Changes in Fundamentals of Nursing Questions in China National Nursing Licensure Examination (2011-2024)

Background The Fundamentals of Nursing is core to China National Nursing Licensure Examination (CNNLE). Clarifying its exam content and evolutionary trends guides evidence-based nursing education and aligns training with licensure requirements. This study analyzed CNNLE Fundamentals of Nursing questions (2011–2024) to optimize teaching strategies and support students’ preparation. Methods A longitudinal analysis design was adopted. Valid Fundamentals of Nursing questions from the 2011–2024 CNNLE were collected, with a final sample of 953 questions. Descriptive analysis was used to examine three key aspects: the proportion of these questions in the total exam, their distribution across course chapters, and temporal trends in cognitive complexity aligned with phases of nursing education reform. Results During the study period, Fundamentals of Nursing questions accounted for 15.1%–35.3% of total CNNLE questions, with recent fluctuations between 24.2%–34.2%. Chapter-wise distribution was significantly imbalanced: “Medication, Infusion, Transfusion and Specimens” consistently had the highest question proportion across all years, highlighting its core assessment status. A statistically significant temporal trend in cognitive complexity was observed across nursing education reform phases (χ²=32.225, P < 0.001). Most chapters focused on basic knowledge and comprehension, while “Admission/Discharge Safety and Occupational Protection” emphasized application skills. Conclusion The question types and variation patterns of CNNLE Fundamentals of Nursing align with modern nursing education and clinical practice requirements. To enhance teaching effectiveness, educators should prioritize key chapters, strengthen clinical practice training, and foster students’ clinical thinking. These findings provide valuable references for the international nursing education community in designing qualification exam questions and adjusting teaching content.