A client who smokes says, “I know smoking worsens my breathing, and part of me wants to quit, but I am not ready to set a quit date.” Complete the counseling plan.
Drop-down Cloze
Choose your responses, then check the answer.
Explanation
The client recognizes harm and is considering change but is not ready to commit to a quit date, which is consistent with contemplation. The nurse asks permission to explore both sides of the ambivalence, listens for the client's own reasons for change, offers evidence-based counseling and treatment options, supports a client-chosen next step, and arranges follow-up. Respecting autonomy does not mean avoiding advice or closing the discussion.
Correct Answer Identify contemplation, ask permission to explore reasons for and concerns about change, then offer evidence-based options with a client-chosen next step and follow-up.
Why It Fits The client acknowledges harm and is weighing change but has not committed to a near-term quit plan.
Clinical Picture Motivational communication elicits the client's reasons while the nurse still provides clear cessation advice and access to effective support.
Memory Link Considering change: explore both sides, evoke the client's reasons, arrange the next contact.
NCLEX Rule Match communication to readiness without withholding indicated prevention, counseling, medication discussion, referral, or follow-up.
Why the Alternatives Fail Precontemplation ignores the expressed concern, preparation requires a near-term plan, and confrontation or permanent closure can increase resistance and abandon support.
Sources
1SAMHSA TIP 35
2USPSTF Tobacco Cessation Recommendation
32026 NCLEX-RN Test Plan
The client has not selected a quit date or begun a quit attempt. The nurse uses readiness to tailor communication without withholding evidence-based cessation advice or support.
Contemplation — A stage in which a person recognizes reasons to change and is considering change but remains ambivalent or is not yet committed to an immediate action plan.
Ambivalence — The simultaneous presence of reasons to change and reasons to maintain the current behavior. It is explored respectfully rather than labeled as refusal or resistance.
Motivational Interviewing — A collaborative communication style that uses open questions, affirmations, reflective listening, summaries, and attention to change talk to strengthen a person's own motivation and plan.