The nurse is caring for a client who has been diagnosed with primary hypertension. Which pathophysiological mechanism does the nurse recognize as the cause of primary hypertension?

Choice A reason: Acute lymphoblastic leukemia (ALL) is an aggressive malignancy of lymphoid cells, often achieving complete remission with intensive chemotherapy, especially in children. Suppression without remission is not typical, as ALL responds well to treatment, targeting rapidly dividing blast cells. CLL, a slower-progressing disease, better fits the description of suppression without complete cure.

Choice B reason: Chronic lymphocytic leukemia (CLL) is a low-grade malignancy of mature B-lymphocytes, often managed with chemotherapy to suppress disease progression rather than achieve complete remission. CLL’s indolent nature means it can be controlled, but residual disease persists due to slow cell turnover, aligning with the question’s description of suppression.

Choice C reason: Acute myelogenous leukemia (AML) is an aggressive malignancy of myeloid cells, requiring intensive chemotherapy or stem cell transplant for potential remission. Suppression without remission is less common, as AML treatment aims for complete response. CLL’s chronic nature makes it more likely to result in disease control rather than cure.

Choice D reason: Hairy-cell leukemia is a rare, indolent B-cell malignancy highly responsive to purine analogs, often achieving long-term remission or near-cure. Suppression without remission is not characteristic, as treatment typically yields durable responses. CLL’s partial response to chemotherapy better matches the scenario of ongoing disease suppression.

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.