In a client with a T4 lesion experiencing autonomic dysreflexia, which action is incorrect to perform first?

• A. Place client supine with legs elevated.
• B. Assess bladder and bowel for distention.
• C. Examine skin for pressure areas.
• D. Eliminate drafts.

Answer: (A)

Autonomic dysreflexia is an urgent situation in high spinal cord injury where blood pressure spikes in response to a stimulus below the level of injury. The first goal is to lower the BP quickly by positioning the patient so that blood pools away from the trunk. Placing the client supine with legs elevated does the opposite: it increases venous return and can raise or fail to reduce the elevated pressure, so it’s not the correct first action.

The best initial move is to sit the patient upright (head of bed elevated) to help lower blood pressure. After that, quickly identify and relieve the precipitating stimulus—most commonly bladder or bowel distention—while also checking for other triggers such as skin irritation or drafts and removing them. If blood pressure remains high after addressing triggers, proceed with further treatments as protocol dictates.