Deck 37: Integrative Care

Question 1

A nurse plans health education for a patient who is having difficulty sleeping and wants to try a natural supplement. Which substance should the nurse recommend to the patient?

A) Ginkgo biloba
B) St. John's wort
C) Valerian
D) Kava kava

Answer 1

Valerian

Question 2

A patient has tried a variety of traditional, complementary, and alternative medicine (TCAM) approaches to manage health concerns. The nurse asks, "How is going to TCAM practitioners different from seeing your medical doctors?" How is the patient most likely to respond?

A) "The TCAM practitioners usually prescribe a course of invasive and sometimes painful treatments."
B) "The TCAM practitioners spend more time talking with me and not just about my symptoms."
C) "The TCAM practitioners say I need to become much more spiritual to be well."
D) "The TCAM practitioners order many tests to determine my diagnoses."

Answer 2

"The TCAM practitioners spend more time talking with me and not just about my symptoms."

Question 3

A patient has just completed 6 weeks of electroconvulsive therapy. When visiting the clinic for a follow-up visit, the patient reports taking ginkgo for memory enhancement. Which nursing diagnosis applies?

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 improvement of memory loss associated with electroconvulsive therapy

Answer 3

Effective management of the therapeutic regime related to improvement of memory loss associated with electroconvulsive therapy

Question 4

For patients with which co-morbid diagnosis would it be most important for the nurse to urge immediate discontinuation of kava kava?

A) Cirrhosis
B) Osteoarthritis
C) Multiple sclerosis
D) Chronic back pain

Question 5

A patient reports, "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 valerian. This morning, I feel very groggy and have a headache." The nurse should explain which of the following?

A) That valerian should be delayed at least 1 hour after using alcohol to avoid side effects
B) That valerian may increase sedation from other central nervous system depressants
C) That herbal teas often cause nervous system adverse effects such as headaches
D) That these feelings are actually a hangover from excessive alcohol intake

Question 6

A patient diagnosed with depression tells the nurse, "I want to try supplementing my selective serotonin reuptake inhibitor with St. John's wort." Which action should the nurse take first?

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.

Question 7

A patient asks, "What is the major difference between conventional health care and traditional, complementary, and alternative medicine (TCAM)?" Which of the following is the nurse's best reply?

A) Conventional health care focuses on what is done to the patient, whereas TCAM focuses on mind-body interaction with an actively involved patient.
B) Conventional health care has been tested by research so less regulation is needed, but TCAM is religiously based and highly regulated.
C) Conventional health care is controlled by the health care industry, but TCAM is the people's medicine and not motivated by profit.
D) Conventional health care is holistic and focused on health promotion, whereas TCAM treats illnesses and is symptom- specific.

Question 8

Select the best desired outcome for a patient who uses valerian.

A) The patient will report that stress level is lower.
B) The patient will report undisturbed sleep throughout the night.
C) The patient will report increased interest in recreational activities.
D) The patient will report early morning waking without an alarm clock.

Question 9

What is the term used in Canada to describe energy drinks?

A) Stimulant
B) Homopathy
C) Natural health product
D) Probiotic

Question 10

A patient tells the nurse, "I've been having problems with my memory. I read some information on the Internet and started taking ginkgo." Select the nurse's best response.

A) "The Internet does not have reliable health information for consumers."
B) "More recent studies indicate ginkgo does not help memory problems."
C) "Valerian has been shown to have better effects for treating memory problems."
D) "Your memory problems are related to your circulation problems. Herbs will not help."

Question 11

A patient says, "I have taken megadoses of vitamin E for 3 months to improve my circulation, but I think I feel worse." Which action should the nurse take first?

A) Explain to the patient that megadoses 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.

Question 12

Which traditional, complementary, and alternative medicine (TCAM) method is associated with using allergy injections of small amounts of an allergen in solution?

A) Naturopathy
B) Homeopathy
C) Chiropractic
D) Shiatsu

Question 13

Acupuncture is a traditional Chinese medical treatment based on which of the following beliefs?

A) That insertion of needles in key locations will drain toxic energies
B) That pressure on meridian points will correct problems in energy flow
C) That insertion of needles modulates the flow of energy along body meridians
D) That taking small doses of noxious substances will alleviate specific symptoms

Question 14

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

A) The Internet
B) The Canadian Nurses Association (CNA)
C) Health Canada's Natural Health Products Directorate (NHPD)
D) National Center for Complementary and Alternative Medicine (NCCAM)

Question 15

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.

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."

Question 16

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?

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."

Question 17

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."

Question 18

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.

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."

Question 19

A patient tells the nurse, "I have a hard time sleeping and find that my sleeping pill only works when I take valerian as well." How should the nurse respond?

A) "That`s great that they work so well together for you."
B) "Thanks for telling me about this combination, I will note it on your medical chart."
C) "The use of valerian is contraindicated when taking other medication to help you sleep."
D) "What other medications have you tried to help you sleep in the past?"

Question 20

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.

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."

Question 21

A patient in good health and without any major health needs says, "I want to try some nutritional supplements I read about on the Internet." What information would be appropriate for the nurse to include in a response? Select all that apply.

A) "Most healthy people who eat a balanced diet do not need nutritional supplements."
B) "Research has not supported claims that various nutritional supplements create significant benefits in healthy people."
C) "Some nutritional supplements are proven to significantly delay aging and reduce the incidence of age-related diseases like cancer."
D) "I am glad you are actively engaged in managing your health by trusting information from the Internet."
E) "Researchers are still studying the benefits and side effects of many supplements. We should know more in the years to come."

Question 22

During an assessment interview, a patient who reports a high level of pain says, "I've been using St. John's wort in small doses for about a week." When the nurse assesses the patient what would the expected findings be?

A) Decreased pain
B) Mental confusion
C) High anxiety level
D) Slurred speech

Question 23

Which vitamin is thought to improve anxiety and depression?

A) Vitamin A
B) Vitamin B
C) Vitamin C
D) Vitamin D

Question 24

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

A) Check active and inactive ingredients.
B) Discontinue use if adverse effects occur.
C) Avoid herbals during pregnancy and breastfeeding.
D) Buying from online sources is preferable and cheaper.
E) Inform your health care provider about the use of herbals.

Question 25

A patient who emigrated from India is hospitalized. The patient and family use Ayurvedic medicine. The nurse wants to alter 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.

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 because the patient's traditions are steeped in history, there may be distrust in high-tech interventions.
E) Provide relevant health-related information, and then allow the patient to determine which course of action to pursue.

Question 26

Which patient would most likely benefit from taking St. John's wort?

A) A patient with mood swings
B) A patient with hypomanic symptoms
C) A patient with mild depressive symptoms
D) A patient with panic disorder with agoraphobia.

Question 27

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

A) Aromatherapy
B) Chamomile
C) Vitamin C
D) Valerian
E) SAM-e

Question 28

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

A) Electroconvulsive therapy
B) Megadoses of vitamins
C) Meditative practices
D) Herbal therapy