1. Right Answer: D
Explanation: If the client develops signs or symptoms of autonomic dysreflexia, they need to be addressed immediately. If the family member is not able to relieve them, a health care provider needs to be notified immediately. The remaining choices are correct; they are all ways to relieve autonomic dysreflexia. Reduction of RiskPotential
2. Right Answer: C
Explanation: Hypotension is not indicative of autonomic dysreflexia; rather, hypertension is a sign of autonomic dysreflexia. The remaining choices are symptoms of autonomic dysreflexia. Reduction of Risk Potential
3. Right Answer: B
Explanation: This statement is incorrect because caffeinated fluids, such as coffee and cola, stimulate fluid loss through urination. Instead, fluids such as water and fruit juices should be taken. The remaining choices indicate correct understanding of bowel management. Reduction of Risk Potential
4. Right Answer: D
Explanation: This response is the most therapeutic because it allows the client to discuss his anxieties and fears with the nurse. The other responses do not allow for such a dialogue, so they are not as therapeutic. Reduction of Risk Potential
5. Right Answer: A
Explanation: This is called the sour grapes form of rationalization. Rationalization is an unconscious form of self-deception in which excuses are made. Denial is an unconscious process that ignores the existence of the situation. Projection operates unconsciously and results in blaming behavior. Compensation is an attempt to make up for a perceived weakness by emphasizing a strong point. Psychosocial Integrity
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