A patient reports smoking two or more packs of cigarettes per day ...

[clippers!]

A patient reports smoking two or more packs of cigarettes per day and expresses a desire to quit smoking. The primary care NP learns that the patient smokes heavily during breaks at work and during the evening but with no established schedule.
 
  The NP should recommend: a. bupropion (Wellbutrin).
  b. nicotine replacement gum or nasal spray.
  c. a high-dose 24-hour nicotine patch.
  d. intensive smoking cessation counseling.

Question 2

A primary care NP has been working with a young woman who wants to quit smoking before she begins having children. She has made several attempts to quit using nicotine replacement therapy and is feeling discouraged.
 
  She does not want to take medication at this time. The NP should: a. discuss the effects of smoking on fetal development.
  b. ask her to write down any factors that triggered her relapses.
  c. give her information about the long-term effects of smoking.
  d. convince her that taking medication will be essential in her case.

[bd5255]

Answer to Question 1

B
Nicotine replacement gum and nasal spray both can be used when patients have cravings and are especially useful for patients who do not smoke at particular times. The patch is useful when patients smoke consistently throughout the day. Bupropion is not indicated. Intensive counseling is often necessary for patients who have difficulty stopping and have failed several times.

Answer to Question 2

B
Each attempt to quit smoking should not be seen as a failure but as a trial for the next attempt. Asking a patient who is motivated to quit to write down things that may have contributed to the relapse will help the patient learn from the previous attempts. The patient already knows about the effects of smoking on fetal development because that is her motivation for quitting. Offering medication may be necessary, but only if the patient desires it.

[clippers!]

Gracias!

[gcook]

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