Chapter 33 My Nursing Test Banks

 

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank
Chapter 33

Question 1

Type: MCMA

A client with a high level of anxiety asks the nurse for suggestions to decrease stress. The nurse suggests which of the following successful stress management strategies?

Standard Text: Select all that apply.

1. Passive progressive relaxation

2. Playing preferred music

3. Body scanning

4. Eye movement desensitization reprocessing (EMDR)

5. Racing nonstop throughout the day

Correct Answer: 1,2,3

Rationale 1: Passive progressive relaxation. The goal is to focus on relaxing the muscles without tightening them first. Focusing on relaxing the entire body has the potential to elicit the relaxation response. At the least, it is a distraction technique that can interrupt the stress response.

Rationale 2: Playing preferred music. Soothing music produces endorphins in the brain. These natural opiates, secreted by the hypothalamus, reduce perception of pain intensity as well as contribute to general relaxation.

Rationale 3: Body scanning. Body scanning helps you to become aware of where tension collects in your body and is an effective way to begin many relaxation techniques, including the use of music.

Rationale 4: Eye movement desensitization and reprocessing (EMDR). EMDR is suggested for PTSD and dissociative identity disorder and is not used for stress management.

Rationale 5: Racing nonstop throughout the day. Racing nonstop throughout the day contributes to stress, not management of stress.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Explain the therapeutic uses for each of the complementary and alternative medicine (CAM) techniques discussed in this chapter.

Question 2

Type: MCSA

A client with high blood pressure is concerned about medication side effects and wants to try natural strategies to treat it. The nurse suggests:

1. Using a combination of visual imagery and music.

2. Doing nothing.

3. Sleeping.

4. Receiving massage.

Correct Answer: 1

Rationale 1: Music can be effectively used in conjunction with guided imagery to lower blood pressure 10 to 20 points. Soothing music produces endorphins (natural opiates) in the brain. Sleeping and doing nothing are not CAM modalities. Receiving massage may or may not contribute to lowered blood pressure.

Rationale 2: Music can be effectively used in conjunction with guided imagery to lower blood pressure 10 to 20 points. Soothing music produces endorphins (natural opiates) in the brain. Sleeping and doing nothing are not CAM modalities. Receiving massage may or may not contribute to lowered blood pressure.

Rationale 3: Music can be effectively used in conjunction with guided imagery to lower blood pressure 10 to 20 points. Soothing music produces endorphins (natural opiates) in the brain. Sleeping and doing nothing are not CAM modalities. Receiving massage may or may not contribute to lowered blood pressure.

Rationale 4: Music can be effectively used in conjunction with guided imagery to lower blood pressure 10 to 20 points. Soothing music produces endorphins (natural opiates) in the brain. Sleeping and doing nothing are not CAM modalities. Receiving massage may or may not contribute to lowered blood pressure.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain the therapeutic uses for each of the complementary and alternative medicine (CAM) techniques discussed in this chapter.

Question 3

Type: MCSA

After explaining active progressive relaxation to the client as a potentially useful technique to help manage anxiety, a nurse guides a client through the experience of active progressive relaxation. The nurse tells the client that:

1. This relaxation technique can be used by anyone at any time.

2. This relaxation technique is useful for postoperative clients.

3. Muscles of the neck and back should not be excessively tightened.

4. This is a safe process and nothing bad can happen.

Correct Answer: 3

Rationale 1: The nurse should counsel clients to observe some cautions while carrying out this technique. To avoid soft tissue and spinal injury, the muscles of the neck and back should not be excessively tightened. Tightening the muscles of the toes and feet too vigorously could also result in uncomfortable muscle cramps. Clients with cardiac arrhythmias should be cautioned against vasovagal stimulation by tensing muscles too tightly. Active progressive relaxation should be avoided with postoperative clients because it could increase pain in the postoperative period. Teach these clients passive progressive relaxation instead.

Rationale 2: The nurse should counsel clients to observe some cautions while carrying out this technique. To avoid soft tissue and spinal injury, the muscles of the neck and back should not be excessively tightened. Tightening the muscles of the toes and feet too vigorously could also result in uncomfortable muscle cramps. Clients with cardiac arrhythmias should be cautioned against vasovagal stimulation by tensing muscles too tightly. Active progressive relaxation should be avoided with postoperative clients because it could increase pain in the postoperative period. Teach these clients passive progressive relaxation instead.

Rationale 3: The nurse should counsel clients to observe some cautions while carrying out this technique. To avoid soft tissue and spinal injury, the muscles of the neck and back should not be excessively tightened. Tightening the muscles of the toes and feet too vigorously could also result in uncomfortable muscle cramps. Clients with cardiac arrhythmias should be cautioned against vasovagal stimulation by tensing muscles too tightly. Active progressive relaxation should be avoided with postoperative clients because it could increase pain in the postoperative period. Teach these clients passive progressive relaxation instead.

Rationale 4: The nurse should counsel clients to observe some cautions while carrying out this technique. To avoid soft tissue and spinal injury, the muscles of the neck and back should not be excessively tightened. Tightening the muscles of the toes and feet too vigorously could also result in uncomfortable muscle cramps. Clients with cardiac arrhythmias should be cautioned against vasovagal stimulation by tensing muscles too tightly. Active progressive relaxation should be avoided with postoperative clients because it could increase pain in the postoperative period. Teach these clients passive progressive relaxation instead.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain the therapeutic uses for each of the complementary and alternative medicine (CAM) techniques discussed in this chapter.

Question 4

Type: MCMA

The nurse refers a client for acupuncture. Stimulating acupuncture points has been shown to be a promising treatment for:

Standard Text: Select all that apply.

1. Mood-related mental disorders.

2. Headache.

3. Posttraumatic stress syndrome.

4. Alcohol withdrawal.

5. Schizophrenia.

Correct Answer: 3,4

Rationale 1: Mood-related mental disorders. The data are equivocal or contradictory for conditions such as irritable bowel syndrome, headache, circulatory problems, mood-related mental disorders, and schizophrenia.

Rationale 2: Headache. The data are equivocal or contradictory for conditions such as headache.

Rationale 3: Posttraumatic stress syndrome. Promising results have emerged for acupuncture in treating posttraumatic stress disorder (PTSD).

Rationale 4: Alcohol withdrawal. Acupuncture, specifically auricular acupuncture, is widely used to ease withdrawal and treat addiction in alcoholics, drug addicts, and smokers in North America and in Europe.

Rationale 5: Schizophrenia. The data are equivocal or contradictory for conditions such as schizophrenia.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain the therapeutic uses for each of the complementary and alternative medicine (CAM) techniques discussed in this chapter.

Question 5

Type: MCSA

A client who has hallucinations is no longer benefiting from medication. The clients wife has heard that repetitive transcranial magnetic stimulation (rTMS) might be helpful. The nurse knows that rTMS may be promising for this client because it:

1. Acts more quickly than electroconvulsive therapy (ECT).

2. Does not cause pain and, therefore, does not require anesthesia.

3. Acts more quickly than antipsychotic medications.

4. Has been around longer than ECT and has more research evidence for its use.

Correct Answer: 2

Rationale 1: As a therapy, rTMS is still experimental. The most promising beneficial effects of this experimental treatment are in clients with depression and hallucinating clients who are medication-resistant. There is no pain involved with rTMS, and no anesthesia is required. rTMS is not proven to act more quickly than antipsychotic medications or ECT. rTMS is still experimental and does not have more research evidence than ECT for its use.

Rationale 2: As a therapy, rTMS is still experimental. The most promising beneficial effects of this experimental treatment are in clients with depression and hallucinating clients who are medication-resistant. There is no pain involved with rTMS, and no anesthesia is required. rTMS is not proven to act more quickly than antipsychotic medications or ECT. rTMS is still experimental and does not have more research evidence than ECT for its use.

Rationale 3: As a therapy, rTMS is still experimental. The most promising beneficial effects of this experimental treatment are in clients with depression and hallucinating clients who are medication-resistant. There is no pain involved with rTMS, and no anesthesia is required. rTMS is not proven to act more quickly than antipsychotic medications or ECT. rTMS is still experimental and does not have more research evidence than ECT for its use.

Rationale 4: As a therapy, rTMS is still experimental. The most promising beneficial effects of this experimental treatment are in clients with depression and hallucinating clients who are medication-resistant. There is no pain involved with rTMS, and no anesthesia is required. rTMS is not proven to act more quickly than antipsychotic medications or ECT. rTMS is still experimental and does not have more research evidence than ECT for its use.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Compare and contrast various CAM techniques, including their important characteristics and functions.

Question 6

Type: MCSA

The nurse is caring for an older client with depression who has begun having trouble sleeping. In addition to antidepressants, a safe, nonpharmacologic and potentially effective adjunctive treatment for insomnia in persons with a diagnosis of depression is:

1. Medical meditation.

2. Watching TV.

3. Progressive relaxation.

4. Alternate-nostril breathing.

Correct Answer: 3

Rationale 1: The technique of progressive relaxation is based on the premise that muscle tension is the bodys physiologic response to anxiety-provoking thoughts. Deep muscle relaxation, by contrast, decreases physiologic tension and blocks anxiety. Clients with insomnia and depression are among those who can achieve positive results using this technique. Alternate-nostril breathing is best for sinus headaches and is not intended for deep relaxation. Watching TV is not a relaxation technique. Medical meditation takes focus and although it may induce the relaxation response, for those who need to sleep it may stimulate alertness rather than encourage sleep.

Rationale 2: The technique of progressive relaxation is based on the premise that muscle tension is the bodys physiologic response to anxiety-provoking thoughts. Deep muscle relaxation, by contrast, decreases physiologic tension and blocks anxiety. Clients with insomnia and depression are among those who can achieve positive results using this technique. Alternate-nostril breathing is best for sinus headaches and is not intended for deep relaxation. Watching TV is not a relaxation technique. Medical meditation takes focus and although it may induce the relaxation response, for those who need to sleep it may stimulate alertness rather than encourage sleep.

Rationale 3: The technique of progressive relaxation is based on the premise that muscle tension is the bodys physiologic response to anxiety-provoking thoughts. Deep muscle relaxation, by contrast, decreases physiologic tension and blocks anxiety. Clients with insomnia and depression are among those who can achieve positive results using this technique. Alternate-nostril breathing is best for sinus headaches and is not intended for deep relaxation. Watching TV is not a relaxation technique. Medical meditation takes focus and although it may induce the relaxation response, for those who need to sleep it may stimulate alertness rather than encourage sleep.

Rationale 4: The technique of progressive relaxation is based on the premise that muscle tension is the bodys physiologic response to anxiety-provoking thoughts. Deep muscle relaxation, by contrast, decreases physiologic tension and blocks anxiety. Clients with insomnia and depression are among those who can achieve positive results using this technique. Alternate-nostril breathing is best for sinus headaches and is not intended for deep relaxation. Watching TV is not a relaxation technique. Medical meditation takes focus and although it may induce the relaxation response, for those who need to sleep it may stimulate alertness rather than encourage sleep.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Compare and contrast various CAM techniques, including their important characteristics and functions.

Question 7

Type: MCSA

Eye movement desensitization and reprocessing (EMDR) mimics rapid eye movement (REM) sleep. The nurse working with injured soldiers knows that EMDR is an intervention suggested for the treatment of:

1. Bipolar I.

2. Childhood-onset trauma victims.

3. Dissociative identity disorder.

4. Depression.

Correct Answer: 3

Rationale 1: Eye movement desensitization reprocessing is a controversial intervention suggested for PTSD and dissociative identity disorder. Clients are asked to recall traumatic memories or a feared stimulus while making a series of rapid lateral eye movements. There is no definitive theoretical explanation of how EMDR might work other than that it is the repetitive redirection of attention in EMDR that induces a neurobiologic state, similar to that of rapid eye movement (REM) sleep, which assists in the integration of traumatic memories into the cortex of the brain. As with conventional medicine, there has been inaccurate and selective reporting of research, inadequately designed studies, and biased or inaccurate reviews. EMDR has been described as having a significant healing outcome for an adult with a childhood memory of medical trauma resulting from a tonsillectomy. However, a randomized clinical trial that compared the short- and long-term benefits of medication (fluoxetine) with those of EMDR in subjects diagnosed with PTSD found that 75% of adult-onset subjects at the six-month follow-up were asymptomatic compared with none in the fluoxetine group. EMDR is not used for treatment of depression or Bipolar I. For most childhood-onset trauma victims, neither medication nor EMDR produced complete symptom remission.

Rationale 2: Eye movement desensitization reprocessing is a controversial intervention suggested for PTSD and dissociative identity disorder. Clients are asked to recall traumatic memories or a feared stimulus while making a series of rapid lateral eye movements. There is no definitive theoretical explanation of how EMDR might work other than that it is the repetitive redirection of attention in EMDR that induces a neurobiologic state, similar to that of rapid eye movement (REM) sleep, which assists in the integration of traumatic memories into the cortex of the brain. As with conventional medicine, there has been inaccurate and selective reporting of research, inadequately designed studies, and biased or inaccurate reviews. EMDR has been described as having a significant healing outcome for an adult with a childhood memory of medical trauma resulting from a tonsillectomy. However, a randomized clinical trial that compared the short- and long-term benefits of medication (fluoxetine) with those of EMDR in subjects diagnosed with PTSD found that 75% of adult-onset subjects at the six-month follow-up were asymptomatic compared with none in the fluoxetine group. EMDR is not used for treatment of depression or Bipolar I. For most childhood-onset trauma victims, neither medication nor EMDR produced complete symptom remission.

Rationale 3: Eye movement desensitization reprocessing is a controversial intervention suggested for PTSD and dissociative identity disorder. Clients are asked to recall traumatic memories or a feared stimulus while making a series of rapid lateral eye movements. There is no definitive theoretical explanation of how EMDR might work other than that it is the repetitive redirection of attention in EMDR that induces a neurobiologic state, similar to that of rapid eye movement (REM) sleep, which assists in the integration of traumatic memories into the cortex of the brain. As with conventional medicine, there has been inaccurate and selective reporting of research, inadequately designed studies, and biased or inaccurate reviews. EMDR has been described as having a significant healing outcome for an adult with a childhood memory of medical trauma resulting from a tonsillectomy. However, a randomized clinical trial that compared the short- and long-term benefits of medication (fluoxetine) with those of EMDR in subjects diagnosed with PTSD found that 75% of adult-onset subjects at the six-month follow-up were asymptomatic compared with none in the fluoxetine group. EMDR is not used for treatment of depression or Bipolar I. For most childhood-onset trauma victims, neither medication nor EMDR produced complete symptom remission.

Rationale 4: Eye movement desensitization reprocessing is a controversial intervention suggested for PTSD and dissociative identity disorder. Clients are asked to recall traumatic memories or a feared stimulus while making a series of rapid lateral eye movements. There is no definitive theoretical explanation of how EMDR might work other than that it is the repetitive redirection of attention in EMDR that induces a neurobiologic state, similar to that of rapid eye movement (REM) sleep, which assists in the integration of traumatic memories into the cortex of the brain. As with conventional medicine, there has been inaccurate and selective reporting of research, inadequately designed studies, and biased or inaccurate reviews. EMDR has been described as having a significant healing outcome for an adult with a childhood memory of medical trauma resulting from a tonsillectomy. However, a randomized clinical trial that compared the short- and long-term benefits of medication (fluoxetine) with those of EMDR in subjects diagnosed with PTSD found that 75% of adult-onset subjects at the six-month follow-up were asymptomatic compared with none in the fluoxetine group. EMDR is not used for treatment of depression or Bipolar I. For most childhood-onset trauma victims, neither medication nor EMDR produced complete symptom remission.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Compare and contrast various CAM techniques, including their important characteristics and functions.

Question 8

Type: MCMA

A nurse is asked to provide a brief presentation comparing and contrasting the modalities within one category of complementary and alternative therapies, as identified by NCCAM. The nurse chooses to speak about whole medical systems; therefore, the presentation would include:

Standard Text: Select all that apply.

1. Traditional Chinese medicine.

2. Herbal products.

3. Naturopathic medicine.

4. Homeopathic medicine.

5. Ayurveda.

Correct Answer: 1,3,4,5

Rationale 1: Traditional Chinese medicine. This is included by NCCAM in the whole medical systems category.

Rationale 2: Herbal products. Herbal products are categorized by NCCAM as Biologically Based Practices.

Rationale 3: Naturopathic medicine. This is included by NCCAM in the whole medical systems category.

Rationale 4: Homeopathic medicine. This is included by NCCAM in the whole medical systems category.

Rationale 5: Ayurveda. This is included by NCCAM in the whole medical systems category.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Compare and contrast various CAM techniques, including their important characteristics and functions.

Question 9

Type: MCSA

A variety of techniques available to clients, their families, and healthcare professionals serve to alleviate muscle tension, anxiety, fatigue, headaches, and more. The technique that is specifically identified as adjunctive treatment for sinus headaches is:

1. Passive progressive relaxation.

2. Tai chi.

3. Alternate-nostril breathing.

4. Guided imagery.

Correct Answer: 3

Rationale 1: Alternate-nostril breathing stems from the practice of yoga and helps reduce tension and sinus headaches. Passive progressive relaxation is a technique to relax the muscles without tightening them first and is useful for muscle spasms, lower back pain, tension headaches, insomnia, and anxiety. Guided imagery takes too much focus to use when suffering from a sinus headache and, if attempting to practice at that time, may in fact worsen the sinus headache. Tai chi is a body-based CAM practice that requires specific education and practice. When learned and practice is maintained, it has shown to improve ones sense of balance and is, therefore, useful as a health promotion and health maintenance tool rather than an adjunctive treatment for sinus headaches.

Rationale 2: Alternate-nostril breathing stems from the practice of yoga and helps reduce tension and sinus headaches. Passive progressive relaxation is a technique to relax the muscles without tightening them first and is useful for muscle spasms, lower back pain, tension headaches, insomnia, and anxiety. Guided imagery takes too much focus to use when suffering from a sinus headache and, if attempting to practice at that time, may in fact worsen the sinus headache. Tai chi is a body-based CAM practice that requires specific education and practice. When learned and practice is maintained, it has shown to improve ones sense of balance and is, therefore, useful as a health promotion and health maintenance tool rather than an adjunctive treatment for sinus headaches.

Rationale 3: Alternate-nostril breathing stems from the practice of yoga and helps reduce tension and sinus headaches. Passive progressive relaxation is a technique to relax the muscles without tightening them first and is useful for muscle spasms, lower back pain, tension headaches, insomnia, and anxiety. Guided imagery takes too much focus to use when suffering from a sinus headache and, if attempting to practice at that time, may in fact worsen the sinus headache. Tai chi is a body-based CAM practice that requires specific education and practice. When learned and practice is maintained, it has shown to improve ones sense of balance and is, therefore, useful as a health promotion and health maintenance tool rather than an adjunctive treatment for sinus headaches.

Rationale 4: Alternate-nostril breathing stems from the practice of yoga and helps reduce tension and sinus headaches. Passive progressive relaxation is a technique to relax the muscles without tightening them first and is useful for muscle spasms, lower back pain, tension headaches, insomnia, and anxiety. Guided imagery takes too much focus to use when suffering from a sinus headache and, if attempting to practice at that time, may in fact worsen the sinus headache. Tai chi is a body-based CAM practice that requires specific education and practice. When learned and practice is maintained, it has shown to improve ones sense of balance and is, therefore, useful as a health promotion and health maintenance tool rather than an adjunctive treatment for sinus headaches.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Compare and contrast various CAM techniques, including their important characteristics and functions.

Question 10

Type: MCSA

Which statement would have the best potential to obtain assessment data from a client about possible use of complementary and alternative practices or products?

1. Tell me everything you takeprescription medicines, over-the-counter medicines, vitamins, dietary supplements, herbs, as well as how much coffee, tea, and soda you drink daily and any recreational drugs you use.

2. Tell me about the medicines the doctor prescribed and the amounts prescribed.

3. What things do you do for yourself to maintain or improve your health?

4. Do you take dietary supplements and herbs on top of the medicines the doctor prescribes for you?

Correct Answer: 3

Rationale 1: Clients often report they do not inform their primary care practitioner of CAM use, most frequently because they were not asked. Using therapeutic communication, such as an open-ended question asking what the client does to maintain or improve health, is more likely to initiate a conversation through which further information about complementary and alternative practices and products will be shared by the client with the nurse. Asking the client to provide details about medications or other products may be construed as threatening or judgmental. Asking if the client takes dietary supplements and herbs is closed-ended and implies a lack of freedom of choice on the part of the client.

Rationale 2: Clients often report they do not inform their primary care practitioner of CAM use, most frequently because they were not asked. Using therapeutic communication, such as an open-ended question asking what the client does to maintain or improve health, is more likely to initiate a conversation through which further information about complementary and alternative practices and products will be shared by the client with the nurse. Asking the client to provide details about medications or other products may be construed as threatening or judgmental. Asking if the client takes dietary supplements and herbs is closed-ended and implies a lack of freedom of choice on the part of the client.

Rationale 3: Clients often report they do not inform their primary care practitioner of CAM use, most frequently because they were not asked. Using therapeutic communication, such as an open-ended question asking what the client does to maintain or improve health, is more likely to initiate a conversation through which further information about complementary and alternative practices and products will be shared by the client with the nurse. Asking the client to provide details about medications or other products may be construed as threatening or judgmental. Asking if the client takes dietary supplements and herbs is closed-ended and implies a lack of freedom of choice on the part of the client.

Rationale 4: Clients often report they do not inform their primary care practitioner of CAM use, most frequently because they were not asked. Using therapeutic communication, such as an open-ended question asking what the client does to maintain or improve health, is more likely to initiate a conversation through which further information about complementary and alternative practices and products will be shared by the client with the nurse. Asking the client to provide details about medications or other products may be construed as threatening or judgmental. Asking if the client takes dietary supplements and herbs is closed-ended and implies a lack of freedom of choice on the part of the client.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Integrate appropriate CAM techniques into a plan of care to promote, maintain, and restore emotional well-being for clients and their families.

Question 11

Type: MCSA

A client has come to a nurse practitioner with concerns about health care costs. The client, who had one myocardial infarction and later suffered from severe anxiety, asks for a plan of care that includes appropriate complementary and alternative therapies. Which of the following CAM modalities is not appropriate for someone with a history of cardiac problems?

1. Massage

2. Moderate exercise

3. Active progressive relaxation

4. Finger-holds for general well-being

Correct Answer: 3

Rationale 1: Clients with cardiac problems may be at increased risk for cardiac arrhythmia because of vasovagal stimulation with certain techniques such as active progressive relaxation. Depending upon client preferences, massage can be a beneficial stress management tool. Finger-holds for general well-being is a form of acupressure and has the potential to bring the anxious client into a moderate meditative state that is not so deep as to cause a vasovagal stimulation. Moderate exercise, as prescribed by ones physician, is a known self-care management technique in cardiac rehabilitation.

Rationale 2: Clients with cardiac problems may be at increased risk for cardiac arrhythmia because of vasovagal stimulation with certain techniques such as active progressive relaxation. Depending upon client preferences, massage can be a beneficial stress management tool. Finger-holds for general well-being is a form of acupressure and has the potential to bring the anxious client into a moderate meditative state that is not so deep as to cause a vasovagal stimulation. Moderate exercise, as prescribed by ones physician, is a known self-care management technique in cardiac rehabilitation.

Rationale 3: Clients with cardiac problems may be at increased risk for cardiac arrhythmia because of vasovagal stimulation with certain techniques such as active progressive relaxation. Depending upon client preferences, massage can be a beneficial stress management tool. Finger-holds for general well-being is a form of acupressure and has the potential to bring the anxious client into a moderate meditative state that is not so deep as to cause a vasovagal stimulation. Moderate exercise, as prescribed by ones physician, is a known self-care management technique in cardiac rehabilitation.

Rationale 4: Clients with cardiac problems may be at increased risk for cardiac arrhythmia because of vasovagal stimulation with certain techniques such as active progressive relaxation. Depending upon client preferences, massage can be a beneficial stress management tool. Finger-holds for general well-being is a form of acupressure and has the potential to bring the anxious client into a moderate meditative state that is not so deep as to cause a vasovagal stimulation. Moderate exercise, as prescribed by ones physician, is a known self-care management technique in cardiac rehabilitation.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Integrate appropriate CAM techniques into a plan of care to promote, maintain, and restore emotional well-being for clients and their families.

Question 12

Type: MCMA

The nurse working in a clinic specializing in treating addiction knows that, in addition to Alcoholics Anonymous and other support groups, a complementary way in which someone might deal with alcohol abuse is to:

Standard Text: Select all that apply.

1. Drink chamomile tea.

2. Do nothing since there are no CAM practices that support AA recovery.

3. Drink kudzu tea.

4. Receive auricular acupuncture.

5. Practice yoga.

Correct Answer: 3,4,5

Rationale 1: Drink chamomile tea. Chamomile tea has not been shown to affect alcohol use.

Rationale 2: Do nothing since there are no CAM practices that support AA recovery. There are potentially supportive CAM modalities.

Rationale 3: Drink kudzu tea. Kudzu tea has been studied as a possible herbal treatment. It appears to act by increasing blood flow to the brain. If kudzu makes alcohol get to the brain more quickly, it could lead drinkers to feel satisfied sooner and thus turn off the craving for more. Further studies are required to explore this herb and its active ingredients, puerarin, daidzin, and daidzen.

Rationale 4: Receive auricular acupuncture. Auricular acupuncture is widely used to ease withdrawal and treat addiction in alcoholics, drug addicts, and smokers. Its effectiveness as a stand-alone treatment is not confirmed.

Rationale 5: Practice yoga. Yoga is a focused meditation process that has the potential to bring one to a state of inner calm which thus may interrupt the need to follow old abuse patterns.

Global Rationale:

Cognitive Level: Creating

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Integrate appropriate CAM techniques into a plan of care to promote, maintain, and restore emotional well-being for clients and their families.

Question 13

Type: MCSA

Taking into consideration the clients level of motivation and ability to manage complex instructions, a nurse counsels a client seen for repeated episodes of anxiety to consider adding the use of complementary and/or alternative modalities to help manage the anxiety. The nurse may suggest which of the following CAM modalities?

1. Kudzu

2. Running

3. Acupressure

4. Ginkgo

Correct Answer: 3

Rationale 1: Acupressure is a recommended CAM modality for treatment of anxiety. Ginkgo is recommended for Alzheimers disease, not anxiety. Although running may be an outlet for anxious feelings, it is not listed as a CAM modality. Kudzu is recommended for adjunctive therapy for alcoholism, not anxiety.

Rationale 2: Acupressure is a recommended CAM modality for treatment of anxiety. Ginkgo is recommended for Alzheimers disease, not anxiety. Although running may be an outlet for anxious feelings, it is not listed as a CAM modality. Kudzu is recommended for adjunctive therapy for alcoholism, not anxiety.

Rationale 3: Acupressure is a recommended CAM modality for treatment of anxiety. Ginkgo is recommended for Alzheimers disease, not anxiety. Although running may be an outlet for anxious feelings, it is not listed as a CAM modality. Kudzu is recommended for adjunctive therapy for alcoholism, not anxiety.

Rationale 4: Acupressure is a recommended CAM modality for treatment of anxiety. Ginkgo is recommended for Alzheimers disease, not anxiety. Although running may be an outlet for anxious feelings, it is not listed as a CAM modality. Kudzu is recommended for adjunctive therapy for alcoholism, not anxiety.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Integrate appropriate CAM techniques into a plan of care to promote, maintain, and restore emotional well-being for clients and their families.

Question 14

Type: MCSA

The nurses friend is taking a benzodiazepine to help with anxiety. The friend tells the nurse about reading that kava is good for anxiety too, and says, I bought some at the local health store. After all, its natural. Id rather use natural products than a medication to help my anxiety.

The nurses response should be which of the following?

1. Its a medicine too and should not be mixed with your other meds.

2. Have you told your doctor about this? Benzos can be addictive.

3. Thats great, Im glad youre going natural.

4. Kava is harmless. Good for you to take such initiative.

Correct Answer: 1

Rationale 1: Herbal products may be natural but they are still medicine. Benzodiazepines may be addictive, but that is not the only reason for the friend to speak about this with a physician. There is a potential for addiction or overdose because kava is comparable to low-dose benzodiazepines. Long-term use or high doses of kava is possibly unsafe as it is associated with liver failure.

Rationale 2: Herbal products may be natural but they are still medicine. Benzodiazepines may be addictive, but that is not the only reason for the friend to speak about this with a physician. There is a potential for addiction or overdose because kava is comparable to low-dose benzodiazepines. Long-term use or high doses of kava is possibly unsafe as it is associated with liver failure.

Rationale 3: Herbal products may be natural but they are still medicine. Benzodiazepines may be addictive, but that is not the only reason for the friend to speak about this with a physician. There is a potential for addiction or overdose because kava is comparable to low-dose benzodiazepines. Long-term use or high doses of kava is possibly unsafe as it is associated with liver failure.

Rationale 4: Herbal products may be natural but they are still medicine. Benzodiazepines may be addictive, but that is not the only reason for the friend to speak about this with a physician. There is a potential for addiction or overdose because kava is comparable to low-dose benzodiazepines. Long-term use or high doses of kava is possibly unsafe as it is associated with liver failure.

Global Rationale:

Cognitive Level: Creating

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Encourage clients and their family members to become educated consumers by educating them about the safety and effectiveness of CAM techniques, quackery and fraud, the qualifications of providers, and quality of service delivery.

Question 15

Type: MCMA

The psychiatricmental health nurse is assessing a new client recently diagnosed with an anxiety disorder and high blood pressure. The nurse knows to closely monitor vital signs and review this clients medication list for:

Standard Text: Select all that apply.

1. Haloperidol (Haldol).

2. Acetaminophen (Tylenol).

3. Aspirin.

4. Olanzapine (Zyprexa).

5. Thioridazine (Mellaril).

Correct Answer: 1,4,5

Rationale 1: Haloperidol (Haldol). Clients with cardiac problems may be at increased risk for cardiac arrhythmia because of vasovagal stimulation with certain techniques such as active progressive relaxation. Some psychotropic medications such as haloperidol may cause hypotension.

Rationale 2: Acetaminophen (Tylenol). Aspirin and Tylenol do not carry risks for negative interaction with relaxation and meditation techniques.

Rationale 3: Aspirin. Aspirin and Tylenol do not carry risks for negative interaction with relaxation and meditation techniques.

Rationale 4: Olanzapine (Zyprexa). Clients with cardiac problems may be at increased risk for cardiac arrhythmia because of vasovagal stimulation with certain techniques such as active progressive relaxation. Some psychotropic medications such as olanzapine may cause hypotension.

Rationale 5: Thioridazine (Mellaril). Clients with cardiac problems may be at increased risk for cardiac arrhythmia because of vasovagal stimulation with certain techniques such as active progressive relaxation. Some psychotropic medications such as thioridazine may cause hypotension.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Encourage clients and their family members to become educated consumers by educating them about the safety and effectiveness of CAM techniques, quackery and fraud, the qualifications of providers, and quality of service delivery.

Question 16

Type: MCSA

Nurses are particularly suited to helping clients become informed consumers of CAM products and practices. One valid and reliable internet website to which nurses might refer clients or their family members is:

1. EMedicine.

2. Medscape.

3. Science Daily.

4. NCCAM.

Correct Answer: 4

Rationale 1: One can learn about the safety and effectiveness of CAM methods and read consumer advisories and news releases about the most recent research by accessing NCCAMs website. The Science Daily website is an advertising-based research resource website but is not dedicated to just CAM. Medscape and eMedicine are websites often used by nurses but do not focus solely on evidence-based research related to CAM practices and products.

Rationale 2: One can learn about the safety and effectiveness of CAM methods and read consumer advisories and news releases about the most recent research by accessing NCCAMs website. The Science Daily website is an advertising-based research resource website but is not dedicated to just CAM. Medscape and eMedicine are websites often used by nurses but do not focus solely on evidence-based research related to CAM practices and products.

Rationale 3: One can learn about the safety and effectiveness of CAM methods and read consumer advisories and news releases about the most recent research by accessing NCCAMs website. The Science Daily website is an advertising-based research resource website but is not dedicated to just CAM. Medscape and eMedicine are websites often used by nurses but do not focus solely on evidence-based research related to CAM practices and products.

Rationale 4: One can learn about the safety and effectiveness of CAM methods and read consumer advisories and news releases about the most recent research by accessing NCCAMs website. The Science Daily website is an advertising-based research resource website but is not dedicated to just CAM. Medscape and eMedicine are websites often used by nurses but do not focus solely on evidence-based research related to CAM practices and products.

Global Rationale:

Cognitive Level: Creating

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Encourage clients and their family members to become educated consumers by educating them about the safety and effectiveness of CAM techniques, quackery and fraud, the qualifications of providers, and quality of service delivery.

Question 17

Type: MCSA

Introspective or meditative techniques may be useful for clients who:

1. Are highly anxious.

2. Have multiple problems.

3. Are severely depressed, delusional, or hallucinating.

4. Are mentally and emotionally healthy.

Correct Answer: 4

Rationale 1: Individuals who are mentally and emotionally healthy may benefit from the use of introspective or meditative techniques as a form of health promotion and/or stress management. If used with clients who are severely depressed, hallucinating, delusional, or have loss of contact with reality, these techniques may result in an increased loss of contact with reality, withdrawal, or increased rumination. Brief and externally focused techniques would be better for these clients.

Rationale 2: Individuals who are mentally and emotionally healthy may benefit from the use of introspective or meditative techniques as a form of health promotion and/or stress management. If used with clients who are severely depressed, hallucinating, delusional, or have loss of contact with reality, these techniques may result in an increased loss of contact with reality, withdrawal, or increased rumination. Brief and externally focused techniques would be better for these clients.

Rationale 3: Individuals who are mentally and emotionally healthy may benefit from the use of introspective or meditative techniques as a form of health promotion and/or stress management. If used with clients who are severely depressed, hallucinating, delusional, or have loss of contact with reality, these techniques may result in an increased loss of contact with reality, withdrawal, or increased rumination. Brief and externally focused techniques would be better for these clients.

Rationale 4: Individuals who are mentally and emotionally healthy may benefit from the use of introspective or meditative techniques as a form of health promotion and/or stress management. If used with clients who are severely depressed, hallucinating, delusional, or have loss of contact with reality, these techniques may result in an increased loss of contact with reality, withdrawal, or increased rumination. Brief and externally focused techniques would be better for these clients.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Encourage clients and their family members to become educated consumers by educating them about the safety and effectiveness of CAM techniques, quackery and fraud, the qualifications of providers, and quality of service delivery.

Question 18

Type: MCMA

There are several ways to encourage clients and their families to become educated consumers of CAM practices and products by gathering information about advantages, disadvantages, or risks related to CAM. Such information might be gained through:

Standard Text: Select all that apply.

1. Contacting their state licensing board.

2. Personal testimonials from friends.

3. Reading the latest research.

4. Websites that report guides to fraud or quackery.

5. Nothing since there is no specific thing they can do to gain enough information to be an educated consumer.

Correct Answer: 1,2,4

Rationale 1: Contacting their state licensing board. Health regulatory bodies can provide information on state licensure or registration and any complaints lodged against specific practitioners.

Rationale 2: Personal testimonials from friends. Testimonials from others who are or have been clients may be helpful, though they should not be the sole criterion in selecting a therapy.

Rationale 3: Reading the latest research. One can determine the safety and effectiveness of CAM methods and read any consumer advisories and news releases about the most recent research by accessing NCCAMs website at http://www.nccam.nih.gov. Another source is the current literature. The National Library of Medicine (NLM) and NCCAM have jointly developed a means of easy access to the literature on CAM from 1966 to the present. Over 12 million CAM journal citations can be found on NLMs PubMed at http://www.ncbi.nlm.nih.gov/entrez, which can be accessed through a direct link on this texts companion website.

Rationale 4: Websites that report guides to fraud or quackery. A guide to fraud, quackery, and informed decision making is available on http://www.quackwatch.com, a website maintained by a physician.

Rationale 5: Nothing since there is no specific thing they can do to gain enough information to be an educated consumer. There is much a person can do to become an educated consumer.

Global Rationale:

Cognitive Level: Creating

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Encourage clients and their family members to become educated consumers by educating them about the safety and effectiveness of CAM techniques, quackery and fraud, the qualifications of providers, and quality of service delivery.

Question 19

Type: MCMA

Meditation, with or without cognitive behavioral therapy (CBT):

Standard Text: Select all that apply.

1. Increases levels of dopamine.

2. Increases mood disturbance.

3. May reduce cognitive decline associated with aging.

4. Is equivalent to a state of rest.

5. Is a difficult technique to master.

Correct Answer: 1,3,4

Rationale 1: Increases levels of dopamine. Meditation increases levels of dopamine and decreases mood disturbance and stress symptoms.

Rationale 2: Increases mood disturbance. Meditation, combined with CBT, has been found to result in a statistically significant reduction in depression and anxiety.

Rationale 3: May reduce cognitive decline associated with aging. Meditation increases levels of dopamine and may reduce the cognitive decline associated with aging.

Rationale 4: Is equivalent to a state of rest. The state of meditation is equivalent to a state of deep rest. The heart rate slows, the body uses less oxygen, and blood lactatea waste product of metabolismdecreases sharply. Alpha brain waves, present during states of calm alertness, increase, as does the secretion of dopamine.

Rationale 5: Is a difficult technique to master. Meditation exercises can be relatively easy to learn. Some people experience immediate relief and pleasure in only one session.

Global Rationale:

Cognitive Level: Evaluating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Educate clients and their families in the effective use of CAM therapies.

Question 20

Type: MCMA

A client asks the nurse for help in learning to relax. The client claims to know about meditation and understands it is supposed to help a person relax but every time the client tries to meditate, the client is easily distracted. Considering the four major requirements that facilitate successful meditation practice, the nurse advises the client to:

Standard Text: Select all that apply.

1. Focus on one word, object, or symbol to look at or think about if the client finds it helpful.

2. Find a position that will be comfortable to hold for a while.

3. Find a quiet place away from distractions.

4. Have a religious belief in order for meditation to be successful.

5. Pay attention to how well the client is doing at meditating.

Correct Answer: 1,2,3

Rationale 1: Focus on one word, object, or symbol to look at or think about if the client finds it helpful. A repeated word, an object, or symbol to look at or think about, or a specific thought or feeling helps keep distracting thoughts from entering the mind.

Rationale 2: Find a position that will be comfortable to hold for a while. A comfortable physical position that can be held for 20 minutes without stress facilitates meditation.

Rationale 3: Find a quiet place away from distractions. The environment for meditation should be one that minimizes distraction; therefore, it is useful to create a quiet place in which to practice meditation.

Rationale 4: Have a religious belief in order for meditation to be successful. The person who practices meditation need not associate it with religion or philosophy. It can be practiced as a means of reducing inner discord and increasing self-knowledge.

Rationale 5: Pay attention to how well the client is doing at meditating. It is counterproductive to worry about how well you are doing at meditating. A passive attitude requires understanding that thoughts and distractions will occur and can be cleared from the mind. If they occur, they should be noted and released without concern about their interference.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Educate clients and their families in the effective use of CAM therapies.

Question 21

Type: MCSA

Massage with aromatherapy is useful for persons diagnosed with:

1. Alzheimers disease.

2. Mania.

3. Acute psychosis.

4. Dementia.

Correct Answer: 4

Rationale 1: There are several CAM modalities that involve the use of touch for healing. Massage is one of the best known. Massage, probably because it releases endorphins, has been helpful for persons with cancer, autistic children, people who are depressed or addicted, and, in combination with aromatherapy, for persons with dementia. Persons who are suffering a psychotic episode as well as those who are experiencing mania are not good candidates for receiving CAM therapies that incorporate touch. Individuals diagnosed with Alzheimers disease have varying personality characteristics so one should not assume that massage (touch) with or without aromatherapy would be an appropriate adjunctive therapy for a person with this diagnosis.

Rationale 2: There are several CAM modalities that involve the use of touch for healing. Massage is one of the best known. Massage, probably because it releases endorphins, has been helpful for persons with cancer, autistic children, people who are depressed or addicted, and, in combination with aromatherapy, for persons with dementia. Persons who are suffering a psychotic episode as well as those who are experiencing mania are not good candidates for receiving CAM therapies that incorporate touch. Individuals diagnosed with Alzheimers disease have varying personality characteristics so one should not assume that massage (touch) with or without aromatherapy would be an appropriate adjunctive therapy for a person with this diagnosis.

Rationale 3: There are several CAM modalities that involve the use of touch for healing. Massage is one of the best known. Massage, probably because it releases endorphins, has been helpful for persons with cancer, autistic children, people who are depressed or addicted, and, in combination with aromatherapy, for persons with dementia. Persons who are suffering a psychotic episode as well as those who are experiencing mania are not good candidates for receiving CAM therapies that incorporate touch. Individuals diagnosed with Alzheimers disease have varying personality characteristics so one should not assume that massage (touch) with or without aromatherapy would be an appropriate adjunctive therapy for a person with this diagnosis.

Rationale 4: There are several CAM modalities that involve the use of touch for healing. Massage is one of the best known. Massage, probably because it releases endorphins, has been helpful for persons with cancer, autistic children, people who are depressed or addicted, and, in combination with aromatherapy, for persons with dementia. Persons who are suffering a psychotic episode as well as those who are experiencing mania are not good candidates for receiving CAM therapies that incorporate touch. Individuals diagnosed with Alzheimers disease have varying personality characteristics so one should not assume that massage (touch) with or without aromatherapy would be an appropriate adjunctive therapy for a person with this diagnosis.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Identify the natural medicines used for psychiatric symptoms and their effectiveness and safety.

Question 22

Type: MCSA

A client taking central nervous system (CNS) depressants asks the nurse what natural medicines would be safe to use. The nurse suggests that there is no contraindication for taking CNS depressants with:

1. Melatonin.

2. Lavender.

3. Hawthorn.

4. Stinging nettle.

Correct Answer: 2

Rationale 1: Lavender is a plant that is used for ornamentation; it may be processed into an essential oil for aromatherapy or used in potpourri. It is not an herbal product for which one must be concerned. CNS depressants should never be mixed with chamomile, hawthorn, kava, melatonin, or stinging nettle because they also act as CNS depressants and may potentiate the effect of prescribed medications or cause serious side effects.

Rationale 2: Lavender is a plant that is used for ornamentation; it may be processed into an essential oil for aromatherapy or used in potpourri. It is not an herbal product for which one must be concerned. CNS depressants should never be mixed with chamomile, hawthorn, kava, melatonin, or stinging nettle because they also act as CNS depressants and may potentiate the effect of prescribed medications or cause serious side effects.

Rationale 3: Lavender is a plant that is used for ornamentation; it may be processed into an essential oil for aromatherapy or used in potpourri. It is not an herbal product for which one must be concerned. CNS depressants should never be mixed with chamomile, hawthorn, kava, melatonin, or stinging nettle because they also act as CNS depressants and may potentiate the effect of prescribed medications or cause serious side effects.

Rationale 4: Lavender is a plant that is used for ornamentation; it may be processed into an essential oil for aromatherapy or used in potpourri. It is not an herbal product for which one must be concerned. CNS depressants should never be mixed with chamomile, hawthorn, kava, melatonin, or stinging nettle because they also act as CNS depressants and may potentiate the effect of prescribed medications or cause serious side effects.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Identify the natural medicines used for psychiatric symptoms and their effectiveness and safety.

Question 23

Type: MCSA

A client is taking fluoxetine (Prozac) and wonders if adding St. Johns wort would help. Knowing that St. Johns wort acts similar to selective serotonin reuptake inhibitors (SSRIs), the nurse is concerned that by taking both, the client may develop:

1. Nothing since these substances do not interact.

2. Serotonin syndrome.

3. Mania.

4. Depression.

Correct Answer: 2

Rationale 1: SSRIs should not be combined with St. Johns wort. Too much serotonin presents a risk for serotonin syndrome. St. Johns wort is stipulated for use as a treatment of depressive symptoms, not mania. There is indeed concern, SSRIs should not be taken with St. Johns wort.

Rationale 2: SSRIs should not be combined with St. Johns wort. Too much serotonin presents a risk for serotonin syndrome. St. Johns wort is stipulated for use as a treatment of depressive symptoms, not mania. There is indeed concern, SSRIs should not be taken with St. Johns wort.

Rationale 3: SSRIs should not be combined with St. Johns wort. Too much serotonin presents a risk for serotonin syndrome. St. Johns wort is stipulated for use as a treatment of depressive symptoms, not mania. There is indeed concern, SSRIs should not be taken with St. Johns wort.

Rationale 4: SSRIs should not be combined with St. Johns wort. Too much serotonin presents a risk for serotonin syndrome. St. Johns wort is stipulated for use as a treatment of depressive symptoms, not mania. There is indeed concern, SSRIs should not be taken with St. Johns wort.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Identify the natural medicines used for psychiatric symptoms and their effectiveness and safety.

Question 24

Type: MCSA

Knowing that the nurse is familiar with CAM modalities, a colleague asks the nurse for advice on dealing with the symptoms of the colleagues mothers recent diagnosis of early-stage Alzheimers disease. The nurse discusses the potential for the use of certain dietary supplements and suggests that the mothers diet include:

1. Kava.

2. Thiamine.

3. Omega-3 fatty acids.

4. Ginkgo leaf extract.

Correct Answer: 3

Rationale 1: Omega-3 fatty acids may slow the cognitive and functional decline in Alzheimers disease. Thiamine, when taken orally, is likely safe for alcoholic encephalopathy. Ginkgo leaf extract, when taken orally, is likely safe for dementia. Kava is comparable to low-dose benzodiazepines for short-term treatment of anxiety.

Rationale 2: Omega-3 fatty acids may slow the cognitive and functional decline in Alzheimers disease. Thiamine, when taken orally, is likely safe for alcoholic encephalopathy. Ginkgo leaf extract, when taken orally, is likely safe for dementia. Kava is comparable to low-dose benzodiazepines for short-term treatment of anxiety.

Rationale 3: Omega-3 fatty acids may slow the cognitive and functional decline in Alzheimers disease. Thiamine, when taken orally, is likely safe for alcoholic encephalopathy. Ginkgo leaf extract, when taken orally, is likely safe for dementia. Kava is comparable to low-dose benzodiazepines for short-term treatment of anxiety.

Rationale 4: Omega-3 fatty acids may slow the cognitive and functional decline in Alzheimers disease. Thiamine, when taken orally, is likely safe for alcoholic encephalopathy. Ginkgo leaf extract, when taken orally, is likely safe for dementia. Kava is comparable to low-dose benzodiazepines for short-term treatment of anxiety.

Global Rationale:

Cognitive Level: Creating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Identify the natural medicines used for psychiatric symptoms and their effectiveness and safety.

Question 25

Type: MCMA

A client taking fluoxetine (Prozac) asks about adding herbal therapy to the treatment. The nurse advises that select serotonin reuptake inhibitors should not be taken with:

Standard Text: Select all that apply.

1. Grapefruit juice.

2. St. Johns wort.

3. Melatonin.

4. Sage.

5. SAMe.

Correct Answer: 2,3,5

Rationale 1: Grapefruit juice. Clomipramine (Anafranil) should not be taken with grapefruit juice.

Rationale 2: St. Johns wort. SSRIs should not be taken in combination with St. Johns wort.

Rationale 3: Melatonin. Fluoxetine (Prozac) and fluvoxamine (Luvox) should not be taken with melatonin.

Rationale 4: Sage. Anticonvulsants should not be taken with sage.

Rationale 5: SAMe. SSRIs should not be taken in combination with SAMe.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Determine when a client should not use natural medicines in combination with prescribed psychopharmacologic medications.

Question 26

Type: MCSA

A client is taking lithium for treatment of a mood disorder. Which of the following herbal products is contraindicated for this client?

1. American ginseng

2. Evening primrose oil

3. Yohimbe

4. Caffeine

Correct Answer: 4

Rationale 1: Lithium is not be taken with black tea, caffeine, cocoa, coffee, green tea, guarana, and psyllium. American ginseng is not to be taken with MAOIs, antipsychotics, or central nervous system stimulants. Evening primrose oil is not to be taken with phenothiazines. Yohimbe is not to be taken with MAOIs, tricyclics, or phenothiazines.

Rationale 2: Lithium is not be taken with black tea, caffeine, cocoa, coffee, green tea, guarana, and psyllium. American ginseng is not to be taken with MAOIs, antipsychotics, or central nervous system stimulants. Evening primrose oil is not to be taken with phenothiazines. Yohimbe is not to be taken with MAOIs, tricyclics, or phenothiazines.

Rationale 3: Lithium is not be taken with black tea, caffeine, cocoa, coffee, green tea, guarana, and psyllium. American ginseng is not to be taken with MAOIs, antipsychotics, or central nervous system stimulants. Evening primrose oil is not to be taken with phenothiazines. Yohimbe is not to be taken with MAOIs, tricyclics, or phenothiazines.

Rationale 4: Lithium is not be taken with black tea, caffeine, cocoa, coffee, green tea, guarana, and psyllium. American ginseng is not to be taken with MAOIs, antipsychotics, or central nervous system stimulants. Evening primrose oil is not to be taken with phenothiazines. Yohimbe is not to be taken with MAOIs, tricyclics, or phenothiazines.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Determine when a client should not use natural medicines in combination with prescribed psychopharmacologic medications.

Question 27

Type: MCSA

In order to improve diet, an eager mental health client bought a juicing machine. The nurse knows that grapefruit juice may interfere with some psychotropic medications. Upon checking the clients medical records, the nurse finds the clients medication should not cause a problem with including grapefruit juice in the clients diet. The client is probably taking:

1. Antidepressants.

2. Anticonvulsants.

3. Atypical antipsychotics.

4. Benzodiazepines.

Correct Answer: 3

Rationale 1: Grapefruit juice is not contraindicated for atypical antipsychotics. There are commonly used natural medicines that should not be taken in combination with psychotropic medications because they either cancel out the therapeutic effect, potentiate the effects above and beyond what is therapeutic, or cause untoward side effects. Grapefruit juice is contraindicated for some anticonvulsants, antidepressants, and benzodiazepines such as carbamazepine (Tegretol), clomipramine (Anafranil), and buspirone (BuSpar).

Rationale 2: Grapefruit juice is not contraindicated for atypical antipsychotics. There are commonly used natural medicines that should not be taken in combination with psychotropic medications because they either cancel out the therapeutic effect, potentiate the effects above and beyond what is therapeutic, or cause untoward side effects. Grapefruit juice is contraindicated for some anticonvulsants, antidepressants, and benzodiazepines such as carbamazepine (Tegretol), clomipramine (Anafranil), and buspirone (BuSpar).

Rationale 3: Grapefruit juice is not contraindicated for atypical antipsychotics. There are commonly used natural medicines that should not be taken in combination with psychotropic medications because they either cancel out the therapeutic effect, potentiate the effects above and beyond what is therapeutic, or cause untoward side effects. Grapefruit juice is contraindicated for some anticonvulsants, antidepressants, and benzodiazepines such as carbamazepine (Tegretol), clomipramine (Anafranil), and buspirone (BuSpar).

Rationale 4: Grapefruit juice is not contraindicated for atypical antipsychotics. There are commonly used natural medicines that should not be taken in combination with psychotropic medications because they either cancel out the therapeutic effect, potentiate the effects above and beyond what is therapeutic, or cause untoward side effects. Grapefruit juice is contraindicated for some anticonvulsants, antidepressants, and benzodiazepines such as carbamazepine (Tegretol), clomipramine (Anafranil), and buspirone (BuSpar).

Global Rationale:

Cognitive Level: Creating

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Determine when a client should not use natural medicines in combination with prescribed psychopharmacologic medications.

Question 28

Type: MCSA

Nurses who wish to use hypnosis in their practice:

1. Recognize that hypnosis is an advanced intervention that requires specialized training in hypnotherapy.

2. Are qualified to do so if they can effectively use guided meditation.

3. Do not need special training in hypnosis.

4. Do not need to be concerned with whether or not hypnosis is within the scope of nursing practice.

Correct Answer: 1

Rationale 1: Nurses who wish to use hypnosis in their practice must recognize that it is an advanced intervention that requires specialized training in hypnotherapy. It is also important to be aware of whether the nurses state board of nursing identifies hypnosis as within the scope of practice of nurses. Nurses who effectively use guided meditation are not necessarily qualified to use hypnosis.

Rationale 2: Nurses who wish to use hypnosis in their practice must recognize that it is an advanced intervention that requires specialized training in hypnotherapy. It is also important to be aware of whether the nurses state board of nursing identifies hypnosis as within the scope of practice of nurses. Nurses who effectively use guided meditation are not necessarily qualified to use hypnosis.

Rationale 3: Nurses who wish to use hypnosis in their practice must recognize that it is an advanced intervention that requires specialized training in hypnotherapy. It is also important to be aware of whether the nurses state board of nursing identifies hypnosis as within the scope of practice of nurses. Nurses who effectively use guided meditation are not necessarily qualified to use hypnosis.

Rationale 4: Nurses who wish to use hypnosis in their practice must recognize that it is an advanced intervention that requires specialized training in hypnotherapy. It is also important to be aware of whether the nurses state board of nursing identifies hypnosis as within the scope of practice of nurses. Nurses who effectively use guided meditation are not necessarily qualified to use hypnosis.

Global Rationale:

Cognitive Level: Evaluating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Integrate CAM strategies into professional practice when appropriate.

Question 29

Type: MCSA

Which of the following statements by a nursing student indicates the need for further training on the use of CAM techniques?

1. I should practice deep breathing exercises before trying to teach a client how to use them.

2. Massage therapy can help alleviate pain for clients with cancer.

3. It is important to assess the clients motivation to participate in treatment before beginning.

4. These techniques should be used for all clients.

Correct Answer: 4

Rationale 1: Not all clients can tolerate touch, do visualizations, relax with music or breathing, or tolerate herbal products. Assessment involves interviewing the client for appropriate techniques rather than assuming all CAM modalities are appropriate for all persons.

Rationale 2: Not all clients can tolerate touch, do visualizations, relax with music or breathing, or tolerate herbal products. Assessment involves interviewing the client for appropriate techniques rather than assuming all CAM modalities are appropriate for all persons.

Rationale 3: Not all clients can tolerate touch, do visualizations, relax with music or breathing, or tolerate herbal products. Assessment involves interviewing the client for appropriate techniques rather than assuming all CAM modalities are appropriate for all persons.

Rationale 4: Not all clients can tolerate touch, do visualizations, relax with music or breathing, or tolerate herbal products. Assessment involves interviewing the client for appropriate techniques rather than assuming all CAM modalities are appropriate for all persons.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Integrate CAM strategies into professional practice when appropriate.

Question 30

Type: MCSA

NCCAM has identified five major domains of complementary and alternative therapies. The fifth domain of energy therapies does not include:

1. Healing touch.

2. Reiki.

3. Bioelectromagnetic-based therapies.

4. Ayurveda.

Correct Answer: 4

Rationale 1: Ayurveda is categorized as a whole medical system by NCCAM, not in the domain of energy therapies. There are four identified modalities included in the category of energy therapies: Healing Touch, Reiki, Biomagnetic-based therapies, and Qi gong.

Rationale 2: Ayurveda is categorized as a whole medical system by NCCAM, not in the domain of energy therapies. There are four identified modalities included in the category of energy therapies: Healing Touch, Reiki, Biomagnetic-based therapies, and Qi gong.

Rationale 3: Ayurveda is categorized as a whole medical system by NCCAM, not in the domain of energy therapies. There are four identified modalities included in the category of energy therapies: Healing Touch, Reiki, Biomagnetic-based therapies, and Qi gong.

Rationale 4: Ayurveda is categorized as a whole medical system by NCCAM, not in the domain of energy therapies. There are four identified modalities included in the category of energy therapies: Healing Touch, Reiki, Biomagnetic-based therapies, and Qi gong.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Integrate CAM strategies into professional practice when appropriate.

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank

Copyright 2012 by Pearson Education, Inc.

Leave a Reply