

   1. A6
   2. B7
   3. C8
   4. D9
   Show answer and explanation▾

   Answer: C. 8

   Eye opening to pain scores 2, incomprehensible sounds score 2 for verbal, and withdrawal from pain scores 4 for motor, giving a total of 8. A GCS of 8 or less usually means the airway needs protecting.

   Reference: Urden, Stacy and Lough, Critical Care Nursing: Diagnosis and Management, 9th ed. (2021)

9. Question 9Adult Nursingeasy

   A patient with acute heart failure is started on IV furosemide. Which laboratory result is the priority for the nurse to monitor?

   1. ASerum potassium
   2. BSerum amylase
   3. CHaemoglobin A1c
   4. DPlatelet count
   Show answer and explanation▾

   Answer: A. Serum potassium

   Loop diuretics cause potassium loss, and hypokalaemia can trigger arrhythmias, especially with digoxin. Potassium, along with sodium, renal function and fluid balance, is the priority. The other tests are not directly affected by furosemide.

   Reference: McCuistion, Pharmacology: A Patient-Centered Nursing Process Approach, 9th ed. (2017)

10. Question 10Maternal-Child Nursingmedium

    Four hours after a vaginal birth, the nurse finds the uterine fundus firm, 2 cm above the umbilicus and deviated to the right. Lochia is moderate. What is the most appropriate action?

    1. AAssist the woman to empty her bladder, then reassess the fundus
    2. BStart an oxytocin infusion
    3. CMassage the fundus vigorously
    4. DDocument this as a normal finding
    Show answer and explanation▾

    Answer: A. Assist the woman to empty her bladder, then reassess the fundus

    A fundus that is firm but high and displaced to one side usually means a full bladder is pushing the uterus up, which can lead to atony and bleeding. Help the woman void, then reassess. Massage and oxytocin are for a boggy uterus, and this is not a normal finding.

    Reference: Ricci, Essentials of Maternity, Newborn, and Women's Health Nursing, 5th ed. (2020)

11. Question 11Maternal-Child Nursingmedium

    At 1 minute after birth, a newborn has a heart rate of 110/min, slow and irregular breathing with a weak cry, some flexion of the limbs, a grimace when suctioned, and a pink body with blue hands and feet. What is the Apgar score?

    1. A5
    2. B6
    3. C7
    4. D8
    Show answer and explanation▾

    Answer: B. 6

    Heart rate under 100 scores 1 and over 100 scores 2, so 110/min scores 2. Slow, irregular breathing scores 1, some flexion 1, grimace 1, and a pink body with blue extremities (acrocyanosis) 1. The total is 6.

    Reference: AAP and ACOG Committee Opinion No. 644: The Apgar Score (2015)

12. Question 12Maternal-Child Nursingeasy

    An 18-month-old has had diarrhoea for two days and has some dehydration: she is thirsty with dry mucous membranes but is alert and can drink. What is the recommended treatment?

    1. AOral rehydration solution given in small, frequent amounts
    2. BUndiluted fruit juice to replace sugar
    3. CIV fluids for every child with diarrhoea
    4. DStop all fluids for 12 hours to rest the bowel
    Show answer and explanation▾

    Answer: A. Oral rehydration solution given in small, frequent amounts

    Mild to moderate dehydration is treated with oral rehydration solution, given in small, frequent sips, while feeding continues. Juice and soft drinks can worsen diarrhoea. IV fluids are kept for severe dehydration or when ORS fails, and withholding fluids is dangerous.

    Reference: Hockenberry and Wilson, Wong's Nursing Care of Infants and Children, 11th ed. (2019)

13. Question 13Maternal-Child Nursingmedium

    A 4-year-old arrives with a high fever, drooling, a muffled voice and sitting forward in a tripod position. Which action should the nurse avoid?

    1. AKeeping the child on the parent's lap
    2. BInspecting the throat with a tongue depressor
    3. CHaving emergency airway equipment ready
    4. DCalling the anaesthetist and ENT team
    Show answer and explanation▾

    Answer: B. Inspecting the throat with a tongue depressor

    These are signs of epiglottitis. Examining the throat with a tongue depressor can provoke laryngospasm and complete airway obstruction, so it is avoided until a team that can secure the airway is present. Keep the child calm with the parent and prepare for intubation.

    Reference: Hockenberry and Wilson, Wong's Nursing Care of Infants and Children, 11th ed. (2019)

14. Question 14Nursing Management and Leadershipeasy

    A registered nurse is planning care for four patients. Which task can be delegated to a nursing assistant?

    1. AThe admission assessment of a newly arrived patient
    2. BTeaching a patient to self-inject insulin
    3. CMeasuring routine vital signs on a stable post-operative patient
    4. DEvaluating a patient's response to IV morphine
    Show answer and explanation▾

    Answer: C. Measuring routine vital signs on a stable post-operative patient

    Routine, predictable tasks on stable patients, such as vital signs, can be delegated, and the RN remains accountable for interpreting them. Assessment, teaching and evaluation need nursing judgement and stay with the registered nurse.

    Reference: NCSBN and ANA National Guidelines for Nursing Delegation (2019)

15. Question 15Nursing Management and Leadershipmedium

    A nurse realises she gave a patient twice the prescribed dose of a medication. After assessing the patient, she finds he is stable. What should she do next?

    1. ASay nothing, because the patient was not harmed
    2. BNotify the prescriber, monitor the patient and complete an incident report
    3. CWrite in the patient's notes that an incident report has been filed
    4. DTell the patient's family that another nurse made the mistake
    Show answer and explanation▾

    Answer: B. Notify the prescriber, monitor the patient and complete an incident report

    Every medication error is reported, even without harm: the prescriber is told so the patient can be monitored and treated, and an incident report is completed for learning. The incident report is a quality document and is not referred to in the patient's notes, though the facts of the event and the care given are documented.

    Reference: Marquis and Huston, Leadership Roles and Management Functions in Nursing, 10th ed. (2020)

1. 1

   Check you are eligible

   BSN or equivalent, or in your internship year, or one year from graduation.

2. 2

   Apply through SCFHS's e-application

   SCFHS processes the application and issues a scheduling permit with your eligibility period. You receive an email with instructions for accessing it.

3. 3

   Book with Prometric

   Use the permit to schedule a date at an SCFHS-approved Prometric centre, in Saudi Arabia or abroad. Scheduling may not be open more than three months ahead, and SCFHS sets the testing windows.

4. 4

   Bring your permit and ID

   Centres open at 7:30 a.m. Bring the scheduling permit, on paper or on your phone, and a passport (or a national or residence ID in Saudi Arabia) with your name exactly as it appears on the permit. Without both you are turned away and pay a fee to reschedule.

5. 5

   Wait for your results

   Results are released 2-6 weeks after the testing window closes, as a statement of results and a feedback report comparing you with other candidates.