Table 3 Item Analysis of Knowledge and Attitudes Survey Regarding Pain Management

1.

Because their nervous systems are underdeveloped, children under 2 years of age have decreased pain sensitivity and limited memory of painful experiences

55

44

78

62.4

.002**

2.

Vital signs are always reliable indicators of the intensity of a patient’s pain

30

24

60

48

<.001**

3.

Patients who can be distracted from pain usually do not have severe pain

61

48

69

55.2

.266

4.

Patients may sleep despite severe pain

31

24.8

53

42.4

.002**

5.

Aspirin and other nonsteroidal anti-inflammatory agents are not effective analgesics for painful bone metastases

53

42.4

74

59.2

.003**

6.

Respiratory depression rarely occurs in patients who have been receiving stable doses of opioids over several months

90

72

81

64.4

.171

7.

Combining analgesics that work by different mechanisms (e.g., combining an NSAID with an opioid) may result in better pain control with fewer side effects than using a single analgesic agent

85

68

83

66.4

.790

8.

The usual duration of analgesia of 1–2 mg of morphine IV is 4–5 hours.

49

39.2

56

44.8

.260

9.

Opioids should not be used in patients with a history of substance abuse

36

28.8

33

26.4

.663

10.

Elderly patients cannot tolerate opioids for pain relief

82

65.6

90

72.0

.209

11.

Patients should be encouraged to endure as much pain as possible before using an opioid

43

34.4

49

39.2

.425

12.

Children less than 11 years old cannot reliably report pain, so clinicians should rely solely on the parent’s assessment of the child’s pain intensity

68

54.4

69

55.2

.900

13.

Patients’ spiritual beliefs may lead them to think pain and suffering are necessary

74

59.2

91

72.8

.006**

14.

After an initial dose of an opioid analgesic is given, subsequent doses should be adjusted following the individual patient’s response

105

84

104

83.2

.882

15.

Giving patients sterile water by injection (placebo) is a useful test to determine if the pain is real

30

24

23

18.4

.251

16.

Vicodin (hydrocodone 5 mg + acetaminophen 300 mg) PO is approximately equal to 5–10 mg of morphine PO

68

54.4

82

65.6

.052

17.

If the source of the patient’s pain is unknown, opioids should not be used during the pain evaluation period, as this could mask the ability to correctly diagnose the cause of pain

23

18.4

23

18.4

.053

18.

Anticonvulsant drugs such as gabapentin (Neurontin) produce optimal pain relief after a single dose

65

52

60

48.0

.595

19.

Benzodiazepines are not effective pain relievers and are rarely recommended as part of an analgesic regiment

77

61.6

82

65.6

.433

20.

Narcotic/opioid addiction is defined as a chronic neurobiological disease characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving

112

89.6

114

91.2

.657

21.

The term “equianalgesia” means approximately equal analgesia and is used when referring to the doses of various analgesics that provide approximately the same amount of pain relief

81

64.8

104

83.2

<.001**

22.

Sedation assessment is recommended during opioid pain management because excessive sedation precedes opioid-induced respiratory depression

115

92

117

93.6

.469

23.

The recommended route of administration of opioid analgesics for patients with persistent cancer-related pain is oral

50

40

34

27.2

.023*

24.

The recommended route of administration of opioid analgesics for patients with brief, severe pain from sudden onset such as trauma or postoperative pain is IV.

88

70.4

106

84.8

.003**

25.

Which of the following analgesic medications is considered the drug of choice for the treatment of prolonged moderate to severe pain for cancer patients? Morphine

105

84

109

87.2

.338

26.

A 30 mg dose of oral morphine is approximately equivalent to Morphine 10 mg IV

53

42.4

59

47.2

.408

27.

Analgesics for postoperative pain should initially be given around the clock on a fixed schedule.

89

71.2

108

86.4

.002**

28.

A patient with persistent cancer pain has been receiving daily opioid analgesics for 2 months. Yesterday, the patient was receiving morphine 200 mg/hour intravenously. Today he has been receiving 250 mg/hour intravenously. The likelihood of the patient developing clinically significant respiratory depression in the absence of new comorbidity is less than 1%.

36

28.8

30

24.0

.416

29.

The most likely reason a patient with pain would request increased doses of pain medication is related to experiencing increased pain

81

64.8

60

48.0

.008**

30.

Which of the following is useful for the treatment of cancer pain? Ibuprofen, Hydromorphone, Gabapentin, all of the above.

65

52

65

52.8

.794

31.

The most accurate judge of the intensity of the patient’s pain is the patient him/herself.

72

57.6

79

63.2

.269

32.

Which of the following describes the best approach for cultural considerations in caring for patients in pain: Patients should be individually assessed to determine cultural influences.

69

55.2

69

55.2

1.00

33.

How likely is it that patients who develop pain already have an alcohol and/or drug abuse problem? 5–15%

41

32.8

53

42.4

.115

34.

The time to peak effect for morphine given IV is 15 minutes.

87

69.6

118

89.6

<.001**

35.

The time to peak effect for morphine given orally is 1–2 hours

70

56

67

53.6

.719

36.

Following the abrupt discontinuation of opioids, physical dependence is manifested by the following: sweating, yawning, diarrhea, and agitation with patients when the opioid is abruptly discontinued

35

28

41

32.8

.398

37.

Which statement is true regarding opioid-induced respiratory depression: Obstructive sleep apnoea is an important risk factor.

54

43.2

51

40.8

.797

38a.

Patient A: Andrew is 25 years old and this is his first day following abdominal surgery. As you enter his room, he smiles at you and continues talking and joking with his visitor. Your assessment reveals the following information: BP = 120/80, HR = 80. He rates his pain as 8. On the patient’s record, you must mark his pain on the scale below. Circle the number that represents your assessment of Andrew’s pain.

35

28

36

28.8

.880

38b.

Your assessment, above, was made 2 hours after he received morphine 2 mg IV. Half-hourly pain ratings following the injection ranged from 6 to 8, and he had no clinically significant respiratory depression, sedation, or other side effects. He has: Administer morphine 3 mg IV now

10

8

9

7.2

.820

39a.

Patient B: Robert is 25 years old and this is his first day following abdominal surgery. As you enter his room, he is lying quietly in bed and grimaces as he turns in bed. Your assessment reveals the following information: BP = 120/80; HR = 80; R = 18. He rates his pain as 8. On the patient’s record, you must mark his pain on the scale below. Circle the number that represents your assessment of Robert’s pain.

50

40

50

40

1.00

39b.

Your assessment, above, was made 2 hours after he received morphine 2 mg IV. Half-hourly pain ratings following the injection ranged from 6 to 8, and he had no clinically significant respiratory depression, sedation, or other untoward side effects: administer morphine 3 mg IV now

17

13.6

16

12.8

.854