29 School Health
12 of 31 The school nurse only had the resources for one education program for all the schools' teachers and support staff. Which of the following topics would be the most important to address in this program? a. Asthma b. Diabetes c. Epilepsy d. Measles and mumps
Asthma In 2011, 9.6 % of children under the age of 18 had asthma, occurring most often among poor (13.5%) and non-Hispanic black children (17%). Asthma is one of the most common chronic childhood conditions, causing more than 4.6 million people to miss more than 1 day of school or work (CDC, 2011d). Because asthma is so prevalent, it is recommended that school-based support exists. Actions undertaken by some schools across the country include immediate access to asthma medications, development and implementation of asthma action plans, and student and staff education on asthma. Because of the severity and prevalence of asthma, this is the most important topic to address and should be addressed instead of diabetes, epilepsy, or measles and mumps.
13 of 31 Which of the following medications can a school nurse expect to most frequently administer? a. Analgesics and antipyretics b. Antibiotics c. Antitussives d. Anticonvulsants e. Attention-deficit hyperactivity disorder (ADHD) medications
e. Attention-deficit hyperactivity disorder (ADHD) medications Medications used to treat ADHD are the most commonly administered. Medications commonly given in schools include analgesics and antipyretics, antacids, antitussives, anticonvulsants, antiemetics and antidiarrheals, antifungals, antihistamines, and antibiotics.
16 of 31 A school nurse was responsible for five schools. To give students required medications during the day, the school nurse teaches a particular office staff member in each school exactly what to give to whom and when, and they practice until both are comfortable. Which of the following remains as the nurse's responsibility in relation to the administration of medications? a. To begin teaching a second person at each school because the original staff member might occasionally not be available to give the medications b. To confirm with each student that they do not mind obtaining their medication from the staff person assigned to the task c. To continue to evaluate the comfort level of the staff person in completing the task d. To systematically continue with assessment, diagnosis, goal setting, and evaluation of student health needs
d. To systematically continue with assessment, diagnosis, goal setting, and evaluation of student health needs Not every school has a full-time nurse available on site. Often a nurse is assigned to three or four schools, resulting in delegation of certain tasks to unlicensed personnel. Each state's nurse practice act stipulates which procedures may be delegated. The responsibility for assessment, diagnosis, goal setting, and evaluation may never be delegated. When tasks are delegated, the nurse must provide appropriate education, written procedures, and ongoing supervision and evaluation of the caregivers.
6 of 31 Which of the following is the single leading preventable cause of death in the United States? a. Alcohol b. Firearms (guns) c. Overweight and obesity d. Tobacco use
d. Tobacco use Tobacco use is a major problem in this country and is the single leading preventable cause of death in the United States. Overweight and obesity is the second leading cause of preventable death in the United States. Alcohol and firearms (guns) are not leaders in the causes of preventable death in the United States.
17 of 31 A school health nurse was concerned about the diagnosed eating disorders of three high school students. A nutrition and body image program was planned. Which of the following classes should receive the program first? a. Elementary school grades 4, 5, and 6 b. Grades 7, 8, and 9 c. High school grades 10, 11, and 12 d. Kindergarten students
Elementary school grades 4, 5, and 6 It is imperative that the school nurse recognize the association between feelings of inadequacy (e.g., low self-esteem, anger, anxiety, and depression) and unhealthy eating practices in adolescents and young people. These self-perceptions begin early in life; therefore education and counseling must begin in elementary school. This program would be offered too early for kindergarten students and too late for grades 7 through 12. Thus, the priority population would be the elementary school children.
14 of 31 A principal called the school nurse into his office and asked, "Will this student be able to attend our school?" after handing over the medical record of a severely handicapped prospective student. Which of the following would be the most appropriate response by the nurse? a. "Legally all students have a right to public education in the least restrictive environment possible, so let me think how we can manage." b. "The student clearly won't be comfortable here; other students can be so cruel. Let me talk to the student's family." c. "There are schools that specialize in the care of the severely handicapped. Let me get in touch to see if one of those schools has the needed resources." d. "This student is so handicapped there is no way to manage the needed care; the family needs a home schooling teacher."
a. "Legally all students have a right to public education in the least restrictive environment possible, so let me think how we can manage." In 1976, Public Law 99-142 was enacted, giving all students, including those who are severely handicapped, the right to public education in the least restrictive environment possible, regardless of mental or physical disabilities. The Education for All Handicapped Children Act of 1973 and the subsequent Individuals with Disabilities Education Act of 1990 enhanced the opportunities for children previously served in acute care and long-term care settings to have access to public education.
31 of 31 A community health nurse is assigned to cover a school health office when the school's nurse is ill. A child is waiting for the nurse's arrival, saying a particular medication is needed. Which of the following can the nurse expect to find in the school health office? (Select all that apply.) a. A nursing policy book with standing orders and nursing protocols b. Medications clearly labeled with student name, as well as typical medication information (e.g., name, dose) c. Approval from the student's teacher for the student to see the nurse for the medication each day d. The student's written assent for the medication to be administered when requested e. Written request from a health care provider for that student to receive that medication f. Written request from the student's parents for the specific medication to be administered
a. A nursing policy book with standing orders and nursing protocols b. Medications clearly labeled with student name, as well as typical medication information (e.g., name, dose) e. Written request from a health care provider for that student to receive that medication f. Written request from the student's parents for the specific medication to be administered The guidelines from the National Association of School Nurses indicate that medications should be in containers that are properly labeled with all appropriate student and medication information, accompanied by a written request from the health care provider and parent or guardian, and administered without violating standing orders or nursing protocols. The nurse would not typically find an approval from the student's teacher for the student to see the nurse each day for a medication or a student's assent for the medication to be administered. The parents and health care provider are responsible for the written request for the medication to be administered.
7 of 31 Which of the following is the most commonly used drug among children and adolescents in the United States? a. Alcohol b. Marijuana c. Methamphetamine d. Cocaine e. Steroids
a. Alcohol All 50 states and the District of Columbia have outlawed the sale of alcohol to anyone under the age of 21 years, yet it is still the most commonly used drug among children and adolescents. Marijuana is the most commonly used illicit drug in the United States. The use of other illegal drugs in high school students includes cocaine (6.8%), inhalants (11.4%), heroin (2.9%), methamphetamine, (3.8%) and steroids (3.6%).
30 of 31 Which of the following screenings are typically administered in the school setting? (Select all that apply.) a. Blood pressure b. Chest x-ray c. Cholesterol and blood glucose d. Height and weight e. Scoliosis f. Visual and hearing acuity
a. Blood pressure d. Height and weight e. Scoliosis f. Visual and hearing acuity Height, weight, vision, and hearing screenings are provided at most schools. Scoliosis or postural screening should be done to identify spinal deviations and intervene early to prevent related secondary problems. The detection of high blood pressure during childhood is important in identifying children who have hypertension and who will benefit from early intervention and follow-up. Screenings in schools must be relatively fast, easy, and noninvasive. Blood work is invasive and cannot be done without parental consent. It is also expensive because test strips must be purchased. Due to the equipment needed, it is not typical that chest x-rays or cholesterol and blood glucose screenings are administered in the school setting.
28 of 31 Which of the following variables create differences from school to school regarding the health services that are available? (Select all that apply.) a. Community resources b. National statistics on health problems c. School leadership preferences d. State legislative requirements e. Students' needs f. Teacher preferences
a. Community resources c. School leadership preferences d. State legislative requirements e. Students' needs School health services goals and objectives vary from state to state, community to community, and school to school. These differences reflect wide variations in state regulation, student needs, community resources, funding sources, and school leadership preferences. The national statistics on health problems and teacher preferences do not create differences among schools in regards to health services that are available.
21 of 31 Everyone in a high school was very upset over the fact that one of the students had shot and killed another student. The nurse decided this was an appropriate time to establish a program to help prevent violence. Which of the following groups of students should receive the program first? a. Elementary school grades 4, 5, and 6 b. Grades 7, 8, and 9 c. High school grades 10, 11, and 12 d. The students who knew the victim and his assailant
a. Elementary school grades 4, 5, and 6 Violence prevention programs should begin in elementary schools. Children who exhibit aggressive behavior in elementary school are more likely to exhibit antisocial and violent behavior as adolescents and adults. Programs should teach stress management, conflict and anger resolution, and personal and self-esteem development. This program would be offered too late for children in grades 7 through 12, and should be offered to a larger audience than only those who knew the victim and assailant. Thus, the priority population would be the elementary school children.
29 of 31 Which of the following best describes how schools can determine what their school health education priorities should include? (Select all that apply.) a. Provide opportunities for students to practice decision-making skills b. Choose priorities according to which behaviors lead to avoidable problems c. Make priorities consistent with the six topics identified by Healthy People 2020 d. Determine priorities by the education and expertise of the local school nurse e. Select priorities according to parent and student interests f. Decide on priorities based on whatever funding sources are willing to fund
a. Provide opportunities for students to practice decision-making skills b. Choose priorities according to which behaviors lead to avoidable problems c. Make priorities consistent with the six topics identified by Healthy People 2020 Healthy People 2020 sets goals that schools provide health education courses in priority areas. The six behavioral categories or topics identified include the following negative behaviors that often start in childhood or adolescence and persist into adulthood: (1) alcohol and drug use; (2) injury and violence; (3) tobacco use; (4) poor nutrition; (5) lack of physical activity; and (6) sexual behavior that results in sexually transmitted diseases or unwanted pregnancies. These problems and behaviors are preventable and lead to additional problems. In a comprehensive health education program, students should be given the opportunity to practice decision-making and communication skills. Funding may not fit local needs. All school nurses should be competent in teaching related to healthy behaviors or know experts who could assist. The priorities should be based on Healthy People 2020, not on the parent and student interests or on the basis of available funding sources.
5 of 31 In addition to their homes, where are children most likely to be injured? a. At entertainment sites (theaters, amusement parks) b. At school, especially on playgrounds c. At their part-time job settings d. Transportation (automobiles, school buses)
b. At school, especially on playgrounds Safety on the schoolyard and playground is also important for this age group, because about 200,000 children per year are injured on playgrounds in the United States. Thus, school playgrounds are the most likely place where children are injured. Injuries at entertainment sites, part-time job settings, and through modes of transportation are less likely to occur than injuries at schoo
10 of 31 Which of the following health problems has been reduced in school-aged and adolescent children? a. Chronic diseases (such as asthma or diabetes) b. Contagious diseases c. Sexually transmitted diseases (STDs) d. Stomach flu (viral gastroenteritis)
b. Contagious diseases Vaccine-preventable deaths (VPD) are at or near record-low levels. According to the Centers for Disease Control and Prevention, many communicable diseases have been reduced by greater than 99% as a result of immunizations. Chronic diseases have been increasing in school-aged and adolescent populations due to the increase in overweight and obesity. STDs and stomach flu have not been greatly reduced in school-aged and adolescent children.
20 of 31 Every day a child came into the school nurse's office with vague complaints, but sometimes it seemed to the nurse that the child just wanted to talk and be listened to for a while. Unfortunately, the child took up almost 15 minutes of the nurse's very busy day. Which of the following actions should be taken by the nurse? a. Ask a staff person to talk with the child so the nurse could complete required tasks b. Continue to listen while assessing for possible underlying problems c. Refer the child to a private physician for follow-up on the constant physical symptoms the child presented d. Talk to the teacher about not letting the child leave the classroom unless obvious symptoms (fever, vomiting) of illness were present
b. Continue to listen while assessing for possible underlying problems The nurse or teacher may be the only stable adult in the child's life who will listen without being judgmental. Therefore, one of the most important roles of the school nurse is to act as counselor and confidante. Children may come to the school nurse with various vague complaints, such as recurrent stomachaches, headaches, or sexually promiscuous behavior, and the nurse must look beyond the initial complaint to identify underlying problems.
9 of 31 Which of the following is one of the most frequent health complaints of school-aged children? a. Anxiety over grades b. Dental caries c. Headaches in response to stress d. Stomachaches
b. Dental caries One of the most frequent complaints of school-aged children is dental caries. Causes include poor oral hygiene, lack of fluoridated water, and lack of funds or insurance for dental care. Half of children aged 12 to 15 years will have dental caries. Approximately 75% of those between the ages of 12 and 19 years have had tooth decay. Dental caries occur as a more frequent complaint than anxiety over grades, headaches in response to stress, and stomachaches.
25 of 31 A student had been absent 4 days out of the last 3 weeks. When the school nurse asked what was wrong, the student replied, "Headaches" in a rather angry tone. The student had previously been heard to complain that school was boring and it was hard to concentrate on such dumb stuff. Which of the following actions would be most appropriate for the nurse to take next? a. Emphasize the importance of completing school for lifelong success b. Express concern that the student was under a lot of stress and offer to help if possible c. Meet with the student's parents to discuss the headaches and the school absences d. Refer the student to a neurologist for a workup to see what is causing the headaches
b. Express concern that the student was under a lot of stress and offer to help if possible Warning signs of stress include angry or hostile feelings, inability to concentrate, increased boredom, frequent headaches or other ailments, and inconsistent school attendance.
8 of 31 Which of the following is the most commonly used illegal drug among children and adolescents in the United States? a. Inhalants b. Marijuana c. Methamphetamine d. Cocaine e. Steroids
b. Marijuana The most commonly used illicit drug among youth in the United States is marijuana. The use of other illegal drugs in high school students includes cocaine (6.8%), inhalants (11.4%), heroin (2.9%), methamphetamine (3.8%), and steroids (3.6%). Inhalants are the most widely abused.
26 of 31 A female coach walks into your office and shares that one student concerns her. The student will not change into her gym clothes and does not seem to "move right." Which of the following actions would be most appropriate for the nurse to take next? a. Call the student into your office and discuss the importance of physical education to one's health b. Meet with the student and ask directly about sexual or physical abuse c. Offer to attend the next physical education class and talk to the student d. Point out how female adolescents are very concerned over body image and are usually embarrassed by their own lack of perfection, and suggest the coach be more understanding
b. Meet with the student and ask directly about sexual or physical abuse Adolescents being physically or sexually abused may have symptoms that include changes in behavior; difficulty in walking, sitting, or other movements; and refusing to change into gym attire or participate in physical activities. It would not be appropriate to minimize the situation, call the student out in front of the class, or have a conversation about the importance of physical education. Rather, the nurse should address the potential signs and symptoms that have been displayed by this student.
18 of 31 Which of the following health problems continues to increase in school-aged and adolescent children? a. Contagious diseases b. Obesity and related problems (diabetes) c. Sexually transmitted diseases (STDs) d. Stomach flu (viral gastroenteritis)
b. Obesity and related problems (diabetes) Obesity is the fastest rising public health concern in the nation and may overtake tobacco use as the single leading preventable cause of death. The obesity rate has more than doubled in children and tripled in adolescents over the past three decades. More than one third of children and adolescents are considered overweight or obese. Vaccine-preventable deaths (VPD) related to contagious diseases are at or near record-low levels. According to the Centers for Disease Control and Prevention, many communicable diseases have been reduced by greater than 99% as a result of immunizations. STDs and stomach flu have not been increasing in school-aged and adolescent children.
15 of 31 The new principal stopped the school nurse in the hall and said, "I need to get oriented here. We seem to have a lot of handicapped children. Please make me a copy of their medical records so I can be prepared to meet with the parents if they come in." Which of the following is the most appropriate response by the nurse? a. "I'd be happy to help you get oriented to our students. I'll prepare a summary of our special students' needs and problems for you." b. "I'm so happy to hear of your interest; I'll get those records to you immediately." c. "I'm glad you're interested. Student health records are confidential, but I'll give you a schoolwide overview without any identifying data." d. "Let me check our school board policies regarding sharing of information and get back to you."
c. "I'm glad you're interested. Student health records are confidential, but I'll give you a schoolwide overview without any identifying data." The Family Educational Rights and Privacy Act, a strong privacy protection act, protects student education records, including the health records. Student health records should be afforded the same level of confidentiality as that given to clients and patients in other settings.
19 of 31 Which of the following best explains why the school nurse and the principal athletic director of the school would frequently be working together? a. As neither are teachers, each is susceptible to job layoffs if the community school tax levy does not pass. b. As support staff to teachers, they have many mutual problems in communicating how they can help teachers be more successful. c. Both are extremely concerned with the typical student's low amount of physical exercise and want to create an intervention plan. d. Both have to create a budget plan and allocate funds for their department for the year.
c. Both are extremely concerned with the typical student's low amount of physical exercise and want to create an intervention plan. Obesity and its prevention or treatment must be of concern to the school nurse. Although many of the underlying causes of obesity are not well understood, several contributing factors have been identified, including reduced access and affordability of nutritious foods, decreased physical activity, and cultural and genetic influences. The nurse and the athletic director would want to cooperate on how to increase physical activity of the students.
1 of 31 Which of the following best describes why the numbers of children seen by the school health nurse is increasing? a. Higher expectations for performance by parents and school administrators b. Increasing school enrollments c. Lack of another source of regular health care d. Overcrowding within the community
c. Lack of another source of regular health care Increasing numbers of children are being seen in the school setting because they lack a source of regular medical care.
27 of 31 In a nationwide survey, which of the following was identified by school health nurses as the most crucial research priority for their specialty? a. Emergency preparedness b. Health education c. Obesity and nutrition d. Role of the school health nurse
c. Obesity and nutrition Gordon and Barry surveyed 263 school nurses in 2006 to identify what the nurses believed to be the top research priorities for the specialty. The first most crucial response was obesity/nutrition—nutrition and weight-loss counseling programs, eating disorders, obesity in children and teens, and importance of exercise.
3 of 31 Which of the following led to school nurses moving beyond the role of screening, assessment, intervention, and exclusion of children for communicable diseases? a. A communicable disease outbreak, which led to the requirement that all children be vaccinated against common infectious diseases b. Federal legislation, which required immunizations for communicable diseases c. Political movements such as temperance, which led schools to educate about the effects of alcohol and tobacco d. The need for inspecting schools to identify children who were ill and exclude them until they were no longer infectious
c. Political movements such as temperance, which led schools to educate about the effects of alcohol and tobacco The federal government was not involved in school health because education and health are responsibilities of the state government. The first citywide vaccination program—against smallpox—was in the 1870s before school nurses were first employed in 1902. Other issues beyond treatment for minor problems quickly became part of school nurse school practice. In the early part of the twentieth century, the temperance movement led schools to teach about the effects of alcohol and tobacco.
23 of 31 A new school nurse was concerned about being accepted, as the previous nurse had been at the school for more than 20 years. Which of the following would be the best approach for the nurse to take? a. Do the best job possible of revising policies and approaches to reflect current information and trends b. Put all the nurse's credentials (degrees, certifications) in an obvious spot in the health office c. Set up workshops on exercise, nutrition, and weight management and perhaps ongoing blood pressure screenings for school staff d. Spend time with each student, making sure the students all think she is very helpful
c. Set up workshops on exercise, nutrition, and weight management and perhaps ongoing blood pressure screenings for school staff The school nurse can assist the faculty and staff by giving workshops on exercise and nutrition, screening for increased blood pressure, and establishing weight management programs.
2 of 31 Which of the following best describes how Lillian Wald helped encourage the idea of school nurses in the schools? a. She brought political pressure to bear on school boards through her political action movement. b. She persuaded very wealthy women to convince their husbands to fund such positions. c. She demonstrated that school nurses decreased absenteeism by 50%. d. She used volunteer nurses until school boards were persuaded to fund such positions.
c. She demonstrated that school nurses decreased absenteeism by 50%. In 1902, New York City hired the first nurses to help inspect children, educate families, and ensure follow-up treatment. Within a few years, the renowned nurse Lillian Wald was able to show that the presence of school nurses could reduce absenteeism by 50%.
4 of 31 Which of the following legislation marked the first entry of the federal government into school health? a. The Drug-Free Schools and Community Act b. The Education for the Handicapped Act c. The National School Lunch Program d. The Safe and Drug Free Schools and Communities Act
c. The National School Lunch Program The federal government did not get involved with school health until the passage of the National School Lunch Program in 1946. The School Breakfast Program was implemented 30 years later. The Drug-Free Schools and Community Act was implemented in 1986 to fight substance abuse through education and was expanded in 1994 to include violence prevention measures. The Education for the Handicapped Act in 1975 mandated that all children, regardless of disabilities, have access to educational services. The Safe and Drug Free Schools and Communities Act supports programs that focus on prevention of school violence and illegal use of alcohol, tobacco, and drugs.
11 of 31 Which of the following does the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service include in its routine screening that may not be included in a typical private physician preschool physical? a. Comprehensive health and developmental history b. Immunizations c. Laboratory testing d. Lead toxicity screenings e. Unclothed physical examination
d. Lead toxicity screenings The EPSDT includes lead paint screening. Medicaid-eligible children are guaranteed access to comprehensive health care services and routine dental examinations. Screening services must include a comprehensive health and developmental history, an unclothed physical examination, plus immunizations and laboratory testing that are age appropriate, as well as lead toxicity screenings. Because these children are very-low income, they probably live in older housing that may have lead paint. Private physicians caring for children with insurance see children of higher income levels who probably live in newer, safer housing.
24 of 31 A school nurse is conducting a program with high school students about adolescent sexuality. Which of the following information would the school nurse most likely include? a. Abstinence is the only way to avoid pregnancy and sexually transmitted diseases. b. Resources are available for assisting teenage parents with, for example, maternity clothing and baby needs. c. There are many sources of free or very-low-cost birth control measures. d. Teenage mothers are less likely to complete high school and often remain single and live in poverty. e. Abortion is dangerous, is illegal in most areas, and can result in lifelong sterility.
d. Teenage mothers are less likely to complete high school and often remain single and live in poverty. Although the nurse might want to include information on abstinence and birth control, it is important to convey the reality of teenage pregnancy. Adolescent fathers can confront a lifetime of paying child support. Teen mothers are less likely to complete high school and are more likely to be single parents and live in poverty.
22 of 31 Everyone is talking about the disaster that has been widely seen on the news programs. Which of the following suggestions would be most appropriate for the nurse to make at this time? a. That this opportunity should be used to discuss how to be brave in a crisis. b. That programs in collaborative problem solving should be created for students and staff. c. That the staff should reassure students that such a disaster would not occur here. d. That the school should develop an emergency management plan.
d. That the school should develop an emergency management plan. Every school is encouraged to develop an emergency management plan. In fact, many states mandate that schools develop plans to address the potential threat of another terrorist attack or a natural or man-made disaster. It would not be appropriate for the nurse to discuss bravery, student safety should come before bravery. Collaborative problem solving will not help the students be safer should this type of a crisis arise at the school. It is not appropriate to provide the students with reassurance as it is impossible to prevent all of these disasters, rather the school must develop an emergency plan so that they are prepared if this would happen at their school.
