Prolonged aspirin therapy can cause ototoxicity, meaning damage to the ear that affects hearing. Salicylates accumulate in the inner ear and disrupt cochlear function, leading to bilateral hearing loss and often accompanying tinnitus. This effect tends to be dose-related and is usually reversible after stopping or reducing the dose. Early signs to watch for are tinnitus and muffled hearing, especially in people taking high-dose or long-term aspirin. The other options don’t fit this typical adverse effect: weight changes and fine motor tremors aren’t characteristic of aspirin toxicity, and while aspirin can influence acid-base balance in overdose, prolonged use most notably risks hearing loss rather than respiratory acidosis.

The nursing process follows a logical sequence that starts with gathering data and ends with evaluating outcomes. You begin with a thorough assessment to collect subjective and objective information about the patient. Without this data, you can’t accurately identify problems. After assessment, you form nursing diagnoses that articulate actual or potential health problems based on the data. Then you move to planning, where you set goals and choose interventions to address the diagnosed problems. Next is implementation, where the planned interventions are carried out. Finally, evaluation measures whether the goals were achieved and determines whether the plan should be continued, adjusted, or terminated. This sequence—Assessment, Diagnosis, Planning, Implementation, Evaluation—keeps care data-driven and results-focused. Orders that place planning before diagnosis, or implementation before planning, or evaluation before having a plan or outcomes to assess, don’t fit the process.

In leukemia, anemia happens because the marrow is overtaken by proliferating white cells, which crowd out red blood cell precursors. This reduces erythropoiesis, so fewer red blood cells are made even though white blood cell production is high. The problem isn’t that red cells die faster; it’s that they aren’t produced in enough numbers due to marrow crowding by leukemic cells.

Elevated levels of acid phosphatase reflect activity of the prostate. Prostatic acid phosphatase (PAP) is an enzyme produced by prostate cells, and its levels in the blood can rise with prostate cancer, especially with bone metastases. This marker was used historically to help indicate prostate cancer and monitor response to treatment, though it’s been largely superseded by PSA today. The other options point to different cancers or conditions: calcitonin is associated with medullary thyroid carcinoma; alkaline phosphatase rises with bone or liver disease in general; CEA is a marker for colorectal and several other cancers. Thus, elevated acid phosphatase is the best indicator among these for prostate cancer.