A client who is receiving chemotherapy for breast cancer is experiencing myelosuppression as a side effect of the treatment. Which of the following is a manifestation directly related to myelosuppression?

A. Otitis media is an infection or inflammation of the middle ear. This condition primarily affects the middle ear structures and can cause conductive hearing loss, which is due to problems with sound transmission through the outer or middle ear.
B. An injury to the eardrum, such as a perforation, can lead to conductive hearing loss. This occurs because the eardrum (tympanic membrane) is crucial for transmitting sound waves from the outer ear to the middle ear. While an eardrum injury affects sound transmission, it does not directly damage the inner ear or auditory nerve, so it does not typically cause sensorineural hearing loss.
C. Exposure to loud noise is a common cause of sensorineural hearing loss. Prolonged or intense noise exposure can damage the sensory hair cells in the cochlea or the auditory nerve pathways, leading to permanent hearing loss. This type of hearing loss is due to damage in the inner ear or auditory nerve rather than the outer or middle ear structures.
D. Impacted earwax can cause conductive hearing loss by blocking sound transmission through the ear canal. This type of hearing loss is due to a blockage and is usually reversible once the wax is removed. It does not cause sensorineural hearing loss, which involves damage to the inner ear or auditory nerve.

Muscle hypertrophy (increase in muscle size) is not a typical manifestation of ALS. In fact, ALS leads to muscle atrophy (wasting) rather than hypertrophy. As motor neurons degenerate, muscles become weaker and smaller because they are no longer receiving adequate nerve signals to maintain strength.
B.A Tinnitus (ringing in the ears) is not a common manifestation of ALS. ALS primarily affects motor neurons and does not usually cause auditory symptoms. Tinnitus is more related to other conditions such as ear infections, exposure to loud noises, or certain neurological conditions, but it is not associated with ALS.
C. Tripping or stumbling is a common manifestation of ALS. As the disease progresses, it causes weakness in the muscles responsible for maintaining balance and coordination. This can lead to difficulties with walking and increased risk of tripping or falling.
D. Confusion is not a typical symptom of ALS. ALS primarily affects motor neurons, leading to muscle weakness and atrophy, but it does not usually affect cognitive function. However, in rare cases, some patients with ALS may develop cognitive or behavioral changes, but these are not the primary symptoms and are less common.
E. Dropping objects is a common manifestation of ALS. Muscle weakness and loss of fine motor control in the hands and arms can make it difficult to hold or manipulate objects, leading to frequent dropping.