A nurse is caring for a client who is recovering from a thoracic spinal cord injury. The nurse should identify that the client is at risk for which of the following conditions?

A. Loss of urinary control: Thoracic spinal cord injuries disrupt autonomic and somatic pathways controlling bladder function. Damage at the thoracic level can impair signals between the brain and the sacral micturition center, leading to neurogenic bladder. Clients may experience urinary retention, incontinence, or reflexive voiding, requiring monitoring and interventions such as catheterization or bladder training. B. Inability to clear secretions: Impaired secretion clearance is primarily a risk for cervical spinal cord injuries, which compromise innervation of the diaphragm and accessory respiratory muscles. Thoracic injuries usually preserve diaphragmatic function, allowing effective breathing and cough reflex, so secretion clearance is typically maintained. C. Decreased fine motor hand movement: Fine motor control of the hands depends on cervical spinal cord innervation, particularly C6–C8 levels. A thoracic injury does not affect upper extremity motor neurons, so hand dexterity and fine motor skills are generally preserved. D. Difficulty swallowing: Dysphagia occurs with lesions affecting cranial nerve nuclei or high cervical spinal cord injuries that impair pharyngeal and laryngeal muscle innervation. Thoracic spinal cord injuries do not impact swallowing mechanisms because these structures are innervated above the level of the thoracic spine.