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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000418925.76095.f1
Feature Articles

CE Test 2.5 Hours: Postoperative Delirium in Elderly Patients

Contrada, Emily

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Continued Education
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To provide registered professional nurses with an understanding of postoperative delirium in elderly surgical patients.

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After reading this article and taking this test, you should be able to

* identify predisposing and precipitating risk factors for postoperative delirium in elderly patients.

* discuss screening and assessment instruments for use with elderly surgical patients and examine potential strategies to minimize postoperative delirium in this population.

1. A predisposing factor to postoperative delirium in elderly surgical patients is

a. physical restraints.

b. surgery.

c. abnormal glycemic control.

d. sleep deprivation.

2. An example of a factor that may precipitate postoperative delirium in elderly surgical patients is

a. physical restraints.

b. hearing deficits.

c. hypoalbuminemia.

d. a poor functional state.

3. A well-established risk factor for postoperative delirium in most studies addressing risk is

a. depression.

b. difficulty sleeping.

c. a history of migraines.

d. advanced age.

4. A factor predictive of postoperative delirium noted by Ansaloni and colleagues is

a. a Cumulative Illness Rating Scale score of 8 or more.

b. a Short Portable Mental Status Questionnaire score of 9 or less.

c. a Hospital Anxiety and Depression Scale score of 10 or more.

d. age over 65 years.

5. In a multivariate analysis by Koebrugge and colleagues, the only significant risk factor for postoperative delirium was

a. 2 or more postoperative complications.

b. age over 74 years.

c. longer ICU stay.

d. low preoperative cognitive screening test scores.

6. Ganai and colleagues reported that an independent predictor of postoperative delirium is

a. a poor preoperative nutritional status.

b. a surgical procedure lasting more than 2 hours.

c. preoperative hyperglycemia.

d. psychological distress.

7. The researchers in the Ganai study suggest that delirium may be linked to use of

a. atenolol.

b. meperidine.

c. furosemide.

d. lisinopril.

8. The auditory verbal learning test used by Morimoto and colleagues was the

a. Ventry and Weinstein criteria.

b. kana–hiroi test.

c. Hasegawa score.

d. Confusion Assessment Method (CAM).

9. Smith and colleagues found that a risk factor independently associated with postoperative delirium was preoperative

a. depression.

b. sleep deprivation.

c. analgesia.

d. poor nutritional state.

10. In the 2007 study by Bellelli and colleagues, 12-month mortality was highest in patients with

a. delirium alone.

b. dementia alone.

c. delirium superimposed on dementia.

d. neither delirium nor dementia.

11. In their 2008 study, Robinson and colleagues discovered that during the 24 hours preceding delirium onset, patients with hearing deficits

a. had higher levels of anxiety.

b. received more sedating medication.

c. showed more signs of depression.

d. received less pain medication.

12. Regarding the use of patient-controlled analgesia (PCA) by delirious patients, Leung and colleagues reported that the patients

a. had no need for PCA.

b. were unable to use PCA.

c. used PCA less than nondelirious patients.

d. used PCA as much or more than nondelirious patients.

13. Sieber and colleagues found that, when compared with deep sedation, light use of which drug halved the frequency of postoperative delirium?

a. midazolam

b. nitrous oxide

c. propofol

d. phenobarbital

14. Those patients who experienced delirium with light sedation had a fewer number of

a. days of delirium during hospitalization.

b. preoperative comorbidities.

c. surgical complications.

d. episodes of in-hospital anxiety.

15. Luetz and colleagues concluded that the delirium assessment tool with the greatest specificity for use in an elderly surgical ICU population is the

a. Edinburgh Delirium Test Box.


c. Delirium Detection Score.

d. Nursing Delirium Screening Scale.

16. Research by Voyer and colleagues revealed that most elderly patients with prior cognitive impairment who were admitted to the hospital experienced

a. an altered level of consciousness.

b. rambling speech.

c. transient memory loss.

d. disorganized thinking.

17. Inouye and Charpentier identified all of the following to be predictive of delirium during hospitalization except

a. use of a bladder catheter.

b. hearing deficits.

c. fecal impaction.

d. pressure sores.

© 2012 Lippincott Williams & Wilkins, Inc.