The nurse is caring for a client who is admitted with head and neck injury following a motor vehicle accident. The nurse should identify which clinical manifestation(s) are associated with a complete transection of the cervical spinal cord? (Select all that apply.)

A. Mannitol is an osmotic diuretic that pulls fluid into the intravascular space and promotes diuresis, so sustained hypervolemia is not expected.

B. Mannitol does not significantly affect blood glucose levels; hyperglycemia is more commonly associated with corticosteroids or dextrose solutions.

C. Mannitol causes fluid shifts from intracellular to extracellular spaces, which can dilute serum sodium and lead to hyponatremia.

D. Mannitol increases urine output; decreased urine output would be an abnormal finding and may indicate renal impairment.

Rationale:

• Document any skin lesions on lower legs: Skin assessment establishes a baseline for postoperative comparison and detects any existing wounds that could complicate perfusion or healing. This is crucial in aneurysm patients who may have compromised circulation in the lower extremities due to altered aortic flow.

• Insert indwelling urinary catheter: Insertion may cause unnecessary movement and increase intra-abdominal pressure, risking aneurysm rupture. Catheterization is delayed until surgical stabilization unless absolutely necessary for monitoring output in critical hypotension.

• Mark pedal pulse sites with a single-use marker: Preoperative marking helps identify pulses for continuous assessment after aneurysm repair. Since distal perfusion can rapidly change if the aneurysm ruptures or surgical complications occur, clear markings guide vascular checks efficiently.

• Place client on 2 L/minute oxygen: Supplemental oxygen supports tissue perfusion and prevents hypoxia, especially as pain and anxiety can increase oxygen demand. It is particularly indicated because the client’s oxygen saturation is 94%, slightly below the desired >95% threshold for stable perfusion.

• Ensure surgical consent has been completed: The imaging studies confirm a large (8.6 cm) abdominal aortic aneurysm, which carries a high rupture risk and typically necessitates emergent surgical intervention. Ensuring consent prepares the patient for prompt operative management once the surgical team is ready.

• Start 0.9% sodium chloride fluid bolus: Rapid fluid boluses can elevate intravascular pressure, potentially worsening aneurysm wall stress and precipitating rupture. Controlled, minimal-volume management is preferred until surgical control of bleeding or rupture risk is achieved.