CCRN Pain, Agitation, and Delirium Management 2 — Questions and Answers
Question 1: Which sedative agent is preferred for ICU sedation in patients at high risk for delirium due to its analgo-sedation properties?
- Midazolam
- Propofol
- Dexmedetomidine (Correct answer)
- Lorazepam
Correct answer: Dexmedetomidine
Dexmedetomidine (an alpha-2 agonist) produces sedation without suppressing respiratory drive and is associated with lower rates of delirium compared to benzodiazepines.
Question 2: According to the PADIS bundle, which approach should be used first when managing pain in ICU patients (analgesia-first strategy)?
- Administer benzodiazepines before opioids
- Treat pain before titrating sedation (Correct answer)
- Start sedation before assessing pain
- Use neuromuscular blockade before analgesia
Correct answer: Treat pain before titrating sedation
The analgesia-first (analgo-sedation) approach recommends treating pain first, as untreated pain is a major driver of agitation and over-sedation.
Question 3: Which opioid is most commonly used for analgesia in mechanically ventilated ICU patients due to its titratability and short duration of action?
- Morphine
- Meperidine
- Fentanyl (Correct answer)
- Codeine
Correct answer: Fentanyl
Fentanyl is preferred in mechanically ventilated ICU patients due to its rapid onset, short duration of action, and ease of titration.
Question 4: A patient with ICU delirium becomes agitated and attempts to remove his endotracheal tube. Which intervention should the nurse implement first?
- Apply soft wrist restraints immediately
- Administer IV haloperidol
- Reorient the patient and address reversible causes (Correct answer)
- Increase sedation to RASS -4
Correct answer: Reorient the patient and address reversible causes
The first intervention for ICU delirium is to reorient the patient and identify/treat reversible causes such as pain, urinary retention, and sleep deprivation.
Question 5: Which benzodiazepine is associated with the highest risk of ICU delirium and prolonged mechanical ventilation?
- Lorazepam (Correct answer)
- Midazolam
- Diazepam
- Clonazepam
Correct answer: Lorazepam
Lorazepam has been identified in studies as an independent risk factor for transitioning to delirium in ICU patients, particularly due to its active metabolites and long half-life.
Question 6: The CPOT (Critical-Care Pain Observation Tool) assesses pain using which four behavioral indicators?
- Vital signs, pupil response, skin color, and diaphoresis
- Facial expression, body movements, muscle tension, and ventilator compliance/vocalization (Correct answer)
- Heart rate, blood pressure, respiratory rate, and oxygen saturation
- Eye opening, verbal response, motor response, and reflexes
Correct answer: Facial expression, body movements, muscle tension, and ventilator compliance/vocalization
The CPOT evaluates four domains: facial expression, body movements, muscle tension, and compliance with ventilator or vocalization in extubated patients.
CCRN Pain, Agitation, and Delirium Management 2
Which sedative agent is preferred for ICU sedation in patients at high risk for delirium due to its analgo-sedation properties?