Correct Answer: C

Rationale: The clinical presentation of fever, malaise, maculopapular rash starting on the face and spreading to the trunk and extremities, along with leukopenia and thrombocytopenia, is highly suggestive of Rocky Mountain spotted fever (RMSF) caused by Rickettsia rickettsii. RMSF is a tick-borne illness transmitted by the American dog tick, Rocky Mountain wood tick, and brown dog tick. The constellation of symptoms described aligns well with the typical presentation of RMSF. Borrelia burgdorferi causes Lyme disease, which presents with erythema migrans but does not typically cause leukopenia or thrombocytopenia. Plasmodium falciparum is the causative agent of severe malaria and would present with symptoms such as cyclic fevers, anemia, and jaundice but not the described rash distribution.

Correct Answer: A

Rationale: Hashimoto's thyroiditis is an autoimmune disorder characterized by chronic inflammation of the thyroid gland. In this condition, lymphocytic infiltration and germinal centers can be seen in the thyroid tissue. This inflammation can lead to the formation of thyroid nodules and enlargement of the thyroid gland, causing symptoms such as difficulty swallowing and breathing due to compression of surrounding structures. Additionally, Hashimoto's thyroiditis can result in hypothyroidism over time, further contributing to the symptoms. Therefore, the patient in this case is most likely experiencing these symptoms due to Hashimoto's thyroiditis. Graves' disease, on the other hand, typically presents with hyperthyroidism and is less likely to manifest as compressive symptoms of the thyroid gland.

Correct Answer: A

Rationale: It is recommended for nurses to conduct physical assessments on school children at least three times a year, or thrice a year. This frequency allows nurses to monitor the children's growth and development, assess any changes in their health status, and provide early intervention if needed. Regular physical assessments help ensure that any health issues are identified promptly and addressed appropriately, promoting the overall well-being and academic performance of the students.

Correct Answer: C

Rationale: Incident Reports (IRs) must be summarized monthly and stored in a secured cabinet for several reasons. Firstly, summarizing the IRs monthly allows for a consolidated overview of the incidents that have occurred, highlighting any recurring patterns or trends that may need to be addressed. By storing the summarized IRs in a secured cabinet, the information is kept confidential and protected from unauthorized access. This practice also ensures that the reports are organized and easily accessible for future reference or audits. Storing the IRs on an open cabinet, table top, or with a classification system that may not be easily understandable can lead to potential breaches of confidentiality or difficulty in retrieving and understanding the information when needed.

Correct Answer: C

Rationale: The initial action the nurse should take when faced with a situation where a patient refuses to take medication after education and explanation is to notify the physician. The physician may need to be informed so they can reassess the medication and potentially explore alternative options or make adjustments based on the patient's concerns and preferences. It is important for medical decisions to be made in collaboration with the healthcare team to ensure the best care for the patient. Consulting the physician also helps in avoiding any potential negative outcomes resulting from the patient's refusal to take the prescribed medication. Once the physician is aware, further actions can be discussed and implemented to address the patient's concerns.