Which patient problem is a significant risk factor for the development of delirium in the intensive care unit (ICU)?
Type 2 diabetes mellitus
Alcohol abuse
Anxiety
Impaired communication
The Correct Answer is B
Choice A reason: Type 2 diabetes mellitus, while a serious chronic condition, does not directly predispose patients to delirium. Diabetes primarily impacts the body's ability to regulate blood glucose levels, leading to complications such as cardiovascular disease, neuropathy, and nephropathy. However, it is not directly linked to the acute cognitive disturbances seen in delirium unless it leads to severe metabolic derangements, which is less common.
Choice B reason: Alcohol abuse is a significant risk factor for the development of delirium, especially in ICU patients. Chronic alcohol use can lead to a condition known as delirium tremens (DTs) during withdrawal, characterized by severe agitation, confusion, hallucinations, and autonomic hyperactivity. Patients with a history of alcohol abuse may have altered brain chemistry and neurotransmitter imbalances that predispose them to delirium when stressed by illness or surgery. Moreover, alcohol abuse can lead to liver dysfunction, nutritional deficiencies (particularly thiamine), and other systemic issues that further exacerbate the risk.
Choice C reason: Anxiety can exacerbate stress and discomfort in a patient but is not a primary causative factor for delirium. Anxiety may contribute to an increased sense of fear or confusion, especially in an ICU setting. However, it does not cause the profound disruption in cognitive function, attention, and awareness that characterizes delirium.
Choice D reason: Impaired communication might be a consequence or symptom seen in patients with delirium, but it is not a root cause. Patients with pre-existing communication difficulties might struggle more to express symptoms or needs, which could complicate care, but it does not inherently lead to the onset of delirium. Effective communication strategies and aids can help manage these challenges but do not address the underlying neurological changes seen in delirium.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C"]
Explanation
Choice A reason: Subcutaneous administration of anticoagulants like Lovenox (enoxaparin) or heparin is a common and effective method for preventing DVT and VTE. These medications help prevent clot formation by thinning the blood and reducing the risk of thrombus development.
Choice B reason: Graduated compression stockings, such as thromboembolic deterrent (TED) hose, are used to improve blood flow in the legs and prevent the formation of blood clots. They apply consistent pressure to the legs, helping to maintain venous return and reduce the risk of DVT.
Choice C reason: Intermittent pneumatic compression devices (IPCs) are also used to prevent DVT and VTE. These devices periodically inflate and deflate, applying pressure to the legs to stimulate blood flow and prevent blood stasis, which can lead to clot formation.
Choice D reason: Strict bed rest is not recommended for DVT and VTE prevention. Prolonged immobility can increase the risk of clot formation. Encouraging early mobilization and activity is crucial to reduce the risk of DVT.
Choice E reason: Early and aggressive mobilization is a key strategy in preventing DVT and VTE. Encouraging patients to move and engage in physical activity as soon as it is safe to do so helps promote blood circulation and prevent the development of blood clots.
Correct Answer is B
Explanation
Choice A reason: 0.45% sodium chloride is a hypotonic solution, which is not ideal for rapidly replacing fluid volume in patients with low blood pressure due to severe diarrhea. Hypotonic solutions can cause fluid to move into cells rather than staying in the vascular space, potentially worsening hypotension.
Choice B reason: 0.9% sodium chloride, also known as normal saline, is an isotonic solution. It is the best choice for rapidly replacing fluid volume in patients with low blood pressure. Isotonic solutions stay in the vascular space and help restore circulating blood volume and blood pressure without causing fluid shifts that can lead to cellular edema or dehydration.
Choice C reason: 5% dextrose in 0.9% sodium chloride is a hypertonic solution, which might not be the most appropriate for initial rapid fluid resuscitation. Hypertonic solutions can draw fluid into the vascular space from the interstitial and intracellular spaces, potentially leading to rapid changes in fluid balance and electrolyte shifts.
Choice D reason: 5% dextrose in 0.45% sodium chloride is also a hypertonic solution but with a hypotonic component (0.45% sodium chloride). This combination is not typically used for rapid fluid resuscitation because it can cause fluid shifts that are less predictable and may complicate the patient's electrolyte balance and hydration status.
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