A client with a spinal cord lesion experiences a sudden, painful spasm of his lower limbs. The priority action by the nurse is to
A) administer pain medication.
B) assess for bladder distention.
C) massage the client's legs.
D) position the client upright.

Question

Quizplus · Accepted Answer

Reflex spasms may be triggered by extrinsic or visceral stimuli, such as a distended bladder. In a client with a new spinal cord injury or for whom spasms are new, the nurse would do best to try to assess for a causative factor before just medicating the client. Antispasmodic medications would be more helpful than pain medications. Massaging the legs is never a good idea because of the theoretical risk of dislodging a DVT. Positioning the client will not assist with muscle spasms.

A Client with a Spinal Cord Lesion Experiences a Sudden