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

Questions 104

ATI RN

ATI RN Test Bank

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 are activated and adhere to the site, forming a plug to stop bleeding. They release chemicals to further enhance clot formation. Plasma is the liquid component of blood, red blood cells carry oxygen, and white blood cells are part of the immune system, none of which are directly involved in clot formation.

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. Rationale: 1. INR of 2.5 is within the therapeutic range (2-3) for patients on warfarin. 2. Holding the dose may lead to fluctuation in INR and risk of thrombosis or bleeding. 3. Notifying the physician is not necessary as the INR is within the target range. 4. Administering vitamin K is not indicated unless the patient is experiencing significant bleeding. In summary, administering the daily Coumadin as ordered is appropriate as the INR is within the therapeutic range, ensuring continuity of anticoagulation therapy without unnecessary intervention.

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. Dyspnea and crackles post-transfusion indicate fluid overload, not an immune response. Step 1: Rule out urticarial (itching/rash) and anaphylactic (rapid onset, hypotension) reactions due to the absence of these symptoms. Step 2: Hemolytic reactions involve destruction of red blood cells, leading to hemoglobinuria and shock. Step 3: Circulatory overload results from an excessive volume of blood given, leading to pulmonary edema and crackles. In this case, the symptoms align with circulatory overload, making it the most likely reaction.

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 of abdominal cramping, diarrhea, fever, and altered white blood cell count with low neutrophils and high lymphocytes suggest a viral infection. Viral infections often present with these symptoms and characteristic lab findings. Other choices are incorrect because fungal infections typically do not cause acute abdominal symptoms, parasitic infections usually present with different symptoms and lab findings, and bacterial infections are more likely to have elevated neutrophils and different clinical presentation.

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: Step 1: Patient's immune system is compromised post-splenectomy. Step 2: Washing hands and avoiding ill individuals reduce infection risk. Step 3: Emphasizing infection prevention crucial for patient safety. Summary: A - relates to clotting issues, B - not relevant, C - not immediate concern. Washing hands is most pertinent.

Access More Questions!

ATI RN Basic


$89/ 30 days

ATI RN Premium


$150/ 90 days

Similar Questions