CULTURAL NURSING AND ALTERNATIVE HEALTH CARE COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES

2504_Ch17_657-676.qxd 10/28/10 1:10 PM Page 672 CULTURAL NURSING AND ALTERNATIVE HEALTH CARE COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES 1. 1. This is challenging the client s question and will not help establish a therapeutic relationship with the client. 2. The nurse should present facts and support the client s alternative health belief unless it hurts the client or makes the disease process worse. 3. The nurse does not need to pass the buck to the HCP to answer this question. 4. Alternative medicine is often helpful to the client, and the nurse should support a client s beliefs as much as possible if it does not hurt the client. Client Needs Physiological Integrity, Physiological Adaptation: 2. 1. The nurse can be concerned about the cost of the herbs and teas, but it is not the most important question to consider. 2. The client s safety is priority, but if the nurse does not have the knowledge, then the nurse cannot answer the question. 3. Teaching about herbs and alternative therapies is not a priority in nursing programs. Therefore, the nurse must determine if he or she has the knowledge to answer the client s question. The nurse should find a reputable resource before answering this question. 4. The nurse must always practice within the scope of nursing, but providing correct and factual information is within the scope of the nurse s practice. Client Needs Physiological Integrity, Physiological Adaptation: Cognitive Level Analysis. 3. 1. Acupuncture does not usually cause paralysis because of the size of the needles/ wires used. 2. Acupuncture is a method of producing analgesia or altering the function of a system of the body by inserting fine, wire-thin needles into the skin at specific sites on the body. Infection does occur if a sterile procedure is not used when inserting the needles. 3. AIDS is not a great concern because the health department regulates the centers which perform acupuncture and there is no sharing of the needles. 672 4. The pain not being resolved is a concern, but the potential for infection is priority. Pain: Integrated Nursing Process Diagnosis: Client Needs Physiological Integrity, Physiological Adaptation: Cognitive Level Analysis. 4. 1. Navajo people practice preventive medicine, and the nurse should support the client s culture if it does not interfere with the medical regimen. 2. Most clients will not get upset and angry and lose faith if the nurse explains the importance of removing an object. 3. Never is an absolute word, and sometimes objects must be removed, such as when going to surgery. 4. This is the reason the object is worn, but it is not the best statement to explain why the nurse should not remove the pouch. Even if the nurse does not understand the reason for the object, the nurse should respect and honor the practice if possible. 5. 1. This is a Mexican folk practitioner known as a sobadore. 2. This is a Mexican folk practitioner known as a yerbera or jerbera. 3. This is a Mexican folk practitioner known as an espiritista. 4. Curanderos receive their gift from God or serve an apprenticeship. Some even prescribe over-the-counter medications. They usually treat traditional illnesses not caused by witchcraft. 6. 1. A tallis (or tallith) is a rectangular prayer shawl with fringes used during prayer. 2. A mezuzah is a small container with scripture inside which is placed on the doorpost of the home; some wear the mezuzah as a necklace. 3. A synagogue is a Jewish house of prayer; Jews may pray alone, or they may pray as a group. 4. Yom Kippur is a high holy day celebrated in September or early October. On Yom

CHAPTER 17 CULTURAL NURSING AND ALTERNATIVE HEALTH CARE 673 Kippur one fasts for a day to cleanse and purify oneself. 7. 1. The nurse should be sensitive to folk medicine, and if it does not hurt the client, the nurse should be respectful and honor the practice. 2. The nurse should not make the client explain his or her folk medicine beliefs. 3. The nurse should first assess the carbuncle to determine if the raw potato is making the carbuncle worse; if it is not, the nurse should support the client s folk medicine. 4. The nurse should assess the carbuncle before deciding not to take any further action. 8. 1. These are not typical signs and symptoms of a psychosomatic disorder. 2. This would be the best explanation because the client has experienced major life changes moving to another area and assuming the role of caregiver to a parent. Chronic unrelieved stress has been shown to decrease immunity, resulting in frequent upper respiratory tract infections and increased blood pressure. 3. Gastric reflux has been linked to asthmatype symptoms but not upper respiratory infections. 4. These signs/symptoms do not support the diagnosis of essential hypertension. Diagnosis: Client Needs Safe Effective Care Level Analysis. 9. 1. Cupping is an alternative treatment modality in which heated cups are applied to the body. They produce round, red or purple circles which may remain for as long as one (1) week. It may be used for clients with respiratory difficulty. 2. This response assumes the areas are bruises resulting from injury or illness. 3. This response assumes the areas are bruises resulting from abuse, which could lead to false accusations and legal issues. 4. This response sounds judgmental and blaming, and the nurse should avoid responses which damage the client nurse relationship. Nursing Process Assessment: Client Needs Safe Effective Care Environment, Management of Care: Cognitive Level Analysis. 10. 1. The client should understand the relationship between stress and illness. 2. For effective teaching, the nurse should use terms the client understands. 3. Methods the nurse has experienced personally or has observed to be successful with other clients can aid the client s selection. 4. The nurse should not refer the client to alternative health-care providers. This is imposing the nurse s cultural beliefs onto the client. 5. The nurse should provide a variety of referrals and resources to use to help reduce and control stressful situations. Psychosocial Integrity: Cognitive Level Synthesis. 11. 1. If the client spends more than threefourths of the time in bed, then this would be a low quality of life and would not be the expected outcome. 2. An expected outcome would be relief of pain or enhanced pain management. Enhanced sensation of pain would be unrelieved pain. 3. CAM would not include prescription medication, and taking medication is an intervention, not an expected outcome. 4. A client performing activities of daily living (ADL) without pain represents an appropriate expected outcome. Nursing Process Evaluation: Client Needs Safe Effective Care Environment, Management of Care: Cognitive Level Synthesis. 12. 1. This behavior does not indicate lack of love; it is a coping mechanism. 2. Family members coping mechanisms should not be criticized by staff. 3. Laughter during times of stress aids in coping with pain and increases relaxation.

674 MED-SURG SUCCESS 4. Laughter is used by many individuals as stress relief, regardless of educational levels. 13. 1. Cabbage leaves have been shown to have some antibacterial and antiinflammatory properties. Softened leaves are applied to wounds, ulcers, and arthritic joints. 2. This response is belittling the client s beliefs and actions. 3. Studies support the placebo effect, but this response does not answer the UAP s question about the use of cabbage leaves. 4. The leaves would not be the best way to keep the wound moist and clean. 14. 1. Condoms are helpful in preventing sexually transmitted diseases and in preventing pregnancy. 2. Sexually active females do need vaginal examinations, but this statement does not address preventing pregnancy. 3. Routes of hormonal therapy include birth control pills, creams, patches, and injections. All address ways to help prevent conception. 4. All methods of birth control do not require a prescription. Condoms and contraceptive creams and ointments are sold over the counter. Planning: Client Needs Health Promotion and Maintenance: Cognitive Level Synthesis. 15. 1. Black cohosh is used for gynecological disorders. 2. Fennel is used as an expectorant or diuretic. 3. Witch hazel has anti-inflammatory properties, but it is prepared with an alcohol base which would cause pain to the client when applying it to the burned area. 4. Aloe vera has been used to promote wound healing. It has some antifungal properties and helps soothe the pain from a superficial burn. Alteration Complementary and Alternative Medicine: Integrated Nursing Process Implementation: Client Needs Physiological Integrity, Pharmacological and Parenteral Therapies: 16. 1. The nurse should support the use of folk and home remedies as long as they are not contraindicated by the medical treatment. 2. Eucalyptus has been used by clients with congestion and as an expectorant; steam helps open the airway and liquefies secretions. 3. This is an inhaled treatment which will provide the medication directly to the lungs and will limit systemic effects. 4. The steam provides moisture to the lungs to liquefy secretions, and the efficacy of rubbing on the chest is provided by inhalation. Complementary and Alternative Medicine: Integrated Nursing Process Implementation: Client Needs Physiological Integrity, Pharmacological and Parenteral Therapies: 17. 1. Continuous, daily doses will not increase the effectiveness of the herb and could cause harm to the client. 2. Ginseng is a stimulant; therefore, additional stimulants such as caffeine should be avoided. 3. Clients should take ginseng intermittently for safety. Every two (2) months the client should omit the ginseng for two (2) or three (3) weeks. 4. There are contraindications to all medications. Ginseng elevates the blood pressure, so clients diagnosed with hypertension should avoid ginseng. Complementary and Alternative Medicine: Integrated Physiological Integrity, Pharmacological and Parenteral Therapies: Cognitive Level Synthesis. 18. 1. Alternating Tylenol with aspirin is recommended for clients with fevers who do not respond to Tylenol alone. 2. Benadryl gel can be applied to the area three (3) to four (4) times a day. The medication is absorbed topically. If the medication is applied more often, the client can develop systemic effects. 3. Washing the area with soap and hot water will increase the itching. 4. Hydrocortisone cream is applied three (3) to four (4) times daily, not every two (2) hours.

CHAPTER 17 CULTURAL NURSING AND ALTERNATIVE HEALTH CARE 675 Nursing Process Implementation: Client Needs Physiological Integrity, Pharmacological and Parenteral Therapies: Cognitive Level Application. 19. 1. This outcome would be for a knowledgedeficit problem. 2. Clients with anemia have decreased energy and are unable to complete activities of daily living. The ability to complete ADLs indicates the treatment has been effective. 3. Green black stools are an expected side effect of taking iron supplements and can be confused with tarry stools indicate blood in the stool. 4. Dystrophy of fingernails is an indication the treatment is ineffective. Nursing Process Assessment: Client Needs Physiological Integrity, Pharmacological and Parenteral Therapies: Cognitive Level Analysis. 20. 1. Antacids should be taken one (1) hour before or two (2) hours after taking iron. 2. Clients should not double up on doses because that may lead to gastrointestinal upset. 3. Food interferes with the absorption of oral supplements, but it is recommended clients take iron between meals to minimize gastrointestinal upset and maximize iron absorption. 4. The client needs to remain in an upright position for 30 minutes after taking oral iron supplements to reduce esophageal irritation or corrosion. Physiological Integrity, Pharmacological and Parenteral Therapies: Cognitive Level Synthesis. 21. 1. Antibiotics such as ampicillin and tetracycline increase the elimination of the oral contraceptive by killing the flora in the gastrointestinal tract. Clients should use another method of birth control while taking an antibiotic. 2. The pills should be taken at the same time each day. If the client misses one (1), that pill should be taken as soon as the client remembers. If the client misses taking the pill two (2) days in a row, then two (2) pills should be taken each day for the next two (2) days. 3. The transdermal patch has the same side effects as oral birth control pills. The advantage of the patch is it does not have to be taken every day. 4. If the contraceptive ring comes out, it should be washed with warm water and replaced. One ring can be used for three (3) weeks. Drug Administration: Integrated Nursing Process Evaluation: Client Needs Physiological Integrity, Pharmacological and Parenteral Therapies: Cognitive Level Synthesis. 22. 1. The Prentif cavity-rim cervical cap has a 40% failure rate for multiparous women. 2. Subdermal levonorgestrel implants are an effective method of birth control for up to five (5) years. 3. When taken as directed, oral contraceptives can be effective, but because this client has had two (2) unplanned pregnancies, compliance should be questioned. 4. Depo-Provera is one of the most effective methods of birth control but lasts for only three (3) months; therefore, this should not be recommended for this client. Implementation: Client Needs Physiological Integrity, Pharmacological and Parenteral Therapies: 23. 1. The frequency of sexual activity would indicate the number of condoms to be distributed, but it would not be the most important information. 2. The public health department provides free condoms and is not concerned with the client s style preference. 3. The most effective condoms are made of latex, but they should not be used if the client is allergic to latex. The client should be instructed to ask the partner about latex allergies. 4. Sexual history should be discussed only if the client has a sexually transmitted disease because the public health department must notify all partners. Assessment: Client Needs Physiological Integrity, Reduction of Risk Potential: Cognitive Level Analysis. 24. 1. Deep breathing would aid the client to relax, but teaching cannot be delegated. 2. This relaxing intervention can be delegated to the unlicensed assistive personnel. 3. Listening to why the client is anxious is part of assessment, which cannot be delegated.

676 MED-SURG SUCCESS 4. Guided imagery is a method which assists clients to relax, but teaching it cannot be delegated. Safe Effective Care Environment, Management of Care: Cognitive Level Synthesis. 25. 1. Progressive muscle relaxation is the systematic contracting and relaxing of muscles. It helps aid in relaxation when the client feels anxious. 2. Soothing music with the rate of 50 to 60 beats per minute can slow the client s heart rate and relax the client. 3. Guided imagery is helpful to decrease anxiety. The more senses involved, the better the results of the guided imagery. 4. Stress is not always harmful, and the absence of all stress is death. 5. Journaling is useful for some individuals, but the nurse cannot insist or demand the client do anything. Planning: Client Needs Psychosocial Integrity: Cognitive Level Synthesis. 26. In order of priority: 2, 4, 1, 5, 3. 2. Any pain not relieved with prescribed pain medication warrants assessment by the nurse to rule out any complications. 4. Soft music is a method of distraction which can be implemented quickly and may have a calming effect on the client. 1. The nurse should notify the HCP and discuss other possible medication regimens which can be provided for the client. 5. According to the gate control theory of pain, flooding the brain with pleasurable sensations will block the transmission of pain. 3. Clients in acute pain are not receptive to being taught; therefore, this intervention should be implemented as soon as the pain is tolerable and may be used by the client for future pain episodes. Client Needs Physiological Integrity, Pharmacological and Parenteral Therapies: Cognitive Level Analysis.