A nurse assesses the pain of an older adult. Which of the following findings indicates the presence of persistent pain?
A) The client's vital signs are unchanged.
B) The client is asleep in the chair.
C) The client has not reported pain to the nurse.
D) The client rubs hands together.
Ans: D
Essential assessment information is also obtained by observing for nonverbal indicators of pain, such as grimacing, muscle tension, rubbing, and protecting body parts. Relying on vital signs, presuming that sleeping clients are not experiencing pain, and relying on the absence of reporting of pain are all flawed pain assessment techniques.
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