Unit 4 Questions-K & E Chapter 41 (Spirituality)

The nurse is determining whether interventions to address the diagnosis of Spiritual Distress for a client newly diagnosed with a chronic illness have been effective. What outcome would indicate that interventions have been effective for this client? 1. The client has talked with the church priest twice during the hospitalization. 2. The client states that there is nothing that can be done spiritually to improve her current outlook on life. 3. The client plans to make an appointment with a psychologist after discharge. 4. The client thanks the nurse for trying to help improve her feelings.

Correct Answer: 1 Rationale 1: Evidence that interventions to address the diagnosis of Spiritual Distress have been effective would be the clients talking with the church priest, as evidence of spiritual health is connecting with a spiritual leader. Rationale 2: The client statement that nothing can be done spiritually would not be evidence that interventions to address the diagnosis of Spiritual Distress have been effective. Rationale 3: The clients planning to see a psychologist would not be evidence to support that interventions to address the diagnosis of Spiritual Distress have been effective. Rationale 4: The clients thanking the nurse for trying to help improve feelings would not be evidence to support that interventions to address the diagnosis of Spiritual Distress have been effective.

The nurse determines that a middle-aged client has developed spiritually. What client statement caused the nurse come to this conclusion? 1. I listen to and learn from others who talk about beliefs in God or a Supreme Being. 2. The tales in the Bible are real to me. 3. I attend service with my friends on most Sundays. 4. I attend the same church as my parents and follow the customs of my culture.

Correct Answer: 1 Rationale 1: The client who listens and learns from others about God or a supreme being is demonstrating openness to others truths, which is a characteristic of spiritual development in middle adulthood. Rationale 2: Stating that the tales in the Bible are real is a characteristic of a school-age client. Rationale 3: Attending services with friends on most Sundays is a characteristic of spiritual development of the adolescent. Rationale 4: Attending the same church and following cultural customs is a characteristic of a school-age client.

The nurse assesses that a client is experiencing spiritual distress. What should be the nurses primary intervention? 1. Establish a trusting nurseclient relationship. 2. Have the client describe the basic problem. 3. Ask the client what religion is practiced in the home. 4. Identify the clients belief in a Supreme Being.

Correct Answer: 1 Rationale 1: The first step in successfully working with a client with spiritual distress is establishing a trusting nurseclient relationship. Rationale 2: This would not be the nurses primary intervention. Rationale 3: This would not be an effective intervention for the client experiencing spiritual distress. Rationale 4: This would not be an effective intervention for the nurse to make initially.

The nurse has identified that many of the clients in the long-term care facility have spiritual concerns and distress. What is the nurses first step in becoming a competent provider for these clients? 1. The nurse must possess a healthy spiritual self-awareness. 2. The nurse must learn about diverse spiritual beliefs and practices. 3. The nurse should start going to church more often. 4. The nurse should establish regular religious services in the facility.

Correct Answer: 1 Rationale 1: The first step of becoming a competent provider for clients who have spiritual distress is for the nurse to possess a healthy spiritual self-awareness. Rationale 2: Learning about diverse spiritual beliefs and practices would be appropriate after the nurse identifies awareness of spirituality within the self. Rationale 3: Going to church more often presupposes that spirituality and religion are the same which is not true. Rationale 4: Establishing regular religious services in the facility presupposes that spirituality and religion are the same, which is not true.

A client who is devoutly Jewish is hospitalized during Yom Kippur, a time when many of the Jewish faith fast. The client expresses a desire to follow this religious pattern. How should the nurse respond to this wish? 1. Support the clients desires to the extent possible. 2. Remind the client that most religions excuse persons who are ill from fasting. 3. Attempt to convince the client to ignore the tradition due to illness. 4. Tell the client that the physician must make this decision.

Correct Answer: 1 Rationale 1: The nurse should support the clients desires to the extent possible. Rationale 2: Because this client is a devout follower of Jewish tradition, it is not up to the nurse to instruct the client regarding Jewish law. Rationale 3: The nurse should not attempt to convince the client to ignore the tradition. Rationale 4: The physician also cannot ethically make this decision for the client.

The nurse is planning to conduct a spiritual self-assessment. What questions would the nurse include in this assessment? Standard Text: 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?

Correct Answer: 1, 2, 4, 5 Rationale 1: What makes me joyful? is a question used for spiritual self-assessment. Rationale 2: What causes me to feel despair? is a question used for spiritual self-assessment. Rationale 3: What possessions do I value the most? is a question used for identifying significant values. Rationale 4: What is my purpose in life? is a question used for spiritual self-assessment. Rationale 5: What feeds my spirit? is a question used for spiritual self-assessment.

The nurse is concerned that the spouse of a recently deceased client is experiencing spiritual distress. What did the nurse observe to come to this clinical decision? Standard Text: Select all that apply. 1. Expressing anger toward God 2. Crying softly in the clients room 3. Hugging family members 4. Talking with caregivers about the clients personal items 5. Refusing comfort from family

Correct Answer: 1, 5 Rationale 1: Defining characteristics of spiritual distress include expressing anger toward God. Rationale 2: Crying softly in the clients room is not a defining characteristic of spiritual distress. Rationale 3: Hugging family members is not a defining characteristic of spiritual distress. Rationale 4: Talking with caregivers about the clients personal items is not a defining characteristic of spiritual distress. Rationale 5: Defining characteristics of spiritual distress include refusing comfort from family.

The nurse is caring for a 5-year-old child. How can the nurse best support the spiritual development of this client? 1. Ask the child who God is. 2. Listen to the childs routine bedtime prayer. 3. Encourage the child to pray before each meal. 4. Bring a Bible storybook in to read to the child at bedtime.

Correct Answer: 2 Rationale 1: Asking who God is assumes that the childs religion recognizes God. At this age, the child is a little young to articulate the identity of God. Rationale 2: The nurse should support the routine spiritual practices encouraged by the family. If the client says routine bedtime prayers, the nurse can support this practice by listening to the prayer. Rationale 3: If the child does not routinely pray before meals, the nurse should not introduce this activity. Rationale 4: Bringing in a Bible storybook to read to the child assumes that the child holds certain religious beliefs.

The 70-year-old client with terminal lung cancer tells the nurse, I am dying because I sinned by smoking cigarettes. What is the nurses best response to this dying client? 1. You are correct, but it is too late to do anything about it now. 2. When you started smoking cigarettes we didnt know about the problems they cause. It is not your fault. 3. Why dont we call the hospital chaplain and you can pray about your sins. 4. Smoking cigarettes isnt a sin. There are many worse habits you could have.

Correct Answer: 2 Rationale 1: If the nurse tells the client that it is too late to do anything about the problem, there is a possibility that distress will increase. Rationale 2: This client is in distress and is seeking forgiveness. The nurse should offer this forgiveness and a reason the forgiveness is valid. Rationale 3: Suggesting that the hospital chaplain be called for prayer reinforces that smoking cigarettes is a sin. Rationale 4: This option minimizes the clients concerns and does not offer forgiveness.

As a part of care planning, the nurse considers the clients spiritual needs. What is the rationale for this concern? 1. Nurses are the only health professionals who provide this type of holistic care. 2. Meeting the clients spiritual needs can decrease suffering. 3. Until spiritual needs are met, physical needs cannot be healed. 4. It is important that the nurses idea of spirituality matches the clients ideas.

Correct Answer: 2 Rationale 1: Nurses do provide holistic care, but so do many other health care professionals. Rationale 2: The nurse is concerned about the clients spiritual health because meeting spiritual needs can decrease suffering. Rationale 3: Physical needs can be addressed and healed without considering the spiritual side, but in order to provide holistic care both should be addressed. Rationale 4: Although the nurse must assess and understand the clients spirituality, it is not necessary for the nurses ideas to match those of the client.

During labor, it becomes apparent that the male infant will survive only a short time after birth. Because this babys parents are Catholic, what planning should the nurse consider? 1. Arrange to have the baby circumcised immediately after birth. 2. Ask the hospital chaplain to be present in the delivery room. 3. Ask the nursing supervisor to find a Catholic nurse to attend the birth. 4. Consider emergency transport of the mother to a Catholic hospital.

Correct Answer: 2 Rationale 1: The concern of this family will be baptism of the infant, not circumcision. Rationale 2: In this situation, the best choice is to have the hospital chaplain present in the delivery room. Rationale 3: This might be applicable if no other option, such as a Catholic chaplain, is available. Rationale 4: Transfer of a laboring woman to another facility is not possible.

The client tells the nurse, I dont know what to do. The treatment plan my physician has suggested is against some of my religious beliefs. What nursing diagnosis problem statement should the nurse identify as appropriate for this client? 1. Ineffective Coping 2. Decisional Conflict 3. Impaired Religiosity 4. Anxiety

Correct Answer: 2 Rationale 1: There is no evidence that this client is coping ineffectively. Rationale 2: For this situation, the best nursing diagnosis problem statement is Decisional Conflict. This client will be called upon to make a decision between two highly regarded but conflicting plans. Rationale 3: Impaired Religiosity is impairment of the ability to exercise religious beliefs, which has not yet occurred in this situation. Rationale 4: Although there may be some anxiety, that nursing diagnosis is not specific to this situation.

The family of a dying client has informed the nurse that their religion requires that a ritual bath be given by members of the faith after death. Because the hospital unit is very busy and there is an acute need for every bed, how should the nurse respond to this request? 1. Notify the mortuary of the familys request. 2. Arrange for supplies and privacy for the family. 3. Tell the family that the bath will have to take place after the body is removed from the hospital. 4. Allow the family to give the bath, but give a 1-hour deadline for completion.

Correct Answer: 2 Rationale 1: There is no need to notify the mortuary. Rationale 2: When a client is dying, much of the nursing care shifts from the client to support of the family. The nurse should allow this bath and should provide supplies and privacy for the family to complete the ritual. Rationale 3: The nurse should not tell the family that they will have to delay the bath until the body is removed. Rationale 4: The nurse should not put a deadline on the bath.

The emergency department nurse contacts the admissions office to request a bed for a bed-bound client who is a practicing Muslim. In acting as an advocate for the client, what request should the nurse make of the admission clerk? 1. Please try to find a private room. 2. A bed that faces east will be best. 3. Have the bed stripped, as the client will provide special sheets. 4. If the only available room is semi-private, the other client should be Muslim.

Correct Answer: 2 Rationale 1: There is no restriction that the room must be private. Rationale 2: Because this bed-bound client is a practicing Muslim and this religion has a sacred practice of five daily prayers performed while facing east, the logical bed assignment for this client is one that faces east. Rationale 3: There is no indication that the client will have hospital linens replaced by special sheets. Rationale 4: There is no restriction that the other client in a semi-private room must be Muslim.

The nurse caring for wheelchair-dependent residents of a long-term care environment has developed a care plan that includes taking the clients outside and assisting them in planting and maintaining a garden. What is the best rationale for this plan? 1. Accreditation agencies require that the residents have regular outings. 2. Keeping in touch with nature is a form of spiritual care. 3. Fresh vegetables from the garden are good sources of nutritional fiber. 4. Sunshine helps activate vitamin D.

Correct Answer: 2 Rationale 1: This may or may not be true. Rationale 2: Keeping in touch with nature is a form of spiritual care for these residents. Rationale 3: Although this might be true, this is not the rationale for this intervention. Rationale 4: Although this might be true, this is not the rationale for this intervention.

The nurse is caring for an older client with end-stage renal disease. What actions should the nurse take to support this clients spiritual development? Standard Text: Select all that apply. 1. Support the client to have hope for a cure. 2. Suggest the client view losses as liberations. 3. Encourage the client to reminisce about life events. 4. Ask open-ended questions about the clients life purpose. 5. Remind the client that time is running out to make any life changes.

Correct Answer: 2, 3, 4 Rationale 1: Supporting the client to have hope for a cure does not support the clients spiritual development. Rationale 2: A nursing action to support the older clients spiritual development includes supporting the client to reframe losses of aging as liberations. Rationale 3: A nursing action to support the older clients spiritual development includes encouraging the client to conduct a life review or reminisce. Rationale 4: A nursing action to support the older clients spiritual development includes asking open-ended questions to encourage open discussion about the clients life. Rationale 5: Reminding the client that time is running out to make any life changes does not support the clients spiritual development.

During the morning bath, the client asks if the nurse is religious and believes in God. What would be most helpful for the nurse to consider in formulating a response to this question? 1. The nurses personal life is none of the clients business. 2. Religion and politics are two subjects not discussed in polite interactions. 3. Will sharing this information positively contribute to the relationship? 4. What is the culture of the facility regarding self-disclosure?

Correct Answer: 3 Rationale 1: Although it is true that the nurses personal life is private, the nurse might decide to self-disclose. Rationale 2: Some cultures do believe that religion and politics should not be discussed in polite interactions, but the client does deserve some answer to the question. Rationale 3: Practice guidelines regarding support of religious practices indicate that the nurse should first consider whether such self-disclosure will contribute to a therapeutic nurseclient relationship. Rationale 4: Although considering the culture of the unit is important, the nurse can make the clinical decision that what is generally done on the unit does not apply in this situation.

The newly hired nurse notices that coworkers routinely pray with clients and their families. The nurse has never been particularly religious or spiritual and is unaccustomed to praying, but holds no strong feeling against prayer. What is the best strategy for the nurse to plan for such situations? 1. Try to ensure assignment to clients who are unlikely to request prayer. 2. Arrange to have a coworker substitute for the nurse in these prayer situations. 3. Memorize two or three short, formal prayers to use when prayer is requested. 4. Just stand silently at the bedside and let others in the room do the praying.

Correct Answer: 3 Rationale 1: It is impossible to be certain that the nurse will not be caring for a patient who will ask for prayer, especially because the practice of prayer is somewhat routine on this unit. Rationale 2: Having a coworker substitute for the nurse will be difficult to operationalize and may not always be an option, so the nurse would need some preparation anyway. Rationale 3: Because this nurse has no objection to praying with clients and families, the best plan is to have two or three short, formal prayers or verses memorized to use when prayer is suggested. Rationale 4: The second best option is to stand silently at the bedside while others pray.

During assessment, the client says that it 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 nurses 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.

Correct Answer: 3 Rationale 1: 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. Rationale 2: Offering to pray for the client is over the boundary of professional practice unless the client requests such intervention and the nurse is comfortable with the arrangement. Rationale 3: 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. Rationale 4: 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.

The client being prepared for a procedure asks to be allowed to wear a religious medal. The client states, I have worn this medal and have not removed it since I was a teenager. What action should the nurse take? 1. Tell the client that the medal must be removed, as it is policy to remove all jewelry for these procedures. 2. Tell the client that the medal can be worn. 3. Tell the client that the nurse will explain to the procedure staff about the medal and will request that they allow the client to wear it. 4. Remove the medal and place it on the head of the bed where the client will be able to see it during the procedure.

Correct Answer: 3 Rationale 1: The fact that there is a policy to remove all jewelry is simply a policy, and an exception might be made and documented in this case. Rationale 2: The nurse should not tell the client that the medal will be allowed, as this decision belongs to those directly involved in the procedure. Rationale 3: The nurse should explain the significance of the medal to the procedure staff and request that the client be allowed to wear it during the procedure. Rationale 4: Removing the medal and placing it on the head of the bed is not a good choice. There may be no reason to remove the medal. Placing the medal on the head of the bed might allow it to be lost.

The client states, I dont know what all this fuss is about religion. God died years ago. The nurse does believe in God and has a strong inclination to share reasons for that belief with the client. What is the best question for the nurse to consider before responding to the clients remark? 1. Will I get into trouble if I say anything? 2. How much longer will I be caring for this client? 3. Am I meeting my needs or the clients? 4. How can I best make this client understand?

Correct Answer: 3 Rationale 1: The nurse should first determine if it is the nurses needs or the clients needs that would be met by a response. Only after that determination is made would the nurse move on to the other questions in formulating the response. Rationale 2: The nurse should first determine if it is the nurses needs or the clients needs that would be met by a response. Only after that determination is made would the nurse move on to the other questions in formulating the response. Rationale 3: The nurse should first determine if it is the nurses needs or the clients needs that would be met by a response. Only after that determination is made would the nurse move on to the other questions in formulating the response. Rationale 4: The nurse should first determine if it is the nurses needs or the clients needs that would be met by a response. Only after that determination is made would the nurse move on to the other questions in formulating the response.

The nurse and client have spent several minutes praying together that the clients upcoming surgery will be successful. What action should the nurse take at this point? 1. Gently tell the client that the nurse must take care of other duties. 2. Smile and pat the client and silently leave the room. 3. Stay with the client until the emotion evoked by the prayer dissipates. 4. Ask the client if there is anything else the nurse can do.

Correct Answer: 3 Rationale 1: This statement makes it appear as if the prayer was just one more task in the nurses list of responsibilities and would not be appropriate. Rationale 2: The nurse should not pat the client and leave the room silently. This would not support the clients spiritual needs. Rationale 3: The nurse should stay with the client for a few minutes after the prayer has ended until the strong emotions that can be evoked by joint prayer dissipate. Rationale 4: Asking if there is anything else the nurse can do makes the prayer look like just another task in a busy day.

The nurse has developed a strong rapport with a client whose medical care necessitates transfusion of multiple units of blood. The client has a religious objection to this treatment even though it is necessary to sustain life. What action should the nurse take? 1. Use the rapport established to influence the client to accept the blood transfusions. 2. Explain the scientific reasons that blood transfusions are necessary and why refusal is dangerous. 3. Encourage the client, the physician, and the clients spiritual adviser to discuss this conflict and any possible alternative therapies. 4. Suggest to the client that as the illness progresses, the blood will probably be transfused despite religious objections.

Correct Answer: 3 Rationale 1: Using the rapport established to influence the decision is unethical. Rationale 2: Just explaining scientific reasons will not generally make a difference in the clients decision. Rationale 3: This is a delicate situation for a nurse who has developed a rapport and relationship with a client. The best response is to support the discussion between client, physician, and spiritual adviser. At that point, the nurse must be prepared to support whatever decision the client makes, even if it is to not permit the transfusions. Rationale 4: This is unethical and should not be done by the nurse.

The nurse is engaging in an activity to develop spiritual self-awareness. What activities can aid the nurse in achieving this goal? Standard Text: Select all that apply. 1. Write a will. 2. Complete an advance directives form. 3. Explore personal end-of-life issues. 4. Create a personal loss history. 5. List significant values.

Correct Answer: 3, 4, 5 Rationale 1: Writing a will is not a strategy to develop spiritual self-awareness. Rationale 2: Completing an advance directives form is not a strategy to develop spiritual self-awareness. Rationale 3: Exploring personal end-of-life issues is a strategy to develop spiritual self-awareness. Rationale 4: Creating a personal loss history is a strategy to develop spiritual self-awareness. Rationale 5: Listing significant values is a strategy to develop spiritual self-awareness.

The female client belongs to a religious community that requires women to dress conservatively in clothing that covers the arms and the knees. This client expresses concern that her body will be exposed during a scheduled cardiac catheterization. How should the nurse respond to this concern? 1. Tell the client that medical personnel have seen so many peoples bodies that they dont even notice any longer. 2. Make a note in the clients chart that she is particularly modest. 3. Explain to the client that in order to perform the study, her body must be exposed. 4. Ask the cath lab charge nurse to come to the clients room to talk with her about the concerns.

Correct Answer: 4 Rationale 1: Although medical personnel are often exposed to unclothed bodies, that information will not make this client more at ease. Rationale 2: Just making a note in the chart is not sufficient. Rationale 3: This is not sufficient to meet the clients needs. Rationale 4: The best plan is to have the cath lab charge nurse talk to the client about her concerns. The charge nurse can then assure the client that even though a small part of her body must be exposed, her modesty will be protected.

After asking general assessment questions regarding spirituality, the nurse finds the client content and satisfied. How should the nurse conduct the rest of the assessment? 1. Specific questions regarding beliefs should be included. 2. The nurse should validate spiritual information with the clients family. 3. The assessment can now move on to physical assessment. 4. No further specific spiritual assessment is currently necessary.

Correct Answer: 4 Rationale 1: If the client is satisfied and content with current levels of spirituality, there is no further specific spiritual assessment necessary. Rationale 2: There is no need to validate spiritual assessment with family unless there is a question of the clients reliability as a historian. Rationale 3: The spiritual assessment should take place at the end of the assessment, so physical assessment should already have been completed. Rationale 4: If the client is satisfied and content with current levels of spirituality, there is no further specific spiritual assessment necessary.

During assessment, the client tells the nurse, I dont believe that the existence of God has been proven. I dont see the scientific evidence I need to be certain. How should the nurse document this finding? 1. The client demonstrates polytheism. 2. The client is an atheist. 3. The client has beliefs that support monotheism. 4. The client is agnostic.

Correct Answer: 4 Rationale 1: Polytheism is the belief in more than one God. Rationale 2: Atheists do not believe in a God. Rationale 3: Monotheism is the belief in one God. Rationale 4: Agnostics are persons who doubt the existence of God or a Supreme Being or believe the existence of God has not been proven.

When arriving to a clients room to provide care, the client is praying with family. What action should the nurse take? 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.

Correct Answer: 4 Rationale 1: Standing inside the room is a violation of privacy and may also unduly influence the length of the prayer session. Rationale 2: Although it is perfectly acceptable for the nurse to pray with clients, joining the prayer without invitation is not acceptable. Rationale 3: The nurse should not interrupt the prayer to request to perform a task. Rationale 4: The nurse should wait in the hall until the prayer is over and the client or family give permission to enter the room.

The client diagnosed with diabetes mellitus develops diabetic ketoacidosis after a religious fast. The client tells the nurse, I have fasted during this season every year since I became an adult. I am not going to stop now. The nurse is not knowledgeable about this particular religion. What is the best action for this nurse? 1. Tell the client that it is different now because of the diabetes. 2. Do some research into the meaning of fasting in this religion. 3. Ask family members of the same religion to discuss fasting with the client. 4. Request a consult from a diabetes educator.

Correct Answer: 4 Rationale 1: Telling the client that life is different now does not support religious beliefs. Rationale 2: Research into the meaning of fasting in this religion would be educative for the nurse, but the client requires more immediate intervention. Rationale 3: Asking the family to talk to the client might help, but the diabetes educator would be able to provide more direct and helpful information for the client. Rationale 4: The diabetes educator should be contacted to work with the client on strategies that might allow the fasting to occur in a safe manner.

A client newly diagnosed with a terminal illness asks to talk with the hospital chaplain and requests a Bible to read. What do these client behaviors indicate to the nurse? 1. The client does not have any family members to discuss spiritual issues. 2. The client is searching for answers. 3. The client wants to talk with someone other than the nurse about spiritual concerns. 4. Interventions for Spiritual Distress have been effective.

Correct Answer: 4 Rationale 1: There is not enough information to determine whether the client does not have family members to discuss spiritual issues. Rationale 2: The nurse has no way of knowing whether the client is searching for answers. Rationale 3: Requesting to talk with a spiritual counselor does not mean that the client does not want to talk with the nurse about spiritual concerns. Rationale 4: Requesting to talk with a spiritual counselor and desiring spiritual reading material indicate that interventions for the diagnosis of Spiritual Distress have been effective.

A client who is facing a final surgery to save his life asks the nurse to stay and pray with him until the surgery begins. In which ways should the nurse demonstrate presencing with this client? Standard Text: Select all that apply. 1. Adjusting the intravenous infusion 2. Talking with the client about the surgery 3. Sitting next to the client in the holding area 4. Praying with the client for divine intervention 5. Focusing on the client and fulfilling his needs

Correct Answer: 4, 5 Rationale 1: Adjusting the intravenous infusion demonstrates partial presence by being present; however, there is more to presencing than just attending to a task. Rationale 2: Talking with the client about the surgery does not demonstrating presencing because this does not fulfill the clients request for the nurse to stay and pray. Rationale 3: Sitting next to the client in the holding area may demonstrate physical presence; however, the nurse is not fulfilling the clients request. Rationale 4: Praying with the client for divine intervention demonstrates transcendent presence because the nurse is spiritually present for the client. Rationale 5: Focusing on the client and fulfilling his needs demonstrates full presence.