# Situation: At the start of the school year, a nurse is assigned to a public elementary school with 1,200 learners from kindergarten to grade 6. Four learners who were sent home with communicable illnesses are brought back this morning. Applying the usual school exclusion rule for each illness, which learner may return to class TODAY?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627288  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: At the start of the school year, a nurse is assigned to a public elementary school with 1,200 learners from kindergarten to grade 6.

Four learners who were sent home with communicable illnesses are brought back this morning. Applying the usual school exclusion rule for each illness, which learner may return to class TODAY?

## 보기

1. Influenza-like illness; no fever for 36 hours; last paracetamol 30 hours ago **✔ 정답**
2. Chickenpox; rash began 6 days ago; no fever; two new blisters appeared yesterday
3. Mumps; jaw swelling began 3 days ago; no fever since yesterday
4. Influenza-like illness; no fever for 48 hours; takes paracetamol every 6 hours

**정답: 1**

## 해설

Each illness has its own exclusion rule. Influenza-like illness requires at least 24 hours without fever and without antipyretics; this learner took the last paracetamol dose 30 hours ago and has had no fever since, so the rule is met. Chickenpox requires all lesions to be crusted, mumps requires 5 days after the salivary gland swelling begins, and a learner still taking paracetamol every 6 hours may have a fever that the drug is masking.

## 심화 해설

Each illness has its own exclusion rule
School health nursing uses illness-specific exclusion rules to decide when a learner with a communicable disease may return to class. For influenza-like illness, the learner returns after at least 24 hours without fever and without antipyretics. For chickenpox, the learner returns when all lesions have crusted. For mumps, the learner returns 5 days after the salivary gland swelling began. The first learner has had no fever for 36 hours, and the last paracetamol dose was 30 hours ago. Both conditions of the influenza rule are met, so this learner may return today.

Why antipyretics matter
Fever is the sign that the learner may still be shedding the virus. Paracetamol lowers body temperature, so a learner taking it regularly may appear fever-free while the illness is still active. The rule therefore counts the 24 hours only from the time the learner is both fever-free and off fever-reducing medicine. In the first learner, 30 hours have passed since the last dose with no fever, which is longer than the required 24 hours.

| Learner | Rule | Status today |
| --- | --- | --- |
| Influenza-like illness, no fever 36 hours, last paracetamol 30 hours ago | 24 hours fever-free without antipyretics | May return |
| Chickenpox, new blisters yesterday | All lesions crusted | Stay home |
| Mumps, swelling began 3 days ago | 5 days after swelling began | Stay home |
| Influenza-like illness, paracetamol every 6 hours | 24 hours fever-free without antipyretics | Stay home |

Why the other learners stay home
The learner with chickenpox developed new blisters yesterday, so not all lesions are crusted and the learner is still contagious, even without fever. The learner with mumps has had swelling for only 3 days; the rule requires 5 days after the swelling began, regardless of fever. The second learner with influenza-like illness has been fever-free for 48 hours, but takes paracetamol every 6 hours, which may mask a fever; the 24-hour count has not started. Watch out! Absence of fever alone does not clear a learner for chickenpox or mumps, and does not count for influenza while antipyretics are still being taken.

Exam takeaway
Apply each illness's own rule: influenza, 24 hours fever-free without antipyretics; chickenpox, all lesions crusted; mumps, 5 days after swelling began. The school nurse checks each returning learner, documents the decision, and explains the reason to parents of learners who must stay home. She also reinforces hand hygiene and respiratory etiquette in class and reports clusters of cases to the municipal health office.

## 임상 시나리오

School Exclusion RulesDeciding which learner may return
Influenza-like illness: return after 24 hours without fever and without antipyretics.

Chickenpox: return when all lesions are crusted. Mumps: return 5 days after the swelling began.

Only the learner fever-free for 36 hours with the last paracetamol 30 hours ago meets the rule today.

CautionRegular paracetamol can hide a fever; the 24-hour count starts only when antipyretics have stopped.

## 핵심 개념

- **Exclusion rule** — A guideline for how long a learner with a communicable disease must stay away from school.
- **Antipyretic** — A medicine that lowers fever, such as paracetamol (acetaminophen).
- **Crusted lesion** — A chickenpox blister that has dried and scabbed, no longer shedding virus.
- **Influenza-like illness** — Sudden fever with cough or sore throat, used as a surveillance case definition.

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