TCRN TCRN Spinal Cord and Vertebral Trauma 2 — Questions and Answers
Question 1: A patient with a T4 SCI suddenly develops a pounding headache, profuse sweating above the injury level, and BP of 210/110 mmHg. What is the FIRST nursing action?
- Administer IV labetalol immediately
- Sit the patient upright and assess for bladder distension or fecal impaction (Correct answer)
- Call the physician for an antihypertensive order
- Apply supplemental oxygen via non-rebreather mask
Correct answer: Sit the patient upright and assess for bladder distension or fecal impaction
Autonomic dysreflexia is first managed by sitting the patient upright (orthostatic BP reduction) and identifying and removing the triggering noxious stimulus, most commonly bladder distension.
Question 2: In Brown-Séquard syndrome from right-sided spinal cord hemisection, the nurse expects which deficits on the RIGHT (ipsilateral) side?
- Loss of pain and temperature sensation
- Loss of motor function and proprioception (Correct answer)
- Loss of motor function only
- Loss of pain, temperature, and vibration sense
Correct answer: Loss of motor function and proprioception
Brown-Séquard syndrome causes ipsilateral loss of motor function and dorsal column function (proprioception, vibration, fine touch), with contralateral loss of pain and temperature because those fibers cross immediately.
Question 3: Which incomplete spinal cord syndrome has the POOREST prognosis for functional motor recovery?
- Central cord syndrome
- Brown-Séquard syndrome
- Anterior cord syndrome (Correct answer)
- Posterior cord syndrome
Correct answer: Anterior cord syndrome
Anterior cord syndrome has the worst prognosis because anterior cord ischemia destroys both the corticospinal (motor) and spinothalamic (pain/temperature) tracts while sparing only posterior column function.
Question 4: At which level of complete cervical spinal cord injury would a patient most likely require permanent mechanical ventilation?
- C5
- C3 (Correct answer)
- C6
- T1
Correct answer: C3
Injuries at C3 and above disrupt the phrenic nerve origin (C3-C5), eliminating diaphragmatic function and requiring permanent ventilatory support.
Question 5: A patient with a high thoracic SCI is noted to have a body temperature that mirrors the room temperature. The nurse documents this as:
- Autonomic dysreflexia
- Poikilothermia (Correct answer)
- Malignant hyperthermia
- Hypothermia secondary to spinal shock
Correct answer: Poikilothermia
Poikilothermia occurs when high-level SCI disrupts the autonomic hypothalamic-to-peripheral thermoregulation pathway, causing the patient's temperature to passively equilibrate with the environment.
Question 6: Which intervention is the HIGHEST priority nursing action to prevent pressure injury in a patient with a complete thoracic spinal cord injury?
- Daily skin inspection with a mirror system
- Repositioning every 2 hours using log-roll technique to maintain spinal alignment (Correct answer)
- Application of prophylactic foam dressings to all bony prominences
- High-protein diet to optimize tissue healing
Correct answer: Repositioning every 2 hours using log-roll technique to maintain spinal alignment
Scheduled repositioning every 2 hours is the cornerstone intervention for pressure injury prevention, directly addressing the causative factor of sustained pressure over insensate skin.
Question 7: A patient with a complete C7 spinal cord injury asks what level of independence to expect. The nurse's BEST response is that C7 complete SCI patients typically can:
- Ambulate with leg braces and forearm crutches
- Transfer independently and propel a manual wheelchair without assistance (Correct answer)
- Require 24-hour attendant care for all activities of daily living
- Have full hand function with weakness limited to the legs
Correct answer: Transfer independently and propel a manual wheelchair without assistance
C7 preserves triceps function (elbow extension), enabling independent transfers, manual wheelchair propulsion, and many ADLs with adaptive equipment.
TCRN TCRN Spinal Cord and Vertebral Trauma 2
A patient with a T4 SCI suddenly develops a pounding headache, profuse sweating above the injury level, and BP of 210/110 mmHg.
What is the FIRST nursing action?