A nurse is preparing to administer purified protein derivative (PPD) to a client. The nurse should use which of the following routes?

A. Loss of urinary control: Thoracic spinal cord injuries disrupt autonomic and somatic pathways controlling bladder function. Damage at the thoracic level can impair signals between the brain and the sacral micturition center, leading to neurogenic bladder. Clients may experience urinary retention, incontinence, or reflexive voiding, requiring monitoring and interventions such as catheterization or bladder training.

B. Inability to clear secretions: Impaired secretion clearance is primarily a risk for cervical spinal cord injuries, which compromise innervation of the diaphragm and accessory respiratory muscles. Thoracic injuries usually preserve diaphragmatic function, allowing effective breathing and cough reflex, so secretion clearance is typically maintained.

C. Decreased fine motor hand movement: Fine motor control of the hands depends on cervical spinal cord innervation, particularly C6–C8 levels. A thoracic injury does not affect upper extremity motor neurons, so hand dexterity and fine motor skills are generally preserved.

D. Difficulty swallowing: Dysphagia occurs with lesions affecting cranial nerve nuclei or high cervical spinal cord injuries that impair pharyngeal and laryngeal muscle innervation. Thoracic spinal cord injuries do not impact swallowing mechanisms because these structures are innervated above the level of the thoracic spine.

A. Constipation: Constipation is not a common adverse effect of cefazolin. While gastrointestinal disturbances such as diarrhea or nausea can occur with antibiotics, constipation is typically unrelated and does not require immediate reporting.

B. Elevated skin patches: Skin eruptions, including hives or elevated erythematous patches, may indicate an allergic reaction to cefazolin. Early recognition and reporting are critical to prevent progression to severe hypersensitivity reactions such as anaphylaxis.

C. Ringing in the ears: Ototoxicity is more commonly associated with aminoglycoside antibiotics, not cefazolin, which is a cephalosporin. Tinnitus would not be an expected adverse effect requiring urgent reporting in this context.

D. Depression: Cefazolin is not linked to mood changes or psychiatric effects. Monitoring for depression is unnecessary in this case, as it is unrelated to the medication’s known adverse effects.