A nurse is caring for a client who has a spinal cord injury at the first thoracic level. Which of the following should the nurse recognize can trigger autonomic dysreflexia? (Select all that apply)

Choice A rationale Constipation, leading to bowel distention and impaction, is a common noxious stimulus below the level of injury that can trigger autonomic dysreflexia. The distended bowel sends afferent signals that ascend the spinal cord, leading to an exaggerated sympathetic response. Choice B rationale Loose clothing does not provide any noxious or irritating stimulus to the skin or body below the level of spinal cord injury. Therefore, it is unlikely to trigger the exaggerated sympathetic response characteristic of autonomic dysreflexia, which requires a specific irritant. Choice C rationale Nausea is a symptom that originates from the gastrointestinal system and/or central nervous system pathways, but it typically does not involve a direct noxious somatic or visceral stimulus below the level of a T1 spinal cord injury that would precipitate autonomic dysreflexia. Choice D rationale Surgery performed below the level of injury can be a significant noxious stimulus that triggers autonomic dysreflexia, even under general anesthesia. The surgical manipulation and tissue irritation can activate the sympathetic nervous system below the lesion, leading to an uncontrolled response. Choice E rationale Urinary tract infections (UTIs) cause bladder irritation and inflammation, which are potent noxious stimuli below the level of a T1 spinal cord injury. The afferent signals from the inflamed bladder can ascend the cord, eliciting a massive sympathetic discharge and autonomic dysreflexia. Choice F rationale Pressure on the testicles, or any form of scrotal or genital irritation, constitutes a strong noxious stimulus below the level of a T1 spinal cord injury. This direct irritation can trigger the exaggerated sympathetic reflex arc, leading to the rapid onset of autonomic dysreflexia.