Question 1: What is the role of ethics in school nursing practice?

• Ethics are only important in emergencies.
• Ethics only apply to medical professionals outside of schools.
• Ethics help guide decisions that protect students and promote trust. (Correct answer)
• Ethics are irrelevant to school nursing.

Correct answer: Ethics help guide decisions that protect students and promote trust.

Ethics play a crucial role in school nursing practice by guiding decisions that protect students and promote trust. Ethical principles ensure that nurses act in the best interest of students, respect their autonomy, maintain confidentiality, and provide equitable care. This framework builds confidence in the nurse's professional judgment and fosters a safe, supportive environment.

Question 2: Which of the following strategies is most likely to be successful in helping a school nurse work with families in a considerate and inclusive manner?

• remaining friendly and curious while asking specific questions about families' backgrounds and living situations
• attempting to discover pertinent characteristics of families' backgrounds before meeting with them
• being professional and sensitive to factors related to socioeconomic, ethnic, and cultural backgrounds (Correct answer)
• acknowledging obvious differences in background right away and using humor to put families at ease

Correct answer: being professional and sensitive to factors related to socioeconomic, ethnic, and cultural backgrounds

Families are essential to the growth and development of their kids. Initial interactions between a school nurse and families should assist the establishment of a positive, culturally sensitive rapport that fosters successful communication and collaboration, which is crucial in the event of a challenging health-related issue. A school nurse who is culturally competent is aware that culture might encompass beliefs, lifestyle, place of residence, experiences in life, gender identity, language, food customs, and social structure. A school nurse can work toward developing rapport, fostering understanding, and encouraging collaboration with the families of students with health problems while being aware of and keeping sensitive to these cultural traits.

Question 3: What is the nurse's primary responsibility in medication administration?

• Minimizing time spent with each patient
• Following physician orders without question
• Completing documentation as quickly as possible
• Advocating for patient safety and well-being (Correct answer)

Correct answer: Advocating for patient safety and well-being

In medication administration, the nurse's primary responsibility is advocating for patient safety and well-being through competent, evidence-based care.

Question 4: During a forward bend screening, which scoliometer reading is commonly used as the referral threshold?

• 3 degrees
• 12 degrees
• 5 degrees
• 7 degrees (Correct answer)

Correct answer: 7 degrees

An angle of trunk rotation of 7 degrees or more is the widely accepted referral criterion.

Question 5: Which U.S. Supreme Court case established that clean intermittent catheterization is a related service that schools must provide under special education law?

• Board of Education v. Rowley
• Irving Independent School District v. Tatro (Correct answer)
• Cedar Rapids Community School District v. Garret F.
• Owasso Independent School District v. Falvo

Correct answer: Irving Independent School District v. Tatro

Tatro (1984) held that CIC is a school health service, not an excluded medical service, because a nurse or trained layperson can perform it.

Question 6: Which action is MOST appropriate when a student presents with signs of a diabetic emergency but the nurse cannot determine if it is hypoglycemia or hyperglycemia?

• Call the parent and wait for further instructions
• Inject glucagon immediately
• Withhold all treatment until a blood glucose reading is obtained
• Administer oral glucose if the student is conscious and able to swallow (Correct answer)

Correct answer: Administer oral glucose if the student is conscious and able to swallow

If blood glucose cannot be checked and the student is conscious and able to swallow, giving oral glucose is safe because treating hypoglycemia with sugar is life-saving while mild additional glucose in hyperglycemia is not immediately harmful.

Question 7: When a student's IEP team meets, what is the school nurse's PRIMARY role?

• To approve the academic goals
• To interpret health information and explain how the student's health condition affects learning and needed services (Correct answer)
• To schedule the meeting
• To determine eligibility for special education alone

Correct answer: To interpret health information and explain how the student's health condition affects learning and needed services

The nurse translates health data into its educational impact and recommends health-related services and accommodations.

Question 8: A student's BMI-for-age falls at the 96th percentile. How is this classified per CDC growth charts?

• Overweight
• Healthy weight
• Severe obesity
• Obesity (Correct answer)

Correct answer: Obesity

BMI at or above the 95th percentile for age and sex is classified as obesity in children.

Question 9: The school nurse is training staff on CPR. According to current American Heart Association guidelines for child CPR, the compression-to-ventilation ratio for a single rescuer is:

• 15:2
• 30:2 (Correct answer)
• 15:1
• 30:1

Correct answer: 30:2

Current AHA guidelines recommend a 30:2 compression-to-ventilation ratio for single-rescuer CPR for children and adults.

Question 10: When a school RN delegates a task to unlicensed assistive personnel, the RN:

• Transfers all legal liability to the delegate
• Keeps accountability for the delegation decision and supervision (Correct answer)
• Can delegate ongoing nursing assessment
• Doesn't need to check competency if the person is CPR-certified

Correct answer: Keeps accountability for the delegation decision and supervision

The RN stays accountable for choosing to delegate, training the delegate, and supervising the task.

Question 11: What kind of solace can you provide a pupil who has ear pain?

• Apply warm packs to the external ear. (Correct answer)
• Irrigate the ears.
• Schedule a doctor’s appointment.
• Apply ice packs.

Correct answer: Apply warm packs to the external ear.

The child with ear discomfort will feel better if you apply a warm compress to the troublesome ear on the outside. Ice or extremely cold temperatures shouldn't be used because they can make ear pain worse. The purpose of ear irrigation is often to remove impacted cerumen or foreign items from the ear canal and is not a suitable remedy for ear pain. If the pain doesn't go away or if the child develops a fever, tell the parents to make an appointment with a doctor.

Question 12: A student is suspected of having a severe asthma attack and does not have their rescue inhaler at school. The school nurse should:

• Have the student sit quietly until their parent arrives with the inhaler
• Use a stock albuterol inhaler per standing orders and call 911 if no improvement (Correct answer)
• Administer epinephrine from the emergency kit as a substitute
• Send the student home immediately to use their inhaler

Correct answer: Use a stock albuterol inhaler per standing orders and call 911 if no improvement

Many states allow schools to stock albuterol for emergencies; using it per physician standing orders while monitoring and calling 911 if needed is the appropriate protocol.

Question 13: How can school nurses contribute to improving public health in schools?

• By organizing after-school events.
• By monitoring classroom behavior.
• By reducing teacher workload.
• By improving health policies and educating students on health issues. (Correct answer)

Correct answer: By improving health policies and educating students on health issues.

School nurses contribute to improving public health in schools by improving health policies and educating students on health issues. By advocating for and implementing effective health policies, they create a healthier environment. Simultaneously, educating students empowers them with knowledge and skills to make healthy choices, extending public health benefits beyond the school walls.

Question 14: Which federal law requires schools receiving federal funds to provide reasonable accommodations for students whose health conditions substantially limit a major life activity, without requiring special education?

• HIPAA
• IDEA
• Section 504 of the Rehabilitation Act (Correct answer)
• FERPA

Correct answer: Section 504 of the Rehabilitation Act

Section 504 covers students with disabilities who need accommodations but may not qualify for special education under IDEA.

Question 15: Which component distinguishes an IHP from an EAP?

• The EAP replaces the IHP for students with chronic conditions
• The EAP is longer and more detailed than the IHP
• The IHP is written by the physician, and the EAP by the parent
• The IHP includes nursing diagnoses, goals, and interventions for daily care; the EAP gives step-by-step emergency response (Correct answer)

Correct answer: The IHP includes nursing diagnoses, goals, and interventions for daily care; the EAP gives step-by-step emergency response

The IHP is the comprehensive nursing plan, while the EAP is a concise emergency protocol often attached to it.

Question 16: Which approach is correct for a student with a suspected forearm fracture before EMS or parent transport?

• Have the student move the arm to test its range of motion
• Realign the bone to restore normal shape
• Apply heat to reduce pain
• Splint in the position found, immobilizing the joints above and below, and check circulation, sensation, and movement before and after (Correct answer)

Correct answer: Splint in the position found, immobilizing the joints above and below, and check circulation, sensation, and movement before and after

Splinting as found and checking neurovascular status prevents further injury and detects compromise.

Question 17: During a lockdown drill, a student with a known anxiety disorder begins hyperventilating. The nurse's FIRST intervention is:

• Have the student breathe into a paper bag
• Escort the student to the health office for monitoring
• Guide the student in slow, controlled diaphragmatic breathing while maintaining lockdown (Correct answer)
• Administer a PRN anxiolytic from the student's emergency medication plan

Correct answer: Guide the student in slow, controlled diaphragmatic breathing while maintaining lockdown

Coaching slow diaphragmatic breathing addresses hyperventilation while keeping the student and nurse safe within the lockdown protocol.

Question 18: What is the primary responsibility of a school nurse in professional practice?

• To discipline students.
• To promote academic performance.
• To enforce school policies.
• To provide health care services and educate students about health. (Correct answer)

Correct answer: To provide health care services and educate students about health.

The primary responsibility of a school nurse is to provide health care services and educate students about health. This dual role encompasses direct medical care, managing chronic conditions, responding to emergencies, and promoting health literacy among the student population. They act as a vital link between healthcare and education, ensuring student well-being supports their learning.

Question 19: During the assessment phase of care planning for a student with seizures, which data source is MOST important for individualizing the plan?

• A general textbook description of epilepsy
• The school's standard first aid policy
• The student's attendance record alone
• Seizure history from parents and provider, including type, typical duration, and prior rescue medication use (Correct answer)

Correct answer: Seizure history from parents and provider, including type, typical duration, and prior rescue medication use

Individualized assessment data, such as the student's specific seizure pattern and orders, drives an accurate IHP.

Question 20: What is the nurse's primary responsibility in health assessment?

• Minimizing time spent with each patient
• Completing documentation as quickly as possible
• Following physician orders without question
• Advocating for patient safety and well-being (Correct answer)

Correct answer: Advocating for patient safety and well-being

In health assessment, the nurse's primary responsibility is advocating for patient safety and well-being through competent, evidence-based care.

Question 21: Which approach BEST supports trauma-informed care in the school health setting?

• Asking students directly about their trauma history at every visit
• Creating a safe, predictable environment and responding to behavior with curiosity about underlying needs rather than punishment (Correct answer)
• Maintaining strict behavioral expectations to provide structure for traumatized students
• Referring all students with behavioral problems for trauma counseling

Correct answer: Creating a safe, predictable environment and responding to behavior with curiosity about underlying needs rather than punishment

Trauma-informed care focuses on creating safety, building trust, and understanding behavior as a response to underlying experiences rather than defiance.

Question 22: How can school nurses promote mental health awareness?

• By providing counseling services and mental health education. (Correct answer)
• By ensuring students attend academic classes.
• By conducting extracurricular activities.
• By organizing physical fitness programs.

Correct answer: By providing counseling services and mental health education.

School nurses can effectively promote mental health awareness by directly offering counseling services and providing mental health education. This allows them to identify students in need, offer support, and equip all students with knowledge about mental well-being and resources. Their role is crucial in destigmatizing mental health issues and fostering a supportive school environment.

Question 23: Why is it important for school nurses to follow legal and ethical guidelines?

• To ensure that care provided is safe, ethical, and legally sound. (Correct answer)
• To avoid additional responsibilities.
• To avoid professional scrutiny.
• To meet student expectations.

Correct answer: To ensure that care provided is safe, ethical, and legally sound.

It is important for school nurses to follow legal and ethical guidelines to ensure that the care provided is safe, ethical, and legally sound. Adherence to these standards protects students' rights, ensures quality of care, and safeguards the nurse from professional misconduct claims. This commitment upholds the integrity of the nursing profession and the school's health services.

Question 24: A student with type 1 diabetes has a blood glucose of 58 mg/dL and is alert. What is the school nurse's FIRST action?

• Have the student rest for 30 minutes
• Call the parent for instructions
• Administer glucagon
• Give 15 grams of fast-acting carbohydrate (Correct answer)

Correct answer: Give 15 grams of fast-acting carbohydrate

The rule of 15 calls for 15 g of fast-acting carbohydrate for a conscious student, with a recheck in 15 minutes.

Question 25: What should school nurses do if they encounter conflicts of interest in professional practice?

• Try to resolve the conflict by themselves.
• Ignore the situation.
• Handle the situation privately without seeking help.
• Report the conflict and seek guidance from appropriate authorities. (Correct answer)

Correct answer: Report the conflict and seek guidance from appropriate authorities.

If school nurses encounter conflicts of interest, they should report the conflict and seek guidance from appropriate authorities. This transparent approach ensures that potential biases are acknowledged and addressed, protecting the integrity of their professional judgment and the welfare of students. Ignoring or privately resolving conflicts can compromise ethical practice and student trust.

Question 26: The NASN Code of Ethics principle that most directly supports a school nurse's duty to speak up for a student's access to care is:

• Veracity in billing
• Autonomy of the nurse
• Advocacy (Correct answer)
• Fidelity to the employer

Correct answer: Advocacy

Advocacy for students' health, safety, and rights is a core ethical obligation in the NASN Code of Ethics.

Question 27: A student presents with signs of heat stroke: hot dry skin, temperature of 104°F, and altered mental status. The MOST important immediate intervention is:

• Administer acetaminophen to reduce the fever
• Give the student cool water to drink to rehydrate
• Begin rapid cooling by removing clothing and applying cool water or ice packs to pulse points, and call 911 (Correct answer)
• Move the student to an air-conditioned room and monitor closely

Correct answer: Begin rapid cooling by removing clothing and applying cool water or ice packs to pulse points, and call 911

Heat stroke is a life-threatening emergency; rapid cooling and EMS activation are the immediate priorities, and oral fluids are contraindicated in an altered-consciousness patient.

Question 28: How should a nurse prioritize tasks related to health assessment?

• By room number sequence
• Based on the acuity and urgency of patient needs (Correct answer)
• Alphabetical order of patient names
• According to family member requests

Correct answer: Based on the acuity and urgency of patient needs

Task prioritization in nursing should always be based on patient acuity and the urgency of clinical needs.

Question 29: A student is stung by a bee and states 'I've had reactions before.' The school nurse's FIRST assessment priority is:

• Calling the parent for medication authorization
• Removing the stinger with tweezers
• Documenting the time and location of the sting
• Assessing for signs of anaphylaxis including respiratory distress and urticaria (Correct answer)

Correct answer: Assessing for signs of anaphylaxis including respiratory distress and urticaria

History of prior reactions elevates anaphylaxis risk; immediate assessment of airway and systemic signs is the top priority.

Question 30: Which of the five rights of delegation is addressed when the school nurse provides clear, step-by-step written instructions for a delegated procedure?

• Right person
• Right direction and communication (Correct answer)
• Right task
• Right circumstance

Correct answer: Right direction and communication

Right direction and communication means giving clear instructions, expectations, and reporting parameters.

Question 31: A student with a seizure action plan for intranasal midazolam has a generalized tonic-clonic seizure. When is the rescue medication typically given?

• Immediately at seizure onset in every case
• When the seizure lasts 5 minutes or as specified in the seizure action plan (Correct answer)
• Only after the seizure has stopped
• Only if the student turns blue

Correct answer: When the seizure lasts 5 minutes or as specified in the seizure action plan

Seizures lasting 5 minutes or more are treated as status epilepticus, and rescue medication is given per the provider's plan.

Question 32: Why should school nurses document student health assessments?

• To maintain accurate health records for legal and care coordination purposes. (Correct answer)
• To track academic performance.
• To monitor attendance rates.
• To evaluate classroom activities.

Correct answer: To maintain accurate health records for legal and care coordination purposes.

School nurses must meticulously document student health assessments to maintain accurate and comprehensive health records. These records serve as a vital legal document, protecting both the student and the school by detailing all health-related interactions, interventions, and communications. Furthermore, accurate documentation is essential for effective care coordination, ensuring that all school staff and external healthcare providers have the necessary information to support the student's health needs consistently.

Question 33: What assessment technique is fundamental to medication administration?

• Relying solely on monitor readings
• Checking only the chief complaint area
• Reading the previous shift's notes only
• Systematic head-to-toe assessment combined with patient interview (Correct answer)

Correct answer: Systematic head-to-toe assessment combined with patient interview

A systematic head-to-toe assessment combined with patient interview provides the comprehensive data needed for safe nursing care.

Question 34: When a conflict arises during medication administration, what is the appropriate nursing action?

• Ignore the conflict and continue working
• Document concerns on social media
• Use the chain of command to escalate concerns through proper channels (Correct answer)
• Confront the individual publicly

Correct answer: Use the chain of command to escalate concerns through proper channels

The chain of command provides an established pathway for resolving conflicts and escalating concerns appropriately.

Question 35: What assessment technique is fundamental to health assessment?

• Reading the previous shift's notes only
• Checking only the chief complaint area
• Systematic head-to-toe assessment combined with patient interview (Correct answer)
• Relying solely on monitor readings

Correct answer: Systematic head-to-toe assessment combined with patient interview

A systematic head-to-toe assessment combined with patient interview provides the comprehensive data needed for safe nursing care.

Question 36: Under the Nurse Practice Act in most states, which task may an RN school nurse NOT delegate to unlicensed assistive personnel?

• Conducting the initial nursing assessment (Correct answer)
• Administering emergency epinephrine via auto-injector
• Performing routine vision screening
• Administering a scheduled oral medication

Correct answer: Conducting the initial nursing assessment

Assessment, nursing judgment, and care planning remain the RN's responsibility and cannot be delegated.

Question 37: A student with severe peanut allergy has no other impairment and does not require specially designed instruction. Which law most appropriately provides for accommodations at school?

• Section 504 of the Rehabilitation Act (Correct answer)
• FERPA
• McKinney-Vento Act
• IDEA

Correct answer: Section 504 of the Rehabilitation Act

Section 504 covers students whose impairment substantially limits a major life activity even if they do not need special education.

Question 38: How should a nurse prioritize tasks related to care planning?

• By room number sequence
• According to family member requests
• Alphabetical order of patient names
• Based on the acuity and urgency of patient needs (Correct answer)

Correct answer: Based on the acuity and urgency of patient needs

Task prioritization in nursing should always be based on patient acuity and the urgency of clinical needs.

Question 39: What is the main purpose of health assessment in school nursing?

• To treat illnesses.
• To diagnose chronic conditions.
• To identify health problems early. (Correct answer)
• To prevent school bullying.

Correct answer: To identify health problems early.

The main purpose of health assessment in school nursing is to identify potential health problems in students at an early stage. By conducting screenings and observations, school nurses can detect signs of physical, mental, or developmental issues that might impact a student's learning or well-being. Early identification allows for prompt intervention, referral to appropriate healthcare providers, and the implementation of necessary accommodations to support the student's health and academic success.

Question 40: What infection control measure is most critical during medication administration procedures?

• Wearing a mask at all times regardless of procedure
• Wearing gloves only when visible contamination is present
• Using hand sanitizer once per shift
• Performing hand hygiene before and after every patient contact (Correct answer)

Correct answer: Performing hand hygiene before and after every patient contact

Hand hygiene before and after every patient contact is the single most effective measure for preventing healthcare-associated infections.

Question 41: The school nurse is implementing a mental health awareness program. According to best practices, which approach is MOST effective in reducing mental health stigma among students?

• Presenting statistics about how rare mental illness is to reassure students
• Sharing personal stories of recovery and emphasizing that mental health conditions are treatable medical conditions (Correct answer)
• Warning students about the dangers of mental illness to promote help-seeking
• Teaching students to identify mentally ill peers so they can offer support

Correct answer: Sharing personal stories of recovery and emphasizing that mental health conditions are treatable medical conditions

First-person recovery narratives combined with education that frames mental health conditions as medical and treatable are most effective at reducing stigma.

Question 42: A student with a ventriculoperitoneal (VP) shunt has an IHP. Which finding should be listed in the EAP as requiring immediate action?

• Requesting a drink of water
• Severe headache with vomiting and lethargy (Correct answer)
• Mild fatigue after recess
• A minor scrape on the knee

Correct answer: Severe headache with vomiting and lethargy

Headache, vomiting, and decreased alertness may indicate shunt malfunction and increased intracranial pressure.

Question 43: A student is referred for suspected eating disorder behaviors including skipping meals and excessive exercise. The school nurse's BEST initial action is:

• Conduct a private, non-judgmental assessment and refer to an eating disorder specialist while maintaining a trusting relationship (Correct answer)
• Send a letter home to the parents describing the concerning behaviors
• Inform the physical education teacher to restrict the student's exercise
• Weigh the student daily and report results to the coach

Correct answer: Conduct a private, non-judgmental assessment and refer to an eating disorder specialist while maintaining a trusting relationship

A private, non-judgmental conversation that leads to appropriate referral preserves trust while ensuring the student receives specialized evaluation.

Question 44: A document that outlines specific steps school staff should take during a student's health crisis, such as a seizure, is called the:

• Individualized Healthcare Plan (IHP)
• Emergency Care Plan (ECP) (Correct answer)
• Individualized Education Program (IEP)
• Section 504 Plan

Correct answer: Emergency Care Plan (ECP)

An Emergency Care Plan gives non-nursing staff clear, step-by-step directions for a health emergency.

Question 45: What is a common method for health promotion in schools?

• Conducting health education sessions and campaigns. (Correct answer)
• Scheduling doctor visits for every student.
• Organizing school health fairs.
• Monitoring sports activities.

Correct answer: Conducting health education sessions and campaigns.

A common and effective method for health promotion in schools is conducting regular health education sessions and campaigns. These initiatives provide students with vital information on topics such as nutrition, hygiene, mental health, and disease prevention. By actively engaging students through structured learning and awareness campaigns, school nurses empower them to make informed decisions and adopt healthy lifestyle choices that benefit their long-term well-being.

Question 46: A student with peanut allergy begins showing signs of anaphylaxis including hives, throat tightening, and difficulty breathing. What is the nurse's immediate priority intervention?

• Administer epinephrine via auto-injector and call 911 (Correct answer)
• Apply a cool compress and wait for symptoms to resolve
• Administer an oral antihistamine and observe
• Give the student water to drink and have them sit down

Correct answer: Administer epinephrine via auto-injector and call 911

Epinephrine is the only effective first-line treatment for anaphylaxis; antihistamines alone are insufficient for a life-threatening allergic reaction, and 911 must be called for emergency transport.

Question 47: A student has a nosebleed. Which positioning and technique is correct?

• Lie flat and apply ice to the forehead
• Tilt the head back and pinch the bridge of the nose
• Sit upright, lean forward, and pinch the soft part of the nose continuously for 10–15 minutes (Correct answer)
• Pack the nostril with dry tissue and resume class

Correct answer: Sit upright, lean forward, and pinch the soft part of the nose continuously for 10–15 minutes

Leaning forward prevents swallowing blood, and steady pressure on the soft nasal tissue controls most anterior bleeds.

Question 48: How should a nurse prioritize tasks related to medication administration?

• According to family member requests
• Based on the acuity and urgency of patient needs (Correct answer)
• Alphabetical order of patient names
• By room number sequence

Correct answer: Based on the acuity and urgency of patient needs

Task prioritization in nursing should always be based on patient acuity and the urgency of clinical needs.

Question 49: What infection control measure is most critical during health assessment procedures?

• Wearing gloves only when visible contamination is present
• Using hand sanitizer once per shift
• Performing hand hygiene before and after every patient contact (Correct answer)
• Wearing a mask at all times regardless of procedure

Correct answer: Performing hand hygiene before and after every patient contact

Hand hygiene before and after every patient contact is the single most effective measure for preventing healthcare-associated infections.

Question 50: An unlicensed school staff member has been trained to give insulin. Which statement about delegation is accurate?

• Delegation is never allowed in schools under any circumstances
• The RN may delegate the initial nursing assessment and evaluation
• The RN keeps accountability for delegating appropriately and must provide training, competency checks, and ongoing supervision per state law (Correct answer)
• Once delegated, the RN is no longer accountable for the task

Correct answer: The RN keeps accountability for delegating appropriately and must provide training, competency checks, and ongoing supervision per state law

Delegation transfers the task but not accountability, and assessment and judgment stay with the RN.

Question 51: A school nurse discovers she administered a medication dose 90 minutes late. What should she do first?

• Notify the parent and complete an incident report per policy after assessing the student (Correct answer)
• Skip documentation since no harm occurred
• Give an extra dose to compensate
• Ask the teacher to sign the medication log

Correct answer: Notify the parent and complete an incident report per policy after assessing the student

Assess the student, notify appropriate parties, and document honestly per district medication error policy.

Question 52: A student's asthma action plan uses green, yellow, and red zones. The student has a peak flow at 65% of personal best and is coughing. Which action does the plan direct?

• Continue normal activity with no medication
• Give the quick-relief medication per the yellow-zone instructions and monitor response (Correct answer)
• Call 911 immediately without giving medication
• Send the student back to class to rest

Correct answer: Give the quick-relief medication per the yellow-zone instructions and monitor response

A peak flow of 50 to 79% of personal best is the yellow zone, which calls for quick-relief medication and reassessment.

Question 53: A student discloses they have been self-harming by cutting but states they do not want to die. How should the school nurse respond?

• Immediately inform the student's entire support team without further discussion
• Dismiss the concern since the student denies suicidal intent
• Provide a caring, non-punitive response, assess for suicide risk, and connect the student with mental health support (Correct answer)
• Tell the student they must stop or face disciplinary action

Correct answer: Provide a caring, non-punitive response, assess for suicide risk, and connect the student with mental health support

Non-suicidal self-injury still requires a thorough safety assessment and mental health referral; a compassionate, non-punitive response supports engagement in care.

Question 54: How should a nurse prioritize tasks related to infection control?

• Alphabetical order of patient names
• By room number sequence
• Based on the acuity and urgency of patient needs (Correct answer)
• According to family member requests

Correct answer: Based on the acuity and urgency of patient needs

Task prioritization in nursing should always be based on patient acuity and the urgency of clinical needs.

Question 55: A student with sickle cell disease reports sudden severe pain in their chest and arms and is having difficulty breathing. What condition should the school nurse suspect and how should they respond?

• Anxiety attack; administer calm reassurance and deep breathing exercises
• Asthma exacerbation; administer rescue inhaler and monitor
• Acute chest syndrome; activate EMS and notify parents immediately (Correct answer)
• Musculoskeletal strain; apply ice and rest the student

Correct answer: Acute chest syndrome; activate EMS and notify parents immediately

Chest pain with dyspnea in a student with sickle cell disease suggests acute chest syndrome, a life-threatening emergency requiring immediate EMS activation.

Question 56: A student has a headache, a fever of more than 102°F, and a loose cough. What course of action would the school nurse take in response to these symptoms?

• Offer fluids and a rest period.
• Call the child’s doctor for an antibiotic.
• Attempt to call a parent or emergency contact and send the child home. (Correct answer)
• Arrange to transport the child to the nearest emergency department.

Correct answer: Attempt to call a parent or emergency contact and send the child home.

The nurse should make every effort to call a parent before sending a student home with a loose cough, a fever over 102°F, and a headache. The child should be sent home until the fever has subsided for 24 hours because a fever and cough are symptoms of communicable infections. Sending the pupil to the emergency room at this time is not acceptable because this is not an emergency medical condition unless the student is exhibiting signs of respiratory distress or a higher fever. In the event that the student's health deteriorates, the school nurse should discuss with the emergency contact any indications or symptoms that call for immediate medical attention. While a suitable course of treatment, fluid intake and relaxation should be encouraged at home to stop the spread of illness to other students. Additionally, it is the parent's responsibility to take the student to the doctor in order to discuss potential pharmaceutical therapies like antibiotics.

Question 57: Which medical information must be provided to each state before a student can enroll in school?

• Notes for possible changes in after-school care.
• Birth information including weight and height.
• Immunization record for the student. (Correct answer)
• Mother and Father’s history with significant illness.

Correct answer: Immunization record for the student.

State laws include requirements for immunization records, and parents who opt not to immunize their children must sign a release. In the event of an epidemic of an infectious disease, it is critical for the school nurse to be aware of which pupils lack the necessary vaccinations. Birth information, after-school care history, and parental health history are solely sought on a school-by-school basis and are not required by the state.

Question 58: Which statement best describes the school nurse's obligation as a mandated reporter of suspected child abuse?

• Report suspicion directly to child protective services or law enforcement per state law (Correct answer)
• Report only after confirming abuse with the parent
• Report only if physical injuries are visible
• Report only through the principal, who decides whether to call

Correct answer: Report suspicion directly to child protective services or law enforcement per state law

Mandated reporters must report reasonable suspicion themselves; the duty cannot be delegated to an administrator.

Question 59: What infection control measure is most critical during care planning procedures?

• Wearing gloves only when visible contamination is present
• Using hand sanitizer once per shift
• Wearing a mask at all times regardless of procedure
• Performing hand hygiene before and after every patient contact (Correct answer)

Correct answer: Performing hand hygiene before and after every patient contact

Hand hygiene before and after every patient contact is the single most effective measure for preventing healthcare-associated infections.

Question 60: Which finding on a pure-tone hearing screening typically requires a rescreen and possible referral?

• Failure to respond at 25 dB at one or more frequencies in either ear (Correct answer)
• Response only when the tone is presented to the better ear first
• Response at 20 dB at 1000, 2000, and 4000 Hz
• Response at 15 dB in both ears

Correct answer: Failure to respond at 25 dB at one or more frequencies in either ear

Failing to respond at the screening level (commonly 20–25 dB) at any frequency in either ear is a screening fail requiring rescreen.

Question 61: A student with ADHD receives a stimulant at noon. Which outcome is most appropriate for the medication section of the IHP?

• The student will no longer have ADHD by year end.
• The student will report to the health office for the noon dose on 95% of school days, as documented on the medication administration record. (Correct answer)
• The teacher will decide whether the dose is needed each day.
• The student will carry and self-administer the stimulant at will.

Correct answer: The student will report to the health office for the noon dose on 95% of school days, as documented on the medication administration record.

A measurable, realistic adherence goal with a documented data source supports evaluation of the plan.

Question 62: A student collapses on the athletic field and has no pulse. The AED is 2 minutes away. The school nurse should:

• Wait for the AED before starting any intervention
• Check for pulse every minute until the AED arrives
• Begin high-quality CPR immediately while someone retrieves the AED (Correct answer)
• Give 2 rescue breaths before starting compressions

Correct answer: Begin high-quality CPR immediately while someone retrieves the AED

High-quality CPR must begin immediately to maintain perfusion; the AED is brought to the nurse, not the other way around.

Question 63: How should a nurse prioritize tasks related to patient care standards?

• Alphabetical order of patient names
• By room number sequence
• According to family member requests
• Based on the acuity and urgency of patient needs (Correct answer)

Correct answer: Based on the acuity and urgency of patient needs

Task prioritization in nursing should always be based on patient acuity and the urgency of clinical needs.

Question 64: Why is health education important for students?

• It prepares students for careers.
• It improves test scores.
• It empowers students to make healthy choices. (Correct answer)
• It enhances physical fitness.

Correct answer: It empowers students to make healthy choices.

Health education is critically important for students because it empowers them with the knowledge and skills to make informed, healthy choices throughout their lives. By understanding topics like nutrition, mental health, and disease prevention, students can take an active role in managing their own well-being. This empowerment leads to better health outcomes, reduced risk of chronic diseases, and a greater capacity to thrive academically and personally.

Question 65: Why are school health policies important for school nurses?

• They monitor student academic progress.
• They help in organizing classroom activities.
• They regulate teacher conduct.
• They ensure that health care practices align with legal and professional standards. (Correct answer)

Correct answer: They ensure that health care practices align with legal and professional standards.

School health policies are important for school nurses because they ensure that health care practices align with legal and professional standards. These policies provide a framework for the nurse's responsibilities, scope of practice, and procedures, guiding their actions and ensuring consistency and compliance. They protect both the students receiving care and the nurse providing it.

Question 66: The family of a third-grade kid has lately gone through trying times. One of the student's younger siblings suffers from a health condition, and both parents have been out of work for six months. The parents have displayed depressive episodes. The school nurse should be aware of the likelihood that these factors will have the greatest impact on the student's development in which of the following areas?

• higher-order thinking
• receptive language
• social relationships (Correct answer)
• motor development

Correct answer: social relationships

Family marital conflict, which is linked to adjustment issues for the children in the home, including impairments in social and academic performance, is at risk when there is unemployment and depression in the home. Greater kid emotional insecurity is directly linked to parent or caregiver depression. According to research, kids whose parents have been depressed are more likely to struggle in school and have interpersonal and social difficulties than kids whose parents have never been depressed.

Question 67: A school nurse suspects a student may be experiencing abuse at home based on unexplained bruising and behavioral changes. The nurse's legal obligation is to:

• Inform the parents of the concern before making a report
• Gather more evidence over the next few weeks to confirm suspicion
• Immediately report the suspicion to child protective services as a mandated reporter (Correct answer)
• Consult with the principal before making any report

Correct answer: Immediately report the suspicion to child protective services as a mandated reporter

School nurses are mandated reporters in all US states and must report suspected child abuse immediately without needing proof or supervisor approval.

Question 68: What assessment technique is fundamental to care planning?

• Checking only the chief complaint area
• Systematic head-to-toe assessment combined with patient interview (Correct answer)
• Relying solely on monitor readings
• Reading the previous shift's notes only

Correct answer: Systematic head-to-toe assessment combined with patient interview

A systematic head-to-toe assessment combined with patient interview provides the comprehensive data needed for safe nursing care.

Question 69: What assessment technique is fundamental to clinical procedures?

• Reading the previous shift's notes only
• Relying solely on monitor readings
• Systematic head-to-toe assessment combined with patient interview (Correct answer)
• Checking only the chief complaint area

Correct answer: Systematic head-to-toe assessment combined with patient interview

A systematic head-to-toe assessment combined with patient interview provides the comprehensive data needed for safe nursing care.

Question 70: When a conflict arises during health assessment, what is the appropriate nursing action?

• Ignore the conflict and continue working
• Confront the individual publicly
• Document concerns on social media
• Use the chain of command to escalate concerns through proper channels (Correct answer)

Correct answer: Use the chain of command to escalate concerns through proper channels

The chain of command provides an established pathway for resolving conflicts and escalating concerns appropriately.

Question 71: Under FERPA and HIPAA, when may a school nurse share a student's mental health information with a teacher without parental consent?

• Never — mental health information is absolutely protected in all circumstances
• Whenever the teacher asks, as they have a professional need to know
• Only after obtaining written consent from the student if they are 18
• When it is necessary to protect the health or safety of the student or others in an emergency (Correct answer)

Correct answer: When it is necessary to protect the health or safety of the student or others in an emergency

FERPA permits disclosure of student records without consent when there is a legitimate safety emergency requiring immediate action to protect the student or others.

Question 72: A school nurse receives a request from a parent to review their child's cumulative health record. Under FERPA, the school must comply within what maximum timeframe?

• 60 days
• 30 calendar days
• 45 days (Correct answer)
• 10 business days

Correct answer: 45 days

FERPA requires schools to grant access to education records within 45 days of the request.

Question 73: A 12-year-old weighing 45 kg needs an epinephrine auto-injector. What is the standard dose?

• 1 mg
• 0.1 mg
• 0.15 mg
• 0.3 mg (Correct answer)

Correct answer: 0.3 mg

The 0.3 mg auto-injector is used for children weighing about 30 kg or more.

Question 74: How can school nurses maintain professional boundaries with students?

• By sharing personal information with students.
• By offering rewards for students' good behavior.
• By socializing with students outside of school hours.
• By establishing clear roles and professional limits. (Correct answer)

Correct answer: By establishing clear roles and professional limits.

School nurses maintain professional boundaries with students by establishing clear roles and professional limits. This involves defining the nature of their relationship as a healthcare provider and educator, avoiding personal disclosures, and refraining from social interactions outside of their professional capacity. Clear boundaries are essential for fostering trust, respect, and a safe therapeutic environment.

Question 75: Why is it important for school nurses to collaborate with teachers and parents?

• To ensure the student's health needs are being met and provide appropriate care. (Correct answer)
• To enforce school policies.
• To improve classroom behavior.
• To monitor academic progress.

Correct answer: To ensure the student's health needs are being met and provide appropriate care.

Collaboration between school nurses, teachers, and parents is paramount to ensuring a student's health needs are comprehensively met and appropriate care is provided. Teachers spend significant time with students and can observe daily health changes or concerns, while parents provide crucial medical history and home context. By working together, this team can develop and implement effective health plans, communicate vital information, and create a supportive environment that addresses the student's holistic well-being.

Question 76: The school nurse is educating staff about recognizing signs of student substance use. Which finding is MOST consistent with opioid intoxication?

• Dilated pupils and increased energy
• Agitation, rapid heartbeat, and elevated blood pressure
• Pinpoint pupils, sedation, and slowed breathing (Correct answer)
• Red eyes, increased appetite, and laughter

Correct answer: Pinpoint pupils, sedation, and slowed breathing

Classic signs of opioid intoxication include miosis (pinpoint pupils), central nervous system depression, and respiratory slowing.

Question 77: Which federal law requires local education agencies that participate in the National School Lunch Program to establish a local school wellness policy?

• Family Educational Rights and Privacy Act
• Americans with Disabilities Act
• Every Student Succeeds Act
• Child Nutrition and WIC Reauthorization Act of 2004 (Correct answer)

Correct answer: Child Nutrition and WIC Reauthorization Act of 2004

The 2004 Child Nutrition and WIC Reauthorization Act first mandated local wellness policies, later strengthened by the Healthy, Hunger-Free Kids Act of 2010.

Question 78: A student says, 'I know I should eat breakfast, and I plan to start next month.' Which Transtheoretical Model stage fits best?

• Contemplation (Correct answer)
• Maintenance
• Action
• Precontemplation

Correct answer: Contemplation

Contemplation is when a person intends to change within roughly the next six months but has not yet prepared or acted.

Question 79: Why should school nurses participate in policy development?

• To focus on student behavior.
• To increase school funding.
• To reduce teacher workload.
• To ensure that health policies meet the needs of students and comply with laws. (Correct answer)

Correct answer: To ensure that health policies meet the needs of students and comply with laws.

School nurses should participate in policy development to ensure that health policies meet the specific needs of students and comply with relevant laws. Their expertise provides a crucial perspective on the practical implications and effectiveness of policies, ensuring they are student-centered, evidence-based, and legally sound. This involvement strengthens the overall health framework of the school.

Question 80: What is one key legal responsibility for school nurses?

• To supervise classroom behavior.
• To monitor academic grades.
• To enforce the school dress code.
• To ensure student health information is kept confidential. (Correct answer)

Correct answer: To ensure student health information is kept confidential.

One key legal responsibility for school nurses is to ensure student health information is kept confidential. This is mandated by federal laws such as the Family Educational Rights and Privacy Act (FERPA) and, in some cases, the Health Insurance Portability and Accountability Act (HIPAA). Upholding confidentiality protects student privacy and maintains trust within the school community.

Question 81: A 10-year-old reads the 20/40 line with the right eye and 20/20 with the left on a Snellen chart. What is the most appropriate action?

• Refer for a comprehensive eye exam (Correct answer)
• Rescreen in one year
• Repeat the test with both eyes open
• Recommend the student sit closer to the board only

Correct answer: Refer for a comprehensive eye exam

A two-line difference between eyes or acuity worse than 20/32 at this age warrants referral to an eye care professional.

Question 82: The frequent absence seizures that define a high school student's seizure disease. Which of the following best captures the most significant impact of this circumstance on the student's learning?

• Additional social support may be needed to facilitate positive peer relationships for the student.
• The student's ability to regulate his or her mood and behavior may be diminished due to a limited attention span.
• Additional reinforcement may be needed to ensure the student maintains focus on personal and academic interests.
• The student may be at risk for low academic achievement due to gaps in concentration and missed information. (Correct answer)

Correct answer: The student may be at risk for low academic achievement due to gaps in concentration and missed information.

In comparison to classmates without epilepsy, pupils with epilepsy typically perform less well on activities requiring attention, concentration, and short-term (working) memory. The epileptic seizure known as an absence seizure (formerly known as a petit mal) is marked by modest symptoms, including a sudden, temporary cessation of activity lasting 10 to 30 seconds, a trance-like appearance, fluttering eyelids, and lip or mouth movements. It's possible for a pupil having an absence seizure to merely appear to be daydreaming. The student can struggle to digest new knowledge and miss important details concerning assignments that were discussed in class. Seizures at night may interfere with sleep and make students more tired throughout the school day. Additionally, sleepiness and issues with memory and concentration are side effects of anti-seizure drugs.

Question 83: What infection control measure is most critical during clinical procedures procedures?

• Performing hand hygiene before and after every patient contact (Correct answer)
• Using hand sanitizer once per shift
• Wearing a mask at all times regardless of procedure
• Wearing gloves only when visible contamination is present

Correct answer: Performing hand hygiene before and after every patient contact

Hand hygiene before and after every patient contact is the single most effective measure for preventing healthcare-associated infections.

Question 84: How should a nurse respond to a change in patient condition during clinical procedures?

• Wait for the physician to notice during rounds
• Ask a family member for their opinion first
• Immediately assess, intervene if within scope, and notify the provider using SBAR (Correct answer)
• Document the change and move to the next patient

Correct answer: Immediately assess, intervene if within scope, and notify the provider using SBAR

Prompt assessment, appropriate intervention, and structured communication using SBAR ensures rapid response to changes in patient condition.

Question 85: What infection control measure is most critical during patient care standards procedures?

• Performing hand hygiene before and after every patient contact (Correct answer)
• Using hand sanitizer once per shift
• Wearing gloves only when visible contamination is present
• Wearing a mask at all times regardless of procedure

Correct answer: Performing hand hygiene before and after every patient contact

Hand hygiene before and after every patient contact is the single most effective measure for preventing healthcare-associated infections.

Question 86: A student with a gastrostomy tube needs a bolus feeding at lunch. Before delegating this task to a trained paraprofessional, the school nurse must FIRST confirm:

• The parent agrees to pay for training
• State nurse practice act and district policy permit delegation of the task (Correct answer)
• The student's teacher is present
• The paraprofessional has a bachelor's degree

Correct answer: State nurse practice act and district policy permit delegation of the task

Delegation decisions must comply with the state nurse practice act and district policy before training and supervision occur.

Question 87: How can school nurses support students with mental health needs?

• By monitoring physical fitness.
• By providing academic tutoring.
• By organizing classroom behavior charts.
• By referring students to mental health professionals and providing ongoing support. (Correct answer)

Correct answer: By referring students to mental health professionals and providing ongoing support.

School nurses play a crucial role in supporting students with mental health needs by serving as a vital link to professional care. They can identify students exhibiting signs of mental health concerns, provide initial emotional support, and then facilitate referrals to appropriate mental health professionals or community resources. Additionally, nurses offer ongoing support within the school setting, collaborating with families and staff to ensure the student receives consistent care and accommodations, promoting their overall well-being.

Question 88: Which statement about including the family in care planning is MOST accurate?

• Family involvement is required only for students under age 10
• Family input is valuable for assessment, goal setting, and cultural considerations throughout the planning process (Correct answer)
• Families should only be notified after the plan is finalized
• Families must write the IHP themselves

Correct answer: Family input is valuable for assessment, goal setting, and cultural considerations throughout the planning process

Family-centered care improves plan accuracy, cultural relevance, and adherence.

Question 89: The school nurse repeatedly observes numerous bruises on a male student's face, arms, and neck. When speaking to this child, what would the school nurse need to keep in mind?

• The nurse is under the obligation to report the concern to the parents.
• Boys often play rough and should be encouraged to participate in less aggressive play.
• Consider the possibility of physical or sexual/physical abuse, and question and act accordingly. (Correct answer)
• The nurse should consider this a private matter and make no comments unless the child seeks assistance.

Correct answer: Consider the possibility of physical or sexual/physical abuse, and question and act accordingly.

If a pupil has unexplained bruises, it's crucial to take the likelihood of physical or sexual abuse into account. Whether or not the student confesses to abuse, the nurse must report any suspicions of abuse and must take appropriate action. The nurse should be aware that the student might make up the story about where the bruises came from, but this should not alter how they go about reporting the problem. In this situation, the nurse shouldn't approach the parents because they might be the ones causing the harm. Instead, the nurse should adhere to protocol when informing the relevant agency of suspected abuse.

Question 90: A student with a known seizure disorder has a generalized tonic-clonic seizure lasting 2 minutes and then stops. The student is postictal and breathing normally. What should the school nurse do next?

• Place the student in the recovery position and monitor airway, breathing, and circulation (Correct answer)
• Begin CPR because the student is unresponsive
• Administer emergency anti-seizure medication immediately
• Restrain the student to prevent injury during the postictal phase

Correct answer: Place the student in the recovery position and monitor airway, breathing, and circulation

After a self-resolving seizure, placing the student in the recovery position protects the airway and allows monitoring while the student recovers from the postictal state.

Question 91: What is a key component of care management in school nursing?

• Creating a health plan for each student. (Correct answer)
• Monitoring physical education classes.
• Providing immediate first aid.
• Managing the school cafeteria.

Correct answer: Creating a health plan for each student.

A key component of care management in school nursing is creating individualized health plans (IHPs) for students, especially those with chronic conditions or special healthcare needs. These plans outline specific medical needs, required interventions, medication administration, and emergency protocols. IHPs ensure that all relevant school staff are aware of a student's health requirements and can provide consistent, appropriate care throughout the school day, promoting safety and well-being.

Question 92: What is the nurse's primary responsibility in infection control?

• Following physician orders without question
• Advocating for patient safety and well-being (Correct answer)
• Minimizing time spent with each patient
• Completing documentation as quickly as possible

Correct answer: Advocating for patient safety and well-being

In infection control, the nurse's primary responsibility is advocating for patient safety and well-being through competent, evidence-based care.

Question 93: In the evaluation phase of the nursing process, the school nurse primarily determines:

• Which staff member will be trained
• Whether the student has met the expected outcomes and if the plan needs revision (Correct answer)
• The student's medical diagnosis
• Which medications the provider should order

Correct answer: Whether the student has met the expected outcomes and if the plan needs revision

Evaluation compares the student's actual progress to the expected outcomes and guides plan revision.

Question 94: Which component of the nursing process involves writing measurable student outcomes for an individualized healthcare plan (IHP)?

• Nursing diagnosis
• Assessment
• Planning (Correct answer)
• Evaluation

Correct answer: Planning

Measurable goals and expected outcomes are established during the planning phase.

Question 95: Under the five rights of delegation, which task is LEAST appropriate for a school nurse to delegate to unlicensed assistive personnel?

• Performing an initial assessment of a student with new-onset chest pain (Correct answer)
• Administering a scheduled oral medication to a stable student
• Checking blood glucose using a meter per a written plan
• Recording a student's temperature

Correct answer: Performing an initial assessment of a student with new-onset chest pain

Assessment requires nursing judgment and cannot be delegated to unlicensed personnel.

Question 96: During scoliosis screening, the school nurse asks the student to bend forward at the waist with arms hanging down. This is called the:

• Romberg test
• Trendelenburg test
• Thomas test
• Adams forward bend test (Correct answer)

Correct answer: Adams forward bend test

The Adams forward bend test shows rib or lumbar asymmetry that suggests scoliosis.

Question 97: A school nurse performing a scoliosis screening asks the student to bend forward at the waist with arms hanging. What is this test called?

• Thomas test
• Trendelenburg test
• Romberg test
• Adams forward bend test (Correct answer)

Correct answer: Adams forward bend test

The Adams forward bend test reveals rib or lumbar asymmetry suggestive of structural scoliosis.

Question 98: A student is exhibiting signs of an acute anxiety attack including rapid breathing, chest tightness, and trembling. After ruling out a medical emergency, the nurse's BEST intervention is:

• Use grounding techniques and calm reassurance while monitoring vital signs (Correct answer)
• Send the student back to class to avoid reinforcing avoidance behavior
• Administer the student's prescribed anxiolytic immediately
• Call the student's parents to pick them up

Correct answer: Use grounding techniques and calm reassurance while monitoring vital signs

Grounding techniques (e.g., 5-4-3-2-1 sensory exercise) and calm reassurance are evidence-based first-line interventions for acute anxiety.

Question 99: During a fire drill, a student with a physical disability cannot evacuate independently. The school nurse's role includes:

• Leaving the student in a safe area and notifying emergency personnel
• Ensuring the student is included in the school's individual emergency evacuation plan
• Both B and C, per the student's pre-established emergency plan (Correct answer)
• Carrying the student down the stairs immediately

Correct answer: Both B and C, per the student's pre-established emergency plan

An individual emergency evacuation plan should pre-identify procedures, including designating a safe area and notifying first responders, tailored to the student's specific needs.

Question 100: The school's AED has only adult pads, and a 5-year-old is in cardiac arrest. What should the nurse do?

• Do not use the AED
• Cut the adult pads in half
• Use the adult pads, placing them anterior-posterior if needed so they do not touch or overlap (Correct answer)
• Wait for EMS to bring pediatric pads

Correct answer: Use the adult pads, placing them anterior-posterior if needed so they do not touch or overlap

Adult pads are acceptable when pediatric pads are unavailable, as long as the pads do not overlap.

Question 101: Which type of health education program is most beneficial for students?

• Comprehensive health education programs that cover nutrition, mental health, and physical activity. (Correct answer)
• Programs focusing solely on disease prevention.
• Programs focused on fitness only.
• Academic-focused health education.

Correct answer: Comprehensive health education programs that cover nutrition, mental health, and physical activity.

Comprehensive health education programs are most beneficial because they address the multifaceted nature of student health. By covering nutrition, mental health, and physical activity, these programs provide a holistic understanding of well-being. This integrated approach ensures students develop a broad range of knowledge and skills necessary for a healthy life.

Question 102: Under FERPA, when do the rights to access and consent to disclosure of a student's education records, including health records, transfer from the parent to the student?

• When the student turns 18 or attends a postsecondary institution (Correct answer)
• When the student obtains a driver's license
• When the student turns 16
• When the student enters high school

Correct answer: When the student turns 18 or attends a postsecondary institution

FERPA rights transfer to the 'eligible student' at age 18 or upon attending a postsecondary institution at any age.

Question 103: When a conflict arises during care planning, what is the appropriate nursing action?

• Ignore the conflict and continue working
• Document concerns on social media
• Use the chain of command to escalate concerns through proper channels (Correct answer)
• Confront the individual publicly

Correct answer: Use the chain of command to escalate concerns through proper channels

The chain of command provides an established pathway for resolving conflicts and escalating concerns appropriately.

Question 104: Which task can a school nurse LEAST appropriately delegate to unlicensed assistive personnel?

• Checking a pre-measured blood glucose reading
• Giving a scheduled oral medication
• Recording a student's temperature
• Assessing a student's new respiratory symptoms (Correct answer)

Correct answer: Assessing a student's new respiratory symptoms

Assessment requires nursing judgment and cannot be delegated to unlicensed personnel.

Question 105: The school nurse is updating the school's emergency action plan for a student with a food allergy. Which element is MOST critical to include?

• The student's favorite foods to avoid accidental exposure
• The name of the student's allergist for routine communication
• The student's home address for parent notification
• The specific trigger foods, symptoms of reaction, and step-by-step emergency treatment including epinephrine location (Correct answer)

Correct answer: The specific trigger foods, symptoms of reaction, and step-by-step emergency treatment including epinephrine location

An effective allergy emergency action plan must specify triggers, recognize symptoms, and detail exactly what to do including where epinephrine is stored.

Question 106: A student's IHP goal of independent glucose monitoring was not met by the target date. What is the school nurse's BEST next action?

• Remove the goal from the plan
• Notify the principal that the student is noncompliant
• Transfer all monitoring permanently to the classroom teacher
• Reassess barriers, revise interventions or timeline, and collaborate with the student and family (Correct answer)

Correct answer: Reassess barriers, revise interventions or timeline, and collaborate with the student and family

An unmet goal calls for reassessment and plan revision, not abandonment or blame.

Question 107: Which sign is MOST consistent with hypoglycemia in a student with Type 1 diabetes?

• Fruity breath, polyuria, and Kussmaul respirations
• Shakiness, diaphoresis, and confusion (Correct answer)
• Flushed skin, dry mucous membranes, and abdominal pain
• Hypertension, bradycardia, and widened pulse pressure

Correct answer: Shakiness, diaphoresis, and confusion

Shakiness, diaphoresis (sweating), and confusion are classic signs of hypoglycemia resulting from adrenergic and neuroglycopenic responses to low blood glucose.

Question 108: Following a student suicide at school, the nurse's role in the postvention response includes:

• Only communicating with parents — student grief support is the counselor's responsibility
• Immediately announcing the cause of death over the school intercom to prevent rumors
• Returning to normal health office operations to maintain school routine
• Participating in the crisis response team, identifying at-risk students, and providing grief support resources (Correct answer)

Correct answer: Participating in the crisis response team, identifying at-risk students, and providing grief support resources

School nurses are integral to the crisis response team during postvention, identifying vulnerable students and coordinating mental health support.

Question 109: The school nurse is assisting in developing a reintegration plan for a student returning after a psychiatric hospitalization. Which action is MOST important?

• Require the student to have a normal schedule immediately to establish routine
• Coordinate with the treatment team, parents, and school staff to create a gradual return-to-learn plan with appropriate supports (Correct answer)
• Restrict the student from participating in physical education until cleared by the psychiatrist
• Inform all teachers about the student's diagnosis to promote awareness

Correct answer: Coordinate with the treatment team, parents, and school staff to create a gradual return-to-learn plan with appropriate supports

A coordinated, gradual return-to-learn plan developed collaboratively supports the student's successful reintegration and prevents relapse.

Question 110: A student with sickle cell disease has a 504 Plan. Which accommodation BEST reflects nursing input on the plan?

• Removal from all physical education
• Extra time on standardized tests only
• Unlimited access to water and restroom breaks (Correct answer)
• Seating near the classroom door for fire drills

Correct answer: Unlimited access to water and restroom breaks

Hydration and bathroom access help prevent sickling crises and are standard health-based accommodations.

Question 111: A school nurse covers four buildings. Which strategy BEST ensures care plans are carried out when the nurse is not on site?

• Share the relevant EAPs with appropriate staff, provide training, and set a clear communication and supervision plan (Correct answer)
• Instruct staff to call 911 for any health concern
• Keep all IHPs locked in the nurse's office
• Ask parents to stay at school daily

Correct answer: Share the relevant EAPs with appropriate staff, provide training, and set a clear communication and supervision plan

Sharing need-to-know plans with trained staff and maintaining supervision ensures continuity of care when the nurse is not present.

Question 112: When a conflict arises during patient care standards, what is the appropriate nursing action?

• Ignore the conflict and continue working
• Document concerns on social media
• Confront the individual publicly
• Use the chain of command to escalate concerns through proper channels (Correct answer)

Correct answer: Use the chain of command to escalate concerns through proper channels

The chain of command provides an established pathway for resolving conflicts and escalating concerns appropriately.

Question 113: How should a nurse respond to a change in patient condition during health assessment?

• Ask a family member for their opinion first
• Document the change and move to the next patient
• Immediately assess, intervene if within scope, and notify the provider using SBAR (Correct answer)
• Wait for the physician to notice during rounds

Correct answer: Immediately assess, intervene if within scope, and notify the provider using SBAR

Prompt assessment, appropriate intervention, and structured communication using SBAR ensures rapid response to changes in patient condition.

Question 114: How should a nurse prioritize tasks related to clinical procedures?

• According to family member requests
• Based on the acuity and urgency of patient needs (Correct answer)
• Alphabetical order of patient names
• By room number sequence

Correct answer: Based on the acuity and urgency of patient needs

Task prioritization in nursing should always be based on patient acuity and the urgency of clinical needs.

Question 115: What should a school nurse do if they observe unethical behavior?

• Discipline the individual.
• Tell other staff members but take no further action.
• Report the behavior to the appropriate authorities. (Correct answer)
• Ignore the behavior.

Correct answer: Report the behavior to the appropriate authorities.

If a school nurse observes unethical behavior, their professional and ethical obligation is to report it to the appropriate authorities. This ensures that the behavior is addressed through proper channels, protecting students, maintaining professional standards, and upholding the integrity of the school environment. Ignoring it or taking informal action is not an acceptable response.

Question 116: Who is primarily responsible for developing an Emergency Care Plan (ECP) for a student with a seizure disorder?

• The school nurse (Correct answer)
• The bus driver
• The classroom teacher
• The school principal

Correct answer: The school nurse

The registered school nurse develops the ECP from provider orders and nursing assessment and shares it with relevant staff.

Question 117: A student with newly diagnosed type 1 diabetes enrolls mid-year. Which document should the school nurse develop FIRST to guide daily nursing care at school?

• Individualized Healthcare Plan (IHP) (Correct answer)
• Behavior Intervention Plan
• Individualized Education Program (IEP)
• Section 504 Plan

Correct answer: Individualized Healthcare Plan (IHP)

The IHP is the nursing care plan the school nurse writes to direct daily health management, and it can later inform 504 or IEP accommodations.

Question 118: Which document defines the legal scope of practice for a registered school nurse in a given state?

• The state Nurse Practice Act (Correct answer)
• The student handbook
• NASN position statements
• The district's school board policy manual

Correct answer: The state Nurse Practice Act

Each state's Nurse Practice Act legally defines RN scope of practice; other documents cannot expand it.

Question 119: An Emergency Action Plan (EAP) for a student with a severe peanut allergy is primarily written for which audience?

• The district insurance carrier
• Unlicensed school staff who may need to respond to an emergency (Correct answer)
• The student's primary care provider
• The school nurse only

Correct answer: Unlicensed school staff who may need to respond to an emergency

EAPs are written in plain language so teachers, bus drivers, and other non-nursing staff can recognize and respond to emergencies.

Question 120: A school nurse teaching an inhaler technique asks the student to demonstrate it back and explain when to use it. Which strategy is this?

• Anticipatory guidance
• Didactic lecture
• Motivational interviewing
• Teach-back (Correct answer)

Correct answer: Teach-back

Teach-back confirms understanding by having the learner restate or demonstrate the information in their own words or actions.

Question 121: How can school nurses assist in developing health-related school policies?

• By focusing solely on first aid.
• By organizing extracurricular activities.
• By ignoring student health concerns.
• By providing input on policies related to student health and safety. (Correct answer)

Correct answer: By providing input on policies related to student health and safety.

School nurses can assist in developing health-related school policies by providing expert input on policies related to student health and safety. Their clinical knowledge and understanding of student health needs are invaluable in creating effective, evidence-based policies that protect and promote the well-being of the school community. They bridge the gap between healthcare and education.

Question 122: At a nearby medical facility, a student with a health condition is getting therapy from a psychologist. The psychologist is willing to speak with the school nurse. What actions should the nurse take to facilitate consultation from the list below?

• inviting the psychologist to a meeting with the student's parent at the school to compare information about the student
• telling the student's parent that psychologist reports would be beneficial and asking the parent to pass updates along
• asking the student's parent for written permission to exchange information with the psychologist (Correct answer)
• requesting that the student's parent set up a meeting between the nurse, the psychologist, and the parent

Correct answer: asking the student's parent for written permission to exchange information with the psychologist

To request health status information from a student's outside health-care provider, a school nurse must have written consent or authorization from the parent/guardian or eligible student. Although a psychologist or other provider may relay or clarify treatment orders to a school nurse or other people involved in a student's treatment, the provider and the school nurse should both respect the legal principle of confidentiality related to student health records and refrain from disclosing information about a student's health status without first obtaining signed authorization.

Question 123: How can a school nurse assist in managing students with chronic health conditions?

• Sending students home when they feel sick.
• Providing long-term medication prescriptions.
• Monitoring classroom behavior.
• Creating individualized health plans and educating staff. (Correct answer)

Correct answer: Creating individualized health plans and educating staff.

School nurses assist in managing students with chronic health conditions by creating individualized health plans (IHPs) tailored to each student's specific needs. These plans detail medication administration, emergency procedures, and daily care requirements. Furthermore, nurses educate school staff, including teachers and administrators, on how to recognize symptoms, respond to emergencies, and support the student's health needs throughout the school day, ensuring a safe and inclusive environment.

Question 124: When developing written health materials for families, the school nurse should target what reading level for general audiences?

• 10th grade or higher
• 8th to 10th grade
• 6th grade or lower (Correct answer)
• College level for accuracy

Correct answer: 6th grade or lower

Health literacy guidance recommends patient materials be written at or below about a 6th-grade reading level.

Question 125: What is an effective method for promoting healthy behaviors in schools?

• Offering rewards for healthy eating.
• Focusing on academic subjects.
• Encouraging regular physical activity and healthy eating. (Correct answer)
• Increasing homework assignments.

Correct answer: Encouraging regular physical activity and healthy eating.

Encouraging regular physical activity and healthy eating is a direct and proactive method for promoting healthy behaviors. This approach focuses on instilling positive habits and knowledge in students, which are fundamental for long-term well-being. It goes beyond temporary incentives to foster a culture of health within the school community.

Question 126: A student with a ventriculoperitoneal shunt arrives with a headache, vomiting, and unusual lethargy. What should the nurse suspect?

• Dehydration requiring oral fluids
• Viral gastroenteritis to be managed at school
• Migraine needing rest only
• Possible shunt malfunction with increased intracranial pressure, requiring urgent notification and medical evaluation (Correct answer)

Correct answer: Possible shunt malfunction with increased intracranial pressure, requiring urgent notification and medical evaluation

Headache, vomiting, and a change in alertness are classic signs of shunt obstruction and need emergency evaluation.

Question 127: Which four elements must a plaintiff prove to establish nursing negligence or malpractice?

• Duty, breach of duty, causation, damages (Correct answer)
• Foreseeability, intent, harm, liability
• Intent, act, causation, damages
• Duty, consent, breach, injury

Correct answer: Duty, breach of duty, causation, damages

Negligence requires a duty owed, a breach of the standard of care, proximate causation, and actual damages.

Question 128: During an anaphylactic reaction, a student's epinephrine auto-injector has been administered. What is the next priority action?

• Observe the student for 15 minutes and discharge to class
• Give oral antihistamines as a follow-up treatment
• Call 911 and transport to the emergency department (Correct answer)
• Administer a second dose of epinephrine immediately

Correct answer: Call 911 and transport to the emergency department

Even after epinephrine administration, the student must be transported to the ED because biphasic reactions can occur hours later.

Question 129: Many students and families in the district, according to a school nurse who works with elementary and middle school students, might benefit from the services offered by family health and human services organizations. Which of the following tactics is most likely to be successful in helping families use these services, according to the school nurse?

• educating students about the types of support their families are eligible to receive through health and human services agencies
• requesting that health and human services agencies maintain a sign-up sheet at the school for families to request assistance
• asking health and human services agencies to provide information that the nurse can share and discuss with all families (Correct answer)
• providing relevant health and human services agencies with contact information for families who appear to be in the greatest need

Correct answer: asking health and human services agencies to provide information that the nurse can share and discuss with all families

A school nurse's primary responsibilities include informing kids and families about community and governmental options for health-related issues and aiding families in finding resources to address the physical, mental, and emotional needs of pupils. The school nurse can respond quickly and link families to necessary services by forming and maintaining ties with neighborhood organizations, doctors, and health advocacy groups. For instance, school nurses might help families sign up for state or federal health insurance programs or find groups that support students with physical or mental challenges.

Question 130: How should a nurse respond to a change in patient condition during medication administration?

• Document the change and move to the next patient
• Wait for the physician to notice during rounds
• Immediately assess, intervene if within scope, and notify the provider using SBAR (Correct answer)
• Ask a family member for their opinion first

Correct answer: Immediately assess, intervene if within scope, and notify the provider using SBAR

Prompt assessment, appropriate intervention, and structured communication using SBAR ensures rapid response to changes in patient condition.

Question 131: A student returning to school after a concussion should have a care plan that MOST likely includes:

• Gradual return-to-learn accommodations, such as reduced screen time and rest breaks, coordinated with the provider (Correct answer)
• Full participation in contact sports immediately
• No changes because symptoms resolved at home
• Permanent exclusion from physical education

Correct answer: Gradual return-to-learn accommodations, such as reduced screen time and rest breaks, coordinated with the provider

Return-to-learn plans use temporary academic accommodations, adjusted as symptoms resolve, before return-to-play.

Question 132: A child of about 6 years is unresponsive and not breathing, and two trained rescuers are present. What is the correct compression-to-ventilation ratio?

• 30:2
• Continuous compressions with no breaths
• 5:1
• 15:2 (Correct answer)

Correct answer: 15:2

For pediatric CPR with two rescuers, AHA guidelines use a 15:2 ratio.

Question 133: A school nurse is planning care for a student with cystic fibrosis. Which accommodation is MOST directly related to the condition?

• Reduced homework load in all subjects
• Permission to wear a hat indoors
• Preferential seating in the front row
• Access to pancreatic enzymes with meals and snacks (Correct answer)

Correct answer: Access to pancreatic enzymes with meals and snacks

Students with CF typically need pancreatic enzyme replacement with food to absorb nutrients.

Question 134: Which statement BEST describes the school nurse's role in a student's Section 504 plan for a mental health condition?

• The nurse serves as the 504 coordinator for all health-related disabilities
• The school nurse has no formal role in 504 plans
• The nurse approves or denies accommodations based on medical necessity
• The nurse provides medical documentation, recommends health-related accommodations, and monitors implementation of health-related plan components (Correct answer)

Correct answer: The nurse provides medical documentation, recommends health-related accommodations, and monitors implementation of health-related plan components

The school nurse contributes medical expertise, recommends health accommodations, and monitors compliance for health-related components of a student's 504 plan.

Question 135: What is the nurse's primary responsibility in patient care standards?

• Advocating for patient safety and well-being (Correct answer)
• Following physician orders without question
• Minimizing time spent with each patient
• Completing documentation as quickly as possible

Correct answer: Advocating for patient safety and well-being

In patient care standards, the nurse's primary responsibility is advocating for patient safety and well-being through competent, evidence-based care.

Question 136: A principal asks the school nurse to share a student's HIV status with the student's teachers "for safety." What is the nurse's most appropriate response?

• Decline, because disclosure requires written parental consent and is not needed for standard precautions (Correct answer)
• Share it only with the homeroom teacher
• Share it only if the student has a chronic absence pattern
• Share it with all teachers who have the student in class

Correct answer: Decline, because disclosure requires written parental consent and is not needed for standard precautions

HIV status is highly protected under FERPA and state law, and standard precautions make disclosure unnecessary without consent.

Question 137: A 2nd grader with a seizure disorder will attend an overnight field trip. Which care planning action is MOST important?

• Ask the parent to keep the student home
• Give the teacher a copy of the school seizure policy
• Update the IHP/EAP for the trip setting, identify and train a responsible adult, and confirm rescue medication accompanies the student (Correct answer)
• Plan to be reachable by phone only

Correct answer: Update the IHP/EAP for the trip setting, identify and train a responsible adult, and confirm rescue medication accompanies the student

Field trips require plan adaptation, trained staff, and access to emergency medication to ensure safety and equal access.

Question 138: Which federal law primarily governs the privacy of health records kept by a school nurse employed by a public school district?

• The Americans with Disabilities Act
• HIPAA Privacy Rule
• FERPA (Correct answer)
• The Affordable Care Act

Correct answer: FERPA

Health records maintained by a public school are education records protected under FERPA, not HIPAA.

Question 139: Which of the following is an example of a health promotion activity in schools?

• Health fairs and wellness programs. (Correct answer)
• Club activities.
• Math tutoring.
• Physical education class.

Correct answer: Health fairs and wellness programs.

Health fairs and wellness programs are excellent examples of health promotion activities in schools because they actively engage the entire school community in health-related topics. These events often feature interactive booths, screenings, educational materials, and demonstrations focused on nutrition, fitness, mental health, and disease prevention. By making health information accessible and engaging, they encourage students, staff, and families to adopt healthier lifestyles and make informed decisions about their well-being.

Question 140: What role do school nurses play in managing emergencies?

• Organizing student extracurricular activities.
• Running school-wide fire drills.
• Creating academic assessments.
• Administering first aid and calling emergency services.

In managing emergencies, school nurses play a critical role as the primary healthcare providers on site. They are responsible for promptly administering first aid and immediate medical care to students or staff experiencing an emergency. Crucially, they also assess the situation, determine the need for advanced medical attention, and initiate calls to emergency services, ensuring a rapid and appropriate response.

Question 141: How can school nurses help ensure a healthy school environment?

• By following health policies, conducting screenings, and educating students and staff. (Correct answer)
• By focusing on school sports.
• By monitoring student behavior.
• By focusing on academics.

Correct answer: By following health policies, conducting screenings, and educating students and staff.

School nurses help ensure a healthy school environment by following health policies, conducting screenings, and educating students and staff. These actions proactively identify health concerns, prevent the spread of illness, and empower the school community with health knowledge. Their comprehensive approach contributes significantly to a safe and supportive learning atmosphere.

Question 142: How do school nurses ensure compliance with health policies?

• By educating staff and monitoring health protocols. (Correct answer)
• By conducting routine tests without informing parents.
• By disregarding state regulations.
• By avoiding student health assessments.

Correct answer: By educating staff and monitoring health protocols.

School nurses ensure compliance with health policies by educating staff and monitoring health protocols. They serve as a resource for health information, train school personnel on emergency procedures, and oversee the implementation of health-related guidelines. This proactive approach helps maintain a consistent and safe health environment for all students.

Question 143: Under Section 504 of the Rehabilitation Act, a student qualifies for accommodations when they have:

• A disability that requires specially designed instruction
• A physical or mental impairment that substantially limits a major life activity (Correct answer)
• A chronic illness diagnosed before age 5
• Below-grade-level academic performance

Correct answer: A physical or mental impairment that substantially limits a major life activity

Section 504 covers impairments that substantially limit a major life activity, even when special education isn't needed.

Question 144: What is the best practice when handling a student's personal health information?

• Sharing it with other students.
• Posting it on school bulletin boards.
• Discussing it with non-medical staff.
• Sharing it only with authorized individuals and keeping it confidential. (Correct answer)

Correct answer: Sharing it only with authorized individuals and keeping it confidential.

The best practice when handling a student's personal health information is sharing it only with authorized individuals and keeping it strictly confidential. This adheres to legal requirements like FERPA and HIPAA, which protect student privacy. Maintaining confidentiality builds trust and ensures that sensitive health data is managed responsibly and securely.

Question 145: When developing an Individualized Healthcare Plan (IHP) for a student with Type 1 diabetes, which component is MOST critical to include?

• Blood glucose monitoring parameters and hypoglycemia/hyperglycemia action steps (Correct answer)
• A list of all classmates who should be aware of the condition
• A schedule of all school field trips for the year
• The student's full medical history since birth

Correct answer: Blood glucose monitoring parameters and hypoglycemia/hyperglycemia action steps

The IHP must include specific blood glucose target ranges and clear action steps for both hypoglycemia and hyperglycemia to ensure safe management during the school day.

Question 146: When writing the interventions section of an IHP, the school nurse should ensure each intervention is:

• Copied directly from the provider's orders without adaptation
• Specific, evidence-based, and linked to a stated nursing diagnosis and goal (Correct answer)
• Written in broad terms so any staff member can interpret it
• Limited to activities performed by the parent

Correct answer: Specific, evidence-based, and linked to a stated nursing diagnosis and goal

Interventions should be specific, evidence-based, and directly support the goal for the identified diagnosis.

Question 147: Which nursing diagnosis is the PRIORITY for a student with a history of anaphylaxis to bee stings who has outdoor recess?

• Readiness for enhanced knowledge
• Risk for allergy reaction (Correct answer)
• Risk for situational low self-esteem
• Impaired social interaction

Correct answer: Risk for allergy reaction

Potential life-threatening physiologic risk takes priority over psychosocial or educational diagnoses.

Question 148: Why is it important for school nurses to assess students' immunization status?

• To ensure compliance with state laws. (Correct answer)
• To reduce school absenteeism.
• To promote academic excellence.
• To monitor student health progress.

Correct answer: To ensure compliance with state laws.

It is crucial for school nurses to assess students' immunization status primarily to ensure compliance with state laws and public health regulations. Most states require specific immunizations for school entry to prevent the spread of communicable diseases within the school community. By verifying immunization records, nurses help protect the health of all students and staff, contributing to a safe and healthy learning environment.

Question 149: How should a nurse respond to a change in patient condition during patient care standards?

• Document the change and move to the next patient
• Immediately assess, intervene if within scope, and notify the provider using SBAR (Correct answer)
• Ask a family member for their opinion first
• Wait for the physician to notice during rounds

Correct answer: Immediately assess, intervene if within scope, and notify the provider using SBAR

Prompt assessment, appropriate intervention, and structured communication using SBAR ensures rapid response to changes in patient condition.

Question 150: A student with asthma arrives at the school nurse's office with mild wheezing and an oxygen saturation of 95%. What is the most appropriate first action?

• Notify the teacher and send the student back to class
• Have the student rest and monitor for 30 minutes without medication
• Administer the student's prescribed short-acting bronchodilator (rescue inhaler) (Correct answer)
• Call 911 immediately

Correct answer: Administer the student's prescribed short-acting bronchodilator (rescue inhaler)

A short-acting bronchodilator (e.g., albuterol) is the first-line treatment for acute asthma symptoms per the student's asthma action plan.

Question 151: Why is confidentiality important in professional practice for school nurses?

• It helps maintain trust and ensures compliance with laws. (Correct answer)
• It reduces workload.
• It keeps parents informed.
• It prevents the spread of rumors.

Correct answer: It helps maintain trust and ensures compliance with laws.

Confidentiality is paramount in school nursing because it helps maintain trust with students and families, encouraging them to seek necessary health services without fear of disclosure. Furthermore, it ensures compliance with legal mandates such as FERPA and HIPAA, protecting sensitive personal health information. Upholding confidentiality is fundamental to ethical and legal professional practice.

Question 152: The school nurse is developing a support plan for a student with ADHD. Which intervention is MOST within the school nurse's scope?

• Prescribing a stimulant medication trial
• Coordinating administration of prescribed ADHD medications and communicating with parents and teachers about behavioral patterns (Correct answer)
• Designing the student's 504 plan independently
• Administering psychological testing to confirm the diagnosis

Correct answer: Coordinating administration of prescribed ADHD medications and communicating with parents and teachers about behavioral patterns

The school nurse's role in ADHD management includes safe medication administration, monitoring for side effects, and serving as a communication bridge between home, school, and healthcare providers.