NEURO-SHOCK & BURNS PRACTICE TEST 2026 | Latest
Detailed Answer Key | Neurogenic Shock, Hypovolemic
Shock, Burn Care | Pass Guaranteed - A+ Graded
Section 1: Neurogenic & Spinal Shock (Q1-15)
Q1. A 28-year-old male is brought to the ED following a motorcycle accident. He is
hypotensive (BP 82/50 mmHg) with a heart rate of 56 bpm. His skin is warm and dry.
He has no motor or sensory function below the nipple line (T4 level). Which
pathophysiological mechanism BEST explains the bradycardia in this patient?
A. Hypovolemia from internal hemorrhage causing baroreceptor-mediated reflex
bradycardia
B. Disruption of sympathetic outflow from T1-L2 resulting in unopposed vagal tone
C. Increased intracranial pressure causing Cushing's triad with reflex bradycardia
D. Cardiac contusion from blunt chest trauma causing direct myocardial injury
Correct Answer: B [CORRECT]
Rationale: Neurogenic shock results from disruption of sympathetic outflow from T1-
L2, causing loss of vasomotor tone and massive vasodilation. The bradycardia is due
to unopposed parasympathetic (vagal) tone because the sympathetic cardiac
accelerator fibers (T1-T4) are interrupted. Option A is incorrect because hemorrhagic
shock would present with tachycardia and cool, clammy skin. Option C is incorrect
because there is no evidence of head trauma or increased ICP. Option D is incorrect
because cardiac contusion would cause arrhythmias or ST changes, not isolated
bradycardia with warm, dry skin.
,Q2. A patient with a C5 complete spinal cord injury presents 6 hours post-injury with
flaccid paralysis of all four extremities, absent deep tendon reflexes, and loss of
bowel and bladder function. The nurse recognizes these findings are MOST
consistent with:
A. Permanent spinal cord transection
B. Spinal shock
C. Neurogenic shock
D. Autonomic dysreflexia
Correct Answer: B [CORRECT]
Rationale: Spinal shock is a temporary state of areflexia, flaccid paralysis, and loss of
autonomic function below the level of spinal cord injury that occurs immediately
after injury and may last from days to weeks. Option A is incorrect because
permanent transection cannot be determined this early; reflexes may return after
spinal shock resolves. Option C is incorrect because neurogenic shock refers
specifically to hypotension and bradycardia from loss of sympathetic tone, not the
areflexic state. Option D is incorrect because autonomic dysreflexia occurs AFTER
spinal shock resolves, typically in injuries at T6 or above.
Q3. A nurse is caring for a patient with a T4 spinal cord injury in neurogenic shock.
Which hemodynamic profile is MOST characteristic of this condition?
A. Low MAP, high SVR, high CVP, tachycardia
B. Low MAP, low SVR, low/normal CVP, bradycardia
C. Low MAP, high SVR, low CVP, tachycardia
D. Normal MAP, low SVR, high CVP, normal heart rate
Correct Answer: B [CORRECT]
Rationale: Neurogenic shock is characterized by low MAP due to massive
vasodilation (low SVR), low or normal CVP due to venous pooling, and bradycardia
due to loss of sympathetic cardiac stimulation with unopposed vagal tone. Option A
describes cardiogenic shock. Option C describes hypovolemic/hemorrhagic shock.
Option D is inconsistent with the hypotensive nature of neurogenic shock.
,Q4. A trauma patient with a suspected C6 spinal cord injury arrives in the ED
hypotensive (MAP 58 mmHg) and bradycardic (HR 48 bpm). The nurse's FIRST
priority intervention is:
A. Administer 2 liters of crystalloid fluid bolus rapidly
B. Initiate norepinephrine infusion via central line
C. Administer atropine 0.5 mg IV for symptomatic bradycardia
D. Apply high-flow oxygen and maintain spinal immobilization
Correct Answer: D [CORRECT]
Rationale: The ABCDE approach prioritizes Airway and Breathing first. High-flow
oxygen addresses potential respiratory compromise, and spinal immobilization
prevents further spinal cord injury. While fluids (A) and vasopressors (B) will be
needed, they follow initial stabilization. Atropine (C) is indicated for symptomatic
bradycardia with hemodynamic compromise, but airway and spinal protection take
precedence in the primary survey.
Q5. Which clinical finding BEST differentiates neurogenic shock from hemorrhagic
shock in a trauma patient with spinal cord injury?
A. Presence of spinal cord injury on imaging
B. Bradycardia with warm, dry extremities
C. Low urine output
D. Elevated serum lactate
Correct Answer: B [CORRECT]
Rationale: Neurogenic shock presents with bradycardia and warm, dry extremities
due to vasodilation and loss of sympathetic tone, whereas hemorrhagic shock
presents with tachycardia and cool, clammy skin due to compensatory
vasoconstriction. While spinal cord injury on imaging (A) may be present in both, the
hemodynamic response differs. Low urine output (C) and elevated lactate (D) can
occur in both shock states and are not distinguishing features.
, Q6. A patient with a T2 spinal cord injury in neurogenic shock has a MAP of 52
mmHg despite receiving 2 liters of Lactated Ringer's. The nurse anticipates which
vasopressor as FIRST-LINE therapy?
A. Phenylephrine
B. Norepinephrine
C. Vasopressin
D. Dopamine
Correct Answer: B [CORRECT]
Rationale: Norepinephrine is the first-line vasopressor for neurogenic shock because
it increases SVR through alpha-1 agonism and provides some beta-1 activity to
support cardiac output. Phenylephrine (A) is a pure alpha-agonist that may worsen
bradycardia by eliminating beta-1 stimulation. Vasopressin (C) is considered second-
line. Dopamine (D) may be used if bradycardia is severe due to its chronotropic
effects, but norepinephrine remains preferred.
Q7. A nurse is monitoring a patient with C4 complete spinal cord injury. Which
respiratory complication is the patient at HIGHEST risk for?
A. Pneumothorax
B. Atelectasis and pneumonia
C. Pulmonary embolism
D. Pleural effusion
Correct Answer: B [CORRECT]
Rationale: C3-C5 injuries affect the phrenic nerve, impairing diaphragmatic function
and leading to decreased vital capacity, poor cough, and inability to clear secretions.
This places the patient at highest risk for atelectasis and pneumonia. While
pulmonary embolism (C) is a risk due to immobility, it is not the highest respiratory
priority. Pneumothorax (A) and pleural effusion (D) are not directly related to cervical
SCI pathophysiology.
Detailed Answer Key | Neurogenic Shock, Hypovolemic
Shock, Burn Care | Pass Guaranteed - A+ Graded
Section 1: Neurogenic & Spinal Shock (Q1-15)
Q1. A 28-year-old male is brought to the ED following a motorcycle accident. He is
hypotensive (BP 82/50 mmHg) with a heart rate of 56 bpm. His skin is warm and dry.
He has no motor or sensory function below the nipple line (T4 level). Which
pathophysiological mechanism BEST explains the bradycardia in this patient?
A. Hypovolemia from internal hemorrhage causing baroreceptor-mediated reflex
bradycardia
B. Disruption of sympathetic outflow from T1-L2 resulting in unopposed vagal tone
C. Increased intracranial pressure causing Cushing's triad with reflex bradycardia
D. Cardiac contusion from blunt chest trauma causing direct myocardial injury
Correct Answer: B [CORRECT]
Rationale: Neurogenic shock results from disruption of sympathetic outflow from T1-
L2, causing loss of vasomotor tone and massive vasodilation. The bradycardia is due
to unopposed parasympathetic (vagal) tone because the sympathetic cardiac
accelerator fibers (T1-T4) are interrupted. Option A is incorrect because hemorrhagic
shock would present with tachycardia and cool, clammy skin. Option C is incorrect
because there is no evidence of head trauma or increased ICP. Option D is incorrect
because cardiac contusion would cause arrhythmias or ST changes, not isolated
bradycardia with warm, dry skin.
,Q2. A patient with a C5 complete spinal cord injury presents 6 hours post-injury with
flaccid paralysis of all four extremities, absent deep tendon reflexes, and loss of
bowel and bladder function. The nurse recognizes these findings are MOST
consistent with:
A. Permanent spinal cord transection
B. Spinal shock
C. Neurogenic shock
D. Autonomic dysreflexia
Correct Answer: B [CORRECT]
Rationale: Spinal shock is a temporary state of areflexia, flaccid paralysis, and loss of
autonomic function below the level of spinal cord injury that occurs immediately
after injury and may last from days to weeks. Option A is incorrect because
permanent transection cannot be determined this early; reflexes may return after
spinal shock resolves. Option C is incorrect because neurogenic shock refers
specifically to hypotension and bradycardia from loss of sympathetic tone, not the
areflexic state. Option D is incorrect because autonomic dysreflexia occurs AFTER
spinal shock resolves, typically in injuries at T6 or above.
Q3. A nurse is caring for a patient with a T4 spinal cord injury in neurogenic shock.
Which hemodynamic profile is MOST characteristic of this condition?
A. Low MAP, high SVR, high CVP, tachycardia
B. Low MAP, low SVR, low/normal CVP, bradycardia
C. Low MAP, high SVR, low CVP, tachycardia
D. Normal MAP, low SVR, high CVP, normal heart rate
Correct Answer: B [CORRECT]
Rationale: Neurogenic shock is characterized by low MAP due to massive
vasodilation (low SVR), low or normal CVP due to venous pooling, and bradycardia
due to loss of sympathetic cardiac stimulation with unopposed vagal tone. Option A
describes cardiogenic shock. Option C describes hypovolemic/hemorrhagic shock.
Option D is inconsistent with the hypotensive nature of neurogenic shock.
,Q4. A trauma patient with a suspected C6 spinal cord injury arrives in the ED
hypotensive (MAP 58 mmHg) and bradycardic (HR 48 bpm). The nurse's FIRST
priority intervention is:
A. Administer 2 liters of crystalloid fluid bolus rapidly
B. Initiate norepinephrine infusion via central line
C. Administer atropine 0.5 mg IV for symptomatic bradycardia
D. Apply high-flow oxygen and maintain spinal immobilization
Correct Answer: D [CORRECT]
Rationale: The ABCDE approach prioritizes Airway and Breathing first. High-flow
oxygen addresses potential respiratory compromise, and spinal immobilization
prevents further spinal cord injury. While fluids (A) and vasopressors (B) will be
needed, they follow initial stabilization. Atropine (C) is indicated for symptomatic
bradycardia with hemodynamic compromise, but airway and spinal protection take
precedence in the primary survey.
Q5. Which clinical finding BEST differentiates neurogenic shock from hemorrhagic
shock in a trauma patient with spinal cord injury?
A. Presence of spinal cord injury on imaging
B. Bradycardia with warm, dry extremities
C. Low urine output
D. Elevated serum lactate
Correct Answer: B [CORRECT]
Rationale: Neurogenic shock presents with bradycardia and warm, dry extremities
due to vasodilation and loss of sympathetic tone, whereas hemorrhagic shock
presents with tachycardia and cool, clammy skin due to compensatory
vasoconstriction. While spinal cord injury on imaging (A) may be present in both, the
hemodynamic response differs. Low urine output (C) and elevated lactate (D) can
occur in both shock states and are not distinguishing features.
, Q6. A patient with a T2 spinal cord injury in neurogenic shock has a MAP of 52
mmHg despite receiving 2 liters of Lactated Ringer's. The nurse anticipates which
vasopressor as FIRST-LINE therapy?
A. Phenylephrine
B. Norepinephrine
C. Vasopressin
D. Dopamine
Correct Answer: B [CORRECT]
Rationale: Norepinephrine is the first-line vasopressor for neurogenic shock because
it increases SVR through alpha-1 agonism and provides some beta-1 activity to
support cardiac output. Phenylephrine (A) is a pure alpha-agonist that may worsen
bradycardia by eliminating beta-1 stimulation. Vasopressin (C) is considered second-
line. Dopamine (D) may be used if bradycardia is severe due to its chronotropic
effects, but norepinephrine remains preferred.
Q7. A nurse is monitoring a patient with C4 complete spinal cord injury. Which
respiratory complication is the patient at HIGHEST risk for?
A. Pneumothorax
B. Atelectasis and pneumonia
C. Pulmonary embolism
D. Pleural effusion
Correct Answer: B [CORRECT]
Rationale: C3-C5 injuries affect the phrenic nerve, impairing diaphragmatic function
and leading to decreased vital capacity, poor cough, and inability to clear secretions.
This places the patient at highest risk for atelectasis and pneumonia. While
pulmonary embolism (C) is a risk due to immobility, it is not the highest respiratory
priority. Pneumothorax (A) and pleural effusion (D) are not directly related to cervical
SCI pathophysiology.
