A client with a C-7 spinal cord injury (SCI) is experiencing autonomic dysreflexia. The nurse should first assess the client for which precipitating factor?

Rationale:
A. Dilated pupils: Pupil dilation is typically associated with increased intracranial pressure, hypoxia, or sympathetic stimulation, not spinal shock. It reflects neurological or ocular changes but does not indicate the loss of spinal reflex activity.

B. Hypertension: Spinal shock causes loss of sympathetic tone, leading to hypotension rather than hypertension. Elevated blood pressure is more characteristic of autonomic dysreflexia, which occurs later in the course of spinal cord injury, not during the initial shock phase.

C. Tachycardia: Spinal shock usually results in bradycardia due to unopposed parasympathetic activity. Tachycardia is inconsistent with the physiological response seen in spinal shock and would more likely indicate pain, anxiety, or hypovolemia.

D. Absence of reflexes: The hallmark of spinal shock is the complete but temporary loss of all motor, sensory, and reflex activity below the level of injury. This areflexia occurs because of sudden interruption of neuronal communication and typically resolves as the spinal cord recovers from the acute insult.

Rationale:
A. Blood pressure measurement of 122/84 mm Hg and a heart rate of 88 beats/minute: These vital signs are within acceptable limits and do not indicate an acute complication following a cerebral angiogram. No immediate intervention is required for these values.

B. No urinary output measured since the procedure: While monitoring urine output is important, a two-hour gap post-procedure may not yet indicate a critical problem. The nurse should continue to monitor and assess, but this is not the most urgent finding.

C. Diminished volume of right dorsalis pedis pulse: A weak or absent peripheral pulse following femoral artery catheterization may indicate arterial obstruction, thrombus, or compromised distal perfusion. Immediate intervention is required to restore circulation and prevent tissue ischemia.

D. Client reports feeling hot during the procedure and cold afterward: These sensations may reflect normal physiological responses to contrast media or procedural stress. While worth noting, they do not require urgent intervention compared to compromised limb perfusion.