# A nurse is counseling a 50-year-old patient who smokes 1 pack per day and is now considering quitting. Which interventions are appropriate components of evidence-based smoking cessation counseling? Select all that apply.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373258&lang=en  
> language: en  
> subject: Health Promotion and Maintenance  
> category: HPM

## Question

A nurse is counseling a 50-year-old patient who smokes 1 pack per day and is now considering quitting. Which interventions are appropriate components of evidence-based smoking cessation counseling? Select all that apply.

1

Arrange follow-up contact within the first week after the quit date, then weekly during the first month, to support relapse prevention.

2

Assess willingness to make a quit attempt, then assist by setting a quit date, removing cigarettes from the home, and offering pharmacotherapy.

3

Advise the patient in clear, strong, personalized terms to quit, linking the recommendation to the patient's personal health concerns.

4

Ask about tobacco use at every visit and document pack-years and current willingness to quit on a 0 to 10 readiness scale.

5

Discourage all pharmacotherapy and recommend "cold turkey" since medications have too many side effects to be worth the risk.

## Explanation

The USPSTF 5 A's framework: ASK (every visit), ADVISE (clear, strong, personalized), ASSESS willingness, ASSIST (quit date, environment, pharmacotherapy), ARRANGE follow-up. Combination NRT + bupropion or varenicline + behavioral support is the most effective evidence-based regimen — about 2 to 3 times more successful than placebo. Choice 5 is wrong — pharmacotherapy doubles to triples cessation success and is recommended for nearly all adults willing to try; "cold turkey" alone has the lowest success rate.

## In-depth explanation

The single highest-yield NCLEX smoking-cessation point is "use combination pharmacotherapy + behavioral counseling." Varenicline is now first-line per USPSTF (more effective than NRT alone or bupropion alone). Bupropion is contraindicated in seizure disorders and active eating disorders.

## Clinical scenario

50-year-old **1-pack-per-day smoker for 30 years** presents for a routine wellness visit. Patient states, "My doctor keeps telling me to quit and I think I am ready to try this time." The nurse uses the **5 A's framework**.

## Key concepts

- **5 A's framework** — Ask, Advise, Assess, Assist, Arrange — USPSTF evidence-based brief intervention for tobacco cessation.
- **Combination pharmacotherapy** — NRT (patch + lozenge/gum), bupropion, or varenicline; combinations 2-3 times more effective than placebo.
- **Quit-date follow-up** — Contact within 1 week of quit date, weekly for 1 month — relapse prevention support and pharmacotherapy adjustment.

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