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: Costovertebral angle tenderness is a classic sign of pyelonephritis, indicating kidney infection or inflammation. Percussing this area elicits pain in renal conditions, making it the correct condition to assess for tenderness.

Choice B reason: Cholecystitis causes pain in the right upper quadrant, not the costovertebral angle. Kidney-related pyelonephritis is linked to this tenderness, so this is incorrect for the assessment focus.

Choice C reason: Gastric ulcers cause epigastric pain, not costovertebral tenderness, which is renal-specific. Pyelonephritis is the condition associated with this sign, so this is incorrect for the suspected condition.

Choice D reason: Pancreatitis presents with abdominal pain, not costovertebral angle tenderness, which indicates kidney issues. Pyelonephritis is the relevant condition, so this is incorrect for the assessment.

Choice A reason: Deep-vein thrombophlebitis involves deep vein inflammation and clotting, causing pain, swelling, and warmth, but not typically visible dilated veins. The described tortuous veins are superficial, not deep, making this an incorrect diagnosis for the findings.

Choice B reason: Varicose veins are dilated, tortuous superficial veins, often in the lower legs, causing heaviness or aching. These result from venous insufficiency, leading to blood pooling, which matches the patient’s visible veins and symptoms, making this correct.

Choice C reason: Peripheral artery disease causes reduced arterial blood flow, leading to pain, pallor, or claudication, not dilated veins. The visible tortuous veins suggest a venous issue, not arterial, making this an incorrect condition for the findings.

Choice D reason: Chronic lymphedema causes swelling due to lymphatic fluid accumulation, typically without dilated veins. The patient’s tortuous veins and heaviness point to venous pathology, not lymphatic, making this an incorrect diagnosis for the described symptoms.