Correct Answer: B

Rationale: When assessing a client's temperature, the method chosen must be accurate, safe, and appropriate for the client's condition. In this scenario, the client is alert but has dehydration secondary to vomiting and diarrhea, which suggests recent or ongoing gastrointestinal disturbances. The oral route (
A) is generally accurate but is contraindicated in this case because vomiting increases the risk of aspiration, and residual nausea or oral irritation could affect the reading or patient comfort. The axillary route (
B) is a safer alternative, as it is non-invasive and avoids the gastrointestinal system, though it may be slightly less accurate (typically 0.5°C lower than oral). It is suitable for an alert client who can cooperate by keeping the thermometer in place. The radial option (
C) is incorrect because it refers to pulse assessment, not temperature. Heat-sensitive tape (
D) is less precise and not a standard method for clinical vital sign monitoring in a hospital setting. Given the client's condition, axillary measurement balances safety and reliability, making B the best choice.

Correct Answer: B

Rationale: Coolness and discoloration post-reimplantation signal compromised circulation, an urgent issue requiring physician notification to prevent tissue loss vascular integrity is critical. Mild fever, pain, or movement issues are expected or less acute. Nurses report this promptly, facilitating rapid intervention like surgical reassessment, preserving the reattached digits' viability.

Correct Answer: A

Rationale: Afternoon naps can disrupt nighttime sleep, unlike other relaxing interventions.

Correct Answer: B

Rationale: The nursing process is a systematic, rational approach encompassing all care phases.

Correct Answer: C

Rationale: Axillary temp needs 7 minutes e.g., skin contact for accuracy, longer than oral (3) or rectal (1-2) due to lower heat. Shorter under-reads; 10 excessive. Nurses time this e.g., watch per protocol, ensuring reliability.