Table 4 Overview of percentage of correct NKAS answers by RNs (n = 40) at baseline (T1)

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

2. Because their nervous system is underdeveloped, children under two years of age have decreased pain sensitivity and limited memory of painful experiences.

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

4. Patients may sleep in spite of severe pain.

5. Aspirin and other non-steroidal anti-inflammatory agents are NOT effective analgesics for painful bone metastases.

6. Respiratory depression rarely occurs in patients who have been receiving stable doses of opioids over a period of months.

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

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

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

10. Morphine has a dose ceiling (i.e. a dose above which no greater pain relief can be obtained).

11. Elderly patients cannot tolerate opioids for pain relief.

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

13. Children less than 11 years old cannot reliably report pain so nurses should rely solely on the parents’ assessment of the child’s pain intensity.

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

15. After an initial dose of opioid analgesic is given, subsequent doses should be adjusted in accordance with the individual patient’s response.

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

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.

18. Anticonvulsant drugs such as gabapentin (Neurontin) provide optimal pain relief after a single dose.

19. Benzodiazepines are not effective pain relievers unless the pain is due to muscle spasm.

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

Multiple choice questions*

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

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

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

24. Which of the following IV doses of morphine administered over a 4-hour period would be equivalent to 30 mg of oral morphine given q 4 hours?

25. Analgesics for post-operative pain should be given initially:

26. A patient with persistent cancer pain has been receiving daily opioid analgesics for two 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:

27. The most likely reason a patient with pain would request increased doses of pain medication is:

28. Which of the following is useful for treatment of cancer pain?

29. The most accurate judge of the intensity of the patient’s pain is:

30. Which of the following describes the best approach for cultural considerations in caring for patients in pain:

31. How likely is it that patients who develop pain already have an alcohol and/or drug abuse problem?

32. The time to peak effect for morphine given IV is:

Items

33. The time to peak effect for morphine given orally is:

34. Following abrupt discontinuation of an opioid, physical dependence is manifested by the following:

Case studies

35. 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; R = 18; on a scale of 0 to 10 (0 = no pain/discomfort, 10 = worst pain/discomfort) 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.

36. Your assessment, above, is made two 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. He has identified 2/10 as an acceptable level of pain relief. His physician’s order for analgesia is “morphine IV 1–3 mg q1h PRN pain relief”. Check the action you will take at this time.

37. 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; on a scale of 0 to 10 (0 = no pain/discomfort, 10 = worst pain/discomfort) 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:

38. Your assessment, above, is made two 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. He has identified 2/10 as an acceptable level of pain relief. His physician’s order for analgesia is “morphine IV 1–3 mg q1h PRN pain relief”. Check the action you will take at this time: