Clinical Manifestations of DVT
Total Questions : 5
Showing 5 questions, Sign in for moreA nurse is assessing a client who has a history of deep vein thrombosis (DVT).
Which of the following findings should the nurse report to the provider?
Explanation
The correct answer is choice A.Warmth and erythema in the affected leg are signs of inflammation and possible infection caused by deep vein thrombosis (DVT), a condition in which blood clots form in veins located deep inside the body, usually in the thigh or lower legs.
The nurse should report this finding to the provider as it may indicate a serious complication.
Choice B is wrong because a negative Homans’ sign, which is the absence of pain in the calf when the foot is dorsiflexed, does not rule out DVT.This sign is unreliable and nonspecific for DVT diagnosis.
Choice C is wrong because decreased calf circumference is not a typical symptom of DVT.In fact, DVT may cause swelling of the affected leg due to impaired blood flow.
Choice D is wrong because pallor and coolness in the affected leg are more indicative of arterial occlusion, which is a blockage of blood flow in an artery, rather than venous occlusion, which is a blockage of blood flow in a vein.
Normal ranges for D-dimer blood test, which measures a substance in the blood that’s released when a blood clot dissolves, are less than 0.5 mcg/mL or 500 ng/mL.High levels of D-dimer may indicate DVT or other conditions that cause blood clots.
A nurse is caring for a client who is at risk for developing DVT after a total hip replacement surgery.
Which of the following interventions should the nurse include in the plan of care to prevent DVT? (Select all that apply.)
Explanation
The correct answer is choice C. Administer low molecular weight heparin.Low molecular weight heparin is an anticoagulant drug that prevents the formation and growth of blood clots in patients at risk for VTE.It is recommended for patients undergoing hip replacement surgery as a pharmacological prophylaxis.
Choice A is wrong because applying sequential compression devices (SCDs) is not enough to prevent VTE in patients undergoing hip replacement surgery.SCDs are mechanical devices that improve blood flow in the legs by inflating and deflating around them.However, they are not as effective as anticoagulant drugs in reducing the incidence of VTE.
Choice B is wrong because encouraging early ambulation is not enough to prevent VTE in patients undergoing hip replacement surgery.Early ambulation is the act of walking soon after surgery to improve circulation and prevent complications.However, it is not associated with a lower risk of VTE compared to bed rest.
It may also be contraindicated in some patients depending on their surgical and medical conditions.
Choice D is wrong because elevating the affected leg above the level of the heart is not enough to prevent VTE in patients undergoing hip replacement surgery.Elevating the leg may help reduce swelling and pain, but it does not prevent clot formation or propagation.
Choice E is wrong because massaging the affected leg gently is not only ineffective but also harmful for preventing VTE in patients undergoing hip replacement surgery.Massaging the leg may dislodge existing clots and cause them to travel to the lungs, resulting in a life-threatening pulmonary embolism.
A nurse is reviewing the laboratory results of a client who is receiving unfractionated heparin for DVT.
Which of the following values indicates a therapeutic effect of heparin?
Explanation
The correct answer is choice B. Activated partial thromboplastin time (aPTT) of 60 seconds.This value indicates a therapeutic effect of heparin because it is about two times the normal value of 25 to 35 seconds.Heparin produces its major anticoagulant effect by inactivating thrombin and factor Xa through an antithrombin-dependent mechanism.The APTT measures the intrinsic and common pathways of coagulation, which are affected by heparin.
Choice A is wrong because platelet count of 150,000/mm3 is within the normal range of 150,000 to 450,000/mm3.Heparin does not affect platelet count directly, but it can cause heparin-induced thrombocytopenia, a serious complication that reduces platelet count and increases the risk of thrombosis.
Choice C is wrong because prothrombin time (PT) of 12 seconds is within the normal range of 11 to 13.5 seconds.Heparin does not affect PT significantly because PT measures the extrinsic and common pathways of coagulation, which are not affected by heparin.
Choice D is wrong because international normalized ratio (INR) of 1.0 is within the normal range of 0.8 to 1.2.Heparin does not affect INR significantly because INR is a standardized measure of PT that reflects the activity of vitamin K-dependent factors, which are not affected by heparin.
A nurse is teaching a client who has DVT and is prescribed warfarin.
Which of the following instructions should the nurse include in the teaching?
Explanation
The correct answer is choice D. All of the above.
The nurse should include the following instructions in the teaching:
• Avoid foods that are high in vitamin K.Vitamin K can lower the effect of warfarin and increase the risk of blood clots.Foods rich in vitamin K are green vegetables, such as lettuce, spinach and broccoli.
• Use an electric razor for shaving.Warfarin can increase the risk of bleeding, so using a sharp blade can cause cuts and bruises.
• Monitor for signs of bleeding gums.Bleeding gums can be a sign of excessive anticoagulation and a potential side effect of warfarin.
Choice A is wrong because avoiding foods that are high in vitamin K is not enough to prevent bleeding complications.
The client should also follow other precautions, such as using an electric razor and monitoring for signs of bleeding gums.
Choice B is wrong because using an electric razor for shaving is not enough to prevent bleeding complications.
The client should also avoid foods that are high in vitamin K and monitor for signs of bleeding gums.
Choice C is wrong because monitoring for signs of bleeding gums is not enough to prevent bleeding complications.
The client should also avoid foods that are high in vitamin K and use an electric razor for shaving.
A nurse is preparing to discharge a client who has DVT and is prescribed low molecular weight heparin (LMWH).
Which of the following information should the nurse include in the discharge teaching?
Explanation
The correct answer is A. How to administer LMWH subcutaneously.LMWH is a class of anticoagulant medications that are used to prevent and treat blood clots, such as DVT and PELMWH can be given subcutaneously and does not require frequent blood tests to monitor coagulation, unlike unfractionated heparinTherefore, the nurse should teach the client how to inject LMWH into the fatty tissue under the skin, usually in the abdomen or thigh, using a prefilled syringe.
B. The need for frequent blood tests to monitor coagulation.This statement is wrong because LMWH has more predictable pharmacokinetics and anticoagulant effect than unfractionated heparin, and does not require routine monitoring of APTT or anti-factor Xa levelsHowever, some patients may need monitoring in special situations, such as extremes of weight, renal impairment, or pregnancy.
C. The signs and symptoms of heparin-induced thrombocytopenia (HIT).This statement is wrong because HIT is a rare but serious complication of heparin therapy that causes a drop in platelet count and an increased risk of thrombosisHIT is more common with unfractionated heparin than with LMWH, but it can still occur with LMWH in some casesTherefore, the nurse should inform the client about the signs and symptoms of HIT, such as fever, chills, rash, bleeding, bruising, or new or worsening clots, and advise them to seek medical attention if they occur.
D. The antidote for LMWH in case of overdose.This statement is wrong because there is no specific antidote for LMWH in case of overdose or bleeding complicationsUnlike unfractionated heparin, which can be reversed with protamine sulfate, LMWH has only partial reversal with protamine sulfate and may require other measures such as transfusion of blood products or use of recombinant factor VIIaTherefore, the nurse should instruct the client to follow the prescribed dose and schedule of LMWH and to report any signs of bleeding or overdose, such as nosebleeds, gum bleeding, blood in urine or stool, or excessive bruising.
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