Urden: Thelan’s Critical Care Nursing, 5th Edition

Test Bank

Chapter 9: Agitation and Sedation Management

MULTIPLE CHOICE

1. To achieve ventilator synchrony in the mechanically ventilated patient with acute

respiratory distress syndrome, which level of sedation might be most effective?
a. Light
b. Moderate
c. Conscious
d. Deep

ANS: D
Deep sedation is used when the patient must be unresponsive to deliver necessary care
safely.

DIF: Cognitive Level: Application REF: 152

OBJ: Nursing Process Step: Planning TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

2. The best method to use for assessing the adequacy of sedation in the critically ill
patient is
a. monitoring heart rate and respirations.
b. assessing the ability to respond to questions and follow simple commands
c. providing continuous electroencephalographic monitoring.
d. using an accepted sedation scale.

ANS: C
The use of continuous electroencephalographic monitoring, such as the BIS system,
provides an objective and consistent method of assessment.

DIF: Cognitive Level: Comprehension REF: 154

OBJ: Nursing Process Step: Assessment TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

Mr. K is a 56-year-old man admitted to the critical care unit with acute respiratory
distress syndrome. He is intubated on mechanical ventilation. He is becoming
increasingly agitated, and the high- pressure alarm on the ventilator has been frequently
triggered.

3. The nurse's first intervention for Mr. K would be to

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Test Bank 2

a. administer midazolam 5 mg by intravenous push immediately.

b. assess Mr. K to see if a physiologic reason exists for his agitation.
c. obtain a stat arterial blood gas level; his agitation indicates he is becoming
increasingly hypoxic.
d. apply soft wrist restraints to keep him from pulling out the endotracheal tube.

ANS: B
The first step in determining the need for sedation is to assess the patient quickly for any
physiologic causes that can be quickly reversed. In this case, endotracheal suctioning may
solve the high-pressure alarm problem.

DIF: Cognitive Level: Analysis REF: 155

OBJ: Nursing Process Step: Intervention TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

4. Mr. K continues to be very agitated and the nurse can find nothing physiologic to
account for the high-pressure alarm. The next step should be to
a. administer midazolam 5 mg by intravenous push immediately.
b. eliminate noise and other stimuli in the room and speak softly and reassuringly to
him.
c. obtain a stat arterial blood gas level; his agitation indicates he is becoming
increasingly hypoxic.
d. call respiratory therapy to replace this obviously malfunctioning ventilator.

ANS: B
Optimizing the environment, speaking calmly, explaining things to the patient, and
providing distractions are all nonpharmacologic means to decrease anxiety.

DIF: Cognitive Level: Application REF: 155

OBJ: Nursing Process Step: Intervention TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

5. The nurse's actions have no effect on Mr. K. He continues to be agitated, triggering

the high-pressure alarm on the ventilator. Which of the following medications would
be appropriate for sedation?
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 per minute by IV infusion
d. Fentanyl 25 mcg IVP over a 15-minute period

ANS: A

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Test Bank 3

Midazolam is the recommended drug for use in alleviating acute agitation Propofol can
be used for long-term sedation, haloperidol is indicated for dementia, and fentanyl is a
narcotic and not appropriate for use as a sedative.

DIF: Cognitive Level: Application REF: 155-156

OBJ: Nursing Process Step: Intervention TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

6. Once Mr. K’ s agitation is controlled, which of the following drugs would be most
appropriate for long-term sedation?
a. Morphine 2 mg/hr continuous IV drip
b. Midazolam 2 to 5 mg IVP every 5 to 15 minutes as needed to keep patient calm
c. Haloperidol 15 mcg/kg per minute continuous IV infusion
d. Propofol 5 mcg/kg per minute by IV infusion

ANS: D
Propofol may be used for ongoing sedation. The recommended dose is 5 mcg/kg per
minute continuous IV infusion, titrating every 5 minutes until the desired state of sedation
is achieved.

DIF: Cognitive Level: Application REF: 155-156

OBJ: Nursing Process Step: Intervention TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

7. When administering propofol over an extended period, it is important to monitor

which of the following?
a. Serum triglyceride level
b. Sodium and potassium levels
c. Platelet count
d. Acid-base balance

ANS: A
Prolonged use of propofol may cause an elevated triglyceride level because of its high
lipid content.

DIF: Cognitive Level: Analysis REF: 156-157

OBJ: Nursing Process Step: Assessment TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

8. The major side effect of benzodiazepines is

a. hypertension.
b. respiratory depression.
c. renal failure.

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 Test Bank 4

d. phlebitis at the IV site.

ANS: B
The major side effects of benzodiazepines include hypotension and respiratory
depression. These side effects are dose related.

DIF: Cognitive Level: Comprehension REF: 157

OBJ: Nursing Process Step: Assessment TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

9. The major advantage of using propofol for short-term sedation is that it

a. has fewer side effects.
b. is slow to cross the blood-brain barrier.
c. has a shorter half-life and rapid elimination rate.
d. is an excellent amnesiac.

ANS: C
With short-term use, the patient can be fully awake within 30 minutes of discontinuation
of the drug.

DIF: Cognitive Level: Knowledge REF: 157

OBJ: Nursing Process Step: Evaluation TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

10. Which of the following drugs is used for sedation in patients experiencing withdrawal
syndrome?
a. Dexmedetomidine
b. Hydromorphone
c. Diazepam
d. Clonidine

ANS: D
Clonidine, a central alpha-agonist, is recommended for sedation during withdrawal
syndrome.

DIF: Cognitive Level: Knowledge REF: 158

OBJ: Nursing Process Step: Intervention TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

Mrs. J has been in the critical care unit for 3 days and has just been weaned from
mechanical ventilation. She suddenly becomes confused, seeing nonexistent animals in
her room and pulling at her gown.

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 Test Bank 5

11. You suspect Mrs. J is

a. experiencing delirium or “ICU psychosis.”
b. increasingly hypoxic.
c. hypocalcemic.
d. acting out to receive the attention she was getting while intubated.

ANS: A
ICU psychosis commonly affects critically ill patients and is exhibited by agitation,
hallucinations, and changes in level of consciousness.

DIF: Cognitive Level: Evaluation REF: 158

OBJ: Nursing Process Step: Diagnosis TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

12. The drug of choice for treating Mrs. J is

a. diazepam.
b. haloperidol.
c. lorazepam.
d. propofol.

ANS: B
Haloperidol is the drug of choice when treating delirium.

DIF: Cognitive Level: Comprehension REF: 159

OBJ: Nursing Process Step: Planning TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

13. The most common contributing factor to the development of delirium in critically ill
patients is
a. sensory overload.
b. hypoxemia.
c. electrolyte disturbances.
d. sleep deprivation.

ANS: D
Sleep deprivation is the most common contributing factor to the development of delirium
in critically ill patients.

DIF: Cognitive Level: Knowledge REF: 159

OBJ: Nursing Process Step: Diagnosis TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

COMPLETION

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Test Bank 6

1. The drug of choice for treating delirium is __________.

ANS:
haloperidol
Rationale: The drug of choice for treating delirium is haloperidol.

DIF: Cognitive Level: Comprehension REF: 159

OBJ: Nursing Process Step: Intervention TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

2. Noise reduction, back rubs, and music therapy are forms of _____-pharmacologic
therapy.
ANS:
non
Rationale: In addition to medications, non-pharmacologic therapies can be helpful in
alleviating pain and anxiety.

DIF: Cognitive Level: Application REF: 160

OBJ: Nursing Process Step: Intervention TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

MATCHING

Match the following terms with the correct definition.

a. LIGHT SEDATION
b. MODERATE SEDATION
c. DEEP SEDATION

1. Used when the procedure or treatment requires the patient to be unresponsive

2. Used to relieve anxiety while allowing t he patient to remain responsive

3. Used in conjunction with analgesia to ensure patient comfort during painful

procedures

1. ANS: C DIF: Cognitive Level: Comprehension REF: 152

OBJ: Nursing Process Step: Assessment TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

2. ANS: A

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Test Bank 7

3. ANS: B

OTHER

1. Which of the following complications can result from oversedation? Select all that
apply.
a. Pressure ulcers
b. Thromboemboli
c. Gastric ileus
d. Pneumonia
e. Delayed weaning from mechanical ventilation

ANS:
a, b, c, d, e
Rationale: Oversedation can result in a multitude of complications.

DIF: Cognitive Level: Application REF: 154

OBJ: Nursing Process Step: Diagnosis TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

2. Put the following steps of sedation management in the order in which the nurse
should perform them.
a. Using an accepted pain scale, assess the patient' s level of pain and medicate
appropriately with morphine sulfate.
b. Assess the degree of agitation the patient is experiencing and select an appropriate
sedative.
c. Attempt nonpharmacologic interventions for relieving pain and anxiety.
d. Reassess the level of sedation at least every 2 hours.
e. Rule out and correct reversible causes.
f. Assess the patient’s level of comfort.

ANS:
f, e, a, c, b, d
Rationale: Pain and sedation scales should be used to accurately assess the patient's
needs; adequate interventions should be applied and the patient frequently reassessed.

DIF: Cognitive Level: Application REF: 155

OBJ: Nursing Process Step: Assessment TOP: Agitation and Sedation Management
MSC: NCLEX: Physiologic Integrity

Copyright © 2006 Mosby, Inc.