NCLEX-PN
NCLEX Questions on Neurological Disorders Quizlet Questions
Extract:
Question 1 of 5
The nurse assesses the client, who was injured in a diving accident 2 hours earlier. The client is breathing independently but has no movement or muscle tone from below the area of injury. A CT scan reveals a fracture of the C4 cervical vertebra. The nurse should plan interventions for which problem?
Correct Answer: B
Rationale: A complete spinal cord transection results in no reflexes or movement distal to the injury. With a C4 injury, the client initially would have some difficulty breathing due to edema of the spinal cord that occurs above the level of the injury. The client is experiencing spinal shock that manifests within a few hours after the injury. Hypotension, flaccid paralysis, and absence of muscle contractions occur. Spinal shock lasts 7 to 20 days, and the SCI cannot be classified accurately until spinal shock resolves. An injury of the upper motor neuron results in spastic paralysis. Quadriplegia, now termed tetraplegia, is paralysis involving all four extremities.
Question 2 of 5
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Question 3 of 5
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Question 4 of 5
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Question 5 of 5
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