Abstract
BACKGROUND: Quality theoretical assessments in nursing education are essential for achieving Sustainable Development Goal 4 (ensuring inclusive and equitable quality education and promoting lifelong learning opportunities for all). However, misalignment with National Qualification Framework (NQF) standards, an overreliance on recall-based questions and inadequate educator training undermine the fairness of assessments and students' ability to demonstrate clinical competence. AIM: This study explores theoretical assessment design in nursing education, evaluating its alignment with NQF standards, competency-based assessments and Sustainable Development Goal 4. SETTING: Conducted at a South African nursing school offering undergraduate nursing programmes. METHODS: A multimethod approach integrated educator interviews, document reviews of moderation reports, a scoping review and a student survey to investigate assessment practices. RESULTS: While educators valued Bloom's Taxonomy, over-reliance on recall-based questions limited critical thinking, clinical decision-making and competency development. Misalignment with NQF standards caused inconsistencies in cognitive demand, while gaps in moderation processes impacted assessment validity and fairness. Educators faced challenges because of limited training and support, and students struggled with ambiguous and linguistically complex assessments that hindered their ability to demonstrate competency. CONCLUSION: Strengthening assessment design, moderation and educator training is essential to improving competency-based assessment practices in nursing education. Policy reforms promoting fair, transparent, and competency-driven assessments will enhance graduate preparedness, ensure alignment with NQF standards and support SDG 4's goal of quality education. CONTRIBUTION: This study provides empirical evidence supporting assessment policy improvements, promoting structured, competency-based assessments that enhance fairness, deepen learning and align with nursing education standards.