Trauma Nurse Core Course (TNCC) Practice Exam

What clinical signs accompany hypotension in a patient with complete spinal cord injury in neurogenic shock?

1. Bradycardia and ipsilateral absence of motor function

2. Tachycardia and respiratory depression

3. Tachycardia and absent motor function below the level of injury

4. Bradycardia and absent motor function below the level of injury

The correct answer is: Bradycardia and absent motor function below the level of injury

In a patient experiencing neurogenic shock as a result of a complete spinal cord injury, bradycardia and absent motor function below the level of injury are key clinical signs. Neurogenic shock occurs due to disruption of sympathetic outflow from the spinal cord, which leads to widespread vasodilation and, consequently, hypotension. Bradycardia is particularly notable because, unlike other forms of shock, where tachycardia might be expected as a compensatory response, the loss of sympathetic tone in neurogenic shock often results in a slower heart rate. This is caused by unopposed vagal tone, particularly if the injury is at or above the cervical level. Additionally, in the context of a complete spinal cord injury, motor function below the level of the injury is absent, consistent with the characteristics of complete cord lesions. This paralysis—including the loss of voluntary and reflex actions—further supports the presentation of neurogenic shock. Overall, the combination of bradycardia and absent motor function below the level of injury effectively illustrates the clinical manifestations associated with hypotension in neurogenic shock due to spinal cord injury.