SCI NCLEX style questions

SCI NCLEX style questions ScienceMedicineNeurology meghan_vasquez Save Spinal Cord and Spinal Nerves 34 terms vtd4ywpmszPreview Plexuses

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nicholas_rottino Preview Vestibular abnormalities & reflexes 10 terms margohawkins Preview CNS - m 11 terms tay A 70-year-old patient is admitted after falling from his roof. He has a spinal cord injury at the C7 level. What findings during the assessment identify the presence of spinal shock?

• Paraplegia with a flaccid paralysis
• Tetraplegia with total sensory loss
• Total hemiplegia with sensory and motor loss
• Spastic tetraplegia with loss of pressure sensation

. b. At the C7 level, spinal shock is manifested by tetraplegia and sensory loss. The neurologic loss may be temporary or permanent. Paraplegia with sensory loss would occur at the level of T1. A hemiplegia occurs with central (brain) lesions affecting motor neurons and spastic tetraplegia occurs when spinal shock resolves Which syndrome of incomplete spinal cord lesion is described as cord damage common in the cervical region resulting in greater weakness in upper extremities than lower?

• Central cord syndrome
• Anterior cord syndrome
• Posterior cord syndrome
• Cauda equina and conus medullaris syndromes

. a. In central cord syndrome, motor weakness and sensory loss are present in both upper and lower extremities, with upper extremities affected more than lower extremities.

The patient is diagnosed with Brown-Séquard syndrome after a knife wound to the spine. Which description accurately describes this syndrome?

• Damage to the most distal cord and nerve roots, resulting in flaccid paralysis of the lower limbs and areflexic

bowel and bladder

• Spinal cord damage resulting in ipsilateral motor paralysis and contralateral loss of pain and sensation below the

level of the lesion

• Rare cord damage resulting in loss of proprioception below the lesion level with retention of motor control and

temperature and pain sensation

• Often caused by flexion injury with acute compression of cord resulting in complete motor paralysis and loss of

pain and temperature sensation below the level of injury

• Brown-Séquard syndrome is characterized by ipsilateral

loss of motor function and position and vibratory sense and vasomotor paralysis with contralateral loss of pain and temperature sensation below the level of the injury.Damage to the most distal cord and nerve roots with flaccid paralysis of the lower limbs and areflexic bowel and bladder is seen with cauda equine syndrome or conus medullaris syndrome. Posterior cord syndrome is rare, with cord damage resulting in loss of proprioception below the lesion level but retention of motor control and temperature and pain sensation. Anterior cord syndrome is often caused by flexion injury, with acute compression of the cord resulting in complete motor paralysis and loss of pain and temperature sensation below the level of injury but touch, position, vibration, and motion remaining intact.What causes an initial incomplete spinal cord injury to result in complete cord damage?

• Edematous compression of the cord above the level of the injury
• Continued trauma to the cord resulting from damage to stabilizing ligaments
• Infarction and necrosis of the cord caused by edema, hemorrhage, and metabolites
• Mechanical transection of the cord by sharp vertebral bone fragments after the initial injury
• The primary injury of the spinal cord rarely affects

the entire cord but the pathophysiology of secondary injury may result in damage that is the same as mechanical severance of the cord. Complete cord dissolution occurs through autodestruction of the cord by hemorrhage, edema, and the presence of metabolites and norepinephrine, resulting in anoxia and infarction of the cord. Edema resulting from the inflammatory response may compress the spinal cord as well as increase the damage as it extends above and below the injury site

A patient with a spinal cord injury has spinal shock. The nurse plans care for the patient based on what knowledge?

• Rehabilitation measures cannot be initiated until spinal shock has resolved.
• The patient will need continuous monitoring for hypotension, tachycardia, and hypoxemia.
• Resolution of spinal shock is manifested by spasticity, hyperreflexia, and reflex emptying of the bladder.
• The patient will have complete loss of motor and sensory functions below the level of the injury but autonomic

functions are not affected.

• Spinal shock occurs in about half of all people with

acute spinal cord injury. In spinal shock, the entire cord below the level of the lesion fails to function, resulting in a flaccid paralysis and hypomotility of most processes without any reflex activity. Return of reflex activity, although hyperreflexive and spastic, signals the end of spinal shock. Rehabilitation activities are not contraindicated during spinal shock and should be instituted if the patient's cardiopulmonary status is stable.Neurogenic shock results from loss of vascular tone caused by the injury and is manifested by hypotension, peripheral vasodilation, and decreased cardiac output (CO). Sympathetic function is impaired below the level of the injury because sympathetic nerves leave the spinal cord at the thoracic and lumbar areas and cranial parasympathetic nerves predominate in control over respirations, heart, and all vessels and organs below the injury, which includes autonomic functions.Two days following a spinal cord injury, a patient asks continually about the extent of impairment that will result from the injury. What is the best response by the nurse?

• "You will have more normal function when spinal shock resolves and the reflex arc returns."
• "The extent of your injury cannot be determined until the secondary injury to the cord is resolved."
• "When your condition is more stable, MRI will be done to reveal the extent of the cord damage."
• "Because long-term rehabilitation can affect the return of function, it will be years before we can tell what the

complete effect will be."

• Until the edema and necrosis at the site of the injury

are resolved in 72 hours to 1 week after the injury, it is not possible to determine how much cord damage is present from the initial injury, how much secondary injury occurred, or how much the cord was damaged by edema that extended above the level of the original injury. The return of reflexes signals only the end of spinal shock and the reflexes may be inappropriate and excessive, causing spasms that complicate rehabilitation.

Priority Decision: The patient was in a traffic collision and is experiencing loss of function below C4. Which effect must the nurse be aware of to provide priority care for the patient?

• Respiratory diaphragmatic breathing
• Loss of all respiratory muscle function
• Decreased response of the sympathetic nervous system
• GI hypomotility with paralytic ileus and gastric distention
• Spinal injury below C4 will result in diaphragmatic

breathing and usually hypoventilation from decreased vital capacity and tidal volume from intercostal muscle impairment. The nurse's priority actions will be to monitor rate, rhythm, depth, and effort of breathing to observe for changes from the baseline and identify the need for ventilation assistance. Loss of all respiratory muscle function occurs above C4 and the patient requires mechanical ventilation to survive. Although the decreased sympathetic nervous system response (from injuries above T6) and GI hypomotility (paralytic ileus and gastric distention) will occur (with injuries above T5), they are not the patient's initial priority needs.A patient is admitted to the emergency department with a spinal cord injury at the level of T2. Which finding is of most concern to the nurse?

• SpO2

of 92%

• Heart rate of 42 bpm
• Blood pressure of 88/60 mm Hg
• Loss of motor and sensory function in arms and legs
• Neurogenic shock associated with cord injuries

above the level of T6 greatly decreases the effect of the sympathetic nervous system and bradycardia and hypotension occur. A heart rate of 42 bpm is not adequate to meet the oxygen needs of the body. While low, the blood pressure is not at a critical point. The oxygen saturation is satisfactory and the motor and sensory losses are expected.