Medical Surgical Nursing Questions with Answers Guaranteed Pass, Exams of Nursing

Download Medical Surgical Nursing Questions with Answers Guaranteed Pass and more Exams Nursing in PDF only on Docsity! Medical Surgical Nursing Questions with Answers Guaranteed Pass Chapter 1 SECTION 1: ASSESSING YOUR UNDERSTANDING Activity A 1. Illness 2. Client 3. Healthcare delivery system 4. Health 5. Medicaid Activity B 1. Holism 2. Healthcare team 3. Medicare 4. Diagnosis-related groups 5. Wellness Activity C 1. C 2. D 3. E 4. A 5. B Activity D 1. The major difference between illness and disease is that illness is highly individual and personal, whereas disease is something more definitive and measurable. For example, a client with arthritis presents with distinct pathologic changes associated with the disease. A person, however, may or may not be ill with arthritis. The degree of pain, suffering, and immobility varies from person to person. 2. Health maintenance refers to protecting one’s current level of health by preventing illness or deterioration, such as by complying with medication regimens, being screened for diseases such as breast cancer or colon cancer, or practicing safe sex. Health promotion refers to engaging in strategies to enhance health such as eating a diet high in grains and complex carbohydrates, exercising regularly, balancing work with leisure activities, and practicing stress-reduction techniques. 3. Medicare covers individuals who are 65 years or older, permanently disabled workers of any age with specific disabilities, and persons with end-stage renal disease. 4. The team includes physicians, nurses, psychologists, pharmacists, dietitians, social workers, respiratory and physical therapists, occupational therapists, nursing assistants, technicians, Activity G 1. Demand for evidence that hospitals and practitioners provide high-quality, cost-effective care comes from insurers, regulatory bodies such as The Joint Commission, and consumers. One example of standardized indicators are the quality indicators (QIs) provided by the Agency for Healthcare Research and Quality (AHRQ). These QIs can be used to measure healthcare quality at the federal, state, and local levels. The Joint Commission has also established National Patient Safety Goals (NPSGs), which are updated annually. Multidisciplinary teams use clinical pathways or care mapping for specific diagnoses or procedures, which standardize important aspects of care. Many other methods exist for determining quality of care. Patient satisfaction surveys, quality-of-life questionnaires, functional assessment tools, number of hospital admissions per year for clients with chronic illnesses, and morbidity (complications) and mortality (deaths) rates are a few important measures assessed when examining quality. 2. Managed care involves insurers who carefully plan and closely supervise the distribution of healthcare services. The goals of managed care include the following: (i) Use healthcare resources efficiently. (ii) Deliver high-quality care at a reasonable cost. (iii) Measure, monitor, and manage fiscal and client outcomes. (iv) Prevent illness through screening and health promotion activities. (v) Provide client education to decrease the risk of the disease. (vi) Case-manage clients with chronic illnesses to minimize number of hospitalizations. 3. In an attempt to reduce redundancy of healthcare services and increase economic leverage, hospitals and other healthcare facilities are forming networks known as integrated delivery systems. Fully integrated healthcare delivery systems provide the following: (i) Wellness programs (ii) Preventive care (iii) Ambulatory care (iv) Outpatient diagnostic and laboratory services (v) Emergency care (vi) General and tertiary hospital services (vii) Rehabilitation (viii) Long-term care (ix) Assisted living facilities (x) Psychiatric care (xi) Home healthcare services (xii) Hospice care (xii) Outpatient pharmacies 4. Illness prevention involves identifying risk factors such as a family history of hypertension or diabetes and reducing the effects of risk factors on one’s health. Early detection uses screening diagnostic tests and procedures to identify a disease process earlier, so that treatment may be initiated earlier and be more effective. Examples include mammography and colonoscopy. Activity H What do you think? <This activity solicits individual responses from the students.> Activity I 1. A sign is the objective manifestation of a disease—something that can be seen, heard, measured, or felt. A symptom is a subjective manifestation of a disease or illness—the experience the client describes. One sign the nurse observed was that the client was overweight at 196 lb. The client’s laboratory test results were also signs that indicated measured characteristics of her blood. Another sign was the client’s previous experience with gestational diabetes. The symptoms the client was experiencing were fatigue, frequent thirst, frequent urination, and increased appetite. 2. See Figure 1-1 in Chapter 1 of the text for an example of the health-illness continuum. The client is determined to stay active and healthy to reduce the possibility of future complications. She is practicing health maintenance while focusing on illness prevention. The client perceives herself in the normal to good health range on the continuum. 3. The nurse practitioner took time to address the physical problems the client was experiencing while trying to put her at ease by answering her questions, encouraging her, and planning a course of action with the client’s input and understanding. The nurse also made arrangements for follow-up care and arranged for services through the network for diabetes education classes and equipment. Holism means viewing a person’s health as a balance of body, mind, and spirit and considering a client’s psychological, sociocultural, developmental, and spiritual needs. The nurse did so in this example by providing information, encouragement, of screening diagnostic tests and procedures to identify a disease process earlier, so that treatment may be initiated earlier and be more effective. Examples include mammography and colonoscopy (Chitty & Black, 2011). 4. *Answer: 1 Rationale: The nurse should recommend Medicare only for the 75-year-old client with high blood pressure. This is because Medicare is for older Americans; it does not cover long-term care and limits coverage for health promotion and illness prevention. It only covers individuals who are 65 years of age or older, permanently disabled workers of any age and their dependents, and individuals with end-stage renal disease. Urinary tract infection, signs of hepatic disease, asthma, and breathlessness are not covered in this plan. 5. *Answer: 2 Rationale: Secondary care refers to referrals to facilities for additional testing such as cardiac catheterization, consultation, and diagnosis, making Option 2 the correct answer. Primary care includes the contact by a client with a healthcare provider such as a family practitioner, internist, or nurse practitioner in order to meet a healthcare need; therefore, Option 3 is not the correct answer. Option 1 is incorrect because tertiary care is provided in hospitals where specialists and complex technology are used to care for the client. Hospice care relates to comfort and supportive care that is received when a client has 6 months left to live, making Option 4 an incorrect answer. 6. *Answer: 3 Rationale: The prospective payment system provides payment for a hospitalization at the same rate regardless of the cost of the hospital surgery and how long the client stays. For diagnosis- related group (DRG) 209, which is Total Joint Replacement, all of the above surgeries that these clients had are reimbursed at the same rate. Therefore, Option 3 is the correct answer. Option 1 is incorrect, because a managed care organization is an insurer that carefully plans and closely supervises the distribution of healthcare services that are usually preventive in nature. Option 2 is incorrect because a preferred provider organization (PPO) operates on the principle that competition can control costs. PPOs create a community network of providers who are willing to discount their fees for service in exchange for a steady supply of referred customers. If the consumer goes outside the network, they pay a higher cost of the bill. Health maintenance organizations (HMOs) are group insurance plans in which participants pay a preset, fixed fee in exchange for healthcare services. The fee is based on the number of participants and expected services in the plan and is also referred to as capitation, which refers to the actual head or person count. 7. *Answer: 4 Rationale: Demand for evidence that hospitals and practitioners provide high-quality, cost- effective care comes from insurers, regulatory bodies such as The Joint Commission, and consumers. To meet this demand, hospitals form performance improvement committees also known as quality improvement or outcomes management committees. These committees use standardized indicators to measure healthcare quality. Therefore, Option 4 is the correct answer. Option 1 is incorrect because identifying clients of interest to the hospital does not necessitate how the “interest” impacts quality. The answer is too vague. Option 2 is incorrect because surveys are not the only way to identify quality measures and are not always standardized. Option 3 is incorrect because risk management’s goal is to reduce liability to the hospital and not ensure quality. 8. *Answer: 3 Rationale: Clinical pathways are care maps that standardize important aspects of care such as diagnostic workups, nursing care, education, physical therapy, and discharge planning across the estimated length of stay and are used by multidisciplinary teams. Variances from the pathway can be used to identify trends that are beneficial or detrimental to a client’s care, and changes can be made as necessary. Options 1, 2, and 4 are not care maps that are used in a client’s care. 9. *Answer: 2 Rationale: The U.S. Department of Health and Human Services (2005) has identified national health goals that provide an overall action plan to improve the health and quality of life for people living in the United States. The Healthy People 2020 goals include increasing the quality and years of healthy life and eliminating health disparities. The Centers for Disease Control and the U.S. Surgeon General do not have this responsibility. The Institute of Healthcare 8. D 9. F 10. J 11. B Activity D 1. These facilities are not regulated as long-term care facilities are, and there is some concern that the quality of care is not at an appropriate level. The Joint Commission is developing a voluntary accreditation process for assisted living facilities to ensure consistency and quality of care. In many instances, this type of living arrangement is very expensive. Clients must provide a large, up-front investment and then pay a high monthly fee. Some facilities may not provide services such as housekeeping, laundry, transportation, and meals. 2. Clients can maximize their independence in this setting because it maintains their privacy and dignity. Clients can maintain a lifestyle more similar to living in their own home. They are also able to make their own decisions about future care needs. 3. Boarding homes are usually small homes with individual rooms. Some residents share rooms. Clients pay for room and board and minimal nursing services. There is usually a common dining area for meals. Residents in boarding homes may relinquish independence and privacy. Boarding homes provide a stable environment for those who cannot live independently. Assisted living facilities provide care for those who require assistance with up to three ADLs. Residents maximize their independence and maintain privacy. In many cases, the cost is very expensive. Residents can often maintain a lifestyle similar to that which they previously enjoyed. SECTION 2: APPLYING YOUR KNOWLEDGE Activity E 1. In functional nursing, a task-oriented method, distinct duties are assigned to specific personnel. For example, one nurse records the vital signs, someone else makes the beds, a third nurse changes dressings, and so on. The tasks are divided, and the client sees several people during the shift. Although efficient, functional nursing fragments care and is confusing for the client. 2. Team nursing emerged in the 1950s, partially in response to the fragmented care of functional nursing and to accommodate staff with varying levels of education and skill. 3. This approach is expensive because it relies entirely on the RNs. Primary nursing is used effectively in the home care setting. An advantage of this model is that the client has a caregiver who sees to all of his or her needs and who provides holistic and comprehensive care. 4. ICFs do not receive reimbursement from Medicare because they are not considered medical facilities. Activity F 1. The licensed practical or vocational nurse (LPN/LVN) provides care to clients under the direction of an RN or the physician in a structured healthcare setting. LPN/LVNs care for clients with well-defined, common problems that often require a high level of technical competency and expertise. They frequently work in settings in which RN supervision is available but must be sought after the LPN/LVN determines the need to do so. 2. Nursing care was historically provided on a case method basis. One nurse provided all the services that a particular client required. Although the nurse could accompany the client to the hospital, the nurse provided care in the home and performed many household duties as well. As times changed and care became more complex, these methods turned out to be impractical, and different models for the hospital-based delivery of nursing care evolved. A modern version of the case method is private duty nursing. 3. In team nursing, teams are made up of an RN team leader, other RNs, LPN/LVNs, and nursing assistants who provide care to a group of clients. The RN team leader directs the care provided by the RNs, LPN/LVNs, and aides and works with them in various capacities. The team conference allows for discussion and care planning, which is a unique feature of team nursing. 4. Hospice allows terminally ill clients to live as fully as possible while pain, discomfort, and other symptoms are controlled. Hospice staff members are specially trained to help families with the grief process. 2. *Answer: 4 Rationale: The licensed practical or vocational nurse (LPN/LVN) provides care to clients under the direction of a registered nurse (RN) or physician in a structured healthcare setting. LPN/LVNs care for clients with well-defined, common problems that often require a high level of technical competency and expertise. They frequently work in settings in which RN supervision is available but must be sought after the LPN/LVN determines the need to do so. Therefore, Option 4 is the correct answer. The LPN would not ask a family member nor would the LPN call the director of the center. Although another LPN may be helpful in providing assistance, the RN is the supervisor of the LPN/LVN. 3. *Answer: 3 Rationale: Subacute care refers to care that is more intense than traditional long-term care but less intense than acute inpatient care (Chitty and Black, 2011). The treatment plan requires frequent assessments and periodic review of clients’ progress, which makes Option 3 correct. A client whose condition changes rapidly and who requires highly skilled care would be given acute care. Generally, clients are in these facilities for a brief period, up to 30 days but may stay as long as 90 days. RNs coordinate clients’ care, and LP/LVNs provide and oversee care provided by unlicensed assistive personnel (UAPs). 4. *Answer: 3 Rationale: Hospices provide care for clients diagnosed with terminal illness whose life expectancy is less than 6 months. Intermediate care facilities (ICFs) are nursing homes that provide custodial care for people who cannot care for themselves because of mental or physical disabilities. Rehabilitation centers provide physical and occupational therapy to the clients. Skilled nursing facilities provide skilled nursing and rehabilitative care to people who have the potential to regain function but need skilled observation and nursing care during an acute illness. 5. *Answer: 1 Rationale: Every client is not aggressively case managed. Those who are very ill, experience complications, or have chronic illnesses require more intensive case management. Case managers plan and coordinate the client’s progress to avoid unnecessary diagnostic testing and overuse of expensive resources. 6. *Answer: 4 Rationale: Many employers, particularly insurance companies, measure the cost of services provided to the case manager’s clients as a means of assessing his or her effectiveness. One of the complaints about case management is that the “bottom line” will become more important than quality. Case managers are in the best position to collect outcome data, and for this reason, case managers are often the integral members of hospital-based and insurance-based quality improvement programs. Case managers often use tools such as clinical pathways to help them plan and coordinate care. 7. *Answer: 4 Rationale: Home healthcare can cover both long-term and short-term health needs and can provide comprehensive services. In primary nursing, an RN assumes 24-hour accountability for the client’s care and secondary nurses carry out the plan of care in the primary nurse’s absence. Total care refers to assignments in which a nurse assumes all the care for a small group of clients. 8. *Answer: 2 Rationale: Total care refers to assignments in which a nurse assumes all the care for a small group of clients. This method focuses more on the client as a whole rather than the collection of nursing tasks that need to be accomplished. Total care often is practiced in intensive care units where nurses are assigned one or two clients. In case method nursing care, one nurse provides all the services that a particular client requires. In functional nursing, distinct duties are assigned to specific personnel. Patient-focused care uses an RN partnered with one or more assistive personnel to care for a group of clients. Activity D Activity E 1. A collaborative problem denotes complications with a physiologic origin; nursing diagnoses address client responses and are managed by nursing interventions. The goal of a collaborative problem is to minimize complications by detecting physiologic changes or the onset of a physiologic problem. 2. A diagnostic statement includes the following parts: (i) The name, or label, of the problem (ii) The cause of the problem (iii) The signs and symptoms, or data, that indicate the problem 3. A client’s lack of progress may result from unrealistic expectations, incorrect diagnosis of the original problem, development of additional problems, ineffective nursing measures, or a premature target date. 4. The nursing process is a dynamic, continuous process that assists nurses to acquire critical thinking and problem-solving skills because it entails scientific problem solving in a systematic, client-centered, and outcome-based way. 3 2 5 1 4 SECTION 2: APPLYING YOUR KNOWLEDGE Activity F 1. The nurse ensures that the client and family actively participate in care planning because an actively involved client is more committed to carrying out the plan and achieving the outcomes. 2. Outcomes are specific and realistic so the client can attain them and does not become frustrated. Outcomes must be measurable so the nurse can reliably determine to what extent the client is meeting the goals. The nurse determines client-centered outcomes from the nursing diagnoses so that the focus is on the client and results as opposed to what the nurse hopes to achieve. Activity G 1. The responsibilities of a nurse during the assessment of a client are the following: (i) Collects information to determine abnormal function and risk factors that contribute to health problems as well as the client strengths (ii) Methodically obtains data about the client’s health and illness (iii) Documents data in the medical record, which contributes to the client database. 2. An important element of implementation is documentation. Accurate and thorough documentation in the medical record serves five functions: (i) Communicates care (ii) Shows trends and patterns in client status (iii) Creates a legal document (iv) Supplies validation for reimbursement (v) Provides a foundation for evaluation, research, and quality improvement By law, nurses must document all nursing actions, observations, and client responses in a permanent record. This record of nursing actions must be a mirror image of the written plan. Appropriate documentation helps in communication among members of the healthcare team and ensures that nurses monitor the client’s progress. Activity H What do you think? <This section solicits individual responses from the students.> Activity I 1. Maslow’s hierarchy of needs is a great tool for nurses to use when prioritizing care. According to Maslow’s hierarchy of needs, humans cannot fulfill higher level needs until their baseline physiologic needs are met. The client’s respiratory needs are baseline survival needs. Until the nurse meets the client’s respiratory needs, he will not be able to focus on anything else. 2. Outcomes need to be derived from the nursing diagnosis, be measurable, and specific in nature. It is also necessary to collaborate with the client and family when developing a goal or outcome to make sure it is realistic and achievable by the client (Alfaro-LeFevre, 2006). An appropriate outcome for the nursing diagnosis of excess fluid volume would be the following: 3. Love and belonging needs (third level) next priority 4. Esteem and self-esteem needs (fourth level) next priority 5. Self-actualization needs (fifth level) next priority 5. *Answer: 2 Rationale: Critical thinking is intentional, contemplative, and outcome-directed thinking. In nursing, critical thinking  Is guided by standards, policies and procedures, ethics codes, and laws  Is based on principles of nursing process, problem solving, and the scientific method  Carefully identifies the key problems, issues, and risks involved  Applies logic, intuition, and creativity  Calls for strategies that make the most of human potential  Is constantly re-evaluating, self-correcting, and striving to improve (Alfaro- LeFevre, 2010, p. 32). 6. *Answer: 3 Rationale: Assessment is the careful observation and evaluation of a client’s health status. During assessment, the nurse collects information to determine abnormal function and risk factors that contribute to health problems as well as client strengths (Alfaro-LeFevre, 2006). Not only is assessment the first step in the nursing process but it is also an important, recurring nursing activity that continues as long as a need for healthcare exists. During assessment, the nurse methodically obtains data about the client’s health and illness. 7. *Answer: 3 Rationale: Concept care mapping follows the nursing process. The first step is to identify the primary reasons for a client’s admission to a health care facility. The second step is to identify the nursing diagnoses or client care problems and related data. The third step involves demonstrating how nursing diagnoses or problems are interrelated. The fourth step involves planning as the nurse writes the nursing diagnoses, expected outcomes, and nursing interventions in the numbered order indicated on the concept care map for each nursing diagnosis. The last step is to evaluate the client’s responses, which provides a foundation for documentation in the client record. 8. *Answer: 1, 2, 3 Rationale: An important element of implementation is documentation. Accurate and thorough documentation in the medical record serves five functions (Alfaro-LeFevre, 2006) including the following: 1. Communicates care 2. Shows trends and patterns in client status 3. Creates a legal document 4. Supplies validation for reimbursement 5. Provides a foundation for evaluation, research, and quality improvement 9. *Answer: 2 Rationale: Evaluation, the fifth step of the nursing process, is assessment and review of the quality and suitability of care given and the client’s responses to that care. During evaluation, nurses compare the actual outcomes to the expected outcomes. This process enables the nurse to revise the expected outcomes or select alternative plans of action when expected outcomes are not met. 10. *Answer: 3 Rationale: A diagnostic statement includes one to three parts: (1) the name, or label, of the problem; (2) the cause or etiology of the problem; and (3) the signs and symptoms, or data, that indicate the problem. The name or label portion of the statement is linked to the cause with the phrase related to, and the data are linked to the name/label and cause by the phrase as manifested by or as evidenced by. The following is an example of a nursing diagnostic statement: Acute Pain (name of the problem) related to tissue trauma secondary to total knee replacement (etiology) as evidenced by verbalization of pain of 8 on scale of 1 to 10, restlessness, and inability to concentrate (signs and symptoms). Activity E 1. The nurse first assesses the client when he or she is admitted to the healthcare system. Findings from this comprehensive initial assessment establish a database that gives all team members relevant client information and becomes a yardstick for measuring effectiveness of care. 2. During an interview with a client, the nurse should obtain the client’s age, occupation, religious affiliation, cultural background and health beliefs, marital status, and home and working environments. 3. During the physical assessment, the nurse examines body structures and observes the client’s physical appearance, mood, mental status, behaviors, and ability to interact. 4. The technique of inspection should include the following measures: (i) Expose the area being inspected while draping the rest of the client. (ii) Look before touching. (iii) Use adequate lighting. (iv) Provide a warm room for examination. SECTION 2: APPLYING YOUR KNOWLEDGE Activity F 1. Putting the client physically and emotionally at ease facilitates the exchange of information and helps establish a bond between the client and the nurse. 2. The nurse asks about the client’s use of alcohol and tobacco because these drugs/chemicals may create or contribute to various other health problems. 3. The family history is important because many disorders are hereditary. 4. The nurse should ask general questions about each body system to trigger the client’s memory of inadvertently overlooked health problems. Activity G 1. Through systematic assessment, the nurse identifies the client’s (i) Current and past health status (ii) Current and past functional status (iii) Coping patterns (iv) Health beliefs (v) Lifestyle and health practices (vi) Relevant cultural practices (vii) Risks for potential health problems (viii) Response to care (ix) Nursing care needs (x) Referral needs 2. Practices the nurse should follow during the preinterview period are the following: (i) Establish a rapport with the client and family members and ensure that the client is comfortable. (ii) During introduction, always address the client by his or her surname. (iii) Ensure a private setting for the interview to eliminate interruptions and maintain the client’s confidentiality. (iv) Explain that the information obtained during the interview helps with planning care. (v) Inform the client that all information is kept confidential, although all members of the healthcare team share the data. 3. The information the nurse should obtain when discussing the client’s past medical problems include the following: (i) The age at which the problem was diagnosed, the treatments prescribed, and whether the problem still exists (ii) Information about past surgeries includes types, when each was done, and whether recoveries were uneventful or accompanied by any kind of complications (iii) Any current and past use of prescription and nonprescription drugs including herbal products (iv) Use of alcohol and tobacco (v) Client’s allergies, including sensitivities to drugs, food, and environmental substances. If the client has a drug allergy, the drug and client’s reaction are described. 2. *Answer: 1 Rationale: The nurse compiles a list of the client’s allergies, including sensitivities to drugs, foods, and environmental substances. If the client has a drug allergy, the drug and the client’s reaction are described; some clients confuse a drug’s side effects with an allergic response. If the client or family cannot remember the name of the drug, the nurse should try to identify it from another source, such as the prescribing physician or past medical records. Determining the purpose of the drug or the family’s history of drug allergies is not sufficient or specific to protect the client’s safety in relation to medication administration. 3. *Answer: 2, 3 Rationale: Avoid tiring the client—allow rest periods if needed; keep the older client warm and away from drafts; be aware of privacy issues if the older client’s hearing impairments require louder interactions; allow ample time for the client to respond to directions and change positions when necessary; and, if possible, observe the client performing ADLs. A family member may be present if the client wishes; otherwise the client’s confidentiality and privacy should be respected. 4. *Answer: 4 Rationale: Inspection is the systematic and thorough observation of the client and specific areas of the body. The nurse (including the LPN/LVN who learns and practices inspection techniques) uses the senses of vision, smell, and hearing to inspect a client. Inspection includes examining the client for changes in skin color, temperature, or both; observing a wound for signs of healing or infection; or generally noting color, size, location, texture, symmetry, odors, and sounds. 5. *Answer: 2 Rationale: Subjective data are statements the client makes about what he or she feels. When the client tells the nurse about nausea, pain, fear, bloating, or other feelings of discomfort, he or she is providing subjective data. Objective data are facts obtained through observation, physical examination, and diagnostic testing. When the nurse assesses blood pressure or heart rate or examines results from urinalysis, he or she obtains objective data. 6. *Answer: 1 Rationale: Objective data are facts obtained through observation, physical examination, and diagnostic testing. When the nurse assesses blood pressure or heart rate or examines results from urinalysis, he or she obtains objective data. Subjective data are statements the client makes about what he or she feels. When the client tells the nurse about nausea, pain, fear, bloating, or other feelings of discomfort, he or she is providing subjective data. Feelings of discomfort are called symptoms. 7. *Answer: 1, 4 Rationale: Questions in the interview are best phrased as open-ended questions that require discussion rather than closed questions that require only “yes” or “no” answers. Both Options 1 and 4 are open-ended questions, and Options 2, 3, and 5 are close-ended questions. 8. *Answer: 1 Rationale: Palpation detects abnormal conditions, such as enlarged organs, tumors, or fluid in a cavity. When palpating, the nurse uses the fingertips to detect pulsations or to differentiate surfaces, the surface of the palm to sense vibrations, and the back of the hand to determine temperature. Techniques for palpation include using first light then deep palpation and palpating tender areas last. 9. *Answer: 3 Rationale: Auscultation means listening with a stethoscope for normal and abnormal sounds generated by organs and structures such as the heart, lungs, intestines, and major arteries. When performing auscultation, nurses describe normal and abnormal sounds using descriptive terms such as high-pitched, low-pitched, harsh, blowing, crackling, loud, distant, and soft. They auscultate the lungs, heart, and abdomen. 8. Common law (also known as judicial law) Activity C 1. D 2. C 3. A 4. B Activity D 1. Tort law is the body of law that governs breaches of duty owed by one person to another. 2. An intentional tort is a deliberate and willful act that infringes on another person’s rights or property. Examples include assault, battery, false imprisonment, invasion of privacy, and defamation. 3. An unintentional tort involves situations that results in injuries, although the person responsible did not mean to cause harm. Types of unintentional torts involve negligence and malpractice. 4. Risk management, which is a concept developed by insurance companies, refers to the process of identifying and then reducing the costs of anticipated losses. 5. The deontologic approach considers the rights of each person, which is a distinct advantage. The second advantage is that the obligation to duty and moral thinking is foremost, and, therefore, the decisions for similar situations are the same. 6. Assault is an act that involves a threat or attempt to do a bodily harm. Types of assault include physical intimidation, verbal remarks, or gestures that lead the client to believe that force or injury may be forthcoming. SECTION 2: APPLYING YOUR KNOWLEDGE Activity E 1. If a client is forewarned of a potential hazard to his or her safety and chooses to ignore the warning, the court may hold the client responsible. For example, if the client objects to having the side rails up or lowers the rails independently, the nurse or healthcare facility may not be held fully accountable if an injury occurs. It is essential that the nurse document that he or she warned the client and that the client ignored the warning. The same recommendation applies when the nurses caution the clients about ambulating only with assistance. 2. Sometimes, it is difficult to reconcile nonmaleficence with medical care because the choice of treatment may initially cause harm, even though the outcome is potentially good. For example, a client with colon cancer has a resection with a colostomy and endures the pain of surgery. In addition, the client undergoes unpleasant chemotherapy and radiation treatments. Although the client is harmed in many ways, the ultimate goal is for the client to be free of cancer. In these cases, the treatment is still ethically right because the intended effect is good and outweighs the bad effect. If the outcome is likely to be poor despite the treatment, what is ethically right may be difficult to determine. 3. The Nurse Practice Act is a statutory law that defines nursing practice and sets standards in each state. These legal statutes regulate the practice of nursing. The authority to regulate the act is given to the administrative agency, which practices administrative law. This administrative agency, usually called the state board of nursing, has the authority to enforce the rules and regulations of the act. 4. Developments in science and technology produce ethical issues that were unheard of even 10 years ago. Some examples include the following: (i) Successful impregnation of a woman past menopause—some governments are considering age limitations for such procedures. (ii) Genetic engineering—such procedures may potentially harm humans, create a “perfect” being, or lead to discrimination. (iii) Cloning animals, humans, or both—this raises difficult questions about the creation of life and individuality. Activity F 1. Examples of felonies involving healthcare workers include falsification of medical records, insurance fraud, and theft of narcotics. If an individual misrepresents himself or herself as a licensed nurse, this person commits the crime of practicing without a license. Activity I 1. Assault is an act that involves a threat or attempt to do bodily harm. Types of assault include physical intimidation, verbal remarks, or gestures that lead the client to believe that force or injury may be forthcoming. This particular statement by the nurse is intended to be informative. The nurse is trying to protect the client by letting him know protocol for situations of this nature. The client is intoxicated and being held by the police. He has been brought in to receive treatment for his wounds. The wounds need to be treated for his safety and the safety of others. 2. Battery is actual physical contact with another person without that person’s consent. Nonconsensual physical contact sometimes is justified. When ill or intoxicated, clients are endangering their own safety and/or the safety of others, health professionals may use physical force to subdue them. Because the client is intoxicated, this nonconsensual physical contact is not battery. The client is placing himself at danger and threatening staff, other clients, and visitors. 3. False imprisonment occurs when healthcare workers physically or chemically restrain an individual from leaving a healthcare institution. Mentally impaired, confused, or disoriented clients may be restrained if their safety or the safety of others is at risk. This confinement requires restraining orders, court-ordered commitments, or medical orders. This client is intoxicated, temporarily mentally impaired and confused, and is placing his safety and others at risk. Therefore, this does not meet the criteria for false imprisonment. 4. A major component in limiting liability is accurate, thorough documentation, required by each healthcare setting. The medical record is a legal document that can be used as evidence in court. The best legal defense is to show just cause through accurate documentation. When recording this situation, the nurse must document the behavior of the client that resulted in the use of force and the client’s response when the nurse tried lesser forms of restraint first. Healthcare facilities have policies related to the use of restraints. Nurses need to follow the agency policies. Documentation must also be timely, objective, accurate, complete, and legible. SECTION 3: GETTING READY FOR NCLEX Activity J 1. *Answer: 3 Rationale: Medical examples of invasion of privacy include photographing an individual without consent, revealing a client’s name in a public report or research paper, and allowing unauthorized persons to observe a client during treatment or care. Defamation is an act that harms a person’s reputation and good name. If a person orally utters a character attack in the presence of others, the action is called slander. If the damaging statement is written and read by others, it is called libel. A nurse should avoid offering unfounded or exaggerated negative opinions about clients, the expertise of physicians, or other colleagues. Injury occurs because the derogatory remarks may blemish a person’s public image or keep potential clients from seeking the services of the defamed person. 2. *Answer: 3 Rationale: A primary role of licensed nurses is to assess changes in clients’ conditions. UAPs are not licensed or educated to make assessments. A nurse must assess a client before reporting a change in condition to a physician or documenting a change. Monitoring a client’s status is the role of the nurse. Although respect for the client is important, it is not relevant to the potential change in the client’s condition. 3. *Answers: 1, 2, 4 Rationale: Primary care providers (PCPs) discuss consent for invasive procedures with their clients. If a nurse is a witness to clients’ signatures on a consent form, it is to verify that the clients were not forced to sign the form; that they are competent to sign; and the clients actually signed the form. Nurses should check with clients to see if they have any questions re: the procedure, and should notify the PCP if clients are misinformed or have doubts about what they are signing. However, the nurse’s signature on a consent form does not verify if clients have more questions or if they actually understand what they are signing. 4. *Answer: 4 Rationale: The principle of veracity is the obligation to be truthful. In Option 4 the nurse is being truthful when answering the client’s question. Option 1 is avoidance of the question. Option 2 10. *Answer: 1 Rationale: Autonomy is the client’s right to self-determination and the freedom to make decisions. Even though the nurse may disagree with a client’s choice, the client has this right. It is essential that nurses respect and protect this right. Beneficence is the duty to do good for the clients assigned to the nurse’s care. Justice is the duty to be fair to all people regardless of age, sex, race, sexual orientation, or other factors. Nonmaleficence is the duty to do no harm to the client. Answer Key for Workbook for Introductory Medical-Surgical Nursing, 11e Chapter 6 SECTION 1: ASSESSING YOUR UNDERSTANDING Activity A 1. Leadership 2. Advocacy 3. Collaboration Activity B 1. Power 2. Time wasters 3. Delegation 4. Acuity Activity C 1. B 2. D 3. E 4. C 5. F 6. A Activity D 1. Effective leaders and managers must possess the following qualities: (i) An ability to gain respect from others through competence and shared goals (ii) Expertise in oral and written communication skills (iii) A capacity to motivate others to achieve a particular purpose or accomplish goals 2. The manager’s overall goal is to coordinate and direct resources, which include workspace, supplies, equipment, budgetary concerns, and services. In addition, managers direct and coordinate the work of assigned employees. 3. The five rights of delegation are as follows: (i) Right task (ii) Right circumstances (iii) Right person (iv) Right direction/communication (v) Right supervision/evaluation 4. The three basic steps for time management are as follows: (i) Plan and establish priorities. (ii) Complete the highest priority task and move to the next task. (iii) Reassess and reprioritize tasks based on any changes. Activity F What do you think? <This section solicits individual responses from the students.> Activity G 1. Time management involves organizing time as well as delegating tasks to other personnel and optimizing available time. Making the most of one’s time is an important skill that takes effort to achieve. Managing time effectively leads to the most success in accomplishing the work that needs to be done. Those with poor time management skills fail to use their time effectively and efficiently. The nurse in the case study becomes entrapped in “time wasters” (see Box 6-4 in the textbook). The nurse uses her time inefficiently by socializing too much and being unwilling to say “no” when she is behind in her own tasks. She also fails to write things down when communicating with the UAP about client care. Because of poor planning and inefficient use of time, the nurse is not only late in completing her assessment and medication tasks but also does not finish her documentation until 30 minutes after her shift has ended. 2. Delegation is a means of accomplishing work through others. Supervision is the process of guiding, directing, evaluating, and following up on tasks delegated to others (NCSBN, 1997). These two functions are closely connected; once a task has been delegated and instructions given, the nurse is obliged to supervise the person assigned to the task. In the given case study, the nurse delegated appropriate tasks for the UAP that involved direct care activities such as vital signs and assistance with morning care. The nurse communicated specific instructions and expectations to the UAP related to the clients and their care. As to supervision, the nurse checked on the UAP throughout the shift to evaluate how the UAP was doing. Her supervision also included positive feedback. It appears the nurse provided appropriate delegation and supervision for client care. 3. Advocacy in healthcare means supporting the needs of a client or organization. Collaboration involves a team effort to achieve client care outcomes. One way that nurses advocate for their clients is by communicating with other professionals. The nurse in the case study advocated for her client’s need to change a medication by contacting another professional, her physician. The nurse called the physician and communicated the client’s need. This advocacy for the client and collaboration with the physician provided a positive outcome for the client. The nurse also worked collaboratively with the UAP to achieve safe, appropriate client care outcomes. SECTION 3: GETTING READY FOR NCLEX Activity H 1. *Answer: 3 Rationale: In democratic leadership style, subordinates contribute to decision making and policy making, and staff members may fail to acknowledge the manager’s role. In laissez-faire leadership style, staff members participate in the process of making decisions for the group and subordinates perform better because of their independence. 2. *Answer: 3 Rationale: Coercive or punishment power is the ability to threaten or punish someone who fails to meet expectations. The nurse in charge of scheduling can have this kind of power. Option 1 is expert power, which results from knowledge, expertise, or experience in a particular area. Option 2 is referent power, which is the power a person has because of his or her association with others who are powerful. Option 4 is motivational power, which refers to a leader’s ability to create enthusiasm for a collaborative project or achievement of a common goal. 3. *Answer: 3 Rationale: Assess expectations for the shift, not for 24 hours. Use a worksheet to identify specific tasks and important assessments that need to be done for that particular shift. This works very well with multiple client assignments. Develop efficiency and the ability to multitask, which means engaging in more than one task at a time, performing only one task at a time will be time consuming. For example, if a client requests pain medication and you need to assess his roommate’s vital signs, bring needed equipment as well as pain medication. Delegate appropriate tasks to appropriate personnel to assist in getting all work accomplished for the shift. 4. *Answer: 1 Rationale: LPN/LVNs must first focus on client care needs. This will help LPN/LVN ensure that the clients receive appropriate care and that tasks are carried out efficiently and in a caring 9. *Answer: 1 Rationale: Leaders often do not have delegated authority but obtain their power through other means, such as influence. Leaders have a wider variety of roles than do managers and focus on group process, information gathering, feedback, and empowering others. Managers, however, are assigned a position in an organization and have a legitimate and more formal source of power owing to the delegated authority that accompanies their position. They are expected to carry out specific functions, duties, and responsibilities while emphasizing control, decision making, decision analysis, and results. Managers manipulate resources to meet organizational goals and direct willing and unwilling subordinates. Supervisors are those that oversee care of a client or unit and are more concerned with tasks being completed for client care or for unit coordination. Delegators often outsource work in order to manage the whole load of the work effectively. 10. *Answer: 2 Rationale: Advocacy means promoting the cause of another person or organization. LPN/LVNs function as client advocates by understanding the rights of all clients; remaining informed about diagnoses, treatments, prognoses, and choices; contributing to the provision of information and education; supporting the client’s decisions; and communicating with other professionals. Collaboration involves a team effort to achieve client care outcomes. Accountability was demonstrated by the LPN/LVN being answerable for the consequences of his or her actions. Responsibility is a duty or assignment related to a specific job and just doing the job does not correlate with the accountability that the LPN took in this situation. Answer Key for Workbook for Introductory Medical-Surgical Nursing, 11e Chapter 7 SECTION 1: ASSESSING YOUR UNDERSTANDING Activity A 1. Caregiver 2. Communication 3. Cognitive learner 4. A teaching plan 5. Therapeutic communication 6. Learning capacity Activity B 1. Collaborator 2. Learning style 3. Empathy 4. Learning needs 5. Nurse–client relationship Activity C 1. E 2. C 3. A 4. B 5. D Activity D 1. To meet client needs, nurses perform four basic roles: caregiver, educator, collaborator, and delegator. 2. Task-oriented touch involves the personal contact that is required when performing nursing procedures. Affective touch is used to demonstrate concern or affection. Its intention is to communicate caring and support. 3. A client who is in pain, uncomfortably warm or cold, anxious, or depressed is not in the best condition for learning. Learning readiness pertains to the optimal time for learning. Ideally, it occurs when a client is in a state of physical and psychological well-being. It is best to restore comfort first and then attend to teaching. 4. An educator is one who provides information. A nurse offers health teaching that is pertinent to each client’s needs and knowledge base. Some examples include explanations about diagnostic test procedures, self-administration of medications, techniques for managing wound care, and restorative exercises like those performed after a mastectomy. 4. Medications that dull mental ability, hunger, thirst, nausea, distention, constipation, or diarrhea interfere with a client’s attention and readiness to learn. Restoring physical comfort increases a client’s receptiveness for learning. Activity G What do you think? <This activity solicits individual responses from the students.> Activity H 1. The working phase involves both the client and nurse planning a course of action and initiating it. During the working phase, the nurse–client relationship is enhanced by attending to the client’s individual needs and allowing the client to work at his or her own pace. Allowing independence in self-care and decision making promotes self-esteem and dignity. In the case study, the nurse is winding down the working phase of the nurse–client relationship. The nurse allows the client to do for herself what she can and only assists when necessary. The termination phase occurs when nurse and client agree that the client has progressed to the point where the nurse’s services are no longer needed. The client may express underlying fears about assuming independence, as demonstrated in the case study. Therefore, a compassionate and caring attitude is needed to help with the transition home. In the case study, the nurse discusses the client’s current capabilities and explains the transitional home evaluation and home healthcare follow-up. This relieves the concerns of the client. 2. In verbal communication, listening is as important during communication as talking. Listening is an activity that includes attending to and becoming fully involved in what the client is saying. The nurse in the case study demonstrates active listening by pulling up a chair and taking a position at the same level as the client. Nonverbal communication is achieved through techniques such as facial expressions, postures, gestures, and body movements. The nurse in the case study demonstrates nonverbal communication by leaning forward while listening to the client. The nurse also demonstrates the therapeutic use of silence by remaining silent while the client verbalizes her concerns. 3. In order to meet the client’s needs, the nurse performs four basic roles: caregiver, educator, collaborator, and delegator.  A caregiver performs health-related activities for sick individuals who cannot perform them independently. This involves not only physical care but a close emotional relationship as well. The nurse in the case study performs the caregiver role when assessing the client’s ability to complete ADL activities and when listening to the client’s concerns and helping her work through them.  An educator provides information. Nurses provide health teaching that meets the client’s needs. The nurse shares information and allows the client to choose. The nurse in the case study fulfills this role when educating the client on hip precautions, ambulation, use of the walker, and the ongoing medication regimen.  A collaborator works with others to achieve a common goal. The nurse demonstrates collaboration by sharing information with the physical therapist, occupational therapist, and home healthcare agency. They work together to meet the client’s goals and provide a successful and safe discharge home.  A delegator assigns a task to someone and knows that the task is appropriate for that particular healthcare worker. It is the delegator’s responsibility to check that the assigned task has been performed and to determine the outcome. In the case study, the nurse assigns the task of taking vital signs to the UAP. This is an appropriate task for the UAP. The nurse checks to make sure the task has been done and obtains the results. SECTION 3: GETTING READY FOR NCLEX Activity I 1. *Answers: 2, 3, 5 Rationale: Physical proximity is common during nursing care, and most Americans tolerate strangers approaching them within to an area of 2 to 3 feet—this distance is known as a person’s comfort zone. Respecting this comfort zone reduces anxiety. Explaining the procedure beforehand and ensuring that the client is well draped are also approaches that relieve a client’s anxiety. Nonverbal communication is transmitting information without words. Care must be taken to monitor nonverbal communication, such as body language, that might be misunderstood or misinterpreted by the client. Maintaining direct eye contact may make the client uncomfortable depending on cultural origin. The use of affective touch communicates caring and support; however, it may be misinterpreted and needs to be used with caution because responses among clients may vary. introductory phase is when the client and nurse meet and begin to establish rapport. The termination phase occurs when the nurse no longer needs the nurse’s services. 8. *Answer: 3 Rationale: The best form of communication with an LEP client is with a certified interpreter, a person who is certified by a professional organization through rigorous testing based on appropriate and consistent criteria. Unfortunately, individuals who meet these qualifications are few and far between. When a certified interpreter is not available in person or by webcam, in descending order of preference, the following may be used: agency employed interpreters, bilingual staff, volunteers, and least desirable, family or friends. 9. *Answer: 4 Rationale: Andragogy is the term for the principles of teaching adult learners, making Option 4 correct. Pedagogy is the science of teaching children or those with cognitive ability comparable to children. Gerogogy is the term for techniques that enhance learning among older adults. Cybertexting is a method of communicating used by Generation Xs and Generation Ys. 10. *Answer: 2, 4, 5 Rationale: Nurse educators are advised to prepare themselves to teach young adults who belong to Generation X, Generation Y, and the Net Generation as they age. Generation Y refers to young adults who graduated from college in the late 1990s; Generation X refers to those born between 1961 and 1981; and the Net Generation, sometimes referred to as “cyberkids,” were born after 1981. Technology and imposed independence as a consequence of growing up in single-parent households or homes in which both parents work are greatly affecting the learning characteristics of these groups. These individuals crave stimulation, quick responses, and expect immediate answers and feedback. They prefer visualization, simulations, and other methods of participatory learning. These individuals are technologically literate and have grown up with computers. They become bored with memorizing information and doing repetitive tasks. They also like a variety of instructional methods from which they can choose. Answer Key for Workbook for Introductory Medical-Surgical Nursing, 11e Chapter 8 SECTION 1: ASSESSING YOUR UNDERSTANDING Activity A 1. Culture 2. Cultural taboos 3. Cultural competence 4. Race Activity B 1. Stereotyping 2. Ethnocentrism 3. Cultural blindness 4. Culturally congruent care 5. Health beliefs Activity C 1. B 2. C 3. A Activity F 1. Components of the biocultural assessment include the following: (i) Physical appearance: age, sex, level of consciousness, facial features, and skin color, including evenness of tone, pigmentation, intactness, and lesions or other abnormalities (ii) Body structure: stature, nutrition, symmetry, posture, position, and overall body build or contour (iii) Mobility: gait and range of motion (iv) Behavior: facial expression, mood and affect, fluency of speech, ability to communicate, appropriateness of word choice, grooming, and attire or dress 2. When performing a cultural assessment, the nurse asks about or observes the following cultural characteristics: (i) Where was the client born? How long has the client lived in this country? (ii) What is the client’s ethnic background? Does the client identify strongly with others from the same cultural background? Does the client live in a neighborhood with others of the same ethnic or cultural background? (iii) To whom does the client turn for support? Who is the head of the family? Is he or she involved in decision making about the client? (iv) What is the client’s primary language and literacy level? (v) What is the client’s religion, and is it important in his or her daily life? Are there religious rituals related to sickness, death, or health that the client observes? (vi) Has the client sought the advice of traditional healers? (vii) What are the client’s communication styles? Does the client avoid eye contact and maintain physical distance? Is the client open and verbal about symptoms? (viii) What are the client’s food preferences or restrictions? (ix) Does the client participate in cultural activities such as dressing in traditional clothing and observing traditional holidays and festivals? 3. The following recommendations will help to develop a growing expertise in culturally sensitive nursing care: (i) Learn to speak a second language. (ii) Use techniques for facilitating interactions: sit within the client’s comfort zone and make appropriate eye contact. (iii) Become familiar with physical differences among ethnic groups. (iv) Be aware of biocultural aspects of disease (see Table 8-2). (v) Perform physical assessments using appropriate techniques that will provide accurate data. (vi) Perform cultural and health beliefs assessment and plan care accordingly. (vii) Consult the client about ways to solve health problems. (viii) Never ridicule a cultural belief or practice, verbally or nonverbally. (ix) Integrate cultural practices that are helpful or harmless into the plan of care. (x) Modify or gradually change unsafe practices. (xi) Avoid removing religious medals or clothing that hold symbolic meaning for the client; if this must be done, keep them safe and replace them as soon as possible. (xii) Provide food that is customarily eaten. (xiii) Advocate routine screening for diseases to which clients may be genetically or culturally prone. (xiv) Facilitate rituals by whomever the client identifies as a healer within his or her belief system. (xv) Apologize if cultural traditions or beliefs are violated. Activity G What do you think? <This section solicits individual responses from the students.> Activity H 1. Health practices are the actions of individuals when trying to maintain or improve health based on their health beliefs. There are three general views: a. Biomedical or scientific perspective: This view is often shared by healthcare workers and follows a cause-and-effect philosophy of human body functions. b. Naturalistic or holistic perspective: This view promotes the idea that human beings are only one part of nature and that balance or harmony is essential for good health. c. Magico-religious perspective: This view promotes the idea that supernatural forces prevail. Examples include faith healing for some Christian groups and witchcraft or voodoo in some Caribbean cultures. The client holds a mixture of beliefs. He recognizes the traditional biomedical or scientific perspective, in that he uses the healthcare system and recognizes the cause-and- effect 4. *Answer: 3 Rationale: Developing strategies to avoid cultural imposition is absolutely pivotal. The culturally competent nurse accepts each client as a unique individual. Becoming familiar with physical differences among ethnic groups, learning to speak a second language, and consulting the client about ways to solve health problems will not help the nurse provide culturally competent care to all individuals. However, these recommendations will help develop a growing expertise in culturally sensitive nursing care. 5. *Answer: 2 Rationale: The nurse should use techniques for facilitating interactions, such as sitting within the client’s comfort zone and making appropriate eye contact. Nurses should show professionalism by introducing themselves and addressing clients by their first name. The nurse should ask questions to those clients whose second language is English that can be answered by a “yes” or “no.” 6. *Answer: 4 Rationale: Assessing a client’s health beliefs and practices helps the nurse view the situation from the client’s perspective. Understanding the health problems affecting a particular cultural group, learning to accept each client as an individual, or providing culturally competent care are not goals that can be met by assessing a client’s health beliefs. 7. *Answer: 2 Rationale: Stereotyping involves the belief that all clients of a particular culture are unable to adapt to another culture and learn the language. Generalization refers to acknowledging common trends in a group while recognizing that more information is needed and then obtaining the needed information. Ethnocentrism is the belief that one’s own ethnic heritage is the “correct” one and superior to others. Cultural imposition is an inclination to impose one’s cultural beliefs, values, and patterns of behavior on those from a different culture. 8. *Answer: 2 Rationale: Option 2 is the correct answer because the nurse needs to remain nonjudgmental when caring for any client, but particularly when a client is from another culture. Cultural assessments are important for all clients. Although it is important that clients adhere to a treatment plan, understanding a client’s background and culture is important, recognizing that modifications may need to occur. Nurses need to be concerned with the total client, not just the physical assessment and objective data. 9. *Answer: 3 Rationale: Option 3 is the correct answer because biologic differences in physical features, such as skin color, bone structure, and eye shape, are considered to describe race. Culture provides a means for understanding people’s values and beliefs, including those that relate to health practices. Ethnicity is the bond or kinship that people feel with their country of birth or place of ancestral origin. Minority describes a group of people who differ from the majority in a society in terms of cultural characteristics, physical characteristics, or both. 10. *Answer: 2 Rationale: Option 2 is the correct answer because mobility refers to the gait and range of motion that a person demonstrates. Physical appearance includes age, sex, level of consciousness, facial features, and skin color, including evenness of tone, pigmentation, intactness, and lesions or other abnormalities. Behavior is described as facial expression, mood and affect, fluency of speech, ability to communicate, appropriateness of word choice, grooming, attire, or dress. Body structure includes the stature, symmetry, posture, position, overall body build, or contour of a person. 4. Structures and systems of the body that manipulative and body-based therapies focus on include the bones and joints, the soft tissues, and the circulatory and lymphatic systems. 5. The U.S. Food and Drug Administration has warned consumers to avoid purchasing Actra- Rx (Yilishen), a product promoted as a “dietary supplement” for treating erectile dysfunction and enhancing sexual performance for men, because it poses serious health risks for some users. SECTION 2: APPLYING YOUR KNOWLEDGE Activity E 1. Increased interest in and the use of complementary and alternative therapies is attributed to one or more of the following reasons: (i) Dissatisfaction with conventional medicine (ii) A desire to become more active in decision making and self-care (iii) Increasing numbers of people with chronic, incurable conditions (iv) Difficulty meeting the rising costs of healthcare (v) Growth of culturally diverse groups who do not share traditional American health beliefs and practices. 2. The client should read labels on over-the-counter medications to check for any known contraindications with herbal use or consult a pharmacist. 3. Herbal therapy is not regulated like pharmaceutical drugs are in the United States. Because herbs are classified as dietary supplements, they are not held to the same standards of unified dosages, safety, and efficacy as drugs. Manufacturers of herbal preparations cannot claim that the herbal product prevent or treat a disease because that automatically places the substance in the category of a drug. 4. Proponents believe that tai chi exercises the whole body, restores health, and prevents disease without the exertion and cardiac risks associated with other aerobic forms of physical exercise. 5. In spite of the absence of empirical evidence for the efficacy of some complementary and alternative therapies, the principle of “First, do no harm” should prevail. If the complementary or alternative therapy is not dangerous or unhealthy, it should be tolerated or even supported if it provides the client with what he or she perceives as intrinsic benefits. Activity F 1. Massage therapy involves applying pressure and movement to stretch and knead soft body tissues. Massage therapists use the warmth of their hands, elbows, and forearms and lubricating oils to stimulate circulation and relieve physical and psychological tension. The benefits of massage include relief from discomfort and improved mobility or functional use of affected body parts. 2. Herbs may have potentially lethal side effects and may also negatively interact with physician-prescribed medications. Consulting with a physician before using herbs and disclosing use of herbal supplements before any medication is prescribed is best. Use of herbs is not recommended for pregnant or lactating women, infants, and children younger than 6 years of age. 3. Apitherapy uses bee venom to treat various inflammatory conditions. Although physicians do not recommend it, experiments have demonstrated symptom relief. This technique is still under investigation. Chiropractic treatment involves spinal manipulation because misaligned vertebrae are believed to affect nerves and the functions they control. Although chiropractic treatment is also controversial, it is among the most popular forms of alternative therapeutic techniques. In terms of cost, chiropractic treatment is more attractive because many health insurance policies cover it, the federal government provides Medicare and Medicaid reimbursement for it, and the costs are an approved income tax deduction. 4. Energy medicine use techniques that claim to manipulate the electromagnetic fields in the body. (i) Reiki shares many features of what Westerners may call “therapeutic touch” and spiritual healing. The practitioner transfers the energy in the universe by laying on of hands. Healing can also occur from a distance; the practitioner moves his or her hands over an object that symbolically represents the sick person while visualizing the transmission of energy. The recipient draws in the energy, which goes where it is needed. techniques/therapies. The nurse needs to make sure, however, that the client also understands any potential risk(s) from participating in therapies that are not yet proven to be beneficial or safe. The nurse’s role is to respect and advocate for the client’s choice of treatment whether that treatment of choice is conventional or nonconventional medicine as long as there is no potential to harm the client. 4. When conventional medicine is combined with complementary or alternative therapy for which there is some indication of scientific evidence, safety, and/or effectiveness, it is referred to as integrative medicine. The nurse would document that the client’s treatment plan demonstrates an integrative medical approach. SECTION 3: GETTING READY FOR NCLEX Activity I 1. *Answer: 4 Rationale: Option 4 is the correct answer because complementary medicine involves the use of an additional treatment in conjunction with conventional medical treatment. Option 1 is incorrect because integrative medicine involves combining conventional medicine with complementary or alternative therapy. Option 2 is incorrect because alternative therapy is used instead of conventional medical treatment. Option 3 is incorrect because allopathic medicine is the same as conventional therapy. 2. *Answer: 2 Rationale: Option 2 is the correct answer because the client appears to have a chronic, incurable back condition for which conventional therapy has not worked. The remaining answers are all appropriate but do not apply to this situation. 3. *Answer: 3 Rationale: Option 3 is the correct answer because the manipulative and body-based therapies are those healing methods that focus on the structures and systems of the body, including the bones and joints, the soft tissues, and the circulatory and lymphatic systems. Option 1 is incorrect because energy medicine is the field of alternative and complementary therapy in which techniques are used that claim to manipulate electromagnetic fields in the body. Option 2 is incorrect because whole medical systems are those alternative systems of healing theory and practice that evolved from other cultures. Option 4 is incorrect because biologically based practices use natural products such as dietary supplements, aromatherapy, and animal-derived extracts such as bee venom. 4. *Answer: 1, 2, 5 Rationale: Options 1, 2, and 5 are the correct answers. It is appropriate to assess the reason the client feels the need for the practitioner and what the client hopes to achieve from it. The practice of Reiki is similar to the practice of therapeutic touch. Because this is a part of the client’s belief system and not likely to harm her, facilitating the interaction is appropriate. The Reiki practitioner transfers energy to the individual by the laying on of hands; observing the practice to ensure the client’s safety is not necessary and violates the client’s right to privacy. It is also appropriate to notify the client’s physician of the client’s request. Adding this complementary therapy to the client’s traditional treatment promotes integrative medical care. Whether or not the Reiki practitioner is certified is not an issue. 5. *Answer: 3 Rationale: Option 3 is the correct answer because the object of Ayurvedic medicine is to help individuals become unified with nature to develop a strong body, clear mind, and tranquil spirit. Option 1 is incorrect because traditional Native American medicine views disease as resulting from disharmony with Mother Earth, possession by an evil spirit, or violation of a taboo. Option 2 is incorrect because Chinese medicine proposes that health is the outcome of balancing yin and yang, opposite forces that must remain equalized to maintain life’s energy force. Option 4 is incorrect because the idea that correcting an imbalance between two attributes, such as motion and stillness or hot and cold, restores harmony and health is part of Chinese medicine. 6. *Answer: 1 Rationale: Option 1 is the correct answer because biofeedback allows an individual to voluntarily control one or more physiologic functions, such as body temperature, heart rate, blood pressure, and brain waves. Option 2 is incorrect because hypnosis is a therapeutic