You are caring for a patient admitted with chronic obstructive pulmonary disease. During your shift assessment, you find that your patient is experiencing a change in his respiratory and mental status.
You are aware that the most accurate measurement of the concentration of oxygen in the patient's blood is what?

Choice A rationale

Obtaining a prescription for an indwelling urinary catheter in a client with a T4 spinal cord injury who is at risk for urinary tract infections (UTIs) is generally discouraged for long-term management. Indwelling catheters significantly increase the risk of UTIs due to biofilm formation and the introduction of bacteria into the sterile urinary tract. Intermittent catheterization or other bladder management strategies are preferred to minimize this risk.

Choice B rationale

Encouraging fluid intake at and between meals is a critical intervention for preventing urinary tract infections in clients with spinal cord injuries. Increased fluid intake promotes frequent bladder emptying, which helps to flush bacteria from the urinary tract, reducing bacterial stasis and colonization. Adequate hydration maintains urine flow and dilutes bacterial concentrations, thereby lowering the risk of ascending infections.

Choice C rationale

Offering the client the bedpan every 2 hours might not be an effective strategy for preventing UTIs in a client with a T4 spinal cord injury. This injury level often results in a neurogenic bladder, where the client may not have normal sensation or control over bladder emptying. Regular, scheduled emptying, often through intermittent catheterization, is more effective in preventing overdistention and residual urine, which are risk factors for UTIs.

Choice D rationale

Cleansing the perineum from back to front is an incorrect technique and significantly increases the risk of urinary tract infections. This method can introduce fecal bacteria, such as Escherichia coli, from the anal area into the urethra, leading to ascending UTIs. The correct and scientifically sound method for perineal cleansing is from front to back, which prevents the migration of enteric microorganisms to the urinary meatus.

Choice A rationale

An elevated blood pressure is a symptom of autonomic dysreflexia, not an indication of risk. Autonomic dysreflexia is a medical emergency characterized by an exaggerated sympathetic response below the level of the injury, typically presenting with sudden, severe hypertension (e.g., systolic BP > 20 mmHg above baseline).

Choice B rationale

Nasal congestion is a common symptom of autonomic dysreflexia, caused by peripheral vasodilation above the level of the injury, but it is not the underlying trigger or primary risk factor. It is a consequence of the exaggerated autonomic response.

Choice C rationale

A severe headache is another common symptom of autonomic dysreflexia, resulting from the sudden increase in blood pressure. Like nasal congestion, it indicates the event is occurring, but it is not the direct cause or risk factor for its initiation.

Choice D rationale

Bladder distention is a common noxious stimulus that triggers autonomic dysreflexia in individuals with spinal cord injuries at T6 or above. The distended bladder activates sympathetic reflexes below the injury, leading to widespread vasoconstriction and the rapid onset of severe hypertension.