You are caring for an older adult with cognitive impairment who recently had hip surgery. You assess the client for pain. You would suspect that the client is in pain when the client demonstrates which of the following? (Select all that apply.)

A. The client ate all of her meals: Consuming full meals generally indicates comfort and stability rather than distress. Clients in pain often experience a reduced appetite, so eating well is not associated with the presence of pain. B. The client pushes caregivers away when they attempt to change the dressing on her hip: Guarding or resisting care near a surgical site is a behavioral indicator of pain, especially in clients with cognitive impairment who may be unable to verbalize discomfort. This reaction shows a protective response to anticipated pain. C. The client cries out repeatedly when anyone approaches her: Vocal expressions such as crying, moaning, or yelling often signal pain in clients with limited communication abilities. Repeated distress when approached suggests fear of painful contact or movement. D. The client sleeps soundly throughout the night: Restful sleep is not typically associated with pain. Clients experiencing significant discomfort often have difficulty sleeping or display restlessness, so this behavior does not indicate pain. E. The client rocks back and forth repetitively when sitting in a chair: Repetitive movements, such as rocking, can be self-soothing behaviors used to cope with unrelieved pain or discomfort. In nonverbal or cognitively impaired clients, such actions are strong indicators of distress.