Choice A reason: This statement is correct and the nurse should inform the client that St. John's wort may interact with oral contraceptives. St. John's wort is an herbal supplement that has antidepressant and anti-inflammatory effects¹². However, it may also affect the metabolism and clearance of some drugs by inducing the activity of certain enzymes in the liver¹². One of these enzymes, called CYP3A4, is responsible for breaking down oral contraceptives, such as ethinyl estradiol and norethindrone¹². Taking St. John's wort with oral contraceptives may reduce their effectiveness and increase the risk of pregnancy or breakthrough bleeding¹². Therefore, the nurse should advise the client to use an alternative or additional method of birth control while taking St. John's wort¹².

Choice B reason: This statement is also correct and the nurse should inform the client that St. John's wort may interact with anticoagulants. Anticoagulants are drugs that prevent blood clots by inhibiting the activity of certain clotting factors in the blood¹². Some examples of anticoagulants are warfarin, heparin, and dabigatran¹². Taking St. John's wort with anticoagulants may decrease their effectiveness and increase the risk of thrombosis or embolism¹². This is because St. John's wort may induce the activity of CYP3A4 and CYP2C9, two enzymes that are involved in the metabolism and clearance of warfarin and dabigatran¹². Therefore, the nurse should advise the client to monitor his or her blood clotting tests, such as INR or PT, and to report any signs or symptoms of bleeding or clotting while taking St. John's wort¹².

Choice C reason: This statement is also correct and the nurse should inform the client that St. John's wort may interact with antiretrovirals. Antiretrovirals are drugs that inhibit the replication of human immunodeficiency virus (HIV) by targeting different stages of its life cycle¹². Some examples of antiretrovirals are protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and integrase inhibitors¹². Taking St. John's wort with antiretrovirals may decrease their effectiveness and increase the risk of HIV resistance or progression to acquired immunodeficiency syndrome (AIDS)¹². This is because St. John's wort may induce the activity of CYP3A4 and P-glycoprotein, two proteins that are involved in the absorption, distribution, metabolism, and excretion of many antiretrovirals¹². Therefore, the nurse should advise the client to avoid taking St. John's wort with antiretrovirals and to consult his or her health care provider before starting or stopping any herbal supplements¹².

Choice D reason: This statement is correct because it includes all of the above statements. St. John's wort may interact with many conventional drugs by affecting their pharmacokinetics or pharmacodynamics¹². Some of these interactions may have serious consequences for the client's health and well-being¹². Therefore, choice D is the best answer for informing the client that St. John's wort may interact with oral contraceptives, anticoagulants, and antiretrovirals.

Choice A reason: This statement is correct and the nurse should ask the client about headache as a possible adverse effect that may occur after chiropractic manipulation. Chiropractic manipulation is a manual therapy that involves applying controlled, sudden force to specific joints of the spine or other parts of the body to improve mobility and function¹². However, it may also cause some mild and transient side effects, such as headache, in 33-60% of patients¹². The mechanism of headache after chiropractic manipulation is not fully understood, but it may be related to changes in blood flow, muscle tension, or nerve irritation in the cervical region¹². Therefore, the nurse should assess the client for headache, its severity, duration, location, and associated symptoms, and advise the client to report any persistent or severe headache to his or her health care provider¹².

Choice B reason: This statement is also correct and the nurse should ask the client about dizziness as a possible adverse effect that may occur after chiropractic manipulation. Dizziness is a common side effect of chiropractic manipulation, especially of the cervical spine¹². It may manifest as vertigo (a sensation of spinning or moving), disequilibrium (a sensation of imbalance or unsteadiness), or presyncope (a sensation of faintness or lightheadedness)¹². The mechanism of dizziness after chiropractic manipulation is not fully understood, but it may be related to changes in blood pressure, vestibular function, or proprioception in the cervical region¹². Therefore, the nurse should assess the client for dizziness, its type, severity, duration, triggers, and associated symptoms, and advise the client to report any persistent or severe dizziness to his or her health care provider¹².

Choice C reason: This statement is also correct and the nurse should ask the client about nausea as a possible adverse effect that may occur after chiropractic manipulation. Nausea is a less common but possible side effect of chiropractic manipulation¹². It may be related to dizziness, anxiety, or visceral stimulation caused by spinal manipulation¹². Therefore, the nurse should assess the client for nausea, its severity, frequency, triggers, and associated symptoms, and advise the client to report any persistent or severe nausea to his or her health care provider¹².

Choice D reason: This statement is correct because it includes all of the above statements. Chiropractic manipulation may cause various mild and transient side effects in some patients¹². Some of these side effects may include headache, dizziness, and nausea¹². Therefore, choice D is the best answer for asking the client about possible adverse effects that may occur after chiropractic manipulation..

Choice A reason: This statement is correct and the nurse should obtain informed consent from the client before using therapeutic touch. Therapeutic touch is a form of energy therapy that involves placing the hands on or near the client's body to assess, balance, and modulate the client's energy field¹². Therapeutic touch is based on the premise that human beings are composed of energy that can be influenced by the practitioner's intention and consciousness¹². Therapeutic touch may have some benefits for reducing pain, anxiety, stress, and enhancing well-being¹². However, therapeutic touch is not a substitute for conventional medical care, and it may not be suitable or acceptable for everyone¹². Therefore, the nurse should explain the nature, purpose, benefits, risks, and alternatives of therapeutic touch to the client, and obtain his or her voluntary agreement to participate in the therapy¹².

Choice B reason: This statement is also correct and the nurse should place the hands on or near the client's body when using therapeutic touch. Therapeutic touch involves using the hands as sensors to detect and manipulate the client's energy field¹². The nurse should hold the hands between 2 to 6 inches away from the client's body while moving them from the head to the feet in a rhythmical, symmetrical manner¹². The nurse should also use hand movements from the midline while continuing to move in a rhythmical and symmetrical manner from the head to the feet to facilitate the symmetrical flow of energy through the field¹². The nurse should also move the hands to the areas that seem to need attention and project, direct, or modulate energy based on the nature of the living field¹².

Choice C reason: This statement is also correct and the nurse should assess the client's energy field for imbalances or disturbances when using therapeutic touch. Therapeutic touch is based on the premise that health is a state of balance and harmony in the energy field, while illness is a state of imbalance or disorder in the energy field¹². The nurse should use the hands as sensors to scan the client's energy field for any sensory cues such as warmth, coolness, static, blockage, pulling, or tingling that may indicate areas of imbalance or disturbance¹². The nurse should also use professional, informed, and intuitive judgment to evaluate the condition of the client's energy field and determine where to intervene¹².

Choice D reason: This statement is incorrect and does not reflect an action that the nurse should perform when using therapeutic touch. The nurse should not meditate before and after the session. Meditation is a practice that involves focusing attention on a word, object, breath, sensation, or emotion, and letting go of distracting thoughts and feelings¹². Meditation can help reduce stress, anxiety, depression, pain, blood pressure, and inflammation, and improve mood, sleep, immune function, cognitive performance, and quality of life¹². However, meditation is not part of therapeutic touch technique. Instead of meditating before and after the session, the nurse should perform centering before and during the session. Centering is a process of bringing the body, mind, emotion to a quiet, focused state of consciousness by using breath, imagery, meditation or visualization¹². Centering helps the nurse to connect with his or her inner core of wholeness and stillness and to attune to the client's energy field¹².

Choice E reason: This statement is also correct and the nurse should provide feedback to the client about the session when using therapeutic touch. Therapeutic touch is a dynamic and interactive process that involves communication between the nurse and the client¹². The nurse should provide feedback to the client about what he or she sensed or did during the session, such as areas of imbalance or disturbance in the energy field, interventions performed to balance or rebalance them, or changes observed in response to them. The nurse should also elicit feedback from the client about his or her experience of therapeutic touch therapy such as sensations felt during or after it effects on pain anxiety stress or well-being expectations met or unmet questions concerns or suggestions for future sessions 1 2 By providing feedback to each other both parties can enhance their understanding awareness learning satisfaction trust rapport collaboration evaluation and improvement of therapeutic touch therapy.

Choice A reason: This statement is correct and the nurse should inform the client that acupuncture involves inserting thin needles into specific points on the body to restore energy balance. Acupuncture is a form of traditional Chinese medicine that is based on the premise that health is a state of harmony and balance in the flow of vital energy (qi) through the body, while disease is a state of disruption or blockage in the flow of qi¹². Acupuncture aims to restore the balance and harmony of qi by stimulating specific points (acupoints) on the body that are connected by pathways (meridians) through which qi flows¹². Acupuncture involves inserting very thin, sterile, disposable needles into the skin and underlying tissues at these acupoints, and sometimes manipulating them by hand or electrical stimulation¹². Acupuncture may have some benefits for relieving pain, reducing inflammation, improving blood circulation, modulating immune function, and enhancing well-being¹².

Choice B reason: This statement is incorrect and does not reflect what acupuncture involves. Applying pressure or massage to specific points on the body to relieve pain or stress is not acupuncture, but acupressure. Acupressure is another form of traditional Chinese medicine that is similar to acupuncture in terms of the theory and principles of qi, meridians, and acupoints¹². However, acupressure does not use needles, but uses fingers, hands, elbows, or other devices to apply pressure or massage to the acupoints¹². Acupressure may also have some benefits for relieving pain, reducing stress, improving blood circulation, and enhancing well-being¹².

Choice C reason: This statement is incorrect and does not reflect what acupuncture involves. Exposing specific points on the body to light, heat, or electricity to stimulate healing is not acupuncture, but phototherapy, thermotherapy, or electrotherapy. These are different forms of physical therapy that use different modalities to deliver energy to the body tissues to promote healing¹². Phototherapy uses light of different wavelengths and intensities to stimulate cellular activity and tissue repair¹². Thermotherapy uses heat or cold to increase or decrease blood flow and reduce inflammation and pain¹². Electrotherapy uses electrical currents or impulses to stimulate nerves, muscles, or cells¹². These therapies may have some benefits for various conditions such as wounds, infections, arthritis, muscle spasms, nerve damage, etc.¹².

Choice D reason: This statement is incorrect and does not reflect what acupuncture involves. Placing cups on specific points on the body to create suction and increase blood flow is not acupuncture, but cupping. Cupping is another form of traditional Chinese medicine that is based on the theory and principles of qi, meridians, and acupoints. Cupping involves placing cups made of glass metal bamboo or silicone on the skin and creating a vacuum inside them by heating or pumping out air.This creates suction and pulls the skin muscle and blood vessels into the cup.Cupping may have some benefits for relieving pain reducing inflammation improving blood circulation and enhancing well-being.

Choice A reason: Asking the client about her beliefs and expectations regarding Reiki is important to understand her motivation, goals, and preferences for the therapy. It can also help to establish rapport, trust, and respect between the nurse and the client¹.

Choice B reason: Observing the client's physical, emotional, and spiritual responses to Reiki can help to evaluate the effects of the therapy on the client's well-being. It can also help to identify any adverse reactions or changes that may require further assessment or intervention².

Choice C reason: Measuring the client's vital signs, oxygen saturation, and pain level before and after Reiki can help to quantify the outcomes of the therapy on the client's physiological status. It can also help to monitor any changes that may indicate improvement or deterioration in the client's condition².

Choice D reason: Palpating the client's energy fields for any imbalances or blockages is not a valid action for the nurse to perform when assessing Reiki. This is because there is no scientific evidence or standardized method to support this practice. It is also outside the scope of practice of a nurse and may be considered invasive or inappropriate by some clients³.

Choice E reason: Documenting the client's Reiki sessions, including frequency, duration, and effects, is essential to maintain accurate and comprehensive records of the client's care. It can also help to communicate the progress and outcomes of the therapy to other health care providers and facilitate continuity of care².

Choice A reason: Using positive affirmations and suggestions to change behavior is not a valid action for hypnosis. This is because hypnosis is not a form of self-help or motivational technique, but a state of altered consciousness that requires the guidance of a trained therapist⁴.

Choice B reason: Using imagery and relaxation techniques to induce a trance-like state is the correct action for hypnosis. This is because hypnosis involves creating a focused and receptive state of mind that allows the client to respond to the therapist's suggestions or directions⁴ .

Choice C reason: Using biofeedback devices to monitor and control physiological responses is not a valid action for hypnosis. This is because biofeedback is a different form of therapy that uses electronic sensors to measure and display information about the body's functions, such as heart rate, blood pressure, muscle tension, etc. Biofeedback aims to teach the client how to regulate these functions voluntarily, while hypnosis aims to influence the client's subconscious mind.

Choice D reason: Using music or art forms to express emotions and thoughts is not a valid action for hypnosis. This is because music or art therapy is a different form of therapy that uses creative expression as a way of coping with stress, trauma, or psychological issues. Music or art therapy does not involve inducing a trance-like state or using suggestions or directions from a therapist.

Choice A reason: Decrease in fecal pH and increase in fecal short-chain fatty acids is a possible effect of probiotics on the client's laboratory results. This is because probiotics, especially those containing LAB, can ferment dietary fibers and produce short-chain fatty acids (SCFAs) such as acetate, propionate, and butyrate. SCFAs can lower the fecal pH and have beneficial effects on the intestinal microbiota, mucosal barrier, immune system, and metabolism¹².

Choice B reason: Increase in fecal pH and decrease in fecal short-chain fatty acids is not a likely effect of probiotics on the client's laboratory results. This is because probiotics, especially those containing LAB, tend to have the opposite effect, as explained above.

Choice C reason: Decrease in serum cholesterol and triglyceride levels is not a consistent or conclusive effect of probiotics on the client's laboratory results. This is because the evidence for the lipid-lowering effects of probiotics is mixed and depends on various factors, such as the type, dose, duration, and formulation of probiotics, as well as the baseline lipid levels, diet, and lifestyle of the client³⁴.

Choice D reason: Increase in serum cholesterol and triglyceride levels is not a common or expected effect of probiotics on the client's laboratory results. This is because most probiotics do not have adverse effects on lipid metabolism and may even have beneficial effects in some cases, as mentioned above..

Choice A reason: Asking the client about his history and frequency of osteopathic manipulation is important to understand his reasons, goals, and satisfaction with the therapy. It can also help to identify any contraindications, precautions, or adverse effects that may affect the client's safety or response to the therapy¹.

Choice B reason: Observing the client's posture, gait, and range of motion is important to assess the client's musculoskeletal function and identify any areas of dysfunction, asymmetry, restriction, or pain that may benefit from osteopathic manipulation².

Choice C reason: Palpating the client's spine, joints, muscles, and fascia is important to evaluate the client's tissue texture, tenderness, temperature, and tone and to detect any somatic dysfunctions that may impair the client's health or well-being. Palpation is also a key component of osteopathic manipulation techniques².

Choice D reason: Measuring the client's vital signs, pain level, and functional status is important to monitor the client's physiological and clinical outcomes of osteopathic manipulation. It can also help to evaluate the effectiveness and safety of the therapy and to adjust the treatment plan accordingly³.

Choice E reason: Documenting the client's osteopathic manipulation sessions, including type, duration, and effects, is essential to maintain accurate and comprehensive records of the client's care. It can also help to communicate the progress and outcomes of the therapy to other health care providers and facilitate continuity of care⁴.

Choice A reason: Aspirin, an antiplatelet agent for cardiovascular prevention, may interact with garlic and increase the risk of bleeding. This is because garlic has antiplatelet and anticoagulant properties that may enhance the effects of aspirin and other drugs that slow blood clotting¹².

Choice B reason: Simvastatin, a statin for hyperlipidemia, may not interact with garlic significantly. This is because garlic does not appear to affect the metabolism or absorption of simvastatin or other statins³⁴. However, some studies suggest that garlic may have additive lipid-lowering effects when combined with statins⁵⁶.

Choice C reason: Metoprolol, a beta blocker for hypertension, may not interact with garlic significantly. This is because garlic does not appear to affect the metabolism or absorption of metoprolol or other beta blockers³⁴. However, some studies suggest that garlic may have additive blood pressure-lowering effects when combined with beta blockers .

Choice D reason: All of the above is not a correct answer because only aspirin may interact with garlic in a clinically relevant way. Simvastatin and metoprolol may not have significant interactions with garlic, although they may have additive effects on lipid levels and blood pressure, respectively..

Choice A reason: Decrease in serum potassium level and increase in serum sodium level is a possible effect of licorice on the client's laboratory results. This is because licorice contains glycyrrhizin, a compound that can inhibit the enzyme 11-beta-hydroxysteroid dehydrogenase, which converts cortisol to cortisone. This leads to increased cortisol levels, which can mimic the effects of aldosterone, a hormone that regulates sodium and potassium balance. As a result, licorice can cause sodium and water retention, hypertension, and hypokalemia (low potassium levels) in some people¹².

Choice B reason: Increase in serum potassium level and decrease in serum sodium level is not a likely effect of licorice on the client's laboratory results. This is because licorice tends to have the opposite effect, as explained above.

Choice C reason: Decrease in serum calcium level and increase in serum magnesium level is not a consistent or conclusive effect of licorice on the client's laboratory results. This is because the evidence for the effects of licorice on calcium and magnesium metabolism is limited and conflicting. Some studies suggest that licorice may lower calcium levels by increasing urinary calcium excretion³, while others suggest that licorice may increase calcium levels by enhancing intestinal calcium absorption⁴. Similarly, some studies suggest that licorice may lower magnesium levels by increasing urinary magnesium excretion, while others suggest that licorice may increase magnesium levels by enhancing intestinal magnesium absorption.

Choice D reason: Increase in serum calcium level and decrease in serum magnesium level is not a common or expected effect of licorice on the client's laboratory results. This is because licorice does not have a clear or consistent impact on calcium and magnesium metabolism, as mentioned above.

Choice A reason: Asking the client about his history and frequency of biologically based therapies use is important to understand his reasons, goals, and satisfaction with the therapies. It can also help to identify any contraindications, precautions, or adverse effects that may affect the client's safety or response to the therapies.

Choice B reason: Observing the client's physical, emotional, and spiritual responses to biologically based therapies is not a valid action for the nurse to perform when assessing biologically based therapies. This is because biologically based therapies are not energy therapies that involve manipulating or balancing the client's energy fields. Biologically based therapies are substances that have pharmacological effects on the body and may interact with conventional drugs or other therapies.

Choice C reason: Measuring the client's vital signs, laboratory values, and pain level before and after biologically based therapies is important to monitor the client's physiological and clinical outcomes of biologically based therapies. It can also help to evaluate the effectiveness and safety of the therapies and to adjust the treatment plan accordingly.

Choice D reason: Palpating the client's abdomen, liver, and kidneys for any signs of toxicity or dysfunction is not a valid action for the nurse to perform when assessing biologically based therapies. This is because palpation is not a reliable or sensitive method to detect organ damage or dysfunction caused by biologically based therapies. The nurse should rely on laboratory tests, such as liver function tests or renal function tests, to assess the impact of biologically based therapies on the client's organ function.

Choice E reason: Documenting the client's biologically based therapies use, including type, dose, route, and effects, is essential to maintain accurate and comprehensive records of the client's care. It can also help to communicate the progress and outcomes of the therapies to other health care providers and facilitate continuity of care.

A. Inserting thin needles into specific points on the body to restore energy balance.

Choice A reason: Inserting thin needles into specific points on the body to restore energy balance is the correct action for acupuncture. This is because acupuncture is based on the traditional Chinese medicine theory that health depends on the balance and flow of vital energy, called qi, through pathways called meridians. Acupuncture aims to stimulate specific points along these meridians, called acupoints, to correct any imbalances or blockages of qi and to promote healing and well-being.

Choice B reason: Applying pressure or massage to specific points on the body to relieve pain or stress is not a valid action for acupuncture. This is because this action describes another CAM practice called acupressure, which is similar to acupuncture but does not use needles. Acupressure also follows the traditional Chinese medicine theory of meridians and acupoints, but uses manual pressure, such as finger pressure, to stimulate the acupoints.

Choice C reason: Exposing specific points on the body to light, heat, or electricity to stimulate healing is not a valid action for acupuncture. This is because this action describes another CAM practice called electroacupuncture, which is a variation of acupuncture that uses electrical currents to stimulate the acupoints. Electroacupuncture may be used as an adjunct to acupuncture or as a standalone therapy.

Choice D reason: Placing cups on specific points on the body to create suction and increase blood flow is not a valid action for acupuncture. This is because this action describes another CAM practice called cupping, which is a form of therapy that uses cups made of glass, bamboo, or plastic to create a vacuum on the skin. Cupping may be used to treat pain, inflammation, blood circulation, and relaxation.

Choice A reason: Asking the client about his history and frequency of meditation practice is important to understand his reasons, goals, and satisfaction with the practice. It can also help to identify any barriers, challenges, or benefits that may affect the client's adherence or response to the practice.

Choice B reason: Observing the client's physical, emotional, and spiritual responses to meditation is important to evaluate the effects of the practice on the client's well-being. It can also help to identify any adverse reactions or changes that may require further assessment or intervention.

Choice C reason: Measuring the client's vital signs, oxygen saturation, and pain level before and after meditation is important to monitor the client's physiological and clinical outcomes of meditation. It can also help to evaluate the effectiveness and safety of the practice and to adjust the treatment plan accordingly.

Choice D reason: Palpating the client's abdomen, liver, and kidneys for any signs of toxicity or dysfunction is not a valid action for the nurse to perform when assessing meditation. This is because meditation is not a substance or a therapy that can cause organ damage or dysfunction. Meditation is a mind-body practice that involves focusing attention, regulating breathing, and cultivating awareness.

Choice E reason: Documenting the client's meditation sessions, including type, duration, and effects, is essential to maintain accurate and comprehensive records of the client's care. It can also help to communicate the progress and outcomes of the practice to other health care providers and facilitate continuity of care.