NFHS Concussion in Sports Certification — Questions and Answers

Question 1: A licensed physician clears an athlete to return to play, but the school's protocol requires clearance from a physician with concussion management training. Which takes precedence?

State law determines which standard applies
The athletic director makes the final call
The school's protocol requiring specialized clearance takes precedence (Correct answer)
The physician's clearance always overrides school policy

Correct answer: The school's protocol requiring specialized clearance takes precedence

School and state concussion protocols may require clearance from physicians with specific concussion training, and those requirements must be met.

Question 2: How should schools use comparative data from similar schools or districts in their concussion QI program?

To argue that their concussion rate is acceptable if it is lower than the average
To identify whether their concussion rates and protocol adherence are above or below peer norms, then investigate why (Correct answer)
To replace their own data collection with district-wide aggregate reports
To rank schools by safety performance and publish a public leaderboard

Correct answer: To identify whether their concussion rates and protocol adherence are above or below peer norms, then investigate why

Peer comparison helps contextualize a school's own data and can reveal both outstanding practices to adopt and deficiencies to address.

Question 3: A football player is hit and immediately loses consciousness for about 10 seconds. Upon regaining consciousness, he insists he feels fine. How should this situation be handled?

Remove him from play and require medical clearance before return (Correct answer)
Have him perform balance tests; clear him if he passes
Monitor him on the sideline for 15 minutes then reassess
Clear him to return since he is now conscious and alert

Correct answer: Remove him from play and require medical clearance before return

Any loss of consciousness, even brief, is a red-flag concussion symptom requiring immediate removal and medical evaluation before any return to play.

Question 4: Which of the following is NOT a recognized cognitive symptom of a concussion?

Increased muscular strength (Correct answer)
Difficulty concentrating
Feeling mentally 'slowed down'
Memory problems

Correct answer: Increased muscular strength

Increased muscular strength is not a concussion symptom; cognitive symptoms include difficulty concentrating, slowed thinking, and memory deficits.

Question 5: Which of the following is an example of a cognitive symptom that may delay return-to-play clearance?

Bruising around the eye
Nausea immediately after the hit
Difficulty concentrating during class (Correct answer)
Balance problems on the sideline

Correct answer: Difficulty concentrating during class

Difficulty concentrating is a cognitive symptom that indicates the brain has not fully recovered and clearance should be withheld.

Question 6: Which symptom is most commonly associated with a concussion?

Increased appetite
Stronger reflexes
Faster heart rate
Headache (Correct answer)

Correct answer: Headache

Headache is one of the most common and frequently reported symptoms of a concussion. It can range from mild to severe and may be accompanied by pressure in the head, making it a key indicator that an athlete may have sustained a concussion.

Question 7: An athlete cleared for Return-to-Play Step 3 (non-contact drills) suddenly reports a headache during practice. The coordinated team response should be to:

Drop back one step and continue monitoring without notifying medical staff
Continue at Step 3 since headaches are normal during exertion
Document the headache and reassess after 24 hours of rest
Stop activity, notify the athletic trainer, and restart the protocol from Step 1 (Correct answer)

Correct answer: Stop activity, notify the athletic trainer, and restart the protocol from Step 1

Any recurrence of symptoms during the graduated protocol requires stopping activity, notifying the healthcare professional, and restarting from the beginning.

Question 8: What is the primary danger of allowing an athlete with an unresolved concussion to return to contact activity too soon?

Second-impact syndrome (Correct answer)
Increased risk of dehydration
Delayed onset muscle soreness
Overuse injury to the cervical spine

Correct answer: Second-impact syndrome

Second-impact syndrome occurs when a second concussion is sustained before the first has healed, and can cause rapid, potentially fatal brain swelling.

Question 9: Under professional standards, when should a school official update parents about an athlete's concussion status?

Only if the athlete's symptoms last more than 48 hours
At the next scheduled parent-teacher conference
Promptly after the suspected concussion occurs and at each stage of the RTP process (Correct answer)
Only when the athlete is cleared to return to full activity

Correct answer: Promptly after the suspected concussion occurs and at each stage of the RTP process

Timely communication with parents at each step of the concussion management process is a professional and ethical obligation.

Question 10: Which factor is MOST important in determining whether EMS should be called for a head injury on the field?

Whether the team physician is present
Whether the athlete is a starter
The presence of red-flag signs such as seizure, repeated vomiting, or loss of consciousness (Correct answer)
The severity of the play that caused the injury

Correct answer: The presence of red-flag signs such as seizure, repeated vomiting, or loss of consciousness

Red-flag signs like seizure, loss of consciousness, and repeated vomiting suggest potential life-threatening injury and always require EMS activation.

Question 11: Which action best demonstrates a school's proactive approach to concussion risk mitigation?

Having a team physician present at every game
Purchasing the most expensive helmets available
Annually educating athletes, parents, and coaches on concussion signs and protocols (Correct answer)
Requiring all athletes to sign a concussion waiver

Correct answer: Annually educating athletes, parents, and coaches on concussion signs and protocols

Annual education of all stakeholders ensures awareness and proper response, which is the foundation of a proactive concussion prevention program.

Question 12: An athlete sustained a concussion on Monday. By Thursday, they report feeling 100% better. Who can authorize their return to full-contact practice?

The athletic director after reviewing the athlete's history
The athlete's parents after signing a consent form
A licensed/certified healthcare professional trained in concussion management (Correct answer)
The head coach after observing a symptom-free practice

Correct answer: A licensed/certified healthcare professional trained in concussion management

Only a licensed or certified healthcare professional trained in concussion management can provide written clearance for return to full contact activity.

Question 13: Which strategy best addresses the risk of concussions in sports that do not traditionally use helmets, such as soccer or basketball?

Requiring all athletes in contact sports to wear protective headgear
Eliminating heading and aerial contests from all youth soccer competitions
Conducting more frequent baseline tests throughout the season
Teaching proper technique to minimize accidental head contacts and educating athletes on reporting symptoms (Correct answer)

Correct answer: Teaching proper technique to minimize accidental head contacts and educating athletes on reporting symptoms

Technique coaching and symptom education are the primary evidence-based risk mitigation tools for sports where helmets are not standard equipment.

Question 14: What role does the athlete play in the communication and documentation process following a suspected concussion?

Athletes sign off on the final report to confirm its accuracy before it is filed
Athletes should be informed of the process and encouraged to honestly report all symptoms (Correct answer)
Athletes determine whether documentation is necessary based on how they feel
Athletes can opt out of the documentation process if they are 18 or older

Correct answer: Athletes should be informed of the process and encouraged to honestly report all symptoms

Athletes should be educated about the process and encouraged to be honest about symptoms, though the documentation responsibility rests with school personnel.

Question 15: Why is it important for athletic trainers and coaches to use consistent terminology when documenting a concussion?

To make reports sound more professional to parents
To satisfy insurance company audit requirements only
To avoid confusion between staff and ensure accurate medical follow-up (Correct answer)
So that reports can be shared on public school websites

Correct answer: To avoid confusion between staff and ensure accurate medical follow-up

Consistent terminology prevents misinterpretation among school staff and healthcare providers, ensuring the athlete receives appropriate and continuous care.

NFHS Concussion in Sports Certification

The NFHS Concussion in Sports course, developed in partnership with the CDC, trains coaches, officials, and parents to recognize, respond to, and manage sports-related concussions and follow safe return-to-play protocols for high school athletes.

Questions

20 min

Time Limit

70%

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