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Practice Question

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

Pat Krin, MSN, M.S., RN, NCSN-E, FNP-BC-Retired, FNASN05-25-2023 11:51 AM

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

Pat Krin, MSN, M.S., RN, NCSN-E, FNP-BC-Retired, FNASN05-26-2023 08:51 AM

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

Pat Krin, MSN, M.S., RN, NCSN-E, FNP-BC-Retired, FNASN05-30-2023 05:13 AM

  • 1.  Practice Question

    Posted 05-25-2023 11:51 AM

    I would like to discuss this month's Challenge the School Nurse Question. For those of you who don't know NBCSN publishes a Challenge the School Nurse Question every month Sept.-June in School Nurse Digest and then it is published on our website, at the end of each year, we publish all 10 questions in our Challenge the School Nurse Archive.

    One of our officers questioned this month's answer so I think it would be a good exercise to discuss the question here.

    A teacher questions why they might be experiencing visual issues and a funny feeling in their face. The nurse's first action would be to *

    A.    Activate EMS,

    B.    Obtain vital signs,

    C.    Advise he call his PCP,

    D.    Ask if he takes any medication.

    Please choose what you think is the correct answer and explain why it is correct. Also please explain why you think the other answers are incorrect.



    ------------------------------
    Pat Krin, MSN, MSCP, RN, FNP-BC-Retired, NCSN-E, FNASN
    Executive Director
    NBCSN
    nbcsnexec@nbcsn.org
    www.nbcsn.org
    ------------------------------


  • 2.  RE: Practice Question

    Posted 05-26-2023 08:23 AM

    Hello Pat,
    D - Still need to gather more information (Assessing) 
    Not A - Unless there is a serious breathing issue
    Not B - You do this as you are collecting the more information
    Not C - PCP would be a call that the parents should make under the advisement of the Nurse once all the information is collected and no life threating issues are in play



    ------------------------------
    Rogelio Rodriguez Jr.
    Wilmington, DE United States
    ------------------------------



  • 3.  RE: Practice Question

    Posted 05-26-2023 08:36 AM

    I will say I had already answered this question on the exam prep page - and I got it "wrong" I do agree with it being quesitoned.

    I think it is to vague to choose A. Activate EMS. I chose B obtain vital signs. If an adult came to me and said they had blurred vision and their face "felt funny" (NOT drooping or slurred speech) I would definitely investigate more (quickly!) before calling EMS..  While taking their vitals I would be asking about their medications... they could have a hx of migraines or low blood sugar etc..  In that 3 minutes if I can't find a "good reason" for these symptoms then I would call 911 if the alert and oriented adult agreed (we can't make adults who are with it and capable of making decisions utilize 911) 



    ------------------------------
    Sarah Casteline, RN , BSN
    Middle School Nurse
    Union County, NC
    ------------------------------



  • 4.  RE: Practice Question

    Posted 05-26-2023 08:51 AM
    Thank you Sarah and Roger. I hope a few more people will answer before we discuss this. No one will be judged. This is the perfect question to have a discussion about and the process each person goes through to come to
    a particular answer.
    Sent from my iPhone
    Pat Krin





  • 5.  RE: Practice Question

    Posted 05-29-2023 08:21 AM

    Sarah, This was my thought process, too....
    I did end up choosing A - call EMS because better to be safe than sorry and while waiting for EMS to come, then I would take v/s, take medication history, etc...



    ------------------------------
    Sandey Stayanoff, MSN-NE, MSN-SN, BSN, DN, RN
    OSHNA Online Forum Manager
    International School Nurse
    Nova International School
    Skopje 1000, Macedonia
    ------------------------------



  • 6.  RE: Practice Question

    Posted 05-26-2023 09:25 AM
    Good morning,
    I also answered this question and got it wrong. 
    I would choose B and obtain VS while I am asking pertinent questions such as in D in regards to medications. If VSS and the teacher is A&O then I would advise them to call their PCP (C). If VS are not stable or other assessments are "off" I would then advise to call EMS.






  • 7.  RE: Practice Question

    Posted 05-26-2023 09:30 AM

    HI Pat,
    My answer would be B-Obtain vital signs. My reasoning is because the question asks for first "action". While doing so I would be asking about meds-D Then activate EMS if necessary



    ------------------------------
    Denise Silva
    Dedham, MA United States
    ------------------------------



  • 8.  RE: Practice Question

    Posted 05-26-2023 09:30 AM

    My initial thought was call EMS (A), but the statement was, "they had blurred vision and their "face felt funny" so I did not feel (A) was the first action necessary. It could be Bell's Palsy which is not typically an emergent situation.

    My answer would be (B) Check vitals. While checking the vital signs, I would continue my triage assessment of medical hx, medications, etc. Depending on the results of the vital signs, I would call EMS and school administrator.  If the adult patient stated they did not want EMS called, I would explain that it is the standard of practice and when EMS arrived they could refuse their services.

    (C) I would not just recommend they follow up with their PCP as this could be the beginning stages of a CVA.

    (D) This is not correct and would be assessed during triage and vital signs.

    --
    If you have any questions or concerns please contact me.

    Thank you. 

    Andrea      
     
    Andrea Ferguson, BSN, RN, CSN
    BPSB Health Services Coordinator              
    DeRidder High School Nurse
    DeRidder, LA  70634
    337-463-3266 x10215
     
           Louisiana 
    School Health Provider 
        of the Year 2022

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  • 9.  RE: Practice Question

    Posted 05-26-2023 09:31 AM

    Hello,

    I would choose C because it seems like there is no immediate danger but they need to reach out to their PCP asap for an evaluation, we could do an assessment but ultimately I think advising them the call their PCP is the most accurate. I think A is wrong because again the teacher is simply asking for advice, there is no indication that EMS is needed at this time. I think B is wrong because I think the teacher is not in distress and is only asking for advice, we could but we still have to refer them to their PCP, we can't diagnose. It is not D because although a nurse could do an assessment, I do not think it is warranted because this is a school setting, and unless it is an emergency we should stick with caring for the children and again we can not diagnose.




    ------------------------------
    Beverly R Jordan MSN, RN, CSN
    School District of Philadelphia
    Philadelphia, PA
    ------------------------------



  • 10.  RE: Practice Question

    Posted 05-26-2023 11:43 AM

    I think checking vital signs is correct only because it can give you some data even though it will not officially diagnose the problem itself.  Activating EMS would not be the first thing I did because this situation does not need immediate attention unless they would have a drooping face and if so then 911 would be called but since those details are not visible then calling 911 is not needed as of yet.  Calling the PCP and asking about medication is important would be what I would suggest after I did the vital signs and did not get any clearer picture of hat is going on.



    ------------------------------
    Leigh Arbaugh RN
    Stuarts Draft, VA United States
    ------------------------------



  • 11.  RE: Practice Question

    Posted 05-26-2023 09:32 AM
    Edited by Beverly Jordan, MSN, RN, NCSN 05-26-2023 09:37 AM

    Sorry I did not fully complete the question earlier, so I posted again and edited this one.



    ------------------------------
    Beverly Jordan MSN, RN, CSN
    The School District of Philadelphia
    Philadelphia, PA United States
    ------------------------------



  • 12.  RE: Practice Question

    Posted 05-26-2023 09:44 AM
    Hi
    I would choose B. While doing vital signs I would ask more follow up questions and base my interventions off of my assessment.
    Kendra

    Sent from my iPhone




  • 13.  RE: Practice Question

    Posted 05-26-2023 10:29 AM
    Hi,
    I saw this question on the NBCSN website and my first answer was B., obtain vital signs.
    The answer from NBCSN was to activate EMS, which makes sense. Activate EMS and then get vital signs due to the possibility that the teacher is having a stroke?
    I eliminated C and D.
    What are other people's thoughts?

    --
    Charlene McCarron, RN, BSN
    School Nurse
    David R. Cawley Middle School
    603-518-5047 x5138



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  • 14.  RE: Practice Question

    Posted 05-26-2023 10:46 AM
    Hi Charlene. I had the same answer you did and was a little surprised by the correct answer. I would always do a brief assessment before activating 911. This was definitely a tough one.

    Sent from my iPhone




  • 15.  RE: Practice Question

    Posted 05-26-2023 10:49 AM
    I agree. This was a tough one.

    --
    Charlene McCarron, RN, BSN
    School Nurse
    David R. Cawley Middle School
    603-518-5047 x5138



    The Right-To-Know Law provides that most e-mail communications, to or from School District employees regarding the business of the School District, are government records available to the public upon request.  Therefore, this e-mail communication may be subject to public disclosure. This e-mail is intended solely for the person or entity to which it is addressed and may contain confidential and/or privileged information. Any review, dissemination, copying, printing, or other use of this e-mail by persons or entities other that the addressee is strictly prohibited. If you receive this e-mail in error, please notify the sender immediately and delete the material from any device.





  • 16.  RE: Practice Question

    Posted 05-26-2023 10:56 AM
    If the thought was the teacher is having a stroke and they presented with facial drooping I would have definitely called 911 immediately. 
    Since the complaint was visual issues and funny feeling face I still believe I would do vitals 1st.





  • 17.  RE: Practice Question

    Posted 05-26-2023 11:00 AM

    me too.



    ------------------------------
    Sarah Casteline, RN , BSN
    Middle School Nurse
    Union County, NC
    ------------------------------



  • 18.  RE: Practice Question

    Posted 05-29-2023 09:07 PM

    I would do the same.  



    ------------------------------
    SJ Valdez RN, BSN
    School Nurse
    SOUTH TEXAS ISD
    Edinburg, TX United States
    ------------------------------



  • 19.  RE: Practice Question

    Posted 05-26-2023 11:14 AM

    A. This teacher could be having a stroke so calling EMS would be the best answer.  
    B. and D. Are obtaining more information  and assessing so they would cancel each other out. 

    C. PCP would delay tx.
    This was my first response. After reading the question for a second time I realized it was the teacher and not a student. I would be more concerned of stroke. 



    ------------------------------
    Denise Schooley
    GOODYEAR, AZ United States
    ------------------------------



  • 20.  RE: Practice Question

    Posted 05-26-2023 12:54 PM
    I think A due to possible stroke (not what happens in real life) Think you are not in the hospital setting so what is the safest answer. I called EMS yesterday and it took 45mins for them to get here. Of course this is an adult that has the right to refuse transport. 





  • 21.  RE: Practice Question

    Posted 05-26-2023 01:55 PM
    In real life I would do the "BE FAST" assessment first or at the same time. 





  • 22.  RE: Practice Question

    Posted 05-26-2023 11:58 AM
    Edited by Bernadette Berset, MSN, RN, NCSN 05-26-2023 12:10 PM

    Dear Pat,

    I must admit I did not think this question (cut and pasted below) was straightforward. I chose answer B: "obtain vital signs as the answer". It was deemed wrong. 

    However, my thinking was there "could be" many causes of "a funny feeling" to their face with visual issues. In fact I recently had an individual present with a "funny tingling feeling to their face and eye".  As we worked with the individual we learned they had an itchy scalp and say the first blisters erupting. The person was diagnosed later that day with shingles tracking the optic nerve. Definitely, a historical experience like this would not preclude the possibility the person in the scenario was having a stroke but I add this information to all the possible avenues that must be explored as the individual presents.

    By getting a set of vital signs, I may identify hypertension, possibly see more symptoms such as weakness, pupil reaction abnormalities. I would continue assessing in case facial droop identified. All this information would be helpful should I contact EMS. Answers C and D could be relevant but would not be the "first" action. There is no mention of acute respiratory or cardiac decompensation which would necessitate immediate EMS activation. 

    Bernadette Berset MSN, RN, NCSN

    Question:

    A teacher questions why they might be experiencing visual issues and a funny feeling in their face. The nurse's first action would be to *

     

    A.    Activate EMS,

    B.    Obtain vital signs,

    C.    Advise he call his PCP,

    D.    Ask if he takes any medication.



    ------------------------------
    Bernadette Berset, MSN, RN, NCSN
    Certified School Nurse
    Vienna, VA.
    ------------------------------



  • 23.  RE: Practice Question

    Posted 05-26-2023 12:56 PM
    I'm going with B.  It could be a number of issues and the nurse can have someone else call EMS while he or she is collecting vitals.  Plus that info will be needed anyway for EMS.

    On Thu, May 25, 2023 at 10:51 AM Pat Krin, MSN, M.S., RN, NCSN-E, FNP-BC-Retired, FNASN via National Association of School Nurses <Mail@connectedcommunity.org> wrote:
    I would like to discuss this month's Challenge the School Nurse Question. For those of you who don't know NBCSN publishes a Challenge the School...

    National Certification Exam Candidates

    Post New Message
    Practice Question
    Reply to Group Reply to Sender
    May 25, 2023 11:51 AM
    Pat Krin, MSN, M.S., RN, NCSN-E, FNP-BC-Retired, FNASN

    I would like to discuss this month's Challenge the School Nurse Question. For those of you who don't know NBCSN publishes a Challenge the School Nurse Question every month Sept.-June in School Nurse Digest and then it is published on our website, at the end of each year, we publish all 10 questions in our Challenge the School Nurse Archive.

    One of our officers questioned this month's answer so I think it would be a good exercise to discuss the question here.

    A teacher questions why they might be experiencing visual issues and a funny feeling in their face. The nurse's first action would be to *

     

    A.    Activate EMS,

    B.    Obtain vital signs,

    C.    Advise he call his PCP,

    D.    Ask if he takes any medication.

     

    Please choose what you think is the correct answer and explain why it is correct. Also please explain why you think the other answers are incorrect.



    ------------------------------
    Pat Krin, MSN, MSCP, RN, FNP-BC-Retired, NCSN-E, FNASN
    Executive Director
    NBCSN
    nbcsnexec@nbcsn.org
    www.nbcsn.org
    ------------------------------
      Reply to Group Online   View Thread   Recommend   Forward  



     
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    --
    "LOVE one another."
                               -John 13:34 NIV

    Johnna McKinley, BSN RN
    Lake Schools Zone
    (601)775-3011






  • 24.  RE: Practice Question

    Posted 05-26-2023 02:08 PM
    I would take vital signs as I instruct someone else to call 911 so my answer is B







  • 25.  RE: Practice Question

    Posted 05-29-2023 10:09 AM

    I chose A.  The question indicated a couple of possible symptoms of stroke.
    In the event of a stroke, the sooner they can get thrombolytics, the better, so I want to get them care immediately.
    There is no VS finding that will rule out stroke, as there won't be a medication that they took that will rule out the possibility of stroke, so no matter what those showed, I'm inclined to activate EMS based on symptoms alone. Also -- the two choices of history/assessment were very closely related, so I thought those two could possibly be ruled out because they were so alike.



    ------------------------------
    Crystal Jarrett RN, BSN
    Nurse
    PROSPER ISD
    Howe, TX United States
    ------------------------------



  • 26.  RE: Practice Question

    Posted 05-30-2023 05:13 AM

    Let's keep asking about questions you don't understand. Make sure you are looking at the Rationale and References for questions you got wrong. Don't be afraid to discuss them.  That is how we all learn.

    Now this question has garnered a lot of discussions. The first thing I would recommend if you get an answer wrong is to look at the rationale and the reference for the question. See if you can see why you might have gotten it incorrect,
    So while this might not be the best question or at least many don't agree with it (34% got it correct - 66% got it incorrect (48% said take vital signs) if we look at the reference and rationale A is the correct answer.  This is probably the type of question that when it got to item reveiw might be edited or tossed.

    A teacher questions why they might be experiencing visual issues and a funny feeling in their face. The nurse's first action would be to

    A.    Activate EMS

    B.    Obtain vital signs, 

    C.    Advise he call his PCP,

    D.    Ask if he takes any medication.

    Rationale: Activation of 911 is essential in order to get treatment started as fast as possible.
    Reference: https://www.cdc.gov/stroke/signs_symptoms.htm

    Numbness or weakness in one side of the face, Vision problems in one or both eyes.

    What are the signs of stroke in men and women?

    • Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
    • Sudden confusion, trouble speaking, or difficulty understanding speech.
    • Sudden trouble seeing in one or both eyes.
    • Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
    • Sudden severe headache with no known cause.

    Call 9-1-1 right away if you or someone else has any of these symptoms.







    I would like to discuss this month's Challenge the School Nurse Question. For those of you who don't know NBCSN publishes a Challenge the School Nurse Question every month Sept.-June in School Nurse Digest and then it is published on our website, at the end of each year, we publish all 10 questions in our Challenge the School Nurse Archive.<o:p></o:p>










    One of our officers questioned this month's answer so I think it would be a good exercise to discuss the question here.<o:p></o:p>

    A teacher questions why they might be experiencing visual issues and a funny feeling in their face. The nurse's first action would be to *<o:p></o:p>

    <o:p> </o:p>

    A.    Activate EMS,<o:p></o:p>

    B.    Obtain vital signs,<o:p></o:p>

    C.    Advise he call his PCP,<o:p></o:p>

    D.    Ask if he takes any medication.<o:p></o:p>



    ------------------------------
    Pat Krin, MSN, MSCP, RN, FNP-BC-Retired, NCSN-E, FNASN
    Executive Director
    NBCSN
    nbcsnexec@nbcsn.org
    www.nbcsn.org
    ------------------------------


  • 27.  RE: Practice Question

    Posted 05-30-2023 07:27 AM
    Even with the rationale, I still stand by my answer of getting vital signs.  The question is extremely vague.  It doesn't mention that she feels the funny feeling in one side or the other.  She could simply be experiencing atypical migraines.  The question also doesn't mention the severity of or how often she is experiencing these symptoms.  It doesn't even mention when the symptoms started.  Obtaining vital signs would show if her heart rate or blood pressure was elevated which could show cause for concern of a stroke more so than the vague symptoms.  

    On Tue, May 30, 2023 at 4:12 AM Pat Krin, MSN, M.S., RN, NCSN-E, FNP-BC-Retired, FNASN via National Association of School Nurses <Mail@connectedcommunity.org> wrote:
    Let's keep asking about questions you don't understand. Make sure you are looking at the Rationale and References for questions you got wrong. Don...

    National Certification Exam Candidates

    Post New Message
    Re: Practice Question
    Reply to Group Reply to Sender
    May 30, 2023 5:13 AM
    Pat Krin, MSN, M.S., RN, NCSN-E, FNP-BC-Retired, FNASN

    Let's keep asking about questions you don't understand. Make sure you are looking at the Rationale and References for questions you got wrong. Don't be afraid to discuss them.  That is how we all learn.

    Now this question has garnered a lot of discussions. The first thing I would recommend if you get an answer wrong is to look at the rationale and the reference for the question. See if you can see why you might have gotten it incorrect,
    So while this might not be the best question or at least many don't agree with it (34% got it correct - 66% got it incorrect (48% said take vital signs) if we look at the reference and rationale A is the correct answer.  This is probably the type of question that when it got to item reveiw might be edited or tossed.

    A teacher questions why they might be experiencing visual issues and a funny feeling in their face. The nurse's first action would be to

    A.    Activate EMS

    B.    Obtain vital signs, 

    C.    Advise he call his PCP,

    D.    Ask if he takes any medication.

    Rationale: Activation of 911 is essential in order to get treatment started as fast as possible.
    Reference: www.cdc.gov/stroke/signs_symptoms.htm

    Numbness or weakness in one side of the face, Vision problems in one or both eyes.

    What are the signs of stroke in men and women?

    • Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
    • Sudden confusion, trouble speaking, or difficulty understanding speech.
    • Sudden trouble seeing in one or both eyes.
    • Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
    • Sudden severe headache with no known cause.

    Call 9-1-1 right away if you or someone else has any of these symptoms.






      Reply to Group Online   View Thread   Recommend   Forward  




     
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    Original Message:
    Sent: 5/30/2023 5:13:00 AM
    From: Pat Krin, MSN, M.S., RN, NCSN-E, FNP-BC-Retired, FNASN
    Subject: RE: Practice Question

    Let's keep asking about questions you don't understand. Make sure you are looking at the Rationale and References for questions you got wrong. Don't be afraid to discuss them.  That is how we all learn.

    Now this question has garnered a lot of discussions. The first thing I would recommend if you get an answer wrong is to look at the rationale and the reference for the question. See if you can see why you might have gotten it incorrect,
    So while this might not be the best question or at least many don't agree with it (34% got it correct - 66% got it incorrect (48% said take vital signs) if we look at the reference and rationale A is the correct answer.  This is probably the type of question that when it got to item reveiw might be edited or tossed.

    A teacher questions why they might be experiencing visual issues and a funny feeling in their face. The nurse's first action would be to

    A.    Activate EMS

    B.    Obtain vital signs, 

    C.    Advise he call his PCP,

    D.    Ask if he takes any medication.

    Rationale: Activation of 911 is essential in order to get treatment started as fast as possible.
    Reference: https://www.cdc.gov/stroke/signs_symptoms.htm

    Numbness or weakness in one side of the face, Vision problems in one or both eyes.

    What are the signs of stroke in men and women?

    • Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
    • Sudden confusion, trouble speaking, or difficulty understanding speech.
    • Sudden trouble seeing in one or both eyes.
    • Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
    • Sudden severe headache with no known cause.

    Call 9-1-1 right away if you or someone else has any of these symptoms.








  • 28.  RE: Practice Question

    Posted 05-30-2023 09:28 AM
    Johnna, I agree with you that the question is vague. There is no mention of sudden numbness or weakness in the face, just a "funny feeling." Was it sudden? Was it numbness? Was it weakness? There is also no mention of sudden trouble seeing, just "visual issues." Again, we do not know if this was sudden.

    Carrie Smith, BSN, RN

    Program Specialist - School Health
    Region 5 Education Service Center
    350 Pine St., Suite 500
    Beaumont, TX 77701
    (409) 951-1767



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  • 29.  RE: Practice Question

    Posted 05-30-2023 01:31 PM

    I would chose A on this as it is "the safest" response. However, the question in vague and in a real-life situation if this were to happen, I think I would honestly get vitals first. But for testing, I remember the safest answer is usually the correct answer. 



    ------------------------------
    Alenna LeCompte
    Waxhaw, NC United States
    ------------------------------