Supporting Students with Special Health Care Needs quiz

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Can you teach students with complex medical conditions in inclusive classrooms?

Smiling young boy in adaptive chair with school bus in the backgroundIncluding children with and without disabilities in the same class has proven benefits to everyone in the class, but what about students who require specialized equipment or care? What does it take to provide a safe and positive learning environment for everyone?

Test your knowledge with this quiz, adapted from Supporting Students with Special Health Care Needs: Guidelines and Procedures for Schools, Third Edition edited by Stephanie M. Porter, M.S.N., RN; Patricia A. Branowicki, MS, RN, NEA-BC, FAAN; & Judith S. Palfrey, M.D.

See how well you do, and discover what has been made possible by advances in medical technology, training, and coordination of care.

Supporting Students with Special Health Care Needs quiz

Question 1

Which of the following conditions would preclude students from attending their local school?

A
Spinal cord injury
B
A developmental disability with mild cerebral palsy
C
Sickle cell anemia
D
Bipolar disorder and ADHD
E
None of the above
Question 1 Explanation: 

E. None of the above. With careful planning, training, and health services support, none of the above conditions alone should preclude students from attending their local public school.

With technological advances and appropriate support systems in place, an increasing number of children and youth with complex medical conditions are attending schools in their home communities.

Educators, school staff, and family members are in a position to develop school programs that provide students with an educational experience that addresses the academic, social, emotional, and vocational needs of the child while ensuring all special health care needs are met.

Question 2
Under IDEA, which requested health service would a school NOT be required to provide under the umbrella of "related services"?
A
Administration of medication
B
Gastronomy tube feeding
C
Replacement of cochlear implants
D
Catheterization
E
Teaching self-care in a school setting
Question 2 Explanation: 

C. Replacement of cochlear implants. IDEA specifically excludes implantation or replacement of surgical devices, such as cochlear implants.

Schools are not expected to provide medical services; however, school health and nurse services are included in IDEA's definition of "related services" that a school must provide as a component of a child's FAPE (free and appropriate education).

The U.S. Supreme Court has ruled that school health services

  • must be provided if they can be performed by a nurse or other qualified person (not if they must be performed by a physician)
  • if the service must be provided during the school day, and
  • if the service will not prove unduly expensive for the school
Question 3
What is the national standard for school-nurse-to-student staffing ratios?
A
There is no national staffing standard
B
1:750 for students in the general population
C
1:225 in student populations that may require daily professional nursing services or interventions
D
1:125 in student populations with complex health care needs
E
1:1 for students who require daily and continuous professional nursing services
Question 3 Explanation: 

A. There is no national staffing standard. Although school nurses are vital to all aspects of care and service delivery for children with specialized health needs, school nurses are not available in all schools. More than 50% of public schools in the United States do not have a full-time registered nurse.

The safe and appropriate management of care for children with complex medical conditions requires careful assessment and individualized health care planning by a registered nurse.

The National Association of School Nurses recommends that school districts provide at least one full-time school nurse in every school building with variation depending on the needs of student populations. The ratios listed above are minimum ratio recommendations by the association.

Question 4
Families of children with special health care needs look to school nurses to do all of the following EXCEPT:
A
Value their child and not see him or her as a myriad of health problems
B
Value the role that parents play in the child's life and in the daily treatment and management of the child's condition
C
Partner with them and the health care provider to establish goals for school learning
D
Provide respite care for the family
E
Provide open communication with all health care providers and advocates involved in the child's and family's life
Question 4 Explanation: 

D. School nurses do not formally provide respite care for the family, but they do play a vital role in reassuring families of their child's safety in school.

Question 5
Where do school districts get funding to support school nursing services?
A
Title I and special education monies
B
Third-party payers, such as Medicaid or private insurance
C
Children's Health Insurance Program (CHIP)
D
Nursing services from town/city public-health departments
E
All of the above
Question 5 Explanation: 

E. All of the above. Most school districts utilize multiple sources to fund or supplement their costs.

In addition to the sources listed, districts have found

  • local funding
  • special state-designated funds
  • state-funded grants (school reform, educational enhancement, systems change, specialized taxes), and
  • support from local philanthropic organizations or foundations
Question 6
What is NOT a basic element of a student's Individualized Health Care Plan?
A
Diet, nutrition, and feeding
B
Equipment list
C
Student- and school-specific emergency plan
D
Transition plan
E
Transportation information
Question 6 Explanation: 

D. Although very important, the transition plan is not part of the IHCP. The IHCP can be a part of the student's transition plan.

Other elements of the IHCP include

  • brief health history
  • baseline health status
  • comprehensive review of medications
  • self-care
  • problem list/nursing diagnosis
  • desired outcomes
  • interventions
  • provider and contact information
  • training and documentation
  • implementation and awareness

A critical element of the individualized health care plan is training; see this guidance on training as part of the IHCP from Supporting Students with Special Health Care Needs.

Question 7
Districts play a vital role by ensuring administrators have what they need to address all of the following questions EXCEPT:
A
Has the administrator received training concerning administrative issues related to students' specialized needs?
B
Has the administrator examined his or own personal responses, such as issues with his or her own comfort with chronic illness, medical technology, treatment, etc.?
C
Does the administrator have the support of the school board and community?
D
Does the administrator have assistance from qualified health care personnel and the family?
E
Have collaborative roles been delineated?
Question 7 Explanation: 

B. The administrator will have to examine his or her own personal responses. To be successful, administrators must have the support of the district, but they must also examine their own attitudes about the inclusion of students with complex health care needs.

School administrators set the tone for inclusion of students with special health care needs and have the overall responsibility for all aspects of their participation in school.

They are in key positions to influence the educational services decisions, placement, and health care that students will receive.

Question 8
What are some factors that can have an impact on learning for students with complex medical conditions?
A
Frequent school absences
B
Lack of concentration because of effects of the illness or medication
C
Lack of stamina, fatigue
D
Emotional or physical effects related to treatment
E
All of the above
Question 8 Explanation: 

E. All of the above. Other additional challenges may include

  • less time for classes/studying
  • personal concerns about acceptance and understanding of peers
  • issues with self-image, -esteem, -confidence
Question 9
Which of the following adjustments could be made for a student with special health care needs?
A
Modifying materials for visual and communication needs (braille writer, amplification system, speech-generating devise)
B
Making logistical considerations, such as rest periods or an extra set of books at home so student does not have to transport them
C
Providing opportunities for experiences missed because of illness or hospitalizations
D
Providing home- or hospital-based instruction services when a student's condition precludes him or her from attending school
E
All of the above
Question 9 Explanation: 

E. All of the above. You can also help a student with special health care needs be successful by making physical adaptations to the environment to make it fully accessible and creating an area for the student to rest, keep supplies, or use an accessible bathroom or changing table.

Question 10
To help prepare students to meet a classmate with special health care needs, all of the following are good ideas EXCEPT:
A
Having a "meet-the-student" session at the beginning of the year
B
Implementing a buddy system
C
Discouraging children from asking questions because it's "not polite"
D
Having a knowledgeable adult present to facilitate open discussion
E
Preparing for emergencies
Question 10 Explanation: 

A. It's better NOT to discourage children from asking questions. Children are naturally curious and will have questions about their classmate, especially if their medical technology or physical condition is visually obvious. Unanswered, these questions can lead to misunderstanding, anxiety, or even fear. If a child is able to communicate, giving him or her the words to use will be helpful for answering other children's questions (My G tube helps me eat).

In the case of a medical emergency, have a plan for the student and also one for the class. Depending on the situation, this can be as simple as having a staff member explain that the student "needs some privacy," or it could mean that someone needs to take the class quickly and quietly to another room. Also plan to talk to the class afterward, as appropriate.

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