NURS 3230 Chapter 45 Spirituality NCLEX

A nurse who provides care on the palliative unit of a hospital is aware of the importance of spiritual assessment and the integration of spirituality into clients' care. What assessment question should the nurse use in an effort to determine clients' spiritual beliefs? a. "Are there any spiritual or religious beliefs or practices that are important to you?" b. "What church do you normally attend?" c. "If you had to identify yourself as either a religious person or a spiritual person, which would you choose?" d. "Do you hold a belief in the afterlife?"

Answer: a. "Are there any spiritual or religious beliefs or practices that are important to you?" Rationale: An open-ended yet clear question about a person's spiritual beliefs is most likely to elicit information about the client in a thoughtful manner. Asking the client to choose between self-identifying as religious or spiritual is not an accurate dichotomy, while asking about the afterlife is not a direct way of assessing religion and spirituality. Not every religious or spiritual group situates their practices in a church.

Which of the following client statements most clearly suggest the potential of a nursing diagnosis of Spiritual Anxiety? a. "Now that I'm nearing the end, I'm worried that God won't think I lived a good enough life." b. "I've never been a religious man, and all these Catholic crosses and pictures in the hospital make me a bit uncomfortable." c. "I guess I should have taken a lot more time to go to church when I was younger." d. "I always tried to do the right thing, so I don't understand why I have to suffer so much now.

Answer: a. "Now that I'm nearing the end, I'm worried that God won't think I lived a good enough life." Rationale: Worry about one's spiritual condition is indicative of the nursing diagnosis of Spiritual Anxiety. Unfamiliarity with the religious character of a care setting suggest Spiritual Alienation, while questions of suffering often indicate Spiritual Pain or Spiritual Despair. Regrets over previous religious or spiritual apathy may suggest a nursing diagnosis of Spiritual Guilt.

Which description best describes the role of a parish nurse? a. A nurse who works to reintegrate the healing tradition into the life of a faith community. b. A trained layperson who provides for the spiritual needs of a congregation or parish. c. A nurse who provides home health services similar to a visiting nurse. d. A spiritual leader, such as a minister, who is also a registered nurse.

Answer: a. A nurse who works to reintegrate the healing tradition into the life of a faith community. Rationale: Parish nurses and health ministry teams work to reintegrate the healing tradition into the life of faith communities. The key roles of the parish nurse are health educator, personal health counselor, referral agent, trainer of volunteers, developer of support groups, integrator of faith and health, and health advocate. Parish nurses are not visiting nurses nor home health nurses.

The nurse's colleague confides to the nurse that he has been proselytizing (convert or attempt to convert) to a client who is described as being in desperate spiritual distress. The nurse advises her colleague to do which of following? a. Consult pastoral care immediately b. Offer to pray more with the client c. Offer last rites d. Continue and include the spouse

Answer: a. Consult pastoral care immediately Rationale: Puchalski (2006) offers the following hints about professional boundaries: -Keep the spiritual history client centered. -Recognize pastoral care professionals as experts in this filed and consult them appropriately. -Proselytizing is never acceptable in professional settings. Addressing spiritual issues should not be coercive. -More in-depth spiritual counseling should be under the direction of chaplains and other spiritual leaders. -Praying with clients should not be initiated by the nurse unless there is no pastoral care available, and the client requests it.

The son of a dying female client is surprised at his mother's adamant request to meet with the hospital chaplain and has taken the nurse aside and said, "I don't think that's what she really wants. She's never been a religious person in the least." What is the nurse's best action in this situation? a. Contact the chaplain to arrange a visit with the client. b. Organize a meeting between the chaplain, the son, and the client to achieve a resolution. c. Document the client's request and wait to see if she reiterates her request. d. Perform a detailed spiritual assessment of the client.

Answer: a. Contact the chaplain to arrange a visit with the client. Rationale: The nurse's primary duty is to honor the client's request for a meeting with a spiritual advisor.

The nurse is caring for a client with Parkinson's disease. The client informs the nurse that he has been angry with God because of his worsening illness, but after talking to the hospital chaplain, he is ready to return to the church choir and become active again in the men's group at the church. What is an appropriate nursing diagnosis for this client? a. Readiness for Enhanced Spiritual Well-Being b. Spiritual Distress c. Risk for Loneliness d. Impaired Religiosity

Answer: a. Readiness for Enhanced Spiritual Well-Being Rationale: The most appropriate diagnosis for this client is Readiness for Enhanced Spiritual Well-Being. The client desires to experience and integrate meaning and purpose in life through connections with self, others, art, music, literature, nature, or a power greater than himself.

A college foreign exchange student is living with a family in England and is confused about the daily Catholic prayers and rituals of the family. The student longs for the comfort of her fundamentalist Protestant practices and reports to the campus nurse for direction. The nurse recognizes the student is experiencing which type of spiritual distress? a. Spiritual alienation b. Spiritual guilt c. Spiritual loss d. Spiritual anger

Answer: a. Spiritual alienation Rationale: Spiritual alienation occurs when an individual is separated from her/his faith community. Spiritual guilt is the failure to live according to religious rules. Spiritual anger is the inability to accept illness. Spiritual loss occurs when one is not able to find comfort in religion.

When preparing for a spiritual counselor to visit a hospitalized client, the nurse should do what? a. Take measure to ensure privacy during the counselor's visit. b. Ask the spiritual counselor to summarize the visit in the client's medical record. c. Ensure that the counselor is approved by the hospital administration. d. Ask to be present during the visit in order to explain any medical information or answer questions about the client's care.

Answer: a. Take measure to ensure privacy during the counselor's visit. Rationale: Visits between a client and a spiritual counselor require privacy. The details of the meeting are not typically documented in the client's chart, though the fact that the visit took place is often noted. The nurse may be present during the meeting, but this should take place at the client's request. Spiritual counselors do not require administrative approval; clients and their families are normally able to seek spiritual help from whomever they prefer.

An American Muslim client seeks care in the emergency room for dehydration related to vomiting. The nurse manager knows that this client, due to his religious needs, should be assigned to which of the following caregivers? a. A female younger than himself b. A member of the black community c. A male older than himself d. A Caucasian physician

Answer: b. A member of the black community Rationale: American Muslims are encouraged to obtain health care provided by members of the black community.

Members of which of the following religious traditions are likely to have the most stringent restrictions and parameters placed on their medical care? a. Buddhism b. Christian Scientist c. Protestantism d. Hinduism

Answer: b. Christian Scientist Rationale: Christian Science places significant restrictions of the use of drugs, medical procedures, therapies, and surgeries. The scope of these restrictions greatly exceeds that dictated by Hinduism, Protestant, Christianity, and Buddhism.

A nurse is caring for a terminally ill client who believes that death and reincarnation are the ultimate gifts from God to mankind. Which of the following would be most appropriate to integrate into this client's plan of care when providing spiritual support? a. Subtly attempt to change the client's belief. b. Provide support that builds on the client's faith. c. Provide literature to the client that says otherwise. d. Request the client refrain from talking about death.

Answer: b. Provide support that builds on the client's faith. Rationale: The nurse should support and build on the client's faith. Nurses should not attempt to change faith that clients already posses. If faith is lost, clients will lose hope; without the will to live, many people are beyond the help of the most potent medical powers. The nurse should not attempt to change the client's belief or provide literature that says otherwise. Conversations regarding faith, however, must not pass judgment or present controversy. Clients need to feel accepted in their beliefs and encouraged to remain open in expressing and learning.

A dying client requests that the nurse pray with him. The nurse is not accustomed to praying aloud but is comfortable praying silently. What is the best approach for this nurse to follow to pray with the client. a. The nurse should defer the client's request to pray. b. The nurse should select a formal prayer or Bible passage to use to pray aloud. c. The nurse should inform the client that she will pray for the client but not with him. d. The nurse should ask the client's roommate to pray with the client.

Answer: b. The nurse should select a formal prayer or Bible passage to use to pray aloud. Rationale: A nurse unaccustomed to praying aloud or in public may find it helpful to have a Bible passage or formal prayer readily available for praying. If the nurse is not comfortable praying with the client, she should call the hospital chaplain or find another individual who is comfortable.

The parents of three children ages 4, 7, and 11 years are interested in fostering spiritual development in their children. The nurse informs the parents that the development of a child's spirituality is best accomplished by... a. educating the child about religion. b. educating through parental behaviors. c. educating through religious-based schools. d. educating the child about God.

Answer: b. educating through parental behaviors. Rationale: A child's parents play a key role in the development of the child's spirituality. What is important is not so much what parents teach a child about God and religion, but rather what the child learns about God, life, and self from the parent's behavior.

While interviewing a hospitalized client, he states, "The holy days of Ramadan are coming soon. I am not to have any food or drink from sunrise to sunset during this time." Further assessment reveals that the client's request is associated with which religion? a. Judaism b. Christianity c. Islam d. Hinduism

Answer: c. Islam Rationale: According to the Islamic religion, neither food nor drink is taken between sunrise and sunset during the holy days of Ramadan. There are no special or universal food beliefs common to Christianity. According to Judaism, Kosher food is eaten, meat cannot be mixed with dairy, and separate cooking and eating utensils are used for food preparation and consumption. According to Hinduism, pork and alcohol are forbidden and other meats must meet ritual requirements.

A man age 79 years is in the later stages of lung cancer with bone metastases. Since receiving his terminal diagnosis, the client has often made mention of the fact that he has a long-estranged daughter and that he was a "miserable father." The client has recently asked for the social worker's assistance in locating his daughter before his death. What spiritual need likely underlies the client's request? a. Need for purpose b. Need for love c. Need for forgiveness d. Need for meaning

Answer: c. Need for forgiveness Rationale: While a need for love may be a factor in the man's request, the fact that he admits his parental failings and wishes to rekindle a relationship with his child suggests that he may feel a need for forgiveness. The needs for purpose and meaning are not directly evident in this scenario.

While studying religion and spirituality, the nursing student exhibits an understanding of the concepts when making which of the following statements? a. Religion and spirituality are synonymous. b. Spirituality is the behavioral manifestation of religious beliefs. c. Religion is a collection of spiritual beliefs and practices. d. Spirituality is a recently developed alternative to traditional religious belief.

Answer: c. Religion is a collection of spiritual beliefs and practices. Rationale: Spirituality may or may not inlace religion, which is a codified system of spiritual beliefs. The two terms are not interchangeable, and spirituality is not solely concerned with outward behavior. Spirituality is not necessarily an "alternative" to religion; nor is it a recent development.

Upon assessment, the nurse is addressing the beliefs of a newly admitted man who reports practicing Adventist religion. Based upon the nurse's familiarity with this religion, she appropriately asks what to the client? a. "What are your beliefs about blood transfusions?" b. "Do you receive care from a medicine man or woman?" c. "Is it acceptable for the health care team to remove undergarments in an emergency?" d. "What are your beliefs about the use of narcotics for pain?"

Answer: d. "What are your beliefs about the use of narcotics for pain?" Rationale: The Adventist religion prohibits the taking of narcotics and stimulants because the body is a temple. Jehovah's Witnesses prohibit blood transfusions because it violates God's law. Native American religions incorporate medicine men or women for health care needs. Members of the Church of Jesus Christ of Latter Day Saints (Mormons) are required to wear special undergarments that should be removed only in an emergency.

A client recently diagnosed with cancer informs the nurse that she values faith and finds comfort in her faith. The nurse is aware that faith is best defined as which of the following? a. A positive outlook even in the bleakest moments. b. An organized belief system about a higher power. c. Practices associated with all aspects of a person's life. d. A belief in something for which there is no proof or material evidence.

Answer: d. A belief in something for which there is no proof or material evidence. Rationale: Faith is a belief in something for which there is no proof or material evidence. Hope is a positive outlook even in the bleakest moments. Religion is an organized belief system about a higher power. Spiritual beliefs are practices associated with all aspects of a person's life.

The nurse is caring for a critically ill client, who informs the nurse that there is conflict between her spiritual beliefs and a proposed health option. What is the nurse's role in this situation? a. The nurse has little role in this situation because it is best managed by the physician. b. The nurse should provide examples of ways other clients from various religions handled the situation. c. Provide a subjective opinion on the appropriate course of action. d. Assist the client in obtaining information to make an informed decision.

Answer: d. Assist the client in obtaining information to make an informed decision. Rationale: The nurse's role in resolving conflicts between spiritual beliefs and treatments is to assist the client in obtaining the information needed to make an informed decision, and to support the client's decision making.

Which of the following food groups would be appropriate to suggest to a client who practices tenets of the Islamic faith? a. Barbecued pork sandwich with a milkshake b. Sliced ham and cheese sandwich and 2% milk c. Salad with crumbled bacon and cheese, with a cup of tea d. Broiled chicken sandwich with skimmed milk

Answer: d. Broiled chicken sandwich with skimmed milk Rationale: Members of the Islamic faith are forbidden to eat pork or drink alcohol.

Which of the following best reflects nursing's view of clients as holistic beings? a. Id, ego, superego b. Spiritual, egocentric, naïve c. Physical, psychosocial, religious d. Mind, body, spirit

Answer: d. Mind, body, spirit Rationale: Nursing has a long history of incorporating spirituality into client care. References to spirituality underlie a primary idea in nursing, that clients are viewed as holistic beings in body, mind, and spirit. Id, ego, and superego are concepts associated with psychoanalytic theory. A holistic view is more than physical, psychosocial, religious, spiritual, egocentric, and naïve.

The family members of a dying client have asked for the hospital chaplain's help in having a member of the clergy come to the client's bedside to perform the anointing of the sick. The nurse who is providing care for the client should recognize that the family is likely which religion? a. Jewish b. Jehovah's Witness c. Christian Scientist d. Roman Catholic

Answer: d. Roman Catholic Rationale: Among the sacraments of the Roman Catholic Church is the anointing of the sick. This specific rite is not a component of Jehovah's Witness, Christian Scientist, or Jewish religious belief.

An older adult who identifies herself as a devout Catholic has recently relocated to an assisted-living facility. The client is please with most aspects of the living situation but laments the fact that the church is not nearby, so attending daily mass is not an option. She is quite upset by this restriction and states, "Going to daily mass was my life." The nurse recognizes that this client is suffering which of the following? a. Spiritual pain b. Hopelessness c. Depression d. Spiritual distress

Answer: d. Spiritual distress Rationale: A diagnosis of depression does not apply to this situation. Spiritual distress involves the inability to integrate meaning and purpose in life, while spiritual pain involves angst over the nature and actions of a higher power. The woman's statements do not directly reflect an outlook of hopelessness.

Upon assessment, the client reports he does not belong to an organized religion. The nurse is correct to interpret this statement as which of the following? a. The client will experience conflicts between religious beliefs and health care options. b. The client's spiritual needs are met. c. The client will not request to see the hospital chaplain or seek spiritual counseling. d. The client is not affiliated with a specific system of belief regarding a higher power.

Answer: d. The client is not affiliated with a specific system of belief regarding a higher power. Rationale: The nurse should not interpret the fact that a client does not belong to an organized religion to mean that the client has no spiritual need; a person may be highly spiritual yet not profess a religion. The client may seek spiritual counseling during hospitalization related to spiritual needs.