NUR 102 Ch. 41 Spirituality
The nurse is planning to conduct a spiritual self-assessment. What questions would the nurse include in this assessment? Select all that apply. 1. "What makes me joyful?" 2. "What causes me to feel despair?" 3. "What possessions do I value the most?" 4. "What is my purpose in life?" 5. "What feeds my spirit?"
Answer: 1,2,4,5. Rationale: Option 3 is a question used for identifying significant values
The mother of a pediatric client states, "I can't understand why God would allow this to happen to my innocent child!" Which NANDA diagnosis is most accurate? 1. Spiritual Distress related to search for meaning of child's illness 2. Impaired Religiosity related to anger at God 3. Ineffective Coping related to anger 4. Risk for Spiritual Distress related to threatened sense of hope
Answer: 1. Rationale: Although the mother is arguably angry, it is unknown whether this anger is impairing her religiosity or her coping. More data are needed before determining that either option 2 or 3 is the best diagnosis. The mother is experiencing distress versus being at risk for it (option 4).
An 88-yr-old woman has just been admitted to a skilled nursing facility. She tells the nurse that she has been a Sunday school teacher and volunteers for many of her church's projects. Which of the following NANDA diagnoses is most appropriate? 1. Risk for Spiritual Distress 2. Risk for Impaired Religiosity 3. Readiness for Enhanced Spiritual Well-Being 4. Impaired Religiosity
Answer: 2. Rationale: Residing in the SNF likely will curb the client's participation in her church. Options 1,3,4 are incorrect because it is not known if the relocation or an alteration in religious practice will affect her spiritual well-being in either a negative or positive way.
A client in the emergency department needs a transfusion of RBCs. The client tells the nurse that, as a Jehovah's Witness, blood transfusions are not permitted. Which statement would most likely lead to a resolution for this conflict? 1. you must accept the transfusion or else leave 2. don't worry, you can ask for pardon after taking the blood 3. may I please call a representative of your religion so that I can understand your position better? 4. I understand your position; I'll be here with you as you die.
Answer: 3. Rationale: Options 1, 2, and 4 are potentially uncaring or unethical. Jehovah's Witnesses have a well-developed network of representatives who can be called to explain and explore medical options with their fellow believers and medical staff.
During assessment, the client says that is has been "a long time" since she has thought very much about religion. The nurse caring for this client has a strong belief in God and the healing power of prayer. What action should be taken by the nurse? 1. mention the nurse's belief and offer to pray with the client for forgiveness. 2. tell the client that the nurse will pray for her often. 3. ask the client if there are any spiritual needs with which the staff can assist. 4. refer the client for spiritual counseling.
Answer: 3. Rationale: The client can be asked general questions to elicit information about what beliefs and practices are important to the present health care situation, and what, if anything, the client would like from the health care team to support spiritual health. Offering to pray with the client is over the boundary of professional practice unless the client requests such intervention and the nurse is comfortable with the arrangement (options 1 and 2). At this point, there is no information that indicates the client is in need of referral for counseling. This would occur only if the client demonstrates spiritual distress at the level best handled by a specialist (option 4).
A client is experiencing severe pain that cannot be controlled by analgesics. An appropriate intervention is full presencing, which involves which of the following? 1. Physical presence 2. Physical presence with mental awareness of a client 3. Physical, mental, and emotional presence 4. Physical, mental, emotional, and spiritual presence
Answer: 3. Rationale: The key term is full. Option 1 would be inadequate; option 2 is only partial presencing; and option 4 is transcendent presencing.
A client reports, "Cancer was the best thing that happened to me! It is making me appreciate life so much more." This statement fits best with which NANDA diagnosis? 1. Spiritual Distress 2. Risk for Spiritual Distress 3. Readiness for Enhanced Spiritual Well-Being 4. Cognitive Denial
Answer: 3. Rationale: This client portrays no distress (option1) or risk for distress (option2), but rather the potential for enhanced spiritual health as a result of the transformative illness experience. Option 4 is not a valid diagnosis.
A dying client states, "Part of what makes dying hard is that I don't know for sure where I'm going. Nurse, what do you believe happens in the hereafter?" Which ethical guideline should guide your response? 1. Never share personal spiritual beliefs. 2. Share all spiritual beliefs, favoring none 3. share only your beliefs. 4. first assess for what prompts the client's question.
Answer: 4. Rationale: Assessment is always the first step of the process of spiritual caregiving or any nursing activity. Options 1,2, and 3 may not respect the spiritual beliefs of either the nurse or the client. While an assessment may lead the nurse to share personal beliefs, these are never urged on the client.
When planning care for an older client residing in your skilled nursing facility who is searching to make life meaningful, which nursing action would be most beneficial? 1. Assess for depression 2. Diagnose and document that the client has "spiritual distress." 3. Keep the client busy with social activities. 4. Explore with the client desired legacy.
Answer: 4. Rationale: Options 1 and 2 involve assessment and diagnosis, not planning. Option 3, simply keeping the client busy, does not necessarily contribute to feeling fulfilled or purposeful.
When arriving to a client's room to provide care, the client is praying with family. What action should be taken by the nurse? 1. stand quietly just inside the room door until the prayer is completed. 2. come to the bedside and join in with the prayer 3. politely ask the client to allow care to proceed. 4. quietly shut the door and wait in the hall until asked to enter.
Answer: 4. Rationale: The nurse should wait in the hall until the prayer is over and the client or family gives permission to enter the room
After having an abortion, the patient told the visiting nurse, "I shouldn't have had that abortion because I'm Catholic, but what else could I do?" I'm afraid I'll never get close to my mother or back in the church again." She then talked with her priest about this feeling of guilt. Which evaluation statement shows a solution to the problem? a. patient states, "I wish I had talked with the priest sooner. I now know God has forgiven me, and even my mother understands." b. Patient has slept from 10pm to 6am for three consecutive nights without medication. c. Patient has developed mutually caring relationships with two women and one man. d. patient has identified several spiritual beliefs that give purpose to her life.
Answer: A. Rationale: Because this patient's nursing diagnosis is Spiritual Distress: Guilt, an evaluative statement that demonstrates diminished guilt is necessary. Only answer A directly deals with guilt.
Because the capacity for abstract thought develops as a child grows older, spirituality is understood differently by children of different ages. Which of the following statements is false? a. Spirituality and perception of God is meaningless for the 4-to5-yr-old. b. Even young children, 4 to 5 years of age, have definite perceptions of God and forms of worship. c. Children's perceptions of their "spiritual self" mature as they mature. d. children 5 to 11 years of age may show anxiety concerning the power they believe God has.
Answer: A. Rationale: It is false that spirituality and perception of God is meaningless for the 4-to 5-yr-old. All the other options are correct.
Which statement is true concerning the influence of spirituality and religion on the various aspects of a person's life? a. All aspects of life may be influenced by spirituality. b. Activities of daily living are rarely influenced by religion. c. Work and recreation are not influenced by religion. d. Whereas physical illness is seldom influenced by religion, mental illness frequently is.
Answer: A. Rationale: Spirituality can influence all aspects of a person's life, including activities of daily living, work and recreation, and all types of illnesses. The other options are incomplete or false.
Which of the following statements most correctly differentiates between an agnostic and an atheist? a. the terms are used interchangeably, both believing there is no God. b. An agnostic denies that humans can know anything about God's existence, whereas an atheist denies God's existence. c. They both deny the need for a philosophy of living to guide their life. d. No aspect of an atheist's life is influenced by spirituality, whereas an agnostic has spiritual values
Answer: B. Rationale: An agnostic denies that humans can know anything about God's existence, whereas an atheist denies God's existence. The other options are incorrect.
When a patient needs spiritual counseling, the nurse who is comfortable with his or her own spirituality should: a. always call the patient's own spiritual adviser b. consult with the patient about the spiritual adviser with who he or she wishes to talk c. attempt to counsel the patient and, if unsuccessful, make a referral d. advise the patient and spiritual adviser concerning health options and the correct decision
Answer: B. Rationale: Even when a nurse feels comfortable discussing spiritual concerns, he or she should always check first with patients to determine the spiritual adviser with whom they wish to talk. Calling the patient's own spiritual adviser (answer a) may be premature if it is a matter the nurse can handle. Answers C and D deny patients the right to speak privately with their spiritual adviser from the outset, if this is what they prefer.
Mr. Brown's teenage daughter had been involved in shoplifting. He expressed much anger toward her and stated he could not face her, let alone discuss this with her: "I just will not tolerate a thief." Which of the following nursing interventions would you take to assist Mr. Brown with his deficit in forgiveness? a. assure him that many parents feel the same way. b. reassure him that many teenagers go through this kind of rebellion and that it will pass. c. assist the patient to identify how unforgiving feelings toward others only hurt the one who cannot forgive. d. Ask him if he is sure he has spent sufficient time with his daughter.
Answer: C. Rationale: Because this is the only nursing intervention that directly addresses the patient's unmet spiritual need concerning forgiveness. Answers A and B may make him feel better initially, but neither addresses his need to forgive. Answer D is likely to make him feel guilty.
The most important source of learning about his or her own spirituality for a child is: a. His or her church or religious organization b. What parents say about God and religion c. How parents behave in relationship to one another and their children, to others, and to God d. The spiritual adviser for the family
Answer: C. Rationale: Children learn most about their own spirituality from how their parents behave in relationship to one another, their children, others, and God. Less important sources of learning are each of the other options.
A nurse who was raised a strict Roman Catholic stated she couldn't assist patients with their spiritual distress because she recognizes only a "field power" in each individual. She said, "My parents and I hardly talk because I've deserted my faith. Sometimes I feel real isolated from them and also God - if there is a God." Analysis of these data reveals which unmet spiritual need? a. need for meaning and purpose b. need for forgiveness c. need for love and relatedness d. need for strength for everyday living.
Answer: C. Rationale: The data point to an unmet spiritual need to experience love and belonging given her estrangement from her family and God after leaving the church. The other options may represent other needs this patient has, but the data provided do not support them.
A man who is declared agnostic is extremely depressed after losing his home, his wife, and his children in a fire. His nursing diagnosis is Spiritual Distress: Spiritual Pain related to inability to find meaning and purpose in his current condition. The most important nursing intervention to plan is to: a. ask the patient which spiritual adviser he would like you to call b. recommend that the patient read spiritual biographies or religious books c. explore with the patient what, in addition to his family, has given his life meaning and purpose in the past d. introduce the belief that God is a loving and personal God
Answer: C. Rationale: The nursing intervention of exploring with the patient what, in addition to his family, has given his life meaning and purpose in the past is more likely to correct the etiology of his problem, Spiritual Pain, than any of the other nursing interventions listed.
When assessment data point to a spiritual problem that can be treated by independent nursing intervention, it receives the NANDA-approved diagnostic label: a. Spiritual Alienation b. Spiritual Despair c. Spiritual Distress d. Spiritual Pain
Answer: C. Rationale: The only NANDA-approved nursing diagnosis among the options is Spiritual Distress. The other options may be further specifications of the broader diagnosis Spiritual Distress.
A patient states she feels so isolated from her family and church and even God "in this huge medical center so far from home." An appropriate goal for the patient to relieve her spiritual distress is as follows. The patient will a. express satisfaction with the compatibility of her spiritual beliefs and everyday living b. identify spiritual beliefs that meet her need for meaning and purpose c. express peaceful acceptance of limitations and failings d. identify spiritual supports available to her in this medical center
Answer: D. Rationale: Each of the four options represents appropriate spiritual goals, but identifying spiritual supports available to her in the medical center demonstrates a decreased sense of isolation.
When the family desires baptism for an infant, it is imperative that the nurse provide for baptism to be done because: a. Baptism frequently postpones or prevents death or suffering b. It is legally required that nurses provide for this care when the family makes this request. c. It is a nursing function to assure the salvation of the baby d. Lack of baptism when desired may increase the family's sorrow and suffering
Answer: D. Rationale: Failure to ensure that an infant baptism is performed when parents desire it may greatly increase the family's sorrow and suffering, and this is an appropriate nursing concern. Whether baptism postpones or prevents death and suffering (answer a) is a religious belief that is insufficient to bind all nurses. There is no legal requirement regarding baptism, so answer b is false. Although some nurses may believe part of their role is to ensure the salvation of the baby (answer c), this function would understandably be rejected by many.
Even though a detailed nursing history in which spirituality is assessed is taken on admission, problems with spiritual distress may not surface until days after admission. The probable explanation is that: a. Patients usually want to conceal information about spiritual needs b. Patients are not concerned about spiritual needs until after their spiritual adviser visits c. family members and close friends often initiate spiritual concerns d. illness increases spiritual concerns, which may be difficult for patients to express in words.
Answer: D. Rationale: Illness may increase spiritual concerns, which many patients find difficult to express. The other options do not correspond to actual experience.
A patient whose last name was Goldstein was served on a paper plate a kosher meal ordered from a restaurant because the hospital made no provision for kosher food or dishes. Mr. Goldstein became angry and accuse the nurse of insulting him: "I want to eat what everyone else does - and give me decent dishes." Analysis of these data reveals that: a. the nurse should have ordered kosher dishes also b. the staff must have behaved condescendingly or critically c. Mr. Goldstein is a problem patient and difficult to satisfy d. Mr. Goldstein was stereotyped and not consulted about his dietary preferences
Answer: D. Rationale: On the basis of his name alone, the nurse jumped to the premature and false conclusion that this patient would want a kosher diet.
You are least likely to encounter resistance to emergency life-saving surgery for a patient from which of the following families? a. Christian Scientist family b. Faith Assembly Healer family c. Jehovah's Witness family d. Orthodox Jewish family
Answer: D. Rationale: There is no teaching in the Hebrew scriptures that prohibits emergency life-saving surgery; in fact, most Orthodox Jews would be highly motivated to have the surgery because of the high value attached to preserving life. All of the other groups mentioned might have religious grounds for refusing surgery.
