Order Heart Failure Exacerbation Discussion

Order Heart Failure Exacerbation Discussion
Order 5906879
Order Heart Failure Exacerbation Discussion
1. A 75-year-old male is admitted to the ICU with combined heart failure exacerbation and
multifocal pneumonia. He is currently on BiPAP and his only lines are two small peripheral
IVs. You anticipate that he many require numerous procedures in the ICU within the first 24 to
48 hours. You consider talking to the patient and his family to obtain anticipatory consent for
numerous specific common ICU procedures (intubation, bronchoscopy, arterial line, central
venous access, etc), or just seeking a blanket consent for “all routine ICU interventions.” What
generally accepted aspects of informed consent may be violated by either of these methods of
obtaining consent?
A. Assessment of decision-making capacity
B. Description of the proposed intervention(s)
C. Discussion of risks and benefits of the proposed intervention(s) and alternatives
D. Assessment of patient / proxy understanding and shared decision-making
E. Ensuring voluntariness of consent
2. You are the director of an ICU in an academic center and are considering hiring NP and/or PA
providers to work alongside residents under the supervision of the ICU attendings and fellows.
Based on existing medical literature, ALLof the following appear to be true about the effect of
integrating advanced practice providers in this manner EXCEPT for:
A. Improved patient clinical outcomes
B. Increased hospital costs for patients
C. Decreased length of ICU admissions
D. Similar or improved efficacy at invasive procedures
E. Improved resident adherence to duty hours and conference attendance
3. Use of the Awakening and Breathing Coordination, Delirium Monitoring/ Management, and
Early Exercise/Mobility (“ABCDE”) Bundle has been shown to have which of the following
effects on ICU patients?
A. Increased need for sedative medications
B. Decreased risk of delirium
C. More frequent need for reintubation
D. Increased risk of patient self-extubation
E. Shorter time to discharge
4. On morning rounds in the ICU, you wish to assess a patient for delirium. You would like to use
the Confusion Assessment Method for ICU (CAM-ICU) scale. Which of the following is most
important to assess in the patient, before using the CAM-ICU tool on them?
A. Heart rate and blood pressure
B. Fluid status
C. If the patient has a history of psychiatric disease
D. The patient’s level of consciousness
E. If the patient has risk factors for delirium in their history
Order Heart Failure Exacerbation Discussion
5. During a busy shift as an ICU attending, you receive several requests for admission to your ICU
from your hospital’s emergency department and inpatient medical floor, as well as from another
smaller hospital nearby that does not have an ICU. However, your unit currently only has one
bed available. Effective and ethical ICU triage involves all of the following EXCEPT for:
A. Assessing for specific patient need(s) that can only be addressed in an ICU
B. Considering the patient’s diagnosis, medical/surgical condition(s), and prognosis
C. Balancing the ethical principle of distributive justice with obligation to individual patients
D. Preferential use of standardized triage tools over case-by-case decisions from experienced
clinicians
E. Multidisciplinary discussion between ICU, emergency medicine, hospitalist medicine, surgery,
and other allied health providers
6. You are leading a project to try and develop machine learning and decision tools in your ICU.
Your team wishes to start by studying a topic for which machine learning has already been
shown to demonstrate promising potential. All of the following topics fit this description
EXCEPT:
A. Sepsis detection
B. Predicting complications in postsurgical ICU patients
C. Deciding need for admission in patients diagnosed with pneumonia
D. Predicting ICU readmission
E. Predicting the need for prolonged mechanical ventilation
7. A 56-year-old female is admitted to the ICU for influenza and acute hypoxemic respiratory
failure. On further review of her chart you note she also has advanced HIV complicated by
AIDS and disseminated candidiasis. However, she has consistently declined antiretroviral
therapy, but is still sexually active with her husband per prior notes, and previously reported
intermittent use of protection. She arrives to the unit on BiPAP but you are able to briefly talk
with her to try and assess her wishes and goals. The patient informs you that her husband is her
healthcare proxy but tells you that he does not know about her HIV status, asks you to not
disclose this to him, and further tells you that you cannot share this information without her
consent because of HIPAA. A short time later her respiratory status further declines; she is
successfully intubated, placed on a mechanical ventilator, and sedated. How should you
proceed in subsequent conversations with her husband?
A. Do not under any circumstances disclose the patient’s HIV status to him because it’s immoral to
do so
B. Tell him about her HIV status to allow him to better understand her medical condition and make
informed decisions about her care
C. Tell him about her HIV status so that he can obtain HIV testing himself
D. Do not tell him because doing so is forbidden by HIPAA
E. Both B and C
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