patient has sustained a C5 spinal cord injury. Which of the following is the most immediate life-threatening… - AIIMS M.Sc. Nsg Entrance exam-2026

AIIMS M.Sc. Nsg Entrance exam-2026

Medical & Surgical Nursing

Hard

Appeared in: AIIMS M.Sc. Nsg Entrance exam-2026

Explanation

A C5 spinal cord injury directly impacts the phrenic nerve, which originates from the C3, C4, and C5 spinal roots.
The phrenic nerve provides the sole motor innervation to the diaphragm, the primary muscle responsible for inspiration.
Damage to this nerve leads to diaphragmatic paralysis or weakness, causing inadequate ventilation and rapid progression to respiratory failure.
According to the Airway, Breathing, Circulation (ABC) framework of emergency care, addressing compromised breathing is a top and immediate priority, making respiratory failure the most imminent life-threatening complication.

Option A: Autonomic dysreflexia is a serious complication, but it is not the most immediate one. It typically occurs after the initial phase of spinal shock has resolved, often days to weeks after the injury.
Option C: Neurogenic shock is a life-threatening circulatory failure that occurs immediately after injury. However, complete cessation of breathing (respiratory arrest) is more rapidly fatal than the hypotension and bradycardia of neurogenic shock.
Option D: Plantar flexion deformity, or foot drop, is a long-term musculoskeletal complication that develops over time due to muscle spasticity and immobility.

Visual 1: Diagram - An illustration showing the cervical spine and the path of the phrenic nerve (originating from C3-C5) down to the diaphragm. This helps visualize why a C5 injury is critical for breathing.
Visual 2: Flowchart - A simple flowchart of the ABC (Airway, Breathing, Circulation) assessment priorities in an emergency setting, highlighting that 'Breathing' is addressed immediately after 'Airway'.

Clinical Relevance

Nursing practice connection: Use the key finding related to Acute complications of cervical spinal cord injury to guide bedside assessment, documentation, and the next nursing action.
For any patient with a suspected cervical spine injury, the nurse's first and most critical action is to assess respiratory status, including rate, depth, and effort. Be prepared for immediate ventilatory support.
Monitoring for signs of ascending spinal cord edema is crucial in the acute phase, as an injury at C5 can swell upwards, further compromising C3 and C4 and leading to complete respiratory arrest.
What if? If the injury was at the L1 level (lumbar spine), respiratory failure due to diaphragmatic paralysis would not be a concern. The immediate life-threatening priorities would shift to neurogenic shock (Circulation) and managing paralysis of the lower body, along with bowel and bladder dysfunction.

How to Approach the Question

First, identify the key elements of the question: a specific injury location (C5 spinal cord) and a specific timeframe (most immediate life-threatening complication).
Next, apply the fundamental principle of emergency nursing prioritization: Airway, Breathing, Circulation (ABC).
Recall the anatomy and physiology related to the C5 level. The phrenic nerve, which controls the diaphragm, originates from C3-C5.
Evaluate each option based on the ABC framework and the C5 injury location.
Option A (Autonomic dysreflexia) is a later complication. Option D (Plantar flexion) is a long-term issue. Option C (Neurogenic shock) relates to 'Circulation'. Option B (Respiratory failure) relates to 'Breathing'.
Conclude that since 'Breathing' is a higher priority than 'Circulation' in the ABCs, and a C5 injury directly affects the primary muscle of breathing, respiratory failure is the most immediate threat.

Concept Tested & Keywords

Concept Tested: Acute complications of cervical spinal cord injury
Stem keywords: C5 spinal cord injury, immediate, life-threatening complication
Lead-in keywords: most
Clinical cues: Injury at C5 level is a critical cue pointing towards compromised diaphragmatic function.

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