Quiz 9: Chapter 24: Spinal Cord Injury Practice Questions

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• A nurse explains that the spinal cord extends from the

brainstem to the level of which vertebra?

• Last thoracic
• Second lumbar
• First sacral
• Coccygeal

ANS: B

The cord starts at the brainstem and extends to the second lumbar vertebra.

• On admission to the emergency department, a patient

with a C5 compression fracture can move only his head and has flaccid paralysis of all extremities. The distraught family asks if the paralysis is permanent. What is the best response by the nurse?

• "Yes. In all likelihood, the paralysis is probably

permanent."

• "No. Significant recovery of function should occur in a

few days."

• "It is too early to tell. When the spinal shock subsides,

we will know more."

• "You should talk to your physician about things of that

nature."

ANS: C

Spinal shock caused by swelling may last from a few days to months, clouding the issue of the true extent of the injury.

• Which assessment would indicate the resolution of

spinal shock?

• Extension and rigidity in affected limbs
• Spastic involuntary movements in affected limbs
• Tingling and burning in affected limbs
• Voluntary purposeful movements of affected limbs

ANS: B

Spastic involuntary movements after a period of flaccid paralysis announce the end of spinal shock.

• Which assessment leads the emergency department

nurse to suspect that a patient's spinal cord injury (SCI) is below C4?

• Voluntary eye movement
• Ability to blink the eyelids
• Unlabored respiration
• Ability to make a facial grimace

ANS: C

The phrenic nerve, which is at C1 to C4, controls the diaphragm and intercostal function for ventilation.

• During a neurologic assessment, a nurse asks a patient

to dorsiflex the foot against the resistance of the nurse's hand. The patient is unable to perform this action. Where does this assessment confirm that cord damage has occurred?

• C4 to C5
• L2 to L4
• L5
• S1

ANS: C

The muscle group that controls the feet is at L5.

• What technique should the nurse implement to move

the impaired legs of a patient with an SCI to avoid stimulation muscle spasm?

• Firmly grasping the calf muscle and the thigh muscle
• Manipulating the limb by supporting the knee and

ankle joints

• Holding the foot upright and slowly dragging the limb

into position

• Requesting assistance to support the calf and thigh

ANS: B

Undue muscle stimulation can cause spasticity. Using the joint locations to support limbs when repositioning them reduces likelihood of spasticity.

• When recording the findings of muscle strength, a

nurse records a 2 for the right arm. How should his score be interpreted?

• Weak contraction
• Muscle movement when supported
• Active muscle movement without support
• Full, active range-of-motion exercises against

resistance

ANS: B

A 2 on the muscle-grading scale means that muscular movement is observed when the limb is supported.

• Which technique of opening the airway in the newly

admitted patient with an SCI is the most appropriate?

• Chin lift
• Head tilt
• Jaw thrust
• Neck flexion

ANS: C

The jaw thrust does not require spinal movement.

• Brown-Séquard syndrome results in which neurologic

deficit?

• Bilateral loss of pain sensation below the level of injury
• Bilateral loss of temperature and motor function below

the level of injury

• Motor and sensory loss in the upper extremities only
• Ipsilateral loss of motor function and contralateral loss

of pain sensation and temperature

ANS: D

Brown-Séquard syndrome is a hemisection of the cord resulting in ipsilateral motor loss and contralateral loss of pain and temperature.

• Which level of independence is an appropriate

nursing care plan goal for a patient with a C8 transection?

• Manage a mechanical wheelchair with a joystick.
• Manage a mechanical wheelchair with hand control.
• Manage a specially equipped wheelchair.
• Manage an ordinary wheelchair.

ANS: D

Upper extremity mobility and enhanced hand grip allow the use of an ordinary wheelchair by an individual with a C8 level SCI.

• A paraplegic patient excitedly reports seeing his foot

move when he was being turned. How is this phenomenon best explained?

• Reflexive movement
• Return of motor function
• Early symptom of autonomic dysreflexia
• Result of hypertonicity of the muscle

ANS: A

Reflexive action is a movement that does not require communication to the brain via the spinal cord.

• After spinal shock has been resolved, an indwelling

catheter is removed. What way should the nurse expect this patient to empty the bladder?

• Manual expression (Credé method)
• Spontaneous reflexive action
• Normal voluntary control
• Self-catheterization

ANS: B

After spinal shock resolves, spasticity of the bladder causes spontaneous emptying.

• A distressed family member asks about the purpose of

the Gardner-Wells tongs. Which is the most helpful explanation by the nurse regarding the action of Gardner-Wells tongs?

• Compress the cervical vertebrae.
• Immobilize the head.
• Allow the patient to be moved out of bed.
• Align the cervical vertebrae.

ANS: D

The Gardner-Wells tongs are secured to the skull to separate and align the cervical vertebrae, but they do not immobilize the head. When the tongs are in place, the patient is bedridden.

• What is the major advantage of the halo device over

the Gardner-Wells tongs?

• Separates the cervical vertebrae
• Allows the patient out of bed
• Aligns the cervical spine
• Relieves pain

ANS: B

The halo device and the Gardner-Wells tongs do exactly the same thing in terms of separation and alignment. The only advantage of the halo device is the mobility it allows. Neither traction modality specifically relieves pain.

• A patient is receiving methylprednisolone. What

purpose should the nurse explain this drug has in treating a patient with an SCI?

• Reduces spinal cord cellular damage
• Counteracts spinal shock
• Increases blood supply to the injured cord
• Enhances sexual function

ANS: A

Methylprednisolone, if given within the first 8 hours of the injury, can significantly reduce cellular damage to the cord.

• A patient with an SCI begins to have seizures, and the

blood pressure (BP) rises rapidly to 210/160 mm Hg.Which is the third indicator of the syndrome of autonomic dysreflexia?

• Profuse vomiting
• Hives on face and neck
• Excessive urine output
• Bradycardia

ANS: D

Bradycardia, hypertension, and seizure are the three signs of autonomic dysreflexia.

• What should be the immediate intervention when a

nurse recognizes autonomic dysreflexia in the patient with an SCI?

• Flex the patient's legs using the knee gatch of the bed.
• Cool the patient with alcohol solution.
• Raise the head of the bed to at least 45 degrees.
• Administer oxygen per mask.

ANS: C

Raising the head of the bed reduces the BP. Flexed legs, cooling, and oxygen will not alleviate the syndrome.

• Which intervention by a nurse is effective in the

prevention of autonomic dysreflexia in the patient with an SCI?

• Ensure patency of the urinary catheter.
• Give warm baths to the patient to stimulate

vasodilation.

• Keep lighting at a minimum to reduce stimulation.
• Offer the patient four or five small meals daily.

ANS: A

A distended bladder, constipation, and sudden jarring can all set off autonomic dysreflexia. Vagal stimulation retards vasodilation. The number and size of meals have no affect on preventing this syndrome.

• A nurse tells a patient with quadriplegia that he is

being treated with intravenous (IV) drugs because this method is more effective than intramuscularly (IM). What explanation should the nurse provide about IM medications to explain to the patient why they are less effective than IV?

• Too concentrated
• Too irritating to poorly perfused tissue
• Not absorbed well below the level of the injury
• Too small a dose to be effective

ANS: C

A patient with quadriplegia has a high cervical lesion, which causes nearly the entire vascular tree to have poor perfusion. This condition would make absorption of medications from the tissues unpredictable.

• The family members of a patient with an SCI, who is in

the rehabilitation phase, wants to take the patient outdoors for a visit. It is 90° F outside and very humid.What should the nurse suggest?

• Do not go outside at all but remain in the hospital.
• Take a spray bottle to spray water to cool the patient

by evaporation.

• Take a light sweater to insulate the patient.
• Have the patient drink at least 32 oz of water during

the outing.

ANS: B

Water will evaporate and cool the patient, similar to perspiration.