Mrs. Thompson, an 82-year-old woman recently admitted to a long-term care facility, has become withdrawn since the loss of her spouse. She expresses feelings of hopelessness and frequently asks, "Why am I still here?" Her appetite has declined, and she avoids participating in group activities she once enjoyed. She has no close family nearby and reports that her church attendance has been irregular since her mobility declined.

A. She has no close family nearby: Limited social support can contribute to loneliness or sadness, but it does not directly indicate spiritual distress. The absence of family primarily affects emotional and social well-being rather than the person’s sense of meaning or connection with a higher purpose. B. She avoids group activities: Withdrawal from social interactions may suggest depression or fatigue but does not necessarily reflect a loss of spiritual connection. Avoiding group participation can result from grief, low motivation, or physical limitations rather than spiritual struggle. C. She questions the meaning of her continued existence: Expressing doubt about life’s purpose and asking existential questions such as “Why am I still here?” are hallmark signs of spiritual distress. This indicates a disruption in her sense of meaning, hope, and connection to her beliefs or faith, suggesting a need for spiritual assessment and support. D. She has trouble sleeping: Disturbed sleep is a nonspecific symptom that can result from many causes, including anxiety, pain, depression, or medication effects. While it may accompany spiritual distress, it is not a defining or direct indicator of it.