Certified Rehabilitation Registered Nurse (CRRN) Practice Exam

If a dysreflexic patient has elevated blood pressure above 150 mm Hg, what should be your next step after evaluating other factors?

1. Instill lidocaine into the rectum

2. Remove stool from the rectum

3. Administer a short-acting antihypertensive

4. Lay the patient flat and elevate the legs

The correct answer is: Remove stool from the rectum

In the context of a dysreflexic patient experiencing an elevated blood pressure above 150 mm Hg, the most appropriate next step involves addressing the likely underlying cause. Dysautonomia, particularly due to stimuli such as a full bladder or impacted bowel, can lead to autonomic dysreflexia, resulting in significantly high blood pressure. Removing stool from the rectum directly addresses a common stimulus for dysreflexia. Constipation or impaction can cause bowel distension, triggering the autonomic reflex that leads to hypertension. By relieving the impaction, you can help restore normal blood pressure and alleviate the other symptoms associated with dysreflexia. Other options, while potentially relevant in a broader clinical context, do not directly address the triggering cause as effectively. Therefore, prioritizing the rectal examination and stool removal is a crucial step in managing the patient’s elevated blood pressure in this scenario.