Acute Care Nurse Practitioner Neurological Assessment and Management in the ICU 2 — Questions and Answers
Question 1: Which sedation scale is most validated for ICU use and includes assessment of agitation levels from +4 to -5?
- Ramsay Sedation Scale
- RASS (Richmond Agitation-Sedation Scale) (Correct answer)
- CPOT (Critical Care Pain Observation Tool)
- FOUR Score
Correct answer: RASS (Richmond Agitation-Sedation Scale)
The RASS is the most validated ICU sedation scale ranging from +4 (combative) to -5 (unarousable).
Question 2: Per PADIS guidelines, what is the target RASS for most mechanically ventilated ICU patients?
- -3 to -4
- -1 to 0 (Correct answer)
- -4 to -5
- 0 to +1
Correct answer: -1 to 0
PADIS guidelines recommend light sedation (RASS -1 to 0) as a target to improve outcomes including shorter ventilator days.
Question 3: Which agent is the preferred sedative for mechanically ventilated ICU patients due to ease of titration and ability to reduce ventilator days?
- Lorazepam
- Midazolam
- Propofol (Correct answer)
- Haloperidol
Correct answer: Propofol
Propofol allows rapid titration and awakening, reducing ventilator days and ICU LOS compared to benzodiazepines.
Question 4: Delirium in the ICU is BEST assessed using which validated tool?
- Mini-Mental State Examination (MMSE)
- Confusion Assessment Method for ICU (CAM-ICU) (Correct answer)
- RASS
- GCS
Correct answer: Confusion Assessment Method for ICU (CAM-ICU)
CAM-ICU is the gold standard for delirium screening in ICU patients, including those who are intubated and cannot speak.
Question 5: Which modifiable risk factor is MOST strongly associated with ICU delirium development?
- Female sex
- Benzodiazepine use (Correct answer)
- Hypertension
- Elevated BNP
Correct answer: Benzodiazepine use
Benzodiazepine use is the most strongly modifiable risk factor for ICU delirium, and reducing their use significantly decreases delirium rates.
Question 6: An ACNP orders dexmedetomidine for a delirious, agitated ICU patient. Which side effect must be monitored closely?
- Respiratory depression
- Hypertension and tachycardia
- Bradycardia and hypotension (Correct answer)
- Hyperglycemia
Correct answer: Bradycardia and hypotension
Dexmedetomidine's alpha-2 agonism reduces sympathetic tone, causing bradycardia and hypotension as its primary adverse effects.
Acute Care Nurse Practitioner Neurological Assessment and Management in the ICU 2
Which sedation scale is most validated for ICU use and includes assessment of agitation levels from +4 to -5?