Skills Fair CAM

2. A nurse is caring for a client who reports back pain and tells the nurse that a friend has recommended a chiropractor. She asks the nurse what a chiropractor does to relieve back pain. Which of the following responses by the nurse is correct? A. "Chiropractors use their hands to manipulate the spine to treat back pain." B. "Chiropractors insert needles or put pressure along meridians in the back." C. "Chiropractors use herbal remedies to treat back pain." D. "Chiropractors use their hands to balance the energy fields in the back."

A. CORRECT: Chiropractors use their hands to manipulate the spine. B. INCORRECT: Acupuncture involves needles or pressure. C. INCORRECT: Naturopathic medicine uses herbal remedies D. INCORRECT: Therapeutic touch practitioners use their hands to balance energy fields.

3. A nurse is reviewing complementary and alternative therapies with a group of nursing students. The nurse should classify which of the following as mind-body therapies? (Select all that apply.) A. Art therapy B. Acupressure C. Yoga D. Therapeutic touch E. Biofeedback

A. CORRECT: Mind-body therapies use the emotional connections between thinking (mind) and functioning (body) to promote health. B. INCORRECT: Acupressure is a body-based therapy because it focuses specifically on body structures and systems. C. CORRECT: Mind-body therapies use the emotional connections between thinking (mind) and functioning (body) to promote health. D. INCORRECT: Therapeutic touch is an energy therapy, not a mind-body therapy. E. CORRECT: Mind-body therapies use the emotional connections between thinking (mind) and functioning (body) to promote health.

4. A nurse is coaching a group of nursing students in learning to use complementary and alternative therapies they can incorporate into their practice without the need for specialized licensing or certification. Which of the following should the nurse encourage the students to use? (Select all that apply.) A. Guided imagery B. Massage therapy C. Meditation D. Music therapy E. Therapeutic touch

A. CORRECT: Nurses need to understand the general principles of using guided imagery with clients, but they do not need certification or licensure for this therapy. B. INCORRECT: Massage therapists undergo extensive training as well as certification and/or licensure. C. CORRECT: Nurses need to understand the general principles of using meditation with clients, but they do not need certification or licensure for this therapy. D. CORRECT: Nurses need to talk with clients to determine their preferences related to music and the effects different types of music have on them, but they do not require special training to do so. E. INCORRECT: Therapeutic touch requires specific training to perform this energy therapy effectively.

1. A nurse admits a client for abdominal surgery. The client's initial vital signs are temperature 37° C (98.6° F), pulse 98/min, respirations 20/min, and blood pressure 148/88 mm Hg. The client states, "I am really worried. This is the first surgery I have ever had." Which of the following is an appropriate use of a complementary alternative intervention? A. Offer information and ask the client if he is interested in trying a relaxation technique. B. Call the provider and get permission to use relaxation techniques with the client. C. Provide the client with reassurance and information about the procedure. D. Give the client a therapeutic back massage and tell him to try to relax.

A. CORRECT: Providing information will help the client make an informed decision. B. INCORRECT: The nurse does not need a provider's prescription for relaxation therapy. C. INCORRECT: Providing reassurance may negate the client's fear. Providing more information without validating this as a need may increase his anxiety. D. INCORRECT: The nurse should not give any therapy without informing the client and obtaining his consent. Telling him to relax does not acknowledge the impact of his anxiety.

6. A nurse is caring for a client scheduled for abdominal surgery. the client reports being worried. Which of the following actions should the nurse take? a. offer information on a relaxation technique and ask the client if he is interested in trying it. b. request a social worker see the client to discuss meditation. c. attempt to use biofeedback techniques with the client. d. tell the client many people feel the same way before surgery and to think of something else.

A. CORRECT: it is appropriate for the nurse to recommend a noninvasive technique to facilitate coping, and to allow the client to make an informed decision about participating. B. INCORRECT meditation does not require specialized training. the nurse can use this therapy and does not need to request a social worker consult. C. INCORRECT the nurse should recognize that biofeedback requires specialized training and licensing or certification. it is not appropriate for the nurse to attempt to use these techniques. d. INCORRECT this response by the nurse is nontherapeutic because it uses stereotyping and dismisses the client's feelings. the nurse should use therapeutic communication techniques to allow the client to further verbalize fears.

5. A nurse is planning to use healing intention with a client who is recovering from a lengthy illness. Which of the following is the priority action the nurse should take before attempting this particular mind-body intervention? A. Ask the client's permission. B. Explain to the client that this therapy involves prayer. C. Request that the client participate actively. D. Encourage the client to relax for this therapy.

A. INCORRECT: Before beginning any therapy, the nurse must obtain the client's permission. However, this is not the nurse's highest priority with the use of healing intention. B. CORRECT: The first action the nurse should take using the nursing process is to assess or collect data from the client. Because people may have personal, cultural, or religious sensitivities or aversions to religious practices such as prayer, the nurse must first determine that the client is comfortable with a therapy that involves prayer. C. INCORRECT: The success of any complementary therapy depends on the client's active participation. However, this is not the nurse's highest priority with the use of healing intention. D. INCORRECT: Before beginning any complementary therapy, the nurse should use strategies such as controlled breathing to encourage the client to relax. However, this is not the nurse's highest priority with the use of healing intention.

8. A patient describes practicing a complementary and alternative therapy involving concentrating and controlling his respiratory rate and pattern, recognizing that breath work is to yoga as a. The "zone" is to acupressure. b. Massage therapy is to Ayurveda. c. Reiki therapy is to therapeutic touch. d. Prayer is to tai chi.

ANS: C This is an analogy that compares different therapies within specific categories. Both yoga and breath work are mind-body therapies, whereas both Reiki and therapeutic touch therapies are energy field therapies. The other options have different design structures; thus, they do not fit the analogy.

25. A nurse should advise a patient taking the herb kava-kava in conjunction with central nervous system medications that it may: a. Have addictive properties. b. Trigger asthmatic attacks. c. Cause fatal arrythmias. d. Exacerbate depression.

Answer: a The FDA Consumer Advisory and Consumer Reports medical experts have cautioned against the use of kava-kava. Use of kava-kava with other central nervous systems medications can be harmful, and kava-kava may have addictive properties with long-term use.

23. The nurse manager of a community clinic arranges for staff in-services about various complementary therapies available in the community. What is the purpose of this training? (Select all that apply.) a. Nurses have a long history of providing some of these therapies and need to be knowledgeable about their positive outcomes. b. Nurses are often asked for recommendations and strategies that promote well-being and quality of life. c. Nurses play an essential role in patient education to provide information about the safe use of these healing strategies. d. Nurses appreciate the cultural aspects of care and recognize that many of these complementary strategies are part of a patient's life. e. Nurses play an essential role in the safe use of complementary therapies. f. Nurses learn how to provide all of the complementary modalities during their basic education.

Answer: a, b, c, d, e. All of the statements are true except that nurses do not learn how to provide all of the complementary modalities during their basic education. Nurses play an essential role in the safe use of complementary therapies in our emerging health care system. They have an appreciation for many types of interventions and can understand the patient's need to become more involved in his or her health care decisions and choices. They also understand the patient's desire to take a more active role in his or her healing and health promotion processes. Culturally relevant care that uses a full complement of intervention strategies that are supported with evidence is a central tenet of contemporary nursing practice.

13. Which of the following statements best explains the actions of therapeutic touch (TT)? a. Intentionally mobilizes energy to balance, harmonize, and repattern the recipient's biofield b. Intentionally heals specific diseases or corrects certain symptoms c. Is overwhelmingly effective in many conditions d. Is completely safe and does not warrant any special precautions

Answer: a. TT is focused on healing the whole person and providing energy to the body that supports innate healing responses. The research literature is questionable; systematic analyses claim that the research designs are too weak for any conclusive evidence to be identified with confidence. Although TT is relatively safe and there have been very few negative events associated with its use, all therapies (complementary or conventional) should be used with caution in certain populations.

26. A young Hispanic woman tells the nurse that she is going to have a healing ritual to center her spirit after the recent death of her husband. The nurse recognizes the alternative medicine system of: a. Ayurveda. b. Curanderismo. c. Reiki. d. Tai chi.

Answer: b Curanderismo is the practice prevalent in the Hispanic culture of spiritual rites and rituals to promote healing. Ayurveda is practiced primarily in the Indian subcontinent and includes diet, herbal remedies, and massage.Reiki is the Japanese health belief that when spiritual energy is channeled through a Reiki practitioner, the client's spirit is healed, subsequently healing the physical body. Tai Chi is an ancient form of martial arts that uses slow, controlled movements, meditation, and breathing to improve overall health and well-being.

24. A patient with chronic depression asks a nurse whether light therapy should be considered as a possible treatment for the disorder. The nurses response should be based on the knowledge that this form of therapy is best suited for: a. Posttraumatic stress disorder. b. Seasonal affective disorder. c. Postpartum depression. d. Situational depression.

Answer: b Light therapy, or phototherapy, has been shown to be effective for the treatment of seasonal affective disorder (SAD). Phase-delayed sleep brought on by the reduced sunlight in winter disrupts circadian rhythms.

18. A nurse is caring for a patient experiencing a stress response. The nurse plans care with the knowledge that systems respond to stress in what manner? (Select all that apply.) a. Always fail and cause illness and disease b. Cause negative responses over time c. React the same way for all individuals d. Protect an individual from harm in the short term

Answer: b, d. In the beginning stress responses serve as a warning and physiological "alarm" of sorts, preparing the person to respond to harm. In this way they can be a protective mechanism. However, stress that continues unmitigated for long periods of time creates states of "exhaustion" that translate ultimately into negative physiological and psychological events.

22. In addition to an adequate patient assessment, when a nurse uses one of the nursing-accessible complementary therapies, he or she must ensure that which of the following has occurred? a. The family has provided permission. b. The patient has provided permission and consent. c. The health care provider has given approval or provided orders for the therapy. d. He or she has documented that the patient has a complete understanding of complementary and alternative medicine.

Answer: b. Nurse-accessible therapies are independent nursing interventions. As long as the Scope of Practice identified by the nurse's State Board of Nursing permits this activity, you do not need to obtain permission from the patient's primary provider or his or her family members unless the patient is underage. An adult can provide consent. Complete understanding of any procedure or intervention is impossible to ensure; therefore documenting that the patient has a complete understanding of complementary and alternative medicine is inaccurate.

21. What role do patients have in complementary and alternative therapies? a. Submissive to the practitioner b. Actively involved in the treatment c. Allow practitioner to experiment d. Total believer in what is being taught

Answer: b. One of the characteristics of complementary therapy users is that they want to be more involved in their care and decision making about the types of treatments that are used. Complementary therapies are one way to provide the patient with increased control of the health care.

10. Traditional Chinese medicine (TCM) is used by many patients. Which statement most accurately describes intervention(s) offered by TCM providers? a. uses acupuncture as its primary intervention modality b. uses many modalities based on the individual's needs c. uses primarily herbal remedies and exercise d. is the equivalent of medicine and acupuncture

Answer: b. TCM practitioners use a variety of interventions that are based on individual patient assessment findings and needs. Modalities include herbal therapies, acupuncture, moxibustion, cupping, prescribed exercise such as tai chi or qi gong, and lifestyle changes. Although acupuncture is often confused with TCM, when used alone acupuncture is not a whole system of medicine. Rather the National Institutes of Health/National Center for Complementary and Alternative Medicine (NIH/NCCAM) considers it to be a mind-body technique that is often referred to as medical acupuncture. Although herbal therapies and exercise are considered to be part of the treatment repertoire of the TCMprovider, these modalities are not considered to be primary interventions.

31. Which of these assessment findings indicate a positive outcome for a client after acupuncture? a) The client has increased his or her flexibility and strength. b) The client has lost 8 pounds over the last 2 months. c) The client reports a reduction in pain level to 3 out of 10. d) The client has improved balance and coordination.

Answer: c Acupuncture can help with reduction of pain and nausea with clients. It is not a treatment for balance and coordination, strength and flexibility, or weight loss.

30. On the advice of friends, a client on a palliative care unit has requested acupuncture. What it is the goal of this form of CAM? a) allowing accumulated toxins to be released from the body b) altering the client's perception and acceptance of reality c) restoring a healthy flow of energy along the meridians of the body d) reconnecting the client's body, spirit, and emotions

Answer: c Acupuncture either increases or decreases the flow of qi along the meridians of the body. It does not directly address the relationships between body, spirit, and emotions, nor does it aim to release toxins or change an individual's perception of reality.

29. The nurse in a medical unit is collecting a client's history and asks the client about the use of complementary and alternative therapies. The client asks why the nurse needs to know about this. What is the nurse's best response? a) "I am just curious on what types of treatments are used by people." b) "I want to make sure you understand all the risks of these treatments." c) "It's important that we list all your home care needs for the hospital." d) "It will help me so that I can recommend use of these for other clients."

Answer: c Nurses need to include complementary and alternative therapy in assessment of the client's current treatments to ensure an understanding of the safety and effectiveness of the treatments, particularly if the client is also receiving allopathic treatment. The nurse would want to be positive with this questioning so that the client is not defensive regarding any complementary and alternative treatments.

19. Several nurses on a busy unit are using relaxation strategies while at work. What is the desired workplace outcome from this intervention? (Select all that apply.) a. Improved health among the staff b. Increased patient safety c. Improved staff satisfaction d. Improved staff relationships e. Fewer overtime assignments

Answer: c, d. Current research has been able to determine that reducing stress by using relaxation strategies in the workplace leads to improved staff relationships, communication, and satisfaction.

11. Which complementary therapies are most easily learned and applied by a nurse? (Select all that apply) a. massage therapy b. traditional Chinese medicine c. progressive relaxation d. breath work and guided imagery e. therapeutic touch

Answer: c, d. These were identified as nurse-accessible complementary therapies. Massage therapists are licensed by local governmental agencies, and additional educational preparation is required to practice. Traditional Chinese medicine practitioners also attend training/educational programs, typically accredited by the Accreditation Commission for Acupuncture and Oriental Medicine.

16. A nurse is planning care for a group of patients who have requested the use of complementary health modalities. Which patient is not a good candidate for guided imagery? a. Pregnant patient b. Hypertensive patient c. Patient with post-traumatic stress disorder (PTSD) d. A pediatric patient

Answer: c. Imagery can often recreate the traumatic experience, intensifying the sensations and emotions that accompany the memory of it and bringing the PTSD to a crisis level.

15. Which statement best describes the evidence associated with complementary therapies as a whole? a. Many clinical trials in complementary therapies support their effectiveness in a wide range of clinical problems. b. It is difficult to find funding for studies about complementary therapies. Therefore we should not expect to find evidence supporting its use. c. The science supporting the effectiveness of complementary therapies is early in its development. d. Most of the research examining complementary and alternative therapies has found little evidence, suggesting that, although people like them, they are not effective.

Answer: c. Science in the field is just beginning. Before the 1990s little attention was paid in the United States at the National Institutes of Health to support funding for studies about complementary therapies. Most of the evidence cited in systematic reviews throughout this chapter indicates preliminary support for the effectiveness of a variety of complementary therapies. Conditions that appear to be particularly responsive include chronic pain, chronic autoimmune disorders, anxiety, depression, impaired well-being and quality of life that accompany cancer and other chronic conditions, and some time-limited acute illnesses and the symptoms that accompany them (e.g., gastrointestinal disturbances, colds/flus).

20. While planning care for a patient, a nurse understands that providing integrative care includes treating which of the following? a. Disease, spirit, and family interactions b. Desires and emotions of the patient c. Mind-body-spirit of patients and their families d. Muscles, nerves, and spine disorders

Answer: c. You could argue that, when you consider the totality of the patient/family, all of these come into play; but AHNA/ANA Standards of Holistic Nursing speak specifically to the mindbody- spirit focus of holistic nursing.

27. Which nursing action is an example of using integrative care? a) A nurse performing a home assessment of an older adult client recommends a referral to social services. b) A nurse monitors the heartbeat of a fetus and charts the height of the mother's fundus on the medical record. c) A nurse provides music therapy along with relaxation techniques for residents of a long-term facility. d) A nurse instructs a laboring woman to use breathing exercises, and assists with the administration of an epidural for her pain.

Answer: d A nurse who uses integrative care uses some combination of allopathic medicine and CAM as seen with the nurse helping the woman in labor.

28. Which is the most important role of the nurse in using complementary and alternative therapies? a) Practicing guided imagery prior to surgery b) Providing nutrition supplements for weight gain c) Administering herbal supplements for anxiety d) Educating the public about safety and effectiveness

Answer: d The most important role of the nurse in using CAT is educating the public about the safety and effectiveness of using the therapies. Herbal supplements for anxiety and nutrition supplements may be considered part of a treatment plan but they are not the most important aspects of CAT. Guided imagery is one aspect of treatment included in CAT.

9. A patient who has been using relaxation wants a better response. The nurse recommends the addition of biofeedback. What is the expected outcome related to using this additional modality? a. to eat less food b. to control diabetes c. to live longer with acquired immunodeficiency syndrome (AIDS) d. to learn how to control some autonomic nervous system responses

Answer: d. Biofeedback is a mind-body technique that teaches self-regulation and voluntary control over specific physiological responses, including autonomic nervous system response.

17. When planning patient education, it is important to remember that patients with which of the following illnesses often find relief in complementary therapies? a. Lupus and diabetes b. Ulcers and hepatitis c. Heart disease and pancreatitis d. Chronic back pain and arthritis

Answer: d. Evidence supports the use of many complementary therapies for chronic pain syndromes, particularly pain that is unremitting and unresponsive to conventional allopathic therapies.

12. A nursing professor is teaching a nursing student about caring patients who use herbal preparations in addition to prescribed medications. Which of the following statements made by the student indicates that the student understands herbal preparations? a. "Herbal preparations are regulated by the Food and Drug Administration (FDA); therefore I need to tell patients that they are completely safe." b. "They are natural products and therefore are safe as long as you use them for the conditions that are indicated." c. "These preparations are covered by insurance, including Medicare, Medicaid, and private payers." d. "We need to treat herbal preparations as though they are "drugs" because many have active ingredients that can interact with other medications and change physiological responses."

Answer: d. Herbal therapies are derived from plant materials and often contain the same active components as medications. Yet they are viewed as dietary supplements and are not regulated by the FDA. You should always explicitly ask patients whether they are taking supplements or other herbal remedies or vitamins when you ask them about the medications that are currently being used during a health history. Many patients do not tell you about these products voluntarily because they do not view them as medications, they fear that conventional providers will not approve of these substances and they want to continue taking them, or they do not think that you are interested in a substance that was not prescribed.

14. Meditation may compound the effects of which of these medications? a. Prednisone and antibiotics b. Insulin and vitamins c. Cough syrups and aspirin d. Antihypertensive and thyroid-regulating medications

Answer: d. Mind-body techniques, including meditation, create physiological responses in the cardiovascular and respiratory systems. These responses may include decreased blood pressure, reduced heart rate, and slowed respirations. They decrease the need for antihypertensive and other cardiac regulators and thyroidregulating medications.

7. a nurse is assessing a client as part of an admission history. the client reports drinking an herbal tea every afternoon at work to relieve stress. the nurse should suspect the tea includes which of the following ingredients? a. Chamomile b. Ginseng c. Ginger d. Echinacea

a. CORRECT: the nurse should suspect the tea might contain chamomile, which produces a calming effect, or valerian, which reduces anxiety. the nurse should attempt to gain further information to confirm the ingredients of any herbal or natural products the client may use. B. INCORRECT the nurse should expect a client to use ginseng tea to improve physical endurance. C. INCORRECT the nurse should expect a client to use ginger tea to prevent or relieve nausea. d. INCORRECT the nurse should expect a client to use echinacea tea to boost the immune system