Week #5: Let's Keep the Momentum Going!

6. RE: Week #5: Let's Keep the Momentum Going!

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Debi Blank, RN, BS

Posted 06-05-2018 10:43 AM

Robin:
Thank You so much for taking the time to add today's 5 practice questions to the group. These are such a great help for me.
As a dyslexic person I often miss the small words such as 'no' and 'except' and such. These strategies you are teaching us are new to this old dinosaur and a great help to give me new ways to think questions through.

------------------------------
Debi Blank, RN, BS
School Nurse
Maine AOS # 91
Bar Harbor, Me
[deborah.blank@mdirss.org)]
------------------------------

Original Message

7. RE: Week #5: Let's Keep the Momentum Going!

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Rebecca West, MSN, RN, CNE

Posted 06-05-2018 11:31 AM

Regarding this question, "What authorizations apply to the dispensing of medications to students during school hours", is medical practitioner authorization needed for over the counter medications?

I thought the signature of a medical practitioner was needed only for prescription medication or OTC medications doses that are higher than the dosing on the box.

Rebecca West MSN RN CNE

Coordinator of Health Services, Washington Township Schools

rwest@msdwt.k12.in.us

Cell 317-363-7955

Fax 317-259-5298

--------------------------------------------------------------------------------------------------------------------- This e-mail and any attachments are from a sender at the Metropolitan School District of Washington Township in Indianapolis, Indiana. They are intended for the named recipients and may contain information that is confidential or privileged under Indiana and Federal Law. Any error in addressing or sending this e-mail is not a waiver of confidentiality and does not consent to copying or distribution of this e-mail or attachments. If you receive this e-mail in error, please notify the sender of the error by return e-mail and delete this e-mail and its attachments. If there is a need to speak to the sender, please call [317] 845-9400 and they can provide you with contact information.

------Original Message------

Hi Rebecca,
Thank you for your question, and while I can't comment on specific questions on the upcoming exam, I think it is certainly possible to have a select all response.

Here are some additional questions to review:

School Nurse Certification Practice Questions

An 11-year-old female student presents to the school nurse with lower abdominal pain. She does not have a fever and is not sick to her stomach. Which statement describes the school nurse's knowledge of this age group?

They fake stomach aches often and should be sent back to class
It is okay to give pain medications for abdominal pain
This age group may be ready to start menstruating and a call home to a parent is advised
None of the above

The nurse is called to the gym for a student who is feeling lightheaded. The nurse notes that the child is pale and diaphoretic. His initial pulse rate is more than 180. What is the first action the nurse should take?

Reassure the child, apply cool rags to the forehead, reassess, and be prepared to call the parents and 911
Scream for someone to call 911 now
Excuse the student from <g class="gr_ gr_620 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar only-ins doubleReplace replaceWithoutSep" id="620" data-gr-id="620">gym</g> for the remainder of the period
Excuse the student from <g class="gr_ gr_619 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar only-ins doubleReplace replaceWithoutSep" id="619" data-gr-id="619">gym</g> for the remainder of the week

3. Which actions would be appropriate if the same student is complaining of stomach aches every morning?

Report the child to Child Protective Services
Ignore the complaints and send the student back to class
Trend the complaints and interpret the data to make intervention recommendations.
Take the student to the emergency department for evaluation

A student with ADHD has been having a difficult time each morning until after the noon dose of medication. Which selection indicates what the school nurse should consider next?

Notifying the parent to complain about the student's behavior
Doubling the noon dose
Checking with a parent to see if the morning dose has been given
Seeking the help of the principal before reporting to Child Protective Services

What authorizations apply to the dispensing of medications to students during school hours?

Parental authorization
Medical authorization
Parental and medical authorization
School board authorization only

School Nurse Certification Answer Key

Answer: C

Girls may start having symptoms of early periods. It is wise to call home and discuss abdominal pain with a parent. Constipation may also be the cause of lower abdominal pain in children.

Answer: A

The child should be reassured so that he does not panic. After applying the cool rags, take note of the child's updated situation and then be ready to call the parents. If conditions worsen, 911 may need to be called.

Answer: C

Trending the complaints and collecting data will help you plan an intervention. Maybe the child does not eat breakfast, maybe it is constipation, or maybe he misses home. Trending the time of day, how many days a week, and other information are useful when discussing with a parent the most effective way to handle the complaints, rather than having the student miss class time.

Answer: C

Checking with a parent to see if morning medications have been given would be appropriate.

Answer: C

Both parental and medical authorizations apply to dispensing medications. Prescription medications need a doctor's order as well as parental permission.

------------------------------
Robin Cogan MEd, RN, NCSN
School Nurse
Rutgers University - Camden
Cherry Hill, NJ
------------------------------

8. RE: Week #5: Let's Keep the Momentum Going!

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Robin Cogan, MEd, RN, NCSN, FNASN, FAAN

Posted 06-05-2018 11:40 AM

Excellent question. It may be dependent on your standing orders. In my district, we require medical authorization for all OTC meds.

------------------------------
Robin Cogan MEd, RN, NCSN
School Nurse
Rutgers University - Camden
Cherry Hill, NJ
------------------------------

Original Message

Original Message:
Sent: 06-05-2018 11:31
From: Rebecca West
Subject: Week #5: Let's Keep the Momentum Going!

Regarding this question, "What authorizations apply to the dispensing of medications to students during school hours", is medical practitioner authorization needed for over the counter medications?

I thought the signature of a medical practitioner was needed only for prescription medication or OTC medications doses that are higher than the dosing on the box.

Rebecca West MSN RN CNE

Coordinator of Health Services, Washington Township Schools

rwest@msdwt.k12.in.us

Cell 317-363-7955

Fax 317-259-5298

--------------------------------------------------------------------------------------------------------------------- This e-mail and any attachments are from a sender at the Metropolitan School District of Washington Township in Indianapolis, Indiana. They are intended for the named recipients and may contain information that is confidential or privileged under Indiana and Federal Law. Any error in addressing or sending this e-mail is not a waiver of confidentiality and does not consent to copying or distribution of this e-mail or attachments. If you receive this e-mail in error, please notify the sender of the error by return e-mail and delete this e-mail and its attachments. If there is a need to speak to the sender, please call [317] 845-9400 and they can provide you with contact information.

Original Message------

Hi Rebecca,
Thank you for your question, and while I can't comment on specific questions on the upcoming exam, I think it is certainly possible to have a select all response.

Here are some additional questions to review:

School Nurse Certification Practice Questions

An 11-year-old female student presents to the school nurse with lower abdominal pain. She does not have a fever and is not sick to her stomach. Which statement describes the school nurse's knowledge of this age group?

They fake stomach aches often and should be sent back to class
It is okay to give pain medications for abdominal pain
This age group may be ready to start menstruating and a call home to a parent is advised
None of the above

The nurse is called to the gym for a student who is feeling lightheaded. The nurse notes that the child is pale and diaphoretic. His initial pulse rate is more than 180. What is the first action the nurse should take?

Reassure the child, apply cool rags to the forehead, reassess, and be prepared to call the parents and 911
Scream for someone to call 911 now
Excuse the student from <g class="gr_ gr_620 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar only-ins doubleReplace replaceWithoutSep" id="620" data-gr-id="620">gym</g> for the remainder of the period
Excuse the student from <g class="gr_ gr_619 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar only-ins doubleReplace replaceWithoutSep" id="619" data-gr-id="619">gym</g> for the remainder of the week

3. Which actions would be appropriate if the same student is complaining of stomach aches every morning?

Report the child to Child Protective Services
Ignore the complaints and send the student back to class
Trend the complaints and interpret the data to make intervention recommendations.
Take the student to the emergency department for evaluation

A student with ADHD has been having a difficult time each morning until after the noon dose of medication. Which selection indicates what the school nurse should consider next?

Notifying the parent to complain about the student's behavior
Doubling the noon dose
Checking with a parent to see if the morning dose has been given
Seeking the help of the principal before reporting to Child Protective Services

What authorizations apply to the dispensing of medications to students during school hours?

Parental authorization
Medical authorization
Parental and medical authorization
School board authorization only

School Nurse Certification Answer Key

Answer: C

Girls may start having symptoms of early periods. It is wise to call home and discuss abdominal pain with a parent. Constipation may also be the cause of lower abdominal pain in children.

Answer: A

The child should be reassured so that he does not panic. After applying the cool rags, take note of the child's updated situation and then be ready to call the parents. If conditions worsen, 911 may need to be called.

Answer: C

Trending the complaints and collecting data will help you plan an intervention. Maybe the child does not eat breakfast, maybe it is constipation, or maybe he misses home. Trending the time of day, how many days a week, and other information are useful when discussing with a parent the most effective way to handle the complaints, rather than having the student miss class time.

Answer: C

Checking with a parent to see if morning medications have been given would be appropriate.

Answer: C

Both parental and medical authorizations apply to dispensing medications. Prescription medications need a doctor's order as well as parental permission.

------------------------------
Robin Cogan MEd, RN, NCSN
School Nurse
Rutgers University - Camden
Cherry Hill, NJ
------------------------------

9. RE: Week #5: Let's Keep the Momentum Going!

Like

Debi Blank, RN, BS

Posted 06-07-2018 10:29 AM

I recall learning way back when that nurses had to have a provider's order
to give any medicine to a patient. I don't think that has changed. I have
a sheet of standing orders most of which specify that I can only give these
with written permission of the parent/guardian and the dosage is to be
determined by the instructions on the bottle. Any medicine I don't stock,
such as bug spray or sunscreen are not on my list and require the child's
provider and their parent/guardian signatures to give.

BTW, what seemed against all odds just a week ago has finally happened:
I've got my test scheduled and I only have to drive for an hour to get to
the testing spot!! I understand now the thrill all of you seemed to get
once you were all scheduled. My question is why does it have to be so
complicated?

Debi

--
"We cannot change the direction of the wind but we CAN adjust the sails"

Debi Blank, RN, BSHE
School Nurse
Trenton Elementary School
51 School Rd
Trenton, Maine 04605
deborah.blank@mdirss.org

Confidentiality Notice: This email message, including any attachments, is
for the sole use of the intended recipient(s) and may contain confidential
and privileged information. Any unauthorized review, use, disclosure, or
distribution is prohibited. If you are not the intended recipient, please
contact the sender by reply email and destroy/delete all copies of the
original message. Thank You.

------Original Message------

Excellent question. It may be dependent on your standing orders. In my district, we require medical authorization for all OTC meds.

------------------------------
Robin Cogan MEd, RN, NCSN
School Nurse
Rutgers University - Camden
Cherry Hill, NJ
------------------------------

10. RE: Week #5: Let's Keep the Momentum Going!

Like

Pat Krin, MSN, M.S., RN, NCSN-E, FNP-BC-Retired, FNASN

Posted 06-07-2018 10:40 AM

Debi, it would help to know what was so complicated in scheduling your exam. It should be a relatively simple process. It appears that there is only one Prometric test center in Maine, which is a fairly large state I know, but if you let me know what difficulties your experienced perhaps we could discover where a breakdown might have occurred.

Pat

Pat Krin, MSN, RN, FNP-BC, NCSN, FNASN

Executive Director

National Board for Certification of School Nurses

www.nbcsn.org

nbcsnexec@nbcsn.org

------Original Message------

I recall learning way back when that nurses had to have a provider's order
to give any medicine to a patient. I don't think that has changed. I have
a sheet of standing orders most of which specify that I can only give these
with written permission of the parent/guardian and the dosage is to be
determined by the instructions on the bottle. Any medicine I don't stock,
such as bug spray or sunscreen are not on my list and require the child's
provider and their parent/guardian signatures to give.

BTW, what seemed against all odds just a week ago has finally happened:
I've got my test scheduled and I only have to drive for an hour to get to
the testing spot!! I understand now the thrill all of you seemed to get
once you were all scheduled. My question is why does it have to be so
complicated?

Debi

--
"We cannot change the direction of the wind but we CAN adjust the sails"

Debi Blank, RN, BSHE
School Nurse
Trenton Elementary School
51 School Rd
Trenton, Maine 04605
deborah.blank@mdirss.org

Confidentiality Notice: This email message, including any attachments, is
for the sole use of the intended recipient(s) and may contain confidential
and privileged information. Any unauthorized review, use, disclosure, or
distribution is prohibited. If you are not the intended recipient, please
contact the sender by reply email and destroy/delete all copies of the
original message. Thank You.

11. RE: Week #5: Let's Keep the Momentum Going!

Like

Bernadette Berset, MSN, RN, NCSN

Posted 06-06-2018 08:20 AM

For this question, I thought of previous advice I have been given to remember that the exam is national. While I do not need medical provider sign off for OTC's (and as Robin confirmed), other jurisdictions do. I constantly remind myself to think big picture as opposed to my exact practice situation.

--

Bernadette Berset, MSN, RN

School Nurse
6600 Little Falls Road Arlington, VA 22213
TEL: 703-237-1443; FAX: 703-237-1465

WWW.BISHOPOCONNELL.ORG

Notice: This e-mail (including attachments) is confidential and may contain individual patient health information. The use and disclosure of information contained in this email is restricted by the Health Insurance Portability and Accountability Act of 1996 and is protected under The Privacy Act of 1974. It is intended only for the use of the individual(s) to whom it is addressed. This material must be destroyed appropriately when its use is no longer required. If the reader of this message is not the intended recipient(s) or the employee or agent responsible for delivering the attached information to the intended recipient(s), please note that any dissemination, distribution or copying of this communication is strictly prohibited. Anyone who receives this communication in error should notify the sender immediately, delete it from your system and destroy any copies.

------Original Message------

Regarding this question, "What authorizations apply to the dispensing of medications to students during school hours", is medical practitioner authorization needed for over the counter medications?

I thought the signature of a medical practitioner was needed only for prescription medication or OTC medications doses that are higher than the dosing on the box.

Rebecca West MSN RN CNE

Coordinator of Health Services, Washington Township Schools

rwest@msdwt.k12.in.us

Cell 317-363-7955

Fax 317-259-5298

--------------------------------------------------------------------------------------------------------------------- This e-mail and any attachments are from a sender at the Metropolitan School District of Washington Township in Indianapolis, Indiana. They are intended for the named recipients and may contain information that is confidential or privileged under Indiana and Federal Law. Any error in addressing or sending this e-mail is not a waiver of confidentiality and does not consent to copying or distribution of this e-mail or attachments. If you receive this e-mail in error, please notify the sender of the error by return e-mail and delete this e-mail and its attachments. If there is a need to speak to the sender, please call [317] 845-9400 and they can provide you with contact information.

12. RE: Week #5: Let's Keep the Momentum Going!

Like

Pat Krin, MSN, M.S., RN, NCSN-E, FNP-BC-Retired, FNASN

Posted 06-06-2018 08:43 AM

Bernadette, that is wonderful advice. One of the comments we get when we survey our new certificants is that the exam did not reflect their practice. It is not a comment that we get frequently, perhaps once per exam. School nursing is very different throughout the country, it varies state to state and in some states district to district. It is important to remember that the test is global. When information is asked about immunizations the correct answer will reflect CDC guidelines. While some states or districts require HPV vaccine for adolescents, many don't so if HPV were in the answer of a list of vaccines required for school that would not be the correct choice. Some districts still require TB screening prior to school entry, but that is not a CDC recommendation.

As far as medications go, nurse practice acts universally require physician's orders for medications, but some states have laws or regulations that allow school nurses to give OTCs without a physician's order.

We have all heard the phrase thing globally, shop locally. For the NCSN exam forget shopping locally, just think globally.

Best of luck to all who are taking the summer exam. Hope to see you in Baltimore. Visit us at booth 111.

Pat Krin, MSN, RN, FNP-BC, NCSN, FNASN

Executive Director

National Board for Certification of School Nurses

www.nbcsn.org

nbcsnexec@nbcsn.org

------Original Message------

For this question, I thought of previous advice I have been given to remember that the exam is national. While I do not need medical provider sign off for OTC's (and as Robin confirmed), other jurisdictions do. I constantly remind myself to think big picture as opposed to my exact practice situation.

--

Bernadette Berset, MSN, RN

School Nurse
6600 Little Falls Road Arlington, VA 22213
TEL: 703-237-1443; FAX: 703-237-1465

WWW.BISHOPOCONNELL.ORG

Notice: This e-mail (including attachments) is confidential and may contain individual patient health information. The use and disclosure of information contained in this email is restricted by the Health Insurance Portability and Accountability Act of 1996 and is protected under The Privacy Act of 1974. It is intended only for the use of the individual(s) to whom it is addressed. This material must be destroyed appropriately when its use is no longer required. If the reader of this message is not the intended recipient(s) or the employee or agent responsible for delivering the attached information to the intended recipient(s), please note that any dissemination, distribution or copying of this communication is strictly prohibited. Anyone who receives this communication in error should notify the sender immediately, delete it from your system and destroy any copies.

13. RE: Week #5: Let's Keep the Momentum Going!

Like

Ann Behnke, MS, RN, CSN

Posted 06-06-2018 08:47 AM

Thank you for the questions. They are so helpful. Sometimes I read too much into the question. When I went from question #2 to question #3, I saw the words "the same student" and assumed it referred back to the student in question #2 and I changed my answer from C to D. If there ever were to be a 2 part question, can I assume that it would be made abundantly clear and if I see wording like "the same student" it would refer to the student in that question alone?
Thank you very much!

------------------------------
Ann Behnke RN, MS, CSN
Certified School Nurse
Reach Cyber Charter School
Carlisle, PA
------------------------------

Original Message

14. RE: Week #5: Let's Keep the Momentum Going!

Like

Pat Krin, MSN, M.S., RN, NCSN-E, FNP-BC-Retired, FNASN

Posted 06-06-2018 09:47 AM

Interesting observation Ann. I did the same thing. Sample questions are just that and do not go through the rigors that official exam questions do. Scenarios that are multi question in format are noted with something like the next two questions are related to the following scenario.

This might be a good opportunity to let you know how official item writing works. When all of you who are taking the exam pass it, you too can be a "subject matter expert" (SME) and become involved in test development activities.

Test development activities are varied. There are Item Writing, Item Review, Pool Review, Form Review, PIA (Problem item Analysis) calls, and every 5-7 years a Job Analysis or Role Delineation Study. NBCSN is currently completing a Job Analysis .

Official exam questions go through a multi-stage process. It can be done either in person or remotely. It starts with an introductory "course" on item writing given by an employee of the testing company. Each SME is instructed as to how to write a question, the various parts of a question, specific pitfalls, etc. Then these SMEs develop questions including a rationale for the correct answer as well as a reference for the question and provide the "key" or correct answer.

Those questions are then reviewed by a different group of SMEs, including a testing company employee, who are also instructed about what makes a good question (Item Review). The newly written questions are either accepted as is, revised, or not accepted.

Once items are accepted they are put in a Pretest Bank. When Form Review (with a different group of SMEs and testing company employee) takes place each version or form of the test (there are three each year) uses 25 of those pretest questions. Pretest questions are not scored for or against the exam candidate.

At the end of the exam window all 200 questions on the test including the pretest items are examined statistically by a psychometrician to determine a number of parameters on how each performed. Any questions that did not perform as expected (for any number of reasons) will be flagged for a PIA call ,with yet a different group of SMEs and testing company employee, who will discuss the questions to determine whether to questionable items should be counted in the score. Items are either approved as they are, removed for revision (which means they don't count for or against the exam candidate) or they are archived, not to be used again (which means they don't count for or against the exam candidate).

I hope you found this helpful, let me know if I can give you any more information on how test development works.

Pat Krin, MSN, RN, FNP-BC, NCSN, FNASN

Executive Director

National Board for Certification of School Nurses

www.nbcsn.org

nbcsnexec@nbcsn.org

------Original Message------

Thank you for the questions. They are so helpful. Sometimes I read too much into the question. When I went from question #2 to question #3, I saw the words "the same student" and assumed it referred back to the student in question #2 and I changed my answer from C to D. If there ever were to be a 2 part question, can I assume that it would be made abundantly clear and if I see wording like "the same student" it would refer to the student in that question alone?
Thank you very much!

------------------------------
Ann Behnke RN, MS, CSN
Certified School Nurse
Reach Cyber Charter School
Carlisle, PA
------------------------------

15. RE: Week #5: Let's Keep the Momentum Going!

Like

Shirley Gordon, PhD, RN, NCSN, AHN-BC, HWNC-BC

Posted 06-06-2018 11:54 AM

This is an excellent summary of our item and exam development activities! Thank you for sharing it Pat!

I have been following the discussions related to the practice questions and answers and would like to emphasize that the NCSN exam questions and answers reflect national standards.

As subject matter experts from around the country write and review questions and evaluate the statistical analysis of pre-test questions that do not perform as expected, one consideration is whether or not the question and/or answer reflects a state or regional expectation rather than a national standard. Questions/answers that do not reflect a national standard do not go forward.

Let me join Pat in encouraging you to volunteer to become a subject matter expert (SME) upon successfully passing the NCSN exam! We select NCSNs with varying years of experience, time certificated, position, education, and geographic location to ensure the NCSN exam reflects current school nurse practice at the national level.

I am wishing you all great success!

Shirley C. Gordon PhD, RN, NCSN, AHN-BC

President, NBCSN

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