Which factor in the history of a client with diabetes mellitus increases the client’s risk for nephropathy?

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: Loss of metatarsal arch indicates flat feet, a musculoskeletal issue unrelated to osteoporosis. Osteoporosis involves reduced bone density, causing fractures and spinal deformities like kyphosis. Arch loss does not reflect bone loss or fragility, making it incorrect for osteoporosis’s pathophysiological process.

Choice B reason: An S-shaped curve to the back suggests scoliosis, a lateral spinal deformity unrelated to osteoporosis. Osteoporosis causes vertebral compression fractures, leading to kyphosis. Scoliosis is structural, not a result of bone density loss, making this incorrect for osteoporosis’s pathophysiological manifestation.

Choice C reason: Obesity is a risk factor for many conditions but not a direct indicator of osteoporosis. In fact, higher body weight may protect against bone loss. Osteoporosis involves bone density reduction, leading to kyphosis from fractures. Obesity does not reflect this process, making it incorrect.

Choice D reason: Severe kyphosis, a forward spinal curvature, results from vertebral compression fractures due to osteoporosis’s reduced bone density. This pathophysiological process weakens bones, causing fractures and spinal deformity, aligning with osteoporosis’s clinical presentation in older adults, per orthopedic and endocrinology evidence.