National Board for Certification of School Nurses Examination
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Question # 1
When assessing a kindergarten class for growth and development milestones, which would be
important?
A. The nurse understands that kindergarteners tend to break rules and rebel at this age. B. The nurse understands that this age group can run and do simple skills independently. C. The nurse understands that most kindergarteners still require assistance when using the toilet. D. The nurse understands that cultural differences do not influence growth and development.
Answer: B Explanation:
It is important to understand what a kindergarten student who is healthy and well
developed can do independently when assessing and comparing with other students that
age. According to the CDC, kindergarteners are rule followers and desire to please, can run
and do simple skills independently, and are able to use the toilet on their own.
Understanding the impact of culture on growth and development (genetics, diet, exercise,
etc.) is also an important part of the school nurse's understanding of kindergarteners.
Question # 2
The nurse is called to the classroom for a student who has his head resting on his desk. What would
be an appropriate initial response?
A. Palpate the abdomen and pulse, B. Administer an EpiPen. C. Ask the student what is wrong while assessing his breathing and color. D. Call for help while slowly lowering the student to the floor,
Answer: C Explanation: The first step in responding to a potentially unresponsive student is to attempt to get
the student's attention and assess vitals. Palpation prior to assessing student's
responsiveness and letting him know you will be touching his abdomen is inappropriate.
Administering epinephrine prior to establishing status is inappropriate and dangerous.
Calling for help prior to establishing status may be preemptive and cause additional stress
and fear.
Question # 3
The school nurse is assessing an active, happy third-grade student who fell on the playground. The
nurse notes a single bruise on the student's shin. What would the next action of the school nurse
be?
A. Call Child Protective Services. B. Ask the student how he bruised his shin. C. Report it to the principal. D. Provide basic pain medication such as aspirin or Tylenol.
Answer: B Explanation:
The initial action on the part of the nurse would be to ask the student how he bruised his shin. In this case abuse is not suspected if the incident of the child falling in the
playground was witnessed. Bruising on the shin is a common bruising pattern in this age
group. The nurse should not administer pain medication without authorization, including
over the counter medications. Reporting the injury to the principal is not indicated unless
the injury was the result of another student's or a teacher's actions.
Question # 4
What would be an appropriate expectation of a healthy first-grade student?
A. To have bowel and bladder control. B. To make healthy diet choices. C. To understand safety rules. D. To have all of their adult teeth.
Answer: A Explanation:
A healthy student should have bowel and bladder control by first grade. Students at
this range that demonstrate multiple instances of incontinence should be assessed further.
First graders cannot be expected to make healthy diet choices consistently, and may break
safety rules by nature. Students generally have a complete set of adult teeth by their
teenage years. First graders will be in the process of starting to lose baby teeth.
Question # 5
What is the normal respiratory rate for an 8-year-old child?
A. 60 to 70 breaths per minute. B. 8 to 10 breaths per minute. C. 12 to 20 breaths per minute. D. 40 to 50 breaths per minute.
Answer: C Explanation:
The normal rate of respirations for an 8-year-old child is 12 to 20 breaths per
minute, the same as an adult. An increase in rate could indicate an increase in activity, such as in
gym class or recess, a fever, or anxiety. Respiratory distress may start as an increased
respiratory rate and then a rapid decrease in rate, which must always be considered when
evaluating a child for respiratory distress. A decrease in respiratory rate can reflect serious
damage to the student's brain (that initiates spontaneous breathing), drug over dose, or
other complications that could lead to respiratory failure and should not be ignored.
Question # 6
Which immunization(s) would NOT be required for students going into kindergarten?
A. Hepatitis B. B. Tetanus, diphtheria, and pertussis. C. MMR D. HINI vaccine.
Answer: D Explanation:
The HI NI vaccine is recommended but not mandatory for students entering
kindergarten. Hepatitis B, Tetanus, diphtheria, pertussis and MMR are generally required
immunizations for students entering kindergarten. Parents have the right to waive vaccines
that are required but must sign a release and the health department must also have a list of
those students that have not had recommended vaccines.
Question # 7
A student knocks out his tooth on the slide. What would the school nurse do with the tooth to
preserve it?
A. Place it in a sterile bag to preserve. B. Place the tooth in milk to preserve. C. Place the tooth in an envelope for the parent because it cannot be saved. D. Call the parent to determine what they request.
Answer: B Explanation:
The tooth should be preserved in milk (or in a prepackaged tooth-saving kit). It may
be possible to reimplant the tooth and these options will properly preserve the tooth to
possible reimplantation. Placing in an envelope or sterile bag would diminish the
preservability of the tooth. While calling the parents is appropriate, it is still important to
first place the tooth in milk for preservation in the case that the parents would like it
preserved or were not aware of the possibility of reimplantation
Question # 8
Which is NOT an appropriate action for the school nurse when caring for an open abrasion?
A. Cleansing the wound with warm soap and water. B. Practicing "universal precautions." C. Applying bacitracin ointment to the abrasion. D. Assessing size, depth, exudate and location of abrasion.
Answer: C Explanation:
While bacitracin is an appropriate ointment in treating abrasions, it cannot be
applied to all abrasions without first assessing for allergies to this ointment and gaining
parent authorization. Bacitracin is a common allergy that can cause a range of allergic
responses, from contact dermatitis to anaphylaxis; therefore, it must be handled with care.
Cleansing the wound with soap and water, utilizing universal precautions, and assessing
the wound's size, depth and exudate are all appropriate interventions in the treatment of
an abrasion
Question # 9
Which is NOT a piece of equipment a school nurse would anticipate using in the school setting?
A. Glucometer. B. Nebulizer. C. Peak flow meter. D. Bovie cauterizing machine.
Answer: D Explanation:
A Bovie cauterizing machine is used to stop bleeding in a surgical setting, therefore
is outside of the scope and requirements of a school nurse. A glucometer is used to measure
blood glucose levels, particularly in diabetic patients. A nebulizer is used to treat asthmatic
patients. A peak flow meter is also a useful tool in measuring pulmonary function in
students with respiratory conditions.
Question # 10
Which is an important health assessment skill needed to monitor a student with asthma?
A. To understand steroid medications. B. To assess for edema. C. To recognize the signs of respiratory distress and compromise. D. To know the age-appropriate stages of growth and development.
Answer: C Explanation:
Recognizing the signs of respiratory distress will help the school nurse to determine
the severity of the asthma attack and act accordingly. A full respiratory assessment is also a
critical element of the pre- and post-treatment assessment in the administration of albuterol and other interventions in the case of an asthma attack The school nurse must be
able to rapidly recognize and respond to respiratory distress to minimize dangerous
complications from this condition.
Question # 11
Which is NOT the function of the school nurse?
A. The school nurse does a general health appraisal for each student. B. The school nurse prescribes medications to treat student illness. C. The school nurse collects and interprets data, and suggests interventions. D. The school nurse follows a physician's orders to administer ADHD medications.
Answer: B Explanation:
The school nurse may not prescribe medications in this general role. The only nurses
with the scope of prescribing medications are nurse practitioners. Students requiring new
medication prescriptions must be preferred to a physician. Nurses may administer
prescribed medications with the authorization to do so.
Question # 12
Which actions would be appropriate if the same student is complaining of stomach aches every
morning?
A. Report the child to Child Protective Services. B. Ignore the complaints and send the student back to class. C. Trend the complaints and interpret the data to make intervention recommendations. D. Refer the student to the emergency department for evaluation.
Answer: C Explanation:
Trending the complaints and collecting data will help you plan an intervention. Data
trending includes documenting time, breakfast eaten, vital signs and a patient description
of the pain. The pain may be due to hunger, stress, or as an avoidance tactic. Trending the time of
day, how many days a week, and other information are useful when discussing with
a parent the most effective way to handle the complaints, rather than having the student
miss class time. If these trends indicate potential abuse, at that point Child Protective
Services may be contacted. If the trends indicate a more serious disease or condition, the
student may need to be referred to a specialist Ignoring a student's complaints is never
appropriate.
Question # 13
Head lice are easily transferred from student to student. What would be an intervention the nurse
could initiate to prevent the spread of head lice in the classroom?
A. Keep a universal lice comb for students to use. B. Educate all students about how lice are spread. C. Shampoo every student during school hours. D. Provide an informative brochure about lice for students to bring home to their parents.
Answer: B Explanation:
It would be most helpful to educate students on how head lice are spread so students
can take an active role in prevention. Simply providing a brochure to be given to their
parents, while helpful, may not make it to the parents and places the responsibility for
education with the parents. A universal lice comb is contraindicated as lice can be spread
from student to student on the comb. Shampooing every student is an excessive measure. If
a student is assessed and found with head lice they must be sent home and treated prior to
returning to school.
Question # 14
Which would be an appropriate task when administering a nebulizer treatment during school hours?
A. Withholding the nebulizer treatment if the student wants to go to recess. B. Assessing the temperature of the student with every treatment. C. Keeping the student in the clinic two hours after every treatment. D. Assessing the student's heart rate before and after a treatment.
Answer: D Explanation:
Assessing the heart rate of a student taking nebulizer treatments is important because
the medicine can cause an abnormal rapid heart rate. Assessing the heart rate prior to
treatment allows the nurse to have a baseline for the student. It is also appropriate to
assess respiratory rate and breath sounds prior to and after nebulizer treatment. The postnebulizer treatment should be conducted 30 minutes after the treatment to assess the full
effectiveness of the treatment.
Question # 15
Which is NOT part of assessing a student who presents to the clinic with a complaint?
A. Observing respiratory rate and effective breathing. B. Cleaning scrapes, abrasions, and assessing for injuries. C. Monitoring for fever when a student is complaining of illness. D. Assessing genitalia at the end of the head to toe assessment once the student is comfortable with the nurse.
Answer: D Explanation:
A school nurse should never examine a student's genitalia unless there is a lifethreatening injury, and then only in the presence of another adult or parent. Observing
respiratory rate and effective breathing, cleaning scrapes/abrasions, assessing for injuries,
and monitoring for fever are all within the school nurse's scope of practice and are
appropriate assessment measures.
Question # 16
The school nurse notices multiple bruises to a male student's face, arms, and neck on more than one
occasion. What would the school nurse need to consider when speaking to this child?
A. Boys often play rough and should be encouraged to participate in less aggressive
play. B. Consider the possibility of physical or sexual/physical abuse, and question and act
accordingly. C. The nurse should consider this a private matter and make no comments unless the
child seeks assistance. D. The nurse is under the obligation to report the concern to the parents.
Answer: B Explanation:
It is important to consider the possibility of physical or sexual abuse if a student has
unexplained bruising. As a mandatory reporter of suspected abuse, the nurse is responsible
for taking action on these observations, whether the student confesses abuse or not. The
nurse should be aware that the student may lie about the source of the bruises and this
should not change their course on reporting the issue. The nurse should not go to the
parents, in this instance, because the parents may be the source of the harm. Rather, the
nurse should follow protocol for reporting suspected abuse to the appropriate agency.
Question # 17
Which piece of medical information is required by each state to enroll a student in school?
A. Mother and Father's history with significant illness. B. Notes for possible changes in after-school care. C. Immunization record for the student. D. Birth information including weight and height.
Answer: C Explanation:
Immunization records are part of state regulations, and parents must sign a waiver if
they have chosen to not immunize their child. It is important for the school nurse to be
aware of which students have not been immunized in the case of an outbreak of a
contagious disease. Parental health history, after-school care and birth information are not
mandated by the state, and are requested only on a school by school basis.
Question # 18
What comfort measure can be used for a student with ear pain?
A. Apply ice packs. B. Irrigate the ears. C. Schedule a doctor's appointment. D. Apply warm packs to the external ear.
Answer: D Explanation:
Applying a warm compress to the external painful ear will offer comfort for the child
having ear pain. Ice/cold temperatures can increase ear pain therefore would not be
appropriate. Irrigation of the ear is not an appropriate intervention for ear pain and is
generally used to remove impacted cerumen or foreign objects from the ear canal. Notify
the parents to schedule a doctor's appointment if the pain does not resolve or if there is a
fever.
Question # 19
The nurse is screening for visual difficulties. Which student would need a referral to an eye doctor?
A. A student with 20/20 vision. B. A student with 20/20 in the right eye and 20/30 in the left eye. C. A student with 20/90 in the right eye and 20/80 in the left eye. D. A student with 20/30 in both eyes.
Answer: C Explanation:
Any student with a visual acuity of 20/90 in either eye should receive follow up with
an eye doctor. What the normal child can see and distinguish at 90 feet, this child must be
20 feet away from in order to distinguish. This can interrupt the child's ability to learn (in the school setting) and can also present obstacles in the child's daily life. This child would
benefit greatly from glasses and the sooner this correction can be made, the better. 20/20
vision is considered optimal and it is not uncommon for one eye to have an acuity that is 10
feet different than the other. 20/30 vision does not warrant a referral to the eye doctor, though this
student should continue to be monitored regularly to ensure vision is not
worsening rapidly.
Question # 20
The nurse is called to the gym for a student who is feeling lightheaded. The nurse notes that the
child is pale and diaphoretic. His initial pulse rate is more than 180. What is the first action the nurse
should take?
A. Reassure the child, apply cool rags to the forehead, reassess, and be prepared to call
the parents and 911. B. Scream for someone to call 911 now. C. Bring the student to the nursing office to rest and excuse the student from gym for
the remainder of the period. D. Call the student's parents or emergency contact to pick up the student, and excuse
the student from gym for the remainder of the week.
Answer: A Explanation:
A pulse rate of 180 is dangerously high (tachycardia) and may represent the
transition into a dangerous rhythm such as supraventricular tachycardia. Because the
student is feeling lightheaded, it is a sign that the tachycardia is unstable and affecting the
child's ability to perfuse critical organs. Keeping the child calm, offering a cool rag for
comfort, and reassessing the pulse rate after a short rest will give the school nurse time to
complete a head to toe assessment very quickly to determine if emergency care is needed
or if the child became overheated during exercise. The cool rag (or ice) to the head can also
induce a vasovagal response and lower the child's heart rate naturally. Regardless of the
causes, parents should be notified and the suggestion should be made to take the child for
an evaluation. If the child remains symptomatic after a few minutes of rest, call 911 and the
parents for cardiac evaluation, as a sustained heart rate of 180 is too fast to provide
sufficient perfusion.
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