NUR 402 Exam 4 Questions With Answers
2026/2027 Updated.
What are the types of SCI? - Answer - Primary injury
Initial physical disruption of spinal cord
- Secondary injury
Progressive damage mostly due to edema of spinal cord
How do you immediately care for a SCI? - Answer ABCs
- Maintain systolic BP>90 mmHg
Immobilize and stabilize cervical spine
What is spinal shock? - Answer Transient physiological reaction to depression of the
cord below the SCI level. Associated loss of sensorimotor function and flaccid paralysis.
Flaccid paralysis symptoms last several days.
Below level of injury
Decreased reflexes
Loss of sensation
Absent thermoregulation
Flaccid paralysis
Lasts days to weeks
What is neurogenic shock? - Answer Characterized by
- Hypotension
- Bradycardia
Loss of SNS innervation
- Peripheral vasodilation
- Venous pooling
- ↓Cardiac output
T6 or higher injury
What is skeletal traction? - Answer Realignment (reduction) of injury
Gardner-Wells tongs
Halo ring with pins
Maintain traction at all times with rope, pulley, weights
,What is kinetic therapy? - Answer Continual side-to-side rotation
Prevent pulmonary complications
Prevent pressure ulcers
immobilization
How can a spinal cord injury impact the respiratory system? - Answer Cervical and
thoracic injuries
abdominal and intercostal muscle paralysis→
ineffective cough →
risk for aspiration, atelectasis, and pneumonia
Cervical - tetraplegia
Above level of C4
Total loss respiratory muscle function
Below level of C4
Diaphragmatic breathing → respiratory insufficiency
Thoracic - paraplegia
@T6 and above respiratory concerns
Regularly assess:
Breath sounds
ABGs
skin color
breathing patterns
How do we care for the cardiovascular system after SCI? - Answer Cardiac monitoring
- Manage hypotension
IV fluid replacement
Abdominal binder or compression gradient stockings
- Maintain HR
Atropine or pacemaker
- Prevent VTE
SCDs
ROM and stretching exercises
Enoxaparin injections
What is a neurogenic bladder? - Answer Bladder dysfunction caused by an interruption
of normal bladder nerve innervation
,- Initially flaccid - retention of urine
- After spinal shock resolved
Spasticity w/reflex bladder emptying
Incontinence
- Bladder management strategies -
Selection guided by
Client preference
Upper extremity function
Availability of a caregiver
Type of bladder dysfunction
What is the bowel movement for SCI? - Answer Neurogenic bowel initially
Bowel program starts in acute care
- Daily rectal stimulant
- Adequate fluid and fiber intake
Increased activity and exercise
What is the typical nutritional management for SCI patient? - Answer Nutrition needed
within 72 hours
High-protein, high-calorie diet
Enteral feeding
Parenteral nutrition
Paralytic ileus may occur, requires short-term NG tube
Monitor fluid and electrolytes
What is Autonomic Hyperreflexia (dysreflexia)? - Answer Life-threatening condition
Massive uncompensated CV reaction mediated by SNS
Triggers:
bladder distension, rectal impaction, skin stimulation, pain, tight clothing
Risk after spinal shock resolves for clients with SCIs T6 or higher
What are the clinical manifestations of autonomic hyperreflexia (dysreflexia)? - Answer -
Sudden onset hypertension (SBP up to 300)
- Throbbing headache
- Bradycardia
- Above level of injury: Diaphoresis, Facial flushing
Blurred vision or spots in visual field
- Nasal congestion
- Below level of injury: Pallor, Piloerection
- Anxiety, apprehension
- Nausea
, What are the nursing interventions for autonomic hyperreflexia? - Answer If reports
headache - check BP
Place in upright position (may ↓BP)
Determine cause and remove
Notify HCP if BP still elevated and/or CMs not relieved
Teach client and caregivers
To recognize causes and CMs
Immediate actions to take
Prevention
What is sickle cell disease? - Answer Inherited, autosomal recessive disorder (from both
parents)
Produces abnormal hemoglobin S (HbS)
Increased oxygen demand or lack of oxygen stimulates RBCs containing HbS to stiffen
and elongate (sickle or crescent shaped)
Lodges in tiny vessels and cause occlusion
What are the clinical manifestations of sickle cell disease? - Answer asymptomatic
except during sickling episodes
Hemolytic anemia
Sickled cells have shorter lifespan [10-15 days]
CMs
Pale mucous membranes
Tachycardia
Jaundice from hemolysis
What is sickle cell crisis? - Answer ischemia caused by occlusion causing mild to severe
pain that may last from minutes to days
Can by caused by
- Infection - increased oxygen demand
- Dehydration - increased blood viscosity impairs oxygen delivery
- Blood loss
Sickled cells cause capillary vascular occlusions
- ↓blood flow to tissues or an organ
- Localized hemostasis, inflammation, hypoxia, ischemia and necrosis
- Very painful
- Can lead to cycle of more sickling
2026/2027 Updated.
What are the types of SCI? - Answer - Primary injury
Initial physical disruption of spinal cord
- Secondary injury
Progressive damage mostly due to edema of spinal cord
How do you immediately care for a SCI? - Answer ABCs
- Maintain systolic BP>90 mmHg
Immobilize and stabilize cervical spine
What is spinal shock? - Answer Transient physiological reaction to depression of the
cord below the SCI level. Associated loss of sensorimotor function and flaccid paralysis.
Flaccid paralysis symptoms last several days.
Below level of injury
Decreased reflexes
Loss of sensation
Absent thermoregulation
Flaccid paralysis
Lasts days to weeks
What is neurogenic shock? - Answer Characterized by
- Hypotension
- Bradycardia
Loss of SNS innervation
- Peripheral vasodilation
- Venous pooling
- ↓Cardiac output
T6 or higher injury
What is skeletal traction? - Answer Realignment (reduction) of injury
Gardner-Wells tongs
Halo ring with pins
Maintain traction at all times with rope, pulley, weights
,What is kinetic therapy? - Answer Continual side-to-side rotation
Prevent pulmonary complications
Prevent pressure ulcers
immobilization
How can a spinal cord injury impact the respiratory system? - Answer Cervical and
thoracic injuries
abdominal and intercostal muscle paralysis→
ineffective cough →
risk for aspiration, atelectasis, and pneumonia
Cervical - tetraplegia
Above level of C4
Total loss respiratory muscle function
Below level of C4
Diaphragmatic breathing → respiratory insufficiency
Thoracic - paraplegia
@T6 and above respiratory concerns
Regularly assess:
Breath sounds
ABGs
skin color
breathing patterns
How do we care for the cardiovascular system after SCI? - Answer Cardiac monitoring
- Manage hypotension
IV fluid replacement
Abdominal binder or compression gradient stockings
- Maintain HR
Atropine or pacemaker
- Prevent VTE
SCDs
ROM and stretching exercises
Enoxaparin injections
What is a neurogenic bladder? - Answer Bladder dysfunction caused by an interruption
of normal bladder nerve innervation
,- Initially flaccid - retention of urine
- After spinal shock resolved
Spasticity w/reflex bladder emptying
Incontinence
- Bladder management strategies -
Selection guided by
Client preference
Upper extremity function
Availability of a caregiver
Type of bladder dysfunction
What is the bowel movement for SCI? - Answer Neurogenic bowel initially
Bowel program starts in acute care
- Daily rectal stimulant
- Adequate fluid and fiber intake
Increased activity and exercise
What is the typical nutritional management for SCI patient? - Answer Nutrition needed
within 72 hours
High-protein, high-calorie diet
Enteral feeding
Parenteral nutrition
Paralytic ileus may occur, requires short-term NG tube
Monitor fluid and electrolytes
What is Autonomic Hyperreflexia (dysreflexia)? - Answer Life-threatening condition
Massive uncompensated CV reaction mediated by SNS
Triggers:
bladder distension, rectal impaction, skin stimulation, pain, tight clothing
Risk after spinal shock resolves for clients with SCIs T6 or higher
What are the clinical manifestations of autonomic hyperreflexia (dysreflexia)? - Answer -
Sudden onset hypertension (SBP up to 300)
- Throbbing headache
- Bradycardia
- Above level of injury: Diaphoresis, Facial flushing
Blurred vision or spots in visual field
- Nasal congestion
- Below level of injury: Pallor, Piloerection
- Anxiety, apprehension
- Nausea
, What are the nursing interventions for autonomic hyperreflexia? - Answer If reports
headache - check BP
Place in upright position (may ↓BP)
Determine cause and remove
Notify HCP if BP still elevated and/or CMs not relieved
Teach client and caregivers
To recognize causes and CMs
Immediate actions to take
Prevention
What is sickle cell disease? - Answer Inherited, autosomal recessive disorder (from both
parents)
Produces abnormal hemoglobin S (HbS)
Increased oxygen demand or lack of oxygen stimulates RBCs containing HbS to stiffen
and elongate (sickle or crescent shaped)
Lodges in tiny vessels and cause occlusion
What are the clinical manifestations of sickle cell disease? - Answer asymptomatic
except during sickling episodes
Hemolytic anemia
Sickled cells have shorter lifespan [10-15 days]
CMs
Pale mucous membranes
Tachycardia
Jaundice from hemolysis
What is sickle cell crisis? - Answer ischemia caused by occlusion causing mild to severe
pain that may last from minutes to days
Can by caused by
- Infection - increased oxygen demand
- Dehydration - increased blood viscosity impairs oxygen delivery
- Blood loss
Sickled cells cause capillary vascular occlusions
- ↓blood flow to tissues or an organ
- Localized hemostasis, inflammation, hypoxia, ischemia and necrosis
- Very painful
- Can lead to cycle of more sickling
