A week after a client suffered a high thoracic spinal cord injury in a motor vehicle collision, the blood pressure suddenly rises to 196/126 mm Hg. Which physiological sign(s) should the nurse identify that the client is exhibiting autonomic dysreflexia? select all that apply.

Rationale: A. Flushed face: Autonomic dysreflexia causes an exaggerated sympathetic response below the level of injury and a parasympathetic response above it. Vasodilation above the injury leads to facial flushing, nasal congestion, and a warm sensation in the upper body. B. Urinary urgency: The client typically cannot sense bladder fullness due to spinal cord disruption. Instead, bladder distention acts as the trigger for autonomic dysreflexia, but the client does not perceive urgency because of impaired sensation below the injury level. C. Pain: Clients with high thoracic or cervical spinal cord injuries do not feel pain below the level of injury. Although pain can sometimes precipitate autonomic dysreflexia, the condition itself does not cause a conscious pain sensation. D. Pale lower extremity: Vasoconstriction occurs below the level of injury due to excessive sympathetic discharge. This results in cool, pale skin and decreased perfusion in the lower extremities while the upper body shows flushing. E. Bradycardia: The baroreceptor reflex activates parasympathetic stimulation in response to severe hypertension, resulting in reflex bradycardia. This slowed heart rate is a hallmark feature of autonomic dysreflexia and helps differentiate it from other hypertensive crises.