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COHN practice questions

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Question 1Occupational Health Nursing Practice (clinical care and health assessment)

Under OSHA's noise standard, a hearing conservation program must be established for employees whose noise exposure equals or exceeds which 8-hour time-weighted average?

  1. 80 dBA
  2. 90 dBA
  3. 85 dBA Correct answer.
  4. 100 dBA

Explanation

OSHA requires a hearing conservation program (monitoring, audiometric testing, hearing protection, training) at an 8-hour TWA of 85 dBA. The 90 dBA level is the permissible exposure limit, a separate requirement that also obligates feasible engineering or administrative controls.

Question 2Occupational Health Nursing Practice (clinical care and health assessment)

On an annual audiogram, a standard threshold shift is defined as an average change of 10 dB or more at which frequencies?

  1. 1000 and 2000 Hz only, in both ears
  2. 2000, 3000, and 4000 Hz in either ear Correct answer.
  3. 500, 1000, and 2000 Hz in either ear
  4. 3000, 4000, and 6000 Hz in both ears

Explanation

OSHA defines a standard threshold shift as an average shift of 10 dB or more at 2000, 3000, and 4000 Hz in either ear, with age correction permitted. These frequencies are selected because noise-induced hearing loss characteristically appears first at 3000 and 4000 Hz.

Question 3Occupational Health Nursing Practice (clinical care and health assessment)

An occupational health nurse is caring for an employee who just sustained a percutaneous needlestick from a contaminated needle. What is the most appropriate immediate action at the exposure site?

  1. Wash with soap and water Correct answer.
  2. Apply bleach solution to the puncture
  3. Scrub with an alcohol-based hand rub only
  4. Squeeze the site to express blood

Explanation

Washing the puncture with soap and water is the recommended first step after a percutaneous exposure. Antiseptics may be applied afterward, but caustic agents, squeezing, and scrubbing are not recommended because they can further damage tissue and do not reduce transmission risk.

Question 4Occupational Health Nursing Practice (clinical care and health assessment)

Which heat-related condition is a medical emergency requiring immediate cooling and transport?

  1. Heat stroke Correct answer.
  2. Heat exhaustion
  3. Heat syncope
  4. Heat cramps

Explanation

Heat stroke involves failure of thermoregulation, with core temperature typically above 40 degrees C and central nervous system dysfunction such as confusion or collapse; it is life-threatening and requires immediate cooling and emergency transport. The other heat disorders are generally self-limited once the worker is removed from the heat and rehydrated.

Question 5Occupational Health Nursing Practice (clinical care and health assessment)

Which spirometry result is most consistent with an obstructive ventilatory defect?

  1. FEV1/FVC of 0.82 with a reduced FVC
  2. FEV1/FVC of 0.62 with a reduced FEV1 Correct answer.
  3. FEV1/FVC of 0.85 with a normal FEV1
  4. FEV1/FVC of 0.78 with a reduced total lung capacity

Explanation

Obstruction is identified by a reduced FEV1/FVC ratio, generally below the lower limit of normal (often cited as under 0.70), accompanied by a reduced FEV1. Airflow limitation with a preserved or increased ratio, and reduction in total lung capacity, would instead suggest restriction.

Question 6Occupational Health Nursing Practice (clinical care and health assessment)

Why is a two-step baseline tuberculin skin test performed on a newly hired health care worker with no documented prior testing?

  1. To detect boosting from remote infection Correct answer.
  2. To measure anergy in immunocompromised workers
  3. To confirm a positive first test
  4. To shorten the observation period

Explanation

The second step distinguishes a boosted reaction in someone with long-standing, remote infection from a newly acquired infection that would be detected on later annual testing. Without a two-step baseline, a boosted response on a subsequent test could be misclassified as a new conversion.

Question 7Occupational Health Nursing Practice (clinical care and health assessment)

When should post-vaccination serologic testing be performed after a health care worker completes the hepatitis B vaccine series?

  1. 1-2 months after the last dose Correct answer.
  2. Within 48 hours of the first dose
  3. 6 months after the third dose
  4. Immediately after the third dose

Explanation

Anti-HBs testing is recommended one to two months after the final dose, when antibody titers peak; testing later may miss vaccine responders. Testing too early, before the series is complete, cannot demonstrate an adequate response.

Question 8Occupational Health Nursing Practice (clinical care and health assessment)

How often must an employee who wears a tight-fitting respirator be fit tested?

  1. Only when the model or size changes
  2. Every 6 months
  3. At least annually Correct answer.
  4. Every 2 years

Explanation

OSHA requires fit testing before initial use and at least annually thereafter for tight-fitting respirators. Fit testing is also repeated when a different respirator model or size is used or when a physical change affects the seal, but those events do not replace the annual requirement.

Question 9Occupational Health Nursing Practice (clinical care and health assessment)

A lifting task has a NIOSH recommended weight limit of 25 lb, but the load actually handled is 40 lb. What is the lifting index?

  1. 65
  2. 0.63
  3. 1.6 Correct answer.
  4. 15

Explanation

The lifting index is the actual load divided by the recommended weight limit (40 divided by 25). A lifting index above 1.0 indicates that the task exceeds the recommended limit and that risk of lifting-related injury is increased.

Question 10Occupational Health Nursing Practice (clinical care and health assessment)

A nurse sustains a hollow-bore needlestick from a patient later confirmed to be HIV positive. How should post-exposure prophylaxis be managed?

  1. Begun as soon as possible and continued for 28 days Correct answer.
  2. Started within 7 days and continued for 6 weeks
  3. Started only after the source's HIV test returns positive
  4. Started only if the worker is seronegative at 6 weeks

Explanation

HIV post-exposure prophylaxis should be initiated as soon as possible after exposure, ideally within hours, because efficacy declines with delay, and it is continued for 28 days. Prophylaxis is started based on risk assessment while source testing is pending rather than waiting for results.

Question 11Occupational Health Nursing Practice (clinical care and health assessment)

Under federal DOT rules applicable to commercial motor vehicle drivers, the minimum annual random drug testing rate is set at what percentage of the average number of safety-sensitive drivers?

  1. 50% Correct answer.
  2. 10%
  3. 25%
  4. 20%

Explanation

The DOT agency rule sets the minimum annual random drug testing rate at 50 percent, while the random alcohol testing rate is 10 percent. The administering agency publishes the rates annually and may adjust them based on reported violation rates.

Question 12Occupational Health Nursing Practice (clinical care and health assessment)

Which physical examination maneuver is used to help identify carpal tunnel syndrome?

  1. Phalen's test Correct answer.
  2. Lachman's test
  3. Adson's test
  4. McMurray's test

Explanation

Phalen's test reproduces median nerve compression symptoms by holding the wrists in maximum flexion, and Tinel's sign over the carpal tunnel is a related provocative finding. The other maneuvers assess the knee menisci, the anterior cruciate ligament, and thoracic outlet structures.

Question 13Occupational Health Nursing Practice (clinical care and health assessment)

Under OSHA's general industry lead standard, medical surveillance is triggered when an employee's blood lead level reaches or exceeds which value?

  1. 80 micrograms/dL
  2. 10 micrograms/dL
  3. 40 micrograms/dL Correct answer.
  4. 60 micrograms/dL

Explanation

A blood lead level of 40 micrograms/dL or greater triggers medical surveillance under the lead standard, in addition to surveillance required by airborne exposure above the action level. Higher thresholds govern additional actions such as medical removal protection.

Question 14Occupational Health Nursing Practice (clinical care and health assessment)

A paint shop employee reports wheezing that improves on weekends and during vacations. Which result would best support a diagnosis of work-related asthma?

  1. Positive methacholine challenge on a Sunday
  2. Sputum culture growing Haemophilus influenzae
  3. Lower serial peak flows on workdays than on days off Correct answer.
  4. Chest radiograph showing hyperinflation

Explanation

Serial peak expiratory flow recordings that fall during work exposures and recover away from work demonstrate the temporal relationship central to occupational asthma. A single nonspecific challenge or a chest radiograph cannot by itself establish work-relatedness.

Question 15Occupational Health Nursing Practice (clinical care and health assessment)

A worker is exposed to noise at 95 dBA for part of the shift. Using the OSHA permissible exposure limit of 90 dBA with a 5-dB exchange rate, what is the maximum permissible exposure duration at 95 dBA?

  1. 8 hours
  2. 4 hours Correct answer.
  3. 1 hour
  4. 6 hours

Explanation

With a 5-dB exchange rate, every 5-dB increase halves the allowable exposure time, so 95 dBA permits 4 hours. The 90 dBA limit applies to an 8-hour shift, and exposures above the limit require a hearing conservation program and feasible controls.

Question 16Occupational Health Nursing Practice (clinical care and health assessment)

A worker splashes a strong alkali into one eye. What is the priority action?

  1. Test the pH and irrigate only if abnormal
  2. Apply an antibiotic ointment and patch the eye
  3. Transport to the emergency department without irrigation
  4. Irrigate immediately with water or saline Correct answer.

Explanation

Alkali burns penetrate ocular tissue rapidly, so immediate copious irrigation must begin at the scene and continue during transport. Delaying irrigation for testing, dressing, or transport allows continued tissue destruction.

Question 17Occupational Health Nursing Practice (clinical care and health assessment)

Before an employee is fit tested and required to wear a respirator, the employer must take which action?

  1. Perform pulmonary function testing on every respirator user
  2. Verify that the employee has no history of asthma
  3. Obtain a chest radiograph
  4. Obtain a medical evaluation using the OSHA questionnaire Correct answer.

Explanation

OSHA requires a medical evaluation before fit testing or respirator use, typically through the mandatory questionnaire reviewed by a physician or other licensed health care professional. Additional tests are ordered only when the reviewer determines they are needed; spirometry and radiographs are not universal requirements.

Question 18Occupational Health Nursing Practice (clinical care and health assessment)

During a computer workstation assessment, the top of the monitor should be positioned where?

  1. Well above eye level to prevent neck flexion
  2. At shoulder height
  3. At or slightly below eye level Correct answer.
  4. At chest height with the screen tilted back 30 degrees

Explanation

Positioning the top of the screen at or slightly below eye level allows the neck to stay in neutral and the gaze to angle slightly downward, reducing neck and eye strain. The monitor should also be at a comfortable viewing distance, roughly an arm's length away.

Question 19Occupational Health Nursing Practice (clinical care and health assessment)

Nurses on a newly implemented rotating night schedule report drowsy driving after shifts. Which change best supports circadian adaptation?

  1. Three-hour naps during the night shift
  2. Longer 12-hour shifts to reduce commutes
  3. Backward rotation from night to evening to day
  4. Forward rotation with a protected, dark sleep period Correct answer.

Explanation

Forward rotation (day to evening to night) allows a phase delay that aligns better with the circadian clock, and limiting morning light exposure while protecting a dark daytime sleep block improves adaptation. Naps help temporarily but do not substitute for circadian alignment.

Question 20Occupational Health Nursing Practice (clinical care and health assessment)

A foundry worker with 20 years of dust exposure has a chest radiograph showing small rounded upper-lobe opacities with calcified hilar nodes. Which exposure is most likely responsible?

  1. Asbestos
  2. Respirable crystalline silica Correct answer.
  3. Cotton dust
  4. Isocyanates

Explanation

Upper-lobe rounded opacities with eggshell hilar calcification are characteristic of silicosis, which follows inhalation of respirable crystalline silica in foundry, mining, and sandblasting work. Silicosis also increases susceptibility to tuberculosis.

Question 21Occupational Health Nursing Practice (clinical care and health assessment)

A farm worker presents with salivation, lacrimation, urination, diarrhea, and pinpoint pupils after mixing insecticide in a field. Which agent class is most likely responsible?

  1. Organophosphate Correct answer.
  2. Pyrethroid
  3. Chlorinated hydrocarbon
  4. Phenoxy herbicide

Explanation

The cholinergic toxidrome of SLUDGE symptoms with miosis after agricultural insecticide mixing is characteristic of organophosphate or carbamate poisoning, which inhibits acetylcholinesterase. Treatment includes decontamination and atropine with pralidoxime for organophosphates.

Question 22Occupational Health Nursing Practice (clinical care and health assessment)

Which condition is the most commonly reported occupational skin disease?

  1. Urticaria
  2. Malignant melanoma
  3. Psoriasis
  4. Contact dermatitis Correct answer.

Explanation

Contact dermatitis, both irritant and allergic, accounts for the large majority of reported occupational skin disease and is most often caused by wet work, solvents, and metalworking fluids. Patch testing distinguishes allergic from irritant forms when the cause is unclear.

Question 23Occupational Health Nursing Practice (clinical care and health assessment)

Which measure most effectively reduces a worker's exposure to hand-arm vibration?

  1. Warming the hands before work
  2. Reducing trigger time with low-vibration tools Correct answer.
  3. Using tools with a higher oscillation frequency
  4. Wearing padded gloves

Explanation

Vibration exposure is dose-dependent, so limiting trigger time and selecting tools with lower vibration magnitude attacks the exposure at its source. Anti-vibration gloves and warming provide only limited protection and do not substitute for reducing exposure duration.

Question 24Occupational Health Nursing Practice (clinical care and health assessment)

Within how many days must an employer record a newly identified recordable injury or illness on the OSHA 300 Log?

  1. 30 days
  2. 24 hours
  3. 7 calendar days Correct answer.
  4. 10 business days

Explanation

Recordable cases must be entered on the OSHA 300 Log within seven calendar days of learning of the injury or illness. Separately, fatalities must be reported to OSHA within 8 hours and certain severe injuries within 24 hours.

Question 25Occupational Health Nursing Practice (clinical care and health assessment)

An employee returns from a shoulder injury with a 20-lb lifting restriction, but the job occasionally requires 50 lb. Under the ADA, what should the employer do first?

  1. Determine whether a reasonable accommodation is available Correct answer.
  2. Terminate employment since the essential functions cannot be met
  3. Require a waiver and return the worker to full duty
  4. Place the employee on unpaid leave until the restriction is lifted

Explanation

The ADA requires an individualized assessment and consideration of reasonable accommodation, such as temporary reassignment of the lifting task, equipment, or a modified schedule, before any adverse action. Termination or forced leave without that analysis risks a discrimination finding.

Question 26Occupational Health Nursing Practice (clinical care and health assessment)

A worker is brought to the clinic confused after being found beside a propane-powered floor buffer in a closed room. Pulse oximetry reads 99% on room air. How should the nurse interpret this reading?

  1. It reliably excludes meaningful carbon monoxide exposure
  2. Carboxyhemoglobin is misread as oxyhemoglobin Correct answer.
  3. It shows that hyperventilation explains the confusion
  4. It confirms that tissue oxygen delivery is adequate

Explanation

Standard two-wavelength pulse oximeters cannot distinguish carboxyhemoglobin from oxyhemoglobin, so saturation appears normal even in serious carbon monoxide poisoning. Diagnosis requires co-oximetry to measure carboxyhemoglobin, and treatment is high-flow 100% oxygen.

Question 27Occupational Health Nursing Practice (clinical care and health assessment)

Which finding is the hallmark that distinguishes heat stroke from heat exhaustion?

  1. A heart rate greater than 100 beats per minute
  2. Muscle cramps that resolve with rest and fluids
  3. Profuse sweating with a normal core temperature
  4. Confusion or other altered mental status Correct answer.

Explanation

Heat stroke is defined by hyperthermia, typically a core temperature above 40 degrees C, together with central nervous system dysfunction such as confusion, ataxia, or seizures. Heat exhaustion causes weakness, dizziness, headache, and heavy sweating while the sensorium remains intact.

Question 28Occupational Health Nursing Practice (clinical care and health assessment)

Standard precautions are applied:

  1. To every patient regardless of infection status Correct answer.
  2. Only to patients with a known or suspected infection
  3. Only when the nurse has broken skin
  4. Only during invasive procedures

Explanation

Standard precautions treat all blood, body fluids, secretions, excretions, nonintact skin, and mucous membranes as potentially infectious, so they apply to every patient at all times. Transmission-based precautions are added when a specific pathogen route is known or suspected.

Question 29Occupational Health Nursing Practice (clinical care and health assessment)

For an adult in cardiac arrest, chest compressions should be delivered at which rate and depth?

  1. 80 to 100 per minute, 1.5 inches deep
  2. 100 to 120 per minute, 2 inches deep Correct answer.
  3. 100 to 120 per minute, 1 inch deep
  4. 60 to 80 per minute, 1 inch deep

Explanation

High-quality adult CPR uses compressions at 100 to 120 per minute with a depth of at least 2 inches, allowing full chest recoil between compressions. Shallow or slow compressions reduce coronary perfusion pressure and lower the chance of return of spontaneous circulation.

Question 30Occupational Health Nursing Practice (clinical care and health assessment)

Minutes after receiving a vaccination, a worker develops urticaria, wheezing, and hypotension. Which medication should be given first?

  1. Epinephrine 0.3 mg intramuscularly Correct answer.
  2. Methylprednisolone 125 mg intravenously
  3. Diphenhydramine 50 mg intramuscularly
  4. Albuterol by metered-dose inhaler

Explanation

Intramuscular epinephrine into the mid-outer thigh is the first-line treatment for anaphylaxis and should be given without delay. Antihistamines, corticosteroids, and inhaled bronchodilators are adjuncts that do not reverse laryngeal edema or shock.

Question 31Occupational Health Nursing Practice (clinical care and health assessment)

Chronic occupational noise exposure typically produces which audiometric pattern?

  1. A flat 40 dB loss across all frequencies
  2. A low-frequency conductive loss in one ear
  3. A bilateral loss greatest at 250 Hz
  4. A notch centered at 3000 to 4000 Hz Correct answer.

Explanation

Noise-induced hearing loss begins as a sensorineural dip in the 3000 to 4000 Hz range, often recovering somewhat at 8000 Hz. Because speech consonants carry energy in this region, the loss is noticed as difficulty hearing in background noise before it is detected on a screening examination.

Question 32Occupational Health Nursing Practice (clinical care and health assessment)

Which vaccine is contraindicated for a pregnant health care worker?

  1. Measles-mumps-rubella Correct answer.
  2. Recombinant hepatitis B
  3. Tetanus-diphtheria-pertussis
  4. Inactivated influenza

Explanation

Live attenuated vaccines such as measles-mumps-rubella and varicella are avoided during pregnancy because of the theoretical risk of fetal infection. Inactivated vaccines, including Tdap, inactivated influenza, and hepatitis B, are recommended when indicated.

Question 33Occupational Health Nursing Practice (clinical care and health assessment)

A nurse sustains a needlestick with a hollow-bore needle used on a patient. What should be done to the wound at once?

  1. Scrub it with an alcohol-based hand rub
  2. Wash it with soap and running water Correct answer.
  3. Cover it with a tight pressure dressing
  4. Squeeze the site to express blood

Explanation

Puncture wounds should be washed promptly with soap and water, and mucous membranes flushed with water or saline. Squeezing, milking, or applying caustic agents is not recommended because it further traumatizes tissue without reducing transmission risk.

Question 34Occupational Health Nursing Practice (clinical care and health assessment)

A machinist exposed to beryllium-containing alloys has no symptoms but is enrolled in medical surveillance. Which test detects sensitization before disease develops?

  1. Sputum culture for acid-fast bacilli
  2. Chest radiograph with lateral view
  3. Serum angiotensin-converting enzyme level
  4. Lymphocyte proliferation testing Correct answer.

Explanation

The beryllium lymphocyte proliferation test measures cell-mediated immune sensitization and can be positive years before chronic beryllium disease produces symptoms or radiographic change. Abnormal results prompt further evaluation, including pulmonary function testing and imaging.

Question 35Occupational Health Nursing Practice (clinical care and health assessment)

A retired insulator with a 30-year asbestos history has no respiratory symptoms. Which chest imaging finding most supports past asbestos exposure?

  1. Cavitary lesions in the upper lobes
  2. Diffuse ground-glass opacities
  3. Bilateral calcified pleural plaques Correct answer.
  4. Eggshell calcification of hilar nodes

Explanation

Well-circumscribed, often calcified pleural plaques are the most common radiographic marker of asbestos exposure and may appear without symptomatic asbestosis. They indicate exposure and are not themselves malignant, but they identify a worker who remains at risk for mesothelioma and lung cancer.

Question 36Occupational Health Nursing Practice (clinical care and health assessment)

A worker who welds stainless steel reports nasal crusting, irritation, and recurrent nosebleeds. Which examination finding most supports hexavalent chromium exposure?

  1. Conjunctival injection
  2. Anosmia
  3. Palatal petechiae
  4. Nasal septal perforation Correct answer.

Explanation

Hexavalent chromium compounds are potent nasal irritants and can produce ulceration and perforation of the anterior nasal septum after prolonged inhalation. Surveillance programs therefore include nasal examination, and effective local exhaust ventilation is the primary control.

Question 37Occupational Health Nursing Practice (clinical care and health assessment)

A worker has a deep puncture wound from a dirty metal spike. Records show a tetanus-diphtheria booster 7 years ago, and the primary series was completed. What is indicated?

  1. A booster dose plus immune globulin
  2. Tetanus immune globulin alone
  3. A tetanus-diphtheria booster dose Correct answer.
  4. No tetanus vaccine or immune globulin

Explanation

For wounds that are not clean and minor, a tetanus-diphtheria booster is indicated when more than 5 years have passed since the last dose. Immune globulin is reserved for people who never completed a primary series or whose vaccination history is unknown.

Question 38Occupational Health Nursing Practice (clinical care and health assessment)

A 45-year-old worker has blood pressures averaging 132/86 mm Hg on two properly measured visits. Using the 2017 ACC/AHA categories, how should this be classified?

  1. Normal blood pressure
  2. Stage 2 hypertension
  3. Elevated blood pressure
  4. Stage 1 hypertension Correct answer.

Explanation

Stage 1 hypertension is a systolic pressure of 130 to 139 mm Hg or a diastolic pressure of 80 to 89 mm Hg, so a value of 132/86 falls in this category. Elevated blood pressure requires a systolic of 120 to 129 with a diastolic below 80.

Question 39Occupational Health Nursing Practice (clinical care and health assessment)

Spirometry in a 40-year-old foundry worker shows an FEV1 of 68% of predicted, an FVC of 88% of predicted, and an FEV1/FVC ratio of 62% after bronchodilator. How should this be characterized?

  1. An obstructive pattern Correct answer.
  2. A normal study
  3. A mixed obstructive-restrictive pattern
  4. A restrictive pattern

Explanation

A reduced FEV1/FVC ratio, generally below 0.70, with a reduced FEV1 defines airflow obstruction. Restriction would be suggested by a reduced FVC with a preserved or increased ratio, and a mixed pattern requires both abnormalities.

Question 40Occupational Health Nursing Practice (clinical care and health assessment)

How often should a spirometer be checked for volume accuracy with a 3-liter calibration syringe?

  1. At the start of each testing day Correct answer.
  2. Only after the device is serviced
  3. Once a week
  4. Once a month

Explanation

Daily calibration checks with a 3-liter syringe verify volume accuracy and detect leaks or drift before testing begins. Less frequent verification can allow a systematic error to affect an entire session of worker surveillance results.

Question 41Occupational Health Nursing Practice (clinical care and health assessment)

A hospital housekeeper with natural rubber latex allergy should be counseled that which foods may cause cross-reactions?

  1. Banana, kiwi, and avocado Correct answer.
  2. Wheat, barley, and rye flour
  3. Cow milk and hen egg
  4. Crustaceans, peanuts, and tree nuts

Explanation

Latex-fruit syndrome results from cross-reactivity between latex proteins and similar proteins in certain plant foods, including banana, kiwi, avocado, chestnut, and tomato. Affected workers should be advised about these foods and about avoiding powdered latex gloves in the workplace.

Question 42Occupational Health Nursing Practice (clinical care and health assessment)

Audiometry shows a 25 dB air-conduction loss from 500 to 2000 Hz in the right ear with bone conduction thresholds of 5 dB. What does this indicate?

  1. Conductive hearing loss needing referral Correct answer.
  2. A normal audiogram for the right ear
  3. An invalid test that must be repeated
  4. Noise-induced sensorineural hearing loss in the right ear

Explanation

An air-bone gap of 15 dB or more indicates a conductive component arising from the outer or middle ear, such as cerumen impaction, effusion, or ossicular disease. Conductive loss requires medical evaluation rather than routine hearing protection alone.

Question 43Occupational Health Nursing Practice (clinical care and health assessment)

A health care worker has a positive interferon-gamma release assay, no symptoms, and a normal chest radiograph. What is the appropriate next step?

  1. Begin four-drug therapy for active tuberculosis
  2. No action, because a positive assay reflects prior BCG vaccination
  3. Repeat the assay in 6 months
  4. Offer treatment for latent tuberculosis infection Correct answer.

Explanation

A positive interferon-gamma release assay with no symptoms and a normal chest radiograph indicates latent tuberculosis infection, and treatment of latent infection should be offered after active disease is excluded. The assay uses antigens absent from BCG, so prior BCG vaccination does not explain a positive result.

Question 44Occupational Health Nursing Practice (clinical care and health assessment)

A new employee reports never having had chickenpox and has no vaccination record. What should the occupational health nurse do?

  1. Exclude her from work until records arrive
  2. Give one dose and document immunity
  3. Check varicella IgG and vaccinate if nonimmune Correct answer.
  4. Assume she is immune because of her age

Explanation

Health care personnel without evidence of varicella immunity should be tested serologically and vaccinated if susceptible. A two-dose varicella vaccine series is required for nonimmune adults, and a single dose does not establish immunity.

Question 45Occupational Health Nursing Practice (clinical care and health assessment)

A urine immunoassay screens positive for amphetamines in a forklift operator. Before the result can be verified as a violation, the laboratory must:

  1. Repeat the same immunoassay on the same specimen
  2. Ask the employee to provide a second sample at the clinic
  3. Confirm with gas chromatography-mass spectrometry Correct answer.
  4. Notify the employee's supervisor of the result

Explanation

A screening immunoassay is presumptive only; a positive result must be confirmed by a different, more specific technique such as gas chromatography-mass spectrometry on the specimen. The medical review officer then evaluates the confirmed result together with any legitimate medical explanation before reporting.

Question 46Occupational Health Nursing Practice (clinical care and health assessment)

A worker who lifted a heavy crate reports three days of low back pain, numbness around the groin and inner thighs, and difficulty starting urination. What is the priority action?

  1. Start a course of oral corticosteroids
  2. Refer for elective physical therapy next month
  3. Recommend bed rest and recheck in one week
  4. Arrange emergency imaging and referral Correct answer.

Explanation

Saddle anesthesia with new urinary retention suggests cauda equina syndrome, a surgical emergency in which delay can cause permanent incontinence and paralysis. The worker needs immediate imaging and neurosurgical or orthopedic evaluation.

Question 47Occupational Health Nursing Practice (clinical care and health assessment)

Under the OSHA hearing conservation amendment, a standard threshold shift is defined as an average change of at least:

  1. 10 dB at 2000, 3000, and 4000 Hz Correct answer.
  2. 15 dB at 4000 and 8000 Hz
  3. 25 dB at 3000 and 6000 Hz
  4. 5 dB at 500, 1000, and 2000 Hz

Explanation

OSHA defines a standard threshold shift as an average shift of 10 dB or more at 2000, 3000, and 4000 Hz in either ear. A persistent shift triggers notification, re-evaluation, and possible recording on the injury and illness log.

Question 48Occupational Health Nursing Practice (clinical care and health assessment)

Ten minutes after an influenza vaccination, a worker feels faint and is diaphoretic. Which set of findings would point to a vasovagal reaction rather than anaphylaxis?

  1. Wheezing, urticaria, and tachycardia
  2. Bradycardia, pallor, and a normal blood pressure Correct answer.
  3. Laryngeal edema and a rising heart rate
  4. Hypotension together with a falling oxygen saturation

Explanation

Vasovagal syncope produces pallor, diaphoresis, nausea, and relative bradycardia with transient hypotension, and it resolves with supine positioning and leg elevation. Anaphylaxis is suggested by urticaria, wheeze, stridor, or hypotension that does not improve with recumbency.

Question 49Occupational Health Nursing Practice (clinical care and health assessment)

A worker collapses inside a sewer manhole and monitoring shows rising hydrogen sulfide. What should the nurse instruct bystanders to do?

  1. Lower a rope and pull the worker out from the opening
  2. Ventilate the space with a fan before entering
  3. Enter wearing a self-contained breathing apparatus to retrieve him
  4. Call for trained rescuers with respiratory protection Correct answer.

Explanation

Hydrogen sulfide causes rapid unconsciousness and death at high concentrations and also deadens the sense of smell, so it provides no warning. Entry is permitted only for rescuers using positive-pressure self-contained breathing apparatus with a retrieval system and atmospheric monitoring.

Question 50Occupational Health Nursing Practice (clinical care and health assessment)

Under NRC regulations, the dose limit to the fetus of a declared pregnant radiation worker over the entire gestation is:

  1. 0.5 rem Correct answer.
  2. 500 mrem per month
  3. 5 rem per year
  4. 0.5 rem per year

Explanation

The fetal dose limit for a declared pregnant worker is 0.5 rem, equivalent to 5 mSv, for the full gestation, with a recommendation that no more than 0.05 rem be accrued in any single month. The worker retains her own occupational limit but should be counseled about realistic dose reduction.