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: 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: An incompetent lower esophageal sphincter causes GERD, leading to heartburn, not lower left quadrant pain or fever. Diverticulitis involves inflamed intestinal outpouchings, unrelated to esophageal function. This choice is incorrect, as it does not explain the client’s abdominal and systemic symptoms.

Choice B reason: Esophagitis from gastric reflux causes epigastric or chest pain, not lower left quadrant pain or fever. Diverticulitis results from inflamed diverticula in the colon, causing localized pain and infection. This choice is incorrect, as it misaligns with diverticulitis’s colorectal pathophysiology.

Choice C reason: A weakened diaphragm may cause hiatal hernia, leading to reflux symptoms, not lower left quadrant pain or fever. Diverticulitis involves colonic diverticula inflammation, unrelated to diaphragmatic issues. This choice is incorrect, as it does not account for the client’s localized abdominal presentation.

Choice D reason: Diverticulitis results from inflammation of diverticula, outpouchings at weak points in the intestinal wall, typically in the sigmoid colon. These become infected, causing lower left quadrant pain and fever. This mechanism directly supports the client’s presentation, aligning with gastrointestinal pathophysiology evidence.