Which one of the following statements concerning spine and spinal cord trauma is true?

Correct Answer: D

Rationale: Step 1: Diaphragmatic breathing in an unconscious patient who has fallen indicates injury to the spine. Step 2: Diaphragmatic breathing occurs when the spinal cord is damaged at a higher level, affecting the phrenic nerve. Step 3: This is a reliable clinical sign of spinal cord injury that requires immediate medical attention. Summary: A: Incorrect. A normal lateral c-spine film does not definitively exclude injury as soft tissue injuries may not be visible. B: Incorrect. Vertebral injuries can occur without immediate signs of cord injury due to the protective nature of the spinal cord. C: Incorrect. Immobilization on a short spine board is not always necessary and should be based on clinical assessment.

Correct Answer: C

Rationale: The correct answer is C. In a stable patient with no concerning symptoms after a traumatic event, cervical spine x-rays are not needed. This is because the decision to obtain imaging should be guided by clinical indications, such as presence of neck pain, neurological deficits, altered mental status, or midline tenderness. In this case, the patient is awake, alert, neurologically normal, and has no neck pain or midline tenderness, making imaging unnecessary. It is important to rely on clinical assessment rather than routine imaging to avoid unnecessary radiation exposure and healthcare costs. Other choices are incorrect because cervical spine x-rays are not always needed, they are not definitive in ruling out injuries, and addressing breathing or circulatory issues takes precedence over imaging in an unstable patient.

Correct Answer: C

Rationale: Neurogenic shock results from disruption of sympathetic nervous system control, leading to vasodilation and subsequent hypotension. Choice C, "Narrowed pulse pressure," is incorrect because neurogenic shock typically presents with widened pulse pressure due to the loss of sympathetic tone on arterial vessels. Therefore, the correct answer is C. Choices A, B, and D are all classic characteristics of neurogenic shock.

Correct Answer: C

Rationale: The correct answer is C because in functional nursing, tasks are divided among staff, leading to fragmented care. This can result in staff overlooking changes in a resident's condition as they focus solely on their assigned tasks. This may delay timely intervention and negatively impact resident outcomes. Choice A is incorrect because task overload is more related to the efficiency of task allocation rather than the style of care. Choice B is incorrect as inadequate training is a separate issue not exclusive to functional nursing. Choice D is incorrect as consistency in care team members is generally seen as a positive aspect of care continuity, not a negative result.

Correct Answer: B

Rationale: The correct answer is B: Advance directive. An advance directive is a legal document that allows an individual to specify their preferences for medical treatment in case they become unable to communicate or make decisions. This includes instructions for end-of-life care, life-sustaining treatments, and other healthcare choices. It is different from a will (A) which dictates how assets are distributed after death, CPR (C) which is a medical procedure to revive a person in cardiac arrest, and Power of Attorney (D) which grants someone the authority to make legal decisions on behalf of another person.