Question 1

While assessing the extent of spinal cord injury in a client using the American Spinal Injury Association (ASIA) impairment scale, the nurse concludes that the client belongs to category C. Which findings enabled the nurse to reach this conclusion?

Accepted Answer

Category C in the ASIA impairment scale indicates that motor function is preserved below the neurological level of injury, and more than half of key muscles below the neurological level have a muscle grade less than 3, which means they are not strong enough for functional use.

Question 2

The registered nurse is teaching about the diagnostic tests for spinal cord injury to a group of student nurses. Which statement made by the student nurse indicates the need for further teaching?

Accepted Answer

Myelography does not show inherent spinal cord pathology; it shows the spinal cord, nerve roots, and subarachnoid space by injecting a radiopaque dye into the subarachnoid space. The other options accurately describe the diagnostic capabilities of X-rays, CT scans, and MRIs for detecting spinal cord injuries.

Question 3

The registered nurse is teaching about Brown-Séquard syndrome to a group of student nurses. Which statement made by the student nurse indicates effective learning?

Accepted Answer

Brown-Séquard syndrome is a condition that results from hemisection, or partial injury, of the spinal cord, often due to penetrating trauma. The syndrome is characterized by ipsilateral paralysis (paralysis on the same side as the injury), loss of joint position sense, and discriminative touch. On the contralateral side, there is loss of pain and temperature sensation. Incontinence is not a characteristic of Brown-Séquard syndrome. Disrupted aortic blood flow and swelling of neuronal axons are not associated with Brown-Séquard syndrome.

Question 4

What does interruption of the dorsal spinal cord columns cause in a client with spinal cord injury?

Accepted Answer

Interrupting the dorsal spinal cord columns can result in loss of proprioception (sense of limb and body position in space) due to the interruption of ascending sensory pathways. This may cause difficulty with movements requiring coordination and balance.

Answer: D
 Interrupting the lateral spinothalamic tract (not dorsal columns) can result in loss of pain and temperature sensation. This is due to interruption of ascending sensory pathways that transmit pain and temperature information from the periphery to the brainstem and thalamus.

Therefore, the correct answer is B.

Question 5

Which symptom should the nurse expect in a client with a skull fracture in the frontal fossa?

Accepted Answer

Periorbital ecchymosis, also known as "raccoon eyes," is a common symptom of a frontal fossa skull fracture, indicating bleeding around the eyes due to the fracture.

Question 6

While reviewing the clinical history of a client with brain injury, the nurse finds that there is a bruising of the mastoid process behind the ear of the affected side. Which fracture should the nurse suspect in the client?

Accepted Answer

Bruising of the mastoid process is a classic sign of a basilar skull fracture, which occurs at the base of the skull and can be life-threatening. A linear fracture is a simple fracture in a straight line, a depressed fracture is when a portion of the skull is pushed inward, and a frontal fossa fracture occurs in the front of the skull. None of these fractures typically present with bruising of the mastoid process.

Question 7

The registered nurse is teaching about subdural hematomas to a group of student nurses. Which statement made by the student nurse indicates effective teaching?

Accepted Answer

Subdural hematomas occur in the space below the dura mater and above the arachnoid membrane, which is accurately described in option B.

Question 8

What is the cause of Horner's syndrome?

Accepted Answer

Horner's syndrome is caused due to an injury at T1 and above, that results in a disruption of the sympathetic pathways leading to a pupil constriction, drooping of the upper eyelid, and decreased sweating on the affected side of the face.

Therefore, option B is the correct answer.

Question 9

Which statement made by the mother of the client with spinal cord injury made the nurse suspect an axial loading injury?

Accepted Answer

Axial loading injuries occur when there is a forceful impact on the head or shoulders that travels down the spine, commonly seen in diving accidents where the person's head hits the bottom of the pool, compressing the spine vertically.

Question 10

Which factor can cause herniation of the brain stem?

Accepted Answer

Rupture of a cerebral artery can lead to subarachnoid hemorrhage, which may cause an increase in intracranial pressure and herniation of the brain stem.

Question 11

While assessing the motor strength in a client with a spinal cord injury, the nurse finds that the movements of the client are active against gravity. Which score should the nurse record?

Accepted Answer

Movements active against gravity are scored as 3 on the muscle strength scale, indicating the patient can move the limb through the full range of motion against gravity but not against resistance.

Question 12

Which nerve is responsible for sexual function?

Accepted Answer

The lumbar nerves, specifically the pudendal nerve, are responsible for sexual function as they innervate the genital region and control sensation and muscle function in the area. The cervical and thoracic nerves do not have a direct role in sexual function.

Question 13

The primary health-care provider prescribes myelography for a client who sustained a spinal cord injury. What is the rationale for this diagnostic test?

Accepted Answer

Myelography is a radiographic contrast study used to evaluate the spinal cord, nerve roots, and CSF flow. In the case of a spinal cord injury, myelography can be used to identify any obstruction in CSF flow that could contribute to neurological deficits. Option A is incorrect as myelography does not provide detailed images of intervertebral discs. Option B is incorrect as carotid arteries are not evaluated through myelography. Option D is incorrect as malalignment of the bones can be identified through other diagnostic tests like X-ray or MRI, but myelography is not used for this purpose.

Question 14

The laboratory reports of a client who had an accident show a fracture in the temporal bone of the middle ear. Which type of fracture should the nurse suspect in this client?

Accepted Answer

A basilar skull fracture involves the base of the skull and can affect the temporal bone, which houses the middle ear structures. This type of fracture is suspected in cases where there's injury to the ear or surrounding areas.

Question 15

Which disorder is associated with the compression of the bilateral nerve roots of the lumbosacral region?

Accepted Answer

Cauda equina syndrome results from compression of the nerve roots that make up the cauda equina in the lumbosacral region. Horner's syndrome is characterized by a drooping eyelid, small pupil, and lack of sweating on one side of the face due to damage to the sympathetic nervous system. Brown-Séquard syndrome is a neurological condition that results from damage to one side of the spinal cord, causing paralysis and loss of sensation on one side of the body. Anterior spinal artery syndrome is a condition that causes damage to the anterior spinal cord, leading to loss of motor and sensory function below the level of the injury.

Question 16

While caring for a client with a neck injury, the nurse finds that the client has no sensation in the arms and hands. Which disorder should the nurse suspect in the client?

Accepted Answer

Central cord syndrome is a type of spinal cord injury that mostly affects the arms and hands. Symptoms include loss of sensation, weakness or paralysis of the arms, hands, and legs. Horner's syndrome is characterized by drooping of the eyelid, a decrease in sweating on the affected side of the face, and a constricted pupil. Cauda equina syndrome and Conus medullaris syndrome involve damage to the lower spinal cord and may result in paraplegia, bowel, and bladder dysfunction, but do not typically cause loss of sensation in the arms and hands.

Question 17

A client who sustained a rear-end motor vehicle collision is admitted to the emergency department. Which injury should the nurse expect to be present in the client?

Accepted Answer

A rear-end motor vehicle collision can cause hyperextension injury to the neck, also known as whiplash, due to the sudden jerking of the head and neck forward and then back. Penetrating injury and rotational injury are not commonly associated with this type of collision. Therefore, the correct option is C, hyperextension injury.

Question 18

After assessing the sensory function in a client with a skull fracture, the nurse records the sensory index score as one. What does this score in the client indicate?

Accepted Answer

A sensory index score of one indicates impaired sensitivity to stimuli. A score of zero indicates an absence of sensitivity to stimuli and a score of two indicates intact sensitivity to stimuli.

Question 19

The nurse is assessing a client who presents to the emergency room with a spinal cord injury. Which finding in the client's reports made the nurse suspect central cord syndrome?

Accepted Answer

Hyperextension of the cervical spine is a common cause of central cord syndrome. Hemisection of the spinal cord, acute intervertebral disc herniation, and fractures at L1 and L2 are not typically associated with this syndrome.

Question 20

The medical reports of a client who suffered an accident show injuries at the sixth thoracic vertebra. Which condition does the nurse suspect in the client?

Accepted Answer

Neurogenic shock can occur due to damage to the central nervous system, such as an injury to the spinal cord at the level of the sixth thoracic vertebra. It results in the loss of sympathetic tone, leading to hypotension, bradycardia, and temperature dysregulation.

Quiz 35: Brain and Spinal Cord Injury