Module 2 (Unit B): Theories and Therapies

What is the best example of an alternative medical system? A. Psychotropic medication B. Chi adjustment C. Homeopathy D. Allopathy

C. Homeopathy Homeopathy is listed as one of the five major domains of complementary and alternative health care by the National Center for Complementary and Alternative Medicine. Other examples are oriental medicine and naturopathy.REF: 639

Which organ secretes hormones that are a normal component of the body's general response to stress? Select all that apply. A. Thyroid gland B. Hypothalamus C. Pituitary gland D. Adrenal glands E. Parathyroid glands

B, C, D The hypothalamus, pituitary, and adrenal glands act as a system that responds to mental and physical stress. The organs secrete corticotropin-releasing hormone, corticotropin, and cortisol; all influence the function of nerve cells of the brain. None of the remaining options secrete hormones associated with general stress.REF: 57-58

Which supplement may be helpful in managing the symptoms of depression? Select all that apply. A. Lavender B. St. John's wort C. Melatonin D. Fish oil E. SAMe

B, D, E St. John's wort, Fish oil, and SAMe have been identified as having some possible positive effect on the symptoms of depression. Melatonin and lavender are associated with insomnia.DIF: Cognitive Level: Remember (Knowledge)REF: Table 36-1TOP: Nursing Process: PlanningMSC: NCLEX: Physiological Integrity

The medication prescribed for a client acts by blocking reuptake of both serotonin and norepinephrine. The nurse evaluates the treatment as successful when observing which client behavior? A. Laughing at a joke B. Apologizing for being sarcastic C. Writing down his telephone number D. Going to his room to "calm down"

A. Laughing at a joke Depression is thought to be at least in part caused by lowered levels of serotonin and norepinephrine. Increasing the amount of these transmitters in the brain by blocking reuptake may result in mood elevation. While the other options demonstrate positive behaviors, none are directly associated with such a medication.REF: 57

When a tumor of the cerebellum is present, the nurse should expect that the client would initially demonstrate which sign/symptom? A. Impaired balance B. Abnormal eye movement C. Impaired social judgment D. Blood pressure irregularities

A. Impaired balance The cerebellum is the organ primarily responsible for symptoms of equilibrium or imbalance and would not be a likely source of any of the other options.REF: 40; Figure 3-3

The nurse responsible for the care of a client prescribed clonazepam should evaluate treatment as being successful when the client demonstrates which behavior? A. Less anxiety B. Normal appetite C. Improved physical balance D. Reduced auditory hallucinations

A. Less anxiety Clonazepam is a benzodiazepine thought to enhance the effects of GABA. GABA is associated with the production of a calming emotional state. None of the other options are associated with clonazepam.REF: 49

What term is used to describe care that places the attention on a patient's physical, mental, and spiritual needs while focusing on prevention and wellness? A. Orthodox B. Integrative C. Allopathic D. Mainstream

B. Integrative Integrative care is holistic and focuses on the patient and on prevention and wellness. The other options all refer to conventional health care systems in the United States.DIF: Cognitive Level: Remember (Knowledge)REF: page 2TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity

Which alternative and complementary treatment modality involves the use of essential oils to release neurotransmitters in the brain? A. Orthomolecular therapy B. Acupuncture C. Hypnosis D. Aromatherapy

D. Aromatherapy Aromatherapy, the use of essential oils for inhalation, works to activate the body's healing energy to balance the mind, body, and spirit. Essential oils stimulate the release of neurotransmitters in the brain. The information in the scenario does not support any of the other options.REF: 639-640

The nurse describing alternative and complementary therapies would best describe them using which phrase? A. Disease focused B. Conventional directed C. Symptom directed D. Holistically focused

D. Holistically focused Many alternative and complementary therapies are holistic in nature, often addressing prevention of disease or healing of the whole person; conventional Western medical and its conventional remedies tend to be disease or symptom specific.REF: 633

A client has been diagnosed with acute anxiety attacks. Which herbal remedy should the nurse caution the client to avoid because of its potential to damage the liver? A. Golden root B. Valerian Root C. Lavender D. Kava

D. Kava Kava has significant analgesic and anesthetic properties. Kava may potentiate the effects of benzodiazepines and other central nervous system depressants such as alcohol. The FDA issued a consumer advisory based on the potential risk for liver failure. This is not a known risk associated with any of the other options.REF: 636; Table 36-1

Based on the current understanding of brain physiology, which neurotransmitter would be the expected target of medication prescribed to manage depression? Select all that apply. A. Dopamine B. γ-aminobutyric acid (GABA) C. Serotonin D. Norepinephrine E. Acetylcholine

A, C, D Antidepressant medication targets serotonin and norepinephrine. While dopamine is implicated in schizophrenia (increase) and Parkinson's disease (decrease), it is also believed to be a factor in depression. GABA is implicated in anxiety disorders. Acetylcholine is implicated in Alzheimer's disease as well as Huntington's disease and Parkinson's disease.DIF: Cognitive Level: Apply (Application)REF: page 16TOP: Nursing Process: ImplementationMSC

What are the risks associated with the use of complementary and alternative medicine (CAM) therapies? Select all that apply. A. Lack of standards or regulations that ensure safety for herbal products. B. There are no specialized educational programs that focus on CAM therapies. C. Interactions between CAM products and prescribed medication. D. Insurance companies do not always cover these forms of treatment. E. Credentialing is unavailable for most CAM modalities.

A, C, D Poor standardization of herbal products and the possible drug-to-herb interaction as well as the fact that these therapies may not be covered by health care insurance are risks associated with CAM therapies. The remaining options are untrue statements concerning CAM therapies.DIF: Cognitive Level: Remember (Knowledge)REF: pages 7-9TOP: Nursing Process: ImplementationMSC: NCLEX: Physiological Integrity

The nurse caring for a client prescribed risperidone observes the client carefully for which possible side effects? Select all that apply. A. Daytime sleepiness B. Reports of heartburn C. A rapid heartbeat D. Sexual dysfunction E. A weight gain

A, D, E Risperidone is a D2 antagonist that has the potential to produce sedation, weight gain, and sexual dysfunction. None of the other side effects are generally associated with this medication.REF: 45

A 38-year-old patient diagnosed with major depression states, "my provider said something about the medicine I've been prescribed will affect my neurotransmitters. What exactly are neurotransmitters?" What is the nurse's best response to the patient's question? A. "Neurotransmitters are chemical messengers in the brain that help regulate specific functions such as depression." B. "Neurotransmitters are too complicated to explain easily. Just know that the medication will help your mood and make you less depressed." C. "Neurotransmitters are chemicals in the brain that are the reason you are depressed." D. "I will ask your provider to give you a more in-depth explanation about why this medication will help your depression."

A. "Neurotransmitters are chemical messengers in the brain that help regulate specific functions such as depression." Neurotransmitters are chemicals released from neurons that function as a neuromessenger and influence brain functions. Telling the patient that the answer is too complicated belittles the patient by implying she cannot understand, while stating that neurotransmitters are the reason she is depressed is too simplistic. Asking the provider to give the education abdicates your responsibility to provide patient education.DIF: Cognitive Level: Apply (Application)REF: page 9TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment

A chiropractic practitioner will explain to clients that chiropractic treatments are effective based on what information? A. Adjustments put the spinal column in a normal position allowing improved energy flow. B. Manipulation of soft tissue reduces muscle spasm and produces relaxation. C. The laying on of hands reduces stress and produces relaxation. D. Needle placement modulates the flow of energy along body meridians.

A. Adjustments put the spinal column in a normal position allowing improved energy flow. Chiropractic is based on the theory that energy flows from the brain to all parts of the body through the spinal cord and spinal nerves. Manipulation of the spinal column puts the vertebrae back into normal position to allow the proper flow. None of the other options accurately relate to chiropractic therapy.REF: 638

When treating mental illnesses with psychotropic drugs what is the focus of the treatment? A. Altering brain neurochemistry. B. Correcting brain anatomical defects. C. Regulating social behaviors. D. Activating the body's normal response to stress.

A. Altering brain neurochemistry. Psychotropic drugs act to increase or decrease neurotransmitter substances within the brain, thus altering brain neurochemistry.REF: 56-57

A nurse is asked to explain the difference between alternative and complementary therapy. The is the best response? A. Complementary therapy is used in conjunction with conventional Western remedies, whereas alternative therapies replace conventional Western remedies. B. Complementary therapy replaces conventional Western remedies, whereas alternative therapies are used in conjunction with conventional Western remedies. C> Complementary therapy is based on Eastern medicine, whereas alternative therapy has no medical basis. D. Complementary therapy is curative, whereas alternative therapy is palliative.

A. Complementary therapy is used in conjunction with conventional Western remedies, whereas alternative therapies replace conventional Western remedies. Alternative therapies are used alone or with other alternative therapies. Complementary therapies are used in tandem with conventional treatments.REF: 633-634

What is the function of a neuron? A. Conduction of electrical impulses B. Diffuses an impulse across a space C. Provides a space at an axon terminal D. Provides an attachment point of the cell surface

A. Conduction of electrical impulses Neurons are nerve cells that conduct electrical impulses. A neurotransmitter is a chemical substance that functions as a neuromessenger. This neurotransmitter then diffuses across a space, or synapse, to an adjacent postsynaptic neuron, where it attaches to receptors on the neuron's surface.REF: 40

A client tells the nurse he has been taking St. John's wort. On the basis of this information, the nurse should gather additional assessment data related to what possible experience? A. Depression B. Hallucinations C. Fears D. Alcohol abuse

A. Depression St. John's wort is primarily used by individuals to elevate a depressed mood. None of the other options are relevant to the use of St. John's wort.REF: 636; Table 36-1

A patient states, "I found out that I was in the section of the research study not actually taking the medicine. I don't understand that, because all my symptoms improved!" This reaction may be related to what concept? A. Mind-body effect B. Meditation C. Homeopathy D. Naturopathy

A. Mind-body effect Mind and body approaches are built on theories that focus on the continuous interaction between mind and body. Most of these techniques emphasize the mind's capacity to affect bodily function and symptoms, but the reverse—the effects of bodily illness on mental health—is also part of the equation. None of the remaining options are associated with the patient's statement.DIF: Cognitive Level: Apply (Application)REF: page 13TOP: Nursing Process: ImplementationMSC: NCLEX: Physiological Integrity

What term is used to identify the structures that respond to stimuli, conduct electrical impulses, and release neurotransmitters? A. Neurons B. Synapses C. Dendrites D. Receptors

A. Neurons Neurons are the basic functional unit of the nervous system responsible for sending and receiving messages as electrochemical events.REF: 40

The nurse cautions a client about the fact that, when using herbal preparations, the client does not know the actual dose being ingested. What is the basis for this caution? A. No manufacturing standardization exists. B. Clients are unreliable resources of medication information. C. Pure drug is cut with impure substances before going on sale in stores. D. Underdosage leads to poor results from herbal supplements.

A. No manufacturing standardization exists. Currently a lack of standardization and regulation of herbal products exists; thus, the individual never knows exactly what is being ingested. This is dangerous because these substances are neither benign nor without potential for drug-drug interactions.REF: 635

The incoherent thought and speech patterns of the client diagnosed with schizophrenia are related to the brain's inability to perform which function? A. Regulate conscious mental activity. B. Retain and recall past experience. C. Regulate social behavior. D. Maintain homeostasis.

A. Regulate conscious mental activity. When the brain cannot regulate conscious mental activity, the individual's speech patterns demonstrate incoherence and lack of reality orientation.REF: 39-40

A nurse is asked by a client about the basis for the nutritional treatment of health problems. The best reply would incorporate the information that alternative and complementary therapies are based on what factual information? A. Research-based findings B. Cultural and historical experience C. Consumer satisfaction with the conventional Western healing system D. Consumer dissatisfaction with conventional Western healing methods

A. Research-based findings There is a good deal of research on the influence of diet and nutrition on general health, as well as mental health. The International Society for Nutritional Psychiatry Research (ISNPR) (2013) was established to study nutritional approaches to the prevention and treatment of mental disorders and their comorbidities and numerous study links can be found on their website.REF: 637

The client tells the nurse, "The CAM practitioner asked me to try to relax my mind and let go of my pain. She then passed her hands over me, beginning at my head and working down to my feet, never actually making physical contact with any part of my body. She told me that when the pain begins to bother me, I can relax and let the pain go." The client is describing which complementary therapy? A. Therapeutic touch B. Acupuncture C. Orthomolecular therapy D. Eye movement desensitization reprocessing

A. Therapeutic touch Practitioners of healing touch believe healing is promoted when the body's energies are in balance. Practitioners assess the energy field and clear and balance it through hand movements or direct energy in a specific region of the body. The therapist does not physically touch the client. After a session of therapeutic touch, many clients express a sense of deep relaxation. The information in the scenario does not support any of the other options.REF: 639

A client says to the nurse, "I am going to stop taking these antidepressants and start using herbs. What is the most likely reason for the client's decision to use herbals? A. They generally cost less. B. They often produce a faster cure. C. Generally have no side effects D. They are recommended by trusted folk healers.

A. They generally cost less. Although not inexpensive, herbal preparations are often less expensive than prescription medication, especially a newer medication still under patent.REF:634; Box 36-1

The client at the alcohol treatment center tells his outpatient group, "I went to an oriental medicine place to see if they could do something to help me stay away from alcohol. I ended up with tiny silver rods placed in various spots in my body. They twirled the rods, then removed them. So far I haven't had any cravings since I went there several days ago." The client is describing which integrative therapy? A. Allopathy B. Acupuncture C. Naturopathy D. Chiropractic manipulation

B. Acupuncture Acupuncture is a Chinese remedy that involves insertion of tiny needles through the skin. The rationale for the use of acupuncture is to restore the balance of the body's energy (chi). The information in the scenario does not support any of the other options.REF: 638

Using a minute amount of a substance that produces the same symptom as the client's chief symptom, so as to stimulate the body's immune system, is the rationale for which form of complementary therapy? A. Allopathy B. Homeopathy C. Naturopathy D. Orthomolecular therapy

B. Homeopathy Homeopathy attempts to stimulate the body's immune system to relieve the client's distress. Tiny amounts of substances known to produce the symptoms the client is experiencing are used to achieve this. The information in the scenario does not support any of the other options.REF: 639

A 49-year-old patient diagnosed with schizophrenia at 22 years old is prescribed risperidone. Which nursing assessment is the priority for this patient? A. Monitoring blood levels to avoid toxicity B. Monitoring for abnormal involuntary movements C. Observing for secondary mania D. Observing for memory changes

B. Monitoring for abnormal involuntary movements Risperidone has the highest rate of extrapyramidal side effects (EPSs) of the second-generation antipsychotic medications, thus making it imperative to monitor for EPSs. Risperidone is not monitored with blood levels and does not cause mania or memory changes.DIF: Cognitive Level: Analyze (Analysis)REF: page 39TOP: Nursing Process: ImplementationMSC: NCLEX: Physiological Integrity

Which imaging technique can provide information about brain function? A. Computed tomography (CT) scan B. Positron emission tomography (PET) scan C. Magnetic resonance imaging (MRI) scan D. Skull radiograph

B. Positron emission tomography (PET) scan The positron emission tomography scan provides information about function; the other imaging techniques provide information about structure.REF: 45; Table 3-2

Which function is classified as a circadian rhythm? A. Sex drive B. Sleep cycle C. Skeletal muscle contraction D. Maintenance of a focused stream of consciousness

B. Sleep cycle Circadian rhythms are biological rhythms that influence specific regulatory functions such as body temperature, sleeping and waking, and the secretion of certain hormones and neurotransmitters.REF: 39-40

Homeostasis is promoted by interaction between the brain and internal organs and is mediated by component of the nervous system? A. The central nervous system B. The autonomic nervous system C. The sympathetic nervous system D. The parasympathetic nervous system

B. The autonomic nervous system The function of the autonomic nervous system is to transmit messages between the brain and the internal organs. This linkage promotes the maintenance of homeostasis.REF: 38-39

Which assessment should the nurse perform to evaluate the pharmacokinetic affect of a monoamine oxidase inhibitors (MAOIs) antidepressant medication? A. The status of the client's appetite B. The results of the liver function test C. The level of depression exhibited by the client D. The client's current sleeping patterns

B. The results of the liver function test Pharmacokinetics refers to the movement of a drug through the body. Four basic processes of pharmacokinetics which determine the concentration of a drug at its sites of action are easily remembered with the acronym ADME: absorption, distribution, metabolism, and excretion. MAOIs can affect liver function and require monitoring. The other options are related to the medication's pharmacodynamic effects.DIF: Cognitive Level: Apply (Application)REF: page 17TOP: Nursing Process: AssessmentMSC: NCLEX: Physiological Integrity

The nurse caring for a client prescribed an antidepressant medication that produces anticholinergic side effects should assess for which possible side effects? Select all that apply. A. Memory dysfunction B. Ejaculatory dysfunction C. Blurred vision D. Dry mouth E. Constipation

C, D, E Anticholinergic effects are the effects produced by atropine: dry mouth, dry eyes, blurred vision, constipation, and urinary retention. None of the remaining options are associated with anticholinergic side effects.REF: 41

When the nurse wishes to obtain assessment data about possible use of complementary substances, which query would have the best potential to yield accurate information? A. "You are taking only the medicines the doctor prescribed and in the amounts prescribed, correct?" B. "Tell me how you take the medicines the doctor prescribed for you." C. "Tell me every pill and supplement you take regularly." D. "What things do you do for yourself to improve your health?"

C. "Tell me every pill and supplement you take regularly." The nurse needs to spell out the information needed rather than leaving up to the client what to report.REF: 635

A client asks which herbal tea would be good to drink at bedtime. What should the nurse suggest? A. Green tea B. Black tea C. Chamomile tea D. Peppermint tea

C. Chamomile tea Chamomile tea has been studied and found to have relaxing properties.REF: 636; Table 36-1

A 53-year-old patient with a pacemaker implant has been prescribed Coumadin. The patient tells the nurse, "I feel so much better now that I've been taking ginseng to relieve my menopausal symptoms." The nurse's response should be based on what knowledge about ginseng? A. It is an appropriate herbal supplement for this patient. B. It has no proven effect on menopausal symptoms. C. It has anticoagulation effects. D. It is implicated in triggering strokes.

C. It has anticoagulation effects. Ginseng has anticoagulant effects. Drinking ginseng tea may increase the effects of prescription anticoagulants, and the consequences could seriously affect blood clotting. The other options are untrue.DIF: Cognitive Level: Analyze (Analysis)REF: page 9TOP: Nursing Process: ImplementationMSC: NCLEX: Physiological Integrity

A prescription for which medication would require the nurse to monitor the client for potential development of the side effect of hypothyroidism? A. Fluoxetine B. Bupropion C. Lithium D. Imipramine

C. Lithium Long-term use of lithium may cause hypothyroidism. The other options refer to drugs whose long-term use does not cause hypothyroidism.DIF: Cognitive Level: Analyze (Analysis)REF: page 33TOP: Nursing Process: ImplementationMSC: NCLEX: Physiological Integrity

Which of the following is a herb commonly used to treat mild depression? A. LMelatonin B. Kava C. St. John's wort D. Chamomile

C. St. John's wort St. John's wort is used for the treatment of mild to moderate depression. None of the other options are associated with the treatment of mild depression.REF: 636; Table 36-1