Chapter 46: Spirituality (NCLEX PREP Q's)
A nurse is caring for patients admitted to a long-term care facility. Which nursing actions are appropriate based on the religious beliefs of the individual patients? Select all that apply. a) The nurse dietitian asks a Buddhist if he has any diet restrictions related to the observance of holy days. b) A nurse asks a Christian Scientist who is in traction if she would like to try nonpharmacologic pain measures. c) A nurse administering medications to a Muslim patient avoids touching the patient's lips d) A nurse asks a Roman Catholic woman if she would like to attend the local Mass on Sunday. e) The nurse is careful not to schedule treatment and procedures on Saturday for a Hindu patient. f ) The nurse consults with the medicine man of a Native American patient and incorporates his suggestions into the care plan.
a, b, d, f. The nurse dietitian should ask a Buddhist if he has any diet restrictions related to the observance of holy days. Since Catholic Scientists avoid the use of pain medications, the nurse should ask a Christian Scientist who is in traction if she would like to try nonpharmacologic pain measures. A nurse administering medications to a Hindu woman avoids touching the patient's lips. A nurse should ask a Roman Catholic woman if she would like to attend the local Mass on Sunday. The nurse is careful not to schedule treatment and procedures on Saturday for a Jewish patient due to observance of the Sabbath. The nurse would appropriately consult with the medicine man of a Native American patient and incorporates his or her suggestions into the care plan.
After having an abortion, a patient tells 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 talks 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 10 PM to 6 AM 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.
a. 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.
A nurse performing a spiritual assessment collects assessment data from a patient who is homebound and unable to participate in religious activities. Which type of spiritual distress is this patient most likely experiencing? a) Spiritual Alienation b) Spiritual Despair c) Spiritual Anxiety d) Spiritual Pain
a. Spiritual Alienation occurs when there is a "separation from the faith community." Spiritual Despair occurs when the patient is feeling that no one (not even God) cares. Spiritual Anxiety is manifested by a challenged belief and value system, and Spiritual Pain may occur when a patient is unable to accept the death of a loved one.
A nurse who is comfortable with spirituality is caring for patients who need spiritual counseling. Which nursing action would be most appropriate for these patients? a) Calling the patient's own spiritual adviser first b) Asking whether the patient has a spiritual adviser the patient wishes to consult c) Attempting to counsel the patient and, if unsuccessful, making a referral to a spiritual adviser d) Advising the patient and spiritual adviser concerning health options and the best choices for the patient
b. Even when a nurse feels comfortable discussing spiritual concerns, the nurse should always check first with patients to determine whether they have a spiritual adviser they would like to consult. Calling the patient's own spiritual adviser may be premature if it is a matter the nurse can handle. The other two options deny patients the right to speak privately with their spiritual adviser from the outset, if this is what they prefer.
A nurse who is caring for patients on a pediatric ward is assessing the children for their spiritual needs. Which is the most important source of learning for a child's own spirituality? a) The child's church or religious organization b) What parents say about God and religion c) How parents behave in relationship to one another, their children, others, and to God d) The spiritual adviser for the family
c. Children learn most about their own spirituality from how their parents behave in relationship to one another, their children, others, and God (or a higher being). What parents say about God and religion, the family's spiritual advisor, and the child's church or religious organization are less important sources of learning.
Mr. Brown's teenage daughter had been involved in shoplifting. He expresses much anger toward her and states he cannot face her, let alone discuss this with her: "I just will not tolerate a thief." Which nursing intervention would the nurse take to assist Mr. Brown with his deficit in forgiveness? a) Assure Mr. Brown that many parents feel the same way. b) Reassure Mr. Brown that many teenagers go through this kind of rebellion and that it will pass. c) Assist Mr. Brown to identify how unforgiving feelings toward others hurt the person who cannot forgive. d) Ask Mr. Brown if he is sure he has spent sufficient time with his daughter.
c. Helping Mr. Brown identify how his unforgiving feelings may be harmful to him is the only nursing intervention that directly addresses his unmet spiritual need concerning forgiveness. Assuring Mr. Brown that many parents would feel the same way or that many teenagers shoplift out of rebelliousness may make him feel better initially, but neither option addresses his need to forgive. Suggesting that Mr. Brown may not have spent enough time with his daughter is likely to make him feel guilty.
A nurse working in an emergency department assesses how patients' religious beliefs affect their treatment plan. With which patient would the nurse be most likely to encounter resistance to emergency lifesaving surgery? a) A patient of the Adventist faith b) A patient who practices Buddhism c) A patient who is a Jehovah's Witness d) A patient who is an Orthodox Jew
c. Patients who practice the Jehovah's Witness faith believe blood transfusions violate God's laws and do not allow them. The other religious groups do not restrict modern lifesaving treatment for their members.
A nurse is performing spirituality assessments of patients living in a long-term care facility. What is the best question the nurse might use to assess for spiritual needs? a) Can you describe your usual spiritual practices and how you maintain them daily? b) Are your spiritual beliefs causing you any concern? c) How can I and the other nurses help you maintain your spiritual practices? d) How do your religious beliefs help you to feel at peace?
c. Questioning how the staff can meet patients' spiritual practices assesses spiritual needs. Asking the patient to describe spiritual practices assesses spiritual practices. Asking about concerns assesses spiritual distress, and asking about feeling at peace assesses the need for forgiveness.
A nurse who was raised as a strict Roman Catholic but who is no longer a practicing Catholic stated she couldn't assist patients with their spiritual distress because she recognizes only a "field power" in each person. She said, "My parents and I hardly talk because I've deserted my faith. Sometimes I feel real isolated from them and also from 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
c. The data point to an unmet spiritual need to experience love and belonging, given the nurse's estrangement from her family and God after leaving the church. The other options may represent other needs this nurse has, but the data provided do not support them.
A man who is a 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. What is the most important nursing intervention to plan? 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.
c. 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.
A hospice nurse is caring for a patient who is dying of pancreatic cancer. The patient tells the nurse "I feel no connection to God" and "I'm worried that I find no real meaning in life." What would be the nurse's best response to this patient? a) Give the patient a hug and tell him that his life still has meaning. b) Arrange for a spiritual adviser to visit the patient. c) Ask if the patient would like to talk about his feelings. d) Call in a close friend or relative to talk to the patient.
c. When caring for a patient who is in spiritual distress, the nurse should listen to the patient first and then ask whether the patient would like to visit with a spiritual adviser. To arrange for a spiritual adviser first may not respect the wishes of the patient. A hug and false reassurances do not address the diagnosis of spiritual distress. Talking to friends or relatives may be helpful, but only if the patient desires their visits.
A patient states she feels so isolated from her family and church, and even from God, "in this huge medical center so far from home." A nurse is preparing nursing goals for this patient. Which is the best goal for the patient to relieve her spiritual distress? a) The patient will express satisfaction with the compatibility of her spiritual beliefs and everyday living. b) The patient will identify spiritual beliefs that meet her need for meaning and purpose. c) The patient will express peaceful acceptance of limitations and failings. d) The patient will identify spiritual supports available to her in this medical center.
d. Each of the four options represents an appropriate spiritual goal, but identifying spiritual supports available to this patient in the medical center demonstrates a goal to decrease her sense of isolation.
The Roman Catholic family of a baby who was born with hydroencephalitis requests a baptism for their infant. Why is it imperative that the nurse provides for this baptism to be performed? 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) Not having a Baptism for the baby when desired may increase the family's sorrow and suffering.
d. Failure to ensure that an infant baptism is performed when parents desire it may greatly increase the family's sorrow and suffering, which is an appropriate nursing concern. Whether baptism postpones or prevents death and suffering is a religious belief that is insufficient to bind all nurses. There is no legal requirement regarding baptism, and although some nurses may believe part of their role is to ensure the salvation of the baby, this function would understandably be rejected by many.
Even though the nurse performs a detailed nursing history in which spirituality is assessed on admission, problems with spiritual distress may not surface until days after admission. What is the probable explanation? a) Patients usually want to conceal information about their 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.
d. 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 is Goldstein was served a kosher meal ordered from a restaurant on a paper plate because the hospital made no provision for kosher food or dishes. Mr. Goldstein became angry and accused the nurse of insulting him: "I want to eat what everyone else does—and give me decent dishes." Analysis of these data reveals what finding? 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.
d. On the basis of his name alone, the nurse jumped to the premature and false conclusion that this patient would want a kosher diet.
