Spinal Issues

Question 1

Which spinal cord disorder is characterized by the buildup of scar tissue or plaques?

1. 
Multiple sclerosis (MS)

2. Spinal cord tumors
3. Herniated nucleus pulposus
4. Amyotrophic lateral sclerosis (ALS)

Answer 1

1

Option 1:
MS is a chronic neurological disorder in which the nerves of the central nervous system degenerate. It is characterized by the buildup of scar tissue (sclerosis) or plaques that are formed during the process of demyelination.
Option 2:
A spinal cord tumor is an abnormal tissue growth in or around the spine. This may not be characterized by a buildup of scars.
Option 3:
Herniated nucleus pulposus is characterized by leakage of the interior disc contents into the vertebral column.
Option 4:
ALS is a result of gradual degeneration and death of motor neurons, causing muscle weakness and atrophy. It may not be characterized by plaques or scar tissue.

Question 2

What is characterized by leakage of the interior disc contents into the vertebral column?

1. 
Multiple sclerosis (MS)

2. Spinal cord tumors
3. Herniated nucleus pulposus
4. Amyotrophic lateral sclerosis (ALS)

Answer 2

3

Option 1:
MS is a chronic neurological disorder in which the nerves of the central nervous system degenerate. It is characterized by the buildup of scar tissue (sclerosis) or plaques that are formed during the process of demyelination.
Option 2:
A spinal cord tumor is an abnormal tissue growth in or around the spine. This may not be characterized by a buildup of scars.
Option 3:
Herniated nucleus pulposus is characterized by leakage of the interior disc contents into the vertebral column.
Option 4:
ALS is a result of gradual degeneration and death of motor neurons, causing muscle weakness and atrophy. It may not be characterized by plaques or scar tissue.

Question 3

What s a result of gradual degeneration and death of motor neurons, causing muscle weakness and atrophy. It may not be characterized by plaques or scar tissue.

1. 
Multiple sclerosis (MS)

2. Spinal cord tumors
3. Herniated nucleus pulposus
4. Amyotrophic lateral sclerosis (ALS)

Answer 3

4

Option 1:
MS is a chronic neurological disorder in which the nerves of the central nervous system degenerate. It is characterized by the buildup of scar tissue (sclerosis) or plaques that are formed during the process of demyelination.
Option 2:
A spinal cord tumor is an abnormal tissue growth in or around the spine. This may not be characterized by a buildup of scars.
Option 3:
Herniated nucleus pulposus is characterized by leakage of the interior disc contents into the vertebral column.
Option 4:
ALS is a result of gradual degeneration and death of motor neurons, causing muscle weakness and atrophy. It may not be characterized by plaques or scar tissue.

Question 4

Which is the most malignant type of spinal cord tumor?

1. Sarcoma
2. Astrocytoma
3. Schwannoma
4. Ependymoma

Answer 4

1

Option 1:
Sarcoma is a tumor of connective tissue cells and is a malignant tumor.
Option 2:
Astrocytoma is a tumor of the cells of tissue that support nerve cells. This type of tumor is usually benign or low-grade malignant.
Option 3:
Schwannoma is a tumor of the cells that form the myelin sheath around peripheral nerve fiber. This is a benign tumor.
Option 4:
Ependymoma is a tumor of the cells lining the center of the spinal cord. This is typically a benign tumor.

Question 5

What is a tumor of the cells of tissue that support nerve cells. This type of tumor is usually benign or low-grade malignant.

1. Sarcoma
2. Astrocytoma
3. Schwannoma
4. Ependymoma

Answer 5

2

Option 1:
Sarcoma is a tumor of connective tissue cells and is a malignant tumor.
Option 2:
Astrocytoma is a tumor of the cells of tissue that support nerve cells. This type of tumor is usually benign or low-grade malignant.
Option 3:
Schwannoma is a tumor of the cells that form the myelin sheath around peripheral nerve fiber. This is a benign tumor.
Option 4:
Ependymoma is a tumor of the cells lining the center of the spinal cord. This is typically a benign tumor.

Question 6

What is a tumor of the cells that form the myelin sheath around peripheral nerve fiber. This is a benign tumor.

1. Sarcoma
2. Astrocytoma
3. Schwannoma
4. Ependymoma

Answer 6

Option 1:
Sarcoma is a tumor of connective tissue cells and is a malignant tumor.
Option 2:
Astrocytoma is a tumor of the cells of tissue that support nerve cells. This type of tumor is usually benign or low-grade malignant.
Option 3:
Schwannoma is a tumor of the cells that form the myelin sheath around peripheral nerve fiber. This is a benign tumor.
Option 4:
Ependymoma is a tumor of the cells lining the center of the spinal cord. This is typically a benign tumor.

Question 7

The RN is caring for a client diagnosed with autonomic dysreflexia (AD). Which action performed by the nurse indicates a need for correction?

1. Placing an indwelling urinary catheter in the client
2. Applying antiembolism stockings on the client
3. Monitoring the client’s blood pressure every 5 minutes
4. Checking the client’s body for the presence of pressure ulcers

Answer 7

2

Option 1:
Distended bladder can result in an episode of AD. Placing an indwelling urinary catheter or performing intermittent catheterization may reduce the risk of AD.
Option 2:
Applying antiembolism stockings should help prevent pooling of blood in the client’s lower extremities and reduce blood pressure, which may be the source of an episode of AD.
Option 3:
Monitoring blood pressure every 5 minutes helps to evaluate treatments and see if the source of the episode has been found and removed.
Option 4:
Checking the body of the client for the presence of pressure ulcers helps to assess for a possible source and remove to terminate an AD episode.

Question 8

Why should you place an indwelling catheter in a client with Autonomic Dysreflexia?

Answer 8

Distended bladder can result in an episode of AD. Placing an indwelling urinary catheter or performing intermittent catheterization may reduce the risk of AD.

Question 9

Why should you check for pressure ulcers in a client with Autonomic Dysreflexia?

Answer 9

Checking the body of the client for the presence of pressure ulcers helps to assess for a possible source and remove to terminate an AD episode.

Question 10

The RN is teaching nursing students about the interventions provided before a cerebral angiography procedure. Which statement made by the nursing student indicates the need for further teaching?

1. “I must advise the client to be well hydrated and to drink plenty of fluids.”
2. “I must inform the client that it takes 60 to 120 minutes for the procedure.”
3. “I will ensure that the procedure is started only after the client gives informed consent.”
4. “I will inform the client not to worry if he or she feels warmth when the IV contrast is administered.”

Answer 10

1

Option 1:
Cerebral angiography is an invasive, intra-arterial, radiological procedure that involves the administration of radiopaque dye through a catheter. The nurse must tell the client not to eat or drink anything by mouth after midnight before the procedure.
Option 2:
The procedure takes up to 120 minutes. Since it is a long period, the nurse must tell the client beforehand about the duration of the procedure.
Option 3:
Cerebral angiography is an invasive procedure. Therefore, the nurse must ensure that the procedure is being initiated only with the informed consent of the client.
Option 4:
After administration of the IV contrast, the client may feel flushed and experience warmth.

Question 11

A client has impairment of lower extremity function and poor trunk control. Which part of the spinal cord is the client most likely to have injured?

1. Sacral region
2. Cervical region
3. Lumbar region
4. Thoracic region

Answer 11

4

Option 1:
Sacral injuries result in decreasing control of leg movements and bowel movements along with bladder dysfunction.
Option 2:
Cervical injuries can result in quadriplegia and an inability to breath.
Option 3:
Lumbar and sacral injuries result in decreasing control of legs and bowel and bladder dysfunction. The clients may also have sexual dysfunction.
Option 4:
Paraplegia is the impairment in the motor and sensory functions of the lower extremities. The client who suffers from thoracic injuries often has paraplegia and poor trunk control.

Question 12

The nurse is caring for a client who has a spinal injury. The client reports difficulty in breathing. Which region of the spinal cord is injured?

1. Sacral region
2. Cervical region
3. Lumbar region
4. Thoracic region

Answer 12

2

Option 1:
Sacral injuries occur in the lower back. There may not be dyspnea in the client with a sacral injury.
Option 2:
Cervical injuries occur in the chest; therefore, a client with an injury to the cervical region may report difficulty in breathing.
Option 3:
Lumbar injuries occur in the lower back. The client may not report difficulty in breathing.
Option 4:
Thoracic injuries occur at chest level and the symptoms include loss of bowel and bladder control. Therefore, the client reports constipation and urinary incontinence.

Question 13

The RN is teaching a nursing student about interventions to be followed while caring for a client with neurogenic shock. Which statement made by the nursing student indicates the need for further teaching?

1. “I should avoid preparing transcutaneous pacing.”
2. “I should assist with insertion of a pulmonary artery catheter.”
3. “I should avoid implementing thromboembolism prophylaxis.”
4. “I should assist with insertion of an arterial line with continuous blood pressure monitoring.”

Answer 13

3

Option 1:
The nurse should avoid preparing transcutaneous pacing when the client does not have transvenous pacing wires in place.
Option 2:
In situations where cardiovascular dysfunction is severe, the nurse should assist with insertion of a pulmonary artery catheter to monitor preload, afterload, and contractility.
Option 3:
The nurse should implement thromboembolism prophylaxis since clients with neurogenic shock are at a high risk for venous thromboembolism.
Option 4:
The nurse should assist with the insertion of an arterial line with continuous blood pressure monitoring.

Question 14

In the Hess grading scale, which grade readings show results related to headache, neck stiffness, and cranial nerve deficit?

1. Grade II
2. Grade III
3. Grade IV
4. Grade V

Answer 14

1

Option 1:
Grade II readings show results related to headache and neck stiffness and a cranial nerve deficit.
Option 2:
Grade III readings show results related to headache, neck stiffness, focal motor deficit, and lethargy.
Option 3:
Grade IV readings show results related to stupor, dense hemiparesis, and posturing.
Option 4:
Grade V readings show results related to coma, posturing, and moribundity.

Question 15

In the Hess grading scale, which grade readings show
results related to headache, neck stiffness, focal motor deficit, and lethargy.

1. Grade II
2. Grade III
3. Grade IV
4. Grade V

Answer 15

2

Option 1:
Grade II readings show results related to headache and neck stiffness and a cranial nerve deficit.
Option 2:
Grade III readings show results related to headache, neck stiffness, focal motor deficit, and lethargy.
Option 3:
Grade IV readings show results related to stupor, dense hemiparesis, and posturing.
Option 4:
Grade V readings show results related to coma, posturing, and moribundity.

Question 16

In the Hess grading scale, which grade readings show results related to stupor, dense hemiparesis, and posturing.

1. Grade II
2. Grade III
3. Grade IV
4. Grade V

Answer 16

3

Option 1:
Grade II readings show results related to headache and neck stiffness and a cranial nerve deficit.
Option 2:
Grade III readings show results related to headache, neck stiffness, focal motor deficit, and lethargy.
Option 3:
Grade IV readings show results related to stupor, dense hemiparesis, and posturing.
Option 4:
Grade V readings show results related to coma, posturing, and moribundity.

Question 17

In the Hess grading scale, which grade readings show results related to coma, posturing, and moribundity.

1. Grade II
2. Grade III
3. Grade IV
4. Grade V

Answer 17

4

Option 1:
Grade II readings show results related to headache and neck stiffness and a cranial nerve deficit.
Option 2:
Grade III readings show results related to headache, neck stiffness, focal motor deficit, and lethargy.
Option 3:
Grade IV readings show results related to stupor, dense hemiparesis, and posturing.
Option 4:
Grade V readings show results related to coma, posturing, and moribundity.

Question 18

Which is true regarding spinal stenosis?

1. It is loss of normal structure and function of the spine.
2. It refers to constriction of the spinal foramen and canals.
3. It is the decreasing support of facet joints caused by lax spinal ligaments.
4. It is the sudden involuntary contraction of a single muscle or muscle group.

Answer 18

2

Option 1:
Spinal degeneration is the loss of normal structure and function of the spine.
Option 2:
Spinal stenosis refers to constriction of the spinal foramen and canals.
Option 3:
Spinal degeneration is the decreasing support of facet joints caused by lax spinal ligaments.
Option 4:
Muscle spasm is the sudden involuntary contraction of a single muscle or muscle group.

Question 19

What is true regarding spinal degeneration? Select all that apply

1. It is loss of normal structure and function of the spine.
2. It refers to constriction of the spinal foramen and canals.
3. It is the decreasing support of facet joints caused by lax spinal ligaments.
4. It is the sudden involuntary contraction of a single muscle or muscle group.

Answer 19

1 and 3

Spinal degeneration is the loss of normal structure and function of the spine.
Option 2:
Spinal stenosis refers to constriction of the spinal foramen and canals.
Option 3:
Spinal degeneration is the decreasing support of facet joints caused by lax spinal ligaments.
Option 4:
Muscle spasm is the sudden involuntary contraction of a single muscle or muscle group.

Question 20

What is true regarding Muscle Spasm

1. It is loss of normal structure and function of the spine.
2. It refers to constriction of the spinal foramen and canals.
3. It is the decreasing support of facet joints caused by lax spinal ligaments.
4. It is the sudden involuntary contraction of a single muscle or muscle group.

Answer 20

4

Option 1:
Spinal degeneration is the loss of normal structure and function of the spine.
Option 2:
Spinal stenosis refers to constriction of the spinal foramen and canals.
Option 3:
Spinal degeneration is the decreasing support of facet joints caused by lax spinal ligaments.
Option 4:
Muscle spasm is the sudden involuntary contraction of a single muscle or muscle group.

Question 21

In which type of multiple sclerosis (MS) is the disease activity initiated in the spinal cord?

1. Relapsing remitting
2. Primary progressive
3. Secondary progressive
4. Progressive relapsing

Answer 21

2

Option 1:
In relapsing remitting MS, new symptoms appear and old ones worsen or reappear. It is the most common form of MS.
Option 2:
In primary progressive MS, disease activity is initiated in the spinal cord, not in the brain.
Option 3:
In secondary progressive MS, the client who initially had relapsing remitting MS develops a gradual worsening of the disease.
Option 4:
In progressive relapsing MS, the disease progress course follows a gradual worsening of symptoms from the onset and the relapse may or may not have recovery.

Question 22

A client reports blurred vision and feeling an electric shock sensation when he or she moves his or her head. Which spinal cord disorder does this most likely indicate?

1. 
Multiple sclerosis (MS)

2. Spinal cord trauma
3. Herniated nucleus pulposus
4. Amyotrophic lateral sclerosis (ALS)

Answer 22

1

Option 1:
The nurse anticipates MS in the client. The clinical manifestations are blurred vision and an electric shock sensation when moving the head.
Option 2:
The clinical manifestations of spinal cord trauma are chronic pain and low blood pressure.
Option 3:
The clinical manifestations of herniated nucleus pulposus are pain in the arm or leg and numbness.
Option 4:
The clinical manifestations of ALS are slurred speech, muscle cramps or stiffness, and muscle weakness.

Question 23

Which diagnostic test involves a radiation beam passing through the back to produce a two-dimensional picture?

1. Magnetic Resonant Imaging (MRI)
2. X-ray
3. Electromyography (EMG)
4. Diskogram

Answer 23

2

Option 1:
MRI involves energy from a powerful magnet, producing signals that are detected by a scanner and analyzed by a computer. The result involves a cross-sectional image of the spine.
Option 2:
In case of x-rays, a radiation beam is passed through the back to produce two-dimensional pictures of the client.
Option 3:
EMG is a test to measure the electrical impulses within the muscle tissue.
Option 4:
An opaque dye is injected into suspected disks, pictures are taken, and the patient reaction and image help determine the disc’s status.

Question 24

Which is considered to be a malignant central nervous system (CNS) tumor?

1. Ependymoma
2. Schwannoma
3. Sarcoma
4. Neurofibroma

Answer 24

3

Option 1:
An ependymoma is considered the most benign CNS tumor.
Option 2:
A schwannoma is a benign tumor.
Option 3:
A sarcoma is considered a malignant CNS tumor.
Option 4:
A neurofibroma is usually a benign tumor in nature.

Question 25

A paralytic ileus is a complication related to which kind of spinal cord injury?

1. Cardiovascular
2. Gastrointestinal
3. Neurologic
4. Musculoskeletal

Answer 25

2

Option 1:
Hypotension, bradycardia, and decreased cardiac output are complications related to the cardiovascular system, but not paralytic ileus.
Option 2:
Paralytic ileus is a spinal cord injury complication related to the gastrointestinal system.
Option 3:
Paralysis, contracture, and spasticity are neurologic complications, but not paralytic ileus.
Option 4:
Musculoskeletal complications include muscle atrophy, but not paralytic ileus.

Question 26

Which are the largest avascular structures in the body?

1. Coccyx
2. Nucleus pulposus
3. Annulus fibrosus
4. Intervertebral discs

Answer 26

4

Option 1:
The coccyx is one of the five sections of vertebrae.
Option 2:
The central or inner portion of the intervertebral discs is called the nucleus pulposus. This portion is made of softer, spongier material.
Option 3:
The outer layer of the intervertebral discs is called the annulus fibrosus. The annulus fibrosus are concentric rings of tough fibrous tissue.
Option 4:
The intervertebral discs are the largest avascular structures in the body.

Question 27

Which is the outermost layer of the spinal meninges called?

1. Pia mater
2. Axons
3. Arachnoid
4. Dura mater

Answer 27

Option 1:
The pia mater comprises the innermost layer of the spinal meninges.
Option 2:
Axons are the long, thin nerve cell extensions that carry impulses away from the cell body.
Option 3:
The arachnoid forms the middle layer of the spinal meninges.
Option 4:
The outermost layer of the spinal meninges is called the dura mater.

Question 28

Which medication belongs to the opioid class?

1. Cardisoprodol
2. Metazalone
3. Codeine
4. Diazepam

Answer 28

3

Option 1:
Cardisoprodol belongs to the class of muscle relaxants.
Option 2:
Metazalone is a muscle relaxant, required to depress the central nervous system.
Option 3:
Codeine belongs to the opioid class of medication.
Option 4:
Diazepam belongs to the class of muscle relaxants.

Question 29

Which NSAID is used for treating lower-back pain?

1. Prednisone
2. Cardisoprodol
3. Codeine
4. Ketolorac tromethamine

Answer 29

4

Option 1:
Prednisone falls under the corticosteroids class of medication. This medication is used for treating lower-back pain.
Option 2:
Cardisoprodol is a muscle relaxant used for treating lower-back pain.
Option 3:
Codeine belongs to the opioid class of medication, which is used for treating lower-back pain.
Option 4:
Ketolorac tromethamine is an NSAID that treats lower-back pain.

Question 30

Which diagnostic test is optimal for detecting soft tissue damage of the discs between the vertebrae and ligaments?

1. Magnetic resonance imaging (MRI)
2. Electromyography
3. Discogram
4. Computed tomography

Answer 30

1

Option 1:
MRI is optimal for detecting soft tissue damage of the discs between vertebrae and ligaments.
Option 2:
Electromyography is a test that indicates if there is old nerve damage that is healing.
Option 3:
Discogram helps determine the disc status in the client.
Option 4:
Computed tomography, or CT scan, is a diagnostic test that is optimal for visualizing bony structures.

Question 31

Which condition refers to the constriction of the spinal foramina and canals?

1. Axial loading
2. Herniation
3. Spinal stenosis
4. Spinal degeneration

Answer 31

3

Option 1:
Axial loading involves every mechanism of hyperextension, hyperflexion, rotation and vertical compression.
Option 2:
Herniation is called the leaking of interior disc contents into the vertebral areas.
Option 3:
Spinal stenosis refers to constriction of the spinal foramina and canals.
Option 4:
Spinal degeneration is characterized by decreasing water content from the disk nucleus. For this reason, the fibers of the annulus begin to wear out

Question 32

The nurse is obtaining an admission health history for a client who smokes 35 packs of cigarettes per year. Which condition is the client most likely to experience due to this cigarette use?

1. Loss of normal structure and function of the spine
2. Decreased absorption of vital nutrients by the intervertebral discs
3. Chronic inflammation caused by congenital abnormalities in the spine
4. Pressure on the spinal cord and nerve roots because of constriction of the spinal foramina and canals

Answer 32

2

Option 1:
Loss of normal structure and function of the spine is often associated with aging, referred to as spinal degeneration.
Option 2:
Nicotine in cigarettes is thought to interfere with vital nutrients being absorbed by the intervertebral discs, causing low back pain.
Option 3:
Chronic inflammation may be due to abnormal growth of the bones and ligaments of the spine caused by congenital abnormalities in the spine, arthritis, or some other forms.
Option 4:
Pressure on the spinal cord and nerve roots because of constriction of the spinal foramina and canals results in pain and is referred to as spinal stenosis.

Question 33

A client involved in an auto accident has severe spinal cord injuries. If the client is having difficulty with diaphragmatic breathing, which level of the spinal cord is injured?

1. C1 to C4
2. C6 to C7
3. T1 to T12
4. Below L1

Answer 33

2

Option 1:
An injury at the C1 to C4 level of the spinal cord is associated with functional loss associated with loss of spontaneous respiratory function.
Option 2:
The injury at the C6 to C7 level of the spinal cord is associated with functional loss associated with difficulty in diaphragmatic breathing.
Option 3:
The functional loss associated with injury at the T1 to T12 level of the spinal cord is paraplegic with varying loss of intercostal and abdominal muscle function.
Option 4:
The functional loss associated with injury at the level below L1 (cauda equina injury) is variable motor and sensory loss in the lower extremities and a reflexive bowel and bladder.

Question 34

While examining a client with brain swelling, the RN notices a decreased heart rate and an irregular respiration pattern. Which type of cerebral herniation does this most likely indicate?

1. Uncal herniation
2. Cingulate herniation
3. Tonsillar herniation
4. Subfalcine herniation

Answer 34

Option 1:
Signs and symptoms of uncal herniation include unilateral dilated pupil and contralateral motor weakness.
Option 2:
In cingulate or subfalcine herniation, there are no specific symptoms.
Option 3:
The nurse anticipates that the client has tonsillar herniation. The symptoms are decreased heart rate and irregular respiratory pattern (Cushing’s triad).
Option 4:
In subfalcine or cingulate herniation, there are no specific symptoms.

Question 35

Which ones are muscle relaxants? Select all that apply

1. Cardisoprodol
2. Metazalone
3. Codeine
4. Diazepam

Answer 35

1, 3, 4

Option 1:
Cardisoprodol belongs to the class of muscle relaxants.
Option 2:
Metazalone is a muscle relaxant, required to depress the central nervous system.
Option 3:
Codeine belongs to the opioid class of medication.
Option 4:
Diazepam belongs to the class of muscle relaxants.