A nurse is caring for a client who has a transection of the spinal cord at the level of cervical 7. Which of the following assessment findings should the nurse anticipate?
The client has no sensation or movement below the level of the injury.
The client has some movement but no sensation below the level of the injury.
The client has some movement and also some sensation below the level of the injury.
The client has some sensation but no movement below the level of the Injury.
The Correct Answer is A
Choice A Reason:
The client has no sensation or movement below the level of the injury is correct. This is a characteristic finding of a complete spinal cord injury, where there is total loss of sensory and motor function below the level of the injury. This pattern is often seen in injuries involving the cervical spinal cord, such as at the level of C7.
Choice B Reason:
The client has some movement but no sensation below the level of the injury is incorrect. This finding would be more indicative of an incomplete spinal cord injury, where there is partial preservation of sensory or motor function below the level of the injury. However, with a transection of the spinal cord at C7, it is less likely for the client to have retained movement below the level of injury.
Choice C Reason:
The client has some movement and also some sensation below the level of the injury is incorrect. This finding is not typically associated with a spinal cord injury at the level of C7. With a transection of the spinal cord at this level, there is typically complete loss of sensory and motor function below the level of the injury.
Choice D Reason:
The client has some sensation but no movement below the level of the injury is incorrect. This finding is more consistent with an incomplete spinal cord injury, where there may be partial preservation of sensory function but no motor function below the level of the injury. However, with a transection of the spinal cord at C7, it is less likely for the client to have retained sensation below the level of injury.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","E"]
Explanation
Choice A Reason:
Light sensitivity is incorrect. Light sensitivity (photophobia) is not typically a direct manifestation of a ruptured cerebral aneurysm. However, it may occur as a secondary symptom due to other neurological disturbances or increased intracranial pressure.
Choice B Reason:
Loss of consciousness is correct. Loss of consciousness is a common manifestation of a ruptured cerebral aneurysm, particularly if the bleeding leads to significant brain injury or compression of vital brain structures.
Choice C Reason:
A dilated pupil is correct. A dilated pupil (mydriasis) may occur as a result of compression of the oculomotor nerve (cranial nerve III) by the expanding hematoma or increased intracranial pressure following a ruptured cerebral aneurysm.
Choice D Reason:
Visual disturbances is correct. Visual disturbances, such as blurred vision, double vision (diplopia), or loss of vision, may occur due to compression of the optic nerve or damage to visual pathways as a result of the hemorrhage.
Choice E Reason:
Nausea and vomiting is correct. Nausea and vomiting are common symptoms associated with a ruptured cerebral aneurysm, often due to irritation of the meninges and increased intracranial pressure resulting from the bleeding.
Choice F Reason:
Numbness on one side of the face is incorrect. Numbness on one side of the face is not typically a direct manifestation of a ruptured cerebral aneurysm. However, it may occur if the hemorrhage affects specific regions of the brain responsible for sensation or if there is associated compression of cranial nerves.
Correct Answer is ["A","B","D"]
Explanation
Choice A Reason:
African American clients is appropriate. Research suggests that African Americans have a lower prevalence of MS compared to White Americans, but they tend to have more severe disease progression and higher disability rates when diagnosed with MS.
Choice B Reason:
White American clients: Individuals of European descent, including White Americans, have the highest prevalence of MS, particularly those of northern European ancestry. MS is more common in populations of northern European descent compared to other racial and ethnic groups.
Choice C Reason:
East Asian clients: East Asians, including individuals of Chinese, Japanese, and Korean descent, have historically had lower rates of MS compared to individuals of European descent. However, MS prevalence appears to be increasing in East Asian populations, possibly due to changes in lifestyle and environmental factors.
Choice D Reason:
Hispanic or Latino clients: Studies suggest that the prevalence of MS is lower in Hispanic/Latino populations compared to White Americans but higher than in African Americans. However, there is considerable variation in MS prevalence among different Hispanic/Latino subgroups.
Choice E Reason:
Navajo Indian clients: Native American populations, including Navajo Indians, have been reported to have a lower prevalence of MS compared to individuals of European descent. However, limited data are available on MS prevalence and incidence in specific Native American tribes, and more research is needed to fully understand the disease burden in these populations.
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