Ch. 31: The Nurse in the Schools

3. A school health nurse is requested by the board of education to assist in choosing new playground equipment for an elementary school that meets safety standards. Which of the following best describes the nurse's role in this scenario? A. Case manager B. Consultant C. Counselor D. Health educator

ANS: B Consultant The school nurse is the person best able to provide health information to school administrators, teachers, and parent-teacher groups. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The nurse also can recommend changes in the school's policies or ask community organizations to help make the children's schools healthier places. DIF: Cognitive Level: Apply (Application) REF: p. 570

17. Which of the following is the leading cause of children being absent from school because of a chronic illness? A. Allergies B. Asthma C. Diabetes D. Upper respiratory infections

ANS: B Asthma Asthma is the leading cause of children being absent from school because of a chronic illness. URIs are an acute problem, not a chronic one. DIF: Cognitive Level: Remember (Knowledge) REF: p. 578

18. A school nurse is demonstrating the use of a peak flow meter to help children with chronic asthma recognize when they need to use a rescue inhaler. Which of the following levels of prevention is being used by the nurse? A. Primary B. Secondary C. Tertiary D. Both primary and secondary

ANS: C Tertiary Tertiary prevention includes caring for children with long-term health needs, including asthma and disabling conditions. The nurse is teaching disease management (i.e., when to use an inhaler). DIF: Cognitive Level: Apply (Application) REF: p. 578

12. A school nurse is administering medications at the school. Which of the following guidelines should be followed? A. A current drug reference should be available in case information is needed B. The nurse should administer medications brought in from home by the child C. Medications cannot be administered without a physician order D. Narcotics and controlled substances should be kept in a locked cabinet

ANS: A A current drug reference should be available in case information is needed A current drug reference should always be available so that it can be consulted for information. DIF: Cognitive Level: Apply (Application) REF: pp. 575-576

23. The mother of a high school student newly diagnosed with a condition that will require special health care services is concerned that the student will be required to be home-schooled away from the friends he has developed. Which of the following would be the most appropriate response by the school nurse? A. "Federal legislation requires that the school make provisions for those with various challenges, so your child will be able to remain in school as long as he is able." B. "I realize that this will be a difficult adjustment, but home-schooling has improved over recent decades and the Internet will allow your child to connect with friends." C. "Whether your child can remain in school will depend on state funding for those with disabilities. You might want to contact your congressman on this issue." D. "Your child may remain in school as long as he can manage the course requirements and doesn't flunk out."

ANS: A "Federal legislation requires that the school make provisions for those with various challenges, so your child will be able to remain in school as long as he is able." Federal legislation specifies that children cannot be excluded from schools because of a disability. The school must provide health services that each child needs. Legislation further requires the school district's committee on the disabled to develop individualized education plans (IEPs) for children. DIF: Cognitive Level: Apply (Application) REF: p. 563

15. A school nurse suggests to teachers that they have a session on coping strategies and stress management techniques. The nurse also sets up a peer counseling program. Which of the following is the school nurse most likely trying to prevent? A. Adolescent suicides B. Bullying C. Obesity D. Teenagers engaging in violence

ANS: A Adolescent suicides Suicide is the third leading cause of death in teenagers. To reduce the incidence of suicide in teenagers, the nurse can emphasize coping strategies and stress management techniques and organize a peer assistance program to help teenagers cope with school stresses. DIF: Cognitive Level: Apply (Application) REF: p. 577

24. A group of nursing students are scheduled to present a program on healthy hearts to various community groups, with a daycare center being the first location. What of the following advice should be given to them by their instructor? A. Base the program on the audience's development and maturity. B. Bring (borrow if necessary) a model of the heart to help explain its functioning. C. Focus on entertaining the learners. D. Have lots of handouts to reinforce the lesson.

ANS: A Base the program on the audience's development and maturity. For younger learners, it is important to keep the lesson to no more than 10 minutes in length; to use plenty of examples, pictures, and stuffed animals in the talk; and to remember the developmental stage of the children when teaching them. DIF: Cognitive Level: Apply (Application) REF: p. 573

20. A pregnant teen asks the school nurse to provide information on abortion and a list of health care providers who offer such services. If the school nurse has very strong personal beliefs against abortion, which of the following actions should be taken by the nurse? A. Call in another nurse to care for this client. B. Explain, from the nurse's perspective, all the reasons that abortion should be made illegal. C. Offer the student a combination of oral contraceptives to induce spontaneous abortion. D. Provide information on alternatives to abortion and give the client information on adoption agencies.

ANS: A Call in another nurse to care for this client. This creates an ethical dilemma for the nurse. If the nurse feels so strongly that he or she cannot work with the situation, another school nurse should be called for help or the student should be referred to other health providers who can provide the care the student needs. DIF: Cognitive Level: Apply (Application) REF: pp. 580-581

9. A nurse would like to implement a primary prevention effort to decrease the leading cause of death among children and teenagers. Which of the following actions would the nurse most likely take? A. Educate students about injury prevention measures B. Provide free condoms to sexually active students C. Screen for signs and symptoms of cancer D. Invite a guest speaker to talk about living with HIV

ANS: A Educate students about injury prevention measures Injuries are the leading cause of death in children and teenagers; therefore, prevention measures should focus on injury prevention. Because the question asks for primary prevention efforts, the intervention must occur before injury. Common interventions by the school nurse include educational programs reminding children to use their seatbelts or bicycle helmets to prevent injuries. Other classes can be on crossing the street, water safety, and fire safety. DIF: Cognitive Level: Apply (Application) REF: p. 573

7. The school health nurse has enlisted the assistance of high school role models in the areas of sports and scholarship to provide an antidrug presentation to their peers. Which of the following levels of prevention is being implemented? A. Primary B. Secondary C. Tertiary D. Both primary and secondary

ANS: A Primary Primary prevention interventions by the school nurse include educating children and adolescents about the effects of drugs. In preventing use, students are taught by the school nurse to stay away from drugs such as marijuana, cocaine, crack, heroin, and alcohol. DIF: Cognitive Level: Apply (Application) REF: p. 572

25. Which of the following activities are included in the Centers for Disease Control and Prevention's school health program? (Select all that apply.) A. Ensuring a healthy school environment B. Assisting teachers with education related to health C. Encouraging nutritious school meals D. Giving immunizations to students, staff, teachers, and their families

ANS: A, B, C A. Ensuring a healthy school environment B. Assisting teachers with education related to health C. Encouraging nutritious school meals The federal government, through the coordination of the Centers for Disease Control and Prevention, developed a plan that school health programs should follow, including health education, physical education, health services, nutrition services, counseling, psychological and social services, healthy school environment, health promotion for staff, and family/community involvement. Unfortunately schools cannot afford to give immunizations to everyone who might want such a benefit. Education in areas other than health is the responsibility of the teachers, not the nurse. DIF: Cognitive Level: Remember (Knowledge) REF: pp. 570-571

29. A school nurse describes to teachers the characteristics of an adolescent who may be thinking about drastic violence. Which of the following behaviors would suggest the adolescent was having such problems? (Select all that apply.) A. Being a gang member B. Damaging property C. Leaving the scene if another student is being bullied or hurt D. Mood swings

ANS: A, B, D A. Being a gang member B. Damaging property D. Mood swings Six characteristics that can help identify a student who may be thinking about drastic violence are (1) Venting: having mood swings; (2) Vocalizing: threatening others; (3) Vandalizing: damaging property; (4) Victimizing: seeing himself or herself as a victim; (5) Vying: belonging to gangs; and (6) Viewing: witnessing the abuse of others. By helping to identify students who might be considering school violence, help may be obtained and violent actions may be prevented. DIF: Cognitive Level: Apply (Application) REF: p. 577

28. Which of the following supplies or equipment should a nurse have available in the school health office? (Select all that apply.) A. Cervical spine collars B. Complete emergency kit that fulfills American Hospital Association requirements C. Epinephrine autoinjector kit D. Material for splints

ANS: A, C, D A. Cervical spine collars C. Epinephrine autoinjector kit D. Material for splints The school nurse needs much equipment to deal with emergencies in the school. Basic necessary equipment includes full oxygen tanks with oxygen masks of different kinds, splints, cervical spine collars, sterile dressings, and an epinephrine autoinjector kit in case a child goes into anaphylactic shock after exposure to an allergen. A hospital-oriented emergency kit would become quickly outdated (medications) and extremely expensive. DIF: Cognitive Level: Understand (Comprehension) REF: p. 575

27. A new student's parents had not yet submitted an immunization record, although the nurse had sent a reminder home with the student twice. Which of the following actions should be taken by the nurse to keep the child in school? (Select all that apply.) A. Call the parents or mail another reminder. B. Report the problem to the teacher and the principal. C. Send the child home with a note saying the child cannot return until the immunization record is received. D. Suggest to the parents that if they don't have health care insurance, they may qualify for programs that provide immunizations free.

ANS: A, D A. Call the parents or mail another reminder. D. Suggest to the parents that if they don't have health care insurance, they may qualify for programs that provide immunizations free. There are many problems with children not being immunized or having incomplete vaccination records, especially in families who have moved many times or who may not have a regular physician. The parents may have no idea whether the child has received the required shots. Families may also be without health care insurance to pay for the immunizations, or they may have insurance that does not pay for preventive care. In these cases, they may lack the resources to pay for the immunizations themselves. Therefore, the nurse's role is to be sure parents are aware of the problem, to help them obtain the records if they have been misplaced, and to suggest ways to obtain the injections without charge, even if there is no obvious evidence that lack of funds is the problem. Telling the teacher or principal won't resolve the problem and it is illegal, immoral, and unprofessional to enter false information in a student's record. DIF: Cognitive Level: Apply (Application) REF: p. 574

13. An upset mother calls the school nurse and says, "How dare you say my child has lice? My child is clean and I keep a clean house! You've obviously made an error." Which of the following would be the best response by the nurse? A. "I'm sorry you're upset, but your child cannot return to school until this problem is addressed." B. "Most lice are found in clean hair. Children often share combs. Let me tell you how to fix the problem." C. "You may have been traveling. Lice are often found in motels." D. "I'm sure you're correct; one of my volunteers probably made an error. I'll recheck."

ANS: B "Most lice are found in clean hair. Children often share combs. Let me tell you how to fix the problem." The nurse must reassure the mother that no insult was intended; in fact, lice are most often found on middle-class children with clean hair. Lice travel easily when children share items such as combs or other property in school. Lice are not life-threatening, and the necessary shampoo and other items to treat lice are widely available over the counter. DIF: Cognitive Level: Apply (Application) REF: p. 576

8. Which of the following best describes the primary reason that school health nurses spend so much time on educational programs that teach children the importance of water and fire safety, using a seatbelt in the car, and wearing a helmet when biking or skateboarding? A. Because children won't know if someone doesn't tell them B. Because injuries are the leading cause of death in children and most injuries are preventable C. Because it is a dangerous world and someone has to warn children about the dangers D. Because teaching is easy and more fun than passing out bandages and documenting care

ANS: B Because injuries are the leading cause of death in children and most injuries are preventable The school nurse, as the trusted person at school, is able to quickly give information to help prevent injuries from occurring, since most injuries are preventable. Injuries are the leading cause of death in children and teenagers. DIF: Cognitive Level: Understand (Comprehension) REF: p. 573

6. Which of the following best describes services that are offered at a school-based health center? A. Employee care at a discounted cost at the school B. Care to others in the community C. Sex education, birth control, family planning, and care throughout pregnancy D. Referral and networking with other health care services in the community

ANS: B Care to others in the community School-based health centers give care not only to students but also to other persons in the community. They may provide social services, daycare, job training, and educational counseling in addition to the medical and nursing care, mental health counseling, and dental care seen in smaller school-based centers. DIF: Cognitive Level: Understand (Comprehension) REF: p. 571

4. At the annual community health fair, the school health nurse displays a science booth that examines the hazards of ineffective hand washing. Which of the following best describes the nurse's role in this scenario? A. Consultant B. Community outreach C. Counselor D. Researcher

ANS: B Community outreach When participating in community outreach, nurses reach out to residents in the community. One common way this occurs is when nurses are involved in activities such as community health fairs or festivals in the schools. DIF: Cognitive Level: Apply (Application) REF: p. 570

21. Which of the following is most important for school nurses to master in order to prepare for health care delivery in the future? A. Complementary and alternative therapies such as acupuncture B. Computer and technology use C. Psychoanalytical techniques D. Self-defense techniques

ANS: B Computer and technology use In the future, school nursing will use telehealth and telecounseling to teach health education. School nurses will use the Internet to work with children and parents. DIF: Cognitive Level: Understand (Comprehension) REF: p. 581

16. A disaster has occurred in the community. Which of the following actions should be taken by the school nurse? A. Continue activities as much as possible as if nothing had happened B. Continue to assess for shock and stress C. Help teachers discuss the disaster with their class D. Maintain school routines and activities

ANS: B Continue to assess for shock and stress After a disaster, the school nurse has many responsibilities—for instance, continuing to assess the school community for the presence of shock and stress; encouraging parents to minimize how much their children view the disaster coverage on TV; providing grief counseling; continuing to communicate with the children, parents, and school personnel; and following up with assessment of children for anxiety, depression, regression, and posttraumatic stress disorder. DIF: Cognitive Level: Apply (Application) REF: pp. 577-578

10. The school nurse has arranged for volunteers to help check each child's hearing and vision. Any child that the volunteers feel did not "pass" will be sent to the nurse for follow-up. The nurse will then send a note to the parents that a physician should be seen. Which of the following levels of prevention is being implemented? A. Primary B. Secondary C. Tertiary D. Both primary and secondary

ANS: B Secondary Because secondary prevention involves caring for children when they need health care, this is the largest responsibility for the school nurse. This includes caring for ill or injured students and school employees. It also involves screening and assessing children and referral to appropriate health agencies or providers. DIF: Cognitive Level: Apply (Application) REF: p. 574

26. Which of the following best explains why the federal government is beginning to fund school-based health centers? (Select all that apply.) A. These centers help young children avoid becoming addicted to drugs while still in elementary school. B. Attendance and learning are higher in schools with health clinics. C. These centers help keep children in school longer by distributing birth control and thus avoiding pregnancies. D. Many children have no other source of health care services.

ANS: B, D B. Attendance and learning are higher in schools with health clinics. D. Many children have no other source of health care services. The U.S. government began funding school-based health centers essentially because many school children may not receive health care services otherwise. These are family-centered, community-based clinics run within the schools. Certainly, avoiding pregnancy and drug addiction are among the goals of school-based health centers, but these are not reasons the government began funding them. DIF: Cognitive Level: Understand (Comprehension) REF: p. 571

30. A child has multiple disabilities, and caring for the child has been both expensive and time consuming for the school. Once the child turns 16, which of the following actions should be taken by the nurse? (Select all that apply.) A. As an adult, the child is no longer eligible for school services without charge. B. The school must continue to provide needed appropriate education for the child. C. The school can exclude the child from any extra special activities. D. The school should prepare an updated individualized education plan.

ANS: B, D B. The school must continue to provide needed appropriate education for the child. D. The school should prepare an updated individualized education plan. Educational services must be offered by the schools for all disabled children from birth through age 22 years. Children cannot be excluded from activities because of a disability. The school must always develop an individualized education plan for each child and update it at appropriate intervals. Turning 16 does not make a child an adult. DIF: Cognitive Level: Apply (Application) REF: p. 568

22. The principal of a school was upset over a rumor that one of the children had engaged in a violent activity that injured a younger sibling. The principal asked the nurse who the children were so that the involved teachers could both support the injured child and guard other children from the violent child. Which of the following would be the best response by the nurse? A. "I'll get the names to you and the involved teachers immediately." B. "Let me get the parents' consent, and then I'll get you the names." C. "Rumors are often inaccurate; let me follow up and see what happened and what needs to be done." D. "Why don't we coordinate a school-wide program on preventing accidents instead?"

ANS: C "Rumors are often inaccurate; let me follow up and see what happened and what needs to be done." The school nurse is responsible for maintaining school health office policies, including privacy and safety of health records. The nurse must follow the HIPAA privacy rules while also ensuring the safety of children at school. When a rumor is involved, it is always wise to check its accuracy. If a child was indeed hurt, the nurse needs to make sure both children involved receive (or have already received) appropriate care. The question about having a school-wide program may be appropriate, but this behavior was apparently purposeful, not accidental. DIF: Cognitive Level: Apply (Application) REF: p. 569

11. Which of the following would be the best way for the school nurse to fulfill his or her responsibilities in an emergency situation? A. Tell all staff to call 911 if the nurse is not in the building. B. Arrange to always be available, even if only by phone. C. Create and share an emergency plan with all teachers and staff. D. Wear a pager so that the nurse can come as soon as humanly possible.

ANS: C Create and share an emergency plan with all teachers and staff. The American Health Association recommends that the school nurse create an emergency plan with at least two different staff members identified and responsible for implementing the plan if the nurse is not in the building at the time of the emergency. The plan would include when to call 911 and how to get a child to the hospital via ambulance if needed. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 574-575

1. According to the American Academy of Pediatrics, which of the following activities are expectations for a school health nurse? A. Ensuring that children with health problems are accepted by their peers B. Driving children home if parents can't pick them up C. Giving emergency care in the school or during school events D. Giving medications as needed if children are ill

ANS: C Giving emergency care in the school or during school events School nursing responsibilities include making sure that children get the health care they need, including emergency care in the school; keeping track of the state-required vaccinations that children have received; carrying out the required screening of the children based on state law; and ensuring that children with health problems are able to learn in the classroom. The nurse cannot convince children to accept other children as peers, although certainly efforts should be made. HIPAA would not allow individual examples of health problems to be shared, other than providing group statistics. DIF: Cognitive Level: Understand (Comprehension) REF: p. 569

2. Which of the following statements best explains why many school nurses are not able to ensure that all children receive needed health care in the schools? A. There is a shortage of baccalaureate-prepared nurses with national school health nurse certification. B. Most nurses prefer to be employed in hospitals giving direct care. C. Most school districts are unable to afford a nurse in every school. D. School districts and taxpayers see no need for nurses in schools.

ANS: C Most school districts are unable to afford a nurse in every school. In Healthy People 2020, objective ECBP-5 states that there should be one nurse for every 750 children in each school (U.S. Department of Health and Human Services, 2010). Most schools have not achieved this objective. In 2006, approximately 40% of the nation's schools met that standard. The new objective is that 44.7% of the country's elementary, middle, junior high, and senior high schools have this many nurses by 2020 (U.S. Department of Health and Human Services, 2010). Having fewer nurses in the schools means that the nurses are expected to perform many different functions. It is therefore possible that they are unable to provide the amount of comprehensive care that the students need (Croghan, 2009). DIF: Cognitive Level: Understand (Comprehension) REF: p. 569

19. A school nurse has developed a special class for pregnant teens to teach them everything from anticipated body changes to methods for managing common pregnancy-associated problems. The classes also allow the nurse to be in close frequent contact with the students to monitor their health status. Which of the following levels of prevention is being used by the nurse? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Both primary and secondary prevention

ANS: C Tertiary prevention Many teenage girls who are pregnant attend school; therefore, the school nurse may provide ongoing care to the mother. Although this may appear to be secondary prevention, it is tertiary prevention because adolescent pregnancies are considered to be high risk. DIF: Cognitive Level: Apply (Application) REF: p. 580

14. A school nurse listens as one student talks about another student being upset because his father frequently spanks him with a leather belt that leaves big marks on the student's back. But the student begs the nurse not to tell anyone because he promised the friend that the information would never be shared. Which of the following actions should be taken by the nurse? A. Ask the student if abuse has occurred. B. Call in the named student and ask him to remove his shirt. C. Discuss the conversation with the student's parents. D. Notify the legal authorities.

ANS: D Notify the legal authorities. When the nurse identifies a child who may be abused or who receives information from someone else that a child may have been abused, the nurse must contact the appropriate legal authorities and the school's principal. Asking the student about the abuse will not always elicit a truthful answer, because children will protect their parents. A confidential file should be made about the incident; however, the nurse should let the government authorities, usually the state or county child protection department, look into the suspected case. In all cases, the child should be protected from harm, and those who have no right to know that child abuse or neglect is suspected should not be given any information. DIF: Cognitive Level: Apply (Application) REF: p. 576

5. Which of the following best explains why school nurses are involved in helping teachers with the task of teaching children how to practice problem solving, communication, and other life skills? A. Teacher shortages have required nurses to be increasingly involved in teaching life skills. B. Because so many nurses want to be employed in schools, this responsibility was assumed to increase employment opportunities. C. States are requiring nurses to screen and to teach life skills. D. Nurses have been enlisted in this role to help reduce risk factors for future health problems in school children.

ANS: D Nurses have been enlisted in this role to help reduce risk factors for future health problems in school children. School health nurses were originally involved in this capacity in 1987 after the CDC began funding schools for HIV-prevention education programs. This program was so successful that it was expanded to include programs to teach children prevention of other chronic illnesses caused in part by risk factors such as poor diet, lack of exercise, and smoking. The schools are actively involved in helping the children practice problem solving, communication, and other life skills so that they can reduce their risk factors for health problems. DIF: Cognitive Level: Understand (Comprehension) REF: p. 571