The home hospice nurse is completing the initial assessment of a client who is has terminal congestive heart failure. The client frequently has pain with breathing. Which questions should the nurse ask?

Question

Standard Text: Select all that apply.
1. "How much pain are you willing to tolerate?"
2. "What do you like to do throughout the day?"
3. "Have you ever been addicted to a pain medication?"
4. "Are there any pain medications you would like to avoid?"
5. "What things besides drugs help with your pain?"

Answer 1

Correct Answer: 1,2,4,5
Rationale 1: It is sometimes impossible to eliminate all pain and all adverse medication effects. The nurse needs to know how much pain and how many of the effects the client is willing to tolerate.
Rationale 2: Knowing what the client likes to do and when it is important for the client to be most awake and alert helps the nurse create a pain management plan.
Rationale 3: Addiction is not a concern at the end of life. Many clients are already concerned about becoming addicted and the nurse should not reinforce this myth.
Rationale 4: Some clients cannot tolerate the side effects of some medications. It is important for the nurse to assess for these preferences.
Rationale 5: Nonpharmacologic pain relief strategies should also be investigated.
Global Rationale: It is sometimes impossible to eliminate all pain and all adverse medication effects. The nurse needs to know how much pain and how many of the effects the client is willing to tolerate. Knowing what the client likes to do and when it is important for the client to be most awake and alert helps the nurse create a pain management plan. Some clients cannot tolerate the side effects of some medications. It is important for the nurse to assess for these preferences. Nonpharmacologic pain relief strategies should also be investigated. Addiction is not a concern at the end of life. Many clients are already concerned about becoming addicted and the nurse should not reinforce this myth.