Background: Higher education has faced numerous challenges due to the COVID 19 outbreak, and written exams conduction with strict precautionary measures is one of them. Study aims were to evaluate adherence to preventive measures and factors affecting suspected COVID-19 symptoms development during exams. Subjects and method: a repeated cross sectional study was conducted at Mansoura University Nursing Faculty. The participants were nursing students at the fourth level and the calculated sample size was 215. Students were videotaped to assess their adherence during the exam hours using an observation checklist and suspected COVID 19 symptoms were measured using the baseline questionnaire and were measured for 6 weeks every two weeks. Results: One or more suspected symptoms of COVID 19 had formed among 60.4% of students who were significantly higher at the first two weeks of exams. The mean hourly contact of the T zone was (13±11.3) and only (42.4%) of students wear the mask all exam time. Conclusion: Higher T zone touch, less adherence to mask wearing all exam time and less reported adherence directly predicting suspected COVID 19 symptoms occurrence. Recommendations: Raising students' awareness and finding new strategies to improve students' adherence to preventive measures during written exams is of great value during this epidemic.