SPINAL CORD AND SPINAL TRAUMA:
TNS CERTIFICATION PRACTICE EXAM
100% CORRECT!
This document is an original study resource designed for Trauma Nurse Specialist (TNS) exam
preparation. These questions focus on advanced clinical judgment, pathophysiology, and
evidence-based interventions for spinal injuries.
Table of Contents
1. Section 1: Practice Questions (1–30)
2. Section 2: Answer Key
3. Section 3: High-Yield Spinal Trauma Review
Section 1: Questions 1–30
Question 1. A 28-year-old male arrives after a diving accident. He is awake and alert but cannot
move his legs. His blood pressure is $82/40\text{ mmHg}$, heart rate is $52\text{ bpm}$, and
his skin is warm and dry below the level of the injury. What is the most likely diagnosis?
A. Hypovolemic shock B. Neurogenic shock C. Spinal shock D. Cardiogenic shock
Correct Answer: B. Neurogenic shock
Rationale:
1. Why the correct answer is best: Neurogenic shock is characterized by the "classic
triad" of hypotension, bradycardia, and peripheral vasodilation (warm, dry skin) due to
the loss of sympathetic tone, usually occurring in injuries above T6.
2. Why each incorrect option is less appropriate: Hypovolemic shock presents with
tachycardia and cool, clammy skin. Spinal shock refers to the loss of all reflex activity
below the level of injury and is a neurological, not hemodynamic, state. Cardiogenic
shock involves pump failure and usually presents with tachycardia or pulmonary
congestion.
3. Key Trauma Principle: Differentiating between neurogenic and hypovolemic shock is
critical; neurogenic shock requires vasopressors (alpha-agonists) and judicious fluid,
while hypovolemic shock requires volume.
, Question 2. A patient with a confirmed C5-C6 fracture is awaiting surgery. The nurse notes the
patient’s blood pressure has spiked to $190/100\text{ mmHg}$, the patient is flushed above the
injury, and complains of a pounding headache. What is the priority nursing action?
A. Administer an IV beta-blocker as ordered. B. Lower the head of the bed to the flat position. C.
Check the patient's urinary catheter for kinks or distension. D. Perform a rapid neurological
assessment (GCS).
Correct Answer: C. Check the patient's urinary catheter for kinks or distension.
Rationale:
1. Why the correct answer is best: These are classic signs of Autonomic Dysreflexia
(AD). The most common trigger is bladder distension or bowel impaction. Removing the
noxious stimulus is the primary treatment.
2. Why each incorrect option is less appropriate: Giving antihypertensives before
removing the trigger can cause extreme hypotension once the trigger is gone. The HOB
should be elevated to help lower intracranial pressure and BP through orthostatic effect.
A GCS is important, but identifying the AD trigger is the priority.
3. Key Trauma Principle: Autonomic Dysreflexia is a medical emergency in spinal cord
injuries above T6 that requires immediate identification and removal of the triggering
stimulus.
Question 3. An elderly patient fell down the stairs. On assessment, the patient has significantly
more motor weakness in the upper extremities than the lower extremities. Sensory loss is
variable. Which cord syndrome is suspected?
A. Anterior Cord Syndrome B. Brown-Séquard Syndrome C. Central Cord Syndrome D. Cauda
Equina Syndrome
Correct Answer: C. Central Cord Syndrome
Rationale:
1. Why the correct answer is best: Central Cord Syndrome, often seen in hyperextension
injuries in patients with pre-existing stenosis, characteristically presents with motor
impairment that is more severe in the arms than the legs.
2. Why each incorrect option is less appropriate: Anterior cord involves total motor loss
and loss of pain/temp, but preserved proprioception. Brown-Séquard involves ipsilateral
motor loss and contralateral sensory loss. Cauda Equina involves lower motor neuron
signs, saddle anesthesia, and bowel/bladder dysfunction.
3. Key Trauma Principle: Recognition of incomplete cord syndromes helps predict
functional recovery and guides rehabilitation expectations.
TNS CERTIFICATION PRACTICE EXAM
100% CORRECT!
This document is an original study resource designed for Trauma Nurse Specialist (TNS) exam
preparation. These questions focus on advanced clinical judgment, pathophysiology, and
evidence-based interventions for spinal injuries.
Table of Contents
1. Section 1: Practice Questions (1–30)
2. Section 2: Answer Key
3. Section 3: High-Yield Spinal Trauma Review
Section 1: Questions 1–30
Question 1. A 28-year-old male arrives after a diving accident. He is awake and alert but cannot
move his legs. His blood pressure is $82/40\text{ mmHg}$, heart rate is $52\text{ bpm}$, and
his skin is warm and dry below the level of the injury. What is the most likely diagnosis?
A. Hypovolemic shock B. Neurogenic shock C. Spinal shock D. Cardiogenic shock
Correct Answer: B. Neurogenic shock
Rationale:
1. Why the correct answer is best: Neurogenic shock is characterized by the "classic
triad" of hypotension, bradycardia, and peripheral vasodilation (warm, dry skin) due to
the loss of sympathetic tone, usually occurring in injuries above T6.
2. Why each incorrect option is less appropriate: Hypovolemic shock presents with
tachycardia and cool, clammy skin. Spinal shock refers to the loss of all reflex activity
below the level of injury and is a neurological, not hemodynamic, state. Cardiogenic
shock involves pump failure and usually presents with tachycardia or pulmonary
congestion.
3. Key Trauma Principle: Differentiating between neurogenic and hypovolemic shock is
critical; neurogenic shock requires vasopressors (alpha-agonists) and judicious fluid,
while hypovolemic shock requires volume.
, Question 2. A patient with a confirmed C5-C6 fracture is awaiting surgery. The nurse notes the
patient’s blood pressure has spiked to $190/100\text{ mmHg}$, the patient is flushed above the
injury, and complains of a pounding headache. What is the priority nursing action?
A. Administer an IV beta-blocker as ordered. B. Lower the head of the bed to the flat position. C.
Check the patient's urinary catheter for kinks or distension. D. Perform a rapid neurological
assessment (GCS).
Correct Answer: C. Check the patient's urinary catheter for kinks or distension.
Rationale:
1. Why the correct answer is best: These are classic signs of Autonomic Dysreflexia
(AD). The most common trigger is bladder distension or bowel impaction. Removing the
noxious stimulus is the primary treatment.
2. Why each incorrect option is less appropriate: Giving antihypertensives before
removing the trigger can cause extreme hypotension once the trigger is gone. The HOB
should be elevated to help lower intracranial pressure and BP through orthostatic effect.
A GCS is important, but identifying the AD trigger is the priority.
3. Key Trauma Principle: Autonomic Dysreflexia is a medical emergency in spinal cord
injuries above T6 that requires immediate identification and removal of the triggering
stimulus.
Question 3. An elderly patient fell down the stairs. On assessment, the patient has significantly
more motor weakness in the upper extremities than the lower extremities. Sensory loss is
variable. Which cord syndrome is suspected?
A. Anterior Cord Syndrome B. Brown-Séquard Syndrome C. Central Cord Syndrome D. Cauda
Equina Syndrome
Correct Answer: C. Central Cord Syndrome
Rationale:
1. Why the correct answer is best: Central Cord Syndrome, often seen in hyperextension
injuries in patients with pre-existing stenosis, characteristically presents with motor
impairment that is more severe in the arms than the legs.
2. Why each incorrect option is less appropriate: Anterior cord involves total motor loss
and loss of pain/temp, but preserved proprioception. Brown-Séquard involves ipsilateral
motor loss and contralateral sensory loss. Cauda Equina involves lower motor neuron
signs, saddle anesthesia, and bowel/bladder dysfunction.
3. Key Trauma Principle: Recognition of incomplete cord syndromes helps predict
functional recovery and guides rehabilitation expectations.
