PrepU ch. 46 Fundamentals
Mrs. Dopson is a 75-year-old widow who lost her last offspring to cancer last month. She shares with the nurse that she fears being alone. The nurse knows that this is related to which of the following spiritual needs believed to be common to all people?
Need for love and relatedness
After teaching a staff development program about the major world religions and their view of health and illness, the nurse determines that the teaching was successful when the participants identify which statement as best reflective of Buddhism?
Dietary restrictions on some holy days.
Which question would be appropriate for the F in the FICA spiritual assessment tool?
"Do you consider yourself a spiritual person?"
The nurse is caring for a critically ill client who informs the nurse that there is a conflict between the client's spiritual beliefs and a proposed health option. Which question does the nurse ask to begin a conversation about the conflict that the client is experiencing?
"Would you like to talk to someone to help you make an informed decision?"
A nurse is conducting a spiritual assessment on a client recently admitted to the hospital unit. Which questions would be appropriate to ask the client about his religious and spiritual practices? Select all that apply.
"Is religion a significant part of your life?" "Does the present situation interfere with any spiritual or religious practice?" "Are there any spiritual practices that you would like to continue while hospitalized?"
When conducting a spiritual assessment, the nurse must be sensitive to the client's personal beliefs. Which questions should the nurse ask? Select all that apply.
"Do you feel your faith is helpful to you?" "Is religion or God significant to you?" "Is there anyone from your church you would like to talk to?"
The nurse is assessing a 27-year-old Navajo male who is being admitted for surgery. The client requests a visit from the spiritual healer. Which is the best response from the nurse?
"Do you have a preference as to which spiritual leader you would like to visit?"
When asked about his religious preference, the client becomes very upset with the nurse. Which response is appropriate for this situation?
"I can see that this question upsets you. Do you have any questions about this?"
The nurse is performing the intake assessment for a 16-year-old adolescent in the emergency department. Which question by the nurse will assist in understanding the adolescent's spirituality?
"What are your spiritual beliefs?"
The nurse overhears a client, who is scheduled to begin chemotherapy, tell a family member that everything will eventually be okay and the cancer will be in remission. Which question will the nurse ask to begin a conversation about hope with the client?
"What provides you with strength to deal with this health situation?"
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?
Islam
A nursing instructor, after teaching about the importance of spirituality, identifies a need for further teaching when overhearing a student make which of the following statements?
"You can provide quality nursing care to clients even though you ignore the spiritual dimension of health."
Which religious groups would the nurse anticipate to regard Saturday as the Sabbath? (Select all that apply.)
Adventist Judaism
The nurse admits a new client to the unit for elective surgery. What would be the best way for the nurse to facilitate the practice of religion for this client? Choose all that apply.
Arrange for the client's pastor to visit if desired. Attempt to meet religious dietary restrictions. Respect the need for privacy during periods of prayer.
A client self identifies as a member of the Jewish faith. When discussing diet and food preferences with the client, which assessment would be useful?
Ask the client what diet is followed at home.
A nurse is assessing children for spirituality and identifies which central themes in children's descriptions of God, based on David Heller's study? Select all that apply.
Children have a notion of a God who works through human intimacy. Children believe in the interconnectedness of human lives. Children show considerable anxiety in the face of God's power.
The nurse is caring for a 55-year-old client admitted to the hospital for liver failure. The client states being an active member of The Church of Jesus Christ of Latter-day Saints. The client tells the nurse about strictly adhering to the religious practices that are condoned by the Church. However, the nurse overhears two health care providers discussing that the client's liver failure is likely due to chronic alcohol use. The nurse suspects that the health care providers are incorrect. Which nursing nursing action is appropriate?
Engage the client in a discussion about past and present religious practices.
The nurse is caring for a dying male client who practices Islam. What is the most appropriate action for the nurse after the client's death?
Ensure that a male washes the client's body.
A nurse overhears a client telling a family member that a belief in God is the only thing helping in the fight against a terminal illness. What is this client demonstrating?
Faith
The nursing instructor is teaching about spirituality and asks a nursing student about the factors that can influence a client's spirituality. Which responses by the student are accurate? Select all that apply.
Family Developmental considerations Ethnic background Formal religion
A nurse working in a facility that cares for clients with Alzheimer's includes spirituality in client care. A family caregiver tells the nurse that faith has been broken and asks about help in getting through the day. What approaches can the nurse use to help the family member? Select all that apply.
Help the family member get relief so church services can be attended Contact the family church group members for assistance Give the family member some spiritual reading materials
A client in a long-term care facility has recently begun to refuse to cooperate with the staff, is having difficulty agreeing with the treatment goals suggested by the nurse, and is showing more stress when the family goes home. What is the best response from the nurse?
Question the client concerning spiritual concerns
A nurse interviews a client and finds that, because of religious beliefs, the client's view on health care does not involve blood transfusions. How can the nurse best handle this client situation?
Record this information in the client's chart.
Allen is an 82-year-old retiree who recently relocated to senior apartments. The apartments are not affiliated with any religious beliefs. Allen was raised in the Roman Catholic church and has attended mass every Sunday since childhood. He has not attended mass for 3 weeks. What best describes Allen's situation?
Separation from spiritual ties
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?
Spiritual alienation
A client informs the nurse about being unsure of some of the health practices as a newly practicing Jehovah's Witness. What information can the nurse share with the client regarding cultural beliefs about blood products?
Spiritual care consultants can provide support to the client.
A client is in the late stages of lung cancer with bone metastases. Since receiving the terminal diagnosis, the client has often made mentioned an estranged child and being a "miserable parent." Which conversation will the nurse have with the client to attend to unfinished business?
The need for forgiveness
After being informed that his wife only has a few hours to live, the nurse hears the husband say; "If you take my wife now. I will never pray to you!" What should be the nurse's reply?
Use silence and allow the husband to express his emotions.
The nurse is caring for a client who states, "No one can understand God." The nurse would document the client's spiritual belief as:
agnostic.
The client states "I have lifted my cancer to God and am accepting of God's plan for me." This is an example of an adaptive expression of spiritual needs labeled:
faith.
While interviewing a client, a nurse is told that the client practices Catholicism. This client is identifying:
his faith.
A new client is on the hospital unit. He was recently diagnosed with metastatic pancreatic cancer and was told that any treatment would be palliative. He tells a nurse that there is no God that he knows of who would subject someone to this. The client's statement is most reflective of:
spiritual crisis.
A nurse is assisting a terminally ill female client with bathing. The client tells the nurse that she has great respect and faith in a particular spiritual leader. The nurse interprets this information as fulfilling which need for the client?
sense of security for present and future
A client who is admitted for a debilitating disease is talking to the nurse. The client relates that family is the only thing that matters, stating that family helps fulfill all the spiritual needs by first fulfilling the most basic of all needs. What is this basic need?
Love
A nurse is conducting online research for information related to spiritual needs and religious traditions. The nurse demonstrates understanding of the information by identifying which need as common to all? Select all that apply.
Meaning Love Forgiveness
According to Shelly and Fish (1988), which of the following are spiritual needs underlying all religious traditions that are common to all people? Select all that apply.
Meaning and purpose Love and relatedness Forgiveness
The nursing diagnosis Spiritual Distress related to crisis of illness as evidenced by loss of meaning in life and overuse of pain medication is created for a client who attempted to take his life. Which intervention is appropriate for these problems?
Plan and coordinate a multidisciplinary team conference including the chaplain.
The nurse is assisting a client with his meal selection for the next day. The client states, "I can't have meat tomorrow, it's a Holy Day." The nurse recognizes that the client is a member of which religious organization?
Roman Catholic
A client who has suffered a debilitating stroke asks the nurse, "Why did God allow this to happen to me?" What question would the nurse ask to promote a conversation with the client about the client's spiritual needs?
"In the past, what has given you strength during a crisis?"
Which client statement most clearly suggests the potential of a nursing diagnosis of Spiritual Anxiety?
"Now that I'm nearing the end, I'm worried that God won't think I lived a good enough life."
The nurse is caring for a client that practices Islam in the hospital. When dietary brings the client a food tray for supper, which food on the tray should the nurse remove that is against the dietary laws for a practicing Muslim?
A pork chop
An older adult client who identifies as a devout Catholic has recently relocated to an assisted living facility. The client is pleased 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. The client is quite upset by this restriction and states, "Going to daily mass was my life." Which action would the nurse take to address the client's spiritual distress?
Actively listen to the client to explore the client's feelings.
The nurse's client states that his pastor is coming in a few hours to pray with him and offer sacrament. The nurse plans to do the following things in preparation for this. Select all that apply.
Clear the bedside table; cover with clean towel. Clear the room of unnecessary items. Have a chair available near the bed.
The nurse is caring for a Roman catholic client who is dying. What would be an appropriate action for the nurse?
Contact a local priest to complete the anointing of the sick ritual.
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?
Contact the chaplain to arrange a visit with the client.
A client who is on hospice care and has no immediate family has been given less than 1 week to live. The nurse caring for the client recognizes that providing presence is most important, especially when a client is dying. What would be the best way for this nurse to provide presence to this client?
Hold the client's hand and sit by the bedside as often as possible.
An older adult client is spiritual and has a deep faith. The client asks the nurse to say a prayer for the client. The nurse, who is not very comfortable praying out loud, wants to honor the client's request. What would be the best action by the nurse?
Read a printed interfaith prayer to the client.
The nurse is taking care of a client who is scheduled for a mastectomy. The client tells the nurse that the client is apprehensive about the operation and asks the nurse to read a passage from the Koran to help prepare the client for surgery. Which action by the nurse is the most appropriate?
Read the Koran passage to the client.
While studying religion and spirituality, the nursing student exhibits an understanding of the concepts when making which of the following statements?
Religion is a collection of spiritual beliefs and practices.
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?
Roman Catholic
The nurse caring for a bedridden hospitalized client who states that this will be the first time that he has missed a Methodist church service in 50 years plans care based on which of the following NANDA-I diagnoses?
Spiritual Distress related to inability to attend church services evidenced by verbal states of guilt
The nurse enters a client's room as the client and family are praying. Which is the most appropriate action of the nurse?
Step outside the door until the prayer is finished.
A nurse is developing a plan of care to meet a client's spiritual needs. When identifying appropriate interventions, which concept would the nurse need to integrate as the foundation for all the interventions?
Supportive presence
An older adult client who is very sick but very spiritual and has a deep faith asks the nurse to say a prayer for her. The nurse, who is not very comfortable praying out loud, wants to honor the client's request. What would be the best action by the nurse?
Take the lead from the client by asking, "How would you like us to pray?"
Mr. V. is recovering from pneumonia. The nurse understands that a well-balanced diet will help him to recover. However, Mr. V. informs the nurse that it is Ramadan and he must fast from sunrise to sunset. What is the nurse's most appropriate nursing action?
Work with the nutrition staff to provide nutritious meals at off hours.
A terminally ill client tells the nurse that he does not belong to an organized religion. It is safe for the nurse to assume:
the client may still be deeply spiritual.
When the client tells the nurse that she believes God's reality is personal, and that God is the creator of all beings, the nurse determines the client is expressing:
theism.
