Certification Review Test Set 4 Rationale

1. Professional Issues

In writing a nursing care plan the foundation for a nursing diagnosis is based on which of the following?

A. Assessment of the student.

B. Information from the teacher.

C. The student’s medical diagnosis.

D. Educational needs of the student.

Nursing assessment is the start and the foundation of all steps of the nursing process. The nursing care plan is the product of the nursing process. Medicine does not guide nursing, which is an independent practice profession. As a result the nursing care plan may include many care needs of a student that are unrelated to a medical diagnosis.

2.Special Health

Under IDEA which of the following is a valid reason for reasonable delay of school entry for a child with special health care needed?

A. The cost of the care is expensive for the school system.

B. The student is unable to interact in the school setting.

C. Safe plans for delivery of care are not yet in place.

D. Designated school staff for care has refused to help.

All of these things happen at some time, and the Office of Civil Rights has been asked to comment on them at various times. Cost is not allowed to be a factor. Many special needs students functionally interact very little, but the school is to meet them at their level and ability in creating an IEP. The school is compelled to locate staff, even if it endsup being the principal. C is the correct answer, even then more than two weeks of waittime is generally not acceptable.

3. Health Problems

A diabetic student takes an 8:00am dose of Lente insulin each day. His 12:00 pm blood sugar check prior to lunch is 70 mg/dl. Which of the following is the best initial action?

A. Repeat the blood sugar to clarify the 12:00 results.

B. Give the student a snack in addition to his lunch.

C. Call the student’s parents for additional guidance.

D. Advise the student to continue with his lunch plan.

You must know the types of insulin and their peaks for the exam (Selekman page 766). This type of insulin will peak starting about 2 pm. So this blood sugar is expected at this time and the child needs to start getting in some carbs. Eat lunch.

4. Health Problems

Triage and immediate first aid are often the responsibility of the school nurse in school disasters resulting in injury. Which of the following student conditions should be classified as code Yellow in a disaster response?

A. A laceration of the palm requiring sutures. (code green, needs help but not immediately)

B. Unconscious student with a head injury. (code red, needs immediate help, salvageable)

C. Open fracture of the lower right leg. (code yellow, needs help soon)

D. A student in cardiac arrest. (code black, not salvageable in a disaster situation). This classification system for mass disaster has shown up on the exam in the past.

  • Immediate: The casualty requires immediate medical attention and will not survive if not seen soon. Any compromise to the casualty's respiration, hemorrhage control, or shock control could be fatal.
  • Delayed: The casualty requires medical attention within 6 hours. Injuries are potentially life-threatening, but can wait until the Immediate casualties are stabilized and evacuated.
  • Minimal: "Walking wounded," the casualty requires medical attention when all higher priority patients have been evacuated, and may not require stabilization or monitoring.
  • Expectant: The casualty is expected not to reach higher medical support alive without compromising the treatment of higher priority patients. Care should not be abandoned, spare any remaining time and resources after Immediate and Delayed patients have been treated.[20]

5.Health Problems

The family of a child with pediculosis asks for advice about cleaning decorative bedpillows that cannot be washed or dry cleaned. Which of the following is the best advice?

A. The only foolproof way to eliminate the lice is to risk dry cleaning anyway.

B. The likelihood of infestation is slim so the pillows do not need to be treated.

C. The family should throw the pillows away to avoid re-contamination.

D. The pillows can be sealed in a plastic bag for two weeks and then used.

See Selekman page 610. Things that cannot be cleaned or washed should be sealed in plastic or exposed to heat. Correct answer D.

6. Health Promotion

Communicable disease instruction by the school nurse often includes guidance related to influenza. Which of the following statements indicates an understanding of the characteristics of pandemic and seasonal influenza?

A. Pandemic flu results from a serious outbreak of a known seasonal flu strain (if that were the case the vaccine would immediately be available).

B. Seasonal flu viruses occur at unpredictable times of each year (true, but not a characteristic of a pandemic).

C. A vaccine will be quickly available when a pandemic virus is identified (we recently saw that this isn’t true).

D. Pandemic flu outbreaks result from viruses that are new to humans. (as with H1N1)

7. Special Health

A regular education student returns to school with a lower leg cast. Which of the following is the best type of plan to meet this student’s needs?

A. Individual Education Plan. (no educational need)

B. 504 Accommodation Plan. (access to education is involved with this student)

C. Emergency Action Plan (condition is not life threatening)

D. Disaster Risk Plan (this is a “made up” term, if you don’t know what something is, don’t pick it)

8. Health Appraisal

Immediately following a seizure, which of the following assessments has the highest priority?

A. Bowel or bladder incontinence.

B. Injury during the seizure.

C. Student level of consciousness.

D. Student respiratory status. (remember your ABC’s)

9.Health Problems

A school-aged child with growth hormone deficiency is starting growth hormone therapy. Understanding of this therapy is best demonstrated by which statement? Treatment,

A. Is most successful with young children.

B. Is most successful during adolescent growth spurts.

C. Will continue to exert an effect when growth plates are fused.

D. Is considered successful if full adult height is attained.

Treatment with growth hormone is started in childhood; that is part of the push for earlier identification of girls with Turner’s Syndrome. As a result, the closer the child is to adolescence the less growth that will be achieved. When the growth plates close no more growth is possible. No one truly know what the child’s adult height should be, so that is not a good indicator. Selekman p. 344 and following.

10. Health Promotion

A 13 year old student complains of frequent knee pain during gym class. He asks to be excused from participation. The nurse’s reply should be based on which of the following?

A.Joint pains are common in boys who are growing quickly. (this is true, and that knowledge will be the basis of a response. I don’t say what the response is so don’t read into the question)

B.Joint pains may be serious and should be immediately evaluated. (if you look at statistics they are rarely the serious things, that doesn’t mean that isn’t possible, but I didn’t say what the response in A would be)

C.Adolescent males often experience psychosomatic complaints. (probably no more than any other adolescent group)

D.Teens often use physical complaints to avoid disliked activities. (may be true, more assessment may be needed, but not the foundation of your response)