Frustration and anger are common emotional responses to chronic illness, especially when the disease affects the client's ability to perform daily activities, maintain social relationships, and cope with uncertainty. These emotions can interfere with the client's adherence to treatment, self-care, and quality of life. The nurse should acknowledge the client's feelings, provide emotional support, and refer the client to appropriate resources, such as counseling, support groups, or stress management techniques.

Incorrect options:

A) The client reports difficulty sleeping due to joint pain and stiffness. - This is a physical finding, not a psychosocial one. However, poor sleep quality can affect the client's mood, energy, and immune function, so the nurse should address this issue and suggest strategies to improve sleep hygiene and comfort.

C) The client has a history of depression and anxiety prior to the diagnosis. - This is a risk factor for developing psychosocial distress related to chronic illness, but it is not a finding in itself. The nurse should assess the client for signs and symptoms of depression and anxiety, such as low mood, hopelessness, excessive worry, nervousness, or changes in appetite or weight. The nurse should also monitor the client for suicidal ideation or behavior and provide appropriate interventions as needed.

D) The client requests information about the prognosis and treatment options for the disease. - This is a positive finding, as it indicates that the client is interested in learning more about the disease and participating in decision-making. The nurse should provide accurate and honest information, clarify any misconceptions, and address any concerns or questions that the client may have.

The client is experiencing low self-esteem and negative self-image due to the loss of roles and functions caused by chronic illness. The nurse should use positive reinforcement and affirmations to help the client recognize their worth and value as a person, regardless of their disease status or limitations. The nurse should also encourage the client to identify their strengths and abilities, such as hobbies, interests, skills, or talents, that they can still enjoy or develop.

Incorrect options:

B) "You are not hopeless. There are many treatments available that can help you manage your symptoms." - This response is dismissive of the client's feelings and may sound unrealistic or insensitive. While providing information about treatments is important, it should not be done without acknowledging and validating the client's emotions first.

C) "You are not alone. There are many people who care about you and want to help you." - This response is supportive but does not address the core issue of low self-esteem and negative self-image. The nurse should also help the client explore their own sense of identity and worth beyond their relationships with others.

D) "You are not helpless. There are many things that you can do to improve your condition and well-being." - This response is empowering but may sound patronizing or demanding if the client is feeling overwhelmed or discouraged by their situation. The nurse should also respect the client's pace and readiness to make changes or take action.

The client is expressing suicidal ideation, which is a medical emergency that requires immediate assessment and intervention. The nurse should first ask the client if they have a plan to harm themselves or others, as this indicates the level of risk and urgency. The nurse should also assess the client for other signs and symptoms of suicidal behavior, such as giving away possessions, saying goodbye, withdrawing from others, or having a history of previous attempts. The nurse should ensure the client's safety, provide emotional support, and notify the health care provider and the mental health team as soon as possible.

Incorrect options:

B) Explore the reasons behind the client's wish to die. - This is an important step in understanding the client's perspective and addressing their underlying issues, such as depression, hopelessness, grief, or loss of control. However, it should not be done before ensuring the client's safety and assessing their risk of suicide.

C) Inform the health care provider about the client's statement. - This is a necessary action, but not the best initial one. The nurse should first assess the client's risk of suicide and ensure their safety before contacting the health care provider and the mental health team.

D) Educate the client about the benefits of hemodialysis and the risks of discontinuing it. - This is an inappropriate action, as it ignores the client's feelings and may sound judgmental or coercive. The nurse should not try to persuade or convince the client to change their mind without first acknowledging and validating their emotions and exploring their reasons for wanting to die.

The client is experiencing self-blame and guilt for contributing to their chronic illness through smoking. The nurse should use motivational interviewing techniques to help the client overcome their ambivalence and resistance to quitting smoking. The nurse should express empathy, avoid confrontation or criticism, elicit the client's own reasons for quitting, highlight the discrepancies between the client's goals and behaviors, and support the client's self-efficacy and autonomy. The nurse should also provide information about the benefits of quitting smoking, such as reducing symptoms, preventing complications, improving lung function, increasing life expectancy, saving money, and enhancing well-being.

Incorrect options:

A) "You should not feel ashamed or guilty. Smoking is an addiction that is hard to overcome." - This response is empathetic but may sound dismissive or minimizing of the client's feelings. The nurse should acknowledge and validate the client's emotions before providing reassurance or information.

B) "You should feel ashamed and guilty. Smoking is a harmful habit that you could have avoided." - This response is judgmental and blaming, which can damage the therapeutic relationship and increase the client's defensiveness or resistance to quitting smoking. The nurse should avoid using words such as "should" or "must" that imply obligation or pressure.

C) "You can still quit smoking if you want to. There are many resources available to help you." - This response is supportive but may sound presumptuous or premature if the client is not ready or willing to quit smoking. The nurse should assess the client's stage of change and readiness to quit before offering resources or assistance.