15 Spinal Cord Injury NCLEX Questions with Answers

Spinal cord injury (SCI) is one of the most complex and high-priority conditions tested on the NCLEX. Because it involves neurological, respiratory, musculoskeletal, cardiovascular, and even psychosocial systems, students must integrate knowledge from multiple areas of nursing. The NCLEX often uses SCI scenarios to assess a candidate’s ability to prioritize care, prevent complications, and apply clinical judgment. This guide provides 15 spinal cord injury NCLEX questions with rationales, as well as a review of causes, symptoms, nursing interventions, complications, and exam strategies. By the end, you will feel more confident in approaching SCI questions and applying critical thinking under exam conditions.

What is Spinal Cord Injury?

A spinal cord injury occurs when trauma, disease, or degenerative changes disrupt the normal transmission of nerve signals between the brain and the rest of the body. This results in partial or complete motor and sensory loss below the level of injury.

Causes of Spinal Cord Injury

NCLEX emphasizes both traumatic and non-traumatic causes:

• Traumatic causes: motor vehicle accidents, falls, sports injuries, gunshot wounds, violence.

• Non-traumatic causes: tumors, infections (spinal abscess, meningitis), degenerative diseases, vascular ischemia.

Levels of Spinal Cord Injury

• Cervical: high risk for respiratory compromise (phrenic nerve involvement, diaphragm paralysis).

• Thoracic: affects trunk control and autonomic regulation.

• Lumbar/Sacral: bowel, bladder, and mobility issues.

Types of Spinal Cord Injury

• Complete injury: total loss of motor and sensory function below the level of injury.

• Incomplete injury: some function preserved (Brown-Séquard, anterior cord, central cord syndromes).

Common Symptoms of Spinal Cord Injury

Recognizing early manifestations is crucial:

• Loss of movement or paralysis below injury site

• Numbness, tingling, or sensory loss

• Respiratory difficulty (especially cervical injury)

• Hypotension and bradycardia (neurogenic shock)

• Loss of bowel and bladder control

• Risk for autonomic dysreflexia (sudden hypertension, bradycardia, headache, flushing, diaphoresis)

Nursing Care Priorities in Spinal Cord Injury

NCLEX frequently tests ABC priorities, safety, and complication management:

1. Airway and breathing support: cervical injury patients may need intubation or ventilator support.

2. Immobilization: cervical collar, log-rolling, spinal precautions.

3. Circulation monitoring: watch for neurogenic or spinal shock.

4. Preventing secondary injury: corticosteroids (controversial), stabilization surgery.

5. Skin integrity: frequent repositioning, pressure ulcer prevention.

6. Bladder and bowel care: intermittent catheterization, bowel program.

7. Psychosocial support: coping, anxiety reduction, rehabilitation education.

Complications of Spinal Cord Injury

• Spinal shock: loss of reflexes and flaccid paralysis immediately after injury.

• Neurogenic shock: hypotension, bradycardia, warm/dry skin (loss of sympathetic tone).

• Autonomic dysreflexia: life-threatening emergency (triggered by bladder distention, fecal impaction).

• Respiratory failure: especially in cervical injuries.

• Pressure injuries: immobility complications.

• Urinary tract infections: due to neurogenic bladder.

15 Spinal Cord Injury NCLEX Questions with Rationales

Question 1

A client with a C5 spinal cord injury suddenly develops severe hypertension, bradycardia, and a pounding headache. Which action should the nurse take first?

• A. Administer antihypertensive medication

• B. Sit the client upright and check for bladder distention

• C. Notify the healthcare provider

• D. Loosen restrictive clothing

Answer: B.
This is autonomic dysreflexia. Immediate action is to relieve the trigger, usually bladder distention. Antihypertensives may be given later, but removing the cause resolves the problem faster.

Question 2

The nurse is caring for a client in spinal shock. Which finding is expected?

• A. Spastic paralysis

• B. Loss of reflexes below injury level

• C. Severe muscle spasms

• D. Hypertension and tachycardia

Answer: B.
Spinal shock = temporary flaccid paralysis and areflexia below injury.

Question 3

A newly admitted client with cervical SCI has weak cough effort. What is the priority nursing intervention?

• A. Suction airway as needed

• B. Position flat to maintain alignment

• C. Encourage deep breathing exercises only

• D. Place in Trendelenburg

Answer: A.
Airway clearance is priority. Suctioning prevents respiratory failure.

Question 4

Which finding indicates neurogenic shock?

• A. Cool, clammy skin and tachycardia

• B. Warm, dry skin and bradycardia

• C. Hypertension and bounding pulse

• D. Increased reflex activity

Answer: B.
Loss of sympathetic tone → hypotension, bradycardia, warm/dry skin.

Question 5

A patient with SCI reports severe throbbing headache. BP is 200/110. The nurse suspects autonomic dysreflexia. What should the nurse do first?

• A. Check bladder catheter for kinks

• B. Administer morphine

• C. Place in supine position

• D. Increase IV fluids

Answer: A.
The most common cause is bladder distention. Always check the catheter first.

Question 6

Which intervention prevents pressure ulcers in SCI patients?

• A. Encourage high fluid intake

• B. Reposition every 2 hours

• C. Avoid use of pressure relief devices

• D. Limit mobility exercises

Answer: B.
Turning/repositioning is essential.

Question 7

What is the priority assessment for a patient with cervical SCI?

• A. Bowel sounds

• B. Respiratory effort

• C. Skin temperature

• D. Mobility strength

Answer: B.
Respiratory compromise is the most immediate risk.

Question 8

The nurse prepares to insert a urinary catheter in a T6 SCI patient. Which precaution reduces risk of autonomic dysreflexia?

• A. Pre-medicate with atropine

• B. Ensure catheter is lubricated and patent

• C. Avoid catheterization completely

• D. Use cold sterile water for balloon inflation

Answer: B.
Smooth catheterization prevents bladder trauma, reducing triggers.

Question 9

Which statement by a SCI patient indicates understanding of bowel care teaching?

• A. “I will drink less water to avoid accidents.”

• B. “I will follow a scheduled bowel program.”

• C. “I should avoid fiber-rich foods.”

• D. “I will limit activity after meals.”

Answer: B.
Scheduled bowel program with fluids and fiber maintains control.

Question 10

During rehab, the SCI patient says, “I’ll never be able to live independently.” Which nursing response is therapeutic?

• A. “Don’t worry, things will get better soon.”

• B. “You seem worried about your independence.”

• C. “You should focus on positive outcomes.”

• D. “That’s not true, you will regain full mobility.”

Answer: B.
Reflecting feelings supports coping.

Question 11

Which drug class is sometimes used acutely in SCI to reduce inflammation?

• A. Steroids

• B. Antibiotics

• C. Antidepressants

• D. Anticoagulants

Answer: A.
High-dose corticosteroids may be used (though controversial).

Question 12

In the acute phase of SCI, what is the nurse’s highest priority?

• A. Pain management

• B. Maintaining spinal alignment

• C. Promoting mobility

• D. Psychological support

Answer: B.
Preventing further spinal cord damage is critical.

Question 13

Which complication requires immediate intervention?

• A. Constipation

• B. Urinary tract infection

• C. Autonomic dysreflexia

• D. Muscle spasms

Answer: C.
AD is a life-threatening emergency.

Question 14

Which discharge teaching is most important for SCI patients?

• A. Avoid high-protein diet

• B. Report signs of urinary retention immediately

• C. Reduce fluid intake to prevent infections

• D. Stay on bed rest permanently

Answer: B.
Neurogenic bladder issues can trigger AD and infections.

Question 15

Which rehab goal best reflects effective nursing care for SCI?

• A. Patient avoids all activity to prevent reinjury

• B. Patient participates in self-care within ability level

• C. Patient refuses adaptive devices

• D. Patient focuses only on cure

Answer: B.
Promoting independence is key in rehab.

NCLEX Exam Strategies for Spinal Cord Injury

• Always prioritize airway and breathing in cervical SCI scenarios.

• Recognize life-threatening complications (autonomic dysreflexia, neurogenic shock).

• Apply Maslow’s hierarchy and ABCs when prioritizing.

• Expect NCLEX to test on immobility complications: skin breakdown, DVT, UTIs.

• Practice select-all-that-apply (SATA) for multi-system issues.

• Review related conditions: hypovolemic shock, multiple trauma, respiratory failure.

Preparation Tips for NCLEX Students

1. Use case studies: SCI often appears in scenario-based format.

2. Master neuro terms: differentiate spinal shock vs neurogenic shock.

3. Practice SATA and priority questions.

4. Review pharmacology: steroids, muscle relaxants, anticoagulants.

5. Understand rehabilitation goals: independence, skin care, bladder/bowel management.

6. Simulate time pressure: NCLEX tests decision-making, not memorization.

Final Comments

Spinal cord injury is a high-yield topic for NCLEX because it integrates neurological, cardiovascular, respiratory, musculoskeletal, and psychosocial care. By understanding causes, symptoms, complications, and nursing priorities, students can master SCI questions confidently.

The 15 spinal cord injury NCLEX questions with rationales provided here reflect the test’s emphasis on safety, critical thinking, and prioritization. With consistent practice and review of related care plans, NCLEX candidates can improve their readiness and ensure safe, effective nursing practice for SCI patients.