Appendix B. Confusion Assessment Method for the ICU (CAM-ICU) Survey Questions.
| 1. Which of the following statements is TRUE for delirium? |
| a. New onset of delirium should be considered a medical emergency |
| b. Mini-Mental Status Examination (MMSE) is the most sensitive tool used to identify patients with delirium |
| c. Confusion Assessment Method (CAM) is a dementia screening tool |
| d. Delirium is most prevalent in ambulatory settings |
| e. The patient’s symptoms of delirium, once treated, should resolve immediately |
| 2. Which of the following medications is MOST LIKELY to cause delirium among older adults? |
| a. Hydrochlorothiazide |
| b. Simvastatin |
| c. Diphenhydramine |
| d. Omeprazole |
| e. Metoprolol |
| 3. Which of the following statements is TRUE regarding delirium? |
| a. The treatment of delirium is independent of the cause |
| b. Laboratory tests are not really helpful in the evaluation of a patient with delirium |
| c. The development of delirium can be prevented with nonpharmacological measures |
| d. Soft-hand restraints are a first line of management |
| e. The development of delirium is independent of the premorbid cognitive status of the patient |
| 4. Nonpharmacologic interventions for delirium include ALL the following EXCEPT? |
| a. A bedside companion |
| b. Visits by friends and caregivers |
| c. Ambulation inside or outside of ICU room |
| d. Glasses and hearing aids for patients who are impaired |
| e. Applications of wrists restraints |
| 5. Which of the following statements is FALSE regarding pharmacologic management of delirium? |
| a. Current evidence is supportive of short-term use of antipsychotics |
| b. Haloperidol 5–10 mg IV q2–4h is the recommended starting dose |
| c. There is no evidence to support the use of psychostimulants or cholinesterase inhibitors |
| d. Adverse effects from antipsychotics include: extrapyramidal signs, QT prolongation on EKG, and orthostasis |
| e. Antipsychotics have been shown to reduce duration of delirium and severity of symptoms |
| 6. The following interventions aid in the prevention of delirium in patients that are CAM-ICU negative EXCEPT: |
| a. Restricting caregivers’ visits |
| b. Encouraging early mobility or ambulation |
| c. Shades up and lights on during the day |
| d. Daily medication review |
| e. Limiting time watching television |
| 7.Causes of and/or risk factors for delirium include all the following EXCEPT: |
| a. Severe sepsis |
| b. Hyponatremia |
| c. Emergent surgical procedures |
| d. Certain medications |
| e. Gender |
| 8. ICU patients should be screened by CAM-ICU for delirium during the following encounters EXCEPT: |
| a. Upon ICU admission |
| b. At ICU discharge |
| c. Every morning |
| d. Every evening |
| e. Whenever there is an acute change in mental state |
| 9. The term “Unable To Assess” refers to patients with RASS scores of |
| a. +3 to +4 |
| b. +1 to +2 |
| c. 0 to –1 |
| d. –2 to –3 |
| e. –4 to –5 |
| 10. Which patient is LIKELY to be labeled “Unable to Assess” when performing CAM-ICU for delirium screening? |
| a. A 32-year-old man with RASS score of 0 who is communicating his needs to the nursing staff by writing on a pad |
| b. A 24-year-old man s/p nasotracheal intubation 2 days ago for high risk airway in setting of head and neck cancer, on high dose propofol, RASS –5 |
| c. A 72-year-old woman with dementia and prior ischemic strokes intubated 5 days ago for streptococcal pneumonia who is now able to follow simple commands and tolerating weaning trials |
| d. A 65-year-old man requiring invasive mechanical ventilation via a tracheostomy tube after extensive surgical resection of a cancer of the right mandible and of the cervical lymph nodes, who is now developing confusion, diaphoresis, tachycardia, and tremulousness |
| e. A 72-year-old woman with leukemia, intubated 4 hours ago in the ICU for massive hemoptysis, who is now waking up and able to use her own electronic tablet to communicate with her daughter and ICU staff |
| 11. What do you do if the Registered Nurse tells you that the result of the patient CAM-ICU is “Unable to Assess?” |
| a. Increase sedation |
| b. Decrease sedation |
| c. Add an antipsychotic |
| d. Do nothing |
| e. Reassess in 3 hours |
| 12. Which FEATURES do you need in order to be CAM-ICU positive? (Ely, 2002) |
| a. All four features |
| b. Features 1 and 2 |
| c. Features 1, 2, and 3 or 4 |
| d. Features 2 and 4 |
| e. Features 2 and 3 |
| 13. For a patient with a CAM-ICU positive result, which medication infusion is MOST appropriate? |
| a. Midazolam |
| b. Fentanyl |
| c. Dexmedetomidine |
| d. Nicardipine |
| e. Lorazepam |
| 14. For a patient with CAM-ICU positive results, which statement summarizes hypoactive delirium? |
| a. A patient pulling at their central venous catheter and Foley catheter |
| b. A combative patient |
| c. A quiet and pleasantly confused patient who is able to follow commands intermittently |
| d. A patient who is alert, awake and oriented × 3 and appropriately interacting with staff and visitors |
| e. An agitated patient who is screaming the names of his deceased parents |
| 15. Which of the following medications is APPROVED by the FDA for the treatment of delirium? |
| a. Haloperidol |
| b. Dexmedetomidine |
| c. Olanzapine |
| d. Quetiapine |
| e. None of the above |
Note. EKG = electrocardiogram. RASS = Richmond Agitation-Sedation Scale; CAM-ICU = Confusion Assessment Method for the ICU. Answers: 1. a, 2. c, 3. c, 4. e, 5. b, 6. a, 7. e, 8. b, 9. e, 10. b, 11. b, 12. c, 13. c, 14. c, 15. e.