A nurse is caring for a client who has uncontrolled type 1 diabetes mellitus. Which of the following findings should the nurse expect?

Choice A reason:
While examining the client for areas of skin breakdown is an important part of ongoing care, especially for clients with spinal cord injuries who are at increased risk for pressure ulcers, it is not the first action to take when autonomic dysreflexia is suspected. Skin breakdown is not an immediate life-threatening issue compared to the potential complications of autonomic dysreflexia.

Choice B reason:
Checking the client's bladder for distention is a critical step in the management of autonomic dysreflexia, as an overfull bladder is a common trigger for this condition. However, the very first action should be to place the client in a sitting position to lower blood pressure, which can be dangerously high during an episode of autonomic dysreflexia.

Choice C reason:
Checking for fecal impaction is another important intervention for managing autonomic dysreflexia, as an impacted bowel can also trigger an episode. However, similar to checking for bladder distention, this is not the first action to take. Immediate measures to lower blood pressure are prioritized for the safety of the client.

Choice D reason:
Placing the client in a sitting position, or elevating the head of the bed to at least 45 degrees, is the first and most critical action when autonomic dysreflexia is suspected. This position helps to lower blood pressure by promoting venous return to the heart and can prevent complications such as stroke from the sudden hypertension associated with autonomic dysreflexia.

Choice A reason:
Annular lesions are ring-shaped with a clear center, which does not describe a lesion with a wavy border. This term is typically used for lesions like ringworm, which present as circular rashes with normal skin in the center.

Choice B reason:
Circinate lesions are also circular but are not characterized by a wavy border. They are similar to annular lesions but often have a more rounded edge and are associated with conditions like psoriasis.

Choice C reason:
Coalesced lesions refer to multiple lesions that have merged to form a larger one. While they can have irregular borders, 'coalesced' does not specifically describe the wavy nature of the border.

Choice D reason:
Serpiginous lesions have a wavy or snake-like border, which matches the description provided by the nurse. This term is often used for parasitic infections, such as cutaneous larva migrains, which create a trail-like pattern on the skin.