Question 1

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

Accepted Answer

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

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.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?

Accepted Answer

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. 
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. B

Question 3

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

Accepted Answer

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) 
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) C

Question 4

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

Accepted Answer

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

Question 5

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?

Accepted Answer

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 
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 6

Which complications can result from prolonged deep sedation?

Accepted Answer

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

Question 7

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?

Accepted Answer

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. 
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 8

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?

Accepted Answer

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

Question 9

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?

Accepted Answer

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

Question 10

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?

Accepted Answer

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 
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 11

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?

Accepted Answer

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

Question 12

What is a major side effect of benzodiazepines?

Accepted Answer

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

Question 13

What are the causes of delirium in critically ill patients?

Accepted Answer

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

Question 14

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

Accepted Answer

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

Question 15

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

Accepted Answer

A)  Fewer side effects 
B)  Slower to cross the blood-brain barrier 
C)  Shorter half-life and rapid elimination rate 
D)  Better amnesiac properties 
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 16

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

Accepted Answer

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

Question 17

What are the risk factors for delirium?

Accepted Answer

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

Question 18

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?

Accepted Answer

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. 
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.

Question 19

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

Accepted Answer

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

Question 20

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

Accepted Answer

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

Exam 9: Sedation,Agitation,and Delirium Management

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

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

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

Which complications can result from prolonged deep sedation?

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 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 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?

What is a major side effect of benzodiazepines?

What are the causes of delirium in critically ill patients?

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

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

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

What are the risk factors for delirium?

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?

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

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

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