A client arrives to the emergency department after falling from a ladder. The client has a loss of sensation and flaccid paralysis. Which of the following complications of an acute spinal cord injury does the nurse suspect?

Choice A Reason: This is incorrect because encouraging coughing and deep breathing can increase intracranial pressure (ICP), which is the pressure inside

the skull that can affect brain function. Coughing and deep breathing can increase blood flow and oxygen demand to the brain, which can worsen cerebral edema. The nurse should suction the patient as needed and maintain a patent airway.

Choice B Reason: This is incorrect because positioning the patient with knees and hips flexed can increase ICP by reducing venous drainage from the head. The nurse should position the patient with neck and body in alignment and avoid extreme flexion or extension of any joints.

Choice C Reason: This is incorrect because performing nursing interventions once an hour can disturb the patient's sleep and increase ICP by stimulating brain activity. The nurse should cluster nursing interventions and provide quiet and dark environment to promote rest and reduce stress.

Choice D Reason: This is correct because keeping the head of the bed elevated to 30 degrees can decrease ICP by facilitating venous drainage from the head and reducing cerebral blood volume. The nurse should monitor the patient's blood pressure and pulse to ensure adequate cerebral perfusion.

Choice A reason: This is incorrect because applying the medication when you are experiencing eye pain can be ineffective or harmful for treating open-angle glaucoma. Open-angle glaucoma is a chronic condition that causes increased pressure inside the eye and damage to the optic nerve, which can lead to vision loss. Eye pain is not a common symptom of open-angle glaucoma, but rather an indication of acute angle closure glaucoma, which is a medical emergency that requires immediate treatment. The nurse should instruct the client to apply the medication as prescribed, regardless of pain level, and seek medical attention if they experience severe eye pain, headache, nausea, or blurred vision.
Choice B reason: This is incorrect because using the medication only until the intraocular pressure returns to normal can cause recurrence or worsening of open-angle glaucoma. Intraocular pressure is the pressure inside
the eye that can affect eye health and vision. Normal intraocular pressure ranges from 10 to 21 mmHg, but it can vary depending on age, time of day, or other factors. The nurse should instruct the client to monitor their intraocular pressure regularly and report any changes to their provider, but not to stop using
the medication without consulting their provider first.
Choice C reason: This is incorrect because using the medication for approximately 10 days, then gradually tapering off can cause rebound or adverse effects of open-angle glaucoma. The medication for open-angle glaucoma can be either beta-blockers, such as timolol, or cholinergic agents, such as pilocarpine, which work by reducing fluid production or increasing fluid drainage in the eye. The nurse should instruct the client to follow their provider's instructions on how long and how much to use the medication and not to change or discontinue it abruptly without their provider's approval.
Choice D reason: This is correct because applying the medication on a regular schedule for the rest of your life can help control and prevent the progression of open-angle glaucoma. Open-angle glaucoma is a lifelong condition that requires consistent and continuous treatment to maintain normal intraocular pressure and prevent vision loss. The nurse should instruct the client to apply the medication at the same time every day and not to miss or skip any doses. The nurse should also teach the client how to store, handle, and administer the medication properly and safely.