Deck 9: Sedation, Agitation and Delirium Management

Question 1

When administering propofol over an extended period, it is important to monitor which of the following?

A) Serum triglyceride level
B) Sodium and potassium levels
C) Platelet count
D) Acid-base balance

Answer 1

Serum triglyceride level

Question 2

A patient was admitted into the critical care unit 3 days ago.She has just been weaned from mechanical ventilation.She suddenly becomes confused, seeing nonexistent animals in her room and pulling at her gown.The drug of choice for treating this patient is

A) diazepam.
B) haloperidol.
C) lorazepam.
D) propofol.

Answer 2

haloperidol.

Question 3

A patient was admitted into the critical care unit 3 days ago.She has just been weaned from mechanical ventilation.She suddenly becomes confused, seeing nonexistent animals in her room and pulling at her gown.You suspect this patient is

A) experiencing delirium or "ICU psychosis."
B) experiencing confusion caused by increased hypoxia.
C) hypocalcemic.
D) acting out to receive the attention she was getting while intubated.

Answer 3

experiencing delirium or "ICU psychosis."

Question 4

Causes of delirium in critically ill patients include

A) hyperglycemia.
B) meningitis.
C) cardiomegaly.
D) pulmonary embolism.
E) alcohol withdrawal syndrome.
F) hyperthyroidism.

Question 5

A 56-year-old patient is admitted to the critical care unit with acute respiratory distress syndrome (ARDS).The patient has been intubated and is mechanically ventilated.The patient is becoming increasingly agitated, and the high-pressure alarm on the ventilator has been frequently triggered.Despite the nurse's actions, the patient continues to be agitated, triggering the high-pressure alarm on the ventilator.Which of the following medications would be appropriate for sedation?

A) Midazolam 2 to 5 mg intravenous push (IVP) every 5 to 15 minutes until the patient is no longer triggering the alarm
B) Haloperidol 5 mg IVP stat
C) Propofol 5 mcg/kg/min by IV infusion
D) Fentanyl 25 mcg IVP over a 15-minute period

Question 6

A 56-year-old patient is admitted to the critical care unit with acute respiratory distress syndrome (ARDS).The patient has been intubated and is mechanically ventilated.The patient is becoming increasingly agitated, and the high-pressure alarm on the ventilator has been frequently triggered.The patient continues to be very agitated, and the nurse can find nothing physiologic to account for the high-pressure alarm.The next step should be to

A) administer midazolam 5 mg by intravenous push immediately.
B) eliminate noise and other stimuli in the room and speak softly and reassuringly to him.
C) obtain a stat arterial blood gas level; his agitation indicates he is becoming increasingly hypoxic.
D) call respiratory therapy to replace this obviously malfunctioning ventilator.

Question 7

To achieve ventilator synchrony in a mechanically ventilated patient with acute respiratory distress syndrome (ARDS), which level of sedation might be most effective?

A) Light
B) Moderate
C) Conscious
D) Deep

Question 8

Risk factors for delirium include

A) hypertension, alcohol abuse, and benzodiazepine administration.
B) coma, hypoxemia, and trauma.
C) dementia, hypertension, and pneumonia.
D) coma, alcohol abuse, hyperglycemia

Question 9

A patient was admitted into the critical care unit 3 days ago.She has just been weaned from mechanical ventilation.She suddenly becomes confused, seeing nonexistent animals in her room and pulling at her gown.Which of the following interventions is indicated to adequately monitor the patient during haloperidol use?

A) Continuous bispectral index (BIS) monitoring
B) Continuous electrocardiographic (ECG) monitoring
C) Continuous pulse oximetry
D) Continuous electrocardiogram (ECG) monitoring

Question 10

The two scales that are recommended for assessment of agitation and sedation in adult critically ill patients are the

A) Ramsay Scale and Riker Sedation-Agitation Scale (SAS).
B) Ramsay Scale and Motor Activity Assessment Scale (MAAS).
C) Riker Sedation-Agitation Scale (SAS) and the Richmond Agitation-Sedation Scale (RASS).
D) Richmond Agitation-Sedation Scale (RASS) and Motor Activity Assessment Scale (MAAS).

Question 11

Which of the following complications can result from oversedation?

A) Pressure ulcers
B) Thromboemboli
C) Diarrhea
D) Nosocomial pneumonia
E) Delayed weaning from mechanical ventilation
F) Hypertension

Question 12

For sedation and analgesia management of mechanically ventilated critical care patients, put the following steps in the appropriate order in which the nurse should perform them.
1)Using an accepted pain scale, assess the patient's level of pain, and if the patient is hemodynamically stable, medicate appropriately with morphine sulfate.
2)Assess the degree of agitation and anxiety with an appropriate sedation scale and select an appropriate medication treatment.
3)Attempt nonpharmacologic treatments; optimize the environment.
4)Reassess the level of sedation, agitation and anxiety, and pain minimally every 2 hours or as indicated per facility standards.
5)Rule out and correct reversible causes.
6)Assess the patient's level of comfort.

A)1, 2, 6, 5, 3, 4
B)6, 5, 1, 2, 3, 4
C)6, 5, 3, 1, 2, 4
D)4, 1, 2, 6, 5, 3

Question 13

A 56-year-old patient is admitted to the critical care unit with acute respiratory distress syndrome (ARDS).The patient has been intubated and is mechanically ventilated.The patient is becoming increasingly agitated, and the high-pressure alarm on the ventilator has been frequently triggered.After the patient's agitation is controlled, which of the following drugs would be most appropriate for long-term sedation?

A) Morphine 2 mg/hr continuous IV drip
B) Haloperidol 15 mcg/kg/min continuous IV infusion
C) Propofol 5 mcg/kg/min by IV infusion
D) Lorazepam 0.01 to 0.1 mg/kg/hr by IV infusion

Question 14

The most common contributing factor to the development of delirium in critically ill patients is

A) sensory overload.
B) hypoxemia.
C) electrolyte disturbances.
D) sleep deprivation.

Question 15

The major advantage of using propofol for short-term sedation is that it

A) has fewer side effects.
B) is slow to cross the blood-brain barrier.
C) has a shorter half-life and rapid elimination rate.
D) is an excellent amnesiac.

Question 16

A patient has been taking benzodiazepines and suddenly develops respiratory depression and hypotension.After careful assessment, the nurse determines that the patient is experiencing benzodiazepine overdose.What is the nurse's next step?

A) Decrease benzodiazepines to half the prescribed dose.
B) Increase IV fluids to 500 cc/hr for 2 hours.
C) Administer flumazenil (Romazicon).
D) Discontinue benzodiazepine and start propofol.

Question 17

A 56-year-old patient is admitted to the critical care unit with acute respiratory distress syndrome (ARDS).The patient has been intubated and is mechanically ventilated.The patient is becoming increasingly agitated, and the high-pressure alarm on the ventilator has been frequently triggered.The nurse's first intervention for this patient would be to

A) administer midazolam (Versed) 5 mg by intravenous push immediately.
B) assess the patient to see if a physiologic reason exists for his agitation.
C) obtain a stat arterial blood gas level; his agitation indicates he is becoming increasingly hypoxic.
D) apply soft wrist restraints to keep him from pulling out the endotracheal tube.

Question 18

Which of the following drugs is used for sedation in patients experiencing withdrawal syndrome?

A) Dexmedetomidine
B) Hydromorphone
C) Diazepam
D) Clonidine

Question 19

A major side effect of benzodiazepines is

A) hypertension.
B) respiratory depression.
C) renal failure.
D) phlebitis at the IV site.

Question 20

Which benzodiazepine has a greater advantage for treatment of alcohol withdrawal syndrome (AWS)because of its longer half-life and high lipid solubility?

A) Ativan
B) Midazolam
C) Propofol
D) Valium