A nurse is assisting with the care of a client who is receiving a spinal epidural to treat a herniated disc. Which of the following findings should the nurse identify as an indicator of unrelieved pain?

A. Difficulty swallowing. While difficulty swallowing (dysphagia) can be associated with certain conditions, it is not a typical indicator of unrelieved pain in a client receiving a spinal epidural. This symptom may be related to neurological involvement or medication side effects and should be assessed further. B. Constipation. Opioids used in conjunction with epidural anesthesia can contribute to constipation, but this is a side effect rather than a direct indicator of pain. Constipation can also result from reduced mobility or decreased fluid intake, so it should be managed appropriately but does not necessarily reflect uncontrolled pain. C. Urinary retention. Epidural anesthesia can affect bladder function by impairing the sensation of fullness and the ability to void. While urinary retention is a common side effect of epidural use, it is not a direct sign of unrelieved pain. Monitoring for bladder distention and assessing for the need for catheterization is important. D. Clenched teeth. Clenching the teeth is a physical manifestation of pain, often indicating discomfort and distress. Clients experiencing unrelieved pain may also exhibit other nonverbal cues such as grimacing, restlessness, or guarding. The nurse should assess pain using an appropriate scale and notify the provider if pain is not adequately controlled.