A nurse is caring for a client who has a spinal cord injury at the first thoracic level. Which of the following should the nurse recognize can trigger autonomic dysreflexia?
(Select All that Apply.)

Choice A Reason:

Pleural cavity decompression via needle aspiration is inappropriate. Pleural cavity decompression via needle aspiration may be indicated in cases of tension pneumothorax, a potentially life-threatening condition in which air accumulates in the pleural space and compresses the lung. While it is an intervention rather than a diagnostic tool, it may be performed emergently if tension pneumothorax is suspected based on clinical findings.

Choice B Reason:

Focused assessment with sonography in trauma (FAST) is appropriate. FAST is a bedside ultrasound examination commonly used in trauma settings to rapidly assess for the presence of free fluid in the pericardial, pleural, and peritoneal spaces. It can help identify hemopericardium, hemothorax, or intra-abdominal hemorrhage, which may be indicative of thoracic injury.

Choice C Reason:

Chest x-ray is appropriate. Chest x-ray is a commonly used imaging modality for evaluating thoracic injuries. It can help visualize abnormalities such as rib fractures, pneumothorax, hemothorax, pulmonary contusions, or other traumatic injuries to the chest.

Choice D Reason:

Thoracentesis is appropriate. Thoracentesis is a procedure used to sample fluid from the pleural space for diagnostic or therapeutic purposes. It may be indicated if there is a suspicion of pleural effusion or if fluid accumulation is seen on imaging studies such as chest x-ray or ultrasound.

Choice E Reason:

Ultrasound is appropriate. Ultrasound can be used to evaluate various aspects of thoracic injuries, including the presence of pneumothorax, hemothorax, or pleural effusion. It is often used as part of the FAST examination but can also be performed separately for more detailed assessment.

Choice A Reason:

Epithelial cells is correct. Epithelial cells lining the airways play a role in initiating the inflammatory response in asthma by releasing cytokines and other inflammatory mediators. These cells can contribute to the circulatory surge of inflammatory cells and cytokines seen in status asthmaticus.

Choice B Reason:

OT lymphocytes is incorrect. There is no specific cell type known as "OT lymphocytes." It's possible this may refer to T lymphocytes (T cells), which are involved in the immune response in asthma but are not typically associated with a circulatory surge in status asthmaticus.

Choice C Reason:

Hyperreactivity is incorrect. Hyperreactivity refers to the exaggerated response of the airways to various stimuli, leading to bronchoconstriction and inflammation. While hyperreactivity is a characteristic feature of asthma, it does not directly contribute to a circulatory surge of inflammatory cells and cytokines.

Choice D Reason:

Mast cells is correct. Mast cells are key players in the pathophysiology of asthma. They release various inflammatory mediators, including histamine and leukotrienes, which contribute to airway inflammation, bronchoconstriction, and mucus production. Mast cells can participate in the circulatory surge of inflammatory cells and cytokines in status asthmaticus.

Choice E Reason:

Inflammation is correct. Inflammation is a hallmark feature of asthma and plays a central role in the pathogenesis of status asthmaticus. The inflammatory response involves the recruitment and activation of various inflammatory cells, release of cytokines, and other mediators that contribute to airway obstruction and systemic effects.