A client is in the acute phase of spinal shock following a spinal cord injury.
Which finding should the nurse expect?

Choice A rationale

The vestibular nerve, which is the eighth cranial nerve's vestibular branch, is primarily responsible for maintaining balance, equilibrium, and spatial orientation. Damage to this specific nerve would manifest as vertigo, dizziness, or nystagmus rather than a specific loss of hearing clarity or volume. Since the patient's complaint is focused entirely on auditory perception and the clarity of speech during conversation, vestibular nerve involvement is not the most likely pathophysiologic cause of these symptoms.

Choice B rationale

Presbycusis, or age-related hearing loss, typically involves the progressive degeneration of the hair cells within the organ of Corti in the cochlea. These hair cells are responsible for converting mechanical sound vibrations into electrical impulses. When they degrade, the patient often loses the ability to hear high-frequency sounds, making speech seem muffled or unclear. Increasing the television volume provides more acoustic energy to stimulate the remaining functional hair cells, which helps improve the clarity of the audio.

Choice C rationale

Degeneration of the auditory cortex in the brain would result in central auditory processing disorders rather than simple hearing loss. In such cases, the person might hear sounds at a normal volume but would be unable to interpret the meaning of those sounds or understand language correctly. Increasing the volume of a television would generally not resolve a cortical processing deficit, as the issue lies in the brain's interpretation of the signal rather than the ear's reception.

Choice D rationale

Obstruction of sound transmission refers to conductive hearing loss, which can be caused by cerumen impaction, fluid in the middle ear, or otosclerosis. In conductive loss, sound is muffled across all frequencies, but the clarity of the signal often remains intact if the volume is loud enough to bypass the obstruction. However, the specific complaint of difficulty hearing conversation despite being able to hear the television often points more toward sensory neural changes in the cochlea.

Choice A rationale

Restricting fluids would be contraindicated in a patient with adrenal insufficiency experiencing hypotension. These patients suffer from a profound deficit of mineralocorticoids, specifically aldosterone, which leads to massive urinary loss of sodium and water. Normal serum sodium is 135 to 145 mEq/L. The resulting hypovolemia requires aggressive fluid resuscitation with isotonic saline to restore circulating volume and blood pressure. Fluid restriction would worsen the cardiovascular collapse and exacerbate the Addisonian crisis.

Choice B rationale

Providing potassium supplements is dangerous because hyperkalemia is already present in adrenal insufficiency. Normal serum potassium is 3.5 to 5.0 mEq/L. Without aldosterone, the kidneys cannot effectively excrete potassium in exchange for sodium. Adding more potassium would increase the risk of life threatening cardiac arrhythmias or cardiac arrest. The clinical goal is to lower the potassium levels through volume expansion and corticosteroid replacement rather than increasing the total body potassium load.

Choice C rationale

Administering insulin is a temporary measure used to shift potassium from the extracellular fluid into the intracellular compartment. While it addresses the hyperkalemia, it does not treat the underlying cause of the crisis, which is a lack of cortisol and aldosterone. Furthermore, patients in adrenal crisis are often hypoglycemic due to glucocorticoid deficiency. Giving insulin without dextrose could cause fatal hypoglycemia. It is not the primary priority compared to replacing the missing hormones.

Choice D rationale

Administering intravenous hydrocortisone is the priority intervention because it provides both glucocorticoid and mineralocorticoid activity. This replacement therapy addresses the underlying hormonal deficit, helping to restore vascular tone, increase blood glucose levels, and promote the renal retention of sodium and excretion of potassium. By correcting the hormonal imbalance, hydrocortisone stabilizes the hemodynamics and electrolyte disturbances. This intervention is essential to reverse the life threatening systemic effects of an acute adrenal or Addisonian crisis.