The nurse notes that a patient's gaping wound is developing a blood clot. Which body substance is responsible for this clot formation?

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ATI Hematologic System Quizlet Questions

Question 1 of 5

The nurse notes that a patient's gaping wound is developing a blood clot. Which body substance is responsible for this clot formation?

Correct Answer: B

Rationale: Platelets are responsible for clot formation in the body. When a wound occurs, platelets adhere to the site and release chemicals to initiate clotting. They then aggregate to form a plug, stopping bleeding. Plasma carries platelets but is not directly involved in clot formation. Red blood cells transport oxygen but do not participate in clotting. White blood cells are part of the immune system and do not play a role in clot formation. Therefore, platelets are the correct choice for clot formation in this scenario.

Question 2 of 5

A patient who is taking warfarin (Coumadin) 5 mg daily has an international normalized ratio (INR) of 2.5. It is time to administer the next dose of Coumadin. What should the nurse do?

Correct Answer: D

Rationale: The correct answer is D: Administer the daily Coumadin as ordered. A therapeutic INR range for patients on warfarin is typically between 2-3. A patient with an INR of 2.5 is within this range, indicating that their blood is adequately anticoagulated. Therefore, the next dose of Coumadin should be administered as prescribed to maintain the therapeutic effect. Holding the dose (B) may lead to subtherapeutic anticoagulation, and notifying the physician (A) is not necessary as the INR is within range. Administering vitamin K (C) is indicated for patients with a high INR and signs of bleeding, which is not the case here.

Question 3 of 5

A patient receiving blood complains of dyspnea. The nurse auscultates the patient's lungs and finds crackles that were not present before the start of the transfusion. Which type of reaction should the nurse suspect?

Correct Answer: D

Rationale: The correct answer is D: Circulatory overload. This type of reaction occurs when the patient receives blood too quickly, leading to fluid overload in the circulatory system. The dyspnea and crackles are indicative of pulmonary edema, a common symptom of circulatory overload. Urticarial reaction (choice A) presents with hives, not dyspnea. Hemolytic reaction (choice B) involves the destruction of red blood cells, not fluid overload. Anaphylactic reaction (choice C) is a severe allergic reaction that includes symptoms like hives, swelling, and hypotension, but not typically pulmonary edema.

Question 4 of 5

A patient reports severe abdominal cramping and diarrhea. Assessment reveals a temperature of 102°F (38.8°C) and pulse of 82 beats/min. Results of a complete blood count reveal lower than normal segmented and banded neutrophils and higher than normal lymphocytes. Which type of infection does the nurse suspect this patient is most likely experiencing?

Correct Answer: A

Rationale: The correct answer is A: Viral. The patient's symptoms (abdominal cramping, diarrhea, fever) are consistent with a viral infection, such as gastroenteritis. The lower segmented and banded neutrophils indicate a viral infection, as viruses often target lymphocytes. The higher lymphocyte count is a characteristic response to viral infections. Other choices are incorrect as fungal, parasitic, and bacterial infections typically present with different symptoms and laboratory findings.

Question 5 of 5

The nurse is caring for a patient who is being discharged after an emergency splenectomy following an automobile accident. Which instructions should the nurse include in the discharge teaching?

Correct Answer: D

Rationale: The correct answer is D because after a splenectomy, the patient is at risk for infections due to a compromised immune system. Washing hands and avoiding sick individuals can help prevent infections. A: Watching for excess bruising is not directly related to post-splenectomy care. B: Checking for swollen lymph nodes is not a priority concern for a post-splenectomy patient. C: Taking iron supplements may not be necessary immediately post-splenectomy and should be discussed with the healthcare provider.

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