A 46-year-old male diagnosed with gouty arthritis is at high risk for developing:

Choice A reason: Pain stimulation above the level of the spinal cord lesion can cause discomfort and an increase in sympathetic activity, but it is not the primary cause of an uncompensated cardiovascular response seen in autonomic dysreflexia. This condition typically results from stimuli below the level of the injury.

Choice B reason: Toxic accumulation of free radicals below the level of the injury can contribute to tissue damage and inflammation but is not the primary cause of the acute cardiovascular responses in autonomic dysreflexia. The condition is primarily triggered by noxious stimuli below the level of the injury.

Choice C reason: A distended bladder or rectum is a common cause of autonomic dysreflexia in patients with spinal cord injuries above the T6 level. This condition involves an exaggerated autonomic response to stimuli below the level of the injury, resulting in severe hypertension, bradycardia, and other cardiovascular symptoms. The distention of the bladder or rectum sends signals that the spinal cord cannot properly process, leading to an uncontrolled sympathetic response.

Choice D reason: An abnormal vagal response typically involves parasympathetic activity and can lead to symptoms such as bradycardia or fainting. However, it is not the primary cause of the sympathetic overactivity and hypertension seen in autonomic dysreflexia. The condition is driven by an imbalance in the autonomic nervous system due to spinal cord injury.

Choice A reason: Abdominal pain and rectal bleeding are not the primary signs of a bowel obstruction. Rectal bleeding could be indicative of other gastrointestinal issues such as hemorrhoids, diverticulosis, or colorectal cancer. While abdominal pain is a symptom of bowel obstruction, rectal bleeding is not typically associated with it.

Choice B reason: The primary symptoms of bowel obstruction include abdominal distention, pain, inability to have a bowel movement, and nausea/vomiting. When a bowel obstruction occurs, the normal movement of intestinal contents is blocked, leading to a buildup of contents and gas. This results in abdominal distention and pain. The blockage also prevents the passage of stool and gas, causing constipation or inability to have a bowel movement. Nausea and vomiting are common as the digestive system tries to expel the contents that cannot pass through the obstruction.

Choice C reason: Dehydration, back pain, and fever are not the hallmark symptoms of bowel obstruction. While dehydration can occur due to vomiting and reduced intake, back pain is not commonly associated with bowel obstruction. Fever may indicate an infection or other complications but is not a primary symptom of bowel obstruction.

Choice D reason: Diarrhea and excessive thirst are not typical signs of bowel obstruction. In fact, bowel obstruction usually leads to constipation or the inability to pass stool rather than diarrhea. Excessive thirst could be a sign of dehydration but is not specific to bowel obstruction.