autonomic dysreflexia nursing Flashcards

What's on the cards

1. Autonomic dysreflexia typically follows a spinal cord injury at which level? A. Below T10 only. B. At or above T6. C. At L1 to L2 only. D. Only at the sacral level.
2. Which trigger causes most episodes of autonomic dysreflexia? A. Bladder distention. B. Ingrown toenail. C. Sunburn. D. Tight shoelaces.
3. What is usually the first symptom a patient with autonomic dysreflexia reports? A. Numbness spreading up from the feet. B. A dull ache in the lower back. C. Itching of the legs. D. A sudden, severe, throbbing headache.
4. A patient with a T4 spinal cord injury suddenly reports a pounding headache. What should the nurse do first? A. Give acetaminophen and reassess in an hour. B. Dim the lights and let the patient sleep. C. Check the blood pressure right away. D. Lay the patient flat with the legs raised.
5. In an adult, what rise in systolic blood pressure above baseline objectively defines an episode of autonomic dysreflexia? A. At least 5 mm Hg. B. At least 20 mm Hg. C. At least 60 mm Hg. D. At least 100 mm Hg.
6. In a child, what rise in systolic blood pressure above baseline defines an episode of autonomic dysreflexia? A. 15 mm Hg. B. 5 mm Hg. C. 30 mm Hg. D. 50 mm Hg.
7. What resting systolic blood pressure is typical for a person with a spinal cord injury at T6 or higher? A. 140 to 160 mm Hg. B. 160 to 180 mm Hg. C. 60 to 70 mm Hg. D. 90 to 110 mm Hg.
8. Which heart rate change is most typical during an autonomic dysreflexia episode, and why? A. Tachycardia, from blood loss. B. Tachycardia, from fever. C. Bradycardia, from compensatory vagal stimulation. D. No change, because the heart is denervated.
9. Where on the body does a patient in autonomic dysreflexia usually flush and sweat heavily? A. Below the level of the injury only. B. Above the level of the injury, such as the face, neck and shoulders. C. On the feet and lower legs. D. Evenly over the whole body.
10. How does the skin below the level of injury usually look during autonomic dysreflexia? A. Cold and pale. B. Warm and flushed. C. Hot and dry. D. Bright red and sweaty.
11. During an episode, where do goose bumps (piloerection) appear? A. Above the level of the injury only. B. On the face only. C. They never occur in this condition. D. Below the level of the spinal injury.
12. Why does the blood pressure keep rising in autonomic dysreflexia even though the brain senses it? A. The kidneys stop filtering blood. B. The baroreceptors are destroyed by the injury. C. The corrective parasympathetic signal cannot travel below the injury. D. The heart rate rises too fast to fill.
13. Constriction of which vascular bed drives the severe hypertension in autonomic dysreflexia? A. The coronary arteries. B. The splanchnic vasculature. C. The cerebral arteries. D. The pulmonary veins.
14. Why is autonomic dysreflexia rare after a spinal cord injury below T10? A. Splanchnic innervation stays intact, so the gut vessels can still dilate. B. The bladder cannot fill after such an injury. C. Those patients have no sympathetic nerves. D. Their baseline blood pressure is too high.
15. A patient with quadriplegia is in suspected autonomic dysreflexia. How should the nurse position the patient first? A. Flat on the back with the legs raised. B. Prone with the head turned. C. Left side with the knees to the chest. D. Sit upright with the legs dangling, and loosen tight clothing.
16. How does sitting a patient upright with the legs down help in autonomic dysreflexia? A. It empties the bladder by gravity alone. B. It raises the heart rate. C. Blood pools in the abdomen and legs, lowering the pressure. D. It increases blood flow to the brain.
17. How often should vital signs be checked during an acute episode until the patient is stable? A. Every 30 minutes. B. About every 2 to 3 minutes. C. Every hour. D. Once at the start, then at discharge.
18. Which possible trigger should be checked first in an acute episode? A. Bladder drainage. B. The toenails. C. Room temperature. D. Recent meals.
19. A patient in autonomic dysreflexia has an indwelling urinary catheter. What should the nurse look for first? A. The color of the urine only. B. The date printed on the drainage bag. C. Whether the bag is above the bladder. D. Kinks, folds, blockages or other obstruction in the catheter and tubing.
20. Why should catheter irrigation fluid be warmed during autonomic dysreflexia? A. Warm fluid dissolves kidney stones. B. Warm fluid kills bacteria in the bladder. C. Cold fluid could trigger more dysreflexic reactions. D. Cold fluid freezes the balloon.
21. When irrigating an indwelling catheter during an episode, how much fluid should be used? A. A large volume, quickly. B. A small volume, gently. C. Enough to fill the bladder fully. D. Fluid should never be used.
22. The indwelling catheter will not irrigate easily during an episode. What is the next step? A. Change the catheter immediately. B. Wait an hour and try again. C. Clamp the catheter. D. Push harder on the syringe.
23. A patient in an episode has no indwelling catheter. What should be done for the bladder? A. Encourage oral fluids. B. Apply a heating pad over the bladder. C. Wait for spontaneous voiding. D. Catheterize the bladder immediately.
24. What should the nurse avoid doing over the bladder during an episode? A. Looking for distention. B. Using a bladder scanner. C. Pressing, tapping or palpating it unduly. D. Recording urine output.
25. The nurse cannot pass a standard urinary catheter during an episode. Which catheter is recommended? A. A smaller condom catheter. B. A coude catheter, or a council tip catheter over a guidewire. C. A rectal tube. D. A nasogastric tube.
26. Why can catheter insertion be harder during autonomic dysreflexia? A. High sympathetic tone can tighten the urethral sphincter. B. The bladder shrinks during an episode. C. The urethra becomes numb. D. Urine production stops.
27. A badly overdistended bladder is being drained after an antihypertensive was given. What must the nurse watch for? A. Rising blood glucose. B. Sudden fever. C. Rising potassium. D. Rebound hypotension, so blood pressure is monitored during drainage.
28. The bladder is not distended and the catheter drains well, but the episode continues. What is the most likely cause? A. A pressure-free skin surface. B. Low room humidity. C. A bowel problem such as fecal impaction. D. Dehydration.
29. When a bowel trigger is suspected, what should be avoided? A. Gentle assessment of the abdomen. B. Large-volume enemas and vigorous rectal stimulation. C. Asking about the last bowel movement. D. Reviewing the bowel program.
30. Systolic pressure is 170 mm Hg and a fecal impaction is suspected. What should happen before the rectal exam? A. Give an antihypertensive to lower the pressure first. B. Do the rectal exam at once without medication. C. Give a large-volume enema. D. Lay the patient flat first.
31. Which drug is the recommended first-line treatment for severe hypertension in autonomic dysreflexia? A. Oral furosemide. B. Oral metoprolol. C. Intramuscular epinephrine. D. Nitroglycerin 2% paste.
32. Where should nitroglycerin 2% paste be applied for autonomic dysreflexia? A. On the feet. B. On the skin below the injury. C. On the skin above the level of the spinal cord injury. D. Inside the mouth.
33. What practical advantage does nitroglycerin paste have once the crisis passes? A. It works only for 30 seconds. B. It can easily be wiped off. C. It needs no blood pressure checks. D. It also empties the bladder.
34. How should nitroglycerin paste be put on the skin? A. Spread lightly without rubbing it in, then cover it with plastic wrap or waterproof tape. B. Rub it in hard until it disappears. C. Leave it uncovered so it dries. D. Mix it with lotion first.
35. Before giving a nitrate for autonomic dysreflexia, what must the nurse ask? A. Whether the patient ate in the last hour. B. Whether the patient has had a flu shot. C. Whether the patient wears glasses. D. Whether the patient recently took a phosphodiesterase inhibitor such as sildenafil.
36. A patient took tadalafil yesterday. For how long after a tadalafil dose should nitrates be avoided? A. 2 hours. B. 6 hours. C. 48 hours. D. 12 hours.
37. Why is sublingual nifedipine not recommended for autonomic dysreflexia? A. It never lowers blood pressure. B. Its absorption is unpredictable. C. It works only in children. D. It must be given into a vein.
38. How is immediate-release nifedipine given for autonomic dysreflexia? A. By the bite-and-swallow technique. B. Dissolved under the tongue. C. As a skin patch. D. As a rectal suppository.
39. What is the usual starting dose of immediate-release nifedipine for an episode? A. 1 mg. B. 60 mg. C. 120 mg. D. 10 mg.
40. What is the maximum nifedipine dose for autonomic dysreflexia in 24 hours? A. 10 mg. B. 100 mg. C. 40 mg. D. There is no maximum.
41. In which patient is nifedipine not recommended for autonomic dysreflexia? A. A patient with a T4 injury. B. A patient with coronary artery disease. C. A patient with a urinary catheter. D. A patient under 50 years old.
42. An older adult already takes other antihypertensives. How is the nifedipine dose adjusted? A. Reduced to 5 mg. B. Doubled to 20 mg. C. Given intravenously. D. Not changed.
43. What kind of antihypertensive is preferred for an autonomic dysreflexia crisis? A. One with a slow onset and long duration. B. One taken once a week. C. One that also raises heart rate. D. One with a rapid onset and short duration of action.
44. After emergency antihypertensive treatment, how long should blood pressure monitoring continue? A. 10 minutes. B. Until the next shift only. C. At least 2 more hours. D. No monitoring is needed.
45. For how long after antihypertensive drugs, especially nitrates, can rebound hypotension occur? A. Up to 5 minutes. B. Up to 5 hours. C. Up to 5 days. D. It does not occur.
46. When should transfer to an intensive care unit be considered? A. When the hypertensive crisis is not controlled within 30 minutes. B. As soon as the headache starts. C. Only after 24 hours of symptoms. D. Never; episodes are always managed on the floor.
47. Which situation is a reason to admit a patient after an autonomic dysreflexia episode? A. The catheter was changed and pressure normalized. B. The patient has had episodes before. C. The patient has a home blood pressure cuff. D. The cause of the episode is still unknown.
48. A patient at risk has dysreflexia-like symptoms but a normal blood pressure. What is most likely? A. This is a severe episode. B. The blood pressure cuff must be broken. C. The patient most likely does not have autonomic dysreflexia. D. Nitroglycerin paste should be applied.
49. Can autonomic dysreflexia occur without any symptoms? A. No; a headache is always present. B. Yes; silent episodes still carry dangerous hypertension. C. No; it always causes fainting. D. Only in children.
50. What is considered the most serious complication of autonomic dysreflexia? A. Hemorrhagic stroke. B. Mild nasal congestion. C. Goose bumps. D. Short-lived anxiety.
51. Which rectal problems can trigger autonomic dysreflexia? A. Only a full stomach. B. Only a dry mouth. C. Only nasal congestion. D. Hemorrhoids, anal abscess or fissure.
52. Which skin or body problem below the injury can set off an episode? A. A clean, dry, loose-fitting gown. B. A normal bowel movement. C. An ingrown toenail or tight clothing. D. A warm, comfortable room.
53. Which medications can trigger autonomic dysreflexia? A. Acetaminophen. B. Nasal decongestants and sympathomimetic drugs. C. Normal saline flushes. D. Vitamin D.
54. When does autonomic dysreflexia usually first appear after a spinal cord injury? A. After spinal shock resolves, typically within 1 year. B. Within the first hour of injury. C. Only after 10 years. D. Only during sleep.
55. How does a complete injury compare with an incomplete one for autonomic dysreflexia risk? A. Incomplete injuries carry the higher risk. B. The risk is identical. C. Complete injuries cannot develop it. D. Complete injuries are more than 3 times as likely to develop it.
56. How often can episodes occur in a susceptible person? A. Only once in a lifetime. B. Only once per year. C. Up to 40 times per day. D. Only during illness.
57. Which receptor change below the lesion adds to the blood pressure surge? A. Loss of all insulin receptors. B. Hypersensitive vascular alpha-adrenergic receptors. C. Blocked histamine receptors. D. Inactive opioid receptors.
58. What causes the pounding headache in autonomic dysreflexia? A. Marked vasodilation above the level of injury. B. Low blood sugar. C. Dehydration of the brain. D. Eye strain.
59. A patient has only mild symptoms. Can the nurse assume the blood pressure is only mildly raised? A. Yes; mild symptoms always mean mild hypertension. B. Yes; pressure need not be checked. C. No; mild symptoms mean hypotension. D. No; symptoms may not match how high the pressure is.
60. A patient with quadriplegia is found unconscious. What should be checked right away? A. Only the blood sugar. B. Only the temperature. C. Blood pressure, to screen for autonomic dysreflexia. D. Only the pupils.
61. Systolic pressure is above 150 mm Hg and the catheter still needs changing. What should the nurse consider? A. Waiting until the catheter is changed before any drug. B. Immediate antihypertensive therapy without waiting for the catheter change. C. Lying the patient flat. D. Giving a decongestant.
62. How is orthostatic hypotension defined in a patient with spinal cord injury? A. A drop in systolic pressure of 20 mm Hg or more on moving upright from lying supine. B. A rise in systolic pressure of 20 mm Hg on standing. C. A heart rate above 100 when lying down. D. Any systolic pressure under 140.
63. Why is skin temperature unreliable in a patient with a high spinal cord injury? A. Skin thermometers do not work on adults. B. Skin is always hot after injury. C. Core temperature cannot be measured. D. Body temperature control is impaired; a core reading is needed.
64. A patient with a spinal cord injury is cold. How should the nurse warm them? A. With a heating pad on the legs. B. With a hot water bottle under the feet. C. With blankets and warm fluids, not heating devices that could injure the skin. D. With a heat lamp close to the skin.
65. Who should carry an emergency autonomic dysreflexia kit? A. Only hospital staff. B. Anyone with a spinal cord injury who has had at least 1 significant episode. C. Only patients with injuries below T10. D. No one; kits are not advised.
66. What should a patient emergency card for autonomic dysreflexia include? A. Causes of prior episodes and the baseline blood pressure. B. Only the home address. C. Only insurance details. D. Only a list of allergies to food.
67. A patient with a known history arrives in an episode. What useful question should staff ask? A. When did you last travel abroad? B. Do you have a family history of migraine? C. What is your shoe size? D. What usually triggers your episodes and what usually fixes them?
68. What home equipment should patients at risk have? A. A home ECG machine. B. A home ventilator. C. A home blood pressure monitor. D. A home glucose clamp.
69. How might bladder management change to prevent recurrent episodes? A. Stopping all catheterization. B. Intermittent self-catheterization more often, about 5 to 6 times a day. C. Catheterizing once a week. D. Restricting all fluids.
70. Is a daily antihypertensive taken only to prevent autonomic dysreflexia usually recommended? A. No, it is generally not recommended. B. Yes, for every patient with a spinal cord injury. C. Yes, but only at night. D. Yes, at double the usual dose.
71. Which bladder treatment has been shown to reduce the incidence of autonomic dysreflexia? A. Daily cranberry juice. B. Restricting fluids to 500 mL a day. C. Removing the catheter permanently. D. Botulinum toxin injections into the bladder muscle.
72. Which routine helps prevent skin-related triggers? A. Checking the skin once a year. B. Avoiding all position changes. C. Periodic skin inspections to catch ulcers and breakdown. D. Wearing tighter clothing.
73. When should blood pressure be checked after sexual activity in a person at risk? A. 24 hours later. B. 5 minutes after finishing. C. Only if a headache lasts a week. D. It does not need checking.
74. Why is prazosin a poor choice for preventing episodes linked to unplanned sexual activity? A. It needs pretreatment 12 hours beforehand. B. It only works for 1 minute. C. It raises blood pressure. D. It must be given intravenously.
75. How might labor present in a pregnant patient with a high spinal cord injury? A. Always with severe typical labor pain. B. Only with fever. C. Only with a low heart rate in the mother. D. Only mild abdominal discomfort, more spasticity and autonomic dysreflexia.
76. Which anesthesia is reported as the best choice for controlling autonomic dysreflexia in labor? A. No anesthesia. B. Local skin anesthetic only. C. Epidural anesthesia. D. Oral sedatives only.
77. An episode begins during a urologic procedure. What should be done first? A. Speed the procedure up to finish faster. B. Stop the procedure and promptly drain the bladder. C. Give ephedrine. D. Lay the patient flat and wait.
78. An episode starts during surgery under general anesthesia. What often relieves it? A. Deepening the anesthesia. B. Lightening the anesthesia. C. Giving ephedrine. D. Cooling the room.
79. Which drug should be avoided around procedures in patients prone to autonomic dysreflexia? A. Nitroglycerin paste. B. Nifedipine. C. Lidocaine gel. D. Ephedrine.
80. How often should blood pressure be measured during a procedure that could trigger an episode? A. Every 30 minutes. B. Once at the start. C. Continuously or at least every 2 minutes. D. Only at the end.
81. What does "boosting" mean in spinal cord injury sport? A. Taking extra protein before a race. B. Deliberately triggering autonomic dysreflexia to improve performance. C. Using a lighter wheelchair. D. Warming up for longer.
82. Which treatment is often the most effective immediate treatment for bladder spasms? A. A belladonna and opium (B & O) suppository. B. A large-volume enema. C. Cold water bladder irrigation. D. Suprapubic tapping.
83. Which drugs can cause dysreflexia-like hypertension in people without a spinal cord injury? A. Acetaminophen. B. Antacids. C. Saline nasal spray. D. Stimulants such as cocaine and amphetamines.
84. Which member of the care team is often first to identify autonomic dysreflexia? A. The pharmacist. B. The dietitian. C. The nurse. D. The radiologist.
85. Besides dysreflexia, which complications are these patients also prone to? A. Cataracts and hearing loss only. B. Deep vein thrombosis and pressure sores. C. Tooth decay only. D. Hair loss only.
86. Do most autonomic dysreflexia episodes need hospital care? A. No; most are mild and handled at home by the patient and caregivers. B. Yes; every episode needs an ICU. C. Yes; every episode needs surgery. D. No; episodes always stop without action.
87. For regional anesthesia in a patient at risk, to what level should the anesthetic extend? A. C2. B. L5. C. S5. D. T10.
88. A continuous intravenous antihypertensive infusion is started. What monitoring is recommended? A. A blood pressure check once per shift. B. Pulse oximetry only. C. An arterial line for close monitoring and titration. D. No extra monitoring.

Answers are on the backs of the cards — or open the full autonomic dysreflexia nursing answer key to read them all at once.