CCRN Pain, Agitation, and Delirium Management 2

Question 1

Which sedative agent is preferred for ICU sedation in patients at high risk for delirium due to its analgo-sedation properties?

Accepted Answer

Dexmedetomidine

Answer

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)?

Accepted Answer

Treat pain before titrating sedation

Answer

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?

Accepted Answer

Fentanyl

Answer

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?

Accepted Answer

Reorient the patient and address reversible causes

Answer

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?

Accepted Answer

Lorazepam

Answer

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.

CCRN Review Practice Test

CCRN Review Practice Test

CCRN Pain, Agitation, and Delirium Management 2