Chapter 09: Sedation, Agitation, and Delirium Management Urden

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

d. Deep

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

c. Administer flumazenil (Romazicon).

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.

b. Assess the patient to see if a physiologic reason exists for his agitation.

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.

b. Eliminate noise and other stimuli in the room and speak softly and reassuringly to

the patient.

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

a. Midazolam 2 to 5 mg intravenous push (IVP) every 5 to 15 minutes until the

patient is no longer triggering the alarm

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

d. Lorazepam 0.01 to 0.1 mg/kg/h by IV infusion

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

a. Serum triglyceride level

What is a major side effect of benzodiazepines?

a. Hypertension

b. Respiratory depression

c. Renal failure

d. Phlebitis

b. Respiratory depression

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

c. Shorter half-life and rapid elimination rate

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

syndrome?

a. Dexmedetomidine

b. Hydromorphone

c. Diazepam

d. Clonidine

d. Clonidine

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

a. Delirium

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

b. 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 parameter should be monitored while the patient is haloperidol?

a. Sedation level

b. QTc-interval

c. Oxygen saturation level

d. Brain waves

b. QTc-interval

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

d. Sleep deprivation

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

d. Diazepam

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

a. Hypertension, alcohol abuse, and benzodiazepine administration

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)

c. Riker Sedation-Agitation Scale (SAS) and the Richmond Agitation-Sedation Scale

(RASS)

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

c. Clustering of nursing care activities

What are the causes of delirium in critically ill patients? (Select all that apply.)

a. Hyperglycemia

b. Meningitis

c. Cardiomegaly

d. Pulmonary embolism

e. Alcohol withdrawal syndrome

f. Hyperthyroidism

b. Meningitis

e. Alcohol withdrawal syndrome

f. Hyperthyroidism

Which complications can result from prolonged deep sedation? (Select all that apply.)

a. Pressure ulcers

b. Thromboembolism

c. Diarrhea

d. Nosocomial pneumonia

e. Delayed weaning from mechanical ventilation

f. Hypertension

a. Pressure ulcers

b. Thromboembolism

d. Nosocomial pneumonia

e. Delayed weaning from mechanical ventilation

True or False: Sedation negates any need for analgesia in mechanically intubated patients.

False

What percentage of mechanically ventilated patients experience delirium?

a. 1 to 25%

b. 25 to 50%

c. over 50%

d. unknown

c. over 50%