The nurse enters the client’s room and smells cigarette smoke. When confronted, the client says, “I only smoked one cigarette because I was having a bad craving.” Which action by the nurse is most appropriate?

  • escort the client outside to smoke
  • call the health care provider to obtain an order for a nicotine patch
  • remind the client that oxygen is in use and smoking is banned in the facility
  • tell the client that if he continues to smoke in the room, he will be discharged from the hospital
Number 3 is correct.
Remind the client that oxygen is highly flammable and that smoking is banned throughout the facility. If the client continues to smoke in the room, notify security so that they can intervene. There have been documented cases of explosions in facilities caused by smoking around oxygen, so this situation should be taken seriously and not dismissed. Escorting the client outside to smoke places the client at risk for falling, especially if he has an IV pole. It also encourages behavior that is not healthy and takes a staff member off the unit without good cause. To help prevent cravings, clients who smoke should be offered a nicotine patch upon admission when the smoking history is documented. The nurse should check and see if the health care provider ordered one as a PRN medication. If not, the nurse can ask the client if he would like a patch. Threatening the client with discharge if he is not compliant with the smoking ban does not address the situation in a safe manner and can escalate the situation.