Which manifestation is a physical sign of acute pain in a client with severe dementia and a fractured femur?

• A. Decreased pulse rate
• B. Normal pulse rate
• C. Increased pulse rate
• D. Decreased respiratory rate

Answer: (C)

When acute pain is present, the body often triggers a sympathetic “fight-or-flight” response, which commonly raises heart rate. In a patient with severe dementia who may not be able to express pain verbally, this increase in pulse rate becomes an important nonverbal cue that pain could be occurring, such as from a fractured femur.

The other possibilities don’t fit as well. A decreased heart rate would be unusual in acute pain unless other factors are at play (medications, specific medical conditions). A normal pulse doesn’t reflect the autonomic arousal that pain typically produces. A decreased respiratory rate contradicts the typical response to acute pain, where breathing often becomes faster and shallower (tachypnea) due to sympathetic activation and distress.

So, an increased pulse rate best indicates acute pain in this scenario.