A client who smokes 2 packs per day expresses interest in quitting. Using the 5 A's framework, what is the nurse's FIRST step?

THE 5 A'S OF TOBACCO CESSATION COUNSELLING: (1) ASK: Systematically ask about tobacco use at every visit — establishes smoking status as a vital sign; (2) ADVISE: Clearly, firmly, and personally advise quitting — brief, direct advice (1-3 minutes) from a clinician increases quit rates; (3) ASSESS: Assess willingness to quit — are they ready now, unsure, or not ready?; (4) ASSIST: Provide cessation resources, medications, counselling referral based on their readiness; (5) ARRANGE: Follow-up visit or call within 1-2 weeks of quit date; THE ALTERNATIVE (for non-ready smokers): THE 5 R'S — Relevance, Risks, Rewards, Roadblocks, Repetition — to motivate those not yet ready to quit;

Evidence: Combined pharmacotherapy + counselling has highest quit rates (~25-35% sustained abstinence); varenicline (Chantix) is most effective single pharmacotherapy; NRT is first-line when cost is a concern or varenicline is contraindicated.