Certified Medical-Surgical Registered Nurse Practice Exam

What findings would a nurse expect in a patient paralyzed below the T4 level?

1. Flaccidity of the upper extremities.

2. Hyperreflexia and spasticity of the upper extremities.

3. Impaired diaphragmatic function requiring ventilator support.

4. Independent use of upper extremities and efficient cough.

The correct answer is: Independent use of upper extremities and efficient cough.

In a patient with paralysis below the T4 level, the expected findings include significant functionality of the upper extremities. The T4 spinal cord level corresponds to the upper part of the thoracic region, and injury at or below this level generally spares the use of the arms and hands. Therefore, patients usually retain an independent ability to use their upper extremities. Additionally, patients at this level maintain an effective cough mechanism and do not typically require ventilator support, as the diaphragm is innervated at a level above T4 (primarily at C3-C5). This means that paralysis below T4 would not impede diaphragmatic function. In contrast, other answer choices reflect conditions that would not typically occur with a T4 or lower injury. For instance, flaccidity and hyperreflexia are not characteristic of patients who can still function with their upper extremities. Thus, independent use of the upper extremities while not being dependent on ventilatory support accurately reflects the condition of a patient paralyzed below the T4 level.