A client requires complete care with ADL's. Before providing oral care, the nurse should assess for which of the following?

D. Rectal temperature measurement involves inserting a thermometer into the rectum. This method provides the most accurate reflection of core body temperature because the rectum closely mirrors internal body temperature. It is often used in infants, young children, and patients who are unable to have their temperature taken orally.

A. Axillary temperature measurement involves placing the thermometer in the armpit. This method is convenient and non-invasive but tends to provide the lowest temperature readings compared to other sites. It is suitable for screening purposes but may not be as accurate as other methods.

B. Skin temperature can vary widely based on environmental factors, circulation, and local skin conditions. Surface skin temperature may not accurately reflect core body temperature and is not typically used for precise temperature measurement in clinical settings.

C. Oral temperature measurement involves placing the thermometer under the tongue. This method is commonly used and provides a reasonably accurate reflection of core body temperature. It is convenient and generally well-tolerated by clients who are conscious and able to cooperate.

A. The psychomotor domain involves the development of physical skills and the ability to manipulate objects. When the client performs a return demonstration of using the incentive spirometer, they are demonstrating their ability to coordinate their muscles and movements to correctly operate the device. This includes actions such as inhaling deeply, maintaining proper technique, and achieving the desired lung volume.

B The cognitive domain pertains to the acquisition and application of knowledge and intellectual skills. Understanding how the incentive spirometer works, its purpose in improving lung function post-surgery, and the correct technique for using it all fall under cognitive learning. The client must grasp the

Rationale behind using the spirometer to promote effective breathing and prevent complications like atelectasis.

C. Imitation involves observing and copying someone else's actions. In the context of using an incentive spirometer, the initial demonstration by the nurse serves as a model for the client to imitate. After receiving instructions and observing the nurse's demonstration, the client imitates the correct technique during the return demonstration. However, imitation alone does not fully capture the learning domain demonstrated by the client.

D. The affective domain focuses on attitudes, values, beliefs, and emotions. While using the incentive spirometer involves physical and cognitive skills, it also involves motivation and willingness to engage in the activity as prescribed by the healthcare provider. This domain encompasses the client's commitment to following through with spirometer use as part of their recovery and adherence to the healthcare plan.