1Test Guidelines forthe National Licensure Examinationfor Nurses (NLEN) 2012Effective August 2012Nepal Nursing CouncilKathmandu, Nepal
2Prepared by:Examination Committee, Nepal Nursing Council (NNC)Approved by:Board of Nepal Nursing Council (NNC) on February 27, 2012Revised: August, 2012Published by:Nepal Nursing CouncilAddress: Kathmandu, NepalTel : 977-1-4372521Fax : 977-1-4377214E-mail : email@example.com, firstname.lastname@example.orgWebsite : http://www.nnc.org.np
3Table of contentI. BackgroundII. ObjectivesIII. Test guidelines for the National Licensure Examination for Nurses (NLEN)Pre-requisite for NLEN- Eligibility- ExceptionApplication process/rulesDistribution of test itemsTypes ofquestions- Duration of examination- Types of questions- Distribution of test items- Frequency of NLEN- Examination fee- Scoring system- Passing standardResult of NLENRegistrationIV. Syllabus for NLEN
4I BackgroundNepal Nursing Council is an autonomous body under Nepal Nursing Council Act 2052 formulated bythe Government of Nepal. It aims at promoting quality nursing education in order to bringeffectiveness in nursing service in the country.The Licensure Examination for Nurses is a national examination for nurses developed by the NepalNursing Council. National Licensure Examination for Nurses is an entrance examination to qualify asnursing professionals. This National Licensure Examination for Nurses is required for all newgraduates of Proficiency Certificate Level (P.C.L.) and Bachelor of Science in Nursing (B.Sc.N.) Theexamination is geared towards testing knowledge and skill in relation to the job functions mostcommonly required by entry-level nurses. The examination determines eligibility to earn a title ofregistered nurse and begin working as a professional nurse.Nepal Nursing Council went through several processes to establish the Licensure Examination forNurses in Nepal. Nursing council took references on licensing exam from SAARC as well as otherdeveloped countries. Nepal Nursing Council also received technical and human resource from JICA toconduct the licensure examination.,, 2 EMHFWLYHVThe objectives of licensure examination are as follows:To maintain quality nursing services to the publicTo maintain professional standard of knowledge and skills among new graduatesTo recommend for strengthening the capability of nursing institutions for quality nursingeducationIII. Test guidelines for the National Licensure Examination for Nurses (NLEN)Pre requisite for NLEN§ Eligibility(A) Nepali citizen graduated from NepalTo 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 approvedby NNC.(B) Nepali citizen graduated from other countriesApplicants, who have completed nursing education from other country, must have theirequivalence certificate from the concerned authority. Individual applicant need to be graduatedfrom the institute recognized from the respective nursing council or authorized governmentbody.(C) Foreigners graduated from NepalForeign applicants graduated from Nepal must have completed nursing program from theinstitution approved by NNC and must submit the document as mentioned in table 3.
5(D) Foreigners graduated from other countriesA person, who comes to Nepal to work, must appear National Licensure Examination forNurses in order to registered in NNC. Person, who stay with tourist visa are not allowed toapply§ Exception(A) Reporting prior convictions or discipline against licensesApplicants are required under Regulation of the National Licensure Examination for Nurses toreport all misdemeanor and felony convictions. Failure to report prior disciplinary action isconsidered falsification of application and is a ground for denial of licensure or revocation oflicense.(B) Applicants with differently abledApplicants, who are differently abled, are under Civil Law.§ Application processThe following documents are required for application.Table 1: The list of documents required for P.C.L. NursingItems NumberApplication form (original) 1Mark sheet and Character certificate of S.L.C., original as well asphotocopy1Citizenship certificate, original as well as photocopy 1Academic Transcript and character of P.C.L. Nursing, original as well asphotocopy1Examination fee (SBI Bank Voucher) 1Passport size photo 5Document of recognition /accreditation of institute or individualregistration from the nursing council of the respective country (onlyapplicable for the Nepalese graduated from the other countries).1Table 2: The list of documents requiredfor B.Sc. NursingItems NumberApplication form (original) 1Mark sheet and Character of S.L.C., original as well as photocopy 1Mark sheet and Character of I.Sc. or 10+2, Original as well as photocopy 1Mark sheet, Character and Academic Transcript of B.Sc. Nursing, originalas well as photocopy1Citizenship certificate, originalas well as photocopy 1Examination fee (SBI Bank, Voucher) 1Passport size photo 5Document of recognition /accreditation of institute from the nursingcouncil or individual registration in the nursing council or in theauthorized body (only in case of non-existence of nursing council) of therespective country (only applicable for the Nepalese graduated fromthe other countries).
6Table 3: The list of documents requiredfor Foreign NursesItems NumberApplication form, original 1Certificate of nursing educational degree, original with photocopy 1Certified copy of transcript of nursing degree in native languageas well as in English original, along with photocopy1Certification of registration from the nursing council of respectivecountry1Recommendation letter from the organization in Nepal in whichthe applicant is going to work ( original)1Valid visa or Passport/citizenship for those who do not need tohave visa to enter Nepal, original as well as photocopy1Examination fee (SBI Bank, Voucher) 1Passport size photo 5The process is:1. The applicant must submit all the documents to NNC within the time period mentioned in thenotice.2. The examination center will be notified at the time of admit card distribution.ATTENTION!- If an applicant changes her/his name and/or address after submitting an applicationfor licensure, the applicant must notify the Examination Committee immediately in order toreceive current information. Applicants are required to submit legal documentation of anychange to the Examination Committee immediately change occurs.- Applicant’s name must match EXACTLY as it appears on photo identification that will be atthe test center. The same name must also be provided to the NLEN test service at the times/he register in order to prevent delays with issuing examination authorization.Examination Process / Rule§ Duration of ExaminationLicensure Examination will be of three and half hours duration. Applicants are not allowed to enterthe examination room after 15 minutes from starting examination. Applicants can leave the room onlyafter 1 hour of starting.§ Type of QuestionsAll of the test items are Multiple Choice Question (MCQ) with four options. Applicants are to selectthe most appropriate choice.Distribution of Test ItemsTable 4: Subject wise distribution of test itemsSubjects Distribution of test items (%) Possible numbers of itemsIntegrated Science 5% 10
7Fundamental of Nursing 25% 50Community Health Nursing 15% 30Adult Nursing 20% 40Child Health Nursing 10% 20Midwifery and Gynecology 20% 40Leadership and Management 5% 10Total 200§ Frequency of the NLENThe Nepal Nursing Council conducts the Licensure Examination for Nurses three times a year. Ifapplicant fails an examination, s/he will be allowed to apply for the next examination.§ Application FeeThe fee for the National Licensure Examination for Nurses is NRs 1,500. Fees are notrefundable even if an applicant is found ineligible.§ Scoring SystemThere is no negative scoring system. It means when applicant gives wrong answer, no minus markingwill be done. Marks count only for correct answers.§ Passing StandardThe grading system on the Licensure Examination for Nurses Examination is either pass or fail. Thereis no numerical score. In order to pass the Licensure examination, the applicant must score at least50 % marks in aggregate.Result of NLENThe result of NLEN will be published within a week after the examination. Results will be publishedin Nepal Nursing Council notice board. Nepal Nursing Council will not inform or contact anyone forthis purpose individually.RegistrationOnce applicants have successfully passed NLEN they can apply for registration to get their nursinglicense. Registration fee is NRs 800 and they should also bring the admit card of licensingexamination.IV. Syllabus for NLENNLEN ContentBelow is the list of topics that will be used by item writers and item reviewers of NLENIntegrated ScienceIntegrated Science includes subjects like Anatomy/ Physiology, Microbiology, and Pharmacologyrelated content but is not limited to:
8Anatomy/ PhysiologyCardiovascular/ Lymphatic System:Body fluid/Electrolytes and Acid-Base BalanceBlood Composition, Plasma and Plasma ProteinsPhysiology of Red Blood Cells, White Blood Cells, PlateletsBlood Groups and blood transfusionAnatomy of Cardiovascular System: The Heart and Blood VesselsPhysiological Activities of the HeartPhysiology of CirculationCardiovascular Regulation and AdjustmentsLymphatic/ Immune systemMusculoskeletal SystemThe Human Skeleton, its structure and physiologyThe JointsThe Skeletal Muscles of Human BodyNeuromuscular Junction and Muscle PhysiologyNervous SystemFunctional unit of nervous systemCentral Nervous SystemPeripheral Nervous SystemAutonomic Nervous SystemSomatosensory, Somatomotor System and ReflexesMeninges, Cerebrospinal Fluid, Blood-Brain Barrier and Central Blood FlowRespiratory SystemStructure and Functions of Respiratory SystemPhysiology/Mechanism/ Control of RespirationGastro-Intestinal SystemStructure and Functions of Digestive SystemDigestion and Absorption of nutrientsAccessory organs of Gastro-Intestinal systemEndocrine SystemStructure and functions of endocrine glands and hormones.Urinary SystemFunctional unit of urinary systemPhysiology of urine formationReproductive SystemMale Reproductive SystemFemale Reproductive SystemPhysiology of ContraceptionSpecial Sensory SystemEye, Ear, Nose, ThroatThe Skin and FasciaMicrobiology/ Parasitologyo Human cell and its structureo Factors affecting the growth and survival of micro organismso Types of parasites affecting to human body and its mechanism to develop diseasesPharmacologyo Types and Function of Drugso Pharmacokinetics: absorption, distribution, metabolism, excretion of drug, and factors influencing thepharmacokinetics
9o Pharmacodynamics: drug action, adverse reaction to drugso Essential, emergency and Life Saving Drugs used in Nepalo Drugs used in different body systemsFundamentals of NursingRelated content includes but is not limited to:o Ethics in nursing: International Councils of Nurses (ICN) Code, Nepal NursingCouncil Act and Regulation.o Patient’s Rightso Informed Consento Nursing Processo CaringAdmission and discharge procedureThe role and responsibility of nurse in laboratory test/examination: invasiveand non- invasive procedures: e.g. blood test, lumbar puncture, thoracentesis,ultrasonographyPersonal hygieneSafety and Infection Control: Safety Devices, Accident/ Injury Prevention, InfectiousMaterials, Universal PrecautionRest and SleepComfort/ Relief of painMeeting nutritional needsCare of eliminationRehabilitative careCare for dead bodyo Nursing responsibility for drug administrationRoutes of administration of the drugDosage Calculation and AdministrationIndications, contraindications and interactions, adverse effect , side-effectResponsibility of nurses on administration of medicine: e.g. Six rules on administration ofthe drugAdministration and management of IV fluids, Blood and Blood productso First AidBasic Cardiopulmonary Resuscitation (CPR)Bites: insects, snake, animalsBurnWounds: Dressing and BandageHemorrhageChokingFractureDrowningFrostbitePoisoningCommunity Health NursingRelated content includes but is not limited to:o Community Health and Community Health NursingCommunication skillsCommunity resourcesHealth EducationHome visiting
10o Primary Health Care (PHC): Elements and role of nurses in PHCo Demography/ Health Indicators: (e.g. IMR. MMR, TFR)o EpidemiologyRole of epidemiologyCommunity DiagnosisRole and responsibilities of Nurses in epidemiological approacho Environmental Health: Sanitation, Water, Housing, Pollutiono NutritionNutritients and their functionsNutritional Deficiency disorders: Types and characteristicsManagement of the clients with nutritionaldeficiencyo ImmunizationTypes, Purposes, Functions of immunizationAdministration of immunizationNational Immunization Program in Nepalo Maternal and Child HealthMCH clinics: Antenatal Care (ANC), Postnatal Care (PNC)Growth Monitoring of Under Five ChildrenUnder Five’s ClinicIMCI guidelineso Gender IssuesSex and genderGender issues: e.g. gender equity, gender equality, gender discrimination, Domestic Violenceo Family PlanningPopulation problems in NepalTypes, methods, advantages and disadvantages of different family planning methodsEmergency Contraception and methodsFP Counselingo HIV/AIDs, STIPrevention and management of HIV/AIDs, STIMedication for the clients with HIV/AIDs, STIo Family Health NursingAdult NursingRelated content includes but is not limited to:o Characteristics of adulthood with developmental tasks in each stage: young adult, middle-agedadults, elderly adultso Aging processo Disorders of each body system: Blood, Body Fluids/Electrolytes, Nervous System, CirculatorySystem, Respiratory System, Musculoskeletal System, Gastro-Intestinal and Nutritional System,Urinary System, Endocrine System, Sensory SystemCommon disorders, investigations and medical/surgical treatment in each systemMedical/Surgical nursing management for the client with disorders in each systemo Mental Health ProblemsAssessment of mentally ill clientsMajor and minor disorders, treatment and nursing managemento Operation Theatre NursingOperation Theatre (OT) Nursing, Characteristics of OT nurseOT technique (e.g. aseptic technique, sterilization, scrubbing, gowning, gloving)Role and Responsibilities of scrub nurse, circulatory nurse, and recovery nurseCommon surgical materials, equipments, and supplies in OT and their preparation
11o Pre and Post-operative Nursing careo RehabilitationDisability: Types and characteristicsRole and responsibility of nurses in rehabilitationNursing management of disable cliento Nursing care of the client in the terminal stageStages of dyingGrief and LossHolistic Careo Stress and Crisis ManagementBody’s response to stressRole of nurses in stress and crisis managementChild Health NursingRelated content includes but is not limited to:o Terminology of Child Health Nursingo Growth and development of child in each stage: neonate, infant toddler? pre-school children,school-age children, adolescento Nursing role on promotion of growth and developmento Nursing care to child and familyInfluences brought by diseases and hospitalizationNursing care for children with accident/ injuryNursing care for children with common communicable diseases on children of NepalNursing care for children with congenital/ chromosomal disordersCommon Childhood Disorders of different system, investigation, treatment andmedical/surgical nursing managementNursing care for children with major diseases in : nervous system, musculoskeletal system,respiratory system, circulatory system, blood, gastro-intestinal, urinary system, endocrinesystem, sensoryo Health Promotion for sick children: Nutrition, exercise, play, anticipatory guidanceo Mortality and Morbidity of Child in NepalRole of nurse to reduce Mortality and Morbidity on Under Five ChildrenNursing role on prevention and management of children with HIV/AIDso Integrated Management of Childhood Illness (IMCI) programo Identification of Child’s need: Meeting physical and comfort needs (e.g. bed size, paediatric setup, placement of the ward)o Paediatric ProcedureOxygen administration (e.g. head box, oxygen tent)NebulizationPositioning/ RestrainingCalculation of drugs and its administrationFeeding in different typesIV fluid administration and managementPhototherapyCare for incubatorColostomy and tracheostomy careCardio Pulmonary Resuscitation (CPR)Specimen collectionAssisting common invasive procedures (e.g. lumbar puncture)Midwifery and GynecologyRelated contents include the following but not limited to:
12o Sex/ sexuality and Reproduction of human beingo Components of reproductive healtho Reproductive health/rightso Maternal and Newborn Health status in NepalStrategies and policies of reproductive health in NepalSkill Birth Attendant (SBA) policySafe Motherhood Programo Nursing care in every stage of female life cyclePuberty/ Adolescent Health: physical and psychological changes, nursing care for duringpuberty /adolescentReproductive age/years: nursing care for the client of reproductive ages/yearsClimacteric care: physical and psychological changes during the peri-menopause, counselingmedical management(e.g. Hormone Replacement Therapy; HRT)o Fetal growth and development: normality and abnormalities on fetal, placenta, membrane andcordo Care during PregnancyHealth promotion of pregnant womenComponents of antenatal careBirth Preparedness and Complication readinessCare of pregnant women with minor/major disorders of pregnancy (e.g. constipation, varicoseveins, back pain, edema, threatened abortion , placenta preavia)o Care during labor and birthPhysiology and mechanism of laborNursing management of mother in labor : normal delivery, induction and augmentation oflaborMonitoring fetal condition: prevention of its abnormalities in laboro Postnatal CarePhysical and psychological changes during puerperial periodNursing 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 motherwith problems on breast feeding (e.g. mastitis)Breast feeding in HIV / Hepatitis B positive mothers (e.g. PMTCT)o Newborn Baby CareNeonatal assessmentImmediate care of newbornNursing care for newborn baby with dysfunction and problems (e.g. Respiratory distresssyndrome, meconium aspiration syndromeo Obstetric EmergenciesNursing 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.gmal presentation and prolapse of the cord. )Nursing management for the clients with high risk/ critical condition in postnatal period (e.g.PPH, ruptured uterus )o Nursing Care for Gynecological problemsSub-infertility/ Infertility: Types, cause and treatment and nursing management of infertilityin both male and female,Sexual Transmitted Infection (STI): National Protocol to manage STIs, Nursing managementNursing management for Cervical Cancer, Breast CancerNursing management for genital prolapsed
13Nursing management obstetric fistula: Recto-vaginal fistula and vesico-vaginalfistula)Leadership and ManagementRelated content includes but is not limited to:o Concept of Leadership and ManagementRole, Styles, Characteristics and Functions of LeadershipRole and Responsibilities of Health Care Team MembersPrinciples, Types and Functions of ManagementConflict ManagementPurpose, principles, categories of SupervisionQualities of Supervisoro Health Service Delivery System: Hospital and CommunityMethods of Organizational managementOrganogramManagement of ResourcesPatient assignment methods: Rotation Plan, assignmentJob Description of different categories of health personnelJob Description of different level of nursing personnelo Professional DevelopmentDefinition and Criteria of ProfessionProfessional Organizations: Nursing Association of Nepal (NAN), Nepal Nursing Council(NNC), International Council of Nurses (ICN), International Confederation of Midwives(ICM)o Health Policy and PlanningNational Health Planning: SLTHP and Five Year Plans Country ProfileFor further information please visit Nepal Nursing Council website: www.nnc.org.np orcontact Nepal Nursing Council office Tel: 4372521.