The nurse obtains the rectal temperature of an adult. Which rectal temperature is within the expected range?

Appeared in: GMCH - 2015

Explanation

The rectal route measures core body temperature and is considered one of the most accurate methods.
A normal rectal temperature in an adult typically ranges from 98.7°F to 100.5°F (37.1°C to 38.1°C).
This is generally about 1°F (0.5°C) higher than a normal oral temperature (average 98.6°F).
The value of 99.8°F falls comfortably within this expected normal range for a rectal temperature.

Option A: A temperature of 101.2°F is above the normal range for any site and is defined as pyrexia, or fever.
Option C: A temperature of 96.4°F is significantly below the normal range and indicates hypothermia, a potentially dangerous condition.
Option D: While 97.6°F is a normal temperature, it is typical for the axillary (armpit) route, which is about 1°F lower than oral. It is considered low for a rectal reading.

Clinical Relevance

Nursing practice connection: Knowing Normal body temperature ranges and measurement sites helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Accurate temperature assessment is a fundamental nursing skill for monitoring a patient's baseline health, detecting infection (fever), or identifying metabolic issues (hypothermia).
The choice of measurement site is critical. Rectal temperature is a core temperature but is contraindicated in newborns, patients with heart conditions (due to vagal stimulation), rectal surgery, or low platelet counts.
A nurse must always document the site of temperature measurement, as a 99.8°F reading is normal for rectal but indicates a fever if taken orally.

How to Approach the Question

First, identify the key term in the question: 'rectal temperature'.
Recall the standard baseline for oral temperature, which is approximately 98.6°F (37°C).
Remember the relationship between different temperature sites: rectal is typically higher than oral, and axillary is typically lower.
Calculate the expected rectal temperature: Oral (98.6°F) + 1°F = ~99.6°F.
Evaluate the given options to see which one falls closest to this expected normal range.
Eliminate options that represent fever (too high) or hypothermia (too low) or are normal for other sites.

Concept Tested & Keywords

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E6 Nursing Fundamentals Taylor pp. 122-124, 118-120

Practise the full GMCH - 2015

Attempt every question from this paper in a timed mock, then review the full solution for each one.