TCRN TCRN Spinal Cord and Vertebral Trauma 1 — Questions and Answers
Question 1: A patient arrives following a diving accident with suspected cervical spine injury. What is the FIRST priority for the trauma nurse?
- Establish two large-bore IV lines immediately
- Maintain cervical spine immobilization while managing the airway (Correct answer)
- Perform a complete ASIA neurological assessment
- Administer high-dose methylprednisolone within 8 hours
Correct answer: Maintain cervical spine immobilization while managing the airway
Airway management with simultaneous cervical spine stabilization is the first priority in any suspected spinal cord injury, following the primary survey framework.
Question 2: Using the ASIA Impairment Scale, a patient with incomplete SCI whose key muscles below the injury level have a motor grade less than 3 in the majority is classified as:
- ASIA A — complete injury
- ASIA B — sensory incomplete only
- ASIA C — motor incomplete, most muscles grade < 3 (Correct answer)
- ASIA D — motor incomplete, most muscles grade ≥ 3
Correct answer: ASIA C — motor incomplete, most muscles grade < 3
ASIA C denotes incomplete injury with preserved motor function below the level but with most key muscles graded below 3 (antigravity strength).
Question 3: Which clinical finding best distinguishes neurogenic shock from hemorrhagic shock in a trauma patient with spinal cord injury?
- Hypotension with tachycardia and cool clammy skin
- Hypotension with bradycardia and warm vasodilated skin (Correct answer)
- Hypertension with bradycardia and flushing
- Hypotension with tachycardia and diaphoresis
Correct answer: Hypotension with bradycardia and warm vasodilated skin
Neurogenic shock results from loss of sympathetic tone, producing hypotension paired with paradoxical bradycardia and peripheral vasodilation, contrasting with the tachycardia of hemorrhagic shock.
Question 4: Current evidence-based guidelines regarding high-dose methylprednisolone for acute spinal cord injury state that it:
- Should be given within 8 hours for all complete cervical injuries
- Is recommended as standard of care within 24 hours of injury
- Is no longer recommended as standard care due to complications outweighing benefit (Correct answer)
- Should be reserved for thoracic injuries only
Correct answer: Is no longer recommended as standard care due to complications outweighing benefit
High-dose methylprednisolone has been removed from standard SCI protocols because risks — including infection, GI bleeding, and pulmonary complications — outweigh the marginal neurological benefit shown in older trials.
Question 5: A patient sustains a complete C5 spinal cord injury. Which functional finding would the nurse expect on assessment?
- Loss of shoulder shrug with intact elbow flexion
- Intact elbow flexion but inability to extend the wrist (Correct answer)
- Complete loss of all upper extremity function with intact diaphragm
- Full hand function with paralysis limited to the lower extremities
Correct answer: Intact elbow flexion but inability to extend the wrist
C5 preserves elbow flexion (biceps, C5-C6) but a complete C5 injury eliminates C6-innervated wrist extension, creating this characteristic pattern.
Question 6: Which spinal cord syndrome is characterized by disproportionately greater motor weakness in the upper extremities than the lower extremities following a hyperextension mechanism?
- Brown-Séquard syndrome
- Anterior cord syndrome
- Posterior cord syndrome
- Central cord syndrome (Correct answer)
Correct answer: Central cord syndrome
Central cord syndrome, most common in older patients with cervical spondylosis after hyperextension, injures the central gray matter and medial corticospinal fibers serving the arms more than the legs.
Question 7: Current guidelines recommend maintaining a mean arterial pressure (MAP) of at least _____ for the first 7 days after acute spinal cord injury to optimize cord perfusion:
- 65 mmHg
- 85 mmHg (Correct answer)
- 75 mmHg
- 95 mmHg
Correct answer: 85 mmHg
Guidelines recommend MAP ≥ 85 mmHg for 7 days post-acute SCI to support spinal cord perfusion pressure and limit secondary injury, a higher target than general ICU goals.
TCRN TCRN Spinal Cord and Vertebral Trauma 1
A patient arrives following a diving accident with suspected cervical spine injury.
What is the FIRST priority for the trauma nurse?