Nepal Nursing Council License Exam Syllabus 

National Licensure Examination for Nurses -NLEN 

Nepal Nursing Council is an autonomous body under the Nepal Nursing Council Act 2052 formulated by the Government of Nepal. It aims at promoting quality nursing and midwifery education in order to bring quality nursing and midwifery service in the country. 

The National Licensure Examination for Nurses is an examination for nurses introduced by the Nepal Nursing Council. The National Licensure Examination for Nurses is an examination to qualify as nursing professionals. It is required for all new pre-service graduates of Proficiency Certificate Level (PCL) and Bachelor of Science in Nursing (BSc N.) Programmes The examination is geared towards testing knowledge and practice in relation to the job functions most commonly required by entry-level professional nurses. The examination determines eligibility to earn a title of registered nurse in order to begin working as a professional nurse. 

The Nepal Nursing Council had gone through several processes to establish the National Licensure Examination for Nurses in Nepal. The Nepal Nursing Council sought references on licensing exam from SAARC including developed countries. The Nepal Nursing Council also received technical and human resource from JICA to support in conducting initial licensure examination. 

 Subject wise distribution of test items 

Subjects	Distribution of test items (%)	Possible numbers of items
Integrated Science	5%	7
Fundamental of Nursing	25%	38
Community Health Nursing	15%	23
Adult Nursing	20%	30
Child Health Nursing	10%	15
Midwifery and Gynecology	20%	30
Leadership and Management	5%	7

Nepal Nursing Council License Exam Syllabus/NLEN Content Below is the list of topics that will be used by item writers and item reviewers of NLEN 

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

1. 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 Rh factor 
• Anatomy of Cardiovascular System: The Heart and Blood Vessels 
• 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 and 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 
• Contraceptives and Action and side effects of contraceptives 

Special Sensory System 

• Eye, Ear, Nose, Throat The Skin and Fascia 

2. 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 

I. 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 

II.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 adults 
• 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 

IV.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 children 
• 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 illness conditions: 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 
• Pediatric 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) 

V. Midwifery and Gynecology Related contents include the following but not limited to: 

• Deformation of sex and sexuality, Reproduction in human being 
• Components of reproductive health 
• Reproductive rights 
• Maternal and Newborn Health in Nepal 

Strategies and policies of reproductive health in Nepal National Policy on Skill Birth Attendant (SBA) 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 management of fetal distress 

• 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 Prolapsed of pelvic organs 

VI. 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: Nepal Nursing Council (NNC), Nursing Association of Nepal (NAN), International Council of Nurses (ICN), International Confederation of Midwives (ICM) 

• Health Policy and Planning 

National Health Planning: SLTHP and Five Year Plans Country Profile 

Note: For further information visit Nepal Nursing Council’s website: http://www.nnc.org.np or contact Nepal Nursing Council’s Office Tel: 4372521.