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COHN(C) practice questions

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Question 1Occupational Health Nursing Practice and Professional Role

Which professional document defines the scope of practice and standards for occupational health nursing in the United States?

  1. The OSHA bloodborne pathogens standard
  2. The National Council of State Boards of Nursing NCLEX test plan
  3. The Joint Commission accreditation manual for ambulatory care
  4. The AAOHN Code of Ethics and Standards of Occupational and Environmental Health Nursing Correct answer.

Explanation

Occupational health nursing practice in the United States is guided by the professional standards and code of ethics published by the American Association of Occupational Health Nurses. These documents describe competencies, scope, and ethical obligations rather than regulatory or licensing requirements. Other listed documents address accreditation, workplace safety regulation, or general licensure examination content.

Question 2Occupational Health Nursing Practice and Professional Role

An occupational health nurse is asked to lead a workplace wellness committee. Which action best demonstrates the role of program planner?

  1. Conducting a needs assessment and setting measurable objectives Correct answer.
  2. Documenting each employee's immunization history in the medical record
  3. Referring employees with abnormal screening results to their providers
  4. Reporting injury trends to the safety committee each quarter

Explanation

The planner role centers on assessing needs, defining measurable objectives, designing interventions, and evaluating outcomes. Documenting records, making referrals, and reporting trends are important activities but belong to other role components such as clinician, case manager, or coordinator. Planning specifically requires a systematic process that links identified needs to intended results.

Question 3Occupational Health Nursing Practice and Professional Role

What is the primary purpose of the occupational health nurse maintaining a confidential employee health record separate from the general personnel file?

  1. To limit access to sensitive health information to authorized persons Correct answer.
  2. To allow supervisors to review diagnoses before return-to-work decisions
  3. To satisfy marketing requirements for the employer's insurance carrier
  4. To simplify payroll deductions for health benefits

Explanation

Employee health records contain sensitive medical information and must be kept separate from personnel files so that access is restricted to those with a legitimate need. Supervisors may receive fitness-for-duty conclusions but generally should not review diagnoses. Payroll, marketing, and insurer preferences are not the rationale for confidentiality.

Question 4Occupational Health Nursing Practice and Professional Role

Under the Americans with Disabilities Act, which action by an occupational health nurse is generally permissible?

  1. Conducting genetic testing as part of a routine pre-placement physical
  2. Requesting medical documentation when an employee requests a reasonable accommodation Correct answer.
  3. Sharing an employee's diagnosis with coworkers who ask about it
  4. Asking all applicants about their history of mental illness during pre-placement screening

Explanation

The ADA allows employers to request medical documentation that is sufficient to support and evaluate a request for reasonable accommodation. Pre-offer inquiries about disability and most genetic testing are restricted, and diagnoses should not be shared with coworkers. Confidentiality of medical information is a core ADA requirement.

Question 5Occupational Health Nursing Practice and Professional Role

Which finding best indicates that an occupational health nurse is functioning in the case manager role?

  1. Serving as the recorder for the safety committee
  2. Auditing respirator fit-test records for completeness
  3. Teaching a lifting class to warehouse staff
  4. Coordinating an employee's treatment, work restrictions, and return-to-work plan with providers and supervisors Correct answer.

Explanation

Case management involves coordinating care and communication among the injured worker, treating providers, the employer, and insurers to promote timely recovery and appropriate return to work. Teaching is a health education function, auditing is quality assurance, and recording minutes is an administrative task. The distinguishing feature is coordinated management of an individual's care and work outcomes.

Question 6Occupational Health Nursing Practice and Professional Role

Which statement accurately describes the occupational health nurse's duty regarding informed consent for workplace screening programs?

  1. Consent must be obtained only after results are known
  2. Consent is unnecessary because employers require participation
  3. Consent should explain the purpose, procedures, risks, and how results are used Correct answer.
  4. Consent may be delegated entirely to the supervisor of the employee

Explanation

Informed consent requires that participants understand the purpose of a screening program, what the procedure involves, potential risks, and how results will be handled and disclosed. Employer sponsorship does not eliminate the need for consent, and consent must precede testing. Supervisors are not appropriate substitutes for obtaining consent from the employee.

Question 7Occupational Health Nursing Practice and Professional Role

Which activity is an example of primary prevention in occupational health nursing?

  1. Training workers in proper lifting mechanics before injury occurs Correct answer.
  2. Providing modified duty for an employee with a back strain
  3. Offering a smoking cessation support group
  4. Screening for hypertension at an annual health fair

Explanation

Primary prevention aims to prevent injury or illness before it occurs, and ergonomic training to reduce risky lifting behavior fits that definition. Modified duty is secondary or tertiary prevention because it addresses an existing condition, while screening seeks early detection. Smoking cessation support addresses an established risk behavior and its consequences.

Question 8Occupational Health Nursing Practice and Professional Role

Which is the most appropriate first step when an occupational health nurse identifies a pattern of needlestick injuries among staff?

  1. Wait for the next annual safety audit to address the issue
  2. Discontinue all sharps use in the facility without further review
  3. Immediately discipline the employees involved
  4. Report the pattern to the safety committee and analyze contributing causes Correct answer.

Explanation

Aggregated injury data should be analyzed for contributing factors and shared with the safety committee so that system-level controls can be implemented. Disciplinary action without cause analysis does not address system failures, and eliminating all sharps is often impractical. Waiting for a scheduled audit delays necessary prevention.

Question 9Occupational Health Nursing Practice and Professional Role

An employee reports a needlestick injury. Which action should the occupational health nurse take first?

  1. Ask the employee to complete an incident report before any care is provided
  2. Schedule a follow-up appointment in one week
  3. Wash the site with soap and water and initiate post-exposure evaluation promptly Correct answer.
  4. Notify the employee's coworkers of the exposure risk

Explanation

Immediate wound care followed by prompt post-exposure evaluation, including source assessment and prophylaxis decisions, is the priority after a bloodborne exposure. Paperwork can follow care, and disclosing the exposure to coworkers would violate confidentiality. Delaying follow-up by a week is inappropriate for time-sensitive prophylaxis.

Question 10Occupational Health Nursing Practice and Professional Role

Which situation best illustrates a conflict between the occupational health nurse's duty to the employer and duty to the employee?

  1. Teaching a voluntary nutrition class during lunch
  2. Participating in a workplace hazard assessment walkthrough
  3. Referring an employee to a personal physician for a non-occupational condition
  4. A supervisor requests information about an employee's diagnosis to decide on discipline Correct answer.

Explanation

The nurse owes confidentiality to the employee while the employer may need only fitness-for-duty information. Requests for diagnoses to inform discipline create a conflict between these obligations, and the nurse should release only information necessary for work decisions. Teaching, referral, and hazard assessment do not inherently create such conflicts.

Question 11Occupational Health Nursing Practice and Professional Role

An occupational health nurse is developing a program to reduce musculoskeletal injuries among assembly workers. Which approach reflects the hierarchy of controls?

  1. Provide back belts to all workers as the primary intervention
  2. Redesign the workstation to eliminate awkward reaches and heavy manual handling Correct answer.
  3. Offer a stretching class once per month
  4. Post a reminder sign about lifting technique

Explanation

The hierarchy of controls prioritizes eliminating or engineering out hazards before relying on administrative measures or personal protective equipment. Redesigning the workstation removes or reduces exposure at the source and is therefore the most effective approach. Signs, stretching classes, and back belts are lower-level measures that depend on worker behavior.

Question 12Occupational Health Nursing Practice and Professional Role

Which action best demonstrates the occupational health nurse's role in health promotion?

  1. Managing a workers' compensation claim
  2. Performing spirometry for respirator clearance
  3. Organizing a walking challenge with incentives and progress tracking Correct answer.
  4. Conducting a risk assessment for chemical exposures

Explanation

Health promotion activities help workers adopt and sustain healthy behaviors and are often voluntary and population-focused. A walking challenge with incentives and progress tracking fits this definition. Risk assessment, claim management, and respirator clearance are protective, case management, or surveillance functions rather than health promotion.

Question 13Occupational Health Nursing Practice and Professional Role

An employee's supervisor asks the occupational health nurse whether a worker is taking a prescribed medication. How should the nurse respond?

  1. Provide the medication name because the supervisor needs it for scheduling
  2. Disclose the information only if the medication could affect safety, and then share only work-relevant restrictions Correct answer.
  3. Tell the supervisor to ask the employee's spouse
  4. Refuse to speak with the supervisor at all

Explanation

The nurse should share only information necessary to protect safety and determine work restrictions, not the underlying diagnosis or medication list. Communicating work-relevant limitations respects both confidentiality and the employer's legitimate safety interest. Providing medication names, refusing all communication, or redirecting to a family member are inappropriate.

Question 14Occupational Health Nursing Practice and Professional Role

Which element is essential for an occupational health nurse to include when documenting an employee encounter in the health record?

  1. Only the employee's subjective complaints
  2. The supervisor's opinion of the employee's work performance
  3. A summary of unrelated visits by other employees
  4. Objective findings, nursing actions, and evaluation of the employee's response Correct answer.

Explanation

Clinical documentation should be accurate, timely, and complete, capturing objective findings, interventions, and the employee's response to care. Subjective complaints alone are insufficient, and opinions about work performance or other employees' visits do not belong in the record. Documentation supports continuity, legal defensibility, and quality improvement.

Question 15Occupational Health Nursing Practice and Professional Role

An occupational health nurse is planning spirometry screening for workers exposed to respiratory irritants. Which consideration is most important for program validity?

  1. Limiting testing to workers who volunteer first
  2. Using equipment calibration records and standardized testing technique Correct answer.
  3. Scheduling all testing at the end of a long work shift
  4. Allowing workers to skip testing if they feel well

Explanation

Valid spirometry depends on calibrated equipment and standardized technique so that results are reliable and comparable over time. Testing at the end of a shift can affect results, and allowing self-exemption or relying only on volunteers introduces bias and misses at-risk workers. Screening programs should be systematic and quality-controlled.

Question 16Occupational Health Nursing Practice and Professional Role

Which statement best describes the occupational health nurse's role in supporting an employee returning to work after surgery?

  1. Keeping the employee off work until all restrictions are permanently resolved
  2. Coordinating with the provider and employer to match temporary restrictions to available work Correct answer.
  3. Clearing the employee for full duty without provider input
  4. Advising the employer to terminate the employee if restrictions persist

Explanation

Return-to-work coordination matches documented functional restrictions with available modified duties, often involving the provider, supervisor, and human resources. Clearance should be based on provider input, and permanent restriction is rarely a reason to remain off work indefinitely. Termination is not a nursing decision and may violate disability law.

Question 17Occupational Health Nursing Practice and Professional Role

Which behavior reflects the ethical principle of veracity in occupational health nursing?

  1. Reporting only favorable program outcomes to management
  2. Explaining honestly to an employee the limits of confidentiality in the workplace Correct answer.
  3. Promising absolute secrecy to encourage disclosure
  4. Withholding a screening result to avoid employee distress

Explanation

Veracity is truthfulness, which includes being transparent about what can and cannot be kept confidential in the occupational setting. Withholding results, promising absolute secrecy, and reporting only favorable outcomes all mislead others. Honest communication allows employees to make informed choices about disclosure.

Question 18Occupational Health Nursing Practice and Professional Role

An occupational health nurse is asked to serve on a team investigating a cluster of dermatitis cases in a manufacturing area. Which contribution is most consistent with the nurse's professional role?

  1. Deciding which employees should be disciplined for poor hygiene
  2. Overriding the industrial hygienist's air sampling results
  3. Determining the workers' compensation settlement amounts
  4. Collecting health history and exposure data and coordinating medical evaluation Correct answer.

Explanation

The nurse contributes clinical and exposure information, facilitates medical evaluation, and supports communication among team members. Settlement amounts and discipline are outside the nursing role, and the nurse should not override the industrial hygienist's technical measurements. Collaborative investigation uses each discipline's expertise.

Question 19Occupational Health Nursing Practice and Professional Role

Which factor most directly affects the occupational health nurse's legal scope of practice?

  1. The number of years the nurse has worked in occupational health
  2. The preferences of the company's chief executive officer
  3. The state nurse practice act and board of nursing rules Correct answer.
  4. The size of the employer's workforce

Explanation

Scope of practice is defined by state statute and board of nursing regulations, which may vary across jurisdictions. Workforce size, executive preference, and tenure do not expand or restrict legal authority. Nurses must know the specific rules of the state in which they practice.

Question 20Occupational Health Nursing Practice and Professional Role

An employee refuses a required respirator fit test and states that the equipment is uncomfortable. What is the nurse's best initial action?

  1. Perform the fit test anyway despite the refusal
  2. Tell the employee that fit testing is optional for all staff
  3. Document the refusal and explore the employee's concerns and available respirator options Correct answer.
  4. Immediately report the employee for insubordination

Explanation

The nurse should first understand the reason for refusal and address it by exploring discomfort, offering different respirator models, or re-educating about requirements. Coercing the employee or immediately escalating to discipline ignores the opportunity to resolve the problem. Fit testing is not optional where respiratory protection is required.

Question 21Occupational Health Nursing Practice and Professional Role

Which scenario best demonstrates secondary prevention in an occupational health program?

  1. Installing ventilation to remove solvent vapors
  2. Conducting annual audiometric testing to detect early hearing loss Correct answer.
  3. Rehabilitating a worker after a repetitive strain injury
  4. Providing hearing protection to all noise-exposed workers

Explanation

Secondary prevention seeks early detection of disease or risk before symptoms become advanced, and periodic audiometry identifies noise-induced hearing loss at an early stage. Ventilation and hearing protection are primary prevention, while rehabilitation after injury is tertiary prevention. Matching the intervention to the prevention level clarifies program design.

Question 22Occupational Health Nursing Practice and Professional Role

An occupational health nurse notes that injury rates are highest among newly hired workers in their first 90 days. Which interpretation is most useful for program planning?

  1. Injury rates cannot be analyzed by tenure
  2. The finding is random and requires no action
  3. The injuries indicate that older workers should be reassigned
  4. New workers may lack task-specific training and should receive enhanced onboarding and mentoring Correct answer.

Explanation

Higher injury rates early in employment suggest gaps in orientation, task training, or supervision, which can be addressed through structured onboarding and mentoring. Dismissing the pattern as random ignores actionable data, and reassigning older workers does not address the identified risk group. Injury rates can and should be stratified by tenure.

Question 23Occupational Health Nursing Practice and Professional Role

A nurse manager wants to evaluate the effectiveness of a new ergonomics program. Which outcome measure provides the strongest evidence of program impact?

  1. Total budget spent on training materials
  2. Comparison of musculoskeletal injury rates before and after implementation with adjustment for work hours Correct answer.
  3. Employee satisfaction ratings collected immediately after training
  4. Number of employees who attended the training session

Explanation

Outcome evaluation should measure changes in health or injury indicators over time while accounting for exposure, such as work hours, to allow fair comparison. Attendance and satisfaction measure process or reaction rather than results, and budget alone says nothing about effectiveness. Injury rate comparison with adjustment supports a credible impact assessment.

Question 24Occupational Health Nursing Practice and Professional Role

An occupational health nurse is reviewing a policy that would allow supervisors to access full employee health records to manage attendance. Which response is most appropriate?

  1. Recommend that all employees sign a waiver allowing unlimited access
  2. Suggest that records be stored in the supervisor's office for convenience
  3. Endorse the policy because attendance management requires clinical detail
  4. Recommend limiting supervisor access to attendance and work-restriction information only Correct answer.

Explanation

Access should follow a need-to-know principle, allowing supervisors only information necessary for attendance and work assignment decisions. Full clinical records contain sensitive details unrelated to attendance management. Convenience storage and broad waivers do not justify unnecessary access and may violate privacy law.

Question 25Occupational Health Nursing Practice and Professional Role

An employee with a chronic condition requests a flexible schedule as an accommodation. Which action by the occupational health nurse best reflects the interactive process required under disability law?

  1. Deny the request because the schedule has always been fixed
  2. Grant the request without involving management or human resources
  3. Engage the employee and management to identify and evaluate possible reasonable accommodations Correct answer.
  4. Ask the employee to disclose the full diagnosis to coworkers

Explanation

The interactive process requires individualized communication among the employee, employer, and health professional to identify effective accommodations and assess undue hardship. Automatic denial forecloses the process, unilateral approval bypasses required management involvement, and disclosure to coworkers is unnecessary and violates confidentiality.

Question 26Occupational Health Nursing Practice and Professional Role

Which document defines the legal boundaries of an occupational health nurse's practice, including which tasks may be performed independently?

  1. The accreditation standards of the hospital where the nurse trained
  2. The professional code of ethics published by the nursing association
  3. The employer's employee handbook and attendance policy
  4. The state nurse practice act and its associated administrative rules Correct answer.

Explanation

Nurse practice acts are statutes enacted by each jurisdiction that establish scope of practice, licensure requirements, and delegation authority; administrative rules issued under them add detail. Institutional policies and ethics codes guide conduct but cannot expand or restrict the legal scope set by statute.

Question 27Occupational Health Nursing Practice and Professional Role

An occupational health nurse is asked to lead a worksite committee that will set priorities for a new wellness initiative. Which action best reflects the nurse's professional role as a program leader?

  1. Delegate all planning decisions to the vendor supplying the program
  2. Perform a needs assessment using employee health data and worker input Correct answer.
  3. Adopt the program used by a neighboring company without modification
  4. Select the interventions the nurse personally finds most clinically valuable

Explanation

Effective leadership begins with systematically identifying the population's needs using health surveillance data, injury records, and worker participation. This evidence-based foundation lets the committee set defensible priorities and tailor interventions to the actual workforce.

Question 28Occupational Health Nursing Practice and Professional Role

An occupational health nurse is documenting care in an electronic health record shared across an employer's clinics. Which practice best protects confidentiality while maintaining a legally sound record?

  1. Recording only the minimum information necessary for treatment and business purposes Correct answer.
  2. Sharing the login credentials with the safety officer for convenience
  3. Omitting sensitive findings so that supervisors cannot view them
  4. Storing the full record in a personal file in case of an audit

Explanation

Confidentiality is preserved by limiting documentation and access to the minimum necessary information, which is a core principle of health information privacy law. Records must still be complete and accurate, so omitting clinically relevant findings or keeping duplicate private files creates both legal and clinical risk.

Question 29Occupational Health Nursing Practice and Professional Role

An occupational health nurse wants to build an internal network of champions who will reinforce safe lifting practices on each shift. Which professional strategy is being used?

  1. Outsourcing safety training to an external agency
  2. Peer-led coalition building within the organization Correct answer.
  3. Individual counseling of injured workers
  4. Regulatory enforcement of safety standards

Explanation

Recruiting influential workers on each shift to promote safe practices is a coalition-building strategy that extends the nurse's reach through peer influence and shared ownership. It differs from enforcement, individual treatment, or outsourcing, which do not create sustainable internal capacity.

Question 30Occupational Health Nursing Practice and Professional Role

An occupational health nurse is invited to advise on a new policy that would require disclosure of employees' mental health treatment to managers. Which analysis best reflects the nurse's professional obligations?

  1. Support the policy because managers need full information to supervise effectively
  2. Endorse the policy if employees sign a general consent at hire
  3. Decline involvement because policy questions fall outside nursing practice
  4. Weigh the employer's operational need against employees' privacy and legal protections Correct answer.

Explanation

The nurse's role includes advocating for employee privacy while acknowledging legitimate employer interests, then recommending the least intrusive approach consistent with law. A general consent at hire is usually insufficient for broad disclosure of sensitive treatment information, and nurses have a duty to contribute their expertise to policy.

Question 31Worker Assessment, Health Surveillance, and Clinical Care

A worker's audiogram shows a threshold shift that has persisted for several weeks. Under typical occupational hearing conservation practice, at what duration does a threshold shift generally become classified as a permanent (standard threshold) shift rather than a temporary one?

  1. After a single shift of eight hours
  2. After six months of continued exposure
  3. After twenty-four hours of rest
  4. After approximately two to four weeks without recovery Correct answer.

Explanation

Temporary threshold shifts generally recover within hours to days after noise exposure ends. When hearing loss persists beyond roughly two to four weeks, it is treated as permanent and reportable under hearing conservation programs. This distinction drives whether a worker is re-tested, re-counseled, or formally recorded as a standard threshold shift.

Question 32Worker Assessment, Health Surveillance, and Clinical Care

In spirometry interpretation, which pattern is defined by a reduced FEV1/FVC ratio with a normal or reduced FVC?

  1. Restrictive pattern
  2. Mixed pattern
  3. Obstructive pattern Correct answer.
  4. Normal pattern

Explanation

An obstructive defect is characterized by a reduced FEV1/FVC ratio, reflecting airflow limitation during forced exhalation. The FVC may be normal or reduced because of air trapping. A restrictive pattern instead shows a normal or elevated ratio with reduced total lung capacity.

Question 33Worker Assessment, Health Surveillance, and Clinical Care

Which biologic monitoring method is appropriate for assessing a worker's recent exposure to a volatile organic solvent that is rapidly metabolized and excreted?

  1. Annual serum liver enzyme panel
  2. Hair sampling for the parent compound
  3. End-of-shift breath or urine sampling for the parent compound or metabolite Correct answer.
  4. Urine collection at the end of the workweek

Explanation

Rapidly eliminated substances require samples collected close to the exposure, typically at the end of the shift. Breath or urine measurement of the parent compound or a metabolite captures recent uptake. Sampling at the end of the week or annually would miss exposure that clears within hours.

Question 34Worker Assessment, Health Surveillance, and Clinical Care

A worker reports hand-arm vibration exposure from powered tools. Which early symptom cluster is most characteristic of hand-arm vibration syndrome?

  1. Bilateral shoulder stiffness with limited abduction
  2. Diffuse elbow pain relieved by rest
  3. Episodic finger blanching triggered by cold, with tingling and numbness Correct answer.
  4. Unilateral wrist drop with grip weakness

Explanation

Hand-arm vibration syndrome classically presents with vascular symptoms such as cold-induced finger blanching (vibration white finger) and sensorineural symptoms of tingling and numbness. These symptoms typically begin in the fingertips and progress proximally. Early recognition allows exposure reduction before irreversible sensorineural loss develops.

Question 35Worker Assessment, Health Surveillance, and Clinical Care

A worker is exposed to a substance with a biological exposure index expressed as a concentration in end-of-shift urine. Which action best reflects correct use of that index in health surveillance?

  1. Compare the result to occupational exposure limits for air
  2. Compare the result to the biological exposure index and investigate exceedances Correct answer.
  3. Average results across all workers to set a facility baseline
  4. Use the result to diagnose occupational disease

Explanation

Biological exposure indices are guidance values for interpreting biological monitoring results in samples collected at a specified time. Results are compared directly with the index, and exceedances prompt investigation of exposure controls. They are not diagnostic tools and are not interchangeable with airborne exposure limits.

Question 36Worker Assessment, Health Surveillance, and Clinical Care

Which finding on a pre-placement evaluation most appropriately triggers a recommendation for restricted duty rather than outright disqualification?

  1. An inability to perform the essential functions with any accommodation
  2. A refusal to complete required medical screening
  3. A contagious respiratory infection in the acute phase
  4. A stable chronic condition that could be aggravated by a specific job task Correct answer.

Explanation

Pre-placement evaluation should focus on the worker's ability to perform essential functions safely. A stable condition that a specific task could aggravate supports targeted restrictions rather than blanket exclusion. Disqualification should be reserved for situations where no reasonable accommodation allows safe performance.

Question 37Worker Assessment, Health Surveillance, and Clinical Care

In the context of occupational health surveillance, what is the primary purpose of periodic medical examinations for workers exposed to a specific hazard?

  1. To determine fitness for promotion
  2. To satisfy insurance underwriting requirements
  3. To detect early health effects and verify the effectiveness of controls Correct answer.
  4. To establish baseline data for litigation

Explanation

Periodic surveillance aims to identify early signs of work-related health effects and to confirm that exposure controls remain effective. Findings feed back into the hierarchy of controls and individual follow-up. It is not a fitness-for-promotion tool or a litigation exercise.

Question 38Worker Assessment, Health Surveillance, and Clinical Care

A worker with known occupational asthma reports increasing symptoms at work. Which initial step best aligns with good clinical management?

  1. Recommend only respiratory protection without changing exposure
  2. Remove the worker from further exposure and arrange specialist evaluation Correct answer.
  3. Prescribe a rescue inhaler and continue the same duties
  4. Continue exposure and reassess in six months

Explanation

Suspected occupational asthma warrants prompt removal from the causative exposure to prevent progression and improve prognosis. Specialist evaluation confirms the diagnosis and guides long-term management. Continued exposure, even with protection, risks worsening disease.

Question 39Worker Assessment, Health Surveillance, and Clinical Care

Which element is essential when obtaining informed consent for occupational health screening that includes biologic monitoring?

  1. A guarantee that no abnormal findings will be reported
  2. Explanation of the purpose, procedures, risks, benefits, and confidentiality protections Correct answer.
  3. A statement that results will be shared with the employer in identifiable form without restriction
  4. A waiver of the worker's right to access their own results

Explanation

Informed consent requires disclosure of purpose, procedures, risks, benefits, and how confidentiality will be maintained. Workers must understand who will receive results and in what form. Consent obtained without these elements is not valid.

Question 40Worker Assessment, Health Surveillance, and Clinical Care

A worker is exposed to lead and undergoes periodic surveillance. Which panel of tests is most appropriate for detecting early lead-related health effects?

  1. Blood lead level and hemoglobin or zinc protoporphyrin Correct answer.
  2. Serum amylase and lipase
  3. Urine cytology and renal ultrasound
  4. Pulmonary function testing with diffusion capacity

Explanation

Lead surveillance relies on blood lead concentration to assess exposure and on indicators of biologic effect such as hemoglobin or zinc protoporphyrin. These detect interference with heme synthesis before overt anemia. Other organ panels are not the primary surveillance tools for lead.

Question 41Worker Assessment, Health Surveillance, and Clinical Care

A worker's chest radiograph shows small rounded opacities in the upper zones with a history of silica exposure. Which classification system is standard for recording such pneumoconiosis findings?

  1. The NYHA functional classification
  2. The Glasgow coma scale
  3. The TNM staging system
  4. The ILO international classification of radiographs of pneumoconioses Correct answer.

Explanation

The ILO classification provides standardized descriptions of pneumoconiotic opacities, including size, shape, and profusion. It supports consistent communication and surveillance across readers. Other systems address cancer staging, neurologic status, or cardiac function.

Question 42Worker Assessment, Health Surveillance, and Clinical Care

A noise-exposed worker has a baseline audiogram and a follow-up audiogram showing a 12 dB shift at 4000 Hz in one ear. What is the most appropriate next action under a hearing conservation program?

  1. Retest after a period of noise-free rest to confirm the shift and provide follow-up Correct answer.
  2. Ignore the change because it is below 25 dB
  3. Immediately record a permanent standard threshold shift and restrict duties
  4. Refer for surgery without further testing

Explanation

A shift should be confirmed with retesting after noise avoidance to distinguish temporary from permanent change. Confirmation guides whether the finding is recorded and whether further evaluation or counseling is needed. Acting on a single unconfirmed test risks misclassification.

Question 43Worker Assessment, Health Surveillance, and Clinical Care

Which statement best describes the role of the occupational health nurse in a respiratory protection program?

  1. Certifying the respirator manufacturer
  2. Selecting the respirator model for each worker
  3. Performing fit testing instead of the safety officer
  4. Conducting medical evaluations to determine fitness for respirator use Correct answer.

Explanation

The occupational health nurse conducts medical evaluations to determine whether a worker can safely use a respirator. Fit testing and equipment selection are separate program elements with distinct responsibilities. Manufacturer certification is a regulatory function outside the nurse's role.

Question 44Worker Assessment, Health Surveillance, and Clinical Care

A worker presents with a skin lesion on the dorsum of the hand after years of outdoor work. Which occupational skin cancer is most strongly associated with cumulative ultraviolet exposure?

  1. Melanoma arising in a pre-existing nevus only
  2. Kaposi sarcoma
  3. Squamous cell carcinoma Correct answer.
  4. Dermatofibrosarcoma protuberans

Explanation

Cumulative ultraviolet exposure is strongly associated with squamous cell carcinoma, particularly on sun-exposed sites such as the dorsum of the hands. Basal cell carcinoma is also linked but squamous cell carcinoma shows a clear dose relationship. Other listed tumors have different etiologies.

Question 45Worker Assessment, Health Surveillance, and Clinical Care

Which action best reflects the principle of maintaining confidentiality when an employer requests an employee's medical information?

  1. Provide the full medical record to the supervisor on request
  2. Share results with coworkers to encourage compliance
  3. Release only fitness-for-duty conclusions with the worker's consent Correct answer.
  4. Post aggregate results with worker names attached

Explanation

Employers generally receive only the information needed to make employment decisions, such as fitness-for-duty conclusions. Detailed medical records are protected and shared only with appropriate consent. This separation preserves worker trust and complies with confidentiality obligations.

Question 46Worker Assessment, Health Surveillance, and Clinical Care

A worker in a hot environment shows confusion, hot dry skin, and a core temperature above 40 degrees Celsius. What is the priority action?

  1. Begin immediate active cooling and emergency medical transport Correct answer.
  2. Have the worker rest in the shade for ten minutes
  3. Give oral fluids and return to light duty
  4. Document the event and reassess next shift

Explanation

These findings indicate heat stroke, a medical emergency with risk of organ failure. Immediate active cooling and emergency transport are required to reduce mortality. Oral fluids and brief rest are inadequate for a worker with altered mental status.

Question 47Worker Assessment, Health Surveillance, and Clinical Care

Which approach best supports the validity of self-reported symptom data collected during occupational health surveillance?

  1. Collect data only when symptoms become severe
  2. Allow workers to complete forms anonymously without identifiers
  3. Ask supervisors to complete forms on behalf of workers
  4. Use a validated symptom questionnaire with consistent administration Correct answer.

Explanation

Validated questionnaires administered consistently improve reliability and comparability of symptom data. Standardized administration reduces interviewer and recall bias. Proxy reporting by supervisors or collecting only severe cases introduces bias and underreporting.

Question 48Worker Assessment, Health Surveillance, and Clinical Care

A worker is being monitored for exposure to an organophosphate pesticide. Which biologic measurement best reflects recent cholinesterase inhibition?

  1. Serum calcium
  2. Erythrocyte cholinesterase activity Correct answer.
  3. Serum creatinine
  4. Blood urea nitrogen

Explanation

Organophosphates inhibit cholinesterase, and erythrocyte cholinesterase reflects red blood cell enzyme activity. Comparison with baseline values detects meaningful depression. Serum creatinine, urea nitrogen, and calcium assess renal or metabolic status, not cholinesterase.

Question 49Worker Assessment, Health Surveillance, and Clinical Care

Which finding on a periodic examination should prompt consideration of occupational contact dermatitis rather than an unrelated dermatosis?

  1. Generalized rash involving the trunk and face equally
  2. Symptoms present since childhood without change
  3. Lesions confined to skin areas in contact with a workplace substance, improving away from work Correct answer.
  4. Lesions limited to sun-exposed areas only

Explanation

Occupational contact dermatitis typically affects skin in contact with the offending agent and improves during time away from work. This temporal and distributional pattern supports a work-related cause. Generalized or lifelong patterns suggest other etiologies.

Question 50Worker Assessment, Health Surveillance, and Clinical Care

Which statement best captures the purpose of a return-to-work evaluation after an occupational injury?

  1. To replace the treating physician's plan of care
  2. To assign blame for the injury
  3. To reduce workers' compensation costs by denying claims
  4. To determine whether the worker can resume duties safely, with restrictions if needed Correct answer.

Explanation

Return-to-work evaluation matches the worker's functional capacity to job demands and identifies necessary accommodations. It supports safe reintegration and prevents re-injury. It is not a fault-finding or claims-denial process.