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Upper extremity weakness only. This finding would not fully explain the mixed motor and sensory deficits seen in Brown-Séquard syndrome, and it is more characteristic of central cord syndrome.

Complete motor and sensory loss below C7. This describes complete spinal cord injury, not an incomplete lesion like Brown-Séquard syndrome. Patients retain some functions because only one half of the cord is damaged.

Loss of position sense and vibration in both lower extremities. This pattern would be more consistent with posterior cord syndrome, where bilateral loss of proprioception occurs without significant motor involvement.

Increased vasomotor tone after injury. This is incorrect because the problem is not increased but decreased vasomotor tone. Loss of sympathetic control leads to vasodilation, not vasoconstriction.

A temporary loss of sensation and flaccid paralysis below the level of injury. This describes spinal shock, which causes motor and sensory deficits, but it does not account for the hemodynamic instability seen in this case.

Loss of parasympathetic nervous system innervation resulting in vasoconstriction. Parasympathetic innervation is not lost; instead, it remains unopposed when sympathetic tone is absent. This results in vasodilation and bradycardia, not vasoconstriction.

Call the physician. Contacting the provider is important but not the first action—the nurse must first assess the patient’s BP to confirm the condition.

Check the patient’s temperature. Headache and nausea are not early signs of infection in this context; checking temperature delays recognition of a true emergency.

Elevate the head of the bed to 90 degrees. This is an essential intervention to lower blood pressure, but assessment (BP check) must be done first to confirm the cause of symptoms.

Bladder function tends to improve with age. Neurogenic bladder does not improve with aging; in fact, complications (UTIs, renal impairment, incontinence) may worsen.

Heart disease is not common in persons with spinal cord injury. Heart disease is common in SCI patients due to immobility, altered lipid metabolism, and reduced physical activity.

As a person ages, the need to change body position is less important. Pressure injury risk increases with both aging and immobility, making repositioning even more important.

Prevention of contractures of the lower extremities. This is important for long-term mobility and function but is a secondary priority compared to protecting the spinal cord.

Prevention of skin breakdown of areas that lack sensation. Pressure injury prevention is critical, but it is not more urgent than preventing permanent neurological damage.

Prevention of postural hypotension when placing the client in a wheelchair. Orthostatic hypotension precautions are necessary during rehabilitation but are not the immediate priority in the acute post-injury phase.

Notify the provider. Important, but provider notification should occur after immediate safety measures are initiated. Delaying action could increase risk of stroke or seizure.

Check the client’s urinary catheter for blockage. Bladder distention is a common trigger, but assessment of the cause comes after immediate BP control.

Administer antihypertensive medication. Medication may be needed if symptoms persist, but nonpharmacologic interventions (sitting upright, removing stimuli) are first-line emergency care.

Neurogenic shock. While possible in high-level SCI, neurogenic shock typically occurs acutely and is managed; it is not as immediately life-threatening as respiratory compromise in C4 injuries.

Paralytic ileus. Paralytic ileus is more common in thoracic and lumbar injuries; it is secondary in priority to airway and breathing concerns.

Stress ulcer. Stress ulcers are a potential complication but develop later and are not an immediate threat to life compared with respiratory failure.

Glucocorticoids. Glucocorticoids are appropriate medications to administer at this time as they are not universally contraindicated.

Plasma expanders. These are standard in managing hypotension or neurogenic shock and are appropriate in acute SCI care.

H2 antagonists. Used prophylactically to prevent stress ulcers, which are common in immobile patients, and are safe for acute SCI management.

Intermittent urinary catheterization. While generally preferred for long-term bladder management, it may not be needed if the patient can void adequately with a condom catheter.

Crede’s method. Manual compression of the bladder is less safe and can increase the risk of urethral trauma or reflux, particularly in high-level injuries.

Indwelling urinary catheter. Continuous catheterization carries a higher risk of infection and urethral injury, making it less desirable for long-term use.

Indoor mobility in manual wheelchair. This is achievable but represents a minimal goal, underutilizing preserved upper-body function.

Ambulate with crutches and leg braces. Lower limb function is generally insufficient for safe ambulation at the T4 level, making this unrealistic.

Completely independent ambulation with short leg braces and canes. This requires significant lower limb motor function, which is not present at T4, so this goal is not feasible.

There is incomplete cord lesion involvement. While incomplete lesions have better prognosis, this alone does not mandate immediate surgery.

The ligaments that support the spine are torn. Ligament injury may require stabilization but is not the primary indicator for urgent decompression.

A high cervical injury causes loss of respiratory function. Respiratory compromise is managed supportively; surgical intervention is not indicated solely for loss of function unless compression is present.

Maintaining immobilization of the cervical spine. While critical to prevent further cord injury, airway compromise has a more immediate threat to life and must be addressed first.

Assessing the patient for head and other injuries. A full trauma assessment is important but secondary to ensuring airway and oxygenation.

Assessing the patient’s motor and sensory function. Neurologic assessment is essential for baseline documentation, but interventions must prioritize life-threatening problems like airway compromise.

Kinetic beds. These beds are used mainly for spinal precautions in thoracic and lumbar injuries, not for cervical stabilization.

Hard cervical collar. This provides immobilization for minor or stable injuries but is insufficient for unstable cervical fractures.

Sternal-occipital-mandibular immobilizer brace. This brace is rarely used and does not provide the precise alignment achieved with skeletal traction in acute unstable cervical injuries.

Heart rate of 68 bpm. Dopamine may increase heart rate at higher doses; a normal heart rate alone does not indicate effective perfusion.

Respiratory rate of 24. Dopamine has minimal direct effect on respiratory rate; this is not a reliable measure of drug efficacy.

Temperature of 96.8°F (36.0°C). Dopamine does not influence body temperature; normalizing temperature is unrelated to therapeutic effect.