A nurse is evaluating a client who has been receiving chiropractic therapy for chronic neck pain. The nurse should ask the client about which of the following adverse effects that may occur after chiropractic manipulation?

The correct answer is

A. Obtain informed consent from the client

B. Place the hands on or near the client's body

C. Assess the client's energy field for imbalances or disturbances

E. Provide feedback to the client about the session

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 field. Therapeutic touch is based on the premise that human beings are composed of energy that can be influenced by the practitioner's intention and consciousness. Therapeutic touch may have some benefits for reducing pain, anxiety, stress, and enhancing well-being. However, therapeutic touch is not a substitute for conventional medical care, and it may not be suitable or acceptable for everyone. 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 therapy.

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 field. 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 manner. 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 field. 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 field.

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 field. 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 disturbance. The nurse should also use professional, informed, and intuitive judgment to evaluate the condition of the client's energy field and determine where to intervene.

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 feelings. Meditation can help reduce stress, anxiety, depression, pain, blood pressure, and inflammation, and improve mood, sleep, immune function, cognitive performance, and quality of life. 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 visualization. Centering helps the nurse to connect with his or her inner core of wholeness and stillness and to attune to the client's energy field.

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 them¹ [^2^. 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 1 2

The correct answer is

D. All of the above.

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 effects. However, it may also affect the metabolism and clearance of some drugs by inducing the activity of certain enzymes in the liver. One of these enzymes, called CYP3A4, is responsible for breaking down oral contraceptives, such as ethinyl estradiol and norethindrone. Taking St. John's wort with oral contraceptives may reduce their effectiveness and increase the risk of pregnancy or breakthrough bleeding. Therefore, the nurse should advise the client to use an alternative or additional method of birth control while taking St. John's wort.

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 blood. Some examples of anticoagulants are warfarin, heparin, and dabigatran. Taking St. John's wort with anticoagulants may decrease their effectiveness and increase the risk of thrombosis or embolism. 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 dabigatran. 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 wort.

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 cycle. Some examples of antiretrovirals are protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and integrase inhibitors. 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). 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 antiretrovirals. 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 supplements.

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 pharmacodynamics. Some of these interactions may have serious consequences for the client's health and well-being. Therefore, choice D is the best answer for informing the client that St. John's wort may interact with oral contraceptives, anticoagulants, and antiretrovirals.