A client has a spinal cord injury (SCI) following a motor vehicle crash. The nurse recognizes that the pathophysiology of secondary SCI includes

release of epinephrine leading to massive vasodilation of spinal cord vessels.

initial infarction of the white matter of the cord.

mechanical transection of the cord.

necrotic destruction of the cord from hemorrhage and edema.

Answer and Explanation

The Correct Answer is D

A. release of epinephrine leading to massive vasodilation of spinal cord vessels: Secondary SCI involves ischemia and inflammation rather than vasodilation caused by epinephrine. Excess catecholamines may contribute to vasoconstriction and further injury, not vasodilation.

B. initial infarction of the white matter of the cord: Infarction can occur, but it is a consequence of secondary injury rather than the initial event. The primary insult triggers processes like hemorrhage, edema, and inflammation, which lead to tissue necrosis. Infarction is part of the progression, not the starting mechanism.

C. mechanical transection of the cord: Mechanical transection describes the primary injury from trauma, such as a laceration or fracture, not secondary injury. Secondary SCI develops from biochemical and cellular responses after the initial trauma.

D. necrotic destruction of the cord from hemorrhage and edema: Secondary SCI is characterized by tissue necrosis resulting from hemorrhage, edema, ischemia, and inflammatory processes following the primary injury. These mechanisms expand the area of injury beyond the initial trauma.

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Correct Answer is B

Explanation

A. Document and continue to monitor the parameters: While ongoing monitoring is important, the combination of hypotension and ICP of 15 mmHg may compromise cerebral perfusion. Immediate reporting is necessary rather than passive observation.

B. Notify the health care provider about the assessments: Hypotension in a client with a head injury can reduce cerebral perfusion pressure and worsen brain injury. ICP of 15 mmHg is at the upper limit of normal. Promptly notifying the provider ensures timely interventions to optimize perfusion and prevent secondary brain injury.

C. Decrease the client's IV infusion rate: Reducing IV fluids could exacerbate hypotension and further compromise cerebral perfusion. Volume support may be necessary to maintain adequate blood pressure in a head-injured client.

D. Check the client's pupillary response to light: Assessing pupillary response is part of neurologic monitoring, but it does not address the immediate concern of low blood pressure affecting cerebral perfusion. Action should focus on hemodynamic stability first.

A. Rapid pulse and prolonged capillary refill B. Increased BP with narrowed pulse pressure C. Sudden diaphoresis D. Increasing urinary output

Correct Answer is A

Explanation

A. Rapid pulse and prolonged capillary refill: A rapid pulse combined with delayed capillary refill strongly suggests poor perfusion and early hypovolemic shock. These findings indicate that the body is compensating for volume loss by increasing heart rate and redirecting blood to vital organs. Capillary refill slows as peripheral circulation decreases.

B. Increased BP with narrowed pulse pressure: Increased blood pressure does not align with internal bleeding, as hypovolemia typically causes the pressure to fall rather than rise. Narrowed pulse pressure can occur in shock, but pairing it with elevated BP makes internal hemorrhage less likely.

C. Sudden diaphoresis: Diaphoresis can occur with pain, anxiety, fever, or sympathetic activation, making it nonspecific. While it may accompany early shock, it does not reliably indicate internal bleeding on its own. The absence of other hemodynamic changes limits its diagnostic value. More definitive perfusion changes would be expected in hemorrhage.

D. Increasing urinary output: Rising urine output generally reflects adequate renal perfusion and fluid status, which contradicts signs of internal hemorrhage. As bleeding progresses, urine output typically declines due to reduced circulating volume. An increase suggests stability rather than deterioration.

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A client has a spinal cord injury (SCI) following a motor vehicle crash. The nurse recognizes that the pathophysiology of secondary SCI includes

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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