A 19-year-old male sustained a single gunshot wound (GSW) to the right neck. He was awake at the scene but unable to move his arms or legs. He was brought by EMS to the hospital.
Spinal shock
Hemorrhagic shock
Neurogenic shock
All of the above
The Correct Answer is C
Rationale:
A. Spinal shock refers to a temporary loss of all reflexes, sensation, and motor function below the level of a spinal cord injury. It affects neurologic function but does not inherently cause hypotension or bradycardia. While the patient has quadriplegia and may be in spinal shock, this does not explain the vital sign abnormalities observed.
B. Hemorrhagic shock occurs due to blood loss, leading to hypotension and tachycardia as a compensatory response. In this patient, the pulse is bradycardic (52 bpm) rather than tachycardic, which is inconsistent with hemorrhagic shock physiology. Although he has a gunshot wound, his vital signs are not typical of hypovolemic shock.
C. Neurogenic shock occurs after a spinal cord injury, especially above T6, resulting in loss of sympathetic tone. This leads to hypotension (BP 90/50) due to vasodilation and bradycardia (pulse 52) due to unopposed parasympathetic activity. The patient’s C3-C4 quadriplegia and vital signs are classic for neurogenic shock.
D. While the patient may also experience spinal shock neurologically, the hemodynamic findings (bradycardia and hypotension) are specific to neurogenic shock. Hemorrhagic shock is unlikely based on the bradycardia, so “all of the above” is incorrect.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
Rationale:
A. Spinal shock refers to a temporary loss of all neurologic activity (motor, sensory, and reflexes) below the level of spinal cord injury. Reflex activity is initially absent and gradually returns over hours to weeks, with the return of reflexes often signaling the end of spinal shock.
B. Neurogenic shock is a distributive type of shock caused by disruption of sympathetic pathways after a spinal cord injury, leading to unopposed parasympathetic activity and loss of autonomic control below the lesion.
C. Several of the statements (A, B, D, E) accurately describe spinal or neurogenic shock.
D. Spinal shock typically begins immediately or within minutes after acute spinal cord injury and may last days to weeks depending on severity.
E. Loss of sympathetic tone in neurogenic shock leads to vasodilation (causing hypotension), unopposed vagal tone (causing bradycardia), and impaired thermoregulation (leading to hypothermia). These features differentiate neurogenic shock from other forms of shock such as hypovolemic shock.
Correct Answer is A
Explanation
Rationale:
A. In trauma care, a transient responder initially shows improvement in vital signs (such as blood pressure, heart rate, and mental status) after receiving a fluid bolus, typically isotonic crystalloids. However, this improvement is short-lived. As fluids are reduced to maintenance levels, signs of poor perfusion (e.g., hypotension, tachycardia, decreased urine output, altered mental status) reappear. This pattern strongly suggests ongoing internal bleeding or unresolved fluid loss. Transient responders are at high risk for decompensation and usually require rapid escalation of care, including blood transfusion, identification of the bleeding source, and possible surgical or interventional control. This classification helps guide urgency and prioritization in trauma management.
B. This describes a rapid responder, not a transient responder. Rapid responders maintain stable vital signs and adequate perfusion after initial resuscitation, indicating that significant ongoing bleeding is unlikely. These patients can often be monitored with less aggressive intervention.
C. This statement is incomplete and nonspecific. While transient responders may temporarily improve with fluids and even blood products, the defining feature is that the improvement is not sustained. Simply stating that the patient “responds” does not capture the transient nature or clinical significance of their response.
D. The classification is not based on the speed of response but on the durability of the response. A transient responder may initially respond quickly, but the key issue is that the improvement is temporary and followed by deterioration, indicating ongoing pathology such as hemorrhage.
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