Alterations in  Fluids & Solutes, Altered Cellular and Tissue Biology; Altered Cellular Proliferation   Academic honesty reminder:  It is ok to discuss the assignments with other students as a learning tool, but it is considered a breach of academic honesty to copy answers directly from each other.  Also, when taking a test, do not have this or any other document visible before you.    



1.           Read and study RRD #2 and any other documents that are referred to.

2.           Fill in this worksheet after you finish your readings.  (Not mandatory to fill in worksheet, but it will

help when you are ready to enter your answers into Assignment Submission section.)

3.           Click on the Assignment Submission offering when you are ready to enter your answers, and follow the instructions there.  Note:  the electronic assignment format LOOKS like a test, but you will be able to access the assignment freely UP UNTIL THE DUE DATE.  At the due date and time, the assignment submission module will become inaccessible.   If you have not submitted your assignment by then you will receive a zero.

4.           NOTE: in a UTA nursing course exam, read the question carefully, answer the question, save/submit and then move to the next question. You cannot go back and re-review the question and change your answer once you have moved forward to the next question.

NOTE:   The test questions are all critical thinking questions (CTQs) similar to the ones in these Assignments.   Use the ones provided in these assignments as study tools and representatives of how information will be asked on a test.    In your studying, remember to approach material via “front-door” and “back door”—for example, if in a test you are given the name of a disease (front door), be able to answer questions about its pathophysiology & S&S.  If you are given the patho or S&S (back door), be able to trace them back to the name of the disease….and so forth.  Also, read scenarios and questions carefully.  Be SURE you understand what is being asked.  Then when you go to choose an answer, first  read ALL the offerings & choose the one that fits the scenario, plus fits the reading that you have done—the RRD and concept maps.  Do not overthink—that is, do not weave in other ungrounded assumptions.  Have a good rationale for why you chose the answer that you did…. AND also why you DIDN’T choose the other answers.


1.           A patient, diagnosed with cancer, has a poor appetite and has lost 80 pounds. Upon assessment (examination),   the nurse notes generalized edema and a low serum protein level.  Which mini-concept               map accurately relates   the relationship of the patient’s serum protein level with the presence of edema?

a.           hypoproteinemiaà concentration in blood is now lower than the normal concentration of fluids inside cellsà fluid goes from B to T.

b.           hypoproteinemiaà concentration in blood is now higher than the normal concentration of fluids inside cellsà fluid goes from B to T.

c.           hypoproteinemiaà blood is now hyperosmolar compared to the cells à fluid goes from T to B.

              d.              hyperproteinemiaàblood now has lower oncotic pressure than normalà fluid goes from T to B.

2.           Which serum osmolar state will NOT cause edema?

              a.           hypertonicity of the plasma space.

              b.           hypotonicity of the plasma space.

              c.           hypoosmolality of the blood.

              d.           diminished osmotic pressure of the blood.

3.           A 28-year-old man presents with a low blood pressure due to blood loss from a gunshot wound.  The regulatory

action that will best compensate for this patient’s fluid volume deficit is:

              a.           increased action of the natriuretic peptide system.

              b.           increased action of the RAAS.

              c.           inhibition of renin secretion.

              d.           conversion of aldosterone into angiotensin II.

4.           A 28-year-old man presents with a low blood pressure due to blood loss from a gunshot wound.  Which aspect, from expected compensatory mechanisms, will NOT occur?

              a.           the patient’s body will “hang on” to water.

              b.           Na+ will be retained by the kidneys.

              c.           water excretion into the urine will increase.

              d.           arterial vasoconstriction is present.

5.           A patient is hospitalized in renal failure.   Because of her kidneys’ inability to excrete water, she has generalized edema & a serum sodium of 129. Because the kidneys have also lost the ability to appropriately regulate potassium, she also has a serum potassium of 5.9.  These lab results show:    

              Normal labs:  Na+: 135 to 145

                                        K+:    3.5 – 5.0  

              a.           hypernatremia & hypokalemia.

              b.           hyperkalemia & hyponatremia.

              c.           hyperosmolality & hypernatremia.

              d.           hypoosmolality & hypocalcemia.

6.           A patient has advanced liver disease.  Blood tests reveal that his serum albumin (albumin is one of

the protein molecules found in the blood) level is very low.  What eventually happens in this patient situation?

a.           Water would shift from blood (B) to tissue (T) because of decreased plasma oncotic pressure.

b.           There would be an increased intravascular volume due to increased plasma oncotic pressure.

              c.           There would be dehydrated brain cells due to fluid shifting from T to B.

d.           Water would shift from T to B because of increased osmolality of the vascular space.

7.           A patient has advanced liver disease and is found to have a decreased serum albumin (albumin is one of

              the protein molecules found in the blood) level and edema.  Identify the physiologic process underlying their      edema.  

              a.           “concentration calls” fluid into hypoosmolar compartments from hyperosmolar ones.

b.           the principle of diffusion results in albumin molecules going from lower to higher concentration.

c.             “concentration calls” fluid into compartments with higher oncotic pressure from compartments with lower oncotic pressure.

              d.           the proteinemia means that protein molecules will diffuse throughout the blood and tissue.

8            A patient who just came out of general anesthesia has lab work done.  The serum osmolality is 165.   The nurse taking care of this patient suspects that the _____ is due to _________.    

              Normal osmolality = 280- 295  

              a.           hyperosmolality: dehydration.

              b.           hypoosmolality: syndrome of inappropriate ADH (SIADH).

              c.           hypertonicity: SIADH.

              d.           high oncotic pressure: a state of hyperpolarization inside the cells.

9.           A patient is admitted to the hospital with a serum osmolality of 165.   As an intervention to return the patient to           normal serum osmolality, the nurse is likely to hang an IV bag of _______ because once the fluid is   distributed in the blood it will __________ and help return fluid compartment status to homeostasis.

              Normal tonicity = 0.9% (normal saline or NS)

              a.           0.45 NaCl: cause water to shift from tissue (T) to blood (B).

              b.           3% NaCl : cause water to shift from T to B.

              c.           0.25 NaCl : shift water from B to T.

              d.           NS : shift water from B to T.

10.         A patient with hyposecretion of ADH (less secretion of antidiuretic hormone) would MOST LIKELY have the following:  

              Normal osmo = 280- 295  

              a.           serum osmolality of 270.

              b.           oliguria (low urine output).

              c.           serum osmolality of 300.

              d.           edema.

11.         Expected signs and symptoms for a patient with a serum osmolality of 300 would include____.

              Normal osmo = 280- 295  

              a.           signs of cerebral edema such as irritability

              b.           signs of cerebral cell dehydration such as confusion

              c.           pitting edema

              d.           crackles in the lungs upon auscultation          

12.         A diabetic patient has pathological changes to his arteries that result in narrowing and blockage.  He is diagnosed with gangrene of the toes  (gangrene is when LOTS of cells die)..  Lab work is drawn and shows an elevated CK.  Which pathological process accurately explains this type of occurrence?

              a.           necrosisàgangreneàischemiaà creatine kinase spillage into blood.             

              b.           infarctà cellular differentiationà release of urea.

              c.           ischemiaà cell injuryàswellingàspillage of cellular enzymes into blood.

              d.           metastasisà superoxide dismutaseà release of free radicals.

13.         A patient says she has read that free radicals might be partly responsible for the development of her disease process.  She wants to know more information and if there is anything that can counteract free radicals. The nurse’s explanation will be based on understanding that all of the following statements are true EXCEPT     

              a.           an example of a free radical is cytochrome oxide.

b.           free radical molecules initiate harmful reactions such as lipid peroxidation, which damages the lipids of cell membranes.

c.           the body’s way to counteract free radicals include enzymes such as superoxide dismutase. 

d.           free radicals are molecules that are in a highly reactive state and can be calmed by taking certain vitamins.

14.         A patient who smokes expresses concern to his nurse about the metaplastic changes of the bronchi that were seen during his bronchoscopy. The nurse bases her response on the knowledge that this type of cellular change is __________________

              a.           an irreversible cellular adaptation pattern.

              b.           considered a precancerous cellular change.

              c.           reversible if the change agent is removed.

              d.           due to a physiologic hyperplasia.

15.         Which sets of information are correctly linked?  

a.           a patient with decreased RBC production: erythropoietin injections are needed to counteract overproliferation of red blood cells.

b.           arterial embolus blocks blood flow: decrease in venous circulation to tissue with resultant hypoxia of cells.

              c.           gout: caused by diet high in urea.

              d.           carbon monoxide: binds to Hgb in oxygen’s place.

16.         A patient that has been recently diagnosed with a neuroma on the sole of his foot is very anxious.  Of the following, which information shows that the nurse understands the nomenclature of neoplasms when explaining the situation to the patient? 

a.           “You should have the neuroma removed, as this is a cancer that will spread to other parts of the body.”

b.           “This is most likely a malignancy that will metastasize to your lymph nodes.”

              c.           “Neuromas are benign growths that usually will not spread.”

d.           “You will soon have the irresistible urge to put on tap shoes and dance in a Broadway musical.”

17.         A family nurse practitioner (FNP) tells a patient that her biopsy shows leiomyosarcoma staged at T2N2M0. This patient has a 

              a.           benign tumor of the endometrium.

              b.           smooth muscle malignancy that has spread to the lymph nodes.

              c.           a malignancy of the uterus that has spread to distant sites.

              d.           muscle cell tumor that is a carcinoma.

18.         Which mini-concept map correctly describes cancer genesis? 

a. angiogenesisàcachexiaàlack of nutritionàcellular starvationàcancerous changes

b.           growth factor signalsàincreased cellular differentiationàanaplasiaàcancer.

              c.           oncogeneàclonal proliferationàincreased cellular differentiationàcancer.

              d.           oncogeneàclonal proliferationàanaplasiaàcancer cells.

19.         Link the genetic etiology with the S&S of CML (chronic myelocytic leukemia):

a.           Genes on a defective chromosome malfunction and code for extreme leukocytosis.

b.           Myelocytic leukocytes attack cells in the blood and cause changes known as The Philadelphia Story.

c.           A genetic defect causes cancerous changes in the blood vessels, producing hemangiosarcomas. 

              d.           Genes on an extra chromosome malfunction and cause defects in leukocyte development, resulting in               leukopenia. 

20.         All of the linkages below are correct EXCEPT  

              a.           cancer-related angiogenesis leaches nutrition from our cellsà cachexia, weakness.

b.           cancer injures prostate cellsà release into blood of high levels of a tumor marker called PSA (prostate-specific antigen)

c.           ingestion of foods high in preservativesà increase genetic “hits”à increased risk of cancer.

              d.           age-related wear and tear of cellsà increased risk of cancerous lesions such as lipomas. 

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