A patient hospitalized for wedge resection of left lower lung lobe expresses anxiety and asks if smoking is allowed. Which statement by the nurse would be most therapeutic?

• A. Smoking is the reason you are here.
• B. The doctor left orders for you not to smoke.
• C. You are anxious about the surgery. Do you see smoking as helping?
• D. Smoking is OK right now, but after your surgery it is contraindicated.

Answer: (C)

Open, reflective communication that addresses feelings while exploring coping behaviors is most therapeutic. By saying, “You are anxious about the surgery. Do you see smoking as helping?” the nurse validates the patient’s anxiety and invites a discussion about how smoking might be used to cope. This approach opens a collaborative dialogue, helps the patient feel heard, and reveals their motivation or readiness to change, which is essential for planning appropriate support and cessation strategies around the perioperative period.

Shaming or blaming (for example, stating smoking is the reason you’re here) tends to trigger defensiveness and can shut down conversation. Telling the patient that there are doctor orders not to smoke is directive and paternalistic, moving the focus away from the patient’s feelings and readiness. Offering a conditional plan that allows smoking now but not after surgery can create mixed messages and fail to address the patient’s immediate concerns and motivations. The open-ended, empathetic approach in the chosen statement best supports therapeutic communication and patient-centered care.