B. Biologically based therapies.

Choice A: Mindbody therapies are CAM practices that use the interaction between the brain, mind, body, and behavior to affect physical functioning and health. Examples include meditation, yoga, hypnosis, and biofeedback².

Choice B: Biologically based therapies are CAM practices that use substances found in nature, such as herbs, foods, vitamins, and dietary supplements. Examples include herbal products, probiotics, omega3 fatty acids, and antioxidants². Herbal products are classified as biologically based therapies by the FDA¹.

Choice C: Manipulative and bodybased therapies are CAM practices that involve manipulation or movement of one or more parts of the body. Examples include chiropractic, osteopathic manipulation, massage therapy, reflexology, and acupuncture².

Choice D: Energy therapies are CAM practices that involve the use of energy fields. There are two types: biofield therapies and bioelectromagneticbased therapies. Biofield therapies are intended to affect energy fields that surround and penetrate the human body. Examples include Reiki, therapeutic touch, and qi gong. Bioelectromagnetic based therapies involve the use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternatingcurrent or directcurrent fields².

Choice A reason: Mindbody therapies are CAM practices that use the interaction between the brain, mind, body, and behavior to affect physical functioning and health. Examples include meditation, yoga, hypnosis, and biofeedback².

Choice B reason: Biologically based therapies are CAM practices that use substances found in nature, such as herbs, foods, vitamins, and dietary supplements. Examples include herbal products, probiotics, omega3 fatty acids, and antioxidants². Herbal products are classified as biologically based therapies by the FDA¹.

Choice C reason: Manipulative and bodybased therapies are CAM practices that involve manipulation or movement of one or more parts of the body. Examples include chiropractic, osteopathic manipulation, massage therapy, reflexology, and acupuncture².

Choice D reason: Energy therapies are CAM practices that involve the use of energy fields. There are two types: biofield therapies and bioelectromagneticbased therapies. Biofield therapies are intended to affect energy fields that surround and penetrate the human body. Examples include Reiki, therapeutic touch, and qi gong. Bioelectromagnetic based therapies involve the use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternatingcurrent or directcurrent fields².

Choice A reason: Pregnancy is a contraindication for acupuncture because some acupuncture points may stimulate uterine contractions or induce labor. These points include LI 4, SP 6, UB 60, UB 67, and sacral foraminal points B 3134¹².

Choice B reason: Bleeding disorders are a contraindication for acupuncture because of the risk of excessive bleeding or bruising from the needle insertion. Patients who have hemophilia or are taking anticoagulant medications should avoid acupuncture or use it with caution¹²³.

Choice C reason: Pacemaker implantation is a contraindication for acupuncture because of the potential interference of the electrical impulses from the pacemaker with the acupuncture needles. This is especially true for electroacupuncture, which uses electrical stimulation of the needles¹²³.

Choice D reason: Diabetes mellitus is not a contraindication for acupuncture, but it may require special precautions. Patients with diabetes should monitor their blood glucose levels before and after acupuncture sessions, and avoid needling areas with poor skin condition or neuropathy¹².

Choice E reason: Hypertension is not a contraindication for acupuncture, but it may require special precautions. Patients with hypertension should monitor their blood pressure before and after acupuncture sessions, and avoid needling points that may cause a sudden drop in blood pressure, such as LI 4 or ST 36¹².

Choice A reason: Guided imagery is a mindbody technique that uses the power of the mind to alter the physical condition of the body. It involves creating and focusing on positive images in the mind, using all the senses to make the image feel as real as possible. It is often performed along with an instructor or a recording that guides the visualization. Guided imagery can help people relax their muscles and reduce tension by activating the parasympathetic nervous system, which lowers the heart rate, blood pressure, and stress hormones¹²³.

Choice B reason: Guided imagery may have some effects on the immune system, but this is not its primary purpose or benefit. Some studies have suggested that guided imagery can enhance immune function by increasing natural killer cells, lymphocytes, and immunoglobulins⁴⁵. However, more research is needed to confirm these findings and to understand the mechanisms behind them.

Choice C reason: Guided imagery may have some effects on the blood flow and blood pressure, but this is not its primary purpose or benefit. Some studies have suggested that guided imagery can improve blood flow and lower blood pressure by reducing vascular resistance, improving endothelial function, and decreasing sympathetic activity⁶ . However, more research is needed to confirm these findings and to understand the mechanisms behind them.

Choice D reason: Guided imagery is not the same as energy therapies, which are CAM practices that involve the use of energy fields. Energy therapies include biofield therapies, such as Reiki, therapeutic touch, and qi gong, and bioelectromagneticbased therapies, such as pulsed fields, magnetic fields, or alternatingcurrent or directcurrent fields. Guided imagery does not involve manipulating or balancing energy fields, but rather using mental images to affect physical functioning and health.

Choice A reason: Probiotics are live microorganisms, such as bacteria or yeast, that can confer health benefits to the host when administered in adequate amounts. Probiotics can restore the normal flora in the gut by competing with pathogenic bacteria, producing antimicrobial substances, enhancing the intestinal barrier function, and modulating the immune system¹². Probiotics have been shown to reduce the risk of antibioticassociated diarrhea (AAD), which is a common side effect of antibiotic use that disrupts the gut microbiota³⁴⁵.

Choice B reason: Probiotics are not dietary supplements, but rather foods or drugs that contain live microorganisms. Probiotics may have some effects on metabolism and digestion, but this is not their primary purpose or benefit. Probiotics may influence metabolism and digestion by affecting nutrient absorption, bile acid metabolism, lipid metabolism, glucose metabolism, and appetite regulation¹². However, more research is needed to confirm these effects and to identify the optimal probiotic strains and doses for different metabolic and digestive conditions.

Choice C reason: Probiotics are not herbal remedies, but rather live microorganisms that can be found in natural sources such as yogurt, fermented foods, or supplements. Probiotics may have some antiinflammatory effects, but this is not their primary purpose or benefit. Probiotics may modulate inflammation by affecting cytokine production, oxidative stress, intestinal permeability, and mucosal immunity¹². However, more research is needed to confirm these effects and to identify the optimal probiotic strains and doses for different inflammatory conditions.

Choice D reason: Probiotics are not natural substances that can detoxify the body and eliminate toxins. Probiotics are live microorganisms that can affect the host's health in various ways. There is no scientific evidence that probiotics can detoxify the body or eliminate toxins. Detoxification is a natural process that occurs in the liver and kidneys, and it is not influenced by probiotics⁶.

Choice A reason: Improving physical fitness, flexibility, strength, and balance. Yoga involves physical poses that stretch the muscles, increase the range of motion, and build strength and endurance. Yoga also challenges the body to maintain stability and coordination, which improves balance and prevents falls.

Choice B reason: Enhancing the body's natural healing abilities and immune system function. Yoga may modulate the immune system by affecting cytokine production, oxidative stress, inflammation, and cellular aging. Yoga may also enhance the body's natural healing abilities by improving blood circulation, oxygen delivery, wound healing, and tissue repair.

Choice C reason: Reducing stress and promoting relaxation and coping skills. Yoga combines breathing exercises, meditation, and relaxation techniques that can lower the levels of stress hormones, such as cortisol and adrenaline, and activate the parasympathetic nervous system, which induces a state of calmness and relaxation. Yoga can also improve mental health by reducing anxiety, depression, and negative emotions, and increasing selfesteem, selfawareness, and coping skills.

Choice D reason: All of the above. Yoga may have all of these effects on the client's health and wellbeing, as supported by the current web page context and various sources. Therefore, this is the correct answer.

Choice A reason: Ayurveda is based on the concept of the balance of five elements in the body and the environment. These elements are ether, air, fire, water, and earth. They are the building blocks of all life forms and are present in different proportions in different individuals and situations. Ayurveda believes that health is a state of harmony between these elements, while disease is a state of disharmony or imbalance¹²³.

Choice B reason: The harmony of yin and yang forces in the body and the universe is not a concept of Ayurveda, but rather of traditional Chinese medicine (TCM). Yin and yang are opposite but complementary principles that represent the dynamic balance of all phenomena. They are constantly changing and influencing each other, and health is a state of equilibrium between them, while disease is a state of excess or deficiency of either one⁴.

Choice C reason: The integration of body, mind, and spirit in health and disease is a concept that is shared by many systems of medicine, including Ayurveda, but it is not unique to Ayurveda. Ayurveda recognizes that health is not just the absence of disease, but a state of physical, mental, emotional, social, and spiritual wellbeing. Ayurveda also considers that each individual has a unique constitution (prakriti) and life force (dosha) that determine their physical, mental, and spiritual characteristics and needs¹²³.

Choice D reason: The stimulation of specific points on the body to restore energy flow is not a concept of Ayurveda, but rather of acupuncture, which is a part of TCM. Acupuncture involves inserting thin needles into specific points on the body that correspond to different organs and functions. Acupuncture aims to regulate the flow of vital energy (qi) along the pathways (meridians) that connect these points. Acupuncture can treat various conditions by restoring the balance and harmony of qi⁴.

Choice A reason: Homeopathy is based on the principle that like cures like. This means that a substance that can produce symptoms in a healthy person can cure similar symptoms in a sick person. For example, coffee can cause insomnia in some people, so homeopathy may use a very diluted form of coffee to treat insomnia¹². This statement is correct and does not indicate a need for further teaching.

Choice B reason: Homeopathy uses very diluted substances to treat diseases. Homeopathy believes that the more a substance is diluted, the more potent it becomes. Homeopathic remedies are prepared by repeatedly diluting and shaking (succussing) a substance in water or alcohol until there is little or no trace of the original substance left. The dilution is often indicated by a number and a letter, such as 6C or 30X¹². This statement is correct and does not indicate a need for further teaching.

Choice C reason: Homeopathy can be used along with conventional antidepressants. Homeopathy is considered a complementary medicine, which means that it can be used together with other treatments, such as conventional drugs, psychological therapy, or lifestyle changes. Homeopathy does not interfere with the action of antidepressants, but it may help to reduce their side effects or dependence¹³. This statement is correct and does not indicate a need for further teaching.

Choice D reason: Homeopathy can treat the root cause of my depression. This statement is incorrect and indicates a need for further teaching. Homeopathy does not claim to treat the root cause of depression, but rather to address the individual symptoms and personality of the person suffering from depression. Homeopathy believes that each person has a unique constitution and susceptibility to disease, and that depression can have different causes and manifestations in different people. Therefore, homeopathy does not offer a single remedy for depression, but rather selects a remedy that matches the totality of the person's physical, mental, and emotional state¹²³.

Choice A reason: Naturopathy is a system that uses natural remedies to support the body's selfhealing ability. Naturopathy is based on the principle that the body has an innate power to heal itself, and that disease is a result of an imbalance or obstruction of this vital force. Naturopathy aims to restore health by using natural substances and methods, such as herbs, nutrition, hydrotherapy, homeopathy, acupuncture, and lifestyle counseling¹². This statement is correct and does not indicate a need for further teaching.

Choice B reason: Naturopathy is not a system that uses manipulation techniques to correct structural problems in the body. This description applies to chiropractic, which is a form of alternative medicine that focuses on the diagnosis and treatment of musculoskeletal disorders, especially those of the spine. Chiropractors use manual adjustments or other devices to manipulate the spine and other joints, with the aim of improving nerve function, reducing pain, and restoring mobility³.

Choice C reason: Naturopathy is not a system that uses energy fields to balance and harmonize the body. This description applies to energy therapies, which are a type of complementary and alternative medicine that involve the use of energy fields. Energy therapies include biofield therapies, such as Reiki, therapeutic touch, and qi gong, and bioelectromagneticbased therapies, such as pulsed fields, magnetic fields, or alternatingcurrent or directcurrent fields. Energy therapies are intended to affect energy fields that surround and penetrate the human body, or to use electromagnetic fields to stimulate biological processes.

Choice D reason: Naturopathy is not a system that uses whole medical systems from different cultures to treat diseases. This description applies to integrative medicine, which is an approach that combines conventional medicine with complementary and alternative medicine from various traditions and disciplines. Integrative medicine may include practices from traditional Chinese medicine, Ayurveda, Native American medicine, Tibetan medicine, and others.

Choice A reason: Lowering systolic and diastolic blood pressure by relaxing blood vessels. This statement is partially correct, but not the best answer. Yoga may help lower both systolic and diastolic blood pressure by relaxing blood vessels, but this is not the main mechanism of action. Yoga may relax blood vessels by reducing inflammation, oxidative stress, and endothelial dysfunction¹². However, the main effect of yoga on blood pressure is mediated by the nervous system, not the vascular system³.

Choice B reason: Raising systolic and diastolic blood pressure by increasing cardiac output. This statement is incorrect. Yoga does not raise blood pressure by increasing cardiac output, but rather lowers blood pressure by decreasing cardiac output. Cardiac output is the amount of blood pumped by the heart per minute, and it depends on the heart rate and the stroke volume. Yoga can lower the heart rate by activating the parasympathetic nervous system, which slows down the heart and reduces stress hormones¹²³. Yoga can also lower the stroke volume by reducing blood volume and venous return, as a result of improved kidney function and fluid balance³.

Choice C reason: Lowering systolic blood pressure by reducing sympathetic nervous system activity. This statement is correct. Yoga can lower systolic blood pressure by reducing sympathetic nervous system activity, which is the main cause of hypertension in most cases³. The sympathetic nervous system is responsible for the fightorflight response, which prepares the body for action by increasing the heart rate, constricting the blood vessels, and releasing stress hormones. Yoga can reduce sympathetic nervous system activity by using breathing exercises, meditation, and relaxation techniques that calm the mind and body¹²³⁴. Systolic blood pressure is more sensitive to sympathetic nervous system activity than diastolic blood pressure, because it reflects the peak pressure in the arteries during each heartbeat.

Choice D reason: Raising diastolic blood pressure by stimulating reninangiotensinaldosterone system. This statement is incorrect. Yoga does not raise diastolic blood pressure by stimulating reninangiotensinaldosterone system, but rather lowers diastolic blood pressure by inhibiting reninangiotensinaldosterone system. The reninangiotensinaldosterone system is a hormonal system that regulates blood pressure and fluid balance. It involves the production of renin, a hormone that converts angiotensinogen into angiotensin I, which is then converted into angiotensin II, a potent vasoconstrictor that raises blood pressure. Angiotensin II also stimulates the release of aldosterone, a hormone that increases sodium and water retention in the kidneys, which also raises blood pressure. Yoga can inhibit reninangiotensinaldosterone system by reducing stress hormones, such as cortisol and adrenaline, which stimulate renin production³.

Choice A reason: Focusing attention on a word, phrase, object, or breathing. This is one of the common actions of meditation, especially in focused attention meditation, where the person concentrates on a single point of reference, such as a mantra, a candle flame, or the sensation of the breath²³. This can help calm the mind and reduce distractions.

- Choice B reason: Inducing a state of deep relaxation and altered consciousness. This is another possible action of meditation, especially in relaxation exercises, such as progressive muscle relaxation or body scan meditation, where the person systematically relaxes different parts of the body and becomes more aware of their physical sensations²⁵. This can help lower the heart rate, blood pressure, and muscle tension.

- Choice C reason: Enhancing awareness and acceptance of thoughts and feelings. This is yet another action of meditation, especially in mindfulness meditation, where the person observes their thoughts and emotions without judging or reacting to them²⁴. This can help foster a more positive and compassionate attitude towards oneself and others.

- Choice D reason: All of the above. Meditation can involve all of these actions, depending on the type and purpose of the practice. Therefore, this is the correct answer.

- Choice A reason: Garlic, which may increase the risk of bleeding with anticoagulants. Garlic has antiplatelet and fibrinolytic effects that can potentiate the action of anticoagulants, such as warfarin, heparin, or aspirin²³. This can increase the risk of bleeding and bruising.

- Choice B reason: Ginseng, which may lower blood glucose levels with antidiabetic agents. Ginseng may have hypoglycemic effects that can enhance the action of antidiabetic agents, such as insulin, metformin, or sulfonylureas²³. This can increase the risk of hypoglycemia and its symptoms.

- Choice C reason: Valerian, which may cause excessive sedation with benzodiazepines. Valerian has sedative and anxiolytic effects that can augment the action of benzodiazepines, such as diazepam, lorazepam, or alprazolam²³. This can increase the risk of excessive sedation, drowsiness, and impaired cognition.

- Choice D reason: Chamomile, which may cause allergic reactions with penicillins. Chamomile may contain cross-reactive allergens that can trigger allergic reactions in patients who are allergic to penicillins, such as amoxicillin, ampicillin, or piperacillin²³. This can cause symptoms such as rash, itching, swelling, or anaphylaxis.

- Choice E reason: Ginger, which may reduce nausea and vomiting with antiemetics. Ginger has antiemetic effects that can complement the action of antiemetics, such as ondansetron, metoclopramide, or promethazine²³. This can reduce the symptoms of nausea and vomiting caused by various conditions or treatments.

- Choice A reason: "I feel more relaxed and less tense after the massage." This is a positive outcome of massage therapy, as it indicates that the massage has reduced the stress and muscle tension that may contribute to neck pain²³. Massage therapy may also stimulate the release of endorphins and other neurochemicals that can enhance the mood and sense of well-being¹.

- Choice B reason: "I have more energy and less fatigue after the massage." This is not a specific outcome of massage therapy for chronic neck pain, although it may be a general benefit of massage therapy for overall health and wellness¹. Massage therapy may improve blood circulation and oxygen delivery, which can boost energy levels and reduce fatigue⁴.

- Choice C reason: "I have more mobility and less stiffness in my neck after the massage." This is not a consistent outcome of massage therapy for chronic neck pain, although it may be a possible benefit for some patients²³. Massage therapy may increase the range of motion and joint space, which can improve mobility and reduce stiffness⁴. However, the evidence for this effect is not strong or conclusive.

- Choice D reason: "I have more confidence and less depression after the massage." This is not a direct outcome of massage therapy for chronic neck pain, although it may be an indirect benefit of massage therapy for mental health¹. Massage therapy may reduce anxiety, depression, and negative emotions, and increase self-esteem, self-awareness, and coping skills⁴.

Choice A reason: This statement is accurate and appropriate for explaining Reiki to a client who has anxiety disorder. Reiki is a form of energy healing that involves the transfer of universal energy from the practitioner's palms to the client²¹. Reiki aims to improve the flow and balance of energy around the body, which can promote relaxation, relieve pain, speed healing, and reduce stress and anxiety²³⁴.

Choice B reason: This statement is incorrect and inappropriate for explaining Reiki to a client who has anxiety disorder. Reiki does not use magnets to stimulate energy points. Magnets are used in another form of energy therapy called magnetic field therapy, which involves applying static magnets to the body for pain relief².

Choice C reason: This statement is incorrect and inappropriate for explaining Reiki to a client who has anxiety disorder. Reiki does not use needles to restore energy flow. Needles are used in another form of energy therapy called acupuncture, which involves inserting thin needles into specific points on the body to regulate the flow of qi (life force energy) and treat various health conditions².

Choice D reason: This statement is incorrect and inappropriate for explaining Reiki to a client who has anxiety disorder. Reiki does not use cups to create suction on energy centers. Cups are used in another form of energy therapy called cupping, which involves placing heated cups on the skin to create a vacuum and increase blood circulation and healing².

Choice A reason: This statement is correct and reflects one of the core concepts of TCM. TCM is based on the theory that sickness stems from an imbalance in the life force energy (qi) and its components of yin and yang¹². Yin and yang are complementary opposites that represent the dynamic balance of all things in the universe, including the body and the environment³. TCM aims to restore harmony between yin and yang by using various healing techniques, such as acupuncture, herbal medicine, diet, and exercise¹².

Choice B reason: This statement is also correct and reflects another core concept of TCM. TCM is based on the principle that health is not just the absence of disease, but a state of complete physical, mental, and spiritual well-being¹². TCM views the body, mind, and spirit as interconnected and interdependent, and considers how emotions, thoughts, beliefs, and lifestyle can affect health¹². TCM also emphasizes the importance of prevention and self-care, as well as the cultivation of inner harmony¹².

Choice C reason: This statement is also correct and reflects one of the healing techniques of TCM. TCM is based on the concept that qi flows through specific pathways or meridians in the body, connecting the organs and functions¹². When qi is blocked or disrupted, it can cause pain, illness, or disease¹². TCM uses acupuncture to stimulate specific points on the meridians to restore or enhance the flow of qi and balance yin and yang¹². Acupuncture involves inserting thin needles into the skin at various depths and angles¹².

Choice D reason: This statement is correct because it includes all of the above statements. TCM is based on a holistic and comprehensive view of health that incorporates the balance of yin and yang in the body and the environment, the integration of body, mind, and spirit in health and disease, and the stimulation of specific points on the body to restore energy balance¹². Therefore, choice D is the best answer for explaining TCM to a client who has diabetes mellitus.

Choice A reason: This statement is correct and reflects one of the potential benefits of CAM products and practices for health and well-being. CAM products and practices may provide relief for chronic or difficult-to-treat conditions that conventional medicine may not be able to cure or manage effectively¹². For example, some people with cancer may use CAM to help cope with the side effects of cancer treatments, such as nausea, pain, and fatigue¹³.

Choice B reason: This statement is also correct and reflects another potential benefit of CAM products and practices for health and well-being. CAM products and practices may enhance the body's natural healing abilities and immune system function by stimulating the self-regulatory mechanisms of the body¹². For example, some CAM therapies, such as acupuncture, massage, and meditation, may modulate the neuroendocrine and immune systems, which are involved in the body's response to stress, inflammation, and infection¹².

Choice C reason: This statement is also correct and reflects another potential benefit of CAM products and practices for health and well-being. CAM products and practices may reduce stress and promote relaxation and coping skills by addressing the psychological, emotional, and spiritual aspects of health¹². For example, some CAM therapies, such as yoga, tai chi, and biofeedback, may enhance the mind-body connection, improve mood, increase self-awareness, and foster resilience¹².

Choice D reason: This statement is correct because it includes all of the above statements. CAM products and practices may offer various benefits for health and well-being by providing relief for chronic or difficult-to-treat conditions, enhancing the body's natural healing abilities and immune system function, and reducing stress and promoting relaxation and coping skills¹². Therefore, choice D is the best answer for recognizing the benefits of CAM products and practices for a client who uses them to cope with anxiety and depression.

Choice A reason: This statement is accurate and appropriate for describing meditation as a CAM practice. Meditation is a mind-body technique that involves focusing attention on a word, object, breath, or sensation, in order to calm the mind, relax the body, and enhance awareness¹². Meditation may have various benefits for health and well-being, such as reducing stress, anxiety, depression, pain, blood pressure, and inflammation, and improving mood, cognition, immune function, and quality of life¹²³.

Choice B reason: This statement is incorrect and inappropriate for describing meditation as a CAM practice. Meditation is not a technique that uses natural or biological substances to intervene at a biological level. Natural or biological substances are used in another type of CAM practice called biologically based therapies, which involve the use of herbs, vitamins, minerals, dietary supplements, or other natural products to treat or prevent various health conditions¹².

Choice C reason: This statement is incorrect and inappropriate for describing meditation as a CAM practice. Meditation is not a technique that uses manipulation techniques to correct structural problems in the body. Manipulation techniques are used in another type of CAM practice called manipulative and body-based therapies, which involve the movement or manipulation of parts of the body, such as bones, joints, muscles, or soft tissues, to improve function and health¹². Examples of manipulative and body-based therapies include chiropractic, osteopathy, massage, and reflexology¹².

Choice D reason: This statement is incorrect and inappropriate for describing meditation as a CAM practice. Meditation is not a technique that uses energy fields to balance and harmonize the body. Energy fields are used in another type of CAM practice called energy therapies, which involve the use of energy sources, either external or internal, to influence health and healing¹². Examples of energy therapies include electromagnetic therapy, reiki, qigong, acupuncture, and therapeutic touch¹².

Choice A reason: This statement is accurate and appropriate for describing meditation as a CAM practice. Meditation is a mind-body technique that involves focusing attention on a word, object, breath, or sensation, in order to calm the mind, relax the body, and enhance awareness¹². Meditation may have various benefits for health and well-being, such as reducing stress, anxiety, depression, pain, blood pressure, and inflammation, and improving mood, cognition, immune function, and quality of life¹²³.

Choice B reason: This statement is incorrect and inappropriate for describing meditation as a CAM practice. Meditation is not a technique that uses natural or biological substances to intervene at a biological level. Natural or biological substances are used in another type of CAM practice called biologically based therapies, which involve the use of herbs, vitamins, minerals, dietary supplements, or other natural products to treat or prevent various health conditions¹².

Choice C reason: This statement is incorrect and inappropriate for describing meditation as a CAM practice. Meditation is not a technique that uses manipulation techniques to correct structural problems in the body. Manipulation techniques are used in another type of CAM practice called manipulative and body-based therapies, which involve the movement or manipulation of parts of the body, such as bones, joints, muscles, or soft tissues, to improve function and health¹². Examples of manipulative and body-based therapies include chiropractic, osteopathy, massage, and reflexology¹².

Choice D reason: This statement is incorrect and inappropriate for describing meditation as a CAM practice. Meditation is not a technique that uses energy fields to balance and harmonize the body. Energy fields are used in another type of CAM practice called energy therapies, which involve the use of energy sources, either external or internal, to influence health and healing¹². Examples of energy therapies include electromagnetic therapy, reiki, qigong, acupuncture, and therapeutic touch¹².

Choice A reason: This statement is correct and reflects one of the core concepts of TCM. TCM is based on the theory that sickness stems from an imbalance in the life force energy (qi) and its components of yin and yang¹². Yin and yang are complementary opposites that represent the dynamic balance of all things in the universe, including the body and the environment³. TCM aims to restore harmony between yin and yang by using various healing techniques, such as acupuncture, herbal medicine, diet, and exercise¹².

Choice B reason: This statement is also correct and reflects another core concept of TCM. TCM is based on the principle that health is not just the absence of disease, but a state of complete physical, mental, and spiritual well-being¹². TCM views the body, mind, and spirit as interconnected and interdependent, and considers how emotions, thoughts, beliefs, and lifestyle can affect health¹². TCM also emphasizes the importance of prevention and self-care, as well as the cultivation of inner harmony¹².

Choice C reason: This statement is also correct and reflects one of the healing techniques of TCM. TCM is based on the concept that qi flows through specific pathways or meridians in the body, connecting the organs and functions¹². When qi is blocked or disrupted, it can cause pain, illness, or disease¹². TCM uses acupuncture to stimulate specific points on the meridians to restore or enhance the flow of qi and balance yin and yang¹². Acupuncture involves inserting thin needles into the skin at various depths and angles¹².

Choice D reason: This statement is correct because it includes all of the above statements. TCM is based on a holistic and comprehensive view of health that incorporates the balance of yin and yang in the body and the environment, the integration of body, mind, and spirit in health and disease, and the stimulation of specific points on the body to restore energy balance¹². Therefore, choice D is the best answer for understanding TCM as a CAM whole medical system for a client who has hypertension.

Choice A reason: This statement is correct and reflects one of the reasons why it is important to seek reliable sources of information about CAM products and practices. There is a lot of misinformation, bias, or fraud on the internet or media regarding CAM products and practices. Some websites or advertisements may make false or exaggerated claims about the benefits, safety, or quality of CAM products and practices, or may try to sell unproven or harmful products to consumers¹². Therefore, it is important to evaluate the credibility and reliability of the source of information on CAM, such as the author, publisher, sponsor, purpose, evidence, and date of publication¹².

Choice B reason: This statement is also correct and reflects another reason why it is important to seek reliable sources of information about CAM products and practices. There is a lack of regulation, standardization, or quality control of many CAM products and practices. Unlike conventional drugs or devices, many CAM products and practices are not subject to rigorous testing, approval, or monitoring by regulatory agencies, such as the Therapeutic Goods Administration (TGA) in Australia or the Food and Drug Administration (FDA) in the United States¹². This means that there may be variations in the ingredients, potency, purity, safety, or effectiveness of CAM products and practices¹². Therefore, it is important to look for evidence of quality assurance or certification of CAM products and practices by reputable organizations or authorities¹².

Choice C reason: This statement is also correct and reflects another reason why it is important to seek reliable sources of information about CAM products and practices. There is a need to evaluate the scientific evidence, credibility, safety, and effectiveness of CAM products and practices before using them. Unlike conventional treatments that are based on scientific research and clinical trials, many CAM products and practices are based on traditional knowledge, personal experience, or anecdotal reports¹². This means that there may be insufficient or inconsistent evidence to support the claims or outcomes of CAM products and practices¹². Therefore, it is important to look for high-quality scientific studies or systematic reviews that have evaluated the safety and effectiveness of CAM products and practices for specific health conditions or symptoms¹².

Choice D reason: This statement is also correct and reflects another reason why it is important to seek reliable sources of information about CAM products and practices. There is a need to compare the costs, benefits, and availability of different CAM products and practices. Unlike conventional treatments that are often covered by health insurance or subsidized by government programs, many CAM products and practices are not reimbursed or supported by these schemes¹². This means that consumers may have to pay out-of-pocket for CAM products and practices, which can be expensive or unaffordable for some people¹². Therefore, it is important to look for information on the costs, benefits, and availability of different CAM products and practices, and weigh them against the risks, harms, or limitations¹².

Choice E reason: This statement is incorrect and does not reflect a reason why it is important to seek reliable sources of information about CAM products and practices. While it is important to respect the cultural, spiritual, and personal beliefs of different CAM users as part of ethical and patient-centered care¹², this does not imply that seeking reliable sources of information about CAM products and practices is unnecessary or irrelevant. On the contrary, seeking reliable sources of information about CAM products and practices can help consumers make informed choices that are consistent with their values and preferences¹².

Choice A reason: This statement is incorrect and inappropriate for counseling a client who wants to use natural medicines as a CAM product to treat his health conditions. While the National Center for Complementary and Integrative Health (NCCIH) website is a reliable source of information about CAM in general, it does not provide detailed or comprehensive information about specific natural medicines, such as their ingredients, dosage, safety, effectiveness, interactions, or quality¹². The NCCIH website mainly provides overviews of common CAM products and practices, such as herbs at a glance, and links to other sources of information, such as the Office of Dietary Supplements or MedlinePlus¹².

Choice B reason: This statement is incorrect and inappropriate for counseling a client who wants to use natural medicines as a CAM product to treat his health conditions. While the Office of Dietary Supplements (ODS) website is a reliable source of information about dietary supplements in general, it does not provide detailed or comprehensive information about specific natural medicines, such as their ingredients, dosage, safety, effectiveness, interactions, or quality¹². The ODS website mainly provides overviews of common dietary supplements, such as vitamins and minerals, and links to other sources of information, such as the Dietary Supplement Label Database or PubMed¹².

Choice C reason: This statement is correct and appropriate for counseling a client who wants to use natural medicines as a CAM product to treat his health conditions. The Natural Medicines Comprehensive Database (NMCD) website is a reliable source of information about specific natural medicines, such as their ingredients, dosage, safety, effectiveness, interactions, and quality¹². The NMCD website provides evidence-based ratings and reviews of over 1,200 natural medicines based on scientific research and clinical trials¹². The NMCD website also provides tools and resources for consumers and health care professionals to make informed decisions about natural medicines¹².

Choice D reason: This statement is incorrect and inappropriate for counseling a client who wants to use natural medicines as a CAM product to treat his health conditions. While the Cochrane Library website is a reliable source of information about evidence-based medicine in general, it does not provide detailed or comprehensive information about specific natural medicines, such as their ingredients, dosage, safety, effectiveness, interactions, or quality¹². The Cochrane Library website mainly provides systematic reviews and meta-analyses of various health interventions, including some CAM products and practices, but not all natural medicines are covered or updated regularly¹².

Choice A reason: This statement is correct and reflects the type of information that Cochrane Library provides about CAM products and practices. Cochrane Library is a reliable source of information about evidence-based medicine in general, and it includes systematic reviews and meta-analyses of randomized controlled trials on CAM products and practices¹². Systematic reviews are comprehensive and rigorous summaries of the best available evidence on a specific health question, and meta-analyses are statistical methods to combine the results of different studies¹². Randomized controlled trials are experimental studies that compare the effects of an intervention (such as a CAM product or practice) with a control (such as a placebo or a conventional treatment) in randomly assigned groups of participants¹². Cochrane Library provides access to over 10,000 Cochrane Reviews, including more than 500 reviews on CAM products and practices, covering topics such as acupuncture, herbal medicine, homeopathy, massage, meditation, yoga, and more¹².

Choice B reason: This statement is incorrect and does not reflect the type of information that Cochrane Library provides about CAM products and practices. While fact sheets and summaries of evidence-based information on CAM products and practices are useful for consumers and health care professionals, they are not the main focus or output of Cochrane Library. Cochrane Library mainly provides systematic reviews and meta-analyses of randomized controlled trials on CAM products and practices, as well as other health interventions¹². Fact sheets and summaries of evidence-based information on CAM products and practices can be found from other sources, such as the National Center for Complementary and Integrative Health (NCCIH) or the Office of Dietary Supplements (ODS)¹².

Choice C reason: This statement is incorrect and does not reflect the type of information that Cochrane Library provides about CAM products and practices. While monographs and ratings of safety, effectiveness, interactions, and adverse effects of natural medicines are useful for consumers and health care professionals, they are not the main focus or output of Cochrane Library. Cochrane Library mainly provides systematic reviews and meta-analyses of randomized controlled trials on CAM products and practices, as well as other health interventions¹². Monographs and ratings of safety, effectiveness, interactions, and adverse effects of natural medicines can be found from other sources, such as the Natural Medicines Comprehensive Database (NMCD) or MedlinePlus¹².

Choice D reason: This statement is incorrect and does not reflect the type of information that Cochrane Library provides about CAM products and practices. While guidelines and recommendations on the appropriate use and dosage of dietary supplements are useful for consumers and health care professionals, they are not the main focus or output of Cochrane Library. Cochrane Library mainly provides systematic reviews and meta-analyses of randomized controlled trials on CAM products and practices, as well as other health interventions¹². Guidelines and recommendations on the appropriate use and dosage of dietary supplements can be found from other sources, such as the National Institutes of Health (NIH), the World Health Organization (WHO), or professional organizations¹².

Choice A reason: This statement is correct and reflects one of the reasons why the nurse should respect the client's preferences and beliefs regarding CAM use. To build trust, rapport, and communication with the client, the nurse should acknowledge and accept the client's choices and values regarding CAM use, without being judgmental, dismissive, or coercive¹². The nurse should also encourage the client to share his or her experiences and expectations of CAM use, and listen actively and empathetically to the client's concerns and needs¹². By doing so, the nurse can establish a positive therapeutic relationship with the client, and facilitate mutual understanding and collaboration on health care decisions¹².

Choice B reason: This statement is also correct and reflects another reason why the nurse should respect the client's preferences and beliefs regarding CAM use. To understand the client's values, goals, expectations, motivations, and experiences regarding his or her health and well-being, the nurse should explore and appreciate the client's perspectives and reasons for using CAM products and practices¹². The nurse should also recognize that the client's preferences and beliefs regarding CAM use may be influenced by various factors, such as personal or family history, culture, spirituality, education, media, or peer pressure¹². By doing so, the nurse can gain a holistic and individualized understanding of the client's health situation, and provide appropriate and tailored health education and counseling¹².

Choice C reason: This statement is also correct and reflects another reason why the nurse should respect the client's preferences and beliefs regarding CAM use. To acknowledge the client's cultural diversity, spirituality, autonomy, dignity, and rights regarding his or her health care, the nurse should respect and support the client's freedom and responsibility to make informed choices about CAM use, based on his or her own values and beliefs¹². The nurse should also avoid imposing his or her own views or biases on the client, or discriminating against the client based on his or her CAM use¹². By doing so, the nurse can demonstrate ethical and patient-centered care, and promote the client's empowerment and self-determination¹².

Choice D reason: This statement is correct because it includes all of the above statements. Respecting the client's preferences and beliefs regarding CAM use is important for various reasons related to the quality, safety, and satisfaction of care¹². Therefore, choice D is the best answer for understanding why the nurse should respect the client's preferences and beliefs regarding CAM use.

Choice A reason: This statement is correct and reflects one of the reasons why the nurse should provide patient education and counseling on safe and effective use of CAM. To help the client make informed and shared decisions about his or her health care, the nurse should provide accurate, evidence-based, and unbiased information about the benefits and risks of CAM products and practices, as well as conventional treatments¹². The nurse should also elicit the client's preferences, values, goals, expectations, and motivations regarding CAM use, and involve the client in the decision-making process¹². By doing so, the nurse can enhance the client's knowledge, confidence, satisfaction, and adherence to his or her chosen health care plan¹².

Choice B reason: This statement is also correct and reflects another reason why the nurse should provide patient education and counseling on safe and effective use of CAM. To provide accurate, evidence-based, and unbiased information about the benefits and risks of CAM products and practices, the nurse should seek reliable sources of information about CAM, such as Cochrane Library, Natural Medicines Comprehensive Database, or National Center for Complementary and Integrative Health¹². The nurse should also evaluate the quality, validity, and applicability of the information to the client's specific health condition or symptom¹². By doing so, the nurse can help the client understand the current state of evidence on CAM use, and avoid misinformation, bias, or fraud that may be present on the internet or media¹².

Choice C reason: This statement is also correct and reflects another reason why the nurse should provide patient education and counseling on safe and effective use of CAM. To advise the client on how to use CAM products and practices appropriately, safely, and effectively, the nurse should provide guidance on the type, dose, duration, frequency, timing, quality, and combination of CAM products and practices that are suitable for the client's health situation¹². The nurse should also monitor for any adverse effects or interactions with conventional treatments that may occur with CAM use, and advise the client on how to prevent or manage them¹². By doing so, the nurse can help the client optimize the outcomes of CAM use, and minimize the potential harms or complications¹².

Choice D reason: This statement is also correct and reflects another reason why the nurse should provide patient education and counseling on safe and effective use of CAM. To empower the client to take responsibility and ownership of his or her health and well-being, the nurse should support the client's autonomy and self-determination regarding CAM use, based on his or her own values and beliefs¹². The nurse should also encourage the client to actively participate in his or her health care plan, self-monitor his or her health status and progress, seek help when needed, and communicate openly with other health care providers about CAM use¹². By doing so, the nurse can promote the client's empowerment and self-care abilities¹².

Choice E reason: This statement is incorrect and does not reflect a reason why the nurse should provide patient education and counseling on safe and effective use of CAM. While monitoring the client's compliance and adherence to his or her conventional treatments is important for ensuring quality and safety of care¹², it does not imply that providing patient education and counseling on safe and effective use of CAM is unnecessary or irrelevant. On the contrary, providing patient education and counseling on safe and effective use of CAM can help improve the client's compliance and adherence to his or her conventional treatments by addressing any concerns or barriers that may prevent him or her from following them¹². For example, if a client is experiencing side effects from chemotherapy that affect his or her quality of life, providing patient education and counseling on safe and effective use of CAM may help him or her find ways to cope with them without compromising his or her chemotherapy treatment¹².

Choice A reason: This statement is incorrect and inappropriate for counseling a client who wants to use meditation as a CAM practice to reduce stress and promote relaxation. The nurse should not tell the client that he or she should meditate for at least an hour every day to achieve optimal results. There is no definitive evidence or guideline on the optimal duration or frequency of meditation practice for different health outcomes¹². The nurse should advise the client to start with a short and comfortable duration of meditation, such as 10 to 15 minutes, and gradually increase it as he or she becomes more familiar and proficient with the technique¹². The nurse should also encourage the client to find a convenient and consistent time and place for meditation, and to practice it regularly but not rigidly¹².

Choice B reason: This statement is incorrect and inappropriate for counseling a client who wants to use meditation as a CAM practice to reduce stress and promote relaxation. The nurse should not tell the client that he or she should consult his or her health care provider before starting meditation practice. Meditation is generally considered a safe and low-risk CAM practice that can be practiced by most people without any adverse effects or contraindications¹². The nurse should inform the client that meditation is not a substitute for conventional medical care, and that he or she should continue to follow his or her health care provider's advice and treatment plan¹². The nurse should also advise the client to inform his or her health care provider about his or her meditation practice, and to report any changes in his or her health status or symptoms¹².

Choice C reason: This statement is correct and appropriate for counseling a client who wants to use meditation as a CAM practice to reduce stress and promote relaxation. The nurse should tell the client that he or she should use meditation as a complementary therapy along with his or her conventional treatments. Meditation is a mind-body technique 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 a cure for any disease or condition, and it does not replace the need for conventional medical care¹². The nurse should advise the client to use meditation as an adjunctive therapy that can enhance the effects of his or her conventional treatments, and not as an alternative therapy that can replace them¹².

Choice D reason: This statement is incorrect and inappropriate for counseling a client who wants to use meditation as a CAM practice to reduce stress and promote relaxation. The nurse should not tell the client that he or she should stop his or her conventional treatments if he or she feels better with meditation. As mentioned above, meditation is not a cure for any disease or condition, and it does not replace the need for conventional medical care¹². The nurse should warn the client that stopping his or her conventional treatments without consulting his or her health care provider may worsen his or her health condition or symptoms, or cause serious complications or side effects¹². The nurse should also remind the client that feeling better with meditation does not necessarily mean that his or her underlying disease or condition has improved or resolved, and that he or she should continue to monitor his or her health status and symptoms with regular check-ups and tests¹².

Choice A reason: This statement is correct and reflects one of the reasons why the nurse should provide patient education and counseling on safe and effective use of CAM. To help the client make informed and shared decisions about his or her health care, the nurse should provide accurate, evidence-based, and unbiased information about the benefits and risks of CAM products and practices, as well as conventional treatments¹². The nurse should also elicit the client's preferences, values, goals, expectations, and motivations regarding CAM use, and involve the client in the decision-making process¹². By doing so, the nurse can enhance the client's knowledge, confidence, satisfaction, and adherence to his or her chosen health care plan¹².

Choice B reason: This statement is also correct and reflects another reason why the nurse should provide patient education and counseling on safe and effective use of CAM. To provide accurate, evidence-based, and unbiased information about the benefits and risks of CAM products and practices, the nurse should seek reliable sources of information about CAM, such as Cochrane Library, Natural Medicines Comprehensive Database, or National Center for Complementary and Integrative Health¹². The nurse should also evaluate the quality, validity, and applicability of the information to the client's specific health condition or symptom¹². By doing so, the nurse can help the client understand the current state of evidence on CAM use, and avoid misinformation, bias, or fraud that may be present on the internet or media¹².

Choice C reason: This statement is also correct and reflects another reason why the nurse should provide patient education and counseling on safe and effective use of CAM. To advise the client on how to use CAM products and practices appropriately, safely, and effectively, the nurse should provide guidance on the type, dose, duration, frequency, timing, quality, and combination of CAM products and practices that are suitable for the client's health situation¹². The nurse should also monitor for any adverse effects or interactions with conventional treatments that may occur with CAM use, and advise the client on how to prevent or manage them¹². By doing so, the nurse can help the client optimize the outcomes of CAM use, and minimize the potential harms or complications¹².

Choice D reason: This statement is also correct and reflects another reason why the nurse should provide patient education and counseling on safe and effective use of CAM. To empower the client to take responsibility and ownership of his or her health and well-being, the nurse should support the client's autonomy and self-determination regarding CAM use, based on his or her own values and beliefs¹². The nurse should also encourage the client to actively participate in his or her health care plan, self-monitor his or her health status and progress, seek help when needed, and communicate openly with other health care providers about CAM use¹². By doing so, the nurse can promote the client's empowerment and self-care abilities¹².

Choice E reason: This statement is incorrect and does not reflect a reason why the nurse should provide patient education and counseling on safe and effective use of CAM. While monitoring the client's compliance and adherence to his or her conventional treatments is important for ensuring quality and safety of care¹², it does not imply that providing patient education and counseling on safe and effective use of CAM is unnecessary or irrelevant. On the contrary, providing patient education and counseling on safe and effective use of CAM can help improve the client's compliance and adherence to his or her conventional treatments by addressing any concerns or barriers that may prevent him or her from following them¹². For example, if a client is experiencing side effects from chemotherapy that affect his or her quality of life, providing patient education and counseling on safe and effective use of CAM may help him or her find ways to cope with them without compromising his or her chemotherapy treatment¹².

Choice A reason: This statement is correct and indicates an understanding of the teaching. The nurse should teach the client that he or she should inform his or her health care providers about his or her CAM use so they can coordinate his or her care¹². The nurse should explain that CAM products and practices may have benefits, risks, interactions, or contraindications with conventional treatments, and that health care providers need to know about them to ensure safe and effective care¹². The nurse should also encourage the client to communicate openly and honestly with his or her health care providers about his or her goals, expectations, experiences, and concerns regarding CAM use, and to seek their advice and guidance when needed¹². By doing so, the client can foster a trusting and collaborative relationship with his or her health care providers, and avoid potential harms or complications from CAM use¹².

Choice B reason: This statement is incorrect and does not indicate an understanding of the teaching. The nurse should teach the client that he or she should not use CAM products and practices as a substitute for his or her conventional treatments¹². The nurse should explain that CAM products and practices are not proven to cure or treat any disease or condition, and that they do not replace the need for conventional medical care¹². The nurse should warn the client that using CAM products and practices instead of conventional treatments may worsen his or her health condition or symptoms, or cause serious complications or side effects¹². The nurse should also advise the client to use CAM products and practices as a complementary therapy along with his or her conventional treatments, and not as an alternative therapy that can replace them¹².

Choice C reason: This statement is incorrect and does not indicate an understanding of the teaching. The nurse should teach the client that he or she should not check the internet or social media for the latest information on CAM products and practices¹². The nurse should explain that the internet or social media may contain inaccurate, misleading, biased, or fraudulent information on CAM products and practices, and that they may not be reliable sources of evidence-based information¹². The nurse should warn the client that relying on the internet or social media for information on CAM products and practices may expose him or her to misinformation, scams, or harm¹². The nurse should also advise the client to seek reliable sources of information on CAM products and practices, such as Cochrane Library, Natural Medicines Comprehensive Database, or National Center for Complementary and Integrative Health¹².

Choice D reason: This statement is incorrect and does not indicate an understanding of the teaching. The nurse should teach the client that he or she should not avoid telling his or her health care providers about his or her CAM use because they might not approve¹². The nurse should explain that hiding his or her CAM use from his or her health care providers may jeopardize his or her safety and quality of care, as they may not be aware of potential benefits, risks, interactions, or contraindications with conventional treatments¹². The nurse should also assure the client that most health care providers are open-minded and respectful of their patients' choices and values regarding CAM use, and that they are willing to work with them to coordinate their care¹². The nurse should also encourage the client to inform his or her health care providers about his or her CAM use so they can coordinate his or her care¹².

Choice A reason: This statement is incorrect and inappropriate for counseling a client who wants to use meditation as a CAM practice to reduce stress and promote relaxation. The nurse should not tell the client that he or she should meditate for at least an hour every day to achieve optimal results. There is no definitive evidence or guideline on the optimal duration or frequency of meditation practice for different health outcomes¹². The nurse should advise the client to start with a short and comfortable duration of meditation, such as 10 to 15 minutes, and gradually increase it as he or she becomes more familiar and proficient with the technique¹². The nurse should also encourage the client to find a convenient and consistent time and place for meditation, and to practice it regularly but not rigidly¹².

Choice B reason: This statement is incorrect and inappropriate for counseling a client who wants to use meditation as a CAM practice to reduce stress and promote relaxation. The nurse should not tell the client that he or she should consult his or her health care provider before starting meditation practice. Meditation is generally considered a safe and low-risk CAM practice that can be practiced by most people without any adverse effects or contraindications¹². The nurse should inform the client that meditation is not a substitute for conventional medical care, and that he or she should continue to follow his or her health care provider's advice and treatment plan¹². The nurse should also advise the client to inform his or her health care provider about his or her meditation practice, and to report any changes in his or her health status or symptoms¹².

Choice C reason: This statement is correct and appropriate for counseling a client who wants to use meditation as a CAM practice to reduce stress and promote relaxation. The nurse should tell the client that he or she should use meditation as a complementary therapy along with his or her conventional treatments. Meditation is a mind-body technique 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 a cure for any disease or condition, and it does not replace the need for conventional medical care¹². The nurse should advise the client to use meditation as an adjunctive therapy that can enhance the effects of his or her conventional treatments, and not as an alternative therapy that can replace them¹².

Choice D reason: This statement is incorrect and inappropriate for counseling a client who wants to use meditation as a CAM practice to reduce stress and promote relaxation. The nurse should not tell the client that he or she should stop his or her conventional treatments if he or she feels better with meditation. As mentioned above, meditation is not a cure for any disease or condition, and it does not replace the need for conventional medical care¹². The nurse should warn the client that stopping his or her conventional treatments without consulting his or her health care provider may worsen his or her health condition or symptoms, or cause serious complications or side effects¹². The nurse should also remind the client that feeling better with meditation does not necessarily mean that his or her underlying disease or condition has improved or resolved, and that he or she should continue to monitor his or her health status and symptoms with regular check-ups and tests¹².

Choice A reason: This statement is correct and reflects one of the outcomes that may indicate the effectiveness of patient education and counseling on safe and effective use of CAM. The nurse should assess whether the client has made informed and shared decisions about his or her health care, based on accurate, evidence-based, and unbiased information about the benefits and risks of CAM products and practices, as well as conventional treatments¹². The nurse should also assess whether the client has involved his or her health care provider and other relevant stakeholders in the decision-making process, and whether the client is satisfied and confident with his or her chosen health care plan¹². By doing so, the nurse can evaluate the impact of patient education and counseling on safe and effective use of CAM on the client's knowledge, autonomy, and empowerment¹².

Choice B reason: This statement is also correct and reflects another outcome that may indicate the effectiveness of patient education and counseling on safe and effective use of CAM. The nurse should assess whether the client has used CAM products and practices appropriately, safely, and effectively, based on guidance on the type, dose, duration, frequency, timing, quality, and combination of CAM products and practices that are suitable for his or her health situation¹². The nurse should also assess whether the client has monitored for any adverse effects or interactions with conventional treatments that may occur with CAM use, and whether the client has prevented or managed them accordingly¹². By doing so, the nurse can evaluate the impact of patient education and counseling on safe and effective use of CAM on the client's health outcomes, safety, and quality of care¹².

Choice C reason: This statement is also correct and reflects another outcome that may indicate the effectiveness of patient education and counseling on safe and effective use of CAM. The nurse should assess whether the client has taken responsibility and ownership of his or her health and well-being, based on support for his or her autonomy and self-determination regarding CAM use, as well as conventional treatments¹². The nurse should also assess whether the client has actively participated in his or her health care plan, self-monitored his or her health status and progress, sought help when needed, and communicated openly with other health care providers about CAM use¹². By doing so, the nurse can evaluate the impact of patient education and counseling on safe and effective use of CAM on the client's self-care abilities, empowerment, and satisfaction¹².

Choice D reason: This statement is correct because it includes all of the above statements. Patient education and counseling on safe and effective use of CAM can have various outcomes that may indicate its effectiveness for different aspects of health care¹². Therefore, choice D is the best answer for assessing the outcomes that may indicate the effectiveness of patient education and counseling on safe and effective use of CAM.

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.