A nurse is caring for a client who is recovering from a thoracic spinal cord injury. The nurse should identify that the client is at risk for which of the following conditions?
Loss of urinary control
Inability to clear secretions
Decreased fine motor hand movement
Difficulty swallowing
The Correct Answer is A
A. Loss of urinary control: Thoracic spinal cord injuries disrupt autonomic and somatic pathways controlling bladder function. Damage at the thoracic level can impair signals between the brain and the sacral micturition center, leading to neurogenic bladder. Clients may experience urinary retention, incontinence, or reflexive voiding, requiring monitoring and interventions such as catheterization or bladder training.
B. Inability to clear secretions: Impaired secretion clearance is primarily a risk for cervical spinal cord injuries, which compromise innervation of the diaphragm and accessory respiratory muscles. Thoracic injuries usually preserve diaphragmatic function, allowing effective breathing and cough reflex, so secretion clearance is typically maintained.
C. Decreased fine motor hand movement: Fine motor control of the hands depends on cervical spinal cord innervation, particularly C6–C8 levels. A thoracic injury does not affect upper extremity motor neurons, so hand dexterity and fine motor skills are generally preserved.
D. Difficulty swallowing: Dysphagia occurs with lesions affecting cranial nerve nuclei or high cervical spinal cord injuries that impair pharyngeal and laryngeal muscle innervation. Thoracic spinal cord injuries do not impact swallowing mechanisms because these structures are innervated above the level of the thoracic spine.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. FACES scale: The FACES pain scale relies on the child’s ability to recognize and point to facial expressions that match their pain intensity. It is appropriate for children aged 3 years and older, as it requires cognitive and emotional development beyond that of a 3-month-old infant.
B. FLACC scale: The FLACC (Face, Legs, Activity, Cry, Consolability) scale is designed to assess pain in infants and young children who cannot verbalize their discomfort. It evaluates observable behaviors, such as facial expressions, leg movement, body activity, crying, and consolability, providing an objective measure of pain in preverbal children.
C. Color tool: Color-based pain assessment tools typically require the child to associate colors with pain intensity. This method is suitable for older children with sufficient cognitive development to understand abstract representations, not for infants.
D. Numeric scale: Numeric rating scales require the child to understand and quantify pain on a scale of 0 to 10. This tool is inappropriate for a 3-month-old, as infants lack the developmental capacity to comprehend numerical concepts or self-report pain.
Correct Answer is A
Explanation
A. Bradycardia: Propranolol is a nonselective beta-adrenergic blocker that inhibits both β1 and β2 receptors. Blockade of β1 receptors in the sinoatrial and atrioventricular nodes decreases heart rate and conduction velocity. Excessive beta blockade can result in clinically significant bradycardia, hypotension, and reduced cardiac output, requiring monitoring of pulse and BP.
B. Hypertension: Propranolol lowers blood pressure by decreasing cardiac output and suppressing renin release from the kidneys. Its pharmacologic action is antihypertensive rather than hypertensive. Elevated blood pressure would not be expected as a direct adverse effect of appropriate beta-blocker therapy.
C. Tinnitus: Tinnitus is more commonly associated with medications such as salicylates, loop diuretics, or certain antibiotics. Propranolol does not typically affect the auditory system or cochlear blood flow in a way that produces ringing in the ears.
D. Urinary hesitancy: Urinary hesitancy is often linked to anticholinergic medications or conditions such as benign prostatic hyperplasia. Propranolol does not have significant anticholinergic effects and does not commonly interfere with bladder detrusor muscle contraction or urinary flow.
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