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 D

Explanation

Choice A reason: A hemoglobin level of 12.0 g/dL is slightly below the normal range for men but is not the most critical concern preoperatively. It indicates mild anemia, which should be monitored but does not present an immediate high risk.

Choice B reason: A serum creatinine level of 1.3 mg/dL is slightly elevated and indicates mild renal impairment. While this should be considered, it is not as immediately concerning as a significantly abnormal coagulation value.

Choice C reason: A Blood Urea Nitrogen (BUN) level of 24 mg/dL is slightly above normal, indicating some renal function impairment or dehydration. However, it does not pose the most significant immediate risk compared to a high INR value.

Choice D reason: An INR of 3.5 is significantly elevated and indicates a high risk of bleeding. For a surgical patient, this is the most concerning pre-op lab value because it suggests that the patient's blood is not clotting properly. This increases the risk of excessive bleeding during and after surgery, making it a priority to address before proceeding with the operation.

A. NPH (Humulin N) B. Detemir (Levemir) C. Lispro (Humalog) D. Glargine (Lantus)

Correct Answer is C

Explanation

Choice A reason: NPH (Humulin N) is an intermediate-acting insulin that is used to control blood sugar levels throughout the day, not specifically for mealtime coverage. It is typically administered twice a day.

Choice B reason: Detemir (Levemir) is a long-acting insulin that provides basal insulin coverage. It helps maintain blood sugar levels stable over a 24-hour period and is not intended for controlling post-meal blood sugar spikes.

Choice C reason: Lispro (Humalog) is a rapid-acting insulin used for mealtime coverage. It is designed to be taken just before or immediately after a meal to control the sudden rise in blood sugar levels that occurs after eating.

Choice D reason: Glargine (Lantus) is a long-acting insulin that provides basal insulin coverage, helping to maintain steady blood glucose levels throughout the day and night. It is not used for mealtime blood sugar control.

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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 D

Explanation

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Correct Answer is C

Explanation

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