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. Restlessness: Restlessness is a behavioral manifestation of pain, reflecting the client’s inability to find a comfortable position despite analgesia. It is a sensitive early indicator that the spinal epidural may not be providing adequate pain relief, prompting further assessment and possible intervention. B. Constipation: Constipation can occur as a side effect of opioids used in epidurals or from immobility, but it develops gradually and does not indicate immediate unrelieved pain. It is a delayed consequence rather than a direct marker of inadequate analgesia. C. Difficulty swallowing: Dysphagia is unrelated to spinal epidural administration and is not a recognized sign of uncontrolled pain in clients with herniated discs. It may indicate other neurological or structural problems. D. Urinary retention: Urinary retention can result from opioid use or local anesthetic effects on sacral nerves, but it is not a primary indicator of unrelieved pain. It reflects pharmacologic effects rather than insufficient analgesia.