NCLEX Style Question

[C0SM0]

To start off, this is NOT a homework assignment. I'm studying for an upcoming exam and our instructor gave us a study guide that included this question. There's some debate between my classmates and me so I wanted to get other peoples' unbiased opinion.

The nurse is assessing the patient who is complaining of an early morning cough. It is most importantfor the nurse to ask which of the following questions?

1. How many packs do you smoke each day, and for how long have you smoked?”
   
2. Do you have pain when I apply pressure to your sinuses?”
   
3. Do you work at a factory, chemical plant, coal mine, farm, or outdoors in heavy traffic?”
   
4. Have you been exposed to anyone with an upper respiratory infection?”
   

So, I like 2 as an answer due to possible sinusitis. To me, the key phrase here is "early morning cough". I feel like 3 and 4 would not strictly be an early morning cough. The only reason I don't like 1 (COPD?) is because that answer implies that the client is a smoker and the question says nothing about them being a smoker. Now, if that answer said something like "Do you smoke, and if so, for how long and how many packs a day", I'd be more inclined to pick that answer. I just think one would assess rather or not the patient smokes at all before asking them how often and how long they've smoked. Any other points of view are greatly appreciated!

[203bravo, MSN, APRN]

A cough that primarily occurs at night may indicate postnasal drip or sinusitis. Exposure to irritants at work causes an afternoon or evening cough. Smokers experience early morning coughing. Coughing associated with acute illnesses such as URI is continuous throughout the day

Jarvis Physical Examination and Health Assessment p 420.