Study Guide

Field 236: School Nurse 
Sample Multiple-Choice Questions

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Each multiple-choice question has four answer choices. Read each question and its answer choices carefully and choose the ONE best answer.

During the test you should try to answer all questions. Even if you are unsure of an answer, it is better to guess than not to answer a question at all. You will NOT be penalized for choosing an incorrect response.

Objective 0001 
Understand human growth and development, the learning process, and factors that affect development and learning of different school-age populations.

1. A third-grade student's family has recently experienced stressful events. The parents have been unemployed for six months and one of the student's young siblings has a health impairment. The parents have exhibited periods of depression. The school nurse should be alert to the fact that these factors are likely to influence the student's development most significantly in which of the following areas?

  1. receptive language
  2. higher-order thinking
  3. social relationships
  4. motor development
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: C.
Unemployment and depression in a family place a couple at risk for marital conflict, which is associated with adjustment problems for children in the family, including impairments in social and academic functioning. Parental/guardian depression is specifically associated with greater child emotional insecurity. Research has shown that children whose parents have been diagnosed with depression are more likely than children whose parents have never been diagnosed with depression to experience interpersonal and social conflicts and school failure.

Objective 0002 
Understand the roles and responsibilities of the school nurse as a health expert and resource person in the school community.

2. A school nurse who serves elementary and middle school populations believes that many students and families in the district would benefit from resources available through family health and human services agencies. Which of the following strategies is likely to be most effective for the school nurse to use to facilitate families' use of these resources?

  1. requesting that health and human services agencies maintain a sign-up sheet at the school for families to request assistance
  2. asking health and human services agencies to provide information that the nurse can share and discuss with all families
  3. educating students about the types of support their families are eligible to receive through health and human services agencies
  4. providing relevant health and human services agencies with contact information for families who appear to be in the greatest need
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: B.
Key roles of a school nurse include providing students and families with information about available health-related community and government resources, and assisting families in accessing resources to meet the physical, mental, and emotional health needs of students. Establishing and maintaining partnerships with local agencies, physicians, and health advocacy organizations allows the school nurse to immediately respond and connect families to needed services. For example, school nurses may assist families enrolling in state or federal health insurance programs or locate advocacy organizations for students with health impairments or physical disabilities.

Objective 0003 
Understand diversity among students, families, and communities; the influence of diversity; and strategies for communicating effectively in a diverse school community.

3. Which of the following approaches is likely to be most effective for a school nurse to use in working with families in a respectful and nondiscriminatory manner?

  1. being professional and sensitive to factors related to socioeconomic, ethnic, and cultural backgrounds
  2. attempting to discover pertinent characteristics of families' backgrounds before meeting with them
  3. acknowledging obvious differences in background right away and using humor to put families at ease
  4. remaining friendly and curious while asking specific questions about families' backgrounds and living situations
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: A.
Families play an integral role in the well-being and development of their children. A school nurse's initial interactions with families should support the goal of establishing a productive and culturally sensitive rapport that supports effective communication and collaboration, which is essential if a difficult health-related situation occurs. A school nurse who is culturally competent understands that culture may include values, occupation, where a person lives or lived, life experiences, religion, gender identity, language, dietary and health practices, and social order. While recognizing and remaining sensitive to these cultural characteristics, a school nurse can work toward establishing rapport, building understanding, and promoting collaboration with the families of students with health needs.

Objective 0004 
Understand the characteristics and needs of students with disabilities and factors that affect their development and learning.

4. A high school student has a seizure disorder that is characterized by frequent absence seizures. Which of the following statements accurately describes the most important implication of this condition for the student's learning?

  1. The student's ability to regulate his or her mood and behavior may be diminished due to a limited attention span.
  2. Additional reinforcement may be needed to ensure the student maintains focus on personal and academic interests.
  3. The student may be at risk for low academic achievement due to gaps in concentration and missed information.
  4. Additional social support may be needed to facilitate positive peer relationships for the student.
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: C.
In general, students with epilepsy show weaker performance on attention, concentration, and short-term (working) memory tasks than peers without epilepsy. Absence seizures (formerly petit mal) are epileptic seizures characterized by subtle symptoms: a sudden brief cessation of activity for 10 to 30 seconds, a trance-like look, fluttering eyelids, and lip or mouth motions. A student experiencing an absence seizure may simply appear to be daydreaming. The student may miss key ideas or information about assignments presented in class, and may have difficulty processing new information. Nighttime seizures may disrupt sleep and increase fatigue during the school day. In addition, anti-seizure medications cause side effects that include lethargy and problems with memory and concentration.

Objective 0005 
Understand the provision and management of school nursing and student health services.

5. Which of the following statements accurately describes a research-supported reason why school nurses are advised to keep on hand a nonspecific order of epinephrine medication, in addition to the epinephrine stocked for individual students?

  1. A significant number of epinephrine administrations to students are for allergies unknown at the time of anaphylaxis.
  2. Epinephrine administrations by teachers or other lay people are often ineffective on the first dose; school nurse–administered second doses are often needed.
  3. In addition to treating anaphylaxis, epinephrine can also be used in heart-related emergencies involving asystole.
  4. Because epinephrine deteriorates over time, the shelf life of epinephrine auto-injectors is typically only one year; therefore, backup supplies are needed.
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: A.
A National Association of School Nurses (N A S N) official position statement supports maintaining a nonpatient supply of epinephrine to administer in cases of life-threatening situations in schools. According to one two-year study of 48 school districts published in the journal Pediatrics, nearly 25 percent of all epinephrine administrations in K to 12schools involved students or staff who did not know they had a life-threatening allergy. The Illinois Emergency Epinephrine Act allows schools to stock a supply of epinephrine auto-injectors and gives school nurses the right to administer epinephrine to any student whom the nurse believes is experiencing anaphylaxis.

Objective 0006 
Understand the care and management of illnesses and chronic health conditions and the development of Individualized Healthcare Plans (I H Ps).

6. In the development of Individualized Healthcare Plans (I H Ps), school nurses carry out comprehensive assessments of students. Nurses review past and current educational and medical records, interview family members and primary care providers, complete physical examinations, and evaluate self-care skills and needs. Which of the following additional types of assessment would be most useful in developing an I H P that addresses the educational implications of a student's health impairment?

  1. observing the student unobtrusively in a variety of school settings
  2. evaluating the student's care in terms of how the student's daily health needs compare to those of other students
  3. checking tentative diagnoses of possible learning problems with colleagues
  4. making a home visit to assess family capacity for assisting the student with his or her illness or condition
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: A.
When conducting a comprehensive assessment for an Individualized Healthcare Plan (I H P), a school nurse gathers, analyzes, and interprets information about a given student using professional health knowledge and expertise. The school nurse should ensure that this information includes first-hand observations of the student in the student's usual school settings. These observations help determine how a student's health condition or issue affects the student's academic skills and achievement and participation in class and school activities. The school nurse can then use this information to evaluate potential barriers to learning and to plan and implement accommodations and interventions that will minimize barriers and benefit the student's educational progress.

Objective 0007 
Understand the roles and responsibilities of the school nurse in the multidisciplinary evaluation of students and the development of Individualized Education Programs (I E Ps) and Section 504 Plans.

7. Benchmarks are important components of a student's Individualized Education Program (I E P) primarily because of their usefulness in:

  1. clarifying expectations for the student's academic performance.
  2. identifying the student's preferred learning styles and modalities.
  3. monitoring the student's shorter-term progress toward longer-term educational goals.
  4. establishing the student's current level of knowledge and skill in various developmental domains.
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: C.
Benchmarks are short-term objectives or interim steps a student takes to achieve an annual Individualized Education Program (I E P) goal. Benchmarks serve as a way to monitor and assess a student’s progress toward attaining an annual I E P goal. Benchmarks can take the form of short-term health maintenance objectives developed to address an overall goal of increasing a student's independence and responsibility in managing his or her own health-care needs. For example, benchmarks for increasing student skills in asthma self-management might focus on identifying asthma triggers and early indications of an asthma flare-up, developing strategies for avoiding triggers or controlling exposure to them, and demonstrating responsibilities for self-carrying and safe use of medications.

Objective 0008 
Understand laws, policies, ethical guidelines, and professional standards that influence the practice of school nursing and the provision of health services.

8. According to professional standards embodied in the Illinois Nurse Practice Act, newly licensed advanced practice registered nurses (A P R Ns) are expected to:

  1. supervise, rather than carry out personally, routine clinical procedures involving students.
  2. remain in communication with a licensed physician while performing any clinical procedure beyond advanced first aid.
  3. carry out procedures and services that physicians normally perform, but only if a physician is on-site.
  4. maintain a written collaborative agreement with a physician that specifies the types of care the A P R N may perform.
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: D.
According to the Illinois Nurse Practice Act and professional school nursing standards, a written collaborative agreement (W C A) is required for all advanced practice registered nurses (A P R Ns) engaged in clinical practice in public schools. The W C A should describe the relationship of the A P R N with the collaborating physician and the categories of care, treatment, or procedures to be provided by the A P R N. The W C A should also outline communication methods to be used by the A P R N in consulting and collaborating with the physician.

Objective 0008 
Understand laws, policies, ethical guidelines, and professional standards that influence the practice of school nursing and the provision of health services.

9. A student with a health impairment is receiving therapy from a psychologist at a local medical center. The school nurse would like to consult with the psychologist. Which of the following steps should the nurse take to facilitate consultation?

  1. inviting the psychologist to a meeting with the student's parent at the school to compare information about the student
  2. requesting that the student's parent set up a meeting between the nurse, the psychologist, and the parent
  3. telling the student's parent that psychologist reports would be beneficial and asking the parent to pass updates along
  4. asking the student's parent for written permission to exchange information with the psychologist
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: D.
A school nurse should have written permission or authorization from the parent/guardian or eligible student in order to request health status information from a student's outside health-care provider. Although a psychologist or other provider may relay or clarify treatment orders to a school nurse or other individuals involved in the treatment of a student, both the provider and the school nurse should honor the legal principle of confidentiality related to student health records and refrain from exchanging information about a student's health status without first getting signed authorization.

Objective 0009 
Understand the importance of acquiring and maintaining current credentials and evidence-based knowledge and competency in school nursing practice.

10. Which of the following statements accurately describes a valuable benefit of membership in the Illinois Association of School Nurses (I A S N)?

  1. The I A S N provides a network of support and access to continuing education opportunities and resources related to school health programs.
  2. The IASN's members receive free training and education in areas such as pathophysiology, biology, and chemistry to help deal with emerging environmental health issues.
  3. The I A S N sponsors community events such as health fairs and free immunization clinics that help highlight the school nurse's role in the community.
  4. The IASN's Web site provides links to the offices of physicians who have collaborative agreements with the organization, so members may consult online with physicians.
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: A.
Membership in the Illinois Association of School Nurses (I A S N) confers automatic membership in the National Association of School Nurses (N A S N). Membership benefits include access to professional podcasts, free and low-cost online learning courses, and peer-to-peer conversations and networking through SchoolNurseNet, an online community that connects all of N A S N's members. I A S N members may attend state or national annual conferences on topics such as how to incorporate the principles of twenty-first-century school nursing practice into school settings to promote student health. N A S N provides members with active links to many resources including federal agencies, national coalitions, and health and education organizations; tracks national legislation on issues affecting child and adolescent health; and offers discounted subscriptions to specialized peer-reviewed clinical and research journals such as N A S N School Nurse and The Journal of School Nursing.

Objective 0010 
Understand health promotion and disease prevention concepts underlying school health and nursing services.

11. A school nurse who is conducting a health screening of three- to five-year-olds as part of the Illinois Child Find Screening Data Collection System identifies a child who may have special educational needs. The nurse refers the child for a case study evaluation, and the district approves the request. Once the child's parents/guardians give permission for an evaluation, which of the following procedures should be followed?

  1. The referral for a case study evaluation must be authorized by a qualified, licensed physician within 10 school days.
  2. Types and durations of related medical services to benefit the child must be documented by the school nurse within 30 school days.
  3. A comprehensive case study evaluation of the student must be completed by a multidisciplinary team within 60 school days of the referral.
  4. The school nurse must complete a health history and a vision and hearing screening of the child before the case study evaluation is conducted.
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: C.
The Illinois State Board of Education rules for special education and the federal Individuals with Disabilities Education Act (I D E A) require that a comprehensive initial evaluation of a student employ a variety of assessment methods, be paid for by the school district, and be completed within 60 school days after parent/guardian written consent is granted. Once a request for an evaluation is received, an Illinois school district convenes a multidisciplinary team, who determines which assessments will be included in the evaluation. Parents/guardians are notified of the assessments to be used in their student's evaluation within 14 school days. Once parental/guardian permission to carry out the evaluation is received, the assessments must be completed in 60 school days.

Objective 0011 
Understand curriculum development and instruction in the school health program.

12. A middle school student has multiple disabilities, including cerebral palsy and an intellectual impairment. The student uses a wheelchair and an electronic communication board. The student currently attends a special education classroom and receives related services from the school nurse, the speech-language pathologist, and the occupational therapist. Which of the following statements describes an important principle that the student's team should keep in mind when providing instruction related to self-help skills?

  1. Each of the student's service providers should be exclusively responsible for providing instruction in specific functional tasks.
  2. Practice in functional tasks should take place primarily in settings where the student will perform those tasks in daily life.
  3. Functional tasks should be initially presented to the student in the special education classroom to the greatest extent possible for the student's comfort.
  4. A variety of functional tasks should be presented to the student each day so that the student remains physically engaged and motivated to learn.
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: B.
Functional life skills and self-management skills such as those related to eating, dressing, grooming, health care, personal safety, communication, decision making, working with others, following directions, and finishing a task are best taught in natural environments so that students can generalize the skills learned. By simulating realistic conditions and working in settings that the student typically encounters in daily life, related services personnel can directly support development of the student's functional life skills in the context of the student's unique health, communication, and physical needs.

Objective 0012 
Understand the processes of assessment and evaluation in the development of school health programs.

13. Which of the following strategies would be most effective in helping to document and monitor the quality of school nursing practices and interventions?

  1. forming a task force to critically evaluate current practices and local standards related to school nursing
  2. seeking local media coverage of unexpected health cases or situations as they occur
  3. maintaining daily program data sheets and detailed records of individuals served
  4. conducting ongoing research into school nursing practices and publishing findings in professional journals
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: C.
Student visits to the school health office should be documented in accordance with Illinois regulations regarding student health records and privacy laws. The maintenance of individual student visit records allows school nurses to track and evaluate student health office use over time, examine information such as frequency and reason for visits for particular students, and review nursing notes to help determine diagnoses and health issues.

Objective 0012 
Understand the processes of assessment and evaluation in the development of school health programs.

14. When presenting student health assessment data in a professional meeting or published document, the school nurse is ethically bound to ensure that:

  1. students whose assessment results have been presented are described using only their defining characteristics.
  2. individual students cannot be identified on the basis of any of the data presented.
  3. the data is distributed before publication to the families of the students whose assessment results have been used.
  4. data are presented as individual results rather than as aggregate data or data in summary form.
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: B.
According to the National Association of School Nurses (N A S N) code of ethics and standards of professional nursing practice, school nurses must maintain the confidentiality and protection of individual students when presenting health-related data or other evidence and research findings. Illinois school nurses are required to uphold the guarantee of confidentiality of health information mandated by the Health Insurance Portability and Accountability Act (H I P A A), the Family Education Rights Protection Act (F E R P A), and the Illinois School Student Records Act. In addition, school nurses must adhere to the ethics of professional research and publishing, which specifically address privacy, confidentiality, and other legal issues.

Objective 0013 
Understand effective approaches to collaboration and delegation in the school health program.

15. According to state guidelines related to responsibilities of school health program staff, which of the following functions is most appropriate for a school nurse to assign to a health services clerk?

  1. assessing the nutritional needs of the overall student population in the school
  2. overseeing medical treatment regimens that are self-administered by students
  3. carrying out developmental screening tests that involve observation and interviewing
  4. collecting, maintaining, and updating emergency information for all students
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: D.
Effective delegation in school nursing often involves using the "five rights of delegation" to assess appropriateness (i.e., right task, right circumstances, right person, right directions and communication, right supervision and evaluation). While steps in the nursing process should not be delegated, tasks such as collecting, maintaining, and updating emergency contact and health information for students are appropriate to delegate. A school health aide, paraprofessional, or other unlicensed assistive personnel (U A P) typically carries out clerical duties such as information gathering, record keeping, filing, contacting students and families, and maintaining health office and medical supplies.

Objective 0014 
Understand the role of the school nurse in preparedness response and coordination during emergencies, crises, and disasters.

16. According to N A S N guidelines on the role of the school nurse in emergency management, which of the following responsibilities is the school nurse expected to fulfill during the recovery phase of emergency management?

  1. meeting the direct physical and mental health-care needs of students and staff and training first-aid response teams
  2. identifying and documenting the unique emergency-related medical and security concerns of students with special needs
  3. providing direct support and serving as the liaison between school community members in need and local resources
  4. educating students and staff about recognizing and reporting potential hazards and suspicious persons or situations
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: C.
The four phases of emergency management planning are prevention/mitigation, preparedness, response, and recovery; a school nurse has a prescribed role in each phase. The recovery phase occurs after a school emergency or disaster, and includes both short-term and long-term recovery for those affected by the incident. In this phase, the school nurse assists students, families, and school staff and, as the main connection in the medical and public health community, assumes the role of liaison between local resources (e.g., mental health services) and school community members in need.

Use the information below to answer the four questions that follow.

A middle school nurse is developing an Individualized Healthcare Plan (I H P) for a student with type 1 diabetes who is beginning his first year at the middle school. The school nurse would like to use a collaborative style in the health management of this student.

Objective 0006 
Understand the care and management of illnesses and chronic health conditions and the development of Individualized Healthcare Plans (I H Ps).

17. At the beginning of the school year, in addition to developing a diabetic management plan for the student, it is most important for the school nurse to:

  1. confer with the student, his family, and his health-care provider regarding interventions for blood sugar fluctuations.
  2. review with the student and his family current recommended nursing interventions for treating and monitoring episodes of diabetic ketoacidosis.
  3. ensure that the student's family understands the etiology of diabetes as a pancreatic cell abnormality that is initiated by a viral or autoimmune disorder.
  4. discuss the pathology and physiology of diabetes and what the future might hold for the student in relation to the disease.
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: A.
Students with type 1 diabetes require a thorough assessment of their health needs and a specific health plan that addresses schedules and procedures for blood glucose monitoring and/or carbohydrate monitoring, meal and snack considerations, treatment and medication protocols, and steps for responding to fluctuations in blood sugar levels. In addition to reviewing medical and educational records, it is essential for the school nurse to interview and consult with the student and his or her parents/guardians to learn about the student's diabetes regimen, physician recommendations, and how and when the family and student monitor the student's glucose levels. The process of developing interventions may involve obtaining materials and medical supplies necessary for performing diabetes care tasks from the parents/guardians, identifying the target range for blood glucose levels recommended by the student's physician, documenting and sending blood glucose levels home to be assessed by parents/guardians, notifying parents/guardians immediately of extremely high or low glucose levels, and agreeing on specific interventions for diabetic emergencies in school settings.

Objective 0005 
Understand the provision and management of school nursing and student health services.

18. The school nurse plans to meet with the student periodically to check on how he is managing his diabetes in the middle school setting. In these meetings, a primary goal of the nurse should be to:

  1. ensure that the student has a wide array of coping strategies, both short-term and long-term, for managing the disease.
  2. summarize, in straightforward terms, the latest research into effective treatment and management of diabetes.
  3. ensure that the student is accurately implementing diet and exercise routines established by his primary care provider.
  4. address any difficulties or barriers in the student's accommodations or concerns related to the treatment regimen.
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: D.
The primary goal of a school nurse who is assisting a student in the treatment of diabetes is ensuring that there is minimal interference with learning and participation in school activities. The school nurse can use periodic meetings with the student to discuss the treatment regimen and related issues, such as insulin administration if needed; where and when blood glucose monitoring takes place; any occurrences of symptoms such as dehydration, frequent urination, vision problems, or fatigue; and any concerns related to the school day (e.g., meal and snack time, restroom use, recess, transportation). In addition, the school nurse could check on whether specific accommodations related to the student's dietary requirements and full participation in particular classes (e.g., physical education), schoolwide activities, field trips, or extracurricular activities are working for the student or need to be adjusted.

Objective 0014 
Understand the role of the school nurse in preparedness response and coordination during emergencies, crises, and disasters

19. The school nurse checks the emergency care plan (E C P) on file that outlines steps to take if the student exhibits signs of hypoglycemia. According to current standards of school nursing practice, which of the following actions is most appropriate to take first in response to a hypoglycemic reaction in a conscious student?

  1. administering warm clear fluids or diet soda in sips
  2. administering a quickly digestible protein source and monitoring the student for 15 minutes
  3. administering insulin according to the dose specified in the student's insulin schedule
  4. administering glucose tabs or a fast-acting carbohydrate such as juice, cake gel, or candy
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: D.
A hypoglycemic (low blood sugar) reaction can occur in a conscious student who has type 1 diabetes when the student's insulin level is too high, when the student misses or delays food intake, or when the student over-exercises. In these cases, the school nurse should administer a source of sugar, in the form of glucose tabs or gel/icing, or simple carbohydrates such as juice, regular soda, candy, or honey. After 10 or 15 minutes and once symptoms have been alleviated, the school nurse may provide the student with a protein and carbohydrate snack (e.g., cheese and crackers).

Objective 0013 
Understand effective approaches to collaboration and delegation in the school health program.

20. The school nurse would like to collaborate with the student's middle school teachers in managing his health-care needs. Which of the following strategies is the most appropriate way of involving teachers in a health care plan for this student?

  1. suggesting to teachers that they buy and store healthful snacks in the classroom in case of an acidosis or hypoglycemic reaction
  2. increasing teachers' understanding of diabetes, signs of early insulin reaction, and what to do if symptoms appear
  3. asking teachers to designate a private corner or place in the classroom where the student can test and record his blood levels
  4. developing a protocol and training course for teacher administration of medication in emergencies
Answer and Rationale. Enter to expand or collapse. Answer expanded
Correct Response: B.
Teachers who have students with diabetes in their classes should have basic knowledge about the disease and how to assist students in managing the disease. The school nurse can coordinate conferences with the student who has diabetes and the student's parents/guardians, teachers, and principal to discuss the student's health and develop a care plan for the student. The school nurse should ensure that teachers are familiar with the supplies students may need during the school day (e.g., testing strips, insulin pen, lancets, blood glucose meter, glucose tablets, juice boxes), signs and symptoms of low and high blood sugar, action plans for hypoglycemia and hyperglycemia, and communication and response considerations (e.g., contacting parents/guardians in the event of a diabetic emergency, never allowing a student who is experiencing low blood sugar to walk to the nurse’s office alone). There are also many professional resources that can support a school nurse's efforts in educating students about diabetes, including downloadable handouts from the Web sites of national diabetes organizations.