Describe a clinical situation in which a registered nurse may encounter moral distress.  Answer the AACN’s Four A’s found on page 84 in your Butts and Rich text to further explain the situation, and the possible mitigation strategies.

Nurses use the Four A’s plan as a guide to identify and analyze moral distress:

•  Ask appropriate questions to become aware that moral distress is present.

•  Affirm your distress and commitment to take care of yourself and address moral distress.

•  Assess sources of your moral distress to prepare for an action plan.

•  Act to implement strategies for changes to preserve your integrity and authenticity.

Preventing moral distress requires nurses to recognize the at-risk dynamics and issues. An environment of good communication and respect for others is essential for decreasing the likelihood of experiencing moral distress.

  

Question

Question 1 1 / 1 point

Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it:

Question options:

Increases peripheral vasoconstriction

Decreases detrusor muscle contractility

Lowers supine blood pressure more than standing pressure

Relaxes smooth muscle in the bladder neck

Question 2 1 / 1 point

Which of the following adverse effects are less likely in a beta1-selective blocker?

Question options:

Dysrhythmias

Impaired insulin release

Reflex orthostatic changes

Decreased triglycerides and cholesterol

Question 3 1 / 1 point

Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the:

Question options:

Symptoms are severe

Patient has not responded to other therapies

Patient has concurrent hypertension

Left ventricular dysfunction is diagnosed

Question 4 1 / 1 point

You are treating a patient with a diagnosis of Alzheimer’s disease. The patient’s wife mentions difficulty with transportation to the clinic. Which medication is the best choice?

Question options:

Donepezil

Tacrine

Doxazosin

Verapamil

Question 5 1 / 1 point

Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for_________ to be used for an episode of status epilepticus.

Question options:

IV phenobarbital

Rectal diazepam (Diastat)

IV phenytoin (Dilantin)

Oral carbamazepine (Tegretol)

Question 6 1 / 1 point

Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include:

Question options:

Dwayne hasn’t been taking his carbamazepine because it causes insomnia.

Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance.

Dwayne was not originally prescribed the correct amount of carbamazepine.

Carbamazepine is probably not the right antiseizure medication for Dwayne.

Question 7 1 / 1 point

Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be:

Question options:

Ibuprofen (Advil)

Acetaminophen with hydrocodone (Vicodin)

Oxycodone (Oxycontin)

Oral morphine (Roxanol)

Question 8 1 / 1 point

Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are:

Question options:

Slurred speech and insomnia

Bradycardia and confusion

Dizziness and orthostatic hypotension

Insomnia and decreased appetite

Question 9 1 / 1 point

An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be:

Question options:

Alprazolam (Xanax)

Diazepam (Valium)

Buspirone (Buspar)

Amitriptyline (Elavil)

Question 10 1 / 1 point

David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression. David’s education regarding his medication would include:

Question options:

Paroxetine may cause intermittent diarrhea.

He may experience sexual dysfunction beginning a month after he starts therapy.

He may have constipation and he should increase fluids and fiber.

Paroxetine has a long half-life so he may occasionally skip a dose.

Question 11 1 / 1 point

An appropriate drug for the treatment of depression with anxiety would be:

Question options:

Alprazolam (Xanax)

Escitalopram (Lexapro)

Buspirone (Buspar)

Amitriptyline (Elavil)

Question 12 1 / 1 point

The longer-term Xanax patient comes in and states they need a higher dose of the medication. They deny any additional, new, or accelerating triggers of their anxiety. What is the probable reason?

Question options:

They have become tolerant of the medication, which is characterized by the need for higher and higher doses.

They are a drug seeker.

They are suicidal.

They only need additional counseling on lifestyle modification.

Question 13 1 / 1 point

A first-line drug for abortive therapy in simple migraine is:

Question options:

Sumatriptan (Imitrex)

Naproxen (Aleve)

Butorphanol nasal spray (Stadol NS)

Butalbital and acetaminophen (Fioricet)

Question 14 1 / 1 point

Xi, a 54-year-old female, has a history of migraines that do not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be:

Question options:

Prescribe the Maxalt, but only give her four tablets with no refills to monitor the use.

Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose.

Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital).

Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan.

Question 15 1 / 1 point

Kelly is a 14-year-old patient who presents to the clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be:

Question options:

Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers.

Prescribe zolmitriptan (Zomig) as abortive therapy and recommend relaxation therapy to reduce her stress.

Prescribe acetaminophen with codeine (Tylenol #3) for her to take at the first onset of her migraine.

Prescribe sumatriptan (Imitrex) nasal spray and arrange for her to receive the first dose in the clinic.

Question 16 1 / 1 point

James has been diagnosed with cluster headaches. Appropriate acute therapy would be:

Question options:

Butalbital and aspirin (Fiorinal)

Meperidine IM (Demerol)

Oxygen 100% for 15 to 30 minutes

Indomethacin (Indocin)

Question 17 1 / 1 point

If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use?

Question options:

NSAIDs, opiates, corticosteroids

Low-dose opiates, salicylates, increased dose of opiates

Opiates, non-opiates, increased dose of non-opiate

Non-opiate, increased dose of non-opiate, opiate

Question 18 1 / 1 point

Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a “red flag” about potential chemical dependency?

Question options:

Use of more than one drug to treat the pain

Multiple times when prescriptions are lost with requests to refill

Preferences for treatments that include alternative medicines

Presence of a family member who has abused drugs

Question 19 1 / 1 point

The Pain Management Contract is appropriate for:

Question options:

Patients with cancer who are taking morphine

Patients with chronic pain who will require long-term use of opiates

Patients who have a complex drug regimen

Patients who see multiple providers for pain control

Question 20 1 / 1 point

Which of the following statements is true about age and pain?

Question options:

Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children.

Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs.

Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain.

Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.