A nurse is reinforcing teaching with the support person of a client who is in the first stage of labor. Which of the following instructions should the nurse include regarding effleurage?

The correct answer is choice D. Decreased hemoglobin.

Choice A rationale:

Cigarette smoking typically causes an increase in blood pressure due to the nicotine’s stimulating effects on the cardiovascular system, not a decrease.

Choice B rationale:

Smoking is more likely to cause tachycardia (increased heart rate) rather than bradycardia (decreased heart rate) because nicotine stimulates the release of adrenaline.

Choice C rationale:

Somnolence (drowsiness) is not a common adverse effect of cigarette smoking. Smoking usually has a stimulating effect due to nicotine.

Choice D rationale:

Decreased hemoglobin can occur as a result of smoking because it can lead to chronic obstructive pulmonary disease (COPD) and other respiratory issues, which can impair oxygen transport in the blood. Additionally, smoking can cause carbon monoxide to bind with hemoglobin, reducing its oxygen-carrying capacity.

Choice A reason:

Determine previous coping skills used by the client is not appropriate. Assessing the client's previous coping skills is an essential step in the assessment phase of the therapeutic relationship, not specifically during the orientation phase. This information helps the nurse to understand the client's coping mechanisms and identify potential areas for improvement or support.

Choice B reason:

Facilitate the client's problem-solving skills is not appropriate the nurse may work on facilitating the client's problem-solving skills throughout the therapeutic relationship, including during the working phase. During this phase, the nurse and client collaborate to explore and address the client's concerns and challenges.

Choice C reason:

Assisting the client in expressing alternative behaviours is not appropriate. This action may also be part of the working phase, where the nurse helps the client explore alternative behaviours and coping strategies to address their issues and challenges.

Choice D reason:

The orientation phase is the initial stage of the therapeutic relationship where the nurse and the client get to know each other and establish the groundwork for their working relationship. During this phase, it is essential to clarify the roles and responsibilities of both the nurse and the client to ensure a clear understanding of each other's expectations.