Postoperative Complications (DVT/PE Prevention) - NCLEX Rn
- What is the most common initial clinical sign of postoperative DVT in an extremity?
- Unilateral calf or leg swelling. Asymmetric swelling reflects venous obstruction from a thrombus in the affected limb.
- Which patient position is most appropriate while managing suspected PE?
- High Fowler position (upright) if tolerated. Upright positioning reduces respiratory effort and improves ventilation-perfusion matching in acute respiratory distress.
- What laboratory test is used to monitor IV unfractionated heparin therapy?
- aPTT. Monitors therapeutic levels to ensure effective anticoagulation without excessive bleeding risk.
- What is the priority nursing intervention when PE is suspected after surgery?
- Apply oxygen and call rapid response/activate emergency system. Addresses hypoxia and stabilizes the patient while summoning expert assistance for potential deterioration.
- Which device provides intermittent pneumatic compression to prevent postoperative DVT?
- Sequential compression device (SCD). Intermittent compression mimics muscle contractions to promote venous flow and prevent clot formation.
- Which assessment finding is most consistent with acute pulmonary embolism (PE)?
- Sudden dyspnea with tachycardia and pleuritic chest pain. These symptoms result from sudden pulmonary artery occlusion, impairing gas exchange and cardiac output.
- Which patient statement indicates correct understanding of PE warning signs after discharge?
- "I will seek urgent care for sudden shortness of breath or chest pain." Recognizing acute symptoms of PE enables prompt medical intervention to prevent fatal outcomes.
- Which postoperative medication class is commonly prescribed specifically for DVT prophylaxis?
- Anticoagulants (e.g., LMWH or unfractionated heparin). These agents inhibit clot formation by interfering with the coagulation cascade, targeting hypercoagulability in surgical patients.
- What is the correct use rule for antiembolism stockings (TED hose) postoperatively?
- Apply smoothly, remove daily to inspect skin, then reapply. Smooth application prevents constriction, and daily inspection detects skin issues early.
- What is the correct positioning intervention to reduce venous stasis after surgery?
- Elevate legs and avoid knee flexion or leg crossing. Elevation facilitates venous drainage while avoiding positions that compress veins, minimizing stasis risk.
- Which medication is the antidote for warfarin-associated bleeding?
- Vitamin K (phytonadione). Reverses warfarin's inhibition of vitamin K-dependent clotting factors, restoring coagulation.
- Which postoperative action best prevents venous stasis in a patient on bed rest?
- Perform leg exercises (ankle pumps/ROM) regularly. Active range of motion exercises enhance circulation and prevent venous pooling in immobilized patients.
- Which finding suggests antiembolism stockings are too tight and need adjustment?
- Numbness/tingling, cool toes, or diminished distal pulses. These signs indicate compromised circulation due to excessive compression, requiring immediate adjustment to prevent tissue damage.
- Which action should the nurse avoid when DVT is suspected postoperatively?
- Do not massage the calf or affected extremity. Massage could dislodge the clot, leading to pulmonary embolism.
- Which symptom pattern most strongly suggests DVT rather than normal postop soreness?
- Unilateral calf pain/tenderness with warmth and erythema. Localized inflammation and pain differentiate DVT from bilateral postoperative muscle strain.
- What is the priority nursing check before applying SCDs postoperatively?
- Assess skin integrity and peripheral circulation. Ensures no contraindications like skin breakdown or impaired circulation that could worsen with compression.
- What laboratory value is commonly monitored to evaluate warfarin therapy?
- INR. Assesses the degree of anticoagulation by measuring prothrombin time, guiding dosage adjustments.
- What is the single most effective postoperative nursing intervention to prevent DVT?
- Early ambulation as soon as it is safe. Promotes venous return and reduces blood stasis in the lower extremities, a key factor in Virchow's triad for thrombosis prevention.
- Which instruction is correct when a patient with SCDs gets out of bed to ambulate?
- Remove SCD sleeves for ambulation and reapply afterward. Allows safe mobility while ensuring continued prophylaxis when the patient returns to bed rest.
- What is the priority nursing action if DVT is suspected in a postoperative patient?
- Stop ambulation and notify the provider immediately. Prevents potential embolization of the clot while alerting the provider for diagnostic confirmation.
- Which postoperative assessment best verifies that SCDs are being used effectively?
- Sleeves are on while in bed and the pump is cycling/compressing. Confirms proper device function and patient compliance during periods of immobility to maintain prophylaxis.
- Which medication is the antidote for unfractionated heparin-associated bleeding?
- Protamine sulfate. Binds to heparin and neutralizes its anticoagulant effects rapidly in cases of overdose or hemorrhage.
- Which nursing instruction best reduces DVT risk for a postoperative patient traveling home by car?
- Stop often to walk and do ankle pumps during the trip. Frequent movement counteracts prolonged venous stasis associated with extended sitting during travel.
- Which surgery type is associated with particularly high postoperative DVT/PE risk?
- Hip or knee replacement (major orthopedic surgery). These procedures involve significant venous trauma and immobility, elevating thrombosis risk per evidence-based guidelines.
- Which postoperative patient factor most increases risk for DVT and requires aggressive prophylaxis?
- Immobility or prolonged bed rest. Stasis from inactivity is a primary component of Virchow's triad, necessitating interventions like compression or ambulation.