Certified Occupational Health Nurse (COHN) Exam — Questions and Answers

Question 1: A nurse calculates that a disease killed 15 people per 100,000 population in one year. This is an example of:

Cause-specific mortality rate (Correct answer)
Years of potential life lost
Case fatality rate
Proportional mortality ratio

Correct answer: Cause-specific mortality rate

A cause-specific mortality rate measures deaths from a particular disease per unit of population over a defined time period.

Question 2: An occupational health nurse practitioner with a master's degree applies for COHN-S. What experience prerequisite must she satisfy?

1,500 hours of occupational health nursing in the past 5 years (Correct answer)
500 hours of occupational health nursing in the past 3 years
3,000 hours of occupational health nursing over any period
No experience required if a master's degree is held

Correct answer: 1,500 hours of occupational health nursing in the past 5 years

The COHN-S requires a minimum of 1,500 hours of occupational health nursing practice within the five years preceding application.

Question 3: A lockout/tagout (LOTO) program falls under which OSHA standard?

29 CFR 1910.95
29 CFR 1910.147 (Correct answer)
29 CFR 1910.132
29 CFR 1910.1200

Correct answer: 29 CFR 1910.147

29 CFR 1910.147 (Control of Hazardous Energy) governs lockout/tagout procedures to protect workers from unexpected energization of equipment.

Question 4: An employee with a history of anxiety requests a modified work schedule as an accommodation under the Americans with Disabilities Act (ADA). As the case manager, what is the occupational health nurse's initial responsibility?

Inform the employee that mental health conditions are not covered by the ADA.
Request access to the employee's complete psychiatric medical history.
Immediately grant the request to avoid potential litigation.
Engage in an interactive process with the employee to understand the limitations and explore reasonable accommodations. (Correct answer)

Correct answer: Engage in an interactive process with the employee to understand the limitations and explore reasonable accommodations.

The ADA requires employers to engage in a good-faith interactive process when an employee requests an accommodation. This involves a dialogue between the employer and employee to identify the precise limitations resulting from the disability and explore potential reasonable accommodations that would allow the employee to perform essential job functions.

Question 5: Hydrogen sulfide (H₂S) is particularly dangerous because at high concentrations it:

Displaces oxygen by filling lungs with heavy gas molecules
Paralyzes the olfactory nerve, eliminating the warning odor (Correct answer)
Causes methemoglobin formation that prevents oxygen delivery
Binds to hemoglobin 200 times more strongly than carbon monoxide

Correct answer: Paralyzes the olfactory nerve, eliminating the warning odor

At high concentrations, H₂S rapidly paralyzes the olfactory nerve so workers lose the rotten-egg warning odor and can be overcome without realizing the danger.

Question 6: A COHN-S is developing a return-to-work program. Which element is MOST important for a successful transitional duty program?

Requiring full medical clearance before any return
Ensuring workers return within the first three days of injury
Limiting all transitional duties to sedentary work only
Collaboration between the nurse, supervisor, and treating physician (Correct answer)

Correct answer: Collaboration between the nurse, supervisor, and treating physician

A successful transitional duty program requires coordinated communication among the occupational health nurse, supervisor, and treating physician to match restrictions with available work.

Question 7: An injured worker has been approved for vocational rehabilitation. Which scenario BEST indicates a need for this service?

A worker requests a raise before returning to work
A worker's injury is classified as non-occupational
A worker recovers fully and can return to their original position
A worker has permanent restrictions that prevent return to their pre-injury occupation (Correct answer)

Correct answer: A worker has permanent restrictions that prevent return to their pre-injury occupation

Vocational rehabilitation is indicated when permanent restrictions prevent a worker from returning to their pre-injury occupation, requiring retraining or job placement in alternative work.

Question 8: Which radiation type has the greatest penetrating power and requires the most shielding in occupational settings?

Neutron radiation
Gamma radiation (Correct answer)
Beta radiation
Alpha radiation

Correct answer: Gamma radiation

Gamma radiation has the highest penetrating power of the common ionizing radiation types, requiring dense shielding materials such as lead or concrete.

Question 9: The ACGIH TLV for a continuous noise exposure of 8 hours is 85 dBA. If exposure is at 88 dBA, the permissible exposure time under ACGIH criteria is:

2 hours
6 hours
4 hours (Correct answer)
8 hours

Correct answer: 4 hours

ACGIH uses a 3-dB exchange rate, so an increase of 3 dB (from 85 to 88 dBA) halves the permissible exposure time from 8 hours to 4 hours.

Question 10: An employer must report the in-patient hospitalization of an employee as a result of a work-related incident to OSHA within what time frame?

24 hours (Correct answer)
48 hours
8 hours
7 calendar days

Correct answer: 24 hours

OSHA's regulation 29 CFR 1904.39(a)(2) requires employers to report any work-related in-patient hospitalization, amputation, or loss of an eye to OSHA within 24 hours of learning about the event. The 8-hour reporting requirement is specifically for a work-related fatality.

Question 11: Which class of fire extinguisher is appropriate for a fire involving energized electrical equipment?

Class C (Correct answer)
Class D
Class A
Class B

Correct answer: Class C

Class C extinguishers use non-conductive extinguishing agents (CO₂ or dry chemical) safe for energized electrical equipment, where water-based Class A agents would create electrocution risk.

Question 12: Which federal agency enforces the Toxic Substances Control Act (TSCA) for chemical risk evaluation?

FDA
NIOSH
OSHA
EPA (Correct answer)

Correct answer: EPA

The EPA administers and enforces TSCA, which regulates the introduction of new or existing chemicals and evaluates their risks to human health and the environment.

Question 13: Treatment for exposure to lead

Remove from exposure and chelation (Correct answer)
Tremors, impaired psychomotor dev in children who are exposed in utero
"The dose makes the poison"
Pleural effusion, asbestosis and mesothelioma

Correct answer: Remove from exposure and chelation

The treatment for lead exposure typically involves two main approaches: removing the individual from further exposure to lead and implementing chelation therapy.

Question 14: Under the ADA, an employer is required to provide a reasonable accommodation unless it causes:

Minor inconvenience
A change in job duties
Undue hardship (Correct answer)
Any additional cost

Correct answer: Undue hardship

The ADA requires reasonable accommodations unless they impose an undue hardship on the employer's operations or finances.

Question 15: In the context of return-to-work, 'vocational rehabilitation' is MOST appropriate when:

The employee requests a salary increase after returning from leave
An employer wants to reduce workers' compensation premiums
An employee needs a brief rest period before resuming their original job
The employee cannot return to their pre-injury occupation and needs retraining or job placement (Correct answer)

Correct answer: The employee cannot return to their pre-injury occupation and needs retraining or job placement

Vocational rehabilitation is indicated when a worker's permanent restrictions prevent return to their former occupation and they need retraining, education, or job placement assistance.

Question 16: Which of the following is a key component that MUST be included in an OSHA-required Bloodborne Pathogens Exposure Control Plan?

A requirement for all employees to receive the influenza vaccine annually.
A list of all employees' personal health conditions.
The procedure for evaluating the circumstances surrounding an exposure incident. (Correct answer)
The brand names of all personal protective equipment (PPE) to be used.

Correct answer: The procedure for evaluating the circumstances surrounding an exposure incident.

OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) mandates that an Exposure Control Plan include procedures for post-exposure evaluation and follow-up. This involves documenting the routes of exposure and the circumstances under which the incident occurred to help prevent future incidents.

Question 17: A newly certified COHN nurse wants to add the CM subspecialty. What additional experience must she demonstrate beyond her COHN eligibility?

1,000 hours of case management practice (Correct answer)
Completion of an ABOHN-approved case management course
A master's degree in nursing
Board certification in case management from another credentialing body

Correct answer: 1,000 hours of case management practice

To earn the CM subspecialty designation, the nurse must document 1,000 hours of occupational health case management experience within the preceding five years.

Question 18: Which federal law requires employers with 50 or more employees to provide up to 12 weeks of unpaid, job-protected leave for serious health conditions?

Occupational Safety and Health Act (OSHA)
Family and Medical Leave Act (FMLA) (Correct answer)
Americans with Disabilities Act (ADA)
Rehabilitation Act of 1973

Correct answer: Family and Medical Leave Act (FMLA)

The FMLA requires covered employers (50+ employees) to provide eligible employees up to 12 weeks of unpaid, job-protected leave per year for qualifying reasons including serious health conditions.

Question 19: The 'biopsychosocial model' of disability, as applied in return-to-work, recognizes that disability is influenced by:

Biological, psychological, and social factors interacting together (Correct answer)
Psychological factors only, such as motivation and attitude
Biological factors only, specifically the severity of tissue damage
Social factors exclusively, such as employer attitudes

Correct answer: Biological, psychological, and social factors interacting together

The biopsychosocial model recognizes that disability results from the interaction of biological (injury severity), psychological (fear, depression), and social (workplace relationships, culture) factors.

Question 20: A COHN reviewing aggregate biometric screening results finds that 35% of employees have pre-hypertension. The MOST appropriate population-level intervention is:

Prescribing antihypertensive medications for all pre-hypertensive employees
Referring all pre-hypertensive employees to cardiologists immediately
Reporting findings to OSHA as a workplace hazard
Implementing a worksite education and lifestyle modification program targeting sodium reduction and physical activity (Correct answer)

Correct answer: Implementing a worksite education and lifestyle modification program targeting sodium reduction and physical activity

Population-level lifestyle interventions addressing modifiable risk factors like diet and activity are the evidence-based first-line approach for pre-hypertension.

Question 21: A worker sprains an ankle and is placed on restricted duty for three days. How should the occupational health nurse classify this on the OSHA 300 log?

Days away from work case
Other recordable case
Non-recordable first aid case
Restricted work or job transfer case (Correct answer)

Correct answer: Restricted work or job transfer case

Restricted or transferred work cases are recorded in the 'Job transfer or restriction' column of the OSHA 300 log.

Question 22: Which criterion distinguishes a 'sentinel event' in public health surveillance?

High case fatality rate
A case whose occurrence signals a possible failure of prevention or control (Correct answer)
Disease affecting more than 100 people
Any hospital-acquired infection

Correct answer: A case whose occurrence signals a possible failure of prevention or control

A sentinel event is one that, by its occurrence, signals that something went wrong in the prevention system and warrants investigation.

Question 23: Primary care differs from public health nursing primarily because public health nursing focuses on:

Providing continuous personal care to individuals
Diagnosing individual illness
Improving health across entire populations (Correct answer)
Prescribing evidence-based treatments

Correct answer: Improving health across entire populations

Public health nursing's defining characteristic is its population focus — it aims to improve the health of communities rather than individual patients.

Question 24: What does a noise dosimeter measure in an occupational setting?

Peak noise levels only during machinery startups
Background noise levels in office environments
Sound frequency ranges in industrial machinery
A worker's cumulative noise exposure over a work shift (Correct answer)

Correct answer: A worker's cumulative noise exposure over a work shift

A noise dosimeter worn by a worker records the time-weighted average noise exposure over the entire shift to compare against OSHA's PEL of 90 dBA and action level of 85 dBA.

Question 25: Which federal agency provides the National Response Framework (NRF) that guides emergency management coordination?

CDC
OSHA
NIOSH
FEMA (Correct answer)

Correct answer: FEMA

FEMA (Federal Emergency Management Agency) publishes the National Response Framework, which establishes a comprehensive approach to national incident response.

Question 26: Which of the following best describes 'light duty' work in occupational health?

Administrative paperwork tasks given to all injured workers
Modified job tasks assigned to an employee within their medical restrictions (Correct answer)
Work performed by part-time employees only
Work that does not qualify for workers' compensation

Correct answer: Modified job tasks assigned to an employee within their medical restrictions

Light duty assignments accommodate the injured worker's medical restrictions while keeping them productive and facilitating their recovery.

Question 27: Under the ADA, when an employee requests a workplace accommodation for a chronic health condition, the COHN's role primarily includes:

Denying accommodation requests that may affect productivity
Providing clinical information to support the interactive accommodation process (Correct answer)
Filing the accommodation paperwork with EEOC directly
Making the final determination on accommodation approval

Correct answer: Providing clinical information to support the interactive accommodation process

The COHN contributes clinical expertise and functional capacity information to support the employer's interactive process but does not make the legal accommodation decision.

Question 28: Under OSHA's Recordkeeping Rule, which form is used to record each work-related injury or illness on a case-by-case basis?

OSHA Form 300A
OSHA Form 300
OSHA Form 301 (Correct answer)
OSHA Form 302

Correct answer: OSHA Form 301

OSHA Form 301 (Injury and Illness Incident Report) captures case-specific details about each individual recordable injury or illness.

Question 29: Initial De Quervain disease treatment entails:

Corticosteroid injections
Thumb spica splint and a 2-week course of NSAIDs (Correct answer)
Physical therapy
Surgery

Correct answer: Thumb spica splint and a 2-week course of NSAIDs

Applying a thumb spica splint to immobilize the thumb and wrist and beginning a 2-week course of nonsteroidal anti-inflammatory medicines are the first steps in treating De Quervain disease (NSAIDs). If immobilization and anti-inflammatory medication fail, corticosteroid injections are typically the next step in treatment. Surgery would be the next course of action after corticosteroid injections. This condition cannot be treated with physical therapy.

Question 30: Which federal agency sets Permissible Exposure Limits (PELs) for chemical hazards in the workplace?

EPA
NIOSH
ACGIH
OSHA (Correct answer)

Correct answer: OSHA

OSHA establishes legally enforceable PELs under 29 CFR 1910.1000, while NIOSH issues recommended exposure limits (RELs) and ACGIH publishes non-mandatory TLVs.

Question 31: Which early indicator would MOST alert the occupational health nurse to a potential musculoskeletal hazard in a warehouse operation?

Workers self-reporting discomfort during end-of-shift symptom surveys (Correct answer)
Increased absenteeism on Mondays only
Elevated workers' compensation insurance premiums
A single acute back injury reported in the OSHA 300 log

Correct answer: Workers self-reporting discomfort during end-of-shift symptom surveys

End-of-shift symptom surveys capture early musculoskeletal discomfort before injuries occur, providing the earliest and most actionable signal of ergonomic hazards.

Question 32: A hearing conservation program is required when workers are exposed to a time-weighted average noise level of:

85 dBA or above (Correct answer)
90 dBA or above
80 dBA or above
75 dBA or above

Correct answer: 85 dBA or above

OSHA's hearing conservation amendment (29 CFR 1910.95) requires a program when the 8-hour TWA reaches 85 dBA (the action level).

Question 33: An employee with a documented anxiety disorder requests a quiet workspace as an ADA accommodation. The employer should:

Immediately provide any workspace the employee requests without discussion
Deny the request because mental health conditions are not covered under the ADA
Engage in the interactive process to determine if the accommodation is reasonable (Correct answer)
Require the employee to provide monthly psychiatric evaluations

Correct answer: Engage in the interactive process to determine if the accommodation is reasonable

The ADA covers mental health conditions, and employers must engage in a good-faith interactive process to determine whether a requested accommodation is reasonable.

Question 34: Health literacy is BEST defined as:

The ability to read medical textbooks
Fluency in both English and a second language
The capacity to obtain, process, and understand basic health information to make informed decisions (Correct answer)
Completion of at least a high school education

Correct answer: The capacity to obtain, process, and understand basic health information to make informed decisions

Health literacy encompasses finding, understanding, and using health information — it is a cognitive and social skill, not simply reading ability.

Question 35: A manufacturing plant wants to identify all possible failure modes of equipment that could expose workers to hazards. Which hazard analysis method is MOST appropriate?

Job hazard analysis
Toxicological review
Failure Mode and Effects Analysis (FMEA) (Correct answer)
Epidemiological study

Correct answer: Failure Mode and Effects Analysis (FMEA)

FMEA systematically evaluates each equipment component for potential failure modes and their effects on worker safety, making it ideal for equipment hazard identification.

Question 36: An industrial hygienist's sampling shows that workers' 8-hour TWA benzene exposure is 0.4 ppm. OSHA's action level for benzene is 0.5 ppm. What should the occupational health nurse recommend?

No action is needed since the level is below the action level
Monitor exposure levels and conduct medical surveillance (Correct answer)
Relocate all workers to a different department
Implement engineering controls and medical surveillance immediately

Correct answer: Monitor exposure levels and conduct medical surveillance

Although currently below the action level, the close proximity warrants continued exposure monitoring and consideration of medical surveillance, as levels can fluctuate above 0.5 ppm.

Question 37: A manufacturer implements a new process that requires workers to use a handheld pneumatic wrench. After several months, a worker reports intermittent blanching (whitening), numbness, and tingling in their fingers, especially in cold conditions. The occupational health nurse should recognize these symptoms as most characteristic of which physical hazard-related condition?

Carpal Tunnel Syndrome
Hand-Arm Vibration Syndrome (HAVS) (Correct answer)
Thoracic Outlet Syndrome
Tendonitis

Correct answer: Hand-Arm Vibration Syndrome (HAVS)

Hand-Arm Vibration Syndrome (HAVS), also known as Vibration White Finger, is caused by regular, prolonged exposure to vibrating hand tools. Its characteristic symptoms include vascular effects like finger blanching (Raynaud's phenomenon), neurological effects like numbness and tingling, and musculoskeletal issues. The use of a pneumatic wrench is a common risk factor for HAVS.

Question 38: An injured worker is cleared for return to work but refuses due to fear of re-injury. Which intervention is MOST appropriate?

File a report with OSHA about the worker's non-compliance
Advise the employer to discipline the worker for non-compliance
Coordinate a graded exposure or work-hardening program and address fear-avoidance with behavioral support (Correct answer)
Terminate case management services immediately

Correct answer: Coordinate a graded exposure or work-hardening program and address fear-avoidance with behavioral support

Work hardening and graded exposure address kinesiophobia and fear-avoidance behaviors that impede return to work following occupational injury.

Question 39: Which organs or tissues are most affected by ionizing radiation?

Calcium edta
Liver
Bone marrow (Correct answer)
Spleen

Correct answer: Bone marrow

Ionizing radiation can have various effects on different tissues and organs in the body, but one of the tissues that is particularly sensitive to radiation is the bone marrow. The bone marrow is responsible for the production of blood cells, including red blood cells, white blood cells, and platelets. These cells are vital for the proper functioning of the immune system, oxygen transport, and blood clotting.

Question 40: A 'job analysis' in occupational health is best described as:

A psychological assessment of an employee's job satisfaction
A financial analysis of the cost of replacing an injured worker
A systematic documentation of the physical, environmental, and cognitive demands of a specific job (Correct answer)
A legal review of an employee's job description for ADA compliance

Correct answer: A systematic documentation of the physical, environmental, and cognitive demands of a specific job

A job analysis systematically documents the essential functions, physical demands, environmental conditions, and cognitive requirements of a specific position.

Question 41: An employer is required to provide a medical surveillance program for workers exposed to which of the following?

Standard fluorescent lighting
Moderate noise below 85 dBA TWA
Ambient office dust
Lead above the action level (30 µg/m³) (Correct answer)

Correct answer: Lead above the action level (30 µg/m³)

OSHA's lead standard requires medical surveillance, including blood lead monitoring, for workers exposed above the action level of 30 µg/m³.

Question 42: When designing a comprehensive workplace wellness program, which component is crucial for identifying the specific health needs and risks of the employee population to ensure the program is targeted and effective?

Conducting aggregate health risk appraisals and biometric screenings. (Correct answer)
Offering a wide variety of fitness classes and challenges.
Marketing the program heavily through internal communication channels.
Securing a significant budget from senior management.

Correct answer: Conducting aggregate health risk appraisals and biometric screenings.

A successful wellness program begins with understanding the specific needs of the workforce. Conducting health risk appraisals (HRAs) and biometric screenings provides valuable aggregate data on health risks, such as high blood pressure, cholesterol, and stress levels, allowing the OHN to tailor interventions and prioritize resources effectively.

Question 43: Which action BEST exemplifies a community health nurse functioning in the coalition builder role?

Documenting patient encounters in the EHR
Conducting blood pressure screenings at a health fair
Convening local stakeholders to develop a shared asthma action plan (Correct answer)
Writing a grant proposal for a new clinic

Correct answer: Convening local stakeholders to develop a shared asthma action plan

Coalition building involves bringing together diverse community partners to collectively address a health issue.

Question 44: An occupational health nurse wants to evaluate whether a new ergonomics intervention reduced injury risk. The MOST objective measure would be:

Manager perception of employee morale
Pre- and post-intervention musculoskeletal disorder incidence rates (Correct answer)
Employee satisfaction survey results
Number of ergonomic education sessions conducted

Correct answer: Pre- and post-intervention musculoskeletal disorder incidence rates

Comparing MSD incidence rates before and after the intervention provides objective, outcome-based evidence of the ergonomics program's impact.

Question 45: A nurse is teaching a group of migrant farmworkers about heat illness prevention. Cultural competence requires the nurse to FIRST:

Provide written materials in English
Schedule teaching sessions during midday breaks
Demonstrate cooling techniques using a mannequin
Assess language preferences and health literacy of the group (Correct answer)

Correct answer: Assess language preferences and health literacy of the group

Culturally competent education begins with assessing the audience's language, literacy, and cultural context before selecting teaching methods.

Question 46: According to OSHA, what is a key component of an effective workplace health and safety program?

Exclusive focus on injury prevention over illness prevention
Annual third-party audits replacing internal reviews
Management leadership and worker participation (Correct answer)
Voluntary compliance without enforcement mechanisms

Correct answer: Management leadership and worker participation

OSHA emphasizes that effective programs require both management leadership and meaningful worker participation.

Question 47: Which OSHA standard most directly applies when a COHN is developing a bloodborne pathogen exposure prevention program for healthcare workers?

29 CFR 1910.132 – Personal Protective Equipment
29 CFR 1910.147 – Control of Hazardous Energy
29 CFR 1910.1030 – Bloodborne Pathogens (Correct answer)
29 CFR 1910.1200 – Hazard Communication

Correct answer: 29 CFR 1910.1030 – Bloodborne Pathogens

The OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) specifically requires exposure control plans and protective measures for bloodborne pathogen risks.

Question 48: Which route of entry is the most common pathway for occupational chemical exposures?

Inhalation (Correct answer)
Ingestion
Injection
Skin absorption

Correct answer: Inhalation

Inhalation is the primary route of entry for most workplace chemical exposures because airborne substances are readily drawn into the lungs.

Question 49: A laser cutter operator reports eye irritation and blurred vision. Which type of radiation hazard is MOST relevant to this worker?

Ionizing radiation from X-ray scatter
Ultraviolet radiation from fluorescent safety lighting
Non-ionizing radiation from coherent light (Correct answer)
Infrared radiation from heat generation only

Correct answer: Non-ionizing radiation from coherent light

Lasers emit coherent non-ionizing radiation that can cause severe retinal burns and corneal damage; proper laser safety eyewear rated for the specific wavelength is required.

Question 50: A case manager is reviewing a treatment plan for an injured worker that includes procedures with questionable evidence of effectiveness. The MOST appropriate response is to:

Contact the employer directly to deny the treatment
Approve all treatments to avoid conflict with the treating physician
Immediately refer the case for an Independent Medical Examination
Apply evidence-based guidelines to evaluate appropriateness and communicate concerns through proper channels (Correct answer)

Correct answer: Apply evidence-based guidelines to evaluate appropriateness and communicate concerns through proper channels

Occupational case managers apply evidence-based clinical guidelines to assess treatment appropriateness and raise concerns professionally and through appropriate channels.

Question 51: Which of the following is the primary goal of health promotion activities in an occupational health setting?

To reduce workers' compensation and healthcare insurance costs for the employer.
To enable employees to increase control over and improve their health. (Correct answer)
To ensure compliance with federal and state health and safety regulations.
To diagnose and treat both work-related and non-work-related illnesses.

Correct answer: To enable employees to increase control over and improve their health.

The fundamental goal of health promotion is to empower individuals and communities to take control of their health. While cost reduction and regulatory compliance are often positive outcomes of a healthy workforce, the primary aim of health promotion programs is to provide employees with the knowledge, skills, and support to make healthy choices and improve their overall well-being.

Question 52: An occupational health nurse wants to maintain COHN certification through professional achievement rather than retaking the exam. This recertification pathway is called:

Portfolio recertification
Professional development recertification (Correct answer)
Continuing competence verification
Examination waiver renewal

Correct answer: Professional development recertification

ABOHN offers a professional development recertification pathway where nurses accumulate required continuing education and professional activities instead of retaking the examination.

Question 53: A construction worker is injured on a multi-employer worksite. Who bears OSHA citation liability?

Only the property owner
Only the general contractor
Potentially any employer whose acts or omissions contributed to the hazard (Correct answer)
Only the subcontractor whose employee was injured

Correct answer: Potentially any employer whose acts or omissions contributed to the hazard

OSHA's multi-employer citation policy holds any employer (creating, exposing, correcting, or controlling) potentially liable if they contributed to or failed to address a hazard.

Question 54: Which of the following is an example of a leading indicator in a health and safety program?

Workers' compensation costs
Number of lost workdays
Percentage of completed safety inspections (Correct answer)
Total recordable incident rate

Correct answer: Percentage of completed safety inspections

Completed safety inspections are a leading indicator because they measure proactive safety activities before injuries occur.

Question 55: An occupational health nurse will conduct a comprehensive physical examination, including a drug test, on both a potential and current employee. Which of the following best sums up the objectives of these tests? (Check every box that applies.)

To document changes that may have occurred while the employee engaged in particular processes or in a particular work area (Correct answer)
To help decide whether or not to hire the prospective employee
To establish a baseline before the employee is exposed to possible workplace hazards (Correct answer)
To warn the employer about specific weaknesses or disabilities in the prospective employee
To measure the strength of organs that may be affected by workplace responsibilities (Correct answer)
To update employee records and fill in any missing information

Correct answer: To document changes that may have occurred while the employee engaged in particular processes or in a particular work area

A preplacement evaluation is conducted before the employee starts work at a new business or is assigned to a new position. A baseline evaluation examination includes: ‥ A medical history. ‥ An occupational health history. ‥ A physical assessment should be tailored to the employee's work. Medical tests for identifying organ functions that might be impacted by exposure to substances already present in the employee's workplace may also be part of the preplacement assessment. To document any changes in health that might have happened while the person was working in a particular region or with a specific process, it is crucial to examine people switching employment. By law, pre-employment health exams are only allowed if they focus on the applicant's overall capacity to carry out job-related tasks rather than on any disabilities and only after a job offer has been made. All applicants performing similar work must be subjected to a regularly administered and job-related assessment.

Question 56: In toxicology, the term LC50 refers to which of the following?

The lowest concentration of a chemical that causes a chronic effect.
The lethal dose of a chemical when ingested by 50% of a test population.
The lethal concentration of an airborne substance that kills 50% of a test population. (Correct answer)
The legal concentration limit for a chemical in the workplace.

Correct answer: The lethal concentration of an airborne substance that kills 50% of a test population.

LC50 stands for Lethal Concentration, 50%. It is a standard measure of the toxicity of an airborne substance (like a gas, vapor, or dust) and represents the concentration that is lethal to half of the tested animal population during a specific exposure period.

Question 57: The FMLA entitles eligible employees to up to how many weeks of unpaid, job-protected leave per year?

12 weeks (Correct answer)
16 weeks
10 weeks
6 weeks

Correct answer: 12 weeks

FMLA provides eligible employees up to 12 weeks of unpaid leave per year for qualifying medical and family reasons.

Question 58: Which of the following justifications would the occupational health nurse (OHN) use to persuade a significant employer that a breast cancer education program is necessary?

It will be excellent media coverage for the employer, especially if the public is invited.
This program would help balance all the male-oriented programs.
A large number of female employees of childbearing age may be interested.
Women employees who believe their employers are interested in their well-being are more productive and satisfied. (Correct answer)

Correct answer: Women employees who believe their employers are interested in their well-being are more productive and satisfied.

Women are more likely to be productive and content workers if they feel their employers care about their personal and family lives. Therefore, the significant employer can prove its conviction by providing a breast cancer education program. Offering this program would not be done primarily to attract attention for the company from the media, pique the interest of female employees, or counterbalance more male-oriented initiatives.

Question 59: A nurse is collecting data to determine the health needs of a rural underserved population. Which data source provides community-level self-reported health behavior data by state?

Behavioral Risk Factor Surveillance System (BRFSS) (Correct answer)
Hospital discharge data
Medicare claims database
National Vital Statistics System

Correct answer: Behavioral Risk Factor Surveillance System (BRFSS)

The BRFSS is a state-based telephone survey that collects self-reported data on health behaviors, chronic conditions, and preventive service use.

Question 60: Which of the following is a PRIMARY responsibility of an occupational case manager during an onsite visit?

Negotiating labor contracts on behalf of the employer
Administering prescription medications to injured workers
Conducting disciplinary actions against supervisors
Performing ergonomic assessments and identifying workplace hazards (Correct answer)

Correct answer: Performing ergonomic assessments and identifying workplace hazards

During onsite visits, occupational case managers assess the work environment, identify hazards, and support ergonomic improvements to facilitate safe return to work.

Question 61: A manufacturing employee is diagnosed with carpal tunnel syndrome, a condition potentially aggravated by their job tasks. In managing this case, the occupational health nurse should prioritize which of the following interventions?

Placing the employee on indefinite medical leave.
Conducting an ergonomic assessment of the employee's workstation. (Correct answer)
Advising the employee to seek employment in a different industry.
Recommending immediate surgery to resolve the condition.

Correct answer: Conducting an ergonomic assessment of the employee's workstation.

A primary principle of occupational health is to identify and mitigate workplace hazards. An ergonomic assessment helps to identify risk factors in the employee's job tasks and environment that may be causing or exacerbating the condition. Addressing these factors is crucial for both recovery and prevention of future injury.

Question 62: Under NIOSH guidelines, what does the hierarchy of controls prioritize as the MOST effective method to control workplace hazards?

Engineering controls
Personal protective equipment (PPE)
Administrative controls
Elimination of the hazard (Correct answer)

Correct answer: Elimination of the hazard

Elimination of the hazard is the most effective control because it completely removes the risk rather than managing or reducing exposure to it.

Question 63: A COHN is coordinating care for an injured worker with a complex lumbar injury. Which action best demonstrates the role of advocate in case management?

Deferring all decisions to the insurance adjuster
Ensuring the worker understands all treatment options and their rights (Correct answer)
Directing the physician on which treatments to prescribe
Limiting specialist referrals to reduce employer costs

Correct answer: Ensuring the worker understands all treatment options and their rights

Advocacy in occupational case management means ensuring the injured worker is informed and can make autonomous, educated decisions about their care.

Question 64: The Hospital Emergency Incident Command System (HEICS) principle of 'span of control' recommends that one supervisor manage no more than how many personnel?

1 to 2
10 to 15
3 to 5 (Correct answer)
7 to 10

Correct answer: 3 to 5

The recommended span of control in ICS/HEICS is 3 to 5 subordinates per supervisor, ensuring effective oversight without cognitive overload.

Question 65: Which concept describes the interaction between the host, agent, and environment in the causation of occupational disease?

Systems safety model
Hierarchy of controls
Energy exchange theory
Epidemiologic triad (Correct answer)

Correct answer: Epidemiologic triad

The epidemiologic triad models disease causation through the interplay of host susceptibility, agent characteristics, and environmental conditions.

Question 66: What does the hierarchy of controls prioritize as the most effective method for controlling workplace hazards?

Elimination of the hazard (Correct answer)
Engineering controls
Personal protective equipment (PPE)
Administrative controls

Correct answer: Elimination of the hazard

Elimination removes the hazard entirely and is the most effective control at the top of the hierarchy, followed by substitution, engineering controls, administrative controls, and PPE.

Question 67: Under the Affordable Care Act, which preventive services must be covered by most health insurance plans without cost-sharing?

Emergency department visits
Services rated A or B by the US Preventive Services Task Force (Correct answer)
All prescription medications
Inpatient hospital stays

Correct answer: Services rated A or B by the US Preventive Services Task Force

The ACA requires coverage of USPSTF grade A and B preventive services without cost-sharing for patients.

Question 68: An employer wants to contest an OSHA citation. Within how many working days of receiving the citation must the employer file a Notice of Contest?

15 working days (Correct answer)
30 working days
5 working days
10 working days

Correct answer: 15 working days

Employers must file a Notice of Contest within 15 working days of receiving an OSHA citation or the citation becomes a final order.

Question 69: When reviewing a physician's return-to-work restrictions, a COHN notices the restrictions are vague (e.g., 'light duty'). What is the BEST action?

Return the employee to full duty since 'light duty' is too vague to enforce
Contact the treating physician to clarify specific functional limitations in measurable terms (Correct answer)
Send the employee back out on full disability leave until clearer restrictions are provided
Interpret the restrictions based on the nurse's clinical judgment alone

Correct answer: Contact the treating physician to clarify specific functional limitations in measurable terms

The COHN should contact the treating physician to obtain specific, measurable restrictions (e.g., maximum pounds lifted, hours standing) to properly match the worker to available duties.

Question 70: An employee returns to work after a back injury with a 20-pound lifting restriction. The employer's only available position requires 50-pound lifts. What should the COHN recommend?

Explore transitional duty modifications or identify alternative temporary assignments (Correct answer)
Have the employee attempt the full-duty job to test their actual capacity
Allow the employee to work and document any re-injuries
Terminate the employee for inability to perform job duties

Correct answer: Explore transitional duty modifications or identify alternative temporary assignments

The COHN should explore modified duty options or alternative assignments that comply with the physician's restrictions while keeping the employee productively working.

Question 71: An occupational health nurse is conducting a walk-through inspection of a busy hospital kitchen. Which of the following represents the most common categories of hazards the nurse should anticipate in this specific environment?

Chemical and ergonomic
Biological and electrical
Safety and physical (Correct answer)
Radiation and psychosocial

Correct answer: Safety and physical

Hospital kitchens present numerous safety hazards, such as wet floors (slips, trips, falls) and sharp objects (cuts), as well as physical hazards like extreme heat from cooking equipment and high noise levels. While other hazards may exist, safety and physical hazards are the most prominent and common in this setting.

Question 72: An agricultural worker presents with acute toxic effects after herbicide exposure. The MOST appropriate initial resource for identifying the chemical's acute health hazards and first aid measures is:

Ordering a complete metabolic panel
Calling the state health department
Reviewing the Safety Data Sheet (SDS) Section 4 (Correct answer)
Consulting the worker's personal physician

Correct answer: Reviewing the Safety Data Sheet (SDS) Section 4

SDS Section 4 (First Aid Measures) provides immediate, chemical-specific first aid instructions and is the most accessible reference for acute exposure management at the worksite.

Question 73: Which federal agency is responsible for conducting research and making recommendations to prevent work-related illness and injury but does NOT have enforcement authority?

EPA
DOL
OSHA
NIOSH (Correct answer)

Correct answer: NIOSH

NIOSH (National Institute for Occupational Safety and Health) conducts research and publishes recommendations but does not issue citations or enforce standards.

Question 74: Universal precautions require that blood and body fluids from ALL patients be treated as:

Potentially infectious regardless of known diagnosis (Correct answer)
Infectious only in high-risk settings such as oncology or ICU units
Infectious only if the patient tests positive for HIV or HBV
Non-infectious unless visible blood contamination is present

Correct answer: Potentially infectious regardless of known diagnosis

Universal precautions, established by CDC, require treating all blood and specified body fluids as potentially infectious for bloodborne pathogens regardless of patient diagnosis or perceived risk.

Question 75: An occupational health nurse is developing a pandemic influenza response plan. Which strategy BEST reduces transmission in the workplace?

Staggered work shifts and cohorting of work teams (Correct answer)
Requiring all symptomatic employees to continue working with masks
Mandatory overtime to maintain staffing levels
Eliminating all personal protective equipment to reduce panic

Correct answer: Staggered work shifts and cohorting of work teams

Staggered shifts and cohorting reduce the number of employee contacts, limiting transmission chains and preserving workforce capacity during a pandemic.

Question 76: A semiconductor fabrication worker is exposed to arsine (AsH₃) gas. The MOST critical early target organ affected by acute arsine toxicity is the:

Liver, causing acute hepatic necrosis
Red blood cells, causing massive hemolysis (Correct answer)
Kidneys, causing direct tubular nephrotoxicity
Lungs, causing chemical pneumonitis

Correct answer: Red blood cells, causing massive hemolysis

Arsine causes rapid, massive hemolysis of red blood cells, leading to hemoglobinuria, acute renal failure (secondary), and potentially fatal anemia — hemolysis is the primary acute mechanism.

Question 77: In the context of industrial hygiene, what does 'engineering controls' refer to?

Physical modifications to the work environment or equipment to reduce hazards (Correct answer)
Training workers on safe chemical handling procedures
Rotating workers to limit individual exposure time
Requiring workers to wear respirators during chemical handling

Correct answer: Physical modifications to the work environment or equipment to reduce hazards

Engineering controls include physical changes such as ventilation systems, enclosures, machine guarding, and substitution that reduce or eliminate worker exposure to hazards.

Question 78: An employee presents with symptoms of acute solvent overexposure including dizziness and nausea. After removing the worker from exposure, the NEXT priority is:

Identifying the specific solvent from the SDS
Scheduling a follow-up appointment for next week
Assessing vital signs and level of consciousness (Correct answer)
Administering activated charcoal

Correct answer: Assessing vital signs and level of consciousness

After removing the worker from the hazardous environment, immediate clinical assessment of vital signs and neurological status is the priority to guide treatment.

Question 79: The purpose of a 'job demands analysis' (JDA) in occupational health is BEST described as:

Determining the minimum education required for a specific position
Evaluating employee performance for merit reviews
Systematically identifying the physical, cognitive, and environmental requirements of a job to match with worker capabilities (Correct answer)
Calculating overtime pay requirements for physically demanding jobs

Correct answer: Systematically identifying the physical, cognitive, and environmental requirements of a job to match with worker capabilities

A JDA identifies and quantifies the essential physical, cognitive, and environmental demands of a job to enable proper matching of worker capability to job requirements.

Question 80: A worksite wellness program achieves a 10% reduction in emergency department visits over one year. This is an example of which type of program evaluation?

Summative (outcome) evaluation (Correct answer)
Process evaluation
Formative evaluation
Economic evaluation

Correct answer: Summative (outcome) evaluation

Summative or outcome evaluation measures the actual results and impact of a program after implementation.

Question 81: An occupational health nurse is part of a team evaluating hazards in a sterile processing department of a hospital. Which type of hazard should be considered a primary focus due to the nature of the items being handled?

Ergonomic hazards from repetitive motions
Biological hazards from contaminated surgical instruments (Correct answer)
Psychosocial hazards from high-pressure deadlines
Physical hazards from autoclave noise

Correct answer: Biological hazards from contaminated surgical instruments

While ergonomic, psychosocial, and physical hazards may be present, the primary and most unique hazard in a sterile processing department is the risk of exposure to biological agents like bacteria and viruses from contaminated instruments. This is a critical focus for preventing occupational infections.

Question 82: What does the 'impairment rating' assigned at MMI primarily determine in the workers' compensation system?

The degree of permanent physical loss, which is used to calculate permanent disability benefits (Correct answer)
The worker's classification for future job applications
The worker's eligibility for unemployment insurance
The employer's OSHA recordkeeping obligation

Correct answer: The degree of permanent physical loss, which is used to calculate permanent disability benefits

An impairment rating quantifies the degree of permanent physical loss using standardized guides (e.g., AMA Guides) and is used to calculate permanent disability benefits.

Question 83: A confined space is classified as a 'permit-required' confined space when it:

Has limited natural lighting
Is located underground
Has a hazardous atmosphere or other serious safety hazard (Correct answer)
Is accessed by a ladder

Correct answer: Has a hazardous atmosphere or other serious safety hazard

A confined space becomes permit-required under OSHA 29 CFR 1910.146 when it contains or has a potential for a hazardous atmosphere, engulfment hazard, internal configuration hazard, or any other recognized serious safety or health hazard.

Question 84: Which statement best describes the relationship between ABOHN and AAOHN?

They are the same organization operating under two names
ABOHN is an autonomous credentialing body whose exam content is informed by AAOHN practice standards (Correct answer)
AAOHN administers all ABOHN examinations
ABOHN is a subsidiary division of AAOHN

Correct answer: ABOHN is an autonomous credentialing body whose exam content is informed by AAOHN practice standards

ABOHN is a separate, autonomous credentialing organization that develops its certification examinations based on AAOHN's published practice standards and competencies.

Question 85: An occupational health nurse is reviewing shelter-in-place procedures. Which scenario BEST indicates when shelter-in-place is preferred over evacuation?

A credible bomb threat received by security
A structural failure warning from engineering
An external airborne chemical release with rapidly changing wind direction (Correct answer)
An active fire in the building's east wing

Correct answer: An external airborne chemical release with rapidly changing wind direction

An external airborne chemical release with unpredictable wind direction makes evacuation dangerous; sheltering in-place protects employees by sealing them indoors away from contaminated air.

Question 86: What type of fire extinguisher is most suited to extinguish kerosene fire?

Class A
Class D
Class B (Correct answer)
Class C

Correct answer: Class B

Flammable substances, including kerosene, oil, and gasoline, are involved in class B fires. Paper, cardboard, and wood are simple materials that can be put out with Class A extinguishers. Electrical fires, such as those in outlets, appliances, and wiring, are handled using Class C extinguishers. Chemical fires require the use of Class D extinguishers.

Question 87: When developing a formal transitional duty program, which component is MOST essential for ensuring the program is effective and legally compliant?

A requirement that employees must be at least 75% recovered before they are eligible to participate in any transitional work.
An agreement with a local non-profit to place all employees on modified duty off-site to avoid workplace disruptions.
Written, goal-oriented plans for each employee with a specified duration and clear objectives for progressing back to full duty. (Correct answer)
A policy that limits program eligibility exclusively to employees with work-related injuries to control workers' compensation costs.

Correct answer: Written, goal-oriented plans for each employee with a specified duration and clear objectives for progressing back to full duty.

Effective transitional duty programs are structured, not open-ended. A written plan with a clear purpose, specific goals, and a defined time limit (e.g., 90 days) ensures the program serves as a bridge back to full employment rather than becoming a permanent, unmanaged placement. This structure helps manage expectations for the employee, supervisor, and medical provider, and demonstrates a good-faith effort to return the employee to their original job.

Question 88: Which of the following is an example of secondary prevention in occupational health case management?

Implementing pre-employment physicals to screen for pre-existing conditions
Returning a permanently disabled worker to the workforce through vocational training
Installing ergonomic workstations before any injuries occur
Early intervention programs after an injury to prevent long-term disability (Correct answer)

Correct answer: Early intervention programs after an injury to prevent long-term disability

Secondary prevention focuses on early intervention after an injury occurs to minimize severity and prevent long-term disability or complications.

Question 89: A COHN notices that the worksite cafeteria predominantly offers high-calorie, low-nutrient foods. Advocating for healthier food options is an example of:

A violation of employee autonomy and should be avoided
Environmental or structural change to support healthy behavior (Correct answer)
Secondary prevention targeting individual employees
Tertiary prevention for employees with diet-related conditions

Correct answer: Environmental or structural change to support healthy behavior

Modifying the food environment to make healthier choices easier is a structural/environmental strategy that supports population-level health promotion.

Question 90: A COHN is developing a respiratory protection program. Under OSHA 29 CFR 1910.134, which step MUST occur before a worker is fit-tested for a respirator?

Engineering controls must be proven technologically infeasible
Industrial hygiene air monitoring must show exposures above PEL
The worker must select their own preferred respirator model
The worker must complete a medical evaluation to determine fitness to wear a respirator (Correct answer)

Correct answer: The worker must complete a medical evaluation to determine fitness to wear a respirator

OSHA's Respiratory Protection Standard requires a medical evaluation (using OSHA Medical Evaluation Questionnaire or equivalent) before fit testing to ensure the worker can safely wear respiratory protection.

Question 91: The term 'transitional work program' in occupational case management refers to:

A program for transitioning employees to retirement
An OSHA-mandated light duty assignment for all injured workers
A vocational training program for permanently disabled workers
A temporary, structured alternative work assignment designed to accommodate restrictions while the worker recovers (Correct answer)

Correct answer: A temporary, structured alternative work assignment designed to accommodate restrictions while the worker recovers

A transitional work program provides temporary modified or alternative work assignments that accommodate a recovering worker's restrictions and support return to full duty.

Question 92: Which of the following is an example of an 'undue hardship' that might excuse an employer from providing a requested ADA accommodation?

The employee's coworkers are inconvenienced by the accommodation
The accommodation is not specifically listed in the employee's job description
The accommodation would cost $50 for a large Fortune 500 company
The accommodation would require extensive restructuring that fundamentally alters the nature of the business operation (Correct answer)

Correct answer: The accommodation would require extensive restructuring that fundamentally alters the nature of the business operation

Undue hardship under the ADA considers significant difficulty or expense relative to the employer's size, resources, and the nature of the business — not mere inconvenience.

Question 93: A COHN implements a walking program at lunch. Three months later, participation has dropped by 50%. The BEST next step is to:

Mandate participation to restore enrollment numbers
Survey participants and non-participants to identify barriers (Correct answer)
Increase incentives immediately without further assessment
Discontinue the program due to low interest

Correct answer: Survey participants and non-participants to identify barriers

Surveying both participants and non-participants identifies specific barriers and facilitators to inform program adjustments.

Question 94: When an employee's work restrictions conflict with the employer's production needs, the COHN's BEST approach is to:

Side with the employer's production needs to protect the company
Advise the employee to ignore the production pressure
Facilitate a multidisciplinary meeting to problem-solve modified duty options that honor restrictions while meeting operational needs (Correct answer)
Remove the employee from work entirely to avoid conflict

Correct answer: Facilitate a multidisciplinary meeting to problem-solve modified duty options that honor restrictions while meeting operational needs

The COHN facilitates collaborative problem-solving among all stakeholders to find solutions that respect medical restrictions while addressing operational realities.

Question 95: When an employer has 10 or fewer employees throughout the year, which OSHA recordkeeping requirement applies?

Only OSHA 300A must be completed
They are exempt from routine OSHA injury and illness recordkeeping (Correct answer)
Full OSHA 300 log and 301 form requirements apply
They must report all injuries to OSHA within 8 hours

Correct answer: They are exempt from routine OSHA injury and illness recordkeeping

Employers with 10 or fewer employees are generally exempt from OSHA's routine recordkeeping requirements, though they must still report severe injuries.

Question 96: Under the ADA, which of the following best defines 'reasonable accommodation' in the context of return-to-work?

Reassignment to a higher-paying position to compensate for limitations
Any modification that eliminates all physical demands of a job
A modification or adjustment that enables a qualified individual with a disability to perform essential job functions (Correct answer)
Providing unlimited leave until the employee fully recovers

Correct answer: A modification or adjustment that enables a qualified individual with a disability to perform essential job functions

Reasonable accommodation is a modification or adjustment that enables a qualified individual with a disability to perform essential job functions without causing undue hardship to the employer.

Question 97: The concept of 'skin notation' (Sk) on a chemical's TLV indicates that:

PPE is not required because the air limit is already protective
Significant absorption through intact skin can contribute to total body burden (Correct answer)
Skin contact must be avoided because dermal TLVs are more restrictive
The chemical causes dermatitis in all exposed workers

Correct answer: Significant absorption through intact skin can contribute to total body burden

Skin notation alerts occupational health professionals that dermal absorption of the chemical can be significant enough to add to systemic toxicity, even when air levels are controlled.

Question 98: In occupational health program evaluation, which metric measures the ratio of benefits gained to program costs?

Severity rate
Incidence rate
Return on investment (ROI) (Correct answer)
Net promoter score

Correct answer: Return on investment (ROI)

ROI calculates the financial return relative to the cost of a program, expressed as a percentage, and is key to demonstrating program value.

Question 99: When conducting a telephonic case management call with an injured worker, which action is MOST important at the start of the call?

Identify yourself, your role, and explain the purpose and voluntary nature of case management services (Correct answer)
Request a recorded statement for the insurer's file
Immediately ask about fraud indicators
Inquire about the worker's attorney contact information

Correct answer: Identify yourself, your role, and explain the purpose and voluntary nature of case management services

Ethical case management requires transparency: identifying yourself and explaining your role and the voluntary nature of services protects worker rights and builds trust.

Question 100: A worker with chronic low-level mercury vapor exposure is MOST likely to present with which early symptom?

Blue-black gum line and loose teeth
Peripheral cyanosis and Raynaud's phenomenon
Fine tremor of the hands and irritability (Correct answer)
Mees' lines on fingernails and hyperkeratosis

Correct answer: Fine tremor of the hands and irritability

Early chronic mercury vapor toxicity classically presents with erethism (irritability, shyness, memory loss) and fine intentional tremor before more severe neurological signs appear.

Question 101: Which lung disease is caused by inhalation of crystalline silica dust in occupational settings?

Asbestosis
Pneumoconiosis due to coal dust
Silicosis (Correct answer)
Byssinosis

Correct answer: Silicosis

Silicosis is a fibrotic lung disease caused by inhaling crystalline silica, common in industries such as mining, quarrying, sandblasting, and construction.

Question 102: Which of the following best illustrates the principle of 'least restrictive environment' in return-to-work planning?

Assigning the worker to a completely different department with no physical demands
Keeping the worker off work until full recovery to prevent any risk
Returning the worker to the closest possible approximation of their pre-injury job with minimal modification (Correct answer)
Requiring the worker to complete 12 weeks of work hardening before any job assignment

Correct answer: Returning the worker to the closest possible approximation of their pre-injury job with minimal modification

Returning the worker to the highest functional level with the least restriction possible promotes faster recovery and workforce integration.

Question 103: When calculating the OSHA incidence rate for days away from work, which denominator is used?

10,000 full-time workers
100 full-time workers (200,000 hours) (Correct answer)
1,000 full-time workers (2,000,000 hours)
Total number of employees on payroll

Correct answer: 100 full-time workers (200,000 hours)

OSHA incidence rates are calculated per 100 full-time equivalent workers, using 200,000 as the standard denominator.

Question 104: Which community assessment data source provides age, race, income, and household composition at the neighborhood level?

Vital statistics registry
National Health Interview Survey
US Census Bureau / American Community Survey (Correct answer)
Behavioral Risk Factor Surveillance System

Correct answer: US Census Bureau / American Community Survey

The US Census and ACS provide detailed sociodemographic data at geographic levels as small as census tracts.

Question 105: A worker sustained a repetitive strain injury and is reluctant to return to a modified duty role. Which approach is MOST effective in motivating return to work?

Contacting the worker's family to persuade them
Requiring a psychiatric evaluation before any further communication
Threatening to stop workers' compensation benefits
Using motivational interviewing to explore the worker's concerns and goals (Correct answer)

Correct answer: Using motivational interviewing to explore the worker's concerns and goals

Motivational interviewing is an evidence-based, collaborative communication technique effective in addressing ambivalence and facilitating behavior change.

Question 106: An employee works in a boiler room where temperatures regularly exceed 95°F. Which early symptom of heat illness should prompt immediate removal from the environment?

Confusion, slurred speech, or cessation of sweating (Correct answer)
Mild perspiration and thirst
Mild headache after the first hour
Muscle cramps in the legs

Correct answer: Confusion, slurred speech, or cessation of sweating

Confusion, slurred speech, and anhidrosis (cessation of sweating) are signs of heat stroke — a life-threatening emergency requiring immediate removal and cooling.

Question 107: An OHN implements a mandatory hearing conservation program for all employees exposed to noise levels at or above the OSHA action level. This program includes baseline and annual audiograms, training, and provision of hearing protection. This entire program is an example of which level of prevention?

Tertiary prevention
Administrative prevention
Secondary prevention (Correct answer)
Primary prevention

Correct answer: Secondary prevention

Secondary prevention focuses on the early detection and treatment of disease to slow its progression. A hearing conservation program with regular screening tests (audiograms) is designed to detect early signs of hearing loss, allowing for timely intervention to prevent further damage. While it has primary prevention elements (training, PPE), its core function of early detection through screening places it firmly in the secondary prevention category.

Question 108: A COHN is asked to develop a stay-at-work program. Which element is MOST critical for its success?

Requiring all injured workers to report injuries immediately under penalty of termination
Early identification of injured workers, prompt medical intervention, and supervisor involvement (Correct answer)
Limiting program access to workers with lost-time injuries only
Outsourcing all case management to third-party vendors

Correct answer: Early identification of injured workers, prompt medical intervention, and supervisor involvement

Successful stay-at-work programs depend on early injury identification, prompt medical care, and active supervisor support to keep workers productively engaged.

Question 109: Which epidemiological measure describes the proportion of a population that has a disease at a specific point in time?

Incidence rate
Attack rate
Cumulative incidence
Point prevalence (Correct answer)

Correct answer: Point prevalence

Point prevalence measures the proportion of individuals in a population with a disease at a single moment in time.

Question 110: Which of the following BEST describes the 'biopsychosocial model' as applied in occupational case management?

A federal regulatory framework for workplace injury reporting
An approach addressing biological, psychological, and social factors that influence recovery and return to work (Correct answer)
A cost-containment strategy used by insurers
A model focused solely on physical injury and biomedical treatment

Correct answer: An approach addressing biological, psychological, and social factors that influence recovery and return to work

The biopsychosocial model recognizes that biological, psychological, and social factors all interact to influence injury recovery and occupational rehabilitation outcomes.

Question 111: Which of the following is a leading indicator of workplace safety performance?

Number of workers' compensation claims
OSHA injury incidence rate
Percentage of employees completing safety training (Correct answer)
Lost workday severity rate

Correct answer: Percentage of employees completing safety training

Leading indicators such as training completion rates measure proactive safety activities before injuries occur, unlike lagging indicators.

Question 112: In legal terms, what is 'causation' in a workers' compensation claim?

The total medical costs associated with the injury
The employer's negligence in preventing the injury
The proof that the injury or illness arose out of and in the course of employment (Correct answer)
The severity of the worker's injury

Correct answer: The proof that the injury or illness arose out of and in the course of employment

Causation establishes that the injury or illness is work-related—it must arise out of (AOE) and in the course of employment (COE) to be compensable.

Question 113: Which type of workers' compensation benefit replaces a portion of an injured worker's lost wages?

Medical benefits
Temporary total disability (TTD) benefits (Correct answer)
Death benefits
Vocational rehabilitation benefits

Correct answer: Temporary total disability (TTD) benefits

TTD benefits provide wage replacement when an injured employee is completely unable to work for a temporary period due to a work-related injury.

Question 114: What is 'vocational rehabilitation' in workers' compensation?

Services to help an injured worker return to suitable employment (Correct answer)
Physical therapy to restore full range of motion
Legal representation during claim disputes
Psychological counseling for work-related stress

Correct answer: Services to help an injured worker return to suitable employment

Vocational rehabilitation includes job retraining, education, and job placement services for workers who cannot return to their previous occupation due to a work-related injury.

Question 115: An ABOHN-certified nurse is asked to testify as an expert witness in a workers' compensation case. This role falls under which functional domain of occupational health nursing?

Legal and regulatory compliance (Correct answer)
Health promotion and protection
Worker and workplace health assessment
Case management and coordination

Correct answer: Legal and regulatory compliance

Expert witness testimony regarding occupational injury or illness falls within the legal and regulatory compliance domain of occupational health nursing practice.

Question 116: A COHN wants to reduce musculoskeletal disorders among assembly line workers. Which primary prevention strategy is MOST appropriate?

Screening workers for pre-existing musculoskeletal conditions
Providing ergonomic training after injury occurs
Redesigning workstations to fit the range of workers (Correct answer)
Offering physical therapy referrals to symptomatic employees

Correct answer: Redesigning workstations to fit the range of workers

Workstation redesign is primary prevention because it eliminates the hazard before injury occurs, rather than responding to symptoms.

Question 117: The PRECEDE-PROCEED model's 'enabling factors' include:

Attitudes and beliefs that motivate behavior
Reinforcements received after performing a behavior
Skills, resources, and accessibility that facilitate behavior (Correct answer)
Social norms and peer influences on behavior

Correct answer: Skills, resources, and accessibility that facilitate behavior

Enabling factors are the skills, resources, and structural supports that make a health behavior possible.

Question 118: An occupational health nurse notices a statistically significant increase in musculoskeletal disorders in the assembly line department. The BEST tool to identify contributing risk factors is:

A severity rate calculation
An ergonomic job analysis (Correct answer)
A OSHA 300 log audit
A pre-placement physical exam review

Correct answer: An ergonomic job analysis

An ergonomic job analysis systematically evaluates tasks for physical stressors such as force, repetition, and awkward posture that contribute to musculoskeletal disorders.

Question 119: Return-to-work programs after occupational injury are BEST described as which level of prevention?

Secondary prevention
Primordial prevention
Tertiary prevention (Correct answer)
Primary prevention

Correct answer: Tertiary prevention

Tertiary prevention aims to reduce the impact of an established disease or injury through rehabilitation, including return-to-work programs.

Question 120: Under OSHA's recordkeeping rule, which criterion determines if a work-related injury requires a physician's visit to be OSHA recordable?

It requires only first aid treatment
It results in days away from work
It requires medical treatment beyond first aid (Correct answer)
It causes a near-miss event

Correct answer: It requires medical treatment beyond first aid

OSHA defines a recordable injury as one requiring medical treatment beyond first aid, not merely first-aid-level care.

Question 121: The first worker's compensation law to be upheld in court was passed in...

Michigan
California
Wisconsin (Correct answer)
Agriculture

Correct answer: Wisconsin

The first legally upheld Worker's Compensation Law was enacted in Germany, not Wisconsin. The German Worker's Compensation Law, also known as the Employers' Liability Law, was passed in 1884 under the leadership of Chancellor Otto von Bismarck. It provided a system of compensation for workers who suffered from work-related injuries or illnesses.

Question 122: Which of the following is considered a primary ergonomic risk factor for developing a work-related musculoskeletal disorder (MSD)?

Low workplace morale.
High noise levels.
Repetitive motion. (Correct answer)
Inadequate lighting.

Correct answer: Repetitive motion.

Repetitive motion is a well-established ergonomic risk factor that can lead to MSDs by causing wear and tear on muscles, tendons, and nerves. While factors like low morale, poor lighting, and high noise can contribute to workplace stress and safety issues, they are not considered primary *ergonomic* risk factors directly causing MSDs in the same way as repetition, force, and awkward postures.

Question 123: A nurse is calculating the cost-benefit of a new ergonomics program. Direct costs of workplace injuries include:

OSHA fines and legal fees
Medical treatment and workers' compensation indemnity payments (Correct answer)
Decreased employee morale and administrative time
Lost productivity and training replacement workers

Correct answer: Medical treatment and workers' compensation indemnity payments

Direct costs are those directly attributable to the injury, including medical expenses and indemnity (wage replacement) payments.

Question 124: What is the minimum number of hours of occupational health nursing experience required to sit for the COHN examination?

1,000 hours (Correct answer)
3,000 hours
4,000 hours
5,000 hours

Correct answer: 1,000 hours

ABOHN requires a minimum of 1,000 hours of occupational health nursing practice within the five years preceding application to sit for the COHN exam.

Question 125: An employee is returning to a physically demanding job with a temporary restriction of 'no lifting over 20 pounds.' Which of the following represents the MOST appropriate communication from the occupational health nurse to the employee's direct supervisor?

"Jane is returning to work tomorrow. For the next four weeks, she is restricted from lifting anything over 20 pounds. Let's discuss how we can accommodate this in her duties." (Correct answer)
"To maintain confidentiality, I cannot share any information about Jane's return. Please observe her and let me know if you see any issues."
"Jane is returning tomorrow, but be aware she has a rotator cuff tear and is still in physical therapy."
"You will need to ensure Jane follows all her medical restrictions, and you should report any non-compliance to me immediately."

Correct answer: "Jane is returning to work tomorrow. For the next four weeks, she is restricted from lifting anything over 20 pounds. Let's discuss how we can accommodate this in her duties."

The supervisor has a legitimate need to know the employee's functional limitations to provide a safe and appropriate work assignment. However, they do not have a need to know the medical diagnosis or details of treatment. This choice correctly shares only the necessary work-related restrictions, specifies the duration, and proactively opens a dialogue about accommodation, all while protecting the employee's private medical information.

Question 126: A construction worker is found unconscious in a confined space where fuel combustion equipment was used. The FIRST priority action is:

Immediately enter and drag the worker out
Put on supplied-air SCBA before entering to rescue (Correct answer)
Ventilate the space for 10 minutes before entering without PPE
Lower a rope and have the worker self-rescue

Correct answer: Put on supplied-air SCBA before entering to rescue

Confined space rescuers must use supplied-air SCBA because entering without respiratory protection leads to multiple fatalities — the majority of confined space deaths are untrained would-be rescuers.

Question 127: OSHA's Process Safety Management (PSM) standard applies to facilities that handle highly hazardous chemicals above threshold quantities. Which regulation number covers PSM?

29 CFR 1910.110
29 CFR 1910.120
29 CFR 1910.119 (Correct answer)
29 CFR 1910.1200

Correct answer: 29 CFR 1910.119

29 CFR 1910.119 is the OSHA Process Safety Management standard, requiring management of hazards associated with processes using highly hazardous chemicals.

Question 128: Which control measure represents the HIGHEST level of the hierarchy of controls for chemical hazards?

Engineering controls such as local exhaust ventilation
Personal protective equipment selection
Elimination of the hazardous chemical from the process (Correct answer)
Administrative controls such as job rotation

Correct answer: Elimination of the hazardous chemical from the process

Elimination (removing the hazard entirely) sits at the top of NIOSH's hierarchy of controls and is the most effective protective measure because it removes risk at the source.

Question 129: A worker is exposed to an organophosphate pesticide. Which set of symptoms is MOST characteristic of this exposure?

Metallic taste, hair loss, peripheral neuropathy
Excessive salivation, miosis, bradycardia (Correct answer)
Cherry-red skin, headache, confusion
Dry mouth, dilated pupils, tachycardia

Correct answer: Excessive salivation, miosis, bradycardia

Organophosphates inhibit acetylcholinesterase, causing cholinergic toxidrome with SLUDGE symptoms (salivation, lacrimation, urination, defecation, GI distress, emesis), miosis, and bradycardia.

Question 130: A worker who handles pesticides daily is found to have cholinesterase levels 30% below their pre-employment baseline. This finding PRIMARILY indicates:

Hepatotoxicity from chronic chemical exposure
Normal variation in enzymatic activity
Organophosphate or carbamate pesticide absorption (Correct answer)
Kidney damage from solvent exposure

Correct answer: Organophosphate or carbamate pesticide absorption

Organophosphate and carbamate pesticides inhibit cholinesterase enzyme activity; a significant drop from baseline confirms systemic absorption and indicates a biological hazard exposure.

Question 131: An employee returning to work after a non-work-related surgery has a permanent lifting restriction of 15 lbs. Their essential job functions as a stock clerk require lifting up to 50 lbs. According to the Americans with Disabilities Act (ADA), what is the occupational health nurse's MOST appropriate initial action?

Immediately refer the employee to human resources to apply for long-term disability benefits.
Request the employee's complete medical file to independently verify the necessity of the restriction.
Initiate the interactive process with the employee to explore potential reasonable accommodations. (Correct answer)
Inform the employee they cannot return to their original job due to the medical restriction.

Correct answer: Initiate the interactive process with the employee to explore potential reasonable accommodations.

The ADA requires employers to engage in a good-faith interactive process when they are aware of an employee's disability and need for accommodation. This collaborative dialogue is the first legal and practical step to determine if a reasonable accommodation exists that would allow the employee to perform the essential functions of the job, such as modifying the job, providing equipment, or reassigning to a vacant position. Terminating employment or referring to disability benefits without this step is premature and could violate the ADA.

Question 132: A COHN-S is reviewing noise dosimetry results. A worker's full-shift dose reads 105%. Per OSHA 29 CFR 1910.95, which action is REQUIRED?

Remove the worker from the noisy environment immediately
Enroll the worker in a hearing conservation program (Correct answer)
Repeat monitoring within 6 months only
Recommend hearing protection on a voluntary basis

Correct answer: Enroll the worker in a hearing conservation program

OSHA requires enrollment in a hearing conservation program when an employee's noise exposure equals or exceeds an 8-hour TWA of 85 dBA (50% dose = 85 dBA, so 105% = well above action level).

Question 133: Which legislation primarily governs the confidentiality of an injured worker's medical information shared in occupational case management?

Fair Labor Standards Act (FLSA)
Employee Retirement Income Security Act (ERISA)
HIPAA Privacy Rule (Correct answer)
OSHA Act of 1970

Correct answer: HIPAA Privacy Rule

HIPAA's Privacy Rule governs the confidentiality and appropriate disclosure of protected health information, including in occupational case management contexts.

Question 134: Mercury affects?

The CNS (Correct answer)
Release of Acetylcholine
Relief of Anxiety
The Liver

Correct answer: The CNS

Mercury can indeed have significant effects on the central nervous system (CNS). It is a neurotoxic substance that can harm the brain and nerves.

Question 135: Which toxicological concept describes the dose below which no adverse effect is observed in a study population?

Permissible exposure limit (PEL)
Threshold limit value (TLV)
LD50
No-observed-adverse-effect level (NOAEL) (Correct answer)

Correct answer: No-observed-adverse-effect level (NOAEL)

The NOAEL is the highest dose in a toxicology study at which no statistically significant adverse effects are observed.

Question 136: The healthy immigrant effect refers to the observation that:

Immigrants receive better health care than native-born citizens
Newly arrived immigrants are often healthier than native-born peers but health deteriorates over time (Correct answer)
Immigration causes stress that immediately worsens health
Immigrants overuse emergency health services

Correct answer: Newly arrived immigrants are often healthier than native-born peers but health deteriorates over time

Newly arrived immigrants tend to be healthier than US-born counterparts due to self-selection, but this advantage diminishes with longer US residence.

Question 137: OSHA's Voluntary Protection Programs (VPP) recognize employers with exemplary safety management systems. Which VPP level represents the highest achievement?

Recognition
Demonstration
Merit
Star (Correct answer)

Correct answer: Star

Star is the highest VPP designation, awarded to employers with comprehensive, effective safety and health management systems and injury/illness rates below industry averages.

Question 138: Which framework is BEST used to analyze the social determinants of health affecting a community?

The biomedical model
Healthy People 2030 social determinants framework (Correct answer)
Kübler-Ross grief model
Maslow's Hierarchy of Needs

Correct answer: Healthy People 2030 social determinants framework

Healthy People 2030 organizes social determinants into five domains: economic stability, education, health care access, neighborhood, and social context.

Question 139: An employee with a shoulder injury is cleared for modified duty but refuses to return, citing fear of re-injury. What is the COHN's BEST initial response?

Conduct a motivational interview to explore concerns and provide education about safe return to work (Correct answer)
Report the employee's refusal to HR for disciplinary action
Contact the workers' compensation carrier to terminate benefits
Require the employee to undergo a psychiatric evaluation

Correct answer: Conduct a motivational interview to explore concerns and provide education about safe return to work

Motivational interviewing and education address fear-avoidance beliefs compassionately and are the most effective initial approaches to overcome psychological barriers to RTW.

Question 140: What is 'subrogation' in the context of workers' compensation?

The process of appealing a denied workers' compensation claim
The insurer's right to recover costs from a liable third party (Correct answer)
The employee's right to choose their own physician
The employer's right to terminate an injured employee

Correct answer: The insurer's right to recover costs from a liable third party

Subrogation allows the workers' compensation insurer to seek reimbursement from a third party whose negligence contributed to the worker's injury.

Question 141: An occupational health nurse is educating a group of assembly line workers on preventing musculoskeletal disorders (MSDs). Which of the following should the nurse identify as a primary ergonomic risk factor?

High-pressure deadlines
Awkward postures (Correct answer)
Inadequate lighting
Poor indoor air quality

Correct answer: Awkward postures

Primary ergonomic risk factors are conditions of a job that can lead to musculoskeletal disorders. These include forceful exertions, repetition, and awkward or static postures. While factors like deadlines (psychosocial stress), air quality, and lighting are important workplace health and safety concerns, awkward posture directly applies mechanical stress to the musculoskeletal system and is a core ergonomic risk factor.

Question 142: What is the role of an independent medical examination (IME) in workers' compensation?

To authorize emergency surgery for workplace injuries
To determine the employer's liability in a court of law
To obtain an objective medical opinion on diagnosis, causation, or work capacity (Correct answer)
To provide treatment recommendations by the employee's personal doctor

Correct answer: To obtain an objective medical opinion on diagnosis, causation, or work capacity

An IME is performed by a neutral physician to provide an unbiased assessment of the worker's condition, causation, or ability to return to work.

Question 143: Which phase of emergency management focuses on activities that reduce or eliminate the risk of a disaster occurring?

Preparedness
Response
Mitigation (Correct answer)
Recovery

Correct answer: Mitigation

Mitigation involves proactive measures taken before a disaster to reduce its likelihood or minimize its impact, such as installing sprinkler systems or strengthening structures.

Question 144: The ACGIH Threshold Limit Value-Short Term Exposure Limit (TLV-STEL) is defined as the concentration to which workers can be exposed for up to:

60 minutes without adverse effects
5 minutes without adverse effects
30 minutes without adverse effects
15 minutes without adverse effects (Correct answer)

Correct answer: 15 minutes without adverse effects

The TLV-STEL is a 15-minute time-weighted average concentration that should not be exceeded during any 15-minute period in the workday.

Question 145: The term 'maximum medical improvement' (MMI) in occupational health means:

The employee is cleared for unrestricted full-duty work
The employee has fully recovered and has no permanent impairment
The employee's injury claim is closed and no further benefits are payable
The condition has stabilized and is unlikely to improve significantly with further treatment (Correct answer)

Correct answer: The condition has stabilized and is unlikely to improve significantly with further treatment

MMI indicates that a condition has reached a plateau and is unlikely to improve significantly with further medical treatment, though some permanent impairment may remain.

Question 146: A case manager is developing a return-to-work plan for a worker with a shoulder injury. Which resource provides the most objective data about physical job demands?

The worker's self-reported pain level
The supervisor's informal description of the job
A job demands analysis (JDA) (Correct answer)
The Dictionary of Occupational Titles (DOT) alone

Correct answer: A job demands analysis (JDA)

A job demands analysis provides objective, site-specific data on the physical requirements of a particular position, making it the most reliable resource for return-to-work planning.

Question 147: Which of the following statements accurately describes the relationship between the Family and Medical Leave Act (FMLA) and the Americans with Disabilities Act (ADA)?

The ADA applies to employers with 50 or more employees, while FMLA applies to those with 15 or more.
Once an employee exhausts their 12 weeks of FMLA leave, an employer has no further obligation to provide additional leave.
An employee who qualifies for FMLA leave is automatically considered to have a disability under the ADA.
An employee can be entitled to protections under both laws simultaneously, and their rights are determined by the provisions of each separate law. (Correct answer)

Correct answer: An employee can be entitled to protections under both laws simultaneously, and their rights are determined by the provisions of each separate law.

FMLA and ADA are separate laws with different definitions and eligibility criteria. An employee's 'serious health condition' under FMLA may also qualify as a 'disability' under the ADA, making them eligible for protections under both. The ADA applies to employers with 15+ employees, while FMLA applies to those with 50+ employees. Importantly, additional leave beyond the FMLA's 12 weeks may be a reasonable accommodation required under the ADA.

Question 148: An employee is medically cleared to return to work without restrictions after an injury, but tells the occupational health nurse, "I'm terrified I'm going to hurt myself again just by doing my regular tasks." This statement indicates a significant barrier to a successful return to work. What is this type of barrier best described as?

A psychosocial factor influencing recovery. (Correct answer)
A legal impediment related to liability.
An administrative policy conflict.
A failure of the medical provider to communicate clearance.

Correct answer: A psychosocial factor influencing recovery.

The employee's fear of re-injury is a classic example of a psychosocial barrier. These factors, which include fear, anxiety, lack of confidence, and perceived lack of support, can significantly impede or delay a return to work even when an employee is physically capable. Addressing these psychological and social components is a critical part of holistic return-to-work case management.

Question 149: Which body has statutory authority to approve ABOHN as a certification organization recognized for occupational health nursing practice standards?

No external statutory body; ABOHN is self-regulating (Correct answer)
OSHA
NCQA (National Committee for Quality Assurance)
ANCC (American Nurses Credentialing Center)

Correct answer: No external statutory body; ABOHN is self-regulating

ABOHN is an independent, self-regulating credentialing body; no external statutory authority is required to approve its occupational health nursing certifications.

Question 150: In case management, the term 'maximum medical improvement' (MMI) means the worker's condition:

Has been classified as a permanent disability
Is unlikely to improve further with treatment (Correct answer)
Has fully resolved with no permanent impairment
Requires surgical intervention

Correct answer: Is unlikely to improve further with treatment

MMI indicates that a worker's medical condition has stabilized and is not expected to improve significantly with further treatment.

Question 151: Which level of prevention does a nurse practice when administering Hepatitis B vaccines to newborns?

Tertiary prevention
Primordial prevention
Primary prevention (Correct answer)
Secondary prevention

Correct answer: Primary prevention

Vaccination before disease occurs is primary prevention, aimed at reducing the incidence of disease.

Question 152: What type of ventilation system removes contaminants at their source before they can spread into the work area?

Positive pressure ventilation
General dilution ventilation
Recirculation ventilation
Local exhaust ventilation (LEV) (Correct answer)

Correct answer: Local exhaust ventilation (LEV)

Local exhaust ventilation captures and removes airborne contaminants at or near their point of generation, preventing worker exposure.

Question 153: The Transtheoretical Model (Stages of Change) identifies which stage as one where an individual has no intention to change behavior in the next 6 months?

Contemplation
Maintenance
Preparation
Precontemplation (Correct answer)

Correct answer: Precontemplation

In the precontemplation stage, the individual is unaware of or not considering the need for behavior change.

Question 154: What is the Permissible Exposure Limit (PEL) as defined by OSHA?

The recommended exposure level set by NIOSH for emergency response
The legal limit for worker exposure to a chemical or physical agent in the workplace (Correct answer)
The maximum concentration of a substance allowed in outdoor air
The dose of a substance that causes death in 50% of test animals

Correct answer: The legal limit for worker exposure to a chemical or physical agent in the workplace

PELs are legally enforceable limits set by OSHA that define the maximum amount of a hazardous substance a worker may be exposed to over a specified time period.

Question 155: Which of the following is a KEY difference between the COHN and COHN-S credential?

COHN-S requires a higher level of clinical nursing education but no occupational health experience
COHN-S is only valid for nurses employed in manufacturing industries
COHN-S focuses exclusively on case management, while COHN covers all occupational health domains
COHN-S requires a BSN or higher degree and demonstrates advanced education in occupational health nursing (Correct answer)

Correct answer: COHN-S requires a BSN or higher degree and demonstrates advanced education in occupational health nursing

The COHN-S (Specialist) designation requires a baccalaureate or higher degree in nursing, distinguishing it from the COHN credential which has a more flexible education requirement.

Question 156: A community health nurse advocates for fluoridation of the municipal water supply. This is an example of which public health role?

Educator
Policy advocate (Correct answer)
Direct care provider
Case manager

Correct answer: Policy advocate

Advocating for evidence-based policy changes such as water fluoridation reflects the policy advocate role in community/public health nursing.

Question 157: An occupational health nurse notices that several employees in a painting department have elevated lead blood levels. The MOST likely primary exposure route is:

Inhalation of lead dust and fumes (Correct answer)
Dermal absorption through intact skin
Ingestion of contaminated food
Ocular absorption from spray mist

Correct answer: Inhalation of lead dust and fumes

Inhalation of lead dust and fumes from sanding, spraying, and heat application is the primary occupational exposure route in painting operations.

Question 158: When establishing a decontamination corridor after a hazardous material release, the occupational health nurse should ensure personnel working in the hot zone are wearing:

Level C PPE (air-purifying respirator)
Level A PPE (fully encapsulated suit with SCBA) (Correct answer)
Level B PPE (splash protective suit with SCBA)
Level D PPE (standard work clothing)

Correct answer: Level A PPE (fully encapsulated suit with SCBA)

Level A PPE provides the highest level of skin, eye, and respiratory protection and is required in the hot zone where the highest potential for exposure exists.

Question 159: A COHN is evaluating outcomes of a worksite smoking cessation program. Which outcome is a PROCESS measure rather than an outcome measure?

Reduction in smoking-related healthcare claims
Change in employees' carbon monoxide breath test readings
Percentage of employees who quit smoking at 6 months
Number of employees who attended cessation classes (Correct answer)

Correct answer: Number of employees who attended cessation classes

Process measures evaluate program delivery activities (e.g., attendance), while outcome measures assess health results.

Question 160: Under workers' compensation, 'temporary total disability' (TTD) benefits are typically paid when:

The worker chooses not to return to modified duty
The worker has a permanent impairment rating above 50%
The worker is completely unable to work while recovering from a work-related injury (Correct answer)
The employer has no light-duty positions available

Correct answer: The worker is completely unable to work while recovering from a work-related injury

TTD benefits are paid when an injured worker is temporarily unable to perform any work while healing from a work-related injury or illness.

Certified Occupational Health Nurse (COHN) Exam

The COHN examination, administered by the American Board for Occupational Health Nurses (ABOHN), certifies nurses who demonstrate competency in occupational health nursing practice across clinical care, case management, coordination, and advisory roles.

160

Questions

180 min

Time Limit

55%

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