The nurse puts restraints on a patient without the
patient’s permission and without a physician’s
order. The nurse may be guilty of:
1. Battery
2. Assault
3. Neglect
4. Invasion of privacy
A patient has undergone a laryngectomy. The nurse notes evidence of wound breakdown. The nurse understands that the patient is at a high risk for developing which of the following?
a) Pneumonia
b) Dehydration
c) Pulmonary embolism
d) Carotid hemorrhage
A nurse is caring for a patient post cardiac surgery. Upon assessment, the patient appears restless and is complaining of nausea and weakness. The patient’s ECG reveals peaked T waves. The nurse reviews the patient’s serum electrolytes anticipating which of the following abnormalities?
a) Hyperkalemia
b) Hypomagnesemia
c) Hyponatremia
d) Hypercalcemia
The nurse is caring for a patient being weaned from the mechanical ventilator. Which of the following patient findings would require the termination of the weaning process?
a) Heart rate less than 100 bpm
b) PaO2 greater than 60 mm Hg with a FiO2 less than 40%
c) Vital capacity of 12 mL/kg
d) Blood pressure increase of 20 mm Hg from baseline
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