Participant Information

Street address:
Address (cont):
City:	State:
Zip:

Daytime phone:
Email:
Nurse license #:
CHES ID #:

Please choose one:
LPN
RN
Nurse Practitioner
Other

Please choose one for contact hours (leave blank for none):
Nursing
CHES
Both

Post Test Questions

1. Currently there is a ______ percent reduction in the incidence of low birth weight deliveries due to increased rates of prenatal smoking cessation.
   7%
   9%
   11%
   15%
   
   
2. Obstetrician Gynecologists need to be actively involved in prenatal smoking cessation efforts because______.
   It is their job as a doctor.
   They are the only physicians women ages 25-44 will see on a regular basis.
   They have the extra time and need to be more involved in client behavior change.
   They do not need to spend valuable office time assisting prenatal smoking cessation.  Simply providing pamphlets is enough to encourage clients who smoke to quit.
   
   
3. The Five A's is _______.
   A counseling program offered by a trained facilitator to aid clients with smoking cessation difficulties.
   A series of pamphlets and brochures offered to clients to inform them of smoking cessation options available to them.
   A five to fifteen minute research-based counseling tool proven to be successful in aiding pregnant women with smoking cessation.
   I am not sure what the Five A's are used for.
   
   
4. Ask, the first step of the Five A's, means to do what?
   Identify every client's tobacco status at each visit.
   Ask clients if they use tobacco products during their first office visit only.
   Establish a rapport with the client.
   Begin questioning the client about her behaviors and telling her which behaviors need to cease.
   
   
5. Which of the following is the best way to implement the Ask portion of the Five A's ensuring that every client is asked about tobacco use at every visit?
   Expand vital signs chart to include a section about tobacco use.
   Label charts using color-coding to identify current smokers, past smokers, and non-smokers.
   Make asking clients about tobacco use status part of the office protocol policy.
   Post a sign in the break area asking clinicians to try to remember to ask clients about tobacco use.
   
   
6. Some clients who are current smokers will want to quit smoking with your assistance, while some may be resistant to considering a smoking cessation program.
   True
   False
   
   
7. Which of the following can be considered a motivator for change in smoking behavior (please check all that apply)?
   Infants of smokers have an increased risk of infant morbidity and mortality.
   Smoking increases the risk of spontaneous abortion.
   Smoking causes premature wrinkling.
   Cigarettes are expensive.
   All of the above
   None of the above
   
   
8. During the Advise portion of the Five A's, clinicians are encouraged to_____.
   Provide the client with advice on smoking cessation techniques.
   Provide the client with a strict program outlining what she has to do each day to quit smoking.
   Provide the client with a brief cessation message that is clear, supportive and non-confrontational.
   Tell the client if she continues to smoke you will not schedule appointments for smoking cessation counseling with her.
   
   
9. In the Assess portion of the Five A's, to be able to assist a client with smoking cessation, you need to _______.
   Assess the client's willingness to commit to this change.
   Assess whether the client has relapsed frequently in the past.
   Assess client knowledge about cessation techniques.
   
   
10. If a client currently uses tobacco products and is willing to quit at this time, what should you as the health care provider do?
    Provide tobacco cessation techniques (the Five A's).
    Provide motivational materials (the Five R's).
    Recommend the client call the American Cancer Society or the American Lung Association and sign up for a smoking cessation class.
    
    
11. What are 4 areas to address with your client when she is considering quitting smoking?
    1. 
    2. 
    3. 
    4. 
    
    
12. What is the purpose of using the Five R's?
    Provide clinicians with a second type of smoking cessation/counseling tool. The Five R's are similar to the Five A's.
    To motivate clients not ready to quit smoking and let them know you are a resource when they are ready.
    To provide a step-by-step outline on how to counsel pregnant women through withdrawal symptoms.
    
    
13. Which of the following forms of assistance are provided during the Assist portion of the Five A's (please check all that apply)?
    Aid client with her cessation attempt.
    Help client develop a cessation plan.
    Provide practical counseling on cessation issues.
    Provide support.
    Provide pamphlets and informational brochures.
    All of the above
    None of the above
    
    
14. When assisting a client in selecting a cessation date, it is important to remind them that no time is perfect for quitting, but that a goal cessation date is important. Within what time period from the date selected should the cessation date take place?
    Within the next month (four weeks).
    Within the next two months (eight weeks).
    Within the next three months (twelve weeks).
    
    
15. How many steps are there in the Developing A Plan with your client section?
    5
    8
    11
    There is not a developing plan section in this training module.
    
    
16. During the Arrange portion of the Five A's the health care provider is doing what to assist the client with smoking cessation (please check all that apply)?
    Arranging to contact the client as a follow-up to the cessation counseling session.
    Arranging a time to discuss questions and concerns that have arisen since the last physicians visit.
    Arranging a time to identify relapse and maintenance skills that client is developing.
    All of the above
    None of the above
    
    
17. How long after the smoking cessation counseling session should the first and second follow-up sessions be made?
    one week and one month
    two weeks and two months
    three weeks and three months
    six weeks and six months
    
    
18. During a follow-up call you find that a client has relapsed, what questions should be asked of the client at this time (please list 5)?
    1. 
    2. 
    3. 
    4. 
    5. 
    
    
19. Please list the Five A's.
    1. 
    2. 
    3. 
    4. 
    5. 
    
    
20. You should measure the success of the office prenatal smoking cessation program by how many pregnant women are able to successfully quit smoking during their pregnancy.
    True
    False
    
    
21. What is one way suggested in the training to build rapport with a client during the smoking cessation counseling session?
    Inform the client of the purpose of the visit.
    Tell the client that you have experience in counseling pregnant women through smoking cessation.
    Inform the client that you are the Office Smoking Cessation Coordinator and have recently quit smoking yourself.
    
    
22. Please identify five forms of reassuring, non-verbal communication that you as a health care provider can use to show you are listening to a client.
    1. 
    2. 
    3. 
    4. 
    5. 
    
    
23. Research indicates that use of multiple choice questions can increase disclosure among pregnant women as much 40%.
    True
    False
    
    
24. Clinics should implement an office-wide system that ensures that, for every patient at every clinic visit, tobacco status is assessed and documented.
    True
    False
    
    
25. List the two types of relapse interventions.