NBCSN - School Nurse Certification Exam Answers

NBCSN – School Nurse Certification Exam Answers

What are the standards of school nursing?

The authoritative statements of the duties school nurses are expected to perform competently

What legal document describes school nurse delegation?

State Nurse Practice Act

Impetigo

Begins as a single lesion which spreads to secondary lesions that crust or scale. Staph bacteria skin infection. Honey colored crust

Pinworm

A student who is tired, can’t sit still, itching bottom

Describe the primary objective of the school nurse

to protect and promote student health, facilitate optimal development and advance academic success. Goal is to strengthen the educational process through improvement of the health status and learning of students

Sickle cell anemia

may cause painful events in hands feel and or long bones. Treatment oxygen and fluids. Monitor for fever, cough, rapid heartbeat that accompany an acute chest syndrome

Adolescents are commonly deficient in which vitamins

Calcium, Iron, Vit D

Connors Rating Scale

ADHD short form Similar to the Vanderbilt Assessment Scales. Practitioner must purchase rights

Tanner staging

staging of sexual maturity

Denver Developmental Screening Test (DDST)

To chart normal progress between the ages of 1 mo. to 6 yrs. To identify children who are NOT developing normally. Does not measure intelligence

Wechsler Adult Intelligence Scale

the WAIS is the most widely used intelligence test; contains verbal and performance (nonverbal) subtests

How often is PPT review required?

Annually

What to do if suspected hearing loss?

Conduct audiometric screening

Cleaning product for Norovirus, C Diff

5-6% hypochlorite solution (chlorine bleach)

Amblyopia (lazy eye)

If corrected early, affected eye can have normal vision. Treatment before kindergarten

Ethical and professional behavior is guided by responsibility to who?

the student

chicken pox communicability

1-2 day before and 4-5 day after onset of rash

When is an adolescent considered obese?

BMI >95% for age

>120% IBW (Ideal Body Weight)

Are active Tuberculosis patients always symptomatic?

active TB may be asymptomatic and only diagnosed with chest x-ray

Does a positive mantoux test indicate presence of disease? Why or why not?

Anyone who has been exposed to TB may have positive Mantoux test

Does BCG vaccine prevent TB?

No but may decrease incidence of sever disease

When is an adolescent with active TB no longer infections?

Beyond 2 weeks of medication therapy

What happens if BP cuff too small

Will give a high reading. Opposite also true. Should have a bladder length 80% of the arm circumference, length to width 2:1,

How long can Hepatitis B Virus survive on surfaces?

1 week

Signs of MDMA intoxication

jaw clenching, teeth grinding, N&V, muscle cramping, blurred vision, inc HR

what does snorting drugs cause

nose bleeds and nasal lesions

Osgood-Schlatter disease

inflammation or irritation of the tibia at its point of attachment with the patellar tendon. Can cause a painful, bony bump on shinbone below knee. Occurs in children and adolescent experiencing growth spurt during puberty. Swelling over ANTERIOR tibial tuberosity

Contraindications of second pertussis dose

encephalopathy within 7 days of first dose or anaphylaxis

Guanfacine (Intuniv, Tenex)

non stimulant ADHD med (antihypertensive) BP should be taken for student

Kehr’s sign

Referred pain down the left shoulder; indicative of a ruptured spleen.

Wilms tumor

malignant tumor of the kidney occurring in childhood. One of the cancers more common to children prior to school age

Shoulder tenderness and inability to shrug shoulder against resistance most likely due to which nerve affected

Accessory (spinal accessory) nerve

tongue piercing

Piercing any oral structure presents a risk of local post procedural infection because of the presence of pathogens in the oral cavity. Tongue piercing poses greatest risk to damage to tooth structure.

Who approves AED

FDA

A diabetic in PE class with HA, diaphoretic, confused, unable to swallow

admin glucagon

bed bugs

small, flat, reddish-brown insects that may live around or near areas where people sleep and that feed on the blood of people and animals. Linear clusters of reactions, generally nocturnal, use heat to treat. Often 3 erythematous papules along a vein. They are active at night.

peak flow meter

if 80% or above best average no action needed

Goal during mass casualty event

Greatest good for the greatest number through triage. Level 1 immediate, correctable, life threatening. Level 2 – serious but not life threatening. Level 3 – non emergent, walking wounded, minimal care. Level 4 dead or mortally wounded. For example would prioritized long bone fracture with compromise over cardiac arrest

Sect. 504 Rehabilitation Act of 1973

assures student has equal right to participate in educational and extra curricular activities as their non disabled peers

IDEA

Federal law that mandates IEP>. Individuals with Disabilities Education Act. Requires LEAST restrictive environment with in class support to the max extent possible

Skin sign of meningitis

petechia

5ths Disease/ Erythema Infectiosum

-sx-Parvovirus B19): SLAPPED CHEEK (erythema of check), lace like rash
-dx-dangerous in SICKLE cell pt (other anemias)
-tx- self limiting
People at risk – weak immune system bc of cancer, organ transplant, HIV. Can cause chronic anemia

scarlet fever

Group A strep illness, bright red rash covers most of body

Carotenemia

yellowing of the skin that results from excess beta-carotene/Vit A in the body

Cutaneous fungal infections

Ringworm and Athlete’s foot Fungus grows on keratin in skin

-Cephalocaudally
-Proximodistally

Development occurs cephalocaudally (head to toe) and proximodistally (trunk to extremities)

Preschool children can jump off step

12 inches high

when can kids sit in the front seat?

Booster Seat until

8 years old, 80 pounds

Precocious Puberty Girls

for caucasian girls before 7, african american before 6yo. May be caused by pituitary tumor

Precocious Puberty Boys

Development of secondary sexual characteristics before the age of 9. May be caused by pituitary tumor

Delayed puberty may be caused by

lack of gonadotropins (pituitary gland)

Shortest time period you can give HBV vaccines

6 months

Paiget

cognitive development

Ericson

psychosocial

Kohlberg

Moral development (preconventional – concern of self, conventional – rules to be good person, postconventional – rules for the good of all of us)

Erikson Psychosocial Stages

1-3Autonomy vs. Shame and Doubt, 3-6Initiative vs. Guilt, 6-11 Industry vs. Interiority, 12-17 Identify vs. Role Confusion

Piaget’s stages of cognitive development

2-7 preoperational (world revolves around them, one thing at a time, fairies), 7-11 concrete operational (can use logic, group objects), 11 and older – formal operational (abstract thought, predict outcomes)

When does moral development begin?

age 9

When do kids first lose teeth

age 6. Perm teeth in by 12

earliest normal puberty

8 years old

When does puberty start for boys

age 11. Sperm devp around age 13 before growth spurt and pub hair

Apical pulse location

Mid-clavicular
Over 7 yo Fifth intercostal space and it is called PMI- point of maximum impulse (4th intercostal space under 7yo)

What to document for murmur

rhythm, rate quality of sound

Normal HR

Up to 8 75-115
8-11 70-110
teens 60-100

Book says 6-10 yo 65-125. Just remember higher for younger child

Respiratory Rate

3-7yo 20-25
8-11 yo. 14-22
over 12 12-20

Or remember average 15-20

Which arm for BP

Dominant first
2. other arm
3. Use highest BP arm next time

Blood Pressure

3yo 90/40
7yo 97/57
11 104/61
teens 113/64

Retake BP how often if abnormal with HA, flushing, weak pulse, bounding pulse, pallor, dizziness

5 min

Bell of stethoscope is used for

soft, low-pitched sounds

McKinney-Vento Act

the nation’s first law to provide assistance to homeless persons, including free public education for children. School stability (can remain in school for duration of academic year), transportation is required. Homeless = children, youth who lack a fixed regular and adequate nighttime residence including sharing a residence, motel or campgrounds

Freud’s stages of development

oral stage, anal stage, phallic stage, latency stage, genital stage

Maslow’s Hierarchy of Needs

(level 1) Physiological Needs, (level 2) Safety and Security, (level 3) Relationships, Love and Affection, (level 4) Self Esteem, (level 5) Self Actualization

6 steps of nursing process (ADOPIE)

Assessment, diagnosis (nursing), outcome identification, planning, implementation, evaluation. FIRST step ASSESSMENT ALWAYS.

Hib

Haemophilus influenzae type B – Not given after 5yo

HBV

hepatitis B vaccine

TIPS for head injury

Time of Injury, Impact position, Positional assessment, Saw it?

Federal Car Seat Regulations

Booster seat until 4’9″ and 8-12 years old, under 13 back seat

MMR first dose

after 12months

Tdap

11-12 years old

Meningococcal

11-12 years – Menactra

Live viruses

MMR and Varicella (weakened/attenuated form of virus). Small risk of causing weak case of disease

Killed/inactivated vaccines

made from protein or other small piece taken from virus

Vision Screening

Chart with lines, numbers and symbols at eye level, arch of foot on line, passing 20/40 for K, 20/30 for 1st and up. Screens for Visual acuity, color discrimination and extraoccular movememnt

Refractive errors

Most common vision problem in children

Greatest cause of death for children 5-9 years old

1)accidents/unintentional injury 2) cancer 3) congenital malformations 4) homocide

Greatest cause of death for children 10-14 years old

1)accident 2) cancer 3) suicide 4) homicide

Greatest cause of death for children 15-19 years old

1) accident 2) homicide 3) suicide 4) Cancer

hearing screening pass

1000, 2000, 4000 (Hertz/pitch) pass at 20/25db (loudness). Can be affected by cerumen impacted

Prevention (primary, secondary, tertiary)

Primary – for everyone! immunizations, info on health promotion, health fair. Secondary for those at risk to a condition (vision screening, referring to dr). Tertiary – prevent additional disability, maximize capabilities (devp IHP for seizures, transition back to school, staff training)

Insulin types

Novolog – fast acting, to cover for meals. Lantus – long acting – all day control

Calcium needs for kids

4-8 yo 1000mg, 9-18 1300mg. also needs sunlight, weigh bearing exercises, broccoli, cheese, yogurt. When fractures occur bone density screening recommended

pneumothorax

air in the pleural cavity caused by a puncture of the lung or chest wall

S/s liver laceration

Rt upper quad tenderness, guarding signs of blood loss, shock

s/sx of bowl perforation

abd pain, N&V

Treatment of abd injuries

bend knees and hips, place pillow or blanket, treat for shock

When do you need stitches

when wound 1 inch, edges don’t fall together

State Board of Nursing develops state Nurse Practice Act

LAW. Denotes what a nurse can and cannot do, intent to protect public

ANA (American Nurses Association)

– professional organization for RNs in the US
– deals with professional scope and standards of practice
– addresses ethics, public policy, and economic/general welfare of nurses
– mission = advance profession of nursing

NBCSN

provides cert exam voluntary

Primary Assessment

ABCDE (Airway, breathing, circulation, disability and exposure)

Secondary Assessment

EFGHI: expose, farenheit (temp), get VS, H head assessment I- inspect and isolate if infection or immune compromised

CIAMPEDS (mneumonic for pediatric triage)

Chief complaint, Immunizations/Isolation, Allergies, Medications/Medical history, Parent’s impression of the situation, Events surrounding, Diet/Diapers, Symptoms associated with illness/injury

Treatment of Shock

lay supine with legs slightly elevated

CPR rescue breathing rate

12-20 bpm for child, 10-12 for adult

Respiratory arrest

under 8 yo – 1 min rescue breath then 911, over 8 call first

Heimlich

heel of one hand in middle of abd slightly over navel with other hand on top. Thrust up 5 times

Treatment of burns

apply room temp water 2-5 min, remove clothes/jewelry, no ointment

Hemorage

rapid weak pulse, cool moist skin, pale, bluish, excessive thirst, low BP, restless, unconscious

How often to assess head injury/spinal cord injury

every 5 min

What do you do with body parts torn from body

wrap in clean damp cloth and place in sealed plastic bath with cold water (not ice) transport with child

How much does fever increase respiratory rate or heart rate

increase 10 pulse beats and 4 breaths per min for every degree of fever

Sign of CHF in child

inc in RR, resp congestion, dry cough, SOB, crackels, diaphoresis

Anemia

Most common abnormal blood condition in children. a symptom, not a disease, impaired production, poor diet, pica, blood loss, kidney disease. Symptoms – pallor, inc HR/RR, muscle weakness, fatigue, dizzy, HA, dec attention, jaundice

Hemophilia

A hereditary disease where blood does not coagulate to stop bleeding. Non contact sports only

Peptic Ulcer Disease cause

pylori. Seen in boys 12-18

Hep A and E transmission

fecal-oral. Can live up to 3 hours on objects. Boil or disinfect with bleach

5 rights of delegation

right procedure, situation, personnel, training, oversight. RN retains accountability for the task and outcome

Student Health Record

part of cumulative education record in public school. Protected by FERPA

Burns (degrees)

1st — minor damage/epidermis — ERYTHEMA. Sunburn

2nd- Partial-thickness- painful
superficial/Papillary dermis– BLISTERS
deep/reticular dermis — RUPTURED blisters

3rd -Full/destroy-dermal appendages – no* sensation
white, leathery, charred

Call EMS if 10% of body burned (1% = students palm)

HEEADSSS is:

home, education/employment, eating, activities, drugs, sexuality, suicide, safety

prominent bone for otoscope exam

Malleus prominent bone

Addison’s disease

a condition that occurs when the adrenal glands do not produce enough cortisol or aldosterone

Cushing’s syndrome

caused by prolonged exposure to high levels of cortisol, causes swelling

Graves disease

(hyperthyroidism) bulging eyes, nervous, weight loss, heat intolerance, insomnia

Hypothyroidism symptoms

Fatigue, lethargy. Modest weight gain with anorexia. Dry, coarse skin and cold intolerance. Swelling of face, hands, and legs. Constipation. Weakness, muscle cramps, arthralgias, paresthesias, impaired memory and hearing.

Prader-Willi Syndrome

genetic disorder, obesity, intellect disability, short

When does eye anatomy mature

last of the senses, around 6

strabismus

crossed eyes

appendicitis

RLQ pain and rebound tenderness. Pain may inc with cough and walk. N&V

Romberg test

-ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed
-expected finding: client should be able to stand with minimal swaying for at least 5 seconds

Backpack should weigh less

than 10-15% body weight

Immunization exemptions

seizure, life threatening allergy, pregnant, immunosuppressed, religious or philosophical,

Tinea Capitis (Scalp Ringworm)

Rounded, patchy hair loss on scalp, leaving broken-off hairs, pustules, and scales on skin. Caused by fungal infection.

Fragile X Syndrome

a disorder produced by injury to a gene on the X chromosome, producing mild to moderate mental retardation, autism, prominent jaw, forehead, ears. In males

rheumatic fever

after strep pharyngitis. Symptoms include joint pain with redness and swelling, rash, low fever

Myopia

nearsightedness

Nystagmus

repetitive rhythmic movements of one or both eyes

Spinal screenings take place

Twice between 5th and 9th grades

Spine disorders

scoliosis (curve), lordosis (swayback – spine sucked forward, anterior convexity of spine), kyphosis (humpback – upper back, posterior convexity)

CPR: single rescuer compression/ventilation ratio

30:2

CPR second rescuer

15 compressions to 2 breaths

If pulse but no breathing

give breaths every 3 seconds and check pulse every 2 min

Use AED immediately

if you saw the child go down. Otherwise use it after 5 cycles of CPR

CPR switch with second rescuer

Every 5 min if possible

How long until epi pen effects are gone?

20 minutes

Lead is toxic at blood levels abover

10mcg/dl

symptoms of pneumothorax

dyspnea (pain with respiration), dec lung sounds on affected side, anxiety, movement of trachea to one side of the midline of the throat, any open chest wound sucking air.

hypergylcemia symptoms

thirst, urination, fruity breath, flushing, irritability, drowsiness, unconsciousness (call EMS if unconscious)

Hypoglycemia symptoms

hunger, fatigue, weakness, sweating, headache, dizziness, low bp, cold or clammy skin

If unconscious give glucagon

most common childhood cancer

leukemia

muscular dystrophy

group of hereditary diseases characterized by degeneration of muscle and weakness. Most are in wheel chair by late teens and dies in 20’s

Achondroplasia

dwarfism., bowed legs, spine is curved

osteogenesis imperfecta

brittle bone disease

Juvenille Rheumatoid Arthritis

peak ages onset of 2-5 and 9-12 years old
usually occurs in girls

cerebral palsy

paralysis caused by damage to the area of the brain responsible for movement. May be seizures, intellectual disability or attention deficit disorders

Tourette’s syndrome

effects boys 4x’s as much as girls, associated with OCD, ADHD, Impulse control, anxiety and depression

febrile seizures

Seizures that result from sudden high fevers, particularly in children. Usually less than 7 yo

status epilepticus

A condition in which seizures recur every few minutes or last more than 30 minutes. Up to 75% of children having first seizure will have status epilepticus. Infection and metabolic disorders usually trigger. Call EMS if first seizure over 5 min or known epileptic over 10 min

signs of shunt malfunction (hydrocephalus)

-Irritability
-Headache
-Diplopia
-Nausea/vomiting
-Lethargy
-Loss of milestones
-Change in seizure pattern
-Decreased level of consciousness
-They also will sometimes show signs of infection and not a blockage

Mantoux test

TB test, read 48-72 hours. 15mm positive w/o risk factors, 10mm positive with risk factors.

Common Cold

Symptoms 2-8 days after exposure and last up to 10 days

Chicken pox

rash develops 10-21 days after exposure and person is infective 24-48 hours before rash until they scab over

viral meningitis

usually self limiting within 7-10 days and is less severe than bacterial meningitis

Disaster Preparedness should prepare to care for students for

3 days

How much time in between doses of same live vaccine?

4 weeks

Can a student get all vaccines needed to start school in one sitting?

Yes and then attend school the next day.

Youth Risk Behavior Surveillance System (YRBSS)

National Youth Behavior Survey conducted by the CDC. Given by states every 2 years to a selection of students in 9-12 grade. It elicits info about tobacco, alcohol, drug use, risky behaviors

School Health Index (SHI)

made by CDC to improve health promotion programs

Most effective hand hygiene?

antibacterial soap for 30 seconds, paper towels. Alcohol foams, gels must have 60-95% alcohol

Fungal infections

should be treated for 24 hours then covered well during sports match

treatment of avulsed tooth

handle by crown, put in Hanks balanced salt solution or milk, normal saline, water and student and tooth transported to dentist

Dietary requirements for children

4-8 years old kids need 1400-1600 cal. Goes up from there. Teen girls 2000 boys 2400-2800

Underweight BMI

less than 5 percentile. Normal 5-84%

What governs staff health information?

HIPPA

Piercing care

If it swells or itches, remove metal causing reaction. Otherwise wash twice a day with abx soap and rotate piercing. Do not use alcohol or hydrogen peroxide.

Title X (The Education Amendment Act of 1972)

schools cannot discriminate against pregnant or parenting teen

Determining malpractice

school nurses’ actions are judged on the basis of whether the nurse performed as a prudent person would do. Determined by using American Nurses association and NASN practice standards. Failure to act properly is negligence

Consent for screenings

If parent consents but child does not do not do it and notify parents of the refusal. Document

Scope of school health services

seek to remove all health barriers to education

Consequence of violations of confidentiality

HIPPA violations can be fined, FERPA violations can lose federal financial assistance.

Heat Exhaustion Treatment

loosen clothing, give sips of fluids, move to cool area, apply cool water to skin, seek medical attention if worsens

Treatment of draining would

cover before athlete returns to play

Most crucial nursing diagnosis

Anxiety and Fear. Must be addressed prior other problems. Adolsecents who are anxious or depressed are at risk for poor developmental outcomes

menstrual dysfunction

most common adolsecent female reproduction problem

Audiometer (pure-tone)

measures decibles and Hertz (frequency and intensity)

Scoliosis

often left shoulder higher than right, right rib hump, slight curve of spinal column at waist when bends. Lateral spinal curvature greater than 10 degrees

zoonotic transmission in classroom pets

reptiles, amphibians, live poultry

Treatment of snakebite

Keep affected area below the heart to slow the spread of venom, cover with loose fitting dry bandage

most frequent cause of cardiopulmonary arrest in children

respiratory conditions

Who prohibits sharing medical info in schools?

FERPA, not HIPPA

Most common causes of spinal cord injuries in children

vehicle accidents and sports injuries

Ronchi

loud rumbling sounds heard on auscultation of bronchi obstructed by sputum. like snoring. Low pitched bubbling or gurgling on inspiration

Hep B vaccine

Birth within 12 hours, then 1-2 months but before 6 weeks then 2-4 weeks after that, then 8 weeks after that. Remember required spacing and do not have to start over to complete the series

linear papularvesicular lesions

poison ivy

puritic maculopapular lesions that become vesicular

varicella

hyperopia

A condition in which visual images come to a focus behind the retina of the eye and vision is better for distant than for near objects — called also farsightedness.

myopia

Light rays entering eyes focus in front of the retina making distant objects out of focus (nearsighted ness)

Conductive hearing loss

from mechanical dysfunction that interferes with sound waves (including chronic or frequent otitis media)

sensorineural hearing loss

the most common form of hearing loss, also called nerve deafness; caused by damage to the cochlea’s receptor cells or to the auditory nerves. Head injury, prolonged music, rubella cause this.

Hand-foot-mouth disease

Coxsackie virus. Blisters in mouth and hands but can be afebrile. Can return to school after fever gone and no draining lessions. Children can spread the virus even w/o symptoms and may be in stools for weeks after symptoms

Treatment of insect stings

Do not remove with tweezers. Can use flat edge like ID card, soap, water, ice. Monitor for anaphylaxis.

Herpes simplex lesions

contagious, reoccur, can spread on skin to skin contact even when no sore visible

Signs of CHF

Visible swelling of the legs, ankles, eyelids, face, and (occasionally) abdomen.
Abnormally fast breathing.
Shortness of breath or labored breathing. – Wheezing
Fatigue.
Nausea.
Falling asleep when feeding or becoming too tired to eat.
Lack of appetite.

Scabies

intense itching, especially at night

Lowest contraceptive failure rate

Birth control pills, then diaphragm, then condom

cleft lip and palate

may have speech and language problems, ear infections

hypovolemic shock

shock resulting from blood or fluid loss. Tachycardia, cool, clammy skin, low BP, general weakness

vision impairment

normal (20/10-20/25), moderate (20/70-20/100), legal blindness (20/200) with best conventional correction