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15. An immigrant from China needs a colonic resection but is anxious and reluctant about surgery. This patient usually follows traditional Chinese health practices. Which comment by the nurse would most likely reduce the patient’s anxiety and reluctance?

a. “Surgery will help rebalance the yin and yang forces and return you to harmony.” b. “The surgery we are recommending will help you achieve final transformation.” c. “I know this is new to you, but you can trust us to take very good care of you.” d. “If you would like, we could investigate using acupuncture to help control pain.”

ANS: D

It would be helpful to incorporate elements of TCM as appropriate; such as acupuncture for pain control. TCM has the goal of healing in harmony with one’s environment and all of creation in mind, body, and spirit, as well as balance of yin and yang energies and a state of transition. However, it would not be helpful to suggest that surgery will balance the yin and the yang, since this is not how balance is achieved in TCM. Transformation is recognized as a stage of healing occurring when mutual, creative, active participation occurs between healers and the patient toward changes in the mind, body, and spirit; but “final transformation” could imply the end of corporeal life and might be perceived as hastening his demise. Appealing to him to trust persons whose practices are foreign to him conflicts with the patient’s values and would not likely be effective.

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

REF: Pages 36-24, 25 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity a. Naturopathy b. Homeopathy c. Chiropractic d. Shiatsu

16. Which CAM method is associated with using allergy injections of small amounts of an allergen in solution?

ANS: B

Homeopathy uses small doses of a substance to stimulate the body’s defenses and healing mechanisms to treat illness. Naturopathy emphasizes health restoration rather than disease. Chiropractic uses manipulation of the body to restore health. Shiatsu is a type of massage.

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

REF: Page 36-18 TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity a. Fish oil b. Black cohosh c. Lavender d. Mandarin

17. A nurse plans health education for a patient who will be receiving warfarin for several weeks after knee-replacement surgery. Which substance should the nurse caution the patient to avoid?

ANS: A

Fish oil may increase bleeding time and therefore has a potentially hazardous interaction with the anticoagulant warfarin. Black cohosh is an herbal treatment for hot flashes. Mandarin and lavender may have calming effects, which may be helpful, but would not cause increased risk of bleeding.

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

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

MSC: Client Needs: Physiological Integrity

18. A patient report, “Last night I had several mixed drinks at a party. When I got home, I had difficulty falling sleep. I made two cups of herbal tea with lavender. This morning, I feel very groggy and have a headache.” The nurse should explain that a. lavender should be delayed at least 1 hour after using alcohol to avoid side effects. b. lavender may increase sedation from other central nervous system depressants. c. herbal teas often cause nervous system side effects such as headaches. d. these feelings are actually a hangover from excessive alcohol intake.

ANS: B

Lavender has sedative properties that are potentiated when used in combination with other central nervous system depressants. Headaches are another possible side effect of this herbal medicine. The nurse should advise caution in ingesting alcohol and lavender for these reasons. Taking lavender an hour after alcohol will not prevent these interactions, and it is likely that the lavender played a role in her feeling perhaps worse than usual after this episode of drinking. Herbal teas cause headaches in some cases, but it is not characteristic of this group of herbal remedies.

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

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

MSC: Client Needs: Physiological Integrity a. Impaired memory related to neurological changes b. Deficient knowledge related to potentially harmful drug interactions c. Ineffective denial related to consequences of mismanagement of therapeutic regime d. Effective management of the therapeutic regime related to augmentation of anti-coagulant therapy

19. A patient had a venous thrombosis 3 weeks ago and is now taking warfarin. When visiting the laboratory to have a prothrombin time drawn, the patient reports drinking ginseng tea to stimulate the immune system. Which nursing diagnosis applies?

ANS: B

Ginseng tea is amongst the top 10 herbal products used in the United States and believed to have multiple beneficial properties. Because it antagonizes platelet-activating factor, it should not be taken by patients who are receiving anticoagulants or who have other potential bleeding problems. Thus, deficient knowledge is an appropriate nursing diagnosis.

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

REF: Page 36-9 TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Physiological Integrity

20. Select the best desired outcome for a patient who uses valerian. The patient will report a. stress level is lower. b. undisturbed sleep throughout the night. c. increased interest in recreational activities. d. early morning waking without an alarm clock.

ANS: B eBay: testbanks_and_xanax

Valerian decreases sleep latency, nocturnal waking, and leads to a subjective sense of good sleep. Sleeping through the night is the best indicator the herb was effective. Although the patient’s stress level may be lowered by use of valerian, the problem is insomnia; outcomes should relate to the problem. Early morning waking is indicative of depression or anxiety.

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

REF: Page 36-36 (Table 36-1)

TOP: Nursing Process: Outcomes Identification/Planning

MSC: Client Needs: Physiological Integrity

21. Which patient would most likely benefit from taking St. John’s wort? A patient with a. mood swings. b. hypomanic symptoms. c. mild depressive symptoms. d. panic disorder with agoraphobia.

ANS: C

St. John’s wort may be effective in treating mild to moderate depression. St John’s wort has not been found to be effective in treatment of cyclothymic, bipolar, or anxiety disorders.

PTS: 1

DIF: Cognitive Level: Understand (Comprehension)

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

MSC: Client Needs: Psychosocial Integrity

22. During an assessment interview, a patient diagnosed with inflammatory bowel disease accompanied by frequent episodes of diarrhea says, “I’ve been using probiotics in small doses for about a week.” When the nurse assesses mental status, expected findings would be a. intact cognitive function. b. slow verbal responses. c. paranoid thinking. d. slurred speech.

ANS: A

Probiotics may reduce inflammation and heal the gut. No effect on cognitive function would be associated with use of microbiomes, including probiotics. The patient has taken small doses, so response times would be normal. It does not usually produce the effects cited in the distracters.

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

REF: Page 36-13 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Electroconvulsive therapy b. Mega doses of vitamins c. Meditative practices d. Herbal therapy

23. Which complementary and alternative therapy may be safely combined with traditional Western medicine in the treatment of anxiety disorder?

ANS: C

Yoga, meditation, and prayer are considered to be beneficial adjuncts to treatment for anxiety disorder. Research supports this with findings of lower catecholamine levels following meditation. Patient self-reports suggest patient satisfaction, with increased ability to relax. Meditation and spiritual practices have no associated untoward side effects. Herbal therapy and megadoses of vitamins have potential associated side effects and interactions. Electroconvulsive therapy is not CAM.

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

REF: Pages 36-13, 14

TOP: Nursing Process: Outcomes Identification/Planning

MSC: Client Needs: Physiological Integrity a. Assess changes in the patient’s level of depression. b. Remind the patient to use a secondary form of birth control. c. Educate the patient about the risks of selective serotonin syndrome. d. Suggest adding valerian to the treatment regimen to further improve results.

24. A patient diagnosed with depression confidently tells the nurse, “I’ve been supplementing my paroxetine with St. John’s wort. It has helped a great deal.” What is the nurse’s priority action?

ANS: C

St. John’s wort inhibits serotonin reuptake by elevating extracellular sodium; thus, it may interact with medication, particularly selective serotonin reuptake inhibitors, to produce serotonin syndrome. Discussing the patient’s birth control method is a secondary priority.

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

REF: Pages 36-9, 36 (Table 36-1)

MSC: Client Needs: Physiological Integrity

Multiple Response

TOP: Nursing Process: Implementation a. Yoga b. Exercise c. Meditation d. Aromatherapy e. Acupuncture f. Spinal manipulation

1. A patient in good health and without any major health needs says, “I want to try some techniques to improve my mental and physical well-being but I’m overwhelmed by all the suggestions on the Internet.” Which techniques would be appropriate for the nurse to suggest? (Select all that apply.)

ANS: A, B, C, D

Yoga, exercise, meditation, and aromatherapy are self-help techniques that may have a positive effect on the patient’s physical and mental well-being. These techniques are unlikely to cause harm. The patient is in good health; therefore, acupuncture and spinal manipulation are not indicated.

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

REF: Pages 36-13, 14, 20, 21

TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance eBay: testbanks_and_xanax a. In preparation for discharge, include a significant focus on preventive practices. b. Spend time exploring the patient’s life overall, focusing on broader issues than health. c. Involve the patient’s entire family and treatment team in decisions about treatment options. d. Anticipate that the patient will prefer and value interventions with high technology features. e. Provide relevant health-related information and then encourage the patient to determine which course of action to pursue.

2. A patient who emigrated from India is hospitalized. The patient and family use ayurvedic medicine. The nurse wants to adjust this patient’s care so that it is more comfortable and familiar. What changes from usual Western practice should be considered? (Select all that apply.)

ANS: A, B, E

Ayurvedic medicine, an ancient practice that originated in India, stresses individual responsibility for health, is holistic, promotes prevention, recognizes the uniqueness of the individual, and offers natural methods of treatment. Ayurvedic medicine does not require spiritual cleansing or the involvement of family and the treatment team in all decisions.

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

REF: Page 36-27 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity a. Check active and inactive ingredients. b. Discontinue use if side or adverse effects occur. c. Avoid herbals during pregnancy and breast-feeding. d. Buying from online sources is preferable and cheaper. e. Inform your health care provider about the use of herbals.

3. Which important points should the nurse teach a patient about using herbal preparations? (Select all that apply.)

ANS: A, B, C, E

All of the instruction is correct except regarding purchase of herbals. Herbals should be purchased from a reputable firm. Internet purchasing might not be the best plan, unless the reputation of the firm can be confirmed.

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

REF: Pages 36-5, 8, 9 TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity a. Melatonin

4. A patient reports frequent sleep disturbances. Which interventions could be considered to help improve the patient’s sleep pattern? (Select all that apply.)