Which of the following is NOT a contraindication in taking ORAL temperature?

Correct Answer: A

Rationale: Quadriplegia isn't an oral temp contraindication e.g., a paralyzed patient can hold a thermometer if alert. NGT (obstruction), dyspnea (breathing), and nausea (gagging) preclude it. Nurses opt for alternatives e.g., axillary per safety protocols.

Correct Answer: B

Rationale: Adult bladder capacity is 400-500 ml e.g., typical urge at 300-400. Less (50-200) or more (800-1000) don't fit. Nurses note e.g., catheter output for function, per physiology.

Correct Answer: B

Rationale: Thyroid hormone regulates metabolism e.g., energy use unlike calcium (parathyroid), sodium/potassium (adrenals). Nurses assess e.g., weight for function, per physiology.

Correct Answer: A

Rationale: Illness prevention in nursing focuses on proactive measures to stop disease development, particularly for conditions like hypertension. Teaching lifestyle modifications, such as diet and exercise, empowers clients to manage blood pressure and reduce risk, aligning with primary prevention's educational emphasis. Performing risk screenings identifies hypertension early, enabling timely intervention before complications arise, another primary prevention strategy. Providing heart-healthy diet literature reinforces these efforts, equipping clients with practical tools for prevention. Reporting low blood pressure or administering medications, while critical interventions, address existing conditions rather than prevent onset, falling under treatment or management. Nurses' preventive role leverages education and screening to foster healthy habits and early detection, significantly impacting chronic disease trajectories like hypertension, where lifestyle plays a pivotal role.

Correct Answer: B

Rationale: In evidence-based practice (EBP), the second step after posing a question is a systematic review, where the nurse summarizes findings from multiple studies on a specific nursing practice like pain relief methods. This involves synthesizing data from diverse sources, assessing consistency, and identifying patterns, not just asking a question (step one) or recommending practice (later step). A meta-analysis, a statistical synthesis, may follow but isn't required here. Systematic review builds a comprehensive evidence base, revealing what works e.g., studies showing non-opioid pain options reduce side effects setting the stage for appraisal and application. It's meticulous, reducing bias by including all relevant research, ensuring nurses ground decisions in a broad, reliable overview rather than isolated findings, critical for effective, patient-centered care.