NURSING PATHOPHYSIOLOGY EXAM #6B: ALTERATIONS IN SPINAL CORD FUNCTION
(2026/2027) | CASE STUDY & STANDARD QUESTIONS WITH CORRECT ANSWERS
Advanced Pathophysiology Examination: Focus on Spinal Cord & Peripheral Nerve Integrity | Core
Domains: Traumatic SCI, Spinal/Neurogenic Shock, Autonomic Dysreflexia, Incomplete Cord
Syndromes, and Spinal Compression | Graduate-Level Nursing Focus | Case Study & Clinical
Application Exam Format
Exam Structure
This exam for the 2026/2027 cycle is a 55-question assessment featuring detailed neurological case
studies (e.g., patient with a T12 fracture, presenting with autonomic dysreflexia) to test precise anatomical
localization of spinal cord lesions and prediction of specific motor, sensory, and autonomic deficits.
Answer Format
All correct answers must be presented in bold and green, followed by rationales that map the exact
anatomical disruption of spinal tracts to the expected neurological findings and potential life-threatening
complications outlined in the case studies and questions.
Questions (55 Total)
1.
A patient with a T3 spinal cord injury has BP 80/50 mm Hg, HR 50 bpm, and warm, dry skin.
What condition is present?
A. Hypovolemic shock
B. Neurogenic shock
C. Spinal shock
D. Cardiogenic shock
Neurogenic shock results from loss of sympathetic tone (T6 or above), causing vasodilation
(hypotension) and unopposed vagal tone (bradycardia). Skin is warm due to vasodilation—unlike cold
skin in hypovolemic shock.
2.
A patient with a T4 spinal cord injury develops severe headache, hypertension (BP 210/110 mm Hg), and
bradycardia.
,What is the priority action?
A. Administer antihypertensive IV
B. Sit the patient upright and check for bladder distension
C. Give oxygen via non-rebreather
D. Prepare for intubation
Autonomic dysreflexia is a medical emergency caused by noxious stimuli below the lesion (e.g., full
bladder). Sitting upright reduces BP. Immediate removal of the trigger (e.g., catheterize) is critical
before medications.
3.
A patient with a right-sided hemisection of the spinal cord at T6 has right leg paralysis and left leg
pain/temperature loss.
What syndrome is this?
A. Central cord syndrome
B. Brown-Séquard syndrome
C. Anterior cord syndrome
D. Cauda equina syndrome
Brown-Séquard syndrome involves ipsilateral motor paralysis (corticospinal tract) and proprioception
loss (dorsal columns), and contralateral pain/temperature loss (spinothalamic tract after decussation).
4.
An older adult with prostate cancer reports new-onset back pain and leg weakness. MRI shows epidural
spinal cord compression.
What is the priority intervention?
A. Administer oral analgesics
B. Initiate high-dose dexamethasone and consult neurosurgery
C. Schedule physical therapy
, D. Apply heat packs
Metastatic spinal cord compression is an oncologic emergency. Dexamethasone reduces edema and
inflammation. Surgical decompression or radiation is often required within 24 hours to prevent
permanent paralysis.
5.
A patient sustains a complete spinal cord injury at C5. What functional ability is preserved?
A. Independent ambulation
B. Shoulder movement and elbow flexion
C. Hand grasp
D. Trunk control
C5 innervates the deltoid (shoulder abduction) and biceps (elbow flexion). Patients can use a power
wheelchair with hand controls but require assistance for most ADLs. Breathing may be impaired due to
partial diaphragm innervation (C3–C5).
6.
A patient with a T3 spinal cord injury has BP 80/50 mm Hg, HR 50 bpm, and warm, dry skin.
What condition is present?
A. Hypovolemic shock
B. Neurogenic shock
C. Spinal shock
D. Cardiogenic shock
Neurogenic shock results from loss of sympathetic tone (T6 or above), causing vasodilation
(hypotension) and unopposed vagal tone (bradycardia). Skin is warm due to vasodilation—unlike cold
skin in hypovolemic shock.
7.
(2026/2027) | CASE STUDY & STANDARD QUESTIONS WITH CORRECT ANSWERS
Advanced Pathophysiology Examination: Focus on Spinal Cord & Peripheral Nerve Integrity | Core
Domains: Traumatic SCI, Spinal/Neurogenic Shock, Autonomic Dysreflexia, Incomplete Cord
Syndromes, and Spinal Compression | Graduate-Level Nursing Focus | Case Study & Clinical
Application Exam Format
Exam Structure
This exam for the 2026/2027 cycle is a 55-question assessment featuring detailed neurological case
studies (e.g., patient with a T12 fracture, presenting with autonomic dysreflexia) to test precise anatomical
localization of spinal cord lesions and prediction of specific motor, sensory, and autonomic deficits.
Answer Format
All correct answers must be presented in bold and green, followed by rationales that map the exact
anatomical disruption of spinal tracts to the expected neurological findings and potential life-threatening
complications outlined in the case studies and questions.
Questions (55 Total)
1.
A patient with a T3 spinal cord injury has BP 80/50 mm Hg, HR 50 bpm, and warm, dry skin.
What condition is present?
A. Hypovolemic shock
B. Neurogenic shock
C. Spinal shock
D. Cardiogenic shock
Neurogenic shock results from loss of sympathetic tone (T6 or above), causing vasodilation
(hypotension) and unopposed vagal tone (bradycardia). Skin is warm due to vasodilation—unlike cold
skin in hypovolemic shock.
2.
A patient with a T4 spinal cord injury develops severe headache, hypertension (BP 210/110 mm Hg), and
bradycardia.
,What is the priority action?
A. Administer antihypertensive IV
B. Sit the patient upright and check for bladder distension
C. Give oxygen via non-rebreather
D. Prepare for intubation
Autonomic dysreflexia is a medical emergency caused by noxious stimuli below the lesion (e.g., full
bladder). Sitting upright reduces BP. Immediate removal of the trigger (e.g., catheterize) is critical
before medications.
3.
A patient with a right-sided hemisection of the spinal cord at T6 has right leg paralysis and left leg
pain/temperature loss.
What syndrome is this?
A. Central cord syndrome
B. Brown-Séquard syndrome
C. Anterior cord syndrome
D. Cauda equina syndrome
Brown-Séquard syndrome involves ipsilateral motor paralysis (corticospinal tract) and proprioception
loss (dorsal columns), and contralateral pain/temperature loss (spinothalamic tract after decussation).
4.
An older adult with prostate cancer reports new-onset back pain and leg weakness. MRI shows epidural
spinal cord compression.
What is the priority intervention?
A. Administer oral analgesics
B. Initiate high-dose dexamethasone and consult neurosurgery
C. Schedule physical therapy
, D. Apply heat packs
Metastatic spinal cord compression is an oncologic emergency. Dexamethasone reduces edema and
inflammation. Surgical decompression or radiation is often required within 24 hours to prevent
permanent paralysis.
5.
A patient sustains a complete spinal cord injury at C5. What functional ability is preserved?
A. Independent ambulation
B. Shoulder movement and elbow flexion
C. Hand grasp
D. Trunk control
C5 innervates the deltoid (shoulder abduction) and biceps (elbow flexion). Patients can use a power
wheelchair with hand controls but require assistance for most ADLs. Breathing may be impaired due to
partial diaphragm innervation (C3–C5).
6.
A patient with a T3 spinal cord injury has BP 80/50 mm Hg, HR 50 bpm, and warm, dry skin.
What condition is present?
A. Hypovolemic shock
B. Neurogenic shock
C. Spinal shock
D. Cardiogenic shock
Neurogenic shock results from loss of sympathetic tone (T6 or above), causing vasodilation
(hypotension) and unopposed vagal tone (bradycardia). Skin is warm due to vasodilation—unlike cold
skin in hypovolemic shock.
7.
