In a long term rehabilitation care unit, a client with spinal cord injury complains of a pounding headache. The client is sitting in a wheelchair watching television. Further assessment by the nurse reveals excessive sweating, a splotchy rash, pilomotor erection, facial flushing, congested nasal passages and a heart rate of 50. The nurse should perform which action next?

B Place the client into the bed and administer the ordered PRN analgesic A Take the client's respirations, blood pressure (BP), temperature and then pupillary responses D Turn the television off and then assist client to use relaxation techniques C Check the client for bladder distention and the client's urinary catheter for kinks