Aug. 07 -NCLEX Daily Practice Questions

August 07, 2024

Wednesday

 

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A client with massive trauma and possible spinal cord injury is admitted to the emergency department following a motorcycle collision. Which assessment finding leads the nurse to suspect neurogenic shock?

Apical heart rate 48/min

Blood pressure 186/92 mm Hg

Cool, clammy skin

Temperature 100 F (37.8 C)

Neurogenic shock belongs to the group of distributive (vasodilatory) shock. Parasympathetic nervous system (PNS) activity, which is directed from the brain through the vagus nerve (cranial nerve X), includes relaxing smooth muscle tone (eg, blood vessels) and decreasing heart rate and contractility. Sympathetic nervous system (SNS) activity, which normally balances the PNS, is communicated from the spinal cord. In neurogenic shock, a cervical or thoracic injury (or spinal anesthesia) disrupts the SNS, leading to bradycardia (eg, apical heart rate 48/min), massive vasodilation, and pooling of blood in the venous circulation (Option 1).

(Option 2) Massive vasodilation from neurogenic shock causes hypotension, not hypertension.

(Option 3) In neurogenic shock, vasodilation in the skin brings blood closer to the surface, causing the skin to be warm and dry initially. Cool, clammy skin is characteristic of other types of shock that involve impaired perfusion in the skin (eg, cardiogenic, hypovolemic).

(Option 4) Neurogenic shock can cause impaired thermoregulation (poikilothermia), but this takes time to manifest. As heat from vasodilation in the skin is lost to the environment, the client's temperature begins to reflect the ambient temperature. Low-grade fever (eg, 100 F [37.8 C]) is not a characteristic manifestation.

Educational objective: Neurogenic shock (a form of distributive [vasodilatory] shock) causes a disruption in the function of the sympathetic, but not parasympathetic, nervous system. Bradycardia is a characteristic manifestation of neurogenic shock that occurs because parasympathetic activity causes a decrease in heart rate.

Neurogenic shock belongs to the group of distributive (vasodilatory) shock. Parasympathetic nervous system (PNS) activity, which is directed from the brain through the vagus nerve (cranial nerve X), includes relaxing smooth muscle tone (eg, blood vessels) and decreasing heart rate and contractility. Sympathetic nervous system (SNS) activity, which normally balances the PNS, is communicated from the spinal cord. In neurogenic shock, a cervical or thoracic injury (or spinal anesthesia) disrupts the SNS, leading to bradycardia (eg, apical heart rate 48/min), massive vasodilation, and pooling of blood in the venous circulation (Option 1).

(Option 2) Massive vasodilation from neurogenic shock causes hypotension, not hypertension.

(Option 3) In neurogenic shock, vasodilation in the skin brings blood closer to the surface, causing the skin to be warm and dry initially. Cool, clammy skin is characteristic of other types of shock that involve impaired perfusion in the skin (eg, cardiogenic, hypovolemic).

(Option 4) Neurogenic shock can cause impaired thermoregulation (poikilothermia), but this takes time to manifest. As heat from vasodilation in the skin is lost to the environment, the client's temperature begins to reflect the ambient temperature. Low-grade fever (eg, 100 F [37.8 C]) is not a characteristic manifestation.

Educational objective: Neurogenic shock (a form of distributive [vasodilatory] shock) causes a disruption in the function of the sympathetic, but not parasympathetic, nervous system. Bradycardia is a characteristic manifestation of neurogenic shock that occurs because parasympathetic activity causes a decrease in heart rate.

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Aug. 07 -NCLEX Daily Practice Questions