Delirium Flashcards
1
Q
- Which type of delirium is most commonly seen in patients over 65 years old?
A) Hyperactive
B) Hypoactive
C) Mixed
D) Drug-induced
A
Answer: B) Hypoactive
2
Q
- Which of the following is NOT a risk factor for delirium?
A) Vision impairment
B) Dehydration
C) Overstimulation
D) Age < 50
A
Answer: D) Age < 50
3
Q
- Which neurotransmitter imbalance is primarily involved in the pathophysiology of delirium?
A) Dopamine and serotonin
B) Acetylcholine and dopamine
C) Glutamate and serotonin
D) Norepinephrine and GABA
A
Answer: B) Acetylcholine and dopamine
4
Q
- Which medication is best suited for managing hyperactive delirium in an elderly patient?
A) Lorazepam
B) Risperidone
C) Haloperidol
D) Dronabinol
A
Answer: C) Haloperidol
5
Q
- Which of the following is considered a modifiable risk factor for delirium?
A) Male gender
B) Dementia
C) Polypharmacy
D) Age > 65
A
Answer: C) Polypharmacy
6
Q
- Which medication is contraindicated in managing delirium in a patient with Parkinson’s disease?
A) Risperidone
B) Haloperidol
C) Lorazepam
D) Dronabinol
A
Answer: B) Haloperidol
7
Q
- What is the primary focus of delirium management?
A) Symptom suppression with medication
B) Reversing the underlying cause
C) Sedation to prevent agitation
D) Treating with antibiotics
A
Answer: B) Reversing the underlying cause
8
Q
- An 82-year-old male is admitted to the ICU for sepsis and develops confusion and agitation 24 hours after admission. He pulls at his IV line and is disoriented to time and place. Which of the following is the most appropriate initial intervention?
A) Administer haloperidol 1 mg IV
B) Assess and treat underlying causes of delirium
C) Place physical restraints to ensure patient safety
D) Start lorazepam 1 mg IV
A
Answer: B) Assess and treat underlying causes of delirium
9
Q
- A 76-year-old female with dementia is hospitalized for pneumonia. On day 3, she becomes lethargic, has difficulty maintaining attention, and is observed talking to people who aren’t present. Which factor likely contributed to her condition?
A) Improved sleep hygiene
B) Initiation of antibiotics for pneumonia
C) Polypharmacy and infection
D) Early mobilization
A
Answer: C) Polypharmacy and infection
9
Q
- A 65-year-old male post-surgical patient develops hypoactive delirium. He is lethargic, minimally responsive, and has poor oral intake. What is the most appropriate next step in management?
A) Administer haloperidol
B) Evaluate for underlying infection or metabolic derangements
C) Start benzodiazepines to prevent agitation
D) Discontinue all medications immediately
A
Answer: B) Evaluate for underlying infection or metabolic derangements
10
Q
An 85-year-old female is admitted for acute mental status changes and is now acutely confused as to the date. The patient refuses to get dressed. What diagnosis do you suspect?
Group of answer choices:
* Dementia
* Depression
* Delirium
* Polypharmacy
A
Answer: Delirium
11
Q
Which of the following factors can increase the risk for delirium? Select all that apply.
Group of answer choices:
* Recent surgery
* Age > 65
* Adequate pain management
* History of delirium
* Nighttime disruption
* Clustering patient care
A
Answer:
* Recent surgery
* Age > 65
* History of delirium
* Nighttime disruption
11
Q
Which of the following statements regarding delirium are correct? Select all that apply.
Group of answer choices:
* It is a disturbance that develops acutely.
* It can cause reduced awareness of surroundings.
* It is often secondary to other disease processes.
* It is irreversible.
A
Answer:
* It is a disturbance that develops acutely.
* It can cause reduced awareness of surroundings.
* It is often secondary to other disease processes.
12
Q
Whole-bowel irrigation can be considered an appropriate method of detoxification in which of the following? Select all that apply.
Group of answer choices:
* A large ingestion of a sustained-release or enteric-coated drug
* Ferrous sulfate overdose
* Ingestion of many packets of an unknown substance
* Ingestion of an entire bottle of acetaminophen
A
Answer:
* A large ingestion of a sustained-release or enteric-coated drug
* Ferrous sulfate overdose
* Ingestion of many packets of an unknown substance
13
Q
- Which of the following is a modifiable risk factor for delirium?
A) Age over 80
B) Vision impairment without correction
C) APOE-4 genetic variant
D) Advanced dementia
A
Answer: B) Vision impairment without correction
14
Q
- A 70-year-old hospitalized patient becomes confused and agitated. What is the most likely diagnosis?
A) Alzheimer’s disease
B) Parkinson’s disease
C) Delirium
D) Depression
A
Answer: C) Delirium
15
Q
- Which environmental intervention can reduce delirium risk?
A) Restricting visitor access
B) Bright lights at night
C) Ensuring sensory aids are used
D) Prolonged immobilization
A
Answer: C) Ensuring sensory aids are used
16
Q
- What is a hallmark feature of hypoactive delirium?
A) Aggression
B) Excessive somnolence
C) Restlessness
D) Hallucinations
A
Answer: B) Excessive somnolence
17
Q
- Which neurotransmitter is elevated in hyperactive delirium?
A) Acetylcholine
B) Dopamine
C) GABA
D) Serotonin
A
Answer: B) Dopamine
18
Q
- Which pharmacologic agent is first-line for managing agitation in delirium?
A) Haloperidol
B) Diazepam
C) Midazolam
D) Flumazenil
A
Answer: A) Haloperidol
18
Q
- A patient experiencing alcohol withdrawal-induced delirium should be treated with:
A) Haloperidol
B) Lorazepam
C) Risperidone
D) Flumazenil
A
Lorazepam
19
Q
- What is the most common and underrecognized type of delirium?
A) Hyperactive
B) Mixed
C) Hypoactive
D) Withdrawal-related
A
Answer: C) Hypoactive
20
Q
- Which neurotransmitter deficiency is strongly associated with the development of delirium?
A) Dopamine
B) Acetylcholine
C) GABA
D) Serotonin
A
Answer: B) Acetylcholine
21
Q
- In elderly patients, which of the following factors increases the risk of delirium?
A) Use of sensory aids
B) Adequate hydration
C) Polypharmacy
D) Proper pain management
A
Answer: C) Polypharmacy
22
7. What is the first step in managing a patient with delirium?
A) Administering antipsychotic medications
B) Identifying and addressing the underlying cause
C) Sedating the patient with benzodiazepines
D) Isolating the patient to reduce overstimulation
Answer: B) Identifying and addressing the underlying cause
23
9. Delirium is characterized by:
A) Gradual cognitive decline
B) Disturbance in attention and awareness
C) Inability to fall asleep
D) Progressive memory loss
Answer: B) Disturbance in attention and awareness
24
11. A significant risk factor for delirium is:
A) Adequate hydration
B) Preexisting cognitive impairment
C) Younger age
D) Regular physical activity
Answer: B) Preexisting cognitive impairment
25
12. Which neurotransmitter imbalance is associated with delirium?
A) Elevated serotonin
B) Deficiency in acetylcholine
C) High dopamine
D) Low norepinephrine
Answer: B) Deficiency in acetylcholine
26
14. Which of the following interventions is contraindicated in patients at risk for delirium?
A) Administering melatonin
B) Prescribing benzodiazepines for sleep
C) Using massage therapy
D) Promoting sleep hygiene routines
Answer: B) Prescribing benzodiazepines for sleep
27
11. A 75-year-old ICU patient becomes acutely confused and restless. They have been on high doses of opioids for pain management. What should be the first step in managing their delirium?
A) Administer haloperidol
B) Perform medication reconciliation to identify potential causes
C) Increase opioid dosage to manage pain
D) Use benzodiazepines to reduce restlessness
Answer: B) Perform medication reconciliation to identify potential causes
28
12. A 67-year-old hospitalized patient with pneumonia exhibits hypoactive delirium. What nonpharmacologic intervention would be most appropriate?
A) Restrain the patient to prevent harm
B) Keep the room dim and quiet at all times
C) Encourage mobility and use of sensory aids
D) Administer sedative medications
Answer: C) Encourage mobility and use of sensory aids
29
13. A patient recovering from surgery is at risk for delirium. Which intervention is most appropriate to prevent delirium?
A) Avoid administering any analgesics
B) Promote sleep by reducing nighttime interruptions
C) Encourage strict bedrest
D) Perform hourly neurological assessments
Answer: B) Promote sleep by reducing nighttime interruptions
30
14. A 78-year-old patient with delirium is being managed in a busy hospital ward. What is the best way to reduce environmental triggers?
A) Increase exposure to staff interaction
B) Maintain a consistent daily schedule
C) Keep the patient isolated in a dark room
D) Allow family visits only during the day
Answer: B) Maintain a consistent daily schedule
31
15. A 70-year-old with cognitive impairment develops delirium after starting antibiotics for a UTI. What is the likely cause of the delirium?
A) Lack of mobility
B) Polypharmacy from antibiotics
C) Excessive hydration
D) Reduced caloric intake
Answer: B) Polypharmacy from antibiotics
32
16. A 65-year-old ICU patient with multiple comorbidities experiences fragmented sleep and develops mild delirium. What is the best initial intervention?
A) Administer haloperidol immediately
B) Provide melatonin one hour before bedtime
C) Begin continuous sedation
D) Limit daytime light exposure to promote rest
Answer: B) Provide melatonin one hour before bedtime
33
17. A 45-year-old patient admitted for alcohol withdrawal is agitated and sleep-deprived. What intervention can reduce their risk of complications?
A) Administer a benzodiazepine to manage withdrawal symptoms
B) Restrict their fluid intake to avoid electrolyte imbalance
C) Encourage minimal movement during the day
D) Perform unnecessary frequent monitoring
Answer: A) Administer a benzodiazepine to manage withdrawal symptoms
34
9. What is the most effective nonpharmacological strategy to prevent delirium in hospitalized elderly patients?
A) Initiate a low-dose sedative protocol
B) Ensure mobility and sensory aids are used
C) Restrict visitors to minimize stimulation
D) Perform frequent neurologic assessments
Answer: B) Ensure mobility and sensory aids are used
35
10. What nonpharmacological approach can help improve sleep in ICU patients?
A) Perform hourly checks during the night
B) Provide a high-calorie bedtime snack
C) Cluster care activities to reduce interruptions
D) Administer melatonin routinely
Answer: C) Cluster care activities to reduce interruptions
36
13. What is the first-line pharmacological treatment for delirium in elderly patients when nonpharmacological measures fail?
A) Haloperidol
B) Risperidone
C) Lorazepam
D) Olanzapine
Answer: A) Haloperidol
37
15. A patient with serotonin syndrome presents with agitation. What is the first-line medication?
A) Cyproheptadine
B) Benzodiazepines
C) Flumazenil
D) Haloperidol
Answer: B) Benzodiazepines
38
16. Which drug is appropriate for alcohol withdrawal with symptoms of seizures and delirium tremens?
A) Haloperidol
B) Lorazepam
C) Clonidine
D) Propofol
Answer: B) Lorazepam
39
17. What is the most common complication of untreated opioid overdose?
A) Aspiration pneumonia
B) Cardiac arrest
C) Respiratory arrest
D) Pulmonary edema
Answer: C) Respiratory arrest
40
1. Which neurotransmitter is suspected to be deficient in the pathophysiology of delirium?
A) Serotonin
B) Acetylcholine
C) GABA
D) Glutamate
Answer: B) Acetylcholine
41
2. What is the most common type of delirium seen in hospitalized patients?
A) Hyperactive delirium
B) Hypoactive delirium
C) Mixed delirium
D) Postoperative delirium
Answer: C) Mixed delirium
42
3. What is the first step in diagnosing delirium in a hospitalized patient?
A) Brain imaging
B) Medication reconciliation and physical examination
C) Lumbar puncture
D) Confusion Assessment Method for the ICU (CAM-ICU)
Answer: B) Medication reconciliation and physical examination
43
4. Which electrolyte imbalance is most likely to cause delirium?
A) Hyperkalemia
B) Hyponatremia
C) Hypocalcemia
D) Hyperphosphatemia
Answer: B) Hyponatremia
44
6. Which environmental intervention is most effective in preventing delirium?
A) Continuous use of dim lighting
B) Encouraging family visitation
C) Restricting patient mobility
D) Limiting access to sensory aids
Answer: B) Encouraging family visitation
45
7. What is an effective way to address overstimulation in patients at risk for delirium?
A) Increase noise levels to maintain alertness
B) Reduce environmental noise and cluster nursing care
C) Keep lights on throughout the night
D) Encourage frequent phone use
Answer: B) Reduce environmental noise and cluster nursing care
46
8. Which antipsychotic is commonly used for severe agitation in delirium but requires QT interval monitoring?
A) Haloperidol
B) Risperidone
C) Quetiapine
D) Olanzapine
Answer: A) Haloperidol
47
9. When is lorazepam most appropriately used for a delirious patient?
A) For patients with dementia-related psychosis
B) For patients with benzodiazepine withdrawal
C) As first-line treatment for hypoactive delirium
D) As a preventive measure for delirium
Answer: B) For patients with benzodiazepine withdrawal
