1.

Spinal cord injury above the first thoracic vertebra or within the cervical sections of C1-C8, result in
some degree of paralysis in all four limbs - the legs and arms.

a. Paraplegia

b. Tetraplegia

c. Complete paraplegia

Answer: B. Tetraplegia (Quadraplegia)

2. Spinal cord injuries below the first thoracic spinal levels T1-L5. Paraplegics are able to fully use their
arms and hands but the degree to which their legs are disabled depends on the injury.

a. Tetraplegia

B. Paraplegia

C. Complete paraplegia

Answer: B. Paraplegia

3. It is described as permanent loss of motor and nerve function at T1 level or below, resulting in loss of
sensation and movement in the legs, bowel, bladder and sexual region.

A. Complete paraplegia

B. Paraplegia

C. Tetraplegia

Answer: A. Complete Paraplegia

4. Is a rare neurological condition characterized by a lesion in the spinal cord which results in weakness
or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the
opposite side.

A. Posterior cord syndrome

B. Anterior cord syndrome

C. Brown sequard syndrome

D. Central cord syndrome

Answer: C. Brown sequard syndrome

5. Is the most common form of incomplete spinal cord injury characterized by impairment in the arms
and hands and to a lesser extent in the legs.

A. Posterior cord syndrome

B. Anterior cord syndrome

C. Brown sequard syndrome

D. Central cord syndrome

Answer: D. Central cord syndrome

6. Is a rare type of incomplete spinal cord injury that affects the dorsal columns of the spinal cord (found
in the posterior—or backside—region of the spinal cord), responsible for the perception of fine-touch,
vibration, sense of self-movement, and body positioning (proprioception).

A. Central cord syndrome

B. Anterior cord syndrome

C. Cauda equina syndrome

D. Posterior cord syndrome

Answer: D. Posterior cord syndrome

7. In paraplegia, spinal cord injury above the first thoracic vertebra or within the cervical sections of C1-
C8, result in some degree of paralysis in all four limbs - the legs and arms.

Answer: False

8. A patient with a spinal cord injury at the T1 level complains of a severe headache and an
"anxious feeling." Which is the most appropriate initial reaction by the nurse?
A. Try to calm the patient and make the environment soothing.
B. Assess for a full bladder.
C. Notify the healthcare provider.
 D. Prepare the patient for diagnostic radiography.

Correct Answer: B

Rationale: Autonomic dysreflexia occurs in patients with injury at level T6 or higher, and is a life-
threatening situation that will require immediate intervention or the patient will die. The most
common cause is an overextended bladder or bowel. Symptoms include hypertension,
headache, diaphoresis, bradycardia, visual changes, anxiety, and nausea. A calm, soothing
environment is fine, though not what the patient needs in this case. The nurse should recognize
this as an emergency and proceed accordingly. Once the assessment has been completed, the
findings will need to be communicated to the healthcare provider.
9. A patient with a spinal cord injury (SCI) is admitted to the unit and placed in traction. Which of
the following actions is the nurse responsible for when caring for this patient?
Select all that apply.
A. modifying the traction weights as needed
B. assessing the patient's skin integrity
C. applying the traction upon admission
D. administering pain medication
E. providing passive range of motion

Correct Answer: B, D and E

Rationale: The healthcare provider is responsible for initial applying of the traction device. The weights
on the traction device must not be changed without the order of a healthcare provider. When caring for
a patient in traction, the nurse is responsible for assessment and care of the skin due to the increased
risk of skin breakdown. The patient in traction is likely to experience pain and the nurse is responsible
for assessing this pain and administering the appropriate analgesic as ordered. Passive range of motion
helps prevent contractures; this is often performed by a physical therapist or a nurse.

10. An unconscious patient receiving emergency care following an automobile crash accident has a
possible spinal cord injury. What guidelines for emergency care will be followed?
Select all that apply.
A. Immobilize the neck using rolled towels or a cervical collar.
B. The patient will be placed in a supine position
C. The patient will be placed on a ventilator.
D. The head of the bed will be elevated.
E. The patient's head will be secured with a belt or tape secured to the stretcher.

Correct Answer: A, B and E

Rationale: In the emergency setting, all patients who have sustained a trauma to the head or spine, or
are unconscious should be treated as though they have a spinal cord injury. Immobilizing the neck,
maintaining a supine position and securing the patient's head to prevent movement are all basic
guidelines of emergency care. Placement on the ventilator and raising the head of the bed will be
considered after admittance to the hospital.

11. Which patient is at highest risk for a spinal cord injury?

A. 18-year-old male with a prior arrest for driving while intoxicated (DWI).
B. 20-year-old female with a history of substance abuse
C. 50-year-old female with osteoporosis
D. 35-year-old male who coaches a soccer team

Correct Answer: A

Rationale: The three major risk factors for spinal cord injuries (SCI) are age (young adults), gender
(higher incidence in males), and alcohol or drug abuse. Females tend to engage in less risk-taking
behavior than young men.

12. Patient with a spinal cord injury (SCI) has complete paralysis of the upper extremities and
complete paralysis of the lower part of the body. The nurse should use which medical term to
adequately describe this in documentation?
A. hemiplegia
B. paresthesia
C. paraplegia
D. quadriplegia

Correct Answer: D

Rationale: Quadriplegia describes complete paralysis of the upper extremities and complete paralysis of
the lower part of the body. Hemiplegia describes paralysis on one side of the body. Paresthesia does not
indicate paralysis. Paraplegia is paralysis of the lower body.

13. A nurse is caring for a client with a spinal cord injury who reports a severe headache and is
sweating profusely. vital signs include BP 220/110, apical heart rate of 54/min. Which of the
following acctions should the nurse take first?
a. notify the provider
b. sit the client upright in bed
c. check the client's urinary catheter for blockage
d. administer antihypertensive medication
Correct Answer: B. sit the client upright in bed
Rationale: The greatest risk to the client is experiencing a cerebrovascular accident (stroke)
secondary to elevated BP. The first action by the nurse is elevate the head of the bed until the
client is in an upright position. this will lower the BP secondary to postural hypotension.
 14. Which of the following nursing actions is appropriate for preventing skin breakdown in a patient
who has recently undergone a laminectomy?
A. Provide the patient with an air mattress.
B. Place pillows under patient to help patient turn.
C. Teach the patient to grasp the side rail to turn.
D. Use the log roll to turn the patient to the side.

Correct Answer: D

Rationale: A patient who has undergone a laminectomy needs to be turned by log rolling to prevent
pressure on the area of surgery. An air mattress will help prevent skin breakdown but the patient still
needs to be turned frequently. Placing pillows under the patient can help take pressure off of one side
but the patient still needs to change positions often. Teaching the patient to grasp the side rail will cause
the spine to twist, which needs to be avoided.

15. A nurse is caring for a client who has a C4 spinal cord injury. Which of the following should the
nurse recognize the client as being at the greatest risk for neurogenic shock?
b. paralytic ileus
c. stress ulcer
d. respiratory compromise
Correct Answer: D. respiratory compromise
Rationale: Using the airway, breathing and circulation priority framework, the greatest risk to
the client with a SCI at the level of C4 is respiratory compromise secondary to involvement of
the phrenic nerve. Maintainance of an airway and provision of ventilator support as needed is
the priority intervention.

16. A patient with a spinal cord injury has spinal shock. The nurse plans care for the patient based
on the knowledge that
a. rehabilitation measures cannot be initiated until spinal shock has resolved
b. the patient will need continuous monitoring for hypotension, tachycardia, and hypoxemia
c. resolution of spinal shock is manifested by spasticity, hyperreflexia, and reflex emptying of the
bladder
d. the patient will have complete loss of motor and sensory functions below the level of the
injury, but autonomic functions are not affected
Correct Answer: C. resolution of spinal shock is manifested by spasticity, hyperreflexia, and
reflex emptying of the bladder
Rationale: 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
signals the end of spinal shock. Sympathetic function is impaired belwo 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
organ below the injury. Neurogenic shock results from loss of vascular tone caused by the injury
and is manifested by hypotension, peripheral vasodilation, and decreased CO. Rehab activities
are not contraindicated during spainl shock and should be instituted if the patient's
cardiopulmonary status is stable.
17. A patient with a C7 spinal cord injury undergoing rehabilitation tells the nurse he must have the
flu because he has a bad headache and nausea. The initial action of the nurse is to
a. call the physician
b. check the patient's temperature
c. take the patient's BP
d. elevate the HOB to 90 degrees
Correct Answer: C Take the patient's BP

18. A patient is admitted to the emergency department with a possible cervical spinal cord injury
following an automobile crash. During the admission of the patient, the nurse places the highest
priority on
a. maintaining a patent airway
b. assessing the patient for head and other injuries
c. maintaining immobilization of the cervical spine
d. assessing the patient's motor and sensory function
Correct Answer: C. maintaining a patent airway
Rationale: The need for a patent airway is the first priority for any injured patient, and a high
cervical injury may decrease the gag reflex and ability to maintain an airway, as well as the
ability to breathe. Maintaining cervical stability is then a consideration, along with assessing for
other injuries and the patients neuro status.

19. In planning community education for prevention of spinal cord injuries, the nurse targets
a. elderly men
b. teenage girls
c. elementary school-age children
d. adolescent and young adult men
Correct Answer: D. adolescent and young adult men
Rationale: Spinnal cord injuries are highest in young adult men between the ages of 15 and 30
and those who are impulsive or risk takers in daily living. Other risk factors include alcohol and
drug abuse as well as participation in sports and occupational exposure to trauma or violence.

20. A patient with a neck fracture at the C5 level is admitted to the intensive care unit (ICU)
following initial treatment in the emergency room. During initial assessment of the patient, the
nurse recognizes the presence of spinal shock on finding
a. hypotension, bradycardia, and warm extremities.
b. involuntary, spastic movements of the arms and legs.
c. the presence of hyperactive reflex activity below the level of the injury.
d. flaccid paralysis and lack of sensation below the level of the injury.
Correct Answer: D flaccid paralysis and lack of sensation below the level of the injury
Rationale: Clinical manifestations of spinal shock include decreased reflexes, loss of sensation,
and flaccid paralysis below the area of injury. Hypotension, bradycardia, and warm extremities
are evidence of neurogenic shock. Involuntary spastic movements and hyperactive reflexes are
not seen in the patient at this stage of spinal cord injury.