Test Guidelines for the National Licensure Examination for Nurses (NLEN) 2012

• Board of Nepal Nursing Council (NNC) on February 27, 2012
• Revised: August, 2012
• Second revised September 2014

Nepal Nursing Council is an autonomous body under Nepal Nursing Council Act 2052 formulated by the Government of Nepal. It aims at promoting quality nursing education in order to bring quality nursing service in the country. The Licensure Examination for Nurses is a national examination for nurses developed by the Nepal Nursing Council. ‘National Licensure Examination for Nurses is an examination to qualify as nursing professionals. This National Licensure Examination for Nurses is required for all new graduates of Proficiency Certificate Level (PCL) and Bachelor of Science in Nursing (BSc N.) The examination is geared towards testing knowledge and skills in relation to the job functions most commonly required by entry-level nurses. The examination determines eligibility to earn a title of registered nurse for to begin to working as a professional nurse. Nepal Nursing Council went through several processes to establish the Licensure Examination for Nurses in Nepal. Nursing council took references on licensing exam from SAARC as well as other developed countries. Nepal Nursing Council also received technical and human resource from JICA to support the conduct of the licensure examination.

Objectives

The objectives of licensure examination are as follows:

• To maintain quality nursing services to the public
• To maintain professional standard of knowledge and skills among new graduates
• To recommend for strengthening the capability of nursing institutions for quality nursing education

Eligibility

• Nepali citizen graduated from Nepal To meet the professional education requirement for licensure as a qualified professional nurse, the candidate must present satisfactory evidence of having received at least a four-year degree (B.Sc N.) or 3 years of Proficiency Certificate Level (Diploma level) program that is approved by NNC.
• Nepali citizen graduated from other countries Applicants, who have completed nursing education from other country, must have their equivalence certificate from the concerned authority. Individual applicant need to be graduated from the institute recognized from the respective nursing council or authorized government body and must submit the documents.
• Foreigners graduated from Nepal Foreign applicants graduated from Nepal must have completed nursing program from the institution approved by NNC and must submit the documents.
• Foreigners graduated from other countries A person, who comes to Nepal to work, must appear National Licensure Examination for Nurses in order to registered in NNC. Person, who stay with tourist visa are not allowed to apply

Exception

• Reporting prior convictions or discipline against licenses Applicants are required under ‘Regulation of the National Licensure Examination for Nurses’ to report all misdemeanor and felony convictions. Failure to report prior disciplinary action is considered falsification of application and is a ground for denial of licensure or revocation of license.
• Applicants with differently abled Applicants, who are differently abled, are under Civil Law.

The list of documents required for P.C.L. Nursing/B.Sc. Nursing

• Application form (original)
• Photocopies of the following documents * (SLC Mark sheet and Character Certificate, Citizenship, Academic Transcript or Mark sheet and Character Certificate of PCL Nursing, Academic Transcript or 10+2 Mark sheet or I.Sc. Mark sheet and Character Certificate for B.Sc. Nursing, Academic Transcript or Mark sheet and Character Certificate of B.Sc. Nursing
• Passport Size Photos (6)
• Examination fee (SBI Bank Voucher Original) Call Deposit A/C No, 20435240100009 (NRS 1500)
• Document of recognition /accreditation of institute from the nursing council or individual registration in the nursing council or in the authorized body (only in case of non-existence of nursing council) of the respective country (only applicable for the Nepalese graduated from the other countries). Attested by Notary Public for Foreign Degree Certificates, Equivalency letter from CTEVT/TU 1

* Original Certificate Document need to brought for Verification

The list of documents required for Foreign Nurses Items Number

• Application form, original
• Photocopy of Certificate of nursing educational degree,
• Photocopy of Certification of registration from the nursing council of respective country
• Recommendation letter from the organization in Nepal where the applicant is going to work (original)
• Photocopy of Valid visa or Passport/citizenship for those who do not need to have visa to enter Nepal,
• Examination fee (SBI Bank Voucher Original) Call Deposit A/C No, 20435240100009 NRS (2500)
• Passport size photos (5)
• Attested Photocopy of the Certificate of Nursing Educational degree by the Concerned Organization where the Individual works.

Examination Process / Rule

Duration of Examination

• Licensure Examination will be of three and half hours (3:30) duration.
• Applicants are not allowed to enter the examination room after 15 minutes from starting examination. Applicants can leave the room only after 1 hour of starting the examination.

Type of Questions

All of the test items are Multiple Choice Question (MCQ) with four options. Applicants are to select the most appropriate choice.

Subject wise distribution of test items

Subjects Distribution of test items (%) (Possible numbers of items)

• Integrated Science 5% (10)
• Fundamental of Nursing 25% (50)
• Community Health Nursing 15% (30)
• Adult Nursing 20% (40)
• Child Health Nursing 10% (20)
• Midwifery and Gynecology 20% (40)
• Leadership and Management 5% (10)
• Total (200)

Syllabus for NLEN

Integrated Science

Integrated Science includes subjects like Anatomy/ Physiology, Microbiology, and Pharmacology related content but is not limited to:

I. Anatomy/ Physiology

• Cardiovascular/ Lymphatic System: Body fluid/Electrolytes and Acid- Base Balance Blood Composition, Plasma and Plasma Proteins Physiology of Red Blood Cells, White Blood Cells, Platelets Blood Groups and blood transfusion
• Anatomy of Cardiovascular System: The Heart and Blood Vessels Physiological Activities of the Heart Physiology of Circulation Cardiovascular Regulation and Adjustments Lymphatic/ Immune system Human cell and its structure
• Musculoskeletal System: The Human Skeleton, its structure and physiology The Joints The Skeletal Muscles of Human Body Neuromuscular Junction and Muscle Physiology
• Nervous System: Functional unit of nervous system Central Nervous System Peripheral Nervous System Autonomic Nervous System Somatosensory, Somatomotor System and Reflexes Meninges, Cerebrospinal Fluid, Blood- Brain Barrier and Central Blood Flow
• Respiratory System: Structure and Functions of Respiratory System Physiology/Mechanism/ Control of Respiration
• Gastro-Intestinal System: Structure and Functions of Digestive System Digestion and Absorption of nutrients Accessory organs of Gastro-Intestinal system
• Endocrine System: Structure and functions of endocrine glands and hormones.
• Urinary System: Functional unit of urinary system Physiology of urine formation
• Reproductive System: Male Reproductive System Female Reproductive System Physiology of Contraception
• Special Sensory System: Eye, Ear, Nose, Throat The Skin and Fascia

Microbiology/ Parasitology

• Factors affecting the growth and survival of micro organisms
• Types of parasites affecting to human body and its mechanism to develop diseases

Pharmacology:

• Types and Function of Drugs
• Pharmacokinetics: absorption, distribution, metabolism, excretion of drug, and factors influencing the pharmacokinetics
• Pharmacodynamics: drug action, adverse reaction to drugs
• Essential, emergency and Life Saving Drugs used in Nepal
• Drugs acting on different body systems

ii Fundamentals of Nursing
 
Related content includes but is not limited to:

• Ethics in Nursing: International Councils of Nurses (ICN) Code, Nepal Nursing Council Act and Regulation.
• Patient’s Rights
• Informed Consent 
• Assessment (history taking vital signs and physical

Nursing diagnosis

• Evaluation of nursing care: objective         data 
• Nursing Process
• Caring
• Admission and discharge procedure
• Role and responsibility   of   nurse   in   laboratory   test/examination:   invasive and    non- invasive   procedures: e.g. blood test, lumbar puncture, thoracentesis,
• ultrasonography
• Personal hygiene
• Safety and Infection Control: Safety Devices, Accident/ Injury Prevention, Infectious Materials, Universal Precaution
• Rest and Sleep pressure relief measure
• Comfort/  pain relief measure
• Meeting nutritional needs Meeting elimination needs: catheterization,  intake
• Rehabilitative care
• Care for dead body

Nursing responsibility for drug administration

• Routes of administration of the drug
• Dosage Calculation and Administration of drugs
• Indications, contraindications and interactions, adverse effect , side-effect
• Responsibility of nurses in administration of medicine: e.g. Six rules in administration of the drug
• Administration and management of IV fluids, Blood and Blood products

First Aid

• Basic Cardiopulmonary Resuscitation (CPR)
• Bites : insects, snake, animals and their first aid management
• Burn: Degrees / types of management Wounds: Dressing and Bandage Hemorrhage
• Choking Fracture Drowning Frostbite Poisoning

Community Health Nursing

Related content includes but is not limited to:

• Community Health and Community Health Nursing
• Communication skills
• Community resources
• Health Education
• Home visiting

Primary Health Care (PHC): Elements and role of nurses in PHC
Demography/ Health Indicators: (e.g. IMR. MMR, TFR)
Epidemiology 

• Role of epidemiology
• Community Diagnosis
• Role and responsibilities of Nurses in epidemiological approach

Environmental Health: Sanitation, Water, Housing, Pollution
Nutrition

• Nutritients and their functions
• Nutritional Deficiency disorders: Types and characteristics
• Management of the clients with nutritional deficiency

Immunization

• Types, Purposes and Functions of immunization
• Administration of immunization Routs
• National Immunization Program in Nepal

Maternal and Child Health

• MCH clinics: Antenatal Care (ANC), Postnatal Care (PNC)
• Growth Monitoring of Under Five Children
• Under Five’s Clinic

Gender Issues 

• Sex and gender
• Gender issues: e.g. gender equity, gender equality, gender discrimination, Domestic Violence

Family Planning

• Population problems in Nepal
• Types, methods, advantages and disadvantages of different family planning methods
• Emergency Contraception and methods
• FP Counseling

HIV/AIDs, STI

• Prevention of HIV/AIDS, STI
• Treatment and management for the clients with HIV/AIDS, STI

Family Health Nursing

III. Adult Nursing

Related content includes but is not limited to:

• Characteristics of adulthood, developmental tasks of young adult, middle-aged adults, elderly adult
• Aging process
• Disorders  of  each  body  system:  Blood,  Body  Fluids/Electrolytes,  Nervous  System,  Circulatory
• System,  Respiratory  System,  Musculoskeletal  System,  Gastro-Intestinal  and  Nutritional  System, Urinary System, Endocrine System, Sensory System (Common disorders, investigations and medical/surgical treatment of different body system disorders,  Medical/Surgical nursing management for the client with disorders in each system)
• Mental Health Problems  (Assessment of mentally ill clients, characteristic of mental health, Major and minor disorders, treatment and nursing management)
• Operation Theatre Nursing (Operation Theatre (OT)  Nursing, Characteristics of OT nurse, OT technique (e.g. aseptic technique, sterilization, scrubbing, gowning, gloving) Role and Responsibilities of scrub nurse, circulatory nurse, and recovery nurse Common surgical materials, equipments, and supplies in OT and their preparation Sterilization and)
• Pre and Post-operative Nursing care
• Rehabilitation (Disability: Types and characteristics, Role and responsibility of nurses in rehabilitation, Nursing management of disable client)
• Nursing  care  of  the  client  in  the  terminal  stage (Stages of dying Grief    and    Loss, Holistic Care)
• Stress and Crisis Management (Body’s response to stress, Role of nurses  in  stress and crisis  management)

Child Health Nursing
Related content includes but is not limited to:

• Terminology of Child Health Nursing 
• Growth and development of child in each stage: infancy,
• school-age and adolescence
• Nursing role on promotion of growth and development of childran
• Nursing care to child and family ( Influences brought by diseases and hospitalization, Nursing care for children with accident/ injury, Nursing care for children with common communicable diseases, Nepal Nursing care for children with congenital/ chromosomal disorders, Nursing care for children with ……….of different body systems : nervous system, musculoskeletal system, respiratory system, circulatory system, blood, gastro- intestinal, urinary system, endocrine system, sensory)

Health Promotion for system children: Nutrition, exercise, play, anticipatory guidance (Mortality and Morbidity in Under Five Children and their prevention, Nursing role on prevention and management of children with HIV/AIDs)
Integrated Management of Childhood Illness (IMCI) program
Paediatric Procedure

• Oxygen administration (e.g. head box, oxygen tent) Nebulization
• Positioning/ Restraining
• Calculation of drugs and its administration
• Different types feeding
• IV fluid administration and management
• Phototherapy
• Care for incubator
• Colostomy and tracheostomy care Cardio Pulmonary Resuscitation (CPR) Specimen collection
• Assisting in common invasive procedures (e.g. lumbar puncture)

Midwifery and Gynecology
Related contents include the following but not limited to:
Deformination of …… and ………….,  Reproduction in human being

• Components of reproductive health
• Reproductive rights

Maternal and Newborn Health in Nepal (Strategies and policies of reproductive health in Nepal, Skill Birth Attendant (SBA) policy Safe Motherhood Program)
Nursing care in every stage of female life cycle (Puberty/ Adolescent Health: physical and psychological changes, nursing care for during puberty /adolescent, Reproductive age/years: nursing care for the client of reproductive ages/years, Climacteric care: physical and psychological changes during the peri-menopause, counseling, medical management(e.g. Hormone Replacement Therapy; HRT)
Fetal  growth  and  development:  normality  and  abnormalities  on  fetal,  placenta,  membrane  and cord
Care during Pregnancy

• Health promotion of pregnant women,
• Components of antenatal care
• Birth Preparedness and Complication readiness,
• Care of pregnant women with minor/major disorders of pregnancy (e.g. constipation, varicose veins, back pain, edema, threatened abortion , placenta preavia)

Care during labor and birth

• Physiology and mechanism of labor
• Management of mother in labor : normal delivery, induction and augmentation of labor, Monitoring fetal condition: prevention and manager ……………..)

Postnatal Care

• Physical and psychological changes during puerperial period
• Nursing care for women with minor/major problems of puerperium (e.g. hemorrhage, infection,
• Breast Feeding: Importance, mechanism of secretion of breast milk, nursing care for mother with problems on breast feeding (e.g. mastitis),
• Breast feeding in HIV / Hepatitis B positive mothers (e.g. PMTCT)

Newborn Baby Care

• Neonatal assessment, Immediate care of newborn
• Nursing care for newborn baby with dysfunction and problems (e.g. Respiratory distress syndrome, meconium aspiration syndrome

Obstetric Emergencies

• Nursing management for the clients with high risk/ critical condition in antenatal period (e.g. PIH)
• Nursing management for the clients with high risk/ critical condition in perinatal period (e.g mal presentation and prolapse of the cord.)
• Nursing management for the clients with high risk/ critical condition in postnatal period (e.g. PPH, ruptured uterus )

Nursing Care for Gynecological problems

• Sub fertility/ Infertility: Types, cause and treatment and nursing management of infertility in both male and female,
• Sexually Transmitted Infection (STI): National Protocol to manage STIs, Cervical Cancer, Breast Cancer
• Genital prolapsed …………….fistula)
• Nursing management obstetric fistula: Recto-vaginal fistula and vesico-vaginal

Leadership and Management

Related content includes but is not limited to:
Concept of Leadership and Management

• Role, Styles, Characteristics and Functions of Leadership Role and Responsibilities of Health Care Team Members Principles, Types and Functions of Management
• Conflict Management
• Purpose, principles, categories of Supervision
• Qualities of Supervisor

Health     Service     Delivery     System:    

• Hospital     and Community Methods of Organizational management
• Organogram Management of Resources
• Patient assignment methods: Rotation Plan, assignment
• Job Description of different categories of health personnel
• Job Description of different level of nursing personnel

Professional Development
Definition and Criteria of Profession

• Professional Organizations: Nursing Association of Nepal (NAN), Nepal Nursing Council (NNC), International Council of Nurses (ICN), International Confederation of Midwives (ICM)

Health Policy and Planning

• National Health Planning: SLTHP and Five Year Plans Country Profile

For further information please visit Nepal Nursing Council website:
www.nnc.org.np or contact Nepal Nursing Council office.