Answer to Question 1
Correct Answer: 2
Referred pain may result when pain is felt in tissues that are not in close proximity to the primary cause or site of the pain. This may be especially true of cardiac pain. It may be exhibited in the jaw, shoulders, arms, or back. It is inappropriate for the nurse to indicate the healthcare provider is treating the client in a manner without certainty. Clenching teeth would not be linked to chest pain. While cardiac pain is serious, this response does not meet the level of client questioning.
Answer to Question 2
Correct Answer: 2, 3, 4, 5
The client may be diaphoretic with acute pain, but not directly as a result of a low-grade temperature. When in acute pain, a client will typically have sympathetic nervous system responses that are exhibited in an increased pulse, respiratory rate, and blood pressure. Facial grimacing may be noted in the expressions of the client experiencing acute pain.