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Chapter 31: The Nurse in the Schools

Test Bank
MULTIPLE CHOICE
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 cant 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
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 cer
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
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 nations schools met that standard. The new objective is that 44.7% of the countrys
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
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 nurses role in this scenario?
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a. Case manager
b. Consultant
c. Counselor
d. Health educator
ANS: B
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 schools policies or ask community organizations to help
make the childrens schools healthier places.
DIF: Cognitive Level: Apply (Application) REF: p. 570
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 nurses role in this scenario?
a. Consultant
b. Community outreach
c. Counselor
d. Researcher
ANS: B
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
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.
Because so many nurses want to be employed in schools, this responsibility was assumed
b. increase employment opportunities.
c. States are requiring nurses to screen and to teach life skills.
Nurses have been enlisted in this role to help reduce risk factors for future health problem
d. school children.
ANS: D
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
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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
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
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
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 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
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 wont know if someone doesnt tell them
b. Because injuries are the leading cause of death in children and most injuries are preventab
c. Because it is a dangerous world and someone has to warn children about the dangers
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d. Because teaching is easy and more fun than passing out bandages and documenting care
ANS: B
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
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
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
10. The school nurse has arranged for volunteers to help check each childs 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
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
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.
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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
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
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 always be available so that it can be consulted for
information.
DIF: Cognitive Level: Apply (Application) REF: pp. 575-576
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! Youve obviously made an error.
Which of the following would be the best response by the nurse?
a. Im sorry youre upset, but your child cannot return to school until this problem is addresse
Most lice are found in clean hair. Children often share combs. Let me tell you how to fix
b. problem.
c. You may have been traveling. Lice are often found in motels.
d. Im sure youre correct; one of my volunteers probably made an error. Ill recheck.
ANS: B
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
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 students back. But the student begs the nurse not to tell anyone because he
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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 students parents.
d. Notify the legal authorities.
ANS: D
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 schools 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
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
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
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
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After a disaster, the school nurse has many responsibilitiesfor 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
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 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 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
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
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d. Both primary and secondary prevention

ANS: C
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
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 nurses perspective, all the reasons that abortion should be made illegal.
c. Offer the student a combination of oral contraceptives to induce spontaneous abortion.
Provide information on alternatives to abortion and give the client information on adoptio
d. agencies.
ANS: A
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
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
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
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. Ill get the names to you and the involved teachers immediately.
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b. Let me get the parents consent, and then Ill get you the names.
c. Rumors are often inaccurate; let me follow up and see what happened and what needs to b
d. Why dont we coordinate a school-wide program on preventing accidents instead?
ANS: C
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
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?
Federal legislation requires that the school make provisions for those with various challen
a. your child will be able to remain in school as long as he is able.
I realize that this will be a difficult adjustment, but home-schooling has improved over re
b. decades and the Internet will allow your child to connect with friends.
Whether your child can remain in school will depend on state funding for those with disab
c. You might want to contact your congressman on this issue.
Your child may remain in school as long as he can manage the course requirements and d
d. flunk out.
ANS: A
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 districts committee on the disabled to develop
individualized education plans (IEPs) for children.
DIF: Cognitive Level: Apply (Application) REF: p. 563
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 audiences 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
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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
MULTIPLE RESPONSE
1. Which of the following activities are included in the Centers for Disease Control
and Preventions 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
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
2. Which of the following best explains why the federal government is beginning to
fund school-based health centers? (Select all that apply.)
These centers help young children avoid becoming addicted to drugs while still in elemen
a. school.
b. Attendance and learning are higher in schools with health clinics.
These centers help keep children in school longer by distributing birth control and thus av
c. pregnancies.
d. Many children have no other source of health care services.
ANS: B, D
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
3. A new students 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.)
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a. Call the parents or mail another reminder.

b. Report the problem to the teacher and the principal.
Send the child home with a note saying the child cannot return until the immunization rec
c. received.
Suggest to the parents that if they dont have health care insurance, they may qualify for p
d. that provide immunizations free.
ANS: A, D
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 nurses 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 wont resolve the problem and it
is illegal, immoral, and unprofessional to enter false information in a students record.
DIF: Cognitive Level: Apply (Application) REF: p. 574
4. 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
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
5. 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
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c. Leaving the scene if another student is being bullied or hurt

d. Mood swings
ANS: A, B, D
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
6. 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
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