A patient begins taking the calcium channel blocker, nifedipine [Procardia], along with metoprolol, to treat hypertension. The nurse understands that metoprolol is used to:

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: Seizures with auras can involve sensory disturbances before the seizure event, but they do not typically present with fever, nuchal rigidity (stiff neck), or decreased consciousness. These symptoms suggest an infectious or inflammatory process, not a seizure disorder.

Choice B reason: Parkinson's disease is a neurodegenerative disorder characterized by tremors, stiffness, and bradykinesia (slowness of movement). It does not present with acute fever, headache, nuchal rigidity, or altered consciousness, nor is it associated with a history of sinusitis. The symptoms described are more indicative of an infectious condition rather than a chronic degenerative disease.

Choice C reason: Bacterial meningitis is an infection of the protective membranes covering the brain and spinal cord (meninges). It is characterized by symptoms such as fever, severe headache, nuchal rigidity, and altered consciousness. The history of sinusitis suggests a possible route of infection, as bacteria from the sinuses can spread to the meninges. The clinical presentation strongly supports the diagnosis of bacterial meningitis, which is a medical emergency requiring prompt treatment.

Choice D reason: Migraines can cause severe headaches and may be accompanied by nausea, vomiting, and sensitivity to light and sound. However, they do not typically cause fever, nuchal rigidity, or decreased consciousness. The presence of fever and neck stiffness suggests an infectious etiology rather than a primary headache disorder like migraines.