Which of the following is a modifiable risk factor of strokes?

Choice A: Sepsis is a serious infection that occurs when the body's immune system overreacts to an injury or illness. It can cause organ failure and death. People with spinal cord injury are more prone to sepsis because they may have impaired bladder and bowel function, skin breakdown, or reduced sensation that can lead to infections.

Choice B: Pulmonary embolism is a blockage of an artery in the lungs by a blood clot. It can cause chest pain, shortness of breath, and death. People with spinal cord injury are more at risk of pulmonary embolism because they may have reduced mobility, blood circulation, or breathing capacity that can promote blood clot formation.

Choice C: Pneumonia is an inflammation of the lungs caused by bacteria, viruses, or fungi. It can cause fever, cough, and difficulty breathing. People with spinal cord injury are more susceptible to pneumonia because they may have weakened cough reflex, impaired lung function, or aspiration of food or saliva into the lungs.

Choice D: All of the above are major causes of death related to spinal cord injury. They can occur separately or together and can be prevented or treated with proper medical care and lifestyle modifications.

Choice A: When patient is fully oriented is incorrect because it is a positive sign of recovery from a concussion. It means that the patient is aware of their person, place, time, and situation. The nurse should monitor the patient's orientation status but does not need to report it to the doctor immediately.

Choice B: Difficulty in awakening, lethargy, dizziness, confusion, irritability, anxiety are correct because they are signs of worsening brain injury or complications from a concussion. They may indicate increased intracranial pressure, bleeding, swelling, or infection in the brain. The nurse should report these symptoms to the doctor immediately and prepare for further diagnostic tests or interventions.

Choice C: When patient is easy to arouse is incorrect because it is also a positive sign of recovery from a concussion. It means that the patient responds quickly and appropriately to verbal or physical stimuli. The nurse should monitor the patient's level of consciousness but does not need to report it to the doctor immediately.

Choice D: All of the above are incorrect because only choice b) requires immediate reporting to the doctor. Choices a) and c) are normal or expected outcomes of a concussion and do not indicate any danger or complication. The nurse should use clinical judgment and follow the guidelines for concussion management and care.