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Nervous, Respiratory and Cardiovascular Systems

Traumatic Brain and Spinal Cord Injury Practice Questions

20 free Traumatic Brain and Spinal Cord Injury practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.

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Question 1 of 20 Medium

What is the most urgent respiratory concern in a patient with high cervical spinal cord injury at C2-C3?

  1. A Mild transient dyspnoea that resolves quickly
  2. B Loss of diaphragmatic and intercostal function needing ventilatory support
  3. C Numbness limited to both upper extremities
  4. D An increase in effective cough strength

Correct answer: Loss of diaphragmatic and intercostal function needing ventilatory support

Injuries at the C2-C3 level impair the phrenic nerve and diaphragmatic control, leading to respiratory failure and the need for ventilation.

Question 2 of 20 Hard

What does a Glasgow Coma Scale (GCS) score ≤ 8 indicate in a severe Traumatic Brain Injury (TBI) patient?

  1. A Mild brain injury
  2. B Moderate brain injury
  3. C Severe brain injury, often needing intubation
  4. D No significant brain injury

Correct answer: Severe brain injury, often needing intubation

A GCS ≤ 8 indicates severe TBI and the possible need for intubation and critical care monitoring.

Question 3 of 20 Medium

A patient with an SCI at T6 develops hypertension with bradycardia, headache, and flushing above the level of injury. What should be the nurse's first response?

  1. A Lower the head of the bed and notify the physician
  2. B Suspect autonomic dysreflexia, sit the patient upright, remove the noxious stimulus
  3. C Administer a rapid intravenous fluid bolus
  4. D Apply cold compresses to the patient's feet

Correct answer: Suspect autonomic dysreflexia, sit the patient upright, remove the noxious stimulus

Autonomic dysreflexia occurs in SCI at T6 or higher triggered by noxious stimuli below the injury, requiring immediate intervention to sit upright and remove trigger.

Question 4 of 20 Medium

Which sign may indicate an increase in intracranial pressure (ICP) in the acute phase following a Traumatic Brain Injury (TBI)?

  1. A Stable vital signs with no reported headache
  2. B Widening pulse pressure, bradycardia, irregular respirations (Cushing's triad)
  3. C Isolated tachycardia without other changes
  4. D Hypotension accompanied by tachypnea

Correct answer: Widening pulse pressure, bradycardia, irregular respirations (Cushing's triad)

Cushing’s triad—hypertension with wide pulse pressure, bradycardia and irregular respirations—signals increased ICP and possible brain herniation.

Question 5 of 20 Medium

How long does the spinal shock phase typically last in a patient after SCI at T6?

  1. A Only a few hours after the injury
  2. B Days to weeks, ending as reflexes begin to return
  3. C It is permanent and never resolves
  4. D Only a few minutes after the injury

Correct answer: Days to weeks, ending as reflexes begin to return

Spinal shock is temporary, lasting days to weeks, with loss of reflexes and tone; return of reflexes often marks its resolution.

Question 6 of 20 Hard

What does a unilateral dilated non-reactive pupil most strongly suggest when monitoring a patient with severe TBI?

  1. A It is a benign anatomical variation of no concern
  2. B Impending uncal herniation with cranial nerve III compression
  3. C An acute migraine headache without structural cause
  4. D A mild concussion with intact brainstem function

Correct answer: Impending uncal herniation with cranial nerve III compression

A dilated non-reactive pupil in TBI indicates impending uncal herniation and the need for urgent neurosurgical intervention.

Question 7 of 20 Medium

What nursing intervention is essential to prevent respiratory complications in an SCI patient?

  1. A Encourage shallow breathing to conserve energy
  2. B Deep breathing, assisted or mechanical cough, chest physiotherapy
  3. C Avoid all suctioning to reduce infection risk
  4. D Keep the patient supine at all times for stability

Correct answer: Deep breathing, assisted or mechanical cough, chest physiotherapy

SCI can impair cough and respiratory muscle strength leading to secretions and pneumonia; respiratory interventions like deep breathing are vital.

Question 8 of 20 Hard

What is the GCS score for a TBI patient who opens eyes to verbal command, is abnormal flexion to pain, and utters incomprehensible sounds?

  1. A 14
  2. B 8
  3. C 6
  4. D 10

Correct answer: 8

Eyes open to speech = 3, abnormal flexion (decorticate) to pain = 3, incomprehensible sounds = 2, giving a total GCS of 8, which indicates severe impairment in TBI.

Question 9 of 20 Medium

In the acute management of SCI, what is the priority according to nursing care?

  1. A Begin early ambulation as soon as possible
  2. B Immobilise the cervical spine and prevent secondary injury
  3. C Delay all imaging until the patient is fully stable
  4. D Treat pain only and defer neurologic assessment

Correct answer: Immobilise the cervical spine and prevent secondary injury

Preventing secondary injury by immobilisation, maintaining alignment, and monitoring neurological changes is a key priority in acute SCI management.

Question 10 of 20 Hard

When a TBI patient's intracranial monitoring shows ICP > 20 mmHg for an extended period, what is an appropriate nursing action?

  1. A Lower the head of the bed to a flat supine position
  2. B Keep the head midline, elevate to 30°, and maintain normocapnia
  3. C Intentionally raise CO₂ to promote cerebral vasodilation
  4. D Reduce sedation and allow frequent patient stimulation

Correct answer: Keep the head midline, elevate to 30°, and maintain normocapnia

Managing elevated ICP includes positioning (head elevation, midline), avoiding stimulation, and maintaining normal CO₂ levels.

Question 11 of 20 Medium

What functional change can be anticipated in an SCI patient with a complete injury at T12?

  1. A Loss of arm function with preserved leg movement
  2. B Paraplegia with bowel and bladder dysfunction, arms spared
  3. C Sensory loss only, with all motor function preserved
  4. D Fully intact bladder and bowel function

Correct answer: Paraplegia with bowel and bladder dysfunction, arms spared

Injury at T12 affects lower limbs and bowel/bladder function while sparing the upper extremities, characteristic of paraplegia.

Question 12 of 20 Medium

What does a GCS motor response of 'extension' to pain indicate in a TBI patient's assessment?

  1. A 6
  2. B 3
  3. C 5
  4. D 4

Correct answer: 3

GCS motor score: 6 = obeys commands, 5 = localises pain, 4 = withdraws, 3 = abnormal flexion (decorticate), 2 = extension (decerebrate); extension corresponds to a motor score of 3.

Question 13 of 20 Medium

Which hemodynamic pattern suggests neurogenic shock in an SCI patient?

  1. A Tachycardia with hypertension from sympathetic surge
  2. B Hypotension with bradycardia from lost sympathetic tone
  3. C Hypertension with bradycardia from a vagal response
  4. D Hypertension with tachycardia from catecholamine release

Correct answer: Hypotension with bradycardia from lost sympathetic tone

Neurogenic shock presents with hypotension, bradycardia, and warm skin due to loss of sympathetic tone following an SCI above T6.

Question 14 of 20 Hard

What does rhinorrhea with clear fluid following head trauma likely indicate in a TBI patient?

  1. A Possible CSF leak; check for the halo sign and notify the provider
  2. B Benign nasal discharge needing no further action
  3. C A confirmed sign of bacterial meningitis
  4. D Routine seasonal allergic rhinitis

Correct answer: Possible CSF leak; check for the halo sign and notify the provider

Clear fluid after head trauma may be CSF rhinorrhea, indicating a risk of basilar skull fracture and meningitis, requiring prompt evaluation.

Question 15 of 20 Hard

Which nursing intervention is NOT advisable to minimize secondary brain injury in a TBI patient?

  1. A Reposition every two hours and inspect skin, using pressure-relief surfaces
  2. B Reposition on a fixed schedule of every eight hours
  3. C Reposition only after visible skin changes appear
  4. D Avoid special surfaces to keep care cost-effective

Correct answer: Reposition every two hours and inspect skin, using pressure-relief surfaces

Inducing hypotension is contraindicated in TBI as it could compromise perfusion and worsen secondary brain injury.

Question 16 of 20 Medium

What is an essential nursing action to prevent pressure injuries in a wheelchair-bound SCI patient?

  1. A A normal pupillary finding expected after sedation
  2. B A sign of brainstem herniation requiring emergency care
  3. C A simple, transient change in the eyelid reflex
  4. D An expected response to instilled mydriatic eye drops

Correct answer: A sign of brainstem herniation requiring emergency care

Patients with SCI are at a high risk for pressure ulcers; frequent turning and pressure-relief surfaces are essential prevention strategies.

Question 17 of 20 Hard

What do bilateral fixed dilated pupils indicate in a TBI patient?

  1. A Skin care, pressure relief, bowel/bladder programs, and dysreflexia prevention
  2. B Permanent bedrest is required for the rest of life
  3. C Physical therapy is all that matters, not skin care
  4. D Routine blood pressure monitoring is unnecessary

Correct answer: Skin care, pressure relief, bowel/bladder programs, and dysreflexia prevention

Bilateral fixed dilated pupils in TBI often signify brainstem compression/herniation, requiring immediate neurosurgical intervention.

Question 18 of 20 Medium

What should be emphasized in the nurse's teaching during the rehabilitation phase after SCI?

  1. A Elevate head of bed 30 degrees, monitor ICP, and protect the craniectomy site
  2. B Keep the head of the bed flat at all times for comfort
  3. C Forgo neurological monitoring once the surgery is complete
  4. D Encourage vigorous passive neck movement right after surgery

Correct answer: Elevate head of bed 30 degrees, monitor ICP, and protect the craniectomy site

Rehabilitation after SCI includes teaching on skin integrity, bowel/bladder management, and recognizing autonomic dysreflexia for long-term care.

Question 19 of 20 Hard

How should a nurse appropriately care for a TBI patient who had a decompressive craniectomy?

  1. A Sit the patient upright, check the catheter for blockage, and monitor BP
  2. B Lay the patient flat and restrict their fluid intake
  3. C Administer an analgesic and continue routine monitoring
  4. D Reassure the patient as it will resolve without intervention

Correct answer: Sit the patient upright, check the catheter for blockage, and monitor BP

Post-craniectomy care involves head elevation to reduce ICP and protecting the surgical site with ongoing neuro checks.

Question 20 of 20 Medium

When a cervical SCI patient experiences pounding headache, blurred vision, and profuse sweating above the level of injury, what is the priority action if autonomic dysreflexia is suspected?

  1. A Lie the patient flat and restrict fluids
  2. B Sit patient upright, check urinary catheter for blockage, loosen clothing, monitor BP
  3. C Administer analgesic only
  4. D Ignore because it will resolve

Correct answer: Sit patient upright, check urinary catheter for blockage, loosen clothing, monitor BP

Autonomic dysreflexia is an emergency requiring upright positioning, removal of trigger, and vital sign monitoring to lower BP.

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