Prep U's - Chapter 46 - Spirituality

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? A. "In the past, what has given you strength during a crisis?" B. "Would you like to see a spiritual advisor?" C. "Why do you think God allowed you to have a stroke?" D. "Do you think you are going to die from this illness?"

Answer: A Rationale: A client who is angry at or questioning God is in spiritual distress. Asking what has given the client strength in the past to deal with crises is a good way to begin the conversation about spiritual needs. The client may not be ready to see a spiritual advisor. Asking "Why" questions are not therapeutic. The client in this scenario has not mentioned the possibility of dying.

While interviewing a client, a nurse is told that the client practices Catholicism. This client is identifying: A. his faith. B. his values. C. his spirituality. D. his culture.

Answer: A Rationale: Faith is a term also used to describe a cultural or institutional religion such as Judaism, Islam, Catholicism, or Confucianism. Spirituality refers to anything that pertains to a person's relationship with a higher power or force. Values refer to those beliefs most meaningful to a person. Culture pertains to a person's background.

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? A. "What provides you with strength to deal with this health situation?" B. "What has the health care provider told you about your treatment?" C. "What is the most important thing in your life right now?" D. "What role does a higher power play in your life?"

Answer: A Rationale: Hope is demonstrated by a positive outlook. It enables a person to consider a future and to work to actively bring that future into being. Asking the client, "What provides you strength?..." is an open-ended question and allows a conversation to begin about hope. Asking what the health care provider has told the client is seeking information, not initiating a conversation about hope. Asking about the most important thing in the client's life is beginning a discussion about meaning and purpose and not specifically about hope. Asking about the role of a higher power would begin a discussion on faith.

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? A. "You can provide quality nursing care to clients even though you ignore the spiritual dimension of health." B. "Nurses can meet spiritual needs by offering a compassionate presence." C. "Nurses can better assist clients by meeting their spiritual needs." D. "You can help clients meet spiritual needs by assisting in their struggle to find meaning in suffering."

Answer: A Rationale: It is impossible to provide quality nursing care to clients while ignoring the spiritual dimensions of health. Nurses can assist clients to meet spiritual needs by offering a compassionate presence; assisting in the struggle to find meaning and purpose in the face of suffering, illness, and death; and fostering relationships with a higher being that nurture their spirit.

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? A. Separation from spiritual ties B. Depression C. Spiritual crisis D. Change in beliefs

Answer: A Rationale: Separation from spiritual ties occurs when an individual changes location and does not have access to spiritual services or feels uncomfortable joining a new group. This separation can be temporary or permanent.

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 loss C. Spiritual anger D. Spiritual guilt

Answer: A Rationale: Spiritual alienation occurs when an individual is separated from one's 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.

A client attempted to take their life. The nurse identifies the nursing concern of spiritual distress related to crisis of illness as evidenced by loss of meaning in life and overuse of pain medication. Which intervention is appropriate to address this nursing concern for this client? A. Plan and coordinate a multidisciplinary team conference including the chaplain. B. Explore past negative coping mechanisms used. C. Provide client education on negative spiritual implications on suicide. D. Encourage the client to watch movies when alone.

Answer: A Rationale: The nurse should facilitate a care-planning conference involving the social support network including family and friends. Initiating a multidisciplinary social network of conferences facilitates a sense of acceptance, love, and belonging. The nurse should work with the client to explore and build on past positive coping mechanisms, which helps enhance a sense of self-control and self-esteem. Encouraging the client to watch movies when alone does not allow the client to interact and find positive elements of his or her life. Although spiritual review can be helpful, the nurse should not "scare" the client away from action by mentioning negative spiritual outcomes.

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? A. "What are your spiritual beliefs?" B. "How many times per week do you attend religious services?" C. "What religion do you practice?" D. "What religion do you want me to write down in your medical record?"

Answer: A Rationale: The purpose of a spiritual assessment is to determine the beliefs and practices of the client to provide high-quality, individualized care. Spirituality is an important aspect of providing holistic health care. Asking the adolescent about spiritual beliefs and what things have meaning to the client is the best way to determine the adolescent's spirituality. Asking what religion is practiced is limiting the client's choices and the client's spirituality may not be practiced in a traditional fashion. Assuming the client goes to religious services may result in a poor nurse-client relationship, as the client may see the nurse as judgmental based on church attendance. Asking what religion to list in the medical record is not demonstrating the importance of this information in the overall health and well-being of the client.

The client is a 75-year-old widow who lost their last child to cancer last month. The client shares with the nurse that they fear being alone. To which spiritual needs does the nurse attribute this fear? A. need for love and relatedness B. need for meaning and purpose. C. need for forgiveness D. need for basic necessities of life

Answer: A Rationale: The three spiritual needs underlying all religious traditions and common to all people are the need for meaning and purpose, the need for love and relatedness, and the need for forgiveness. The client is experiencing a loss of love and relatedness. A need for meaning and purpose can be related to loss of a job or function. Need for forgiveness is reconciling differences with other persons. Basic necessities are something necessary or indispensable such as food, water, and shelter.

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. A. Attempt to meet religious dietary restrictions. B. Respect the need for privacy during periods of prayer. C. Arrange for the client's pastor to visit if desired. D. Discuss similarities and differences between the nurse's religion and the client's religion. E. Offer to pray with the client whenever she likes.

Answer: A, B, C Rationale: The following are means the nurse can use to help the client continue normal spiritual practices in the unfamiliar environment of the hospital or care center: • Familiarize the client with the religious services and materials available within the institution. • Respect the client's need for privacy or quiet during periods of prayer. • Assist the client to obtain devotional objects and protect them from loss or damage. • Arrange for the client wishing to receive the sacraments to do so. • Attempt to meet the client's religious dietary restrictions. • Arrange for the client's minister, priest, or rabbi to visit if the client so wishes. Proselytizing is never acceptable in professional settings. Addressing spiritual issues should not be coercive. Praying with clients should not be initiated by the nurse unless there is no pastoral care available and the client requests it. Comparing and contrasting religious beliefs is not likely to benefit the client.

The nurse is caring for a client diagnosed with human immunodeficiency virus (HIV) 10 years ago. The client states, "my relationship with God has helped me to survive this long". The nurse determines that the client's spiritual well-being is demonstrated by being at peace with which entities? Select all that apply. A. Environment B. Self C. God D. Family E. Community

Answer: A, B, C, E Rationale: Spiritual well-being is the condition in which a person is at peace with God, self, community, and environment.

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. A. "Is religion a significant part of your life?" B. "Are there any spiritual practices that you would like to continue while hospitalized?" C. "You would like the priest to come and visit you, right?" D. "Does the present situation interfere with any spiritual or religious practice?"

Answer: A, B, D Rationale: A spiritual and religious assessment attempts to identify and document any practices or beliefs that are important for the client to maintain or that may alter medical or nursing treatment.

The nursing instructor is teaching a class on spiritual health and its importance in nursing care. When talking about the model using the unifying approach, which of the following does the spiritual dimension affect? Select all that apply. A. The psychological dimension B. The sociological dimension C. The unifying dimension D. The integrated dimension E. The physiological dimension

Answer: A, B, E Rationale: In the unifying approach, the spiritual dimension grounds or affects the physiological, psychological, and sociological dimensions. There is not a unifying dimension but a unifying approach. The integrated approach is a separate model and is not a dimension.

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. A. Meaning B. Love C. Punishment D. Ritual E. Forgiveness

Answer: A, B, E Rationale: Three spiritual needs underlie all religious traditions and are common to all people: need for meaning and purpose; need for love and relatedness; and the need for forgiveness.

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. A. "Are there any spiritual practices that you would like to continue while hospitalized?" B. "You would like the priest to come and visit you, right?" C. "Is religion a significant part of your life?" D. "Does the present situation interfere with any spiritual or religious practice?"

Answer: A, C, D Rationale: A spiritual and religious assessment attempts to identify and document any practices or beliefs that are important for the client to maintain or that may alter medical or nursing treatment.

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. A baked potato with butter and sour cream. B. A fresh fruit salad. C. A pork chop. D. A salad with balsamic vinaigrette dressing.

Answer: C Rationale: For practitioners of Islamic religion, Koranic law and customs influence diet; eating pork and drinking alcohol are forbidden. The nurse should remove the pork chop from the tray and have the meat replaced with beef, chicken, or fish as the protein.

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. A. "Is religion or God significant to you?" B. "Why can't you share your feelings with me? I am your nurse." C. "Do you feel your faith is helpful to you?" D. "Is there anyone from your church you would like to talk to?" E. "Why do you still not believe in God?"

Answer: A, C, D Rationale: Several nurses have developed spiritual assessment tools. Stoll's (1979) Guidelines for Spiritual Assessment is an early widely recognized spiritual assessment tool. This tool is built around a definition of spirituality that encompasses religion and belief in a higher power. It identifies four areas and suggests questions for each: (a) concept of God or deity, (b) source of hope and strength, (c) religious practices and rituals, and (d) relationship between spiritual beliefs and state of health. "Is religion or God significant to you?" is a question asking about the concept of God or deity. "Do you feel your faith is helpful to you?" focuses on the relationship between spiritual beliefs and state of health. "Is there anyone from your church you would like to talk to?" asks about their source of hope and strength. Asking the client why they do not believe in God and why they will not share their belief are questions focusing on belittling and degrading the client.

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. A. Clear the room of unnecessary items. B. Complete your work so you may join them. C. Clear the bedside table; cover with clean towel. D. Have a chair available near the bed. E. Keep the bed curtains open so as to allow others to join in prayer.

Answer: A, C, D Rationale: When expecting a visit from a client's spiritual counselor, preparations may vary, but the following are usually recommended:• The room should be orderly and free of unnecessary equipment and items.• There should be a seat for the religious counselor at the bedside or near the client so that both can be comfortable.• The bedside table should be free of items and covered with a clean, white cover if a sacrament is to be administered.• The bed curtains should be drawn for privacy if the client can't be moved to a more private setting.The nurse should not expect or plan to join a private group such as described.

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. A. Love and relatedness B. Power C. Formal religion D. Meaning and purpose E. Forgiveness

Answer: A, D, E Rationale: According to Shelly and Fish (1988), there are three spiritual needs underlying all religious traditions and common to all people: need for meaning and purpose, need for love and relatedness, and need for forgiveness.

Which question would be appropriate for the F in the FICA spiritual assessment tool? A. "How would you like me to address this issue in your health care?" B. "Do you consider yourself a spiritual person?" C. "Do you use your church family for support? D. "Are you actively involved with a church community?

Answer: B Rationale: "F" is for questions of faith. Some examples of questions to ask would include the following: Do you consider yourself a spiritual person? What gives your life meaning? "I" represents the importance of this resource in the client's life. Assessment questions might include asking how often the client attends worship services. Do your beliefs strongly influence your decisions with regards to your medical practices? "C" is for community. Are you actively involved with a church community, and do you use this as a support? "A" is for the practitioner to address these concerns with the client, such as to ask, how would you like me to address these issues in your health care?

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 action is appropriate? A. Know that the health care providers are incorrect; the restored gospel of Jesus Christ does not permit alcohol use. B. Engage the client in a discussion about past and present religious practices. C. Accuse the client of lying and find out why the client lied. D. Order several laboratory tests looking for genetic defects that affect the liver.

Answer: B Rationale: A client's current religious practice is not necessarily indicative of lifelong practices. The nurse should talk with the client about lifelong religious practice. As a result, useful information may be uncovered that will help to guide the plan of care.

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? A. Tell the client that the nurse is not comfortable praying out loud. B. Read a printed interfaith prayer to the client. C. Tell the client the nurse is busy at the moment and hope the client will forget the request. D. Inform the client that the nurse will try to get another nurse to pray for the client.

Answer: B Rationale: A nurse unaccustomed to praying aloud or in public may find it helpful to have a printed interfaith prayer readily available. Interfaith prayers are designed for use regardless of the client's faith. The other action are not therapeutic.

When reviewing the history of a client admitted to the health care facility, the nurse notes that the client reported being an atheist. Which action will the nurse take to meet spiritual needs when planning nursing care for the client? A. Arrange for the client to join a support group of other atheists. B. Ask the client how he or she expresses spirituality. C. Ask if the client ever participated in organized religion. D. Only bring up spirituality if the client mentions it.

Answer: B Rationale: An atheist believes that divine entities do not exist. People can be spiritual and not believe in divine entities. The nurse would explore how the client expresses spirituality. Asking if the client ever participated in organized religion would not meet the client's needs. Spiritual needs should be addressed; the nurse should not just bring spirituality if the client mentions it or arrange for a support group for atheists.

The nurse is caring for a client who states, "No one can understand God." The nurse would document the client's spiritual belief as: A. theist. B. agnostic. C. atheist. D. holistic.

Answer: B Rationale: Beliefs may range from atheism (denial of God's existence) to agnosticism (belief that God's reality is unknown and unknowable) to theism (belief that God's reality is personal, without a body, perfect in all things, and creator and sustainer of the universe).

When a nurse supports the client's spiritual needs, the nurse supports which level of the Maslow's hierarchy of needs? A. Security needs B. Self-actualization needs C. Ego needs D. Physiologic needs

Answer: B Rationale: In the hierarchy of human needs, spiritual well-being appears to connote fulfillment of needs beyond the self-actualization level. Spiritual well-being has been associated with health and general well-being. Safety needs in Maslow's hierarchy refer to the need for security and protection. When we have our physiological needs for food and water met, our safety needs dominate our behavior. Physiological needs deal with the maintenance of the human body. This lowest category includes the most basic needs that are vital to survival, such as the need for water, air, food, and sleep. There are no ego needs in the hierarchy.

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? A. Place the body on the floor to facilitate the soul's journey. B. Ensure that a male washes the client's body. C. Ensure that someone performs the anointing of the sick sacrament prior to the client's death. D. Ensure that no one is in the room when the client dies.

Answer: B Rationale: Islamic beliefs about death are that the family should be with the dying person so they can read the Koran and pray. There are also special procedures for care of the body after death; men wash male bodies and women wash female bodies and a variety of other rituals are performed. Hinduism beliefs include placing the body on the floor to facilitate the soul's journey. The anointing of the sick sacrament is part of the Roman Catholic faith.

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? A. Autonomy B. Love C. Self-reliance D. Belonging

Answer: B Rationale: Love develops from the basic human need to love and be loved, and we cannot be spiritually whole, spiritually healthy, unless this need is met. Autonomy is freedom from external control or influence. Self reliance is reliance on one's own powers and resources rather than those of others. Autonomy and self reliance are higher level of needs. A sense of belonging is a human need, just like the need for food and shelter but love is more important.

The nurse is caring for a client who asks that the special undergarments not be removed for an upcoming procedure. The nurse is aware that these undergarments are related to the client's religion. This religion is: A. Islam. B. The Church of Jesus Christ of Latter-day Saints. C. Christian Scientist. D. Adventist.

Answer: B Rationale: Members of the Church of Jesus Christ of Latter-Day Saints wear a special undergarment that should only be removed in emergencies, or when absolutely necessary. The other religions have no special undergarments related to their beliefs.

Which set of terms best reflects nursing's view of clients as holistic beings? A. id, ego, superego B. mind, body, spirit C. physical, psychosocial, religious D. spiritual, egocentric, naive

Answer: B 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, egocentric, and naïve.

The nurse working on a hospice unit is giving an in-service on the importance of faith and religion in client care. What does the nurse tell the group is a benefit of religious fellowship? A. It allows for further isolation. B. It offers support for the client. C. It distracts the client. D. It puts a good label on the client.

Answer: B Rationale: Regular religious fellowship benefits health by offering support that buffers the effects of stress and isolation. Fellowships provide a way for the client to be involved in another activity related to their spirituality rather than a distraction. It does not put a label on a person that allows others to discriminate.

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

Answer: B Rationale: Spirituality may or may not include 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.

The nurse is assessing a client for spirituality using the HOPE acronym. Which statement describes an element of this tool? A. E = external stressors affecting spirituality B. O = organized religion C. H = sources of help D. P = persons important in the person's life

Answer: B Rationale: The HOPE assessment tool asses the client's spirituality. The acronym stands for:H—Sources of hope, meaning, comfort, strength, peace, love, and connectionO—Organized religionP—Personal spirituality and practiceE—Effects on medical care and end-of-life issue

When asked about his religious preference, the client becomes very upset with the nurse. Which response is appropriate for this situation? A. "There is nothing to be upset about. This is part of my assessment." B. "I can see that this question upsets you. Do you have any questions about this?" C. "I can see that this upsets you. Let me come back later when you are feeling better." D. "You need to understand that I am just doing my job here."

Answer: B Rationale: The nurse should assist the client in understanding that his nursing history is a review of the whole human being and that questions will be wide ranging, including spiritual health, physical health, and emotional health. A client who appears angry, anxious, depressed, or defensive when asked spiritual questions may need to hear something like, "I can see from your response that you might not have expected these questions; however, they do let you know that we are interested in how you are experiencing your current situation. Do you have a question or concern in this area?" Telling the client that the nurse is just completing his or her job or telling the client that it is part of the assessment is not appropriate or therapeutic.

A terminally ill client tells the nurse that he does not belong to an organized religion. It is safe for the nurse to assume: A. the client is an agnostic. B. the client may still be deeply spiritual. C. the client has no belief system. D. the client is an atheist.

Answer: B Rationale: The nurse should not interpret the fact that a client does not belong to an organized religion to mean that he or she has no spiritual needs; a person may be deeply spiritual yet not profess to belong to an organized religion. An atheist is a person who denies the existence of a higher power; an agnostic is one who holds that nothing can be known about the existence of a higher power.

Upon assessment, the client reports not belonging to an organized religion. Which assessment question would the nurse ask to assess the client's spirituality? A. "Why do you not belong to an organized religion?" B. "Tell me about spiritual or religious beliefs that are important to you." C. "Can I set up an appointment for you with our hospital chaplain?" D. "Do you think of yourself as a religious person?"

Answer: B 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 needs. A person may be highly spiritual yet not profess a religion. The nurse should invite the client to tell the nurse about spiritual or religious beliefs that are important to the client. "Why" questions are not therapeutic. The reason why the client does not belong to an organized religion will not provide the nurse with information about the client's spirituality. Asking an open-ended question rather than the close-ended "Do you think of yourself as a religious person?" will provide more information about the client's spirituality. The client may seek spiritual counseling or ask to see the hospital chaplain during the hospitalization related to spiritual needs, but this is not the best way for the nurse to assess the client's spirituality.

Upon assessment, the client reports not belonging to an organized religion. Which assessment question would the nurse ask to assess the client's spirituality? A. "Why do you not belong to an organized religion?" B. "Tell me about spiritual or religious beliefs that are important to you." C. "Do you think of yourself as a religious person?" D. "Can I set up an appointment for you with our hospital chaplain?"

Answer: B 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 needs. A person may be highly spiritual yet not profess a religion. The nurse should invite the client to tell the nurse about spiritual or religious beliefs that are important to the client. "Why" questions are not therapeutic. The reason why the client does not belong to an organized religion will not provide the nurse with information about the client's spirituality. Asking an open-ended question rather than the close-ended "Do you think of yourself as a religious person?" will provide more information about the client's spirituality. The client may seek spiritual counseling or ask to see the hospital chaplain during the hospitalization related to spiritual needs, but this is not the best way for the nurse to assess the client's spirituality.

A nurse is caring for a client with terminal illness who believes that death and reincarnation are the ultimate gifts from a higher power. What would be most appropriate to integrate into this client's plan of care when providing spiritual support? A. Document "no blood or blood products due to religious beliefs" on the care plan. B. Provide support that builds on the client's faith. C. Consult the pastoral care department to assist the client. D. Only provide foods that are halal.

Answer: B Rationale: The nurse should support and build on the client's faith. Nurses should not attempt to change the faith that a client already possess. Consulting the pastoral care department should only be done upon request of the client. Providing foods that are halal is assuming that the client is of Muslim faith, which is not indicated in the scenario. Documenting "no blood products..." on the client's plan of care is assuming the client is of the Jehovah's Witness faith, but again there is no clear indication of a specific faith identified in the scenario.

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? A. "Do you want to refuse the proposed health care option?" B. "Would you like to talk to someone to help you make an informed decision?" C. "Shall I call the health care provider for you to discuss the conflict?" D. "What, specifically, are you asking me to do for you?"

Answer: B 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. The client may not know specifically what to ask of the nurse and the client needs assistance in making an informed decision. The nurse is instrumental in advocating for the client's needs. The health care provider is not usually involved as a client advocate. Asking if the client wishes to refuse the treatment option does not provide the client with information to make an informed decision.

A nursing student is studying spirituality and completing a report on The Church of Jesus Christ of Latter-day Saints. Which fact about this faith should the student include in the report? A. Latter-day Saints are not allowed to practice birth control. B. Latter-day Saints are not allowed to use tobacco or alcohol. C. Latter-day Saints are not allowed to have blood transfusions. D. Latter-day Saints are not allowed to have a health care provider of a different sex.

Answer: B Rationale: The restored gospel of Jesus Christ directs Latter-day Saints to avoid using alcohol, tobacco, and caffeinated beverages. Jehovah's Witnesses are not allowed to have blood transfusions. Roman Catholics do not adhere to birth control measures. Muslims do not allow opposite sexed health care providers to care for them, especially women.

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: A. agnosticism. B. theism. C. deism. D. atheism.

Answer: B Rationale: Theism is the belief that God's reality is personal, without a body, perfect in all things, and creator and sustainer of the universe.

The nurse enters a client's room as the client and family are praying. Which is the most appropriate action of the nurse? A. Stand quietly by the inside the room until the prayer is finished. B. Walk up to the client's bedside and stand quietly. C. Walk up to the client's bedside and join in the prayer. D. Step outside the door until the prayer is finished.

Answer: D Rationale: By stepping outside the door, the family and client will not be rushed to finish the prayer. Stepping up to the bedside may distract the client and or family.

Which client statement most clearly suggests the potential that the nurse will identify the client is experiencing spiritual anxiety? A. "I have never been a religious man, and all these Catholic crosses and pictures in the hospital make me a bit uncomfortable." B. "Now that I am nearing the end of life, I am worried that a higher power will not think I lived a good enough life." 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 do not understand why I have to suffer so much now."

Answer: B Rationale: Worry about one's spiritual condition is indicative of spiritual anxiety. Unfamiliarity with the religious character of a care setting suggests spiritual alienation, whereas questions of suffering often indicate spiritual pain or spiritual despair. Regrets over previous religious or spiritual apathy may suggest a nursing spiritual guilt.

A nurse is educating staff members about the importance of meeting the spiritual needs of clients on the unit. What spiritual needs should be met in the delivery of care? Select all that apply. A. need for comfort and money B. need for forgiveness C. need for complete health and freedom D. need for love and relatedness E. need for meaning and purpose.

Answer: B, C, D, E Rationale: There are three spiritual needs that underlie all religious traditions and are common to all people: need for meaning and purpose, need for love and relatedness, and need for forgiveness. Need for comfort and money, as well as need for complete health and freedom, are nice but are not part of spirituality.

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. A. Tell the family member you wish you could help but don't know how. B. Contact the family church group members for assistance. C. Help the family member get relief so church services can be attended. D. Ignore the family member's concerns. E. Give the family member some spiritual reading materials.

Answer: B, C, E Rationale: Spiritual nurturing for the client's family caregiver(s) also is important. Recent research findings support the importance and value of caregivers' spirituality, yet this resource is often overlooked. Consider using interventions that enhance a caregiver's ability to take part in spiritual activities to satisfy his or her spiritual needs and to work with religious groups to secure helpful services. Using clergy, prayer, forgiveness, and spiritual reading materials as resources for caregivers may also be helpful.

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? A. Prayer B. Strength C. Supportive presence D. Religion

Answer: C Rationale: A nurse's supportive presence must underlie all other types of intervention to meet the client's spiritual needs. The aim of this intervention is to create a hospitable and sacred space ("holy ground") in which clients can share their vulnerabilities without fear. Supportive presence communicates value and respect. Prayer, strength and religion are not foundational to spiritual interventions.

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: A. depression. B. separation from spiritual ties. C. spiritual crisis. D. change in beliefs.

Answer: C Rationale: A spiritual crisis can occur with an acute illness, sudden loss, or a new challenging diagnosis. These turning points often result in the questioning of one's beliefs.

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? A. Attempt to find someone on staff who is the same religion as the client. B. Ask the client whether it would be okay to call a minister to pray with client. C. Read the Koran passage to the client. D. Gently inform the client that nurses cannot practice religion with clients.

Answer: C Rationale: According to Maslow's hierarchy, self-actualization is a need related to the spiritual and intellectual dimension of a client. Reading a religious passage to a client is not practicing a religion, and asking to call a minister or another staff member to address this spiritual need is deferring the client's needs to someone else.

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? A. "I will see who is available and ask him or her to come by and visit with you." B. "I will get a phone number for you so you can call a healer to ask for a visit." C. "Do you have a preference as to which spiritual leader you would like to visit?" D. "Would you like me to contact the hospital chaplain to come and visit with you?"

Answer: C Rationale: Although many Native Americans and many Southeast Asian groups seek spiritual leadership from a traditional tribal healer, the nurse should not assume that this is true with each client. The other choices would be inappropriate and not provide the best nursing care.

A new nurse observes a priest visiting the clients every Saturday afternoon and praying with them. This activity supports which of the nursing outcomes? A. The client will experience alternate venues of spiritual expression. B. The client expresses satisfaction with life. C. The client uses a type of spiritual experience that provides comfort. D. The client expresses hope and sense of meaning.

Answer: C Rationale: As with other age groups, listening and support are essential as older adults deal with health and illness. Older adults used several religious or spiritual interventions with health professionals and also in isolation. Most older adults enjoy participating in conventional religious practices such as worship and prayer either alone or in groups to facilitate effective relationships and coping. A client expressing a sense of hope, meaning in life, and satisfaction can only communicated but not witnessed. A client may tell a nurse this to be looked as having communicated happiness in their life. A client, if satisfied with religious influence, will not seek alternative venues for spiritual expression.

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? A. Church elders will make health care decisions for the client. B. Nursing leadership can explain blood transfusion policy to the client. C. Spiritual care consultants can provide support to the client. D. Medical professionals know what is best for the client.

Answer: C Rationale: Jehovah's Witnesses do not accept blood transfusions. If the client is unsure of what decision to make regarding blood transfusions, the nurse may request a spiritual care consult. The spiritual care team can give the client support needed to make an informed decision. The medical team can offer the client information regarding risks and benefits, but ultimately, the client decides what is best. Although church elders may provide support, they cannot legally make decisions for the client. Hospital policies do not force a client to make a decision without regarding cultural or religious preferences.

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? A. Conduct a focused assessment to eliminate any potential infections. B. Review the client's medication list for possible side effects. C. Question the client concerning spiritual concerns. D. Search the client's room for any drugs or other substances.

Answer: C Rationale: Refusing to cooperate with staff, not forming goals and being stressed or worried when separated from loved ones are signs of maladaptive behavior of spiritual needs and should be addressed by the nursing staff. These findings would not suggest an infection is occurring, nor are they signs of an addiction or use of a substance.

A client who is admitted to the ER with severe right-sided abdominal pain is diagnosed with appendicitis. The surgeon is called and proceeds to explain the procedure to the client and asks her to sign the consent. The client refuses and informs the doctor that her husband needs to be called to do this. Which of the following religions does this client likely practice? A. Hinduism B. Judaism C. Islam D. Catholicism

Answer: C Rationale: Some Muslim women are not allowed to make independent decisions; husbands may need to be present when consent is sought. The other religions, Hinduism, Catholicism, and Judaism, do not restrictions on women to make independent health care decisions.

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? A. Describe to the client how the nurse only goes to church on Sundays. B. Explain to the client that a local church group conducts a service at the facility on Wednesday nights. C. Actively listen to the client to explore the client's feelings. D. Tell the client about the other activities available at the facility.

Answer: C Rationale: Spiritual distress involves the inability to integrate meaning and purpose in life. The client is in distress over not being able to attend daily mass. The nurse would actively listen to the client with empathy to further explore the client's feelings. Explaining about other facility activities and informing the client that a local church group conducts a service once a week will not relieve the client's distress. The nurse should not interject the nurse's personal feelings into the client's situation.

When preparing for a spiritual counselor to visit a hospitalized client, the nurse should: A. ask to be present during the visit in order to explain any medical information or answer questions about the client's care. B. ensure that the counselor is approved by the hospital administration. C. take measures to ensure privacy during the counselor's visit. D. ask the spiritual counselor to summarize the visit in the client's medical record.

Answer: C 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.

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? A. The need for meaning. B. The need for love. C. The need for forgiveness. D. The need to find purpose.

Answer: C Rationale: While a need for love may be a factor in the client's request, the fact that the client admits parental failings suggests that the client may feel a need for forgiveness to repair past behavior. The need for meaning focuses on the past, while the need for purpose looks to the future. The purpose of a person is often related to the individual's values, which may be social in nature. The need for love is the need for togetherness with another person.

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 religious-based schools. C. educating the child about God. D. educating through parental behaviors.

Answer: D 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 parents' behavior.

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? A. "Do you think you are going to die from this illness?" B. "Why do you think God allowed you to have a stroke?" C. "Would you like to see a spiritual advisor?" D. "In the past, what has given you strength during a crisis?"

Answer: D Rationale: A client who is angry at or questioning God is in spiritual distress. Asking what has given the client strength in the past to deal with crises is a good way to begin the conversation about spiritual needs. The client may not be ready to see a spiritual advisor. Asking "Why" questions are not therapeutic. The client in this scenario has not mentioned the possibility of dying.

A client recently diagnosed with cancer informs the nurse that they value faith and finds comfort in their faith. The nurse is aware that faith is best defined as: A. an organized belief system about a higher power. B. practices associated with all aspects of a person's life. C. a positive outlook even in the bleakest moments. D. a belief in something for which there is no proof or material evidence.

Answer: D Rationale: Faith is a belief in something for which there is no proof or material evidence. The client is expressing a sense of faith to the nurse. 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 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? A. Dysfunctional Grieving related to inability to attend church services as a result of his medical condition. B. Spiritual Need as evidenced by verbalizations and distress at missing Methodist church services. C. Potential for Enhanced Spiritual Well-Being related to distress at missing Methodist church services. D. Spiritual Distress related to inability to attend church services evidenced by verbal states of guilt.

Answer: D Rationale: Persons suffering spiritual dysfunction or distress may verbalize such distress or express a need for help. Developing a three-part nursing diagnosis consists of data analysis, problem identification, and the formulation of the nursing diagnosis. There are four different types of nursing diagnoses: actual nursing diagnosis, wellness (or health promotion) nursing diagnosis, risk nursing diagnosis, and syndrome diagnosis. The other three statements are missing part of the nursing diagnosis.

The nurse is caring for a Roman catholic client who is dying. What would be an appropriate action for the nurse? A. After death, place the client's body on the floor to facilitate the soul's journey. B. Contact a local priest to provide special care to the body after death. C. Ensure that a person of the same sex as the deceased clean the body. D. Contact a local priest to complete the anointing of the sick ritual.

Answer: D Rationale: Roman Catholics believe that people should have the anointing of the sick, as well as the Eucharist and penance, by a priest before death. There are no special care rituals for the body after death.

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: A. forgiveness. B. love and relatedness. C. trust. D. faith.

Answer: D Rationale: The nurse should be aware of adaptive behaviors of faith. These include: Faith depends on divine wisdom/God; faith is motivated toward growth; faith expresses satisfaction with explanation of life after death; faith expresses a need to enter into and/or understand the larger drama of human history; faith expresses a need for the symbolic, or ritual; faith expresses a need for sense of a shared faith/community. In this case, the client believes that he will depend on the divine wisdom of God for guidance. Trust is believing in the truth. Forgiveness is seeking out peace between two people. Love and relatedness is to support and cherish the relationship between two.

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. Organize a meeting between the chaplain, the son, and the client to achieve a resolution. B. Perform a detailed spiritual assessment of the client. C. Document the client's request and wait to see if the client reiterates the request. D. Contact the chaplain to arrange a visit with the client.

Answer: D Rationale: The nurse's primary responsibility is to honor the client's request for a meeting with a spiritual advisor. Completing a spiritual assessment is not necessary at this time. Organizing a meeting between the chaplain, the son, and the client is not an accurate intervention at this time unless requested by the client. Documentation of the conversation with the client and calling for a spiritual advisor should be recorded in the client's health record. It is not necessary to document and wait for the client to ask again before the nurse considers the request. Afterall, she is dying and waiting for her to ask again is not warranted.

A middle-aged female client visits the clinic to confirm pregnancy. "I cannot believe this is happening. I cannot be pregnant. My parents will kill me. I was raised in a strict Roman Catholic home. I was not supposed to get pregnant before marriage." Complete the following sentence by choosing from the lists of options. The client is exhibiting signs of spiritual _______________ (alienation, guilt, anger) related to the ____________________ (disengagement from faith community; failure to accept the possibility of pregnancy; inability to live up to devout practices).

Answer: guilt; inability to live up to devout practices. Rationale: The client is exhibiting spiritual guilt related to the inability to live up to devout practices. Because the Roman Catholic doctrine prohibits getting pregnant before marriage, the client feels that they have betrayed their family and their religion. Spiritual anger pertains to feelings of outrage or frustration against an ultimate or higher power. Spiritual alienation refers to feelings of separation or estrangement from a supreme power or being. Clients experiencing spiritual alienation may feel that they are detached from their faith source. Birth control and abortion are prohibited in the Roman Catholic religion. These rules may make the client feel disengaged from their faith if this situation is making the client reconsider their options related to pregnancy. The feeling of questioning their belief and value systems is characteristic of spiritual anxiety. The client's comments indicate that the client has not yet fully accepted the pregnancy. The client is displaying risk factors characteristic of spiritual pain because the client is unable to reconcile being pregnant before marriage and the religious teachings.