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NUR 254- Unit 2.3 Exam Questions with Complete Solutions Graded A+
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NUR 254- Unit 2.3 Exam Questions with Complete Solutions Graded A+
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NUR 254- Unit 2.3Exam Questions
with Complete
Solutions Graded
A+
Denning [Date] [Course title]
, how would the nurse "grade" muscle strength for a patient who was not able to move to some
resistance but not full resistance? - Correct Ans: 4 (out of 5)
a patient paralyzed from the neck down is said to have what? - Correct Ans: quadraplegia
a patient with weakness from the waist down would be documented as what? - Correct Ans:
paraparesis
a patient with spinal cord injury <8 hours ago, present with hypotension, bradycardia, and absent
reflexes and flaccid paralysis below the level of injury. what complication is this indicative of? - Correct
Ans: spinal shock
the nurse would anticipate which electrolyte imbalance related to immobility for a patient with a
complete cord injury at T5? - Correct Ans: hypercalcemia
at what level will a patient with complete spinal cord injury be ventilator dependent? - Correct Ans: C4
(above C5)
aside from ensuring ABCs, what should the priority intervention be for a patient with suspected spinal
cord injury? - Correct Ans: immobilization
a patient is at risk for autonomic dysreflexia. what are three things that could stimulate AD? - Correct
Ans: full bladder/bowel, skin irritation (tight clothing, SCDS, etc.), pressure areas
the patient with acute spinal cord injury is receiving high dose methylprednisolone. what is the purpose
for this medication? - Correct Ans: decrease inflammation and decrease secondary injury to the spinal
cord
at what level of SCI will a patient be ventilator dependent? - Correct Ans: C4
above which level of injury would a patient be at high risk for neurogenic shock and AD? - Correct Ans:
T6
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