A client who suffered a spinal cord injury is experiencing an exaggerated autonomic response. What aspect of the client’s current health status is most likely to have precipitated this event?

Reasoning:

Choice A reason: Bleeding, particularly gastrointestinal, is the most common cause of iron deficiency anemia in males and postmenopausal females. Blood loss reduces iron stores, as hemoglobin contains iron, and chronic bleeding (e.g., from ulcers or colon cancer) depletes iron faster than dietary intake can replenish, leading to anemia.

Choice B reason: Chronic alcohol use may contribute to anemia through nutritional deficiencies or liver disease, but it is not the primary cause. Alcohol can impair folate metabolism or cause gastrointestinal bleeding, but direct blood loss is a more common and significant driver of iron deficiency in these populations.

Choice C reason: Menorrhagia, or heavy menstrual bleeding, is a common cause of iron deficiency anemia in premenopausal women, not males or postmenopausal females. After menopause, menstruation ceases, eliminating this as a cause, making bleeding from other sources, like the gastrointestinal tract, more relevant.

Choice D reason: Iron malabsorption, as in celiac disease or gastric surgery, can cause iron deficiency but is less common than bleeding. Malabsorption impairs dietary iron uptake, but chronic blood loss, especially from gastrointestinal sources, is the leading cause in males and postmenopausal females due to higher prevalence.

Reasoning:

Choice A reason: Constant supervision is impractical and not the most effective way to reduce fall risk in Cushing syndrome. While supervision can help, it does not address environmental hazards or promote independence. Muscle weakness from corticosteroid-induced myopathy increases fall risk, making targeted prevention strategies more practical and effective.

Choice B reason: Fall-prevention measures, such as removing obstacles, ensuring adequate lighting, and using non-slip mats, directly address the risk of injury from muscle weakness in Cushing syndrome. These measures reduce environmental hazards and promote safety, effectively mitigating the risk of falls due to corticosteroid-induced myopathy and osteoporosis.

Choice C reason: Encouraging bed rest increases the risk of complications like muscle atrophy and thromboembolism in Cushing syndrome. Prolonged immobility exacerbates muscle weakness and bone loss, both already worsened by corticosteroids, making bed rest counterproductive to maintaining strength and reducing injury risk from falls.

Choice D reason: Assistive devices like canes or walkers can help, but they are not the primary strategy. Fall-prevention measures address environmental risks broadly, benefiting all patients with weakness. Devices are useful for severe mobility issues but are less comprehensive than environmental modifications for preventing falls in Cushing syndrome.