Chapter 36: Integrative Care

Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

Multiple Choice

1. A patient tells the nurse, “I’ve been having problems getting a good night’s sleep. I read some information on the Internet and started taking kava kava.” Select the nurse’s priority response.

a. “The Internet does not have reliable health information for consumers.” b. “The Food and Drug Administration warned against using it due to the link to severe liver damage.” c. “Melatonin has been shown to have better effects for treating sleep disturbances.” d. “Your sleep disturbances are related to your problems with anxiety. Herbs will not help.”

ANS: B

The Food and Drug Administration (FDA) warned against using kava kava due to the link to severe liver damage. The nurse has responsibilities to educate patients regarding safe use of complementary therapies. Melatonin may be useful for sleep disturbances, but the patient’s safety is a higher priority. The other distracters are misleading.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 36-36 (Table 36-1) TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance a. “Over-the-counter products for sleep problems are ineffective.” b. “Do not take anything unless it’s prescribed by your doctor.” c. “Let’s do some additional investigation of that product.” d. “It sounds like you are trying to self-medicate.”

2. A patient shows a nurse this advertisement: “Our product is a scientific breakthrough helpful for depression, anxiety, and sleeplessness. Made from an ancient formula, it stimulates circulation and excretes toxins. Satisfaction guaranteed or your money back.” Select the nurse’s best response.

ANS: C

Helping consumers actively evaluate the quality of information available to them is important. It is important for the nurse to work with the patient and include the patient’s preferences regarding management of health. Advertisements indicating scientific breakthroughs or promising miracles for multiple ailments are usually for products that are useless and being fraudulently marketed. Some may even be harmful. Some over-the-counter products can be useful, and patients do not need a prescription for these products. The broader issue is safety and efficacy, rather than whether the patient is trying to self-medicate.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 36-3, 4, 6 TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. Internet b. American Nurses Association (ANA) c. Food and Drug Administration (FDA) d. National Center for Complementary and Integrative Health (NCCIH)

3. A patient wants to learn more about integrative therapies. Which resource should the nurse suggest for the most reliable information?

ANS: D

The NCCIH provides reliable, objective, and scientific information to help in making decisions about use of these practices. NCCIH supports not only research, but also the development and sharing of this kind of information. The FDA has information, but it is not as extensive as NCCIH. The Internet has many resources but some are unreliable. The ANA does not provide extensive information about this topic.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 36-3 TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance a. Support the patient’s efforts to become informed and to find health solutions. b. Suggest the patient check with friends who have tried aromatherapy for treatment of anxiety. c. Remind the patient, “If you spend that much on oils, you may not be able to buy your prescribed medication.” d. Tell the patient, “Aromatherapy can complicate respiratory problems such as asthma. Let’s consider some other options.”

4. A patient with a history of asthma says, “I’ve been very nervous lately. I think aromatherapy will help. I am ordering $250 worth of oils from an Internet site that promised swift results.” Select the nurse’s best action.

ANS: D

Safety is paramount, and aromatherapy may cause complications for a patient with asthma. The nurse should view alternative treatments with an open mind and try to recognize the importance of the treatment to the patient while trying to give the patient accurate, reliable information about the treatment. Although efforts to become health literate should be supported, educating the patient about the pitfalls of relying on the Internet is essential. The opinions of others, whether they are positive or negative, lack a scientific basis and are subject to confounding variables such as the placebo effect and individual factors such as age and health history. Admonishing the patient may jeopardize the relationship.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 36-21 TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance a. Explain to the patient that vitamin mega doses may be harmful and advise caution. b. Assess the patient for symptoms and signs of toxicity from excess vitamin exposure. c. Assess for signs of circulatory integrity to determine whether improvement has occurred. d. Educate the patient that research has not shown that megadoses of vitamins produce benefits.

5. A patient says, “I have taken mega doses of vitamins for 3 months to improve my circulation, but I think I feel worse.” Which action should the nurse take first?

ANS: B

Mega doses of many vitamins, especially when taken over long periods, may produce dangerous side effects or toxicity. The priority for the nurse is to assess for signs of any dangerous consequences of the patient’s use of such a regimen. Secondary interventions would include patient education about research findings related to the practice, along with any benefits and undesired effects associated with the practice. A health care provider should also assess the patient for cardiovascular concerns.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 36-11, 12 TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity

6. Acupuncture is a traditional Chinese medical treatment based on the belief that a. insertion of needles in key locations will drain toxic energies. b. pressure on meridian points will correct problems in energy flow. c. insertion of needles modulates the flow of energy along body meridians. d. taking small doses of noxious substances will alleviate specific symptoms.

ANS: C

Acupuncture involves the insertion of needles to modulate the flow of body energy (qi) along specific body pathways called meridians. Acupressure uses pressure to affect energy flow. Homeopathy involves the use of microdosages of specific substances to effect health improvement. Traditional Chinese medicine (TCM) is more concerned with energy and life force balance, and acupuncture is not predicated on the removal of toxic energies.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 36-15 TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance a. “Thanks for telling me. I’ll make a note in your medical record that you take it.” b. “You are experiencing a placebo effect. When we believe something will help, it usually does.” c. “Self-management of health problems can be dangerous. You should have notified me sooner.” d. “Research studies show that herbals actually increase migraine pain by inflaming nerve cells in the brain.”

7. A patient reports good results from taking an herb to manage migraine headache pain. The nurse confirms there are no hazardous interactions between the herb and the patient’s current prescription drugs. Select the nurse’s best comment to the patient.

ANS: A

The nurse should reinforce the patient for reporting use of the herb. Many patients keep secrets about use of alternative therapies. If it poses no danger, the nurse can document the use. The patient may also get placebo effect from the herb, but it is not necessary for the nurse to point out that information. The distracters are judgmental and may discourage the patient from openly sharing in the future.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 36-4, 5, 40 (Box 36-1) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity eBay: testbanks_and_xanax a. Advise the patient of the danger of serotonin syndrome. b. Suggest that aromatherapy may produce better results. c. Assess the patient for depression and risk for suicide. d. Suggest the patient decrease the antidepressant dose.

8. A patient diagnosed with major depressive disorder tells the nurse, “I want to try supplementing my selective serotonin reuptake inhibitor (SSRI) with St. John’s wort.” Which action should the nurse take first?

ANS: A

Research has suggested that St. John’s wort is a mild inhibitor of serotonin reuptake and could lead to serotonin syndrome; this risk is increased if the patient is taking other medications that increase serotonin activity. Assessing the depression would be a secondary intervention. Aromatherapy has not been shown to be an effective adjunct or treatment for depression. Although a dosage reduction in her SSRI medication might reduce the risk of serotonin syndrome, this intervention is not in the nurse’s scope of practice.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 36-9, 36 (Table 36-1) TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity a. Gastrointestinal distress b. Spontaneous bleeding c. Thromboembolism d. Drowsiness

9. A patient tells the nurse, “I get sick so much, so I started taking ginseng to boost my immune system.” The patient’s only other medication is warfarin daily. Which potential complication should be included in the nursing assessment?

ANS: B

Ginseng may interact with anticoagulants and cause spontaneous bleeding. Warfarin is such an agent and can predispose the patient to spontaneous bleeding. It would not increase the risk of thromboembolism. Drowsiness and gastrointestinal complaints are common side effects.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 36-9, 35 (Figure 36-3)

MSC: Client Needs: Physiological Integrity

TOP: Nursing Process: Assessment

10. A patient asks, “What is the major difference between conventional health care and complementary and alternative medicine (CAM)?” The nurse’s best reply is that conventional health care a. focuses on what is done to the patient, whereas CAM focuses on body–mind interaction with an actively involved patient. b. has been tested by research so less regulation is needed, but CAM is religiously based and highly regulated. c. is controlled by the health care industry, but CAM is the people’s medicine and not motivated by profit. d. is holistic and focused on health promotion, whereas CAM treats illnesses and is symptom-specific.

ANS: A

Conventional health care focuses primarily on curative actions implemented on a mostly passive patient, whereas CAM focuses more on the mind–body aspects of health, along with the active involvement of the patient. Conventional health care is largely grounded in scientific research, and its various components are heavily regulated; the opposite tends to be true of CAM. Some forms of CAM have their roots in religious or cultural practices, but this is not characteristic of CAM as a whole. Both conventional health care and CAM can focus on health promotion and treatment of illness. Although critics express concern about the role of profit in conventional health care, the profit motive can also apply in CAM.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 36-2 TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance

11. A patient has tried a variety of CAM approaches to manage health concerns. The nurse asks, “How is going to CAM practitioners different from seeing your medical doctors?” The patient is most likely to respond, “The CAM practitioners a. usually prescribe a course of invasive and sometimes painful treatments.” b. spend more time talking with me and not just about my symptoms.” c. say I need to become much more spiritual to be well.” d. order many tests to determine my diagnoses.”

ANS: B

CAM practitioners often spend considerable time assessing the person in a holistic way. Visits typically involve lengthy discussions, in contrast to traditional physician visits, where contact is often brief. CAM remedies can sometimes be invasive or slightly painful, but usually they are noninvasive and well-tolerated. Some CAM practices are very spiritually focused, but most do not have overt religious elements. Conventional health care involves more diagnostic testing than CAM.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 36-4 TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. Melatonin b. Meditation c. Purification d. Acupuncture

12. An older male patient has suffered with episodic pruritus and skin eruptions for over 2 years. This patient tells the nurse, “When my skin gets better for a few days, I start worrying that it’s going to start itching again soon. I think my worry may actually trigger the problems to start all over again.” Which self-help technique should the nurse consider suggesting for this patient?

ANS: B

The patient’s comment suggests an element of anxiety accompanies the skin problem. Meditation is a popular self-help method recommended to reduce physical and emotional stress and to promote wellness. Purification, associated with ayurvedic practices, may or may not appeal to this patient. Acupuncture is performed by a professional practitioner, so it is not a self-help technique. The scenario does not indicate the patient is experiencing insomnia, so melatonin is not indicated.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 36-9 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

13. For which patient would it be most important for the nurse to urge immediate discontinuation of kava? A patient with a comorbid diagnosis of a. cirrhosis. b. osteoarthritis. c. multiple sclerosis. d. chronic back pain.

ANS: A

Kava should be used with caution in patients with liver disease because of its potentially hepatotoxic effects. The other health problems do not pose immediate dangers.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 36-9, 36 (Table 36-1) TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity a. “Natural substances tend to be safer than conventional medical remedies.” b. “Natural remedies give you the idea that you are controlling your treatment.” c. “The word natural can be a marketing term used to imply a product is healthy, but that’s not always true.” d. “You should not treat your own physical problems. You should see your health care provider for these problems.”

14. A patient tells the nurse, “I prefer to treat my physical problems with herbs and vitamins. They are natural substances, and natural products are safe.” Which response by the nurse would be most appropriate?

ANS: C

CAM remedies are usually natural substances, but it is a fallacy that products labeled natural are safer than conventional medicines. Some natural products contain powerful ingredients that can cause illness and damage to the body if taken inappropriately and, for some persons, can be dangerous even when used as directed. This is the most important message for the nurse to convey to the patient. So-called natural substances can have a number ofsignificant side effects. Natural substances may give one the belief that he is controlling his own treatment, but that is not the message that most needs to be communicated here. Many patients can safely self-manage minor physical problems.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 36-8, 9 TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance