A client is admitted with gastrointestinal (GI) bleeding and a flat plate of the abdomen reveals an orange-sized mass in the stomach. After identifying the mass upon palpation of the abdomen, which location should the nurse document this finding?

Choice A reason: Mixed sensorineural-conductive hearing loss involves both inner ear and middle ear pathology. Ototoxic medications primarily damage cochlear hair cells, causing sensorineural loss. Mixed loss requires dual mechanisms (e.g., infection and ototoxicity), which are less likely than pure sensorineural loss from medication in this acute scenario.

Choice B reason: Presbycusis is age-related sensorineural hearing loss, not medication-induced. Ototoxic drugs cause acute, bilateral sensorineural loss by damaging cochlear hair cells, unrelated to aging. The client’s new onset loss linked to medication points to ototoxicity, not presbycusis, making this an incorrect type for this scenario.

Choice C reason: Conductive hearing loss results from middle ear or external ear issues, like wax or ossicle damage. Ototoxic medications target inner ear hair cells, causing sensorineural loss. Conductive loss is unrelated to ototoxicity, as drugs do not affect sound conduction, making this incorrect for medication-induced hearing loss.

Choice D reason: Sensorineural hearing loss is caused by ototoxic medications, which damage cochlear hair cells or auditory nerves, impairing sound processing. Bilateral, new-onset loss aligns with ototoxicity’s pathophysiology, as seen with drugs like aminoglycosides. This is the expected type, supported by audiology evidence linking ototoxins to inner ear damage.

Choice A reason: Hypertension increases cardiac workload, causing left ventricular hypertrophy and eventual heart failure. Chronic high blood pressure impairs the heart’s pumping ability, a leading cause of HF in older adults. This history is strongly associated with HF development, per cardiovascular pathophysiology evidence.

Choice B reason: Renal lithiasis (kidney stones) causes pain or obstruction but is not directly linked to heart failure. While renal issues may complicate HF management, lithiasis itself does not strain the heart or cause HF, making it irrelevant to the client’s HF development history.

Choice C reason: Atrial fibrillation reduces cardiac efficiency by impairing atrial contraction, decreasing cardiac output, and increasing HF risk. In older adults, it can cause tachycardia-induced cardiomyopathy, exacerbating HF. This arrhythmia is a significant contributor to HF, supported by cardiology evidence.

Choice D reason: Emphysema, a COPD form, causes pulmonary hypertension and right heart strain, leading to right-sided HF (cor pulmonale). Chronic hypoxia from emphysema exacerbates cardiac stress, contributing to HF in comorbid patients, making it a relevant historical factor for HF development.

Choice E reason: Gouty arthritis involves uric acid crystal deposition, causing joint inflammation but not cardiac strain. While linked to metabolic syndrome, it does not directly cause HF. Other factors like hypertension are more directly associated, making gout irrelevant to HF development in this client.