A community health nurse is planning a smoking cessation class. Which of the following factors will have the greatest effect on the success of the class?

Choice A reason: Discussing the benefits of eating a well-balanced diet with the client's family is not the first action that the nurse should take. This is an important intervention that can help the client and the family to improve their nutrition and reduce the risk of further complications, but it should be done after the nurse has assessed the family's coping and learning needs.

Choice B reason: Assisting the client and the client's partner with finding an affordable exercise program is not the first action that the nurse should take. This is an important intervention that can help the client and the partner to increase their physical activity and enhance their cardiovascular health, but it should be done after the nurse has evaluated the client's physical and functional status.

Choice C reason: Offering to accompany the client and the client's partner during health care provider visits is not the first action that the nurse should take. This is an important intervention that can help the client and the partner to receive support and guidance during the treatment process, but it should be done after the nurse has established rapport and trust with the family.

Choice D reason: Asking family members about the impact of the disease on relationships within the family is the first action that the nurse should take. This is based on the principle of family-centered care, which states that the nurse should recognize and respect the family as the primary source of support and care for the client. The nurse should ask open-ended questions, listen actively, and express empathy to the family members, and explore how the disease has affected their roles, responsibilities, emotions, and communication.

Choice A reason: A fee-for-service health care insurance program is not a payment structure of a health maintenance organization. In a fee-for-service program, the client pays a premium to the insurer, and the insurer pays the provider for each service rendered, regardless of the outcome or quality of care.

Choice B reason: A fixed sum payment for the client on a monthly or yearly basis is a payment structure of a health maintenance organization. In this structure, the provider receives a set amount of money per client per period of time, regardless of the number or type of services provided. This encourages the provider to deliver preventive and primary care, and to avoid unnecessary or costly procedures.

Choice C reason: A percentage of the total costs for each service rendered by the provider is not a payment structure of a health maintenance organization. This is a type of cost-sharing arrangement, where the client pays a portion of the expenses and the insurer pays the rest. This may result in higher out-of-pocket costs for the client and higher utilization of services by the provider.

Choice D reason: A predetermined percentage of the cost of services is not a payment structure of a health maintenance organization. This is a type of discounted fee-for-service arrangement, where the provider agrees to accept a lower fee than the usual charge for each service. This may reduce the costs for the insurer, but not necessarily for the client or the provider.