Ignatavicius: Medical-Surgical Nursing, 6th Edition

Chapter 2: Introduction to Complementary and Alternative herapies est !an" M#$ I%$E C&'ICE 1. Which activity would be appropriate for the National Center for Complementary and Alternative Medicine? a Funding a study on the effectiveness of herbal therapy for weight loss . b ducating new mothers on the benefits of complementary therapy . c ngaging in fundraising . d !roviding a scholarship for a student to study naturopathy . AN"# C $he purposes of the National Center for Complementary and Alternative Medicine are to fund studies e%amining the effectiveness of various complementary therapies& advance the 'nowledge about complementary therapies of health professionals& and serve as a clearinghouse for information about these therapies. (t does not fund scholarships nor is it a nonprofit organi)ation. (t focuses on advancing 'nowledge for health professionals rather than the general public. *(F# ./0# $.!# M"C# Cognitive +evel# Comprehension , F# p. +earning .utcome 1 Client Needs Category# !hysiological (ntegrity 2/asic Care and Comfort3 (ntegrated !rocess# $eaching4+earning

5. A client is an%ious about having a dressing change. What statement indicates that the nurse is promoting appropriate complementary therapy? a 6(7ll call the doctor and as' for a larger dose of pain medication before the . dressing change.8 b 6As we begin the ne%t dressing change& ( want you to thin' of a beautiful& calm . place where you feel happy and peaceful.8 c 6(7ll get another nurse to stay in the room with us during the dressing change so . that you can s9uee)e her hand during the procedure.8 d 6Are you familiar with controlled deep breathing? (t7s a very effective . techni9ue.8 AN"# /

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/ecause the client7s primary problem is an%iety rather than pain at this point& the use of guided visual imagery should be the most effective intervention. Calling the physician for more pain medication& having another nurse present to help comfort the client& and attempting to teach the client controlled deep breathing will not address the main problem of the client. *(F# Cognitive +evel# Application , F# N4A for Application and above ./0# +earning .utcome 5 $.!# Client Needs Category# =ealth !romotion and Maintenance 2=ealth !romotion !rograms3 M"C# (ntegrated !rocess# Nursing !rocess 2!lanning3 1. $he nurse has designed a treatment plan that includes the use of massage. Which intervention will the nurse implement first? a Assesses the client to determine the most effective type of massage techni9ue to . use b (nspects the s'in over the tissue to be massaged to ensure that it is not infected or . bruised c *etermines if a licensed therapist will be needed to carry out the massage . techni9ue d .btains the permission of the client to implement this type of techni9ue . AN"# * $he permission of the client to use the procedure must be obtained before any of the other interventions can be implemented. *(F# ./0# $.!# M"C# Cognitive +evel# Application , F# N4A for Application and above +earning .utcome > Client Needs Category# !hysiological (ntegrity 2/asic Care and Comfort3 (ntegrated !rocess# Nursing !rocess 2Assessment3

>. Which client re9uires the most immediate intervention by the nurse? a A client who has been using aromatherapy to treat her depression . b A client who has been using herbal preparations to treat her hypertension . c A client who has been using therapeutic touch to decrease her level of pain . d A client who has been using tai chi to improve her ?oint fle%ibility . AN"# /

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$he client who has been using herbal preparations to treat her hypertension may have endangered her life if she has inadvertently ingested a substance that interacts poorly with another drug or can be to%ic. Aromatherapy may be used as a complementary therapy to treat depression. $herapeutic touch has been shown to decrease pain& and tai chi may assist in mobility. $hese therapies are appropriate and not life@threatening. *(F# ./0# $.!# M"C# Cognitive +evel# Application , F# N4A for Application and above +earning .utcome A Client Needs Category# !hysiological (ntegrity 2,eduction of ,is' !otential3 (ntegrated !rocess# Nursing !rocess 2Assessment3

B. A client scheduled for surgery has been ta'ing garlic supplements. Which action is most important for the nurse to ta'e? a No action is necessary because the herbal agent is harmless. . b Notify the charge nurse that the client has been ta'ing garlic. . c Note the new information on the client7s record and place in the chart. . d Notify the surgeon that the client has been ta'ing garlic capsules. . AN"# * /ecause garlic has the potential to decrease clotting& much in the same way as aspirin& the surgeon will have to decide whether the surgery will be postponed. $he nurse should never assume that any herbal supplement is 6harmless8 because many can interact with medications and diet. $he decision is better left to the surgeon. $he nurse will put the information on the client7s chart& but that is not the only action that the nurse should ta'e. $he nurse needs to e%plain why the answer is right and wrong. Cive the student information in the answer. *(F# Cognitive +evel# Application , F# N4A for Application and above ./0# +earning .utcome 5 $.!# Client Needs Category# =ealth !romotion and Maintenance 2=igh@,is' /ehaviors3 M"C# (ntegrated !rocess# Nursing !rocess 2!lanning3 <. Which client is the best candidate for animal@assisted therapy? a A middle@aged adult in a psychiatric facility with a history of schi)ophrenia . b An older adult client in hospice care . c An older adult client in a nursing home who is catatonic . d An adolescent in a drug treatment facility with a history of violent outbursts

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AN"# / A client in hospice care may benefit from animal@assisted therapy& because this type of therapy may decrease stress. A client in a psychiatric facility who has schi)ophrenia may not yet be stable enough to e%perience this type of therapy. A client who is catatonic and not interacting with the environment is not li'ely to benefit from this therapy. A client who is prone to violent outbursts would not be able to benefit from this type of therapy. *(F# ./0# $.!# M"C# Cognitive +evel# Application , F# N4A for Application and above +earning .utcome < Client Needs Category# !hysiological (ntegrity 2/asic Care and Comfort3 (ntegrated !rocess# Nursing !rocess 2Assessment3

D. A client receiving chemotherapy for cancer is also ta'ing echinacea. Which action is most important for the nurse to ta'e? a Notify the physician that the client has been ta'ing echinacea daily. . b ncourage the client to be more forthcoming with her health care providers in the . future. c Notify the facility7s pharmacist that the client has been ta'ing echinacea daily. . d ncourage the client to continue to ta'e echinacea if she believes that it is . effective. AN"# A $he physician should be notified of the client7s use of echinacea because it could interfere with her chemotherapy medications. Although it is important that the client be forthcoming with her provider& this is not the primary intervention. $he client should not be encouraged to continue a practice that could be dangerous. Notifying the facility7s pharmacist will not change the client7s use of a potentially dangerous substance. *(F# ./0# $.!# M"C# Cognitive +evel# Application , F# N4A for Application and above +earning .utcome 5 Client Needs Category# =ealth !romotion and Maintenance 2=ealth and Wellness3 (ntegrated !rocess# Nursing !rocess 2!lanning3

-. Which statement indicates that the nurse understands the ris's associated with herbal preparations? a =erbs are guaranteed to be safe and effective but are not necessarily natural. . b =erbs re9uire a different type of prescription than standard prescribed . medications. c =erbs are not classified as drugs and are not regulated by the E.". Food and *rug

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$est /an' . Administration 2F*A3. d =erbs are guaranteed to be all natural and of high 9uality but are not necessarily . effective.

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AN"# C =erbal preparations are not classified as medications and are not regulated by the F*A. $hey do not re9uire a prescription because they are not medications. Enfortunately& herbs are not under regulation by the government& and are not guaranteed to be natural& safe& or effective. $his is one of the ma?or disadvantages of herbal therapy. *(F# ./0# $.!# M"C# Cognitive +evel# Comprehension , F# p. 15 +earning .utcome 1 Client Needs Category# =ealth !romotion and Maintenance 2=ealth and Wellness3 (ntegrated !rocess# $eaching4+earning

A. A client as's the nurse to pray with them. $he nurse is an atheist. Which statement by the nurse is the correct response? a 6Fes& let7s pray together.8 . b 6No& (7m sorry& ( can7t do that.8 . c 6No& ( don7t believe in prayer.8 . d 6(7ll hold your hand while you pray.8 . AN"# * /y stating that the nurse will hold the client7s hand& the nurse offers support for the client7s choice without compromising their beliefs. $he nurse should not participate in an activity that is against his or her beliefs. $he nurse should not ?ust state that she can7t do this or tell the client her personal views or preferences. *(F# ./0# $.!# M"C# Cognitive +evel# Application , F# N4A for Application and above +earning .utcome D Client Needs Category# !hysiological (ntegrity 2/asic Care and Comfort3 (ntegrated !rocess# Nursing !rocess 2!lanning3

1;. $he client has been diagnosed with cancer and is e%periencing depression and insomnia as side effects of her chemotherapy treatment. "he tells the nurse that she has been supplementing her antidepressant medication with lavender oil and sandalwood but they aren7t wor'ing. Which statement by the nurse is the correct response? a 6$ell me more about e%actly what you are ta'ing& how much you ta'e& and when . you ta'e the pills.8 b 6!erhaps you7re not using enough of the oil or are using it incorrectly.8

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(7ll spea' with your doctor to get you some medication that you can ta'e while continuing the aromatherapy.8 6Fou don7t want your doctor to put you on sleeping pills and antidepressants. Geep using them.8

AN"# A $he nurse should continue the assessment of the client to determine e%actly what type of complementary therapy she is using and whether the regimen is dangerous. *(F# ./0# $.!# M"C# Cognitive +evel# Application , F# N4A for Application and above +earning .utcome 1 Client Needs Category# =ealth !romotion and Maintenance 2"elf@Care3 (ntegrated !rocess# Nursing !rocess 2Assessment3

11. $he client is undergoing treatment for cancer. "he is e%periencing a high level of an%iety and tells the nurse that she is interested in e%ploring complementary therapies that might decrease her level of an%iety. Which complementary therapies would be highest priority for the nurse to implement with this client? a Music& rela%ation& and touch . b Acupuncture& massage& and imagery . c =ypnotherapy& spirituality& and rela%ation . d Massage& acupressure& and music . AN"# A Music& rela%ation& and touch are low@ris' complementary and alternative treatments that can be used by nurses in a variety of settings. $reatments such as aromatherapy& acupuncture& acupressure& and hypnotherapy are procedures that re9uire additional training. *(F# ./0# $.!# M"C# Cognitive +evel# Comprehension , F# p. A@11 +earning .utcome B Client Needs Category# !hysiological (ntegrity 2/asic Care and Comfort3 (ntegrated !rocess# Nursing !rocess 2(mplementation3

15. Which statement best demonstrates that the nurse understands the purpose of rela%ation therapy? a 6,ela%ation reduces physical& mental& and emotional tension.8 . b 6,ela%ation has been shown to increase immune system functioning.8

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$est /an' . c 6,ela%ation is used only for individuals undergoing painful procedures.8 . d 6,ela%ation is best suited to people who do not have a terminal diagnosis.8 .

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AN"# A /y reducing physical& mental& and emotional tension& rela%ation is believed to result in changes opposite those of the 6fight@or@flight8 mechanism. ,ela%ation has not been found to increase immune system functioning& and is not suited only for clients with a terminal diagnosis. *(F# ./0# $.!# M"C# Cognitive +evel# Gnowledge , F# p. A +earning .utcome Client Needs Category# !hysiological (ntegrity 2/asic Care and Comfort3 (ntegrated !rocess# Nursing !rocess 2 valuation3

11. A nurse is assisting a client preparing for surgery by using progressive muscle rela%ation. Which rationale best supports the use of this therapy at this time? a $his therapy rebalances or repatterns a person7s energy field. . b $his therapy improves fle%ibility and assists with positioning during surgery. . c $his therapy applies pressure& releasing congestion and promoting energy flow. . d $his therapy provides intentional tensing and releasing of successive muscle . groups& AN"# * !rogressive muscle rela%ation provides the intentional tensing and releasing of successive muscle groups& thereby promoting rela%ation and decreasing an%iety. An%iety reduction would be the best rationale for a client preparing for surgery. $he other statements are inaccurate descriptions of progressive muscle rela%ation and its use. *(F# ./0# $.!# M"C# Cognitive +evel# Gnowledge , F# p. A +earning .utcome B Client Needs Category# !hysiological (ntegrity 2/asic Care and Comfort3 (ntegrated !rocess# Caring

1>. A client tells a nurse that she is considering using herbal supplements to replace her prescription medications. What is the nurse7s best response? a 6=erbs are not classified as drugs in the Enited "tates& so there is no . contraindication to using them.8 b 6=erbs have pharmacologic effects on the body and can interact with some

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$est /an' . c . d . prescription medications.8 6(t is never permissible to use herbal supplements with prescription medications.8 6( will refer you to an herbalist who can help you decide which medications you can ta'e.8

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AN"# / Although herbs are not classified as drugs& they do possess pharmacologic properties. (n caring for clients& the nurse should in9uire if the client ta'es herbal preparations and& if so& for what purpose. Many herbal preparations have not been ade9uately studied and some can interact with prescription medications& causing to%ic effects. $he nurse should not refer the client to an herbalist. $he client should be instructed that there are contraindications to herbal usage but could be used with prescription medications& depending on the medication& the herbal substance& and the condition of the client. *(F# ./0# $.!# M"C# Cognitive +evel# Application , F# N4A for Application and above +earning .utcome 5 Client Needs Category# =ealth !romotion and Maintenance 2=ealth and Wellness3 (ntegrated !rocess# Nursing !rocess 2!lanning3

1B. A client who is status postHaortic valve replacement ta'es sodium warfarin 2Coumadin3 daily and has started ta'ing Ginkgo biloba. What will the nurse tell the client? a 6Memory problems following valve replacement surgery are common& but . temporary.8 b 6Ginkgo biloba has been shown to interact with many anticoagulant drugs.8 . c 6$his drug combination is most effective if the Ginkgo biloba is ta'en twice . daily.8 d 6Geep a record of episodes of forgetfulness to monitor effectiveness of the . medication.8 AN"# / $a'ing Ginkgo biloba with warfarin increases the client7s ris' of bleeding. $herefore& the client needs to be informed of this and should be monitored for bruising or bleeding associated with the use of this combination. Memory problems are not common or temporary after valve replacement& but a symptom of another problem. Ginkgo biloba is not more effective if ta'en twice daily. (t would be difficult to 'eep a record of forgetfulness& and this herb is not 6proven8 to be effective. *(F# ./0# $.!# M"C# Cognitive +evel# Application , F# N4A for Application and above +earning .utcome 5 Client Needs Category# =ealth !romotion and Maintenance 2*isease !revention3 (ntegrated !rocess# Nursing !rocess 2!lanning3

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$est /an' 1<. Which statement indicates the client needs further teaching about complementary therapy? a 6(7ve decided to use herb therapy for cancer treatment& so ( can cancel my . radiation treatments.8 b 6(7m hoping that massage therapy will help reduce the amount of pain medication . ( use for my myalgia.8 c 6( thin' it helps me get better faster when ( picture the drugs punching out the . germs in my body.8 d 6( intend to pray about my cancer treatment several times a day. (t ma'es me feel . so much better.8

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AN"# A Complementary therapies are intended to be used with& rather than replace& traditional forms of therapy to integrate the mind& body& and spirit into the healing process. $he client must have this information clarified so that he will follow his recommended regimen for cancer treatment. $he other statements appropriately indicate that the client understands the purpose of complementary therapy. *(F# Cognitive +evel# Application , F# N4A for Application and above ./0# +earning .utcome 5 $.!# Client Needs Category# =ealth !romotion and Maintenance 2!rinciples of $eaching4+earning3 M"C# (ntegrated !rocess# Nursing !rocess 2Assessment3 1D. Which teaching strategy is appropriate for a client wishing to use complementary therapy to supplement traditional treatment for cancer? a (nstruct the client to ma'e a follow@up appointment with the health care provider . after using alternative treatments to assess the client7s response to the treatment. b (nstruct the client never to use alternative or complementary treatments for . serious illnesses. c %plain to the client that physicians and nurses are not prepared to recommend . and monitor alternative treatments. d %plain to the client that physicians and nurses do not incorporate such . treatments into their practice. AN"# A Complementary or alternative treatments may be used in association with traditional therapy. $he client using complementary or alternative therapy should be advised to ma'e a follow@up visit with the health care provider to assess the client7s response to the therapy and to detect any adverse effects. *(F# Cognitive +evel# Gnowledge , F# p. A ./0# +earning .utcome 5 $.!# Client Needs Category# =ealth !romotion and Maintenance 2!rinciples of $eaching4+earning3 M"C# (ntegrated !rocess# Nursing !rocess 2Assessment3

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1-. Which complementary or alternative therapy would the nurse recommend to a client with 6stiff ?oints8 to improve mobility? a (magery . b Animal@assisted therapy . c $ai chi . d Magnet therapy . AN"# C $ai Chi is an active holistic therapy that integrates body movements& concentration& muscle rela%ation& and breathing to improve body function& such as fle%ibility and posture. (magery has been used successfully to reduce pain& nausea and vomiting& and an%iety. Animal@assisted therapy is generally used with clients who need to improve motor s'ills or the ability to concentrate. Magnet therapy is used primarily to relieve chronic pain. Aromatherapy uses essential oils to achieve rela%ation& improve concentration& and ease depression. *(F# ./0# $.!# M"C# Cognitive +evel# Application , F# N4A for Application and above +earning .utcome D Client Needs Category# !hysiological (ntegrity 2/asic Care and Comfort3 (ntegrated !rocess# Nursing !rocess 2Assessment3

1A. A client e%periencing nausea and vomiting from chemotherapy for cancer might benefit from which of the following alternative or complementary therapies? a Meditation . b (magery . c 0ournaling . d Magnet therapy . AN"# / (magery has been fre9uently used to help clients reduce nausea and vomiting. Meditation& ?ournaling& and magnet therapy are more useful for chronic pain& hypertension& and improving emotional health. *(F# Cognitive +evel# Gnowledge ./0# +earning .utcome < , F# p. A

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$est /an' $.!# Client Needs Category# !hysiological (ntegrity 2/asic Care and Comfort3 M"C# (ntegrated !rocess# Nursing !rocess 2Assessment3 M#$ I%$E (ES%'NSE

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1. *uring an initial health assessment interview& the nurse learns that the client is ta'ing warfarin 2Coumadin3 for a history of deep vein thrombosis. +ater& the client states that she ta'es several herbal preparations. Which of the following herbal preparations would the nurse caution her to avoid? (Select all that apply.) a Ginkgo biloba . b Carlic . c Cinseng . d "aw palmetto . AN"# A& /& C Ginkgo biloba may increase the anticoagulant effects of warfarin. Carlic and ginseng have also been found to affect the international normali)ed ratio 2(N,3. *(F# ./0# $.!# M"C# Cognitive +evel# Gnowledge , F# N4A for Application and above +earning .utcome 5 Client Needs Category# =ealth !romotion and Maintenance 2*isease !revention3 (ntegrated !rocess# Nursing !rocess 2Assessment3

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