1.

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The nurse is scheduling a home visit for a client whose religion is listed as Seventh-Day Adventist. Using the box shown, the nurse plans care based on awareness that the client will require: a. Assistance in paying for health care services. b. Avoidance of Western medical intervention. c. The visit to be made before sundown on Friday. d. Meals that do not mix meat and dairy. Grade: User Responses: Feedback: 1 c.The visit to be made before sundown on Friday. a.Rationale: Click the thumbnail below to see a larger view of the image.

Seventh-Day Adventists avoid activity such as diagnostics or appointments on the Sabbath, which begins at sundown on Friday. Cognitive Level: Applying Nursing Process: Implementation Client Need: Psychosocial Integrity 2. Click the thumbnail below to see a larger view of the image.

The home health nurse receives report that an elderly homebound client of the Jewish faith has not been eating since a meal delivery service has been initiated. Using the box shown, what action should the nurse take first? a. Have the family keep a 3 day food log for the client. b. Assess the client to determine why he is not eating. c. Do a complete physical assessment. d. Request that a dietitian visit the client.

Grade: User Responses: Feedback:

1 b.Assess the client to determine why he is not eating. a.Rationale: Click the thumbnail below to see a larger view of the image.

This is the first action to take. The client may not be eating if the meal service if not complying with religious practices or there may be other issues related to the way the meals are served or prepared so the nurse must first assess to determine what is occurring. Cognitive Level: Applying Nursing Process: Implementation Client Need: Physiological Integrity 3. A 27-year-old client with a bleeding duodenal ulcer has refused blood transfusions because of religious beliefs. What is the best action for the nurse to take? a. Administer the blood transfusion after the client becomes unconscious. b. Explain that God does not want the client to die, and ask the client to reconsider. c. Provide information that the client needs to make an informed decision, and support the clients decision. d. Seek a court order forcing the client to accept the blood transfusion. Grade: User Responses: Feedback: 1 c.Provide information that the client needs to make an informed decision, and support the clients decision. a.Rationale: The client is an adult who has every right to make his own decisions, whether or not the client agrees with medical opinion. The nurses best action is to ensure that the client has all the information needed in order to make the best decision and then support whatever decision is made. Cognitive Level: Applying Nursing Process: Implementation Client Need: Physiological Integrity 4. Which of the following clients does the nurse consider to be at high risk for spiritual distress? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. a. A client in severe pain following severe burns b. The widow of a policeman killed in the line of duty c. A 26-year-old female admitted after a miscarriage d. A client with a poor prognosis for recovery from cancer e. An older adult client recovering from joint replacement surgery

Grade: User Responses: Feedback:

1 a.A client in severe pain following severe burns,b.The widow of a policeman killed in the line of duty,c.A 26-year-old female admitted after a miscarriage,d.A client with a poor prognosis for recovery from cancer a.Rationale:Cognitive Level: Analyzing Nursing Process: Assessment Client Need: Psychosocial Integrity A client suffering a miscarriage is at high risk for spiritual distress. She may blame herself for the miscarriage or see it as God punishing her, adding to spiritual distress. There is no indication that this client is at high risk of spiritual distress. Pain, especially severe ongoing pain, puts the client at risk for spiritual distress. The clients poor prognosis puts him at risk for spiritual distress. Loss of a loved one, especially when the loved ones death was the result of an injury or unexpected trauma, puts one at risk for spiritual distress.

5.

An adult survivor of child sexual abuse by a relative felt spiritual distress for many years as a result. Which statement made to the clients support group provides evidence to the nurse that the client is recovering from spiritual distress? a. I am beginning to forgive the person who did this to me. b. Abusers create so much pain in their victims. c. I dont need God to live a full life. d. I no longer see my family because I dont need the grief. Grade: User Responses: Feedback: 1 a.I am beginning to forgive the person who did this to me. a.Rationale: Forgiveness is a defining characteristic of spiritual wellness and indicates some resolution of spiritual distress. Cognitive Level: Analyzing Nursing Process: Evaluation Client Need: Psychosocial Integrity

6.

The nurse explains that research evidence suggests that: a. Older adults are not very religious, but are very spiritual. b. Increased spiritual well-being is found among older adults with chronic health conditions. c. Older adults who are more religious have more illness. d. Older adults spiritual health and mental health are correlated. Grade: User Responses: Feedback: 1 d.Older adults spiritual health and mental health are correlated. a.Rationale: Evidence shows spiritual well-being to be directly correlated to mental health and physical well-being. Cognitive Level: Remembering Nursing Process: Implementation Client Need: Psychosocial Integrity

7.

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A client tells the nurse that she is concerned about her college-age son because he has suddenly rejected the spiritual traditions of their family. Using the table shown, the nurses best response is to: a. Contact the son to discuss the clients concern. b. Refer the client to a local minister. c. Reassure the client that everything will work out. d. Discuss spiritual development of young adults with the client. Grade: User Responses: Feedback: 1 d.Discuss spiritual development of young adults with the client. a.Rationale: Click the thumbnail below to see a larger view of the image.

Teaching the client that young adults begin to develop their own beliefs and practices may help her to understand her sons choices. Cognitive Level: Applying Nursing Process: Implementation Client Need: Psychosocial Integrity 8. Click the thumbnail below to see a larger view of the image.

A parent asks the nurse at what age it is appropriate to enroll the child in a program to learn about the familys religious faith. Using the table shown, the nurses best response is: a. 2 years of age. b. When the child asks to attend. c. 12 to 14 years of age. d. During the early school-age years.

Grade: User Responses: Feedback:

1 d.During the early school-age years. a.Rationale: Click the thumbnail below to see a larger view of the image.

Children in the 7- to 12-year-old age group have the ability to learn the practices of their culture and religion. Cognitive Level: Understanding Nursing Process: Implementation Client Need: Psychosocial Integrity 9. Click the thumbnail below to see a larger view of the image.

The nurse is planning care for a client who follows Orthodox Jewish beliefs. Using the box shown, how should the nurse adapt the plan of care? a. Financial arrangements for care will be made through the religious community. b. Family teaching should not be planned for Saturday. c. A vegetarian diet will likely be followed. d. The client will want to receive communion. Grade: User Responses: Feedback: 1 b.Family teaching should not be planned for Saturday. a.Rationale: Click the thumbnail below to see a larger view of the image.

Orthodox Jews do not travel, use electricity, or write on the Sabbath, which begins at sundown on Friday and continues through sundown on Saturday. Family members are not able to participate in education sessions on the Sabbath. Cognitive Level: Applying Nursing Process: Implementation Client Need: Psychosocial Integrity 10. A client confides in the nurse that she reads religious scripture and practices meditation every day but has not engaged in these practices since being admitted to the hospital. The best action for the nurse to take is to: a. Take the client to the hospital chapel. b. Arrange for the client to get her reading material and schedule time for meditation. c. Find other reading materials that the client might enjoy. d. Give the client a roommate who engages in the same practices.

Grade: User Responses: Feedback:

1 b.Arrange for the client to get her reading material and schedule time for meditation. a.Rationale: Inability to meet spiritual needs or engage in rituals can be a cause of spiritual distress. The nurse should make an effort to meet the needs of the client by obtaining the reading materials and providing uninterrupted time for meditation. Cognitive Level: Applying Nursing Process: Implementation Client Need: Psychosocial Integrity

11.

When planning care for a young client who states that she has never missed receiving communion on Sunday, the nurse includes: a. Arranging for the client to receive communion while hospitalized. b. Encouraging family to visit the client after Sunday services. c. Asking a social worker to talk with the client. d. Explaining that receiving communion will depend on the diet that is ordered. Grade: User Responses: Feedback: 1 a.Arranging for the client to receive communion while hospitalized. a.Rationale: Arranging for the client to receive communion addresses the clients need to participate in this ritual. Cognitive Level: Applying Nursing Process: Implementation Client Need: Psychosocial Integrity

12.

Strategies the nurse uses to increase spiritual awareness includes: (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. a. Listing significant values. b. Comparing own beliefs to others. c. Exploring cultural beliefs related to end-of-life issues. d. Creating a personal loss history. e. Writing a self-epitaph. Grade: User Responses: Feedback: 1 a.Listing significant values.,d.Creating a personal loss history.,e.Writing a self-epitaph. a.Rationale: Cognitive Level: Remembering Nursing Process: Planning Client Need: Psychosocial Integrity Writing a self-epitaph that sums up the significance of the nurses life is a strategy to increase spiritual awareness. Exploring personal beliefs about end-of-life issues is more important than a study of cultural beliefs when the nurse is trying to increase spiritual self-awareness. Creating a personal loss history helps nurses to assess their own response to loss. Listing significant values helps nurses to clarify what is most valuable in their lives. Comparing own beliefs to others is not a component of selfawareness.

13.

A client tells the nurse that he just knows that the outcome of his surgery will be positive. This statement is an expression of: a. Faith. b. Transcendence. c. Hope. d. Religion. Grade: User Responses: Feedback: 1 c.Hope. a.Rationale: Hope is anticipation that involves future fulfillment. This statement reflects hope. Cognitive Level: Understanding Nursing Process: Assessment Client Need: Psychosocial Integrity

14.

When asked about religious beliefs, a client describes his personal beliefs as agnostic. How should the nurse interpret this information? a. The client believes in the existence of one God or supreme being. b. The client neither believes nor disbelieves in God or a supreme being. c. The client belongs to the agnostic sect of Catholicism. d. The client believes in more than one God or supreme being. Grade: User Responses: Feedback: 1 b.The client neither believes nor disbelieves in God or a supreme being. a.Rationale: An agnostic neither believes nor disbelieves in God or a supreme being. Cognitive Level: Understanding Nursing Process: Assessment Client Need: Psychosocial Integrity

15.

The nurse develops a care plan with the nursing diagnosis Spiritual Distress for a client who expresses a fear of death because he has not lived a good life. An appropriate expected outcome for this client is: a. The client expresses hope that his punishment after death will be tolerable. b. The client accepts his punishment after death as just. c. The client quietly listens as his family comforts him. d. The client expresses self-forgiveness. Grade: User Responses: Feedback: 1 d.The client expresses self-forgiveness. a.Rationale: Self-forgiveness is an indication of spiritual health. Cognitive Level: Understanding Nursing Process: Evaluation Client Need: Psychosocial Integrity

16.

The nurse determines that the client has met the expected outcome of spiritual health when observing that: a. The client smiles when the nurse enters the room. b. The client reads religious writings every day. c. The client is receptive to the nurses views of spirituality. d. The client watches TV with family members when they visit.

Grade: User Responses: Feedback:

1 b.The client reads religious writings every day. a.Rationale: Desired outcomes for spiritual health include: sharing thoughts, feelings, and beliefs with others; using a type of spiritual experience that provides comfort; and interacting with the spiritual leader of the client's religion. By reading religious writings every day, the client is demonstrating interaction with her religion. Cognitive Level: Understanding Nursing Process: Evaluation Client Need: Psychosocial Integrity

17.

The nurse is caring for a dying newborn whose parents request a Roman Catholic baptism before the child dies. There is no priest immediately available. The nurses best action is to: a. Perform the baptism for the family. b. Call local churches to find a priest. c. Encourage the parents to pray over the child instead. d. Tell the parents that it is impossible. Grade: User Responses: Feedback: 1 a.Perform the baptism for the family. a.Rationale: It is not uncommon for health care personnel to perform baptisms in the absence of a clergy member. If the nurse is not comfortable performing the procedure, it is likely that another nurse on the unit can fulfill this ritual. Cognitive Level: Applying Nursing Process: Implementation Client Need: Psychosocial Integrity

18.

A client who is being prepared for surgery refuses to allow the nurse to remove a necklace that holds a religious metal. How should the nurse respond? a. Call the surgeon. b. Cancel the surgery. c. Leave the necklace in place. d. Ask a relative to intervene. Grade: User Responses: Feedback: 1 c.Leave the necklace in place. a.Rationale: Leaving the medal in place will address the clients need for spiritual comfort. If necessary, operating room staff can be asked to remove it and ensure its safety. The nurse should place a note on the front of the chart to inform operating room staff. Cognitive Level: Applying Nursing Process: Implementation Client Need: Psychosocial Integrity

19.

A client is critically ill. The policy in the critical care unit is that no more than two visitors are allowed at one time. A group of 12 church members arrives for the laying on of hands, anointing, and prayers of healing. The nurses best response is to: a. Be kind but firm about the policy. Explain that there are no exceptions, and the unit adheres to the policy. b. Call the clients primary care provider for approval. Write the instructions as an order and explain the orders to the client and church members. c. With the clients permission, allow the church members to pray in the waiting room. d. Discuss the situation with the client and respect the clients wishes with the least disruption possible. Grade: User Responses: Feedback: 1 d.Discuss the situation with the client and respect the clients wishes with the least disruption possible. a.Rationale: The nurse is an advocate for the client before others. If a critically ill client desires prayer and a healing ceremony, the nurse should try to accommodate that situation while keeping in mind the needs of other clients in the critical care unit. Cognitive Level: Applying Nursing Process: Implementation Client Need: Psychosocial Integrity