When examining a patient who is paralyzed below the T4 level, the medical-surgical nurse expects to find:

Correct Answer: D

Rationale: Paralysis below T4 (thoracic spinal cord injury) spares upper extremities (C5-T1 innervation), allowing independent use, and preserves diaphragm function (C3-5), enabling an efficient cough (D). Flaccidity (A) or spasticity (B) affects lower limbs, and ventilatory support (C) is for higher injuries, making D correct.

Correct Answer: D

Rationale: Isotonic Ringer's expands volume, raising cardiac output and renal flow (A), increasing GFR (B), and elevating ANP while lowering renin (C) to excrete excess. All are true—volume boosts output/flow, GFR rises, ANP counters renin—making E (all are correct), reassigned as D, correct.

Correct Answer: D

Rationale: The renal cortex, the outer kidney layer, contains glomeruli and tubules, not pyramids (A), papillae (B), or calyces (C), which are in the medulla or pelvis. ‘None of the preceding' (D) fits, as these structures are absent from the cortex, making D correct.

Correct Answer: B

Rationale: Atrial natriuretic peptide (ANP), a natriuretic hormone, is produced by the heart's atria, not kidneys (B), to reduce sodium and volume. Kidneys produce renin and erythropoietin, making False the correct answer over True (A).

Correct Answer: D

Rationale: The loop of Henle (D), not vasa recta, creates the medullary osmotic gradient via countercurrent multiplication. Vasa recta maintains it, making D the correct clarification.