The nurse is reviewing the principles of pain. Which type of pain is due to an abnormal processing of the pain impulse through the peripheral or central nervous system?

Choice A reason: Malnutrition may cause skin changes like dryness or thinning but does not typically cause tenting. Tenting reflects loss of skin elasticity due to fluid deficit, not primarily nutritional deficiency, making this an incorrect interpretation of the finding.

Choice B reason: Overhydration causes skin edema, leading to pitting or swelling, not tenting. Tenting occurs when skin lacks moisture and elasticity, which is the opposite of fluid excess, making this an incorrect interpretation of the observed skin turgor.

Choice C reason: Severe edema results in swollen, pitting skin due to fluid retention, not tenting. Tenting indicates a lack of interstitial fluid, as seen in dehydration, making this an incorrect interpretation of the skin turgor finding.

Choice D reason: Skin tenting, where skin slowly returns to its normal position after pinching, indicates severe dehydration. This occurs due to reduced interstitial fluid and loss of skin elasticity, commonly seen in significant fluid loss, making this the correct interpretation.

Choice A reason: Inspection visually assesses abdominal shape and distention but cannot differentiate gas from constipation, as both may cause distention. It lacks the specificity to identify the cause, making it less effective for this purpose.

Choice B reason: Auscultation assesses bowel sounds but cannot directly distinguish gas from constipation. Hyperactive sounds may suggest gas, but this is indirect, and constipation can also alter sounds, making this less specific than percussion.

Choice C reason: Percussion produces a tympanic sound over gas-filled areas, indicating air in the bowel, versus a dull sound over solid masses like feces in constipation. This directly differentiates the cause of distention, making it the correct technique.

Choice D reason: Palpation assesses tenderness or masses but cannot reliably distinguish gas from constipation, as both may feel firm or distended. It lacks the specificity of percussion’s auditory cues, making it less effective for this purpose.