#january2020mccqe1
An 80-year old woman living in a nursing home with history of dementia is admitted to the hospital with pneumonia. In the emergency department, a peripheral intravenous line was inserted, appropriate antibiotics were initiated, she was given oxygen by nasal cannula, and a urinary catheter was placed. On physical examination, temperature is 38.3°C (101.0°F), blood pressure is 140/88 mm Hg, pulse rate is 100/min, and respiration rate is 16/min. Pulmonary auscultation reveals left lower lobe crackles. Cardiac examination is normal. Moderate cognitive impairment is noted but no inattention or focal neurologic deficits. She is provided access to her glasses and hearing aid, and a large clock and night light are in place in her room. Which of the following additional steps should be taken to prevent delirium in this patient?
(A) Administer benzodiazepine, as needed
(B) Administer diphenhydramine for sleep
(C) Administer haloperidol twice daily
(D) Check vital signs every 4 hours through the night
(E) Remove her urinary catheter
An 80-year old woman living in a nursing home with history of dementia is admitted to the hospital with pneumonia. In the emergency department, a peripheral intravenous line was inserted, appropriate antibiotics were initiated, she was given oxygen by nasal cannula, and a urinary catheter was placed. On physical examination, temperature is 38.3°C (101.0°F), blood pressure is 140/88 mm Hg, pulse rate is 100/min, and respiration rate is 16/min. Pulmonary auscultation reveals left lower lobe crackles. Cardiac examination is normal. Moderate cognitive impairment is noted but no inattention or focal neurologic deficits. She is provided access to her glasses and hearing aid, and a large clock and night light are in place in her room. Which of the following additional steps should be taken to prevent delirium in this patient?
(A) Administer benzodiazepine, as needed
(B) Administer diphenhydramine for sleep
(C) Administer haloperidol twice daily
(D) Check vital signs every 4 hours through the night
(E) Remove her urinary catheter
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