In cases of multiple myeloma the following alterations are frequently present, except:

Correct Answer: D

Rationale: Multiple myeloma features nitrogen retention (A renal failure), hypercalcemia (C bone lysis), proteinuria (D Bence-Jones), but not glucosuria glucose isn't excreted unless diabetic, unrelated to plasma cell dyscrasia. Hypoproteinemia (B) is rare hypergammaglobulinemia dominates. Glucosuria's absence is key, guiding nursing for renal function and calcium monitoring.

Correct Answer: D

Rationale: Anemia of hepatic disease blood loss, folate deficiency, alcohol (D) cause it (e.g., varices, poor diet, toxicity), yielding normocytic/macrocytic anemia. Iron block (A) is chronic. EPO (B) is renal. Normocytic (C) is effect. Multifactorial etiology is key, guiding nursing for liver function and folate.

Correct Answer: C

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: D

Rationale: A stab wound in the chest wall causing pneumothorax disrupts the negative intrapleural pressure (normally around -4 to -6 mmHg) that keeps the lungs expanded against the chest wall. When air enters the pleural space, this pressure equalizes with atmospheric pressure, eliminating the force holding the lung open. The lung, due to its elastic recoil, collapses inward toward the hilum, reducing its volume significantly. Conversely, the chest wall, with its outward elastic recoil, springs outward, expanding away from the lung. This results in the lung collapsing and the chest wall expanding, a classic feature of pneumothorax. The lung doesn't expand, as it loses the negative pressure tether, and the chest wall doesn't collapse, as its natural tendency is to spring outward when unrestrained. Other scenarios, like both expanding or fixing at FRC, don't reflect the mechanics of pleural pressure loss, making the collapse-expansion dynamic the expected outcome of such an injury.

Correct Answer: D

Rationale: Residual volume (RV) is the air remaining in the lungs after a maximal, forceful exhalation, typically 1-1.5 liters in adults. It prevents alveolar collapse and maintains gas exchange potential, measurable only indirectly (e.g., helium dilution). Tidal volume (VT) is the air moved in a normal breath (~500 ml), not after forceful effort. Expiratory reserve volume (ERV) is the extra air exhaled beyond a normal expiration (~1-1.5 L), expelled during forced exhalation, leaving RV behind. Vital capacity (VC) is the maximum air exhaled after maximal inhalation (ERV + VT + IRV, ~4-5 L), excluding RV. Inspiratory reserve volume (IRV) is additional air inhaled beyond a normal breath (~2-3 L), irrelevant here. RV's persistence reflects lung elasticity and chest wall mechanics, ensuring some air always remains, distinguishing it from volumes tied to active breathing phases or maximal efforts.