Patho Module Two Assignment Answers and
Rationales
Alterations in Fluids & Electrolytes, 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.
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. hypoproteinemia concentration in blood is now lower than the normal concentration of fluids inside
cells fluid goes from B to T.
b. hypoproteinemia concentration in blood is now higher than the normal concentration of fluids inside
cells fluid goes from B to T.
c. hypoproteinemia blood is now hyperosmolar compared to the cells fluid goes from T to B.
d. hyperproteinemiablood now has lower oncotic pressure than normal fluid goes from T to B.
Make sure ALL parts of the answer choice are correct. Yellow highlighted statement is correct. The
other parts of the answer option are incorrect. WHY write a question with this kind of trickery? The
nurse licensure exam writes questions this way –we try to prepare you. In addition, 3 wrong options are
present. The wrong options must make you THINK critically. For every Patho exam (and nursing exam at
ANY college), look for the option that is COMPLETELY CORRECT.
Rationales for question # 1: After something has changed the concentration status of the
blood, figure out which has the higher concentration of solutes. Does blood (B) now have a
higher concentration than tissue (T)? Or does T now have a higher concentration than B? Fluids
will always move by the principle of osmosis TOWARDS the higher concentration, higher
osmolality, higher tonicity, higher oncotic pressure, etc (all these terms have the same
PRINCIPLES driving them.) Remember: CONCENTRATION CALLS! and OSMOLALITY ORDERS!
In this question, proteins in the blood have diminished, so the blood has become LESS
concentrated than normal, ie less concentrated than the tissues, which INITIALLY are normal
concentration. But when the CHANGED blood (now HYPOproteinemic compared to the tissues
NORMAL protein levels) gets to the tissue, an osmotic shift BEGINS. That shift will be that fluid
will be “called in” to the higher concentration—the TISSUE in this case. So with fluid going INTO
the tissues, the patient would then develop edema. When edema occurs in the brain cells, the
patient can become confused. Crackles indicate edema in the lung tissue (alveoli) and edema
can be found in the feet.
, 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.
Rationale for #2 When you are given a scenario in which the patient has edema, always
correlate this with FLUID VOLUME OVERLOAD—picture a patient who for some reason (make
sure you KNOW the causes for a fluid volume overload state) has extra water in the blood, thus
diluting it & decreasing its concentration—this goes along with decreased osmolality (C) and
diminished osmotic pressure (D). Thus B, C, D go together, and will cause fluid to shift into the
tissues, causing edema. [Remember, the tissues will initially be NORMAL in their osmolality &
tonicity, therefore, their concentration is now greater than that of the blood, so according to
the rule – CONCENTRATION CALLS—the tissue cells will pull water into them from the blood (“B
to T”), causing edema.]
Answer A is the outlier in this EXCEPT question, thus it is the correct answer.
Pearl: Draw pictures!
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.
Rationale for 3 & 4: When there is a diminished blood volume (fluid volume DEFICIT) sensed
by the kidneys, they respond by secreting renin; angiotensin II will be formed. Angiotensin II
stimulates the secretion of aldosterone from the adrenal cortex aldosterone “tells” the
kidneys to hang on to Na by not excreting it in the urine & instead keeping it in the blood
stream when the kidneys hang on to Na, H2O follows. As a result of hanging on to H2O in the
body, urine output is DECREASED and blood volume is INCREASED. Angiotensin II ALSO causes
the constriction of blood vessels in the periphery blood volume that normally circulates out to
peripheral vessels is decreased due to the constriction, so that a larger part of the blood volume
can be shunted to the central areas where it is most needed—heart, lungs, kidneys. So in
essence the main, most important circulatory areas have a compensatory increase in volume
(and a much needed increase in blood pressure), whereas the periphery gets a decrease (that’s
why this patient probably has cool & pale hands & feet). Answer 3A is wrong because the
natriuretic system kicks in when the heart senses an excessive amount of volume returning to
it atrial natriuretic peptide or b-type natriuretic peptide is secreted by the stretch of the heart
from increased volume the kidneys respond by increasing urination, therefore reducing the
fluid volume; a reduction in blood volume is NOT what this person needs! Inhibition of renin
Rationales
Alterations in Fluids & Electrolytes, 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.
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. hypoproteinemia concentration in blood is now lower than the normal concentration of fluids inside
cells fluid goes from B to T.
b. hypoproteinemia concentration in blood is now higher than the normal concentration of fluids inside
cells fluid goes from B to T.
c. hypoproteinemia blood is now hyperosmolar compared to the cells fluid goes from T to B.
d. hyperproteinemiablood now has lower oncotic pressure than normal fluid goes from T to B.
Make sure ALL parts of the answer choice are correct. Yellow highlighted statement is correct. The
other parts of the answer option are incorrect. WHY write a question with this kind of trickery? The
nurse licensure exam writes questions this way –we try to prepare you. In addition, 3 wrong options are
present. The wrong options must make you THINK critically. For every Patho exam (and nursing exam at
ANY college), look for the option that is COMPLETELY CORRECT.
Rationales for question # 1: After something has changed the concentration status of the
blood, figure out which has the higher concentration of solutes. Does blood (B) now have a
higher concentration than tissue (T)? Or does T now have a higher concentration than B? Fluids
will always move by the principle of osmosis TOWARDS the higher concentration, higher
osmolality, higher tonicity, higher oncotic pressure, etc (all these terms have the same
PRINCIPLES driving them.) Remember: CONCENTRATION CALLS! and OSMOLALITY ORDERS!
In this question, proteins in the blood have diminished, so the blood has become LESS
concentrated than normal, ie less concentrated than the tissues, which INITIALLY are normal
concentration. But when the CHANGED blood (now HYPOproteinemic compared to the tissues
NORMAL protein levels) gets to the tissue, an osmotic shift BEGINS. That shift will be that fluid
will be “called in” to the higher concentration—the TISSUE in this case. So with fluid going INTO
the tissues, the patient would then develop edema. When edema occurs in the brain cells, the
patient can become confused. Crackles indicate edema in the lung tissue (alveoli) and edema
can be found in the feet.
, 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.
Rationale for #2 When you are given a scenario in which the patient has edema, always
correlate this with FLUID VOLUME OVERLOAD—picture a patient who for some reason (make
sure you KNOW the causes for a fluid volume overload state) has extra water in the blood, thus
diluting it & decreasing its concentration—this goes along with decreased osmolality (C) and
diminished osmotic pressure (D). Thus B, C, D go together, and will cause fluid to shift into the
tissues, causing edema. [Remember, the tissues will initially be NORMAL in their osmolality &
tonicity, therefore, their concentration is now greater than that of the blood, so according to
the rule – CONCENTRATION CALLS—the tissue cells will pull water into them from the blood (“B
to T”), causing edema.]
Answer A is the outlier in this EXCEPT question, thus it is the correct answer.
Pearl: Draw pictures!
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.
Rationale for 3 & 4: When there is a diminished blood volume (fluid volume DEFICIT) sensed
by the kidneys, they respond by secreting renin; angiotensin II will be formed. Angiotensin II
stimulates the secretion of aldosterone from the adrenal cortex aldosterone “tells” the
kidneys to hang on to Na by not excreting it in the urine & instead keeping it in the blood
stream when the kidneys hang on to Na, H2O follows. As a result of hanging on to H2O in the
body, urine output is DECREASED and blood volume is INCREASED. Angiotensin II ALSO causes
the constriction of blood vessels in the periphery blood volume that normally circulates out to
peripheral vessels is decreased due to the constriction, so that a larger part of the blood volume
can be shunted to the central areas where it is most needed—heart, lungs, kidneys. So in
essence the main, most important circulatory areas have a compensatory increase in volume
(and a much needed increase in blood pressure), whereas the periphery gets a decrease (that’s
why this patient probably has cool & pale hands & feet). Answer 3A is wrong because the
natriuretic system kicks in when the heart senses an excessive amount of volume returning to
it atrial natriuretic peptide or b-type natriuretic peptide is secreted by the stretch of the heart
from increased volume the kidneys respond by increasing urination, therefore reducing the
fluid volume; a reduction in blood volume is NOT what this person needs! Inhibition of renin
