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Title: Managing the Potential Spread of Communicable Diseases in a Preschool Setting
The director of a preschool is concerned about how to minimize the potential spread of
communicable diseases among the school’s children as well as staff. The school has an
enrollment of between 40-50 children from ages 2 to 5 and a staff of between 12 and 14 adults.
The children come from diverse backgrounds that include minority racial groups as well as single
parent, blended, and multigenerational families. The children spend on average 6-10 hours a
day at the preschool and are fed two snacks and lunch by the staff. The children are cared for in
groups/classes according to age and development but do interact with other groups/classes
during the course of the day especially at snack times, lunch, and nap times. Parents are
encouraged to visit their child(ren) during the day when possible. The program includes
activities that take the children away from the facility for short periods of time, e.g., play time to
a nearby park, walks around the neighborhood, and a monthly trip to interact with residents of
a senior assisted living facility two blocks away. Regular celebrations of birthdays are scheduled
for individual groups/classes with treats being supplied by parents. The major religious holidays,
Easter, Halloween, and July 4th, are observed and attended by all the children and staff. The
director of the school asks a local community health nurse to help identify existing risks for the
internal spread of communicable diseases within the facility.
1. Item Type: Spot/Highlighting
Highlight the provided data that require immediate follow-up by the nurse.
Scenario, continued
The community health nurse has reviewed the information provided by the preschool director
and has suggested expanding concerns to include additional risk factors that apply to children
and staff contributing to the spread of the disease to individuals outside the preschool
2. Item Type: Extended Drag and Drop
Use an X (or drag and drop) to indicate which events listed in the left column should be
considered a potential risk for the spread of communicable diseases by the children or staff to
persons outside the facility.
Potential Risk
Multigenerational family situations
Copyright © 2022 by Elsevier, Inc. All Rights Reserved.
Next-Generation NCLEX® (NGN) Examination–Style Case Studies
Parent provided group/class treats
Trips to assisted living facility
Play time at the neighbor park
Group/class birthday parties
Preschool wide celebrations
Parents’ visits
Scenario, continued
The community health nurse has discussed the various risk factors presented by the preschool
environment with the director. The director has spoken about the safety of the residents with
the director of that facility. The hope is that they can work out a plan that will continue to allow
the children to visit on a regular basis. The community health nurse and the director now favor
focusing on modifiable factors that will affect the most individuals in minimizing the risk of
contracting a communicable disease.
3. Item Type: Cloze (Drop Down)
Choose the most likely options for the information missing from the statements below by
selecting from the lists of options provided.
Based on the situation and the identified risks, the priority need will be to
__________1________. In addition, there will need to be interventions to _____2_______and
Option 1
Option 2
Eliminate risk of spread to external contacts
Present a hygienic physical environment at
the preschool
Minimize risk of spread inside school
Limit contact with individuals outside the
usual preschool contacts
Eliminate exposure to communicable
Maximize the children’s natural
immunological defenses
Copyright © 2022 by Elsevier, Inc. All Rights Reserved.
Next-Generation NCLEX® (NGN) Examination–Style Case Studies
Increase number of staff while decreasing
number of children
Provide the children with adequate, effective
Scenario, continued
The director has asked the community health nurse to provide a series of in-service programs
for the staff of the preschool. The purpose is to both introduce and reinforce strategies that will
assist in achieving the facility’s goal of promoting a healthy environment for the children and
4. Item Type: Extended Multiple Response
Based on the goal presented by the preschool director, which topics should the community
health nurse focus on when preparing relevant in-service programs for the staff? Select all that
A. Effective cleaning to reduce direct contact spread of bacteria and viruses
B. Understanding how communicable diseases are transmitted
C. How to talk to parents about caring for their sick child
D. How to minimize airborne and droplet transmission
E. Protocols for sending a contagious child home
F. Effective supervision of the preschool child
G. How to achieve effective hand hygiene
Scenario, continued
The staff has been scheduled to attend the in-service focusing on achieving effective hand
hygiene. To assure effective technique, each staff member is asked to demonstrate the process
as presented by the community health nurse.
5. Item Type: Matrix
Use an X for the actions listed below that are Indicated (necessary), Contraindicated (would be
ineffective), or Nonessential (not necessary) when striving to effectively wash hands. Only one
selection can be made for each action.
Copyright © 2022 by Elsevier, Inc. All Rights Reserved.
Next-Generation NCLEX® (NGN) Examination–Style Case Studies
Apply soap to wet hands
Use hot water for washing
Lather hands and forearms
Dry hands with clean towel
Wet hands with running water
Apply lotion after rinsing hands
Rub hands together for at least 20
Sing the “Happy Birthday” song twice
while performing cleaning process
Scenario, continued
The new Health Promotion policies and practices designed to help minimize the transmission of
communicable diseases among the preschool children have been in place for several weeks.
6. Item Type: Extended Multiple Response
Which option demonstrates the staff’s positive efforts to implement effective airborne/droplet
and direct contact transmission of communicable disease pathogens? Select all that apply.
A. Group/class size is limited to no more than 10 children.
B. A staff member helps a child lather their hands sufficiently.
C. Staff is observed washing their hands after preparing the children’s snacks.
D. A staff member is observed wiping down the children’s communal toys.
E. A staff member encourages a child to “give your friend a bite of your cookie.”
F. The children and their class aide sing a song entitled What do I do when I sneeze?
G. Children are observed setting a timer at the beginning of the handwashing process.
Copyright © 2022 by Elsevier, Inc. All Rights Reserved.

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