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

Answer and Explanation

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.

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Correct Answer is ["A","B"]

Explanation

Choice A reason: Warfarin should be held before surgery due to its anticoagulant properties. Continuing warfarin increases the risk of excessive bleeding during and after surgery. The patient's INR level is already elevated, indicating a higher risk of bleeding.

Choice B reason: Metformin should be held before surgery, especially for patients undergoing procedures that involve the use of contrast dye or anesthesia. Metformin can cause lactic acidosis in patients with renal impairment or when kidney function is affected by contrast agents or surgery.

Choice C reason: Lisinopril is an ACE inhibitor used to manage blood pressure. While some guidelines suggest holding ACE inhibitors before surgery due to the risk of intraoperative hypotension, this decision is often individualized based on the patient's condition and the type of surgery. It is not as universally indicated to be held as warfarin and metformin.

A. Contact the health care provider B. Recheck the pulse in another 30 minutes C. Measure the ankle-brachial index D. Administer an oral anticoagulant

Correct Answer is A

Explanation

Choice A reason: Contacting the health care provider is the most appropriate action because a change in the Doppler sound may indicate a potential complication, such as graft occlusion or compromised blood flow. Immediate assessment and intervention by the health care provider are essential to prevent further complications and ensure the patient's safety.

Choice B reason: Rechecking the pulse in another 30 minutes is not advisable in this situation because it could delay necessary medical intervention. Prompt communication with the health care provider is crucial to address the underlying issue and provide timely care.

Choice C reason: Measuring the ankle-brachial index can provide valuable information about blood flow in the lower extremities, but it is not the immediate priority when a significant change in the Doppler sound is detected. Contacting the health care provider for further assessment and instructions takes precedence.

Choice D reason: Administering an oral anticoagulant is not an appropriate action without the direct instruction from a health care provider. The nurse must first report the change in the Doppler sound to the provider and follow their specific orders regarding medication and treatment.

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Which patient problem is a significant risk factor for the development of delirium in the intensive care unit (ICU)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["A","B"]

Explanation

The nurse provides postoperative care to a patient who underwent peripheral artery bypass surgery. Thirty minutes after the initial assessment, the nurse reassesses the patient and detects a change in the Doppler sound over a pulse. Which action should the nurse take?

Correct Answer is A

Explanation

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