Critical Care Registered Nurse (CCRN) Practice Exam

How does neurogenic shock typically present in patients with cervical spinal injuries?

1. Hypotension and tachycardia

2. Increased muscle tone and hypertension

3. Bradycardia and hypotension

4. Hypothermia and tachycardia

The correct answer is: Bradycardia and hypotension

Neurogenic shock is characterized primarily by the loss of sympathetic tone due to spinal cord injury, particularly in the cervical region. In this context, patients often present with bradycardia, which is a result of unopposed parasympathetic activity, and hypotension due to vasodilation and decreased systemic vascular resistance. The combination of these two findings—bradycardia and hypotension—effectively illustrates the cardiovascular disturbances associated with neurogenic shock. In cervical spinal injuries, especially at higher levels (C1-C3), the heart rate tends to decrease because the sympathetic pathways that control heart rate are disrupted. Meanwhile, the vasodilatory effect leads to a significant drop in blood pressure, as the blood vessels cannot constrict effectively to maintain vascular tone. This presentation differentiates neurogenic shock from other types of shock, such as hypovolemic or obstructive, which are typically associated with tachycardia due to compensatory mechanisms. Other options describe different physiological responses that are not characteristic of neurogenic shock. Increased muscle tone and hypertension do not occur as a feature because the disruption of sympathetic innervation leads to flaccid paralysis and vasodilation rather than increased muscle tone. Hypothermia and tachycardia are