1. Test Guidelines for
the National Licensure Examination
for Nurses （NLEN）2012
1st edition
Effective 2012
Nepal Nursing Council
Kathmandu, Nepal

2. Prepared by:
Examination Committee, Nepal Nursing Council (NNC)
Ms. Chandrakala Sharma, Coordinator
Dr. Sarala Shrestha , member
Ms. Takma K.C. , member
Ms. Pramila Dewan , member
Ms. Jamuna Sayami , member
Ms. Kei MIYAMOTO, Japan International Cooperation Agency (JICA)
Approved by:
Board of Nepal Nursing Council (NNC) on February 27, 2012
Published by:
Nepal Nursing Council
Address: Bansbari, Kathmandu, Nepal
Tel : 977-1-4372521
Fax : 977-1-4377214
E-mail : nncouncil@wlink.com.np
Website : http://www.nnc.org.np

3. Table
I. Background
II. Test Guidelines for the 1st National Licensure Examination for Nurses
Introduction
Beliefs
Scope of Examination
Definition of the National Licensure Examination for Nurses
Definition of Nurse
Legal Force
Groups to the development and administration of the NLEN examination
Type of Questions
Distribution of Test Items
III. NLEN Content
IV. Licensure Requirements
Education Requirements
Examination Requirements
V. Administrative Process of the NLEN
Duration of Examination
Number of Test Items
Time and Frequency of the NLEN
Fee
Application Process
Scoring System
Passing Standard
Result of NLEN
Registration
Appendix
Test Items / Answers samples

4. I. Background
Nepal Nursing Council is an autonomous body under Nepal Nursing Council Act 2052 formulated by the
Government of Nepal with the aim to bring effectiveness in nursing service in the country, scientific
management and mobilization of nurses according to their qualification.
Nursing in Nepal commenced in 1956 at Bir hospital. Currently nursing educational program such as Auxiliary
Nurse Midwife, Proficiency Certificate level, Bachelor of Science in Nursing, Bachelor of Nursing, Master in
Nursing, and Master of Science in Nursing are available in Nepal.
To maintain the aim of Nepal Nursing Council it is important that the council accreditates nursing courses and
supervises nursing education institutions to ensure quality nursing care for the people in Nepal. Registration of
all nurses is required to assist workforce planning, nurse immigration and professional misconduct reporting.
II. Test Guidelines for the 1st National Licensure Examination for Nurses Guidelines
Introduction
The Licensure Examination for Nurses is a national, standardized examination for nurses developed by the
Nepal Nursing Council. The examination is practical oriented in relation to the job functions most commonly
required for entry-level nurses. The examination tests current medical knowledge, nursing competencies and
determines eligibility to earn a nurse license and begin working as a nurse
The licensure examination was developed in several steps. Firstly, the NNC requested a technical person to
Japan International Cooperation Agency (JICA) and gained one nursing professional deputed by JICA for
starting preparation of the National Licensure Examination for Nurses. Secondary, an Examination Committee
was established and started collecting information nationally and internationally how to conduct the licensure
examination including observation visits to India Nursing Council, Texas Board Nursing Council, United
States, and Nepal Medical Council. Thirdly, the Council conducted orientation programs in five regions in
order to make stakeholders, such as nursing institutions, nursing faculties, nursing students, practitioner in
clinical fields and consumers, aware of the licensure examination. The total number of participants was over
250 and those who participated in the programs gave feedback positively. After that, the Examination
Committee drafted the National Licensure Examination for Nurses Guidelines. Guidelines were moderated
through one workshop with representatives of nursing campuses and Council of Technical Education and
Vocational Training (CTEVT). The guidelines for licensure examination were approved by the board of Nepal
Nursing Council and disseminated to all the nursing campuses and candidates. The guidelines provide
information on selection of content, behaviors to prepare for test, and administration of the examination.
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
The guidelines for National Licensure Examination for Nurses provide a concise summary of the content and
scope of the licensing examination. It serves as a guide for examination development as well as candidate
preparation. Each licensure examination is based on the guidelines. The licensure examination assesses the
knowledge, skills, medical ethic and abilities that are essential in order to cure, care, rehabilitate and promote
the health of clients.

5. Beliefs
There are more than 245 nursing educational programs in Nepal that have commenced after the government
privatized health manpower education production. As the number of institutes is growing the quality has been
reported as deteriorating due to the lack of clinical placements and frequent turnover of nursing faculty. At the
same time development of modern medicine has identified patient's right to receive quality health care/
services and make them aware of care/services. Therefore, qualified nursing education is essential for job
opportunity in the country and immigration abroad. To maintain the standard in all the nursing educational
program is becoming difficult even though Nepal Nursing Council is monitoring and accrediting all the
program regularly.
With the aim of quality of nursing education and registration of new graduates, Nepal Nursing Council
believes that Licensure Examination shall have to be conducted as one method for maintaining quality of both
nursing education and nursing care in the clinical sector.
Scope of Examination
Standardize knowledge, skills and abilities essential to public safety and effective nursing practice
Definition of the National Licensure Examination for Nurses
'National Licensure Examination for Nurses' is defined to be an entrance examination to be qualified to be
identified? as a nursing professional. This National Licensure Examination for Nurses is applied to all the new
graduates from Proficiency Certificate Level (P.C.L.) and Bachelor of Science in Nursing (B.Sc.N.) .
Graduation or completion of nursing education in P.C.L. or B.Sc. N is a requirement to sit the National
Licensure Examination. All the graduates of P.C.L and B.Sc. N must pass the National Licensure Examination
before they start working as a nursing professional.
The National Licensure Examination for Nurses is the entry qualification to be a nursing professional. It
should be distinguished differently from academic degree so that the Licensure Examination is applied to both
B.SC.N and P.C.L at diploma level.
The title was recognized by the Board of Nepal Nursing Council, and also has exclusive right on the title. No
one can employ the title with making alterations. The abbreviated title is 'NLEN' in this context.
Definition of Nurse
Nurse is a person who has a degree in nursing and has passed an examination to be allowed to work in Nepal.
It can be defined differently from A.N.M. which completes a- 18 month nursing educational program after
S.L.C. passed or a- 24 month nursing educational program after 10th grades, and work as a nurse.
Legal force
'Nepal Nursing Council First Amendment Act 2052 (1996)' lays down a Licensing Examination issue on Act
No.15 of 2052 B.S. and Nursing Council Act Section 24 "Ka" has the provision of conducting National
Licensing Examination for Nurses.
Groups to the development and administration of the NLEN examination.

6. The groups listed below contributed to the development and administration of the NLEN.
Nepal Nursing Council Board
All related process and documents have been approved by the Board of Nepal Nursing Council.
Examination Committee
The Examination Committee provides general oversight of the examination process of
administration and quality assurance to ensure consistency and fairness.
Type of Questions
All of test items are based on Multiple Choice Question (MCQ) with four items. Applicants are to select the
most appropriate choice (key). Situational questions may also be included. Applicants are advised to read test
items carefully before answering.
Distribution of Test Items
Table 1 Distribution of test items in subject wise
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

7. III. NLEN Content
The following provides information on the NLEN test content that will be used by item writers and item
reviewers.
Integrated Science
Integrated Science means subjects related to Anatomy/ Physiology, microbiology, and pharmacology, and
mechanism of diseases and promotion. Related content includes but is not limited to:
Anatomy/ Physiology
Composition, Structure, Functions of each organ and accessory organs
Cardiovascular/ Lymphatic System:
Body fluid/Electrolytes and Acid-Base Balance
Blood Composition, Plasma and Plasma Proteins
Physiology of Red Blood Cells, White Blood Cells, Plates
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
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
Accessory organs of Gastro-Intestinal system
Endocrine System
Organization and General Principles of Endocrinal System: Hypothalamus, Pituitary Gland,
Thyroid Gland, Parathyroid Glands, Thymus, and Adrenal Glands
Physiology of Hormones: e.g. Pancreatic and Gastrointestinal Hormones of other organs
Urinary System
Functional unit of urinary system
Physiology of urine formation
Reproductive System
Growth and Development in sexual organs
Male Reproductive System
Female Reproductive System
Physiology of Contraception
Special Sensory System

8. Eye, Ear, Nose, Throat
The Skin and Fascia
Common disorders in each system
Medicine used for clients with common disorders in each system
Microbiology/ Parasitology
Human cell and its structure
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 used in different body system ( e.g. antibiotics, antipyretic, antiinflammatory, antianalgic,
anticoagulant, anti-tubercular, anti-leprosy, anti-malarial, anti-leishmaniases, anti-filarial, cytotoxic, and
drugs for HIV/AIDS)
Fundamental of Nursing
Related content includes but is not limited to:
Foundation of nursing
Law and ethics in nursing: International Councils of Nurses (ICN) Code, Nepal Nursing
Council Act and Regulation.
Patient’s Rights
Informed Consent
Nursing Process
Communication: types and its characteristics
Client’s needs, Maslow’s hierarchy
Taking vital signs and assessment of changes
Physical examination
Nursing care planning
Recording/ Documentation
Caring
Admission and discharge procedure
The 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
Comfort/ Relief pain
Care of Nutritional needs
Care of Elimination
Rehabilitative care
Care for dead body
Nursing responsibility for drug administration
Route of administration of the drug :topical, instillation, oral, injectable medicine and
inhalation, medicine through rectum and vagina

9. Dosage Calculation and Administration
Indications, contraindications and interactions, adverse effect , side-effect
Responsibility of nurses on administration of medicine: e.g. Six rules on administration of
the drug
Administration and management of IV fluids, Blood and Blood products
First Aid
Basic Cardiopulmonary Resuscitation (CPR)
Bites: insects, snake, animals
Burn
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
Components of nutrition and its function
Nutritional Deficiency: types and characteristics
Management for the clients with nutritional deficiency
Immunization
Types, Purposes, Functions of immunization
Administration of each immunization
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
IMCI guidelines
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 each family planning method in male and
female

10. Emergency Contraceptive Methods
Nursing management: e.g. Counseling
HIV/AIDs, STI
Prevention and management of HIV/AIDs, STI
Medication for the clients with HIV/AIDs, STI
Family Health Nursing
Adult Nursing
Related content includes but is not limited to:
Characteristics of adulthood with developmental tasks in each stage: young adult, middle-aged adults,
elderly adults
Aging process
Disorders of each 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 in each system
Medical/Surgical nursing management for the client with disorders in each system
Mental Health Problems
Assessment of mentally ill clients
Major and minor disorders, treatment and nursing management
Operational Theatre Nursing (OT nursing)
Characteristics of OT nursing
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
Pre-, Post-operative nursing care
Rehabilitation
Disability: types and characteristics
Role and responsibility of nurses in rehabilitation
Nursing management to disability on chronic process
Nursing care for 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: neonate, infant toddler、pre-school children, school-age
children, adolescent
Nursing role on promotion of growth and development
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 on children of Nepal

11. Nursing care for children with congenital/ chromosomal disorders
Common Childhood Disorders of different system, investigation, treatment and
medical/surgical
nursing management
Nursing care for children with major diseases in : nervous system, musculoskeletal system,
respiratory system, circulatory system, blood, gastro-intestinal, urinary system, endocrine
system, sensory
Health Promotion for sick children: nutrition, exercise, play, anticipatory guidance
Mortality and Morbidity of Child in Nepal
Role of nurse to reduce Mortality and Morbidity on Under Five Children
Nursing role on prevention and management of children with HIV/AIDs
Integrated Management of Childhood Illness (IMCI) program
Identification of Child unit: meeting physical and comfort needs (e.g. bed size, paediatric set up,
placement of the ward)
Paediatric Procedure
Oxygen administration (e.g. head box, oxygen tent)
Nebulization
Positioning/ Restraining
Calculation of drugs and its administration
Feeding in different types
IV fluid administration and management
Phototherapy
Care for incubator
Colostomy and tracheostomy care
Cardio Pulmonary Resuscitation (CPR)
Specimen collection
Assisting common invasive procedures (e.g. lumbar puncture)
Midwifery and Gynecology
Related contents include the following but not limited to:
Sex/ sexuality and Reproduction of human being
Components of reproductive health
Reproductive health/rights
Maternal and Newborn Health status 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

12. Physiology and mechanism of labor
Nursing management of mother in labor : normal delivery, induction and augmentation of
labor
Monitoring fetal condition: prevention of its abnormalities in labor
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-infertility/ Infertility: Types, cause and treatment and nursing management of infertility
in both male and female,
Sexual Transmitted Infection (STI): National Protocol to manage STIs, Nursing management
Nursing management for Cervical Cancer, Breast Cancer
Nursing management for Uterine prolapsed
Nursing management for other problems on reproductive and genital organs (e.g. obstetric
fistula)
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, 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

13. (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

14. IV. Licensure Requirements
Education Requirements
(A) Nepali citizen graduated from Nepal
To meet the professional education requirement for licensure as a qualified professional nurse,
candidates 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.
(B) Nepali citizen graduated from other countries
Applicants, who have completed general nursing education out of country, must have their
equivalence certificate from the concerned authority.
(C) Foreigners graduated from Nepal
Foreign applicants, who have completed nursing program from Nepal approved by NNC, must
submit required documents.
(D) Foreigners graduated from other countries
Person who were sent from governmental organizations or international cooperation agencies
are not required to sit in the National Licensure Examination for Nurses in Nepal. A person,
who come to Nepal voluntarily on an individual basis to work, must sit in the National
Licensure Examination for Nurses. Person, who stay with tourist visa are not allowed to apply.
Examination Requirements
(A) 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 or disciplinary action is
considered falsification of application and is grounds for denial of licensure or revocation of
license.
(B) Applicants with differently abled
Applicants, who are differently abled, are under Civil Law.

15. V. Administrative Process of the NLEN
Duration of Examination
A Licensure Examination will be of three and half hours. Applicants are not allowed to enter the examination
room after 15 minutes from starting examination. Applicants can leave the room after 1 hour of starting.
Number of Test Items
The number of test item would be 200 Multiple Choice Questions (MCQs).
Time and Frequency of the NLEN
The Nepal Nursing Council conducts the Licensure Examination for Nurses biannually in April / May and
November / December every year. If applicant fails an examination, s/he should apply for the next examination
date.
Fee
The fee for the National Licensure Examination for Nurses is NRs 1,500. Fees are not refundable even if an
applicant is found ineligible. Applicants are totally responsible for their application to sit the examination.
Application process
Applicants must complete an application form for the licensure examination and pay examination fee.
The following documents are required to be submitted with an application form.
Table 2 The list of documentation and payment required for P.C.L. Nursing
Items Published by Number
Application form of NNC, original Nepal Nursing Council 1
Mark sheet and Character of S.L.C., original HMG Board, School 1
with photocopy
Citizenship certificate, original with District Office 1
photocopy
Academic Transcript and character of Nursing Institute graduated 1
P.C.L. Nursing, original with photocopy
Bank receipt, original SBI Bank 1
Passport size photo - 5

16. Table 3 The list of documentation and payment required for B.Sc. Nursing
Items Published by Number
Application form of NNC, original Nepal Nursing Council 1
Mark sheet and Character of S.L.C., original HMG Board, School 1
with photocopy
Mark sheet and Character of I.Sc. or 10+2, HSEB / TU, College 1
Original with photocopy
Mark sheet, Character and Academic Nursing Institute graduated 1
Transcript of B.Sc. Nursing, original with
photocopy
Citizenship certificate, original with District Office 1
photocopy
Bank receipt, original SBI Bank 1
Passport size photo - 5
Table 4 The list of documentation and payment required for Foreign Nurse
Items Published by Number
Application form of NNC, original Nepal Nursing Council 1
Certificate of nursing educational degree, Nursing Institution 1
original with photocopy
Certified copy of transcript from nursing Nursing Institution 1
degree in original language and Nepali,
original with photocopy
Certificate of Home country registration as a Nursing Council 1
nurse
Recommendation letter from the organization Organization 1
in which the applicant is going to, original
Valid visa or citizenship who do not need to - 1
have visa to entry Nepal, original with
photocopy
Bank receipt, original SBI Bank 1
Passport size photo - 5
The process is:
1. An applicant must submit all the documents required at one time to Nepal Nursing Council
2. When an applicant submits all documents and they are recognized at NNC, s/he receives a
examination card with entry number, date and time of the examination, but no name of examination
center.
3. The name of examination center will be informed to all applicants two days prior to the examination.
ATTENTION!
- If an applicant changes her/his name and/or address after submitting an application
for licensure, the applicant must notify the Examination Committee immediately in order to receive
current information. Applicants are required to submit legal documentation of any change to the
Examination Committee immediately change occurs.
- Applicant’s name must match EXACTLY as it appears on photo identification that will be at the test
center. The same name must also be provided to the NLEN test service at the time s/he register in
order to prevent delays with issuing examination authorization.
Scoring System

17. There is no negative scoring system. It means when applicant gives wrong answer, no minus marking occurs.
Marks count only for correct answers.
Passing Standard
The grading system on the Licensure Examination for Nurses Examination is either pass or fail. There is no
numerical score. Examination Committee may have to make fine adjustments to the passing standard,
however, total mark is required to be over 60 % aggregate. An applicant’s performance on the examination
must be above the pass standard.
Result of NLEN
The result of NLEN will be published within a week after the examination. Results will be published on Nepal
Nursing Council notice board. Nepal Nursing Council individually will not inform or contact anyone for this
purpose.
Registration
Once applicants have successfully passed NLEN they may apply for registration to get their nursing license.
Registration fee is NRs 800. Application is required within one month of NLEN examination result. Required
documents are the following.
a. Certification of NLEN pass, original
b. Registration fee: NRs 800
For further information please contact e-mail address: nncouncil@wlink.com.np

18. APPENDIX
Test Items/ Answers Samples
1. The nurse calculates the IV flow rate for a postoperative client. The client is to receive 3,000 ml of
Ringer’s lactate solution IV to run over 24 hours. The IV infusion set has 10 drops per milliliter. The nurse
should regulate the client’s IV to deliver how many drops per minute?
a. 18
b. 21 (key)
c. 35
d. 40
2. The nurse in a primary care clinic is caring for a 68-year-old man. History reveals that the client has
smoked one pack of cigarettes per day for 45 years and drinks two beers per day. He is complaining of a
non-productive cough, chest discomfort, and dyspnea. The nurse hears isolated wheezing in the right
middle lobe. It would be MOST important for the nurse to complete which of the following orders?
a. Pulmonary function tests
b. Echocardiogram
c. Chest X-ray (key)
d. Sputum culture
3. An adult client with a history of gastrointestinal bleeding has a platelet count of 300,000 cells/mm3.
Which action by the nurse is MOST appropriate after seeing the laboratory results?
a. Report the abnormally low count.
b. Report the abnormally high count.
c. Place the client on bleeding precautions.
d. Place the normal report in the client’s record (key)
4. When collecting a 24-hour urine specimen for creatinine clearance, it is MOST important for the to do
which of the following?
a. Obtain an order from the physician for insertion of a Foley catheter.
b. Obtain the client’s weight prior to beginning the urine collection.
c. Discard the last voided specimen prior to ending the collection.
d. Ask if preservative is present in the container (key)
5. A client with emphysema becomes restless and confused. What step should the nurse take next?
a. Encourage the client to perform pursed-lip breathing.(key)
b. Check the client’s temperature.
c. Assess the client’s potassium level.
d. Increase the client’s oxygen flow rate to 5 litre/min.
6. Haloperidol (Haldol) 5 mg tid is ordered for a client with schizophrenia. Two days later, the client
complains of “tight jaws and a stiff neck.” The nurse should recognize that these complains are

19. a. common side effects of antipsychotic medications that will diminish over time.
b. early symptoms of extrapyramidal reactions to the medication. (key)
c. psychosomatic complains resulting from a delusional system.
d. permanent side effects of haldol.
7. The nurse cares for a client following surgery for removal of a cataract in her right eye. The client
complains of severe eye’s pain in her right eye. The nurse knows this symptom
a. is expected and should administer analgesic to the client
b. is expected and should maintain the client on the bed rest
c. is unexpected and may signify s detached retina.
d. is unexpected and may signify hemorrhage.(key)
8. The nurse is teaching a class on natural family planning. Which of the following statements, is made by a
client, indicates that teaching has been successful?
a. “When I ovulate, my basal temperature will be elevated for two days and then will decrease.”
b. “My cervical mucus will be thick, cloudy, and sticky when I ovulate.”
c. “Since I am regular, I will be fertile about 14 days after the beginning of my period.” (key)
d. “When I ovulate, my cervix will feel firm.”
9. The nurse is caring for clients on the pediatric ward. An eight –old- year client with second- and third-
degree burn on the right thigh is being admitted. The nurse should assign the new client to which one of
the following roommates?
a. A two-year-old with chicken pox
b. A four-year-old with asthma (key)
c. A nine-year-old with acute diarrhea
d. A ten-year-old with methicillin-resistant staph auerus (MRSA)
10. Which one is the characteristic to high risk of suffocation in the infant?
a. Because the nasal cavity is wide
b. Because the respiratory tract has small diameter (key)
c. Because the epiglottis is in the low position
d. Because the occupied ratio of tongue in the mouth is small
11. Which is incorrect one as the explanation of chlamydiosis in female?
a. The symptoms easily become apparent. (key)
b. It might be caused of infertility.
c. The partner of female should be treated.
d. Pelvic inflammatory disease can be occurred.
12. The nurse is caring for an RH negative mother who has delivered an Rh positive child. The mother states,
“The doctor told me about Rho GAM, but I’m still a little confused.” Which of the following responses, if
made by the nurse, is MOST appropriate?

20. a. “Rho GAM is given to your child to prevent the development of antibodies.”
b. “Rho GAM is given to your child to supply the necessary antibodies.”
c. “Rho GAM is given to you to prevent the formation of antibodies.” (key)
d. “Rho GAM is given to you to encourage the production of antibodies.”
13. A nurse in a maternity unit is reviewing the records of the clients on the unit. Which client would the nurse
identify as being at the greatest risk for developing disseminated coagulation (DIC)?
a. A primigravida with mild pre-eclampsia
b. A primigravida who delivered a 10-lb baby 3hours ago
c. A gravida II who has just been diagnoses with dead fetus syndrome (key)
d. A gravida IV who delivered 8 hours ago and has lost 500 mL of blood
14. To determine the structural relationship of one hospital department with another, the nurse should consult
which of the following?
a. Organization chart (key)
b. Job descriptions
c. Personnel policies
d. Policies and procedure manual
15. A new unit nurse, manager is holding her first staff meeting. The manager greets the staff and comments
that she has been employed to bring about performance improvement. The manager provides a plan that
she developed, as well as a list of tasks and activities for which each staff member must volunteer to
perform. In addition, she instructs staff members to report any problems directly to her. What type of
leadership style do the new manager’s characteristics suggest?
a. Autocratic (key)
b. Situational
c. Democratic
d. Laisses-faire