Deck 9: Sedation,Agitation,and Delirium Management

Question 1

What are the risk factors for delirium?

A) Hypertension, alcohol abuse, and benzodiazepine administration
B) Coma, hypoxemia, and trauma
C) Dementia, hypertension, and pneumonia
D) Coma, alcohol abuse, hyperglycemia

Answer 1

Hypertension, alcohol abuse, and benzodiazepine administration

Question 2

A patient is admitted 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 medication would be appropriate to sedate the patient this time?

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

Answer 2

Midazolam 2 to 5 mg intravenous push (IVP) every 5 to 15 minutes until the patient is no longer triggering the alarm

Question 3

A patient was admitted 5 days ago and has just been weaned from mechanical ventilation.The patient suddenly becomes confused,seeing nonexistent animals in the room and pulling at the bedding.What parameter should be monitored while the patient is haloperidol?

A) Sedation level
B) QTc-interval
C) Oxygen saturation level
D) Brain waves

Answer 3

QTc-interval

Question 4

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

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

Question 5

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

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 6

A patient was admitted 5 days ago and has just been weaned from mechanical ventilation.The patient suddenly becomes confused,seeing nonexistent animals in the room and pulling at the bedding.What is the medication of choice for treating this patient?

A) Diazepam
B) Haloperidol
C) Lorazepam
D) Propofol

Question 7

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

A) Sensory overload
B) Hypoxemia
C) Electrolyte disturbances
D) Sleep deprivation

Question 8

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 9

A patient is admitted 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.What action should be the nurse take first?

A) Administer midazolam 5 mg by intravenous push immediately.
B) Assess the patient to see if a physiologic reason exists for his agitation.
C) Obtain an arterial blood gas level to ensure the patient is not hypoxemic.
D) Apply soft wrist restraints to keep him from pulling out the endotracheal tube.

Question 10

What is the major advantage of using propofol as opposed to another sedative for short-term sedation?

A) Fewer side effects
B) Slower to cross the blood-brain barrier
C) Shorter half-life and rapid elimination rate
D) Better amnesiac properties

Question 11

A patient is admitted with acute respiratory distress syndrome (ARDS).The patient has been intubated and is mechanically ventilated.The patient had become very agitated and required some sedation.After the patient's agitation is controlled,which medications would be most appropriate for long-term sedation?

A) Morphine 2 mg/h 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/h by IV infusion

Question 12

When administering propofol over an extended period,what laboratory value should the nurse routinely monitor?

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

Question 13

A patient is admitted 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.What action should the nurse take next?

A) Administer midazolam 5 mg by intravenous push immediately.
B) Eliminate noise and other stimuli in the room and speak softly and reassuringly to the patient.
C) Obtain an arterial blood gas to ensure the patient is not becoming more hypoxemic.
D) Call the respiratory care practitioner to replace the malfunctioning ventilator.

Question 14

What are the causes of delirium in critically ill patients?

A) Hyperglycemia
B) Meningitis
C) Cardiomegaly
D) Pulmonary embolism
E) Alcohol withdrawal syndrome
F) Hyperthyroidism

Question 15

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

A) Lorazepam
B) Midazolam
C) Propofol
D) Diazepam

Question 16

A patient was admitted 5 days ago and has just been weaned from mechanical ventilation.The patient suddenly becomes confused,seeing nonexistent animals in the room and pulling at the bedding.The nurse suspects the patient may be experiencing what issue?

A) Delirium
B) Hypoxemia
C) Hypocalcemia
D) Sedation withdrawal

Question 17

What is a major side effect of benzodiazepines?

A) Hypertension
B) Respiratory depression
C) Renal failure
D) Phlebitis

Question 18

Which complications can result from prolonged deep sedation?

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

Question 19

Which intervention is an effective nursing strategy to decrease the incidence of delirium?

A) Restriction of visitors
B) Early nutritional support
C) Clustering of nursing care activities
D) Bedrest

Question 20

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 action?

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