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DEEP VENOUS THROMBOSIS: LESSON INTRODUCTION

In venous thrombosis (also termed thrombophlebitis), a blood clot forms on the wall of a vein, resulting in
inflammation and some obstruction of blood flow back to the heart for reoxygenation. Deep venous thrombosis (DVT) is
thrombosis in one of the body's deep veins. Prevention of venous thrombosis is particularly important in caring for the
patient who is immobilized, postoperative, or postpartum.
This lesson covers:
• Pathophysiology and Etiology
• Risk Factors
• Clinical Manifestations
• Diagnostic Tests
• Prophylaxis
• Pharmacologic Therapies
• Surgeries
• Clinical Therapies
• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation.

TEST: 16.5 PRETEST DEEP VENOUS THROMBOSIS

1. A client is scheduled for a duplex venous ultrasonography D. Duplex venous ultrasonography is a noninvasive test used to
to assist in the diagnosis of a DVT. What should the nurse visualize the vein and measure the velocity of blood flow in the
instruct the client about this diagnostic test? veins; although the clot often cannot be visualized directly, its
A. "Duplex venous ultrasonography removes thrombi to presence can be inferred by an inability to compress the vein
improve venous circulation and prevent pulmonary during the examination. Ascending contrast venography uses an
embolism or gangrene." injected contrast medium to assess venous thrombosis.
B. "Duplex venous ultrasonography uses an injected Percutaneous transluminal angioplasty passes a balloon
contrast medium to assess venous thrombosis." catheter through the skin, into the vessel, and through the
C. "Duplex venous ultrasonography passes a balloon vessel to the site of a lesion, where the tip of the catheter is
catheter through the skin, into the vessel, and through inflated to expand the lumen of the vessel. Venous
the vessel to the site of the lesion." thrombectomy is a surgical procedure that removes thrombi to
D. "Duplex venous ultrasonography measures changes in improve venous circulation and prevent pulmonary embolism or
blood flow through the veins." gangrene.

2. The nurse is caring for a postoperative client who has A,B,C,D. Manifestations of DVT include calf pain/tightness or
limited mobility. Which assessment finding should the dull, aching pain in the affected extremity that gets worse
nurse report as a possible sign of a pending DVT? (Select all with walking; possible tenderness, swelling, warmth, and
that apply.) erythema along the affected vein; and edema and cyanosis of
A. Area of redness along a left lower leg vein the affected extremity. Muscle twitching is not a manifestation
B. Aching of the left calf of DVT.
C. Pale skin color of the left lower leg
D. Swelling of the left lower leg
E. Muscle twitching of the left thigh
3. Before receiving the morning report, the nurse makes D. Vitamin K is the antagonist for warfarin; as a safety feature
rounds on assigned clients. At the bedside of one client, in the event of bleeding, vitamin K should be at the bedside of
the nurse notes an ampule of vitamin K. What should the any client prescribed warfarin. Protamine sulfate is the
presence of this medication indicate to the nurse? antagonist for heparin. The risk of bleeding is reduced with
A. The client is receiving low-molecular-weight heparin low-molecular-weight heparin injections. Vitamin K is not an
injections. antagonist for aspirin therapy.
B. The client is receiving high-dose aspirin therapy.
C. The client is receiving intravenous heparin.
D. The client is receiving warfarin.
4. The nurse is reviewing assigned clients to determine which B. Along with the expected immobilization associated with this
are at risk for developing a DVT. Which client should the injury, recent fracture of the femur places a client at high risk
nurse identify as a candidate for DVT preventivetherapy? for DVT. Hypertension is not considered a direct risk factor for
A. The client with elevated cholesterol levels DVT. Diabetes mellitus and elevated cholesterol levels are risk
B. The client with a recently fractured femur factors for peripheral arterial disease.
C. The client with a history of diabetes mellitus
D. The client with a history of hypertension
5. The nurse is planning care for a client with a DVT of the A,B,C,D. Interventions that may be appropriate for inclusion in
right calf. What should the nurse include in this client's the plan of care for the client with DVT include measuring the
plan of care? (Select all that apply.) calf and thigh diameter of the affected leg everyshift; applying
A. Coaching to perform deep breathing and coughing warm, moist heat to the affected extremity at least four times
every 2 hours a day; encouraging range-of-motion exercises; and assisting
B. Applying warm, moist heat to the affected area every with deep breathing and coughing. The legs should be
6 hours elevated, not dependent.
C. Measuring the calf and thigh diameter of the right leg
every shift
D. Encouraging range-of-motion exercises every 2 to 4
hours
E. Assisting to a sitting position with the legs dependent
every 4 hours
6. During a health history interview, the nurse is concerned C. Considerations related to the development of DVT include
that a client is experiencing signs of a developing DVT. complaints of leg or calf pain. A history of hypertension, joint
Which information should cause this concern? replacement 5 years ago, and current diagnosis of
A. Osteoarthritis of both wrists osteoarthritis of the wrists do not increase the client's risk for
B. Total hip replacement 5 years ago developing a DVT.
C. Current calf pain with walking
D. History of hypertension

OVERVIEW
Overview: Pathophysiology and Etiology
Trauma to a blood vessel stimulates the clotting cascade, causing platelet
aggregation at the site of trauma. An initial clot is formed from platelets
and fibrin. Red blood cells are trapped in the fibrin meshwork, causing the
thrombus to grow in the direction of blood flow. The inflammatory response
that is triggered leads to tenderness, swelling, and erythema in the area of
the thrombus. The thrombus floats within the vein at first. Pieces may break
loose and move through the circulatory system as emboli. Fibroblasts invade
the thrombus, causing vein wall scarring and destroying venous valves. This
valve damage may be permanent and affects directional blood flow.

The three pathological factors, known as the Virchow triad, associated with thrombophlebitis are:
• Blood stasis
• Vessel damage
• Increased blood coagulability.
Venous thrombi are more common than arterial thrombi. Venous thrombi often occur where the vein is normal but
blood flow is low. The most common type of venous thrombosis is deep venous thrombosis (DVT), which occurs in a
deep vein that leads to the vena cava. DVT occurs most often in the deep veins of the legs (particularly the calf) and
the pelvis. DVT less frequently occurs in the arm, chest, or other location. About half of DVTs are asymptomatic.
Symptoms depend on the location and size of the thrombus.

Overview: Risk Factors


The incidence of DVT is highest in individuals who are immobilized or who have had recent
surgery, particularly abdominal or thoracic surgery. Trauma and certain cancers may also
increase the risk of DVT. Women of childbearing age have a higher risk of DVT than men.
The risk of DVT is high during pregnancy and the first few months postpartum. Clients with
DVT are at risk for chronic venous and pulmonary embolism.

The following table provides more information about risks for DVT.

Characteristics
Risk Factor
Atrial fibrillation • Thrombi form within the atria and can enter general circulation. Transesophageal
echocardiography can identify clients at risk of thromboembolism.
Acute myocardial infarction • Risk of DVT is almost 20% for clients who had an MI. Older adults at risk include those with
recurrent angina, heat failure, and ventricular arrhythmias.
Ischemic stroke • Risk of DVT is 40% for clients with stroke and paralyzed extremities.
Orthopedic procedures • Risk of DVT is 25% in clients with total hip replacement without prophylaxis, about 50% in
clients with traumatic hip fracture, and up to 60% in clients with total knee
replacement.
Coagulation disorders • These disorders promote clotting.
Cancer • High incidence of DVT in clients with pancreatic, lung, ovary, testes, urinary tract, breast,
and stomach cancers.
Hormone therapy • Oral contraceptives increase risk.
• Hormone replacement therapy increases risk.
Immobilization • Recovery from myocardial infarction, heart failure, stroke, and surgical procedures
involving immobility increases risk.
Pregnancy and delivery • Pregnancy increases blood volume and stresses blood vessels.
• During pregnancy and the first few months postpartum, risk is 4 times greater than that for
nonpregnant women.
Surgery • Orthopedic, thoracic, abdominal, or genitourinary surgery involves more risk.
Trauma • Fracture of the spine, pelvis, femur, or tibia increases risk.
• Spinal cord injury increases risk.

Overview: Clinical Manifestations


DVT is usually asymptomatic. Clinical manifestations are primarily the result of the
inflammatory process that accompanies the thrombus and may include:
• Calf pain/tightness or dull aching pain in the affected extremity that gets worse with
walking
• Possible tenderness, swelling, warmth, and erythema along the affected vein
• Cyanosis of the affected extremity
• Edema of the affected extremity
• Chronic venous and pulmonary emboli.

COLLABORATION
Collaboration: Diagnostic Tests
Diagnostic Test Purpose Diagnostic tests make it possible to differentiate venous
Duplex venous • To visualize the vein and thrombosis from other causes of extremity pain, such as
ultrasonography measure the velocity of lymphedema, contusion, muscle strain, and cellulitis.
blood flow Tests used to diagnose DVT are detailed in the table to the
Plethysmography • To measure changes in blood left.
flow through the veins
• Often used in combination
with Doppler
ultrasonography
• Important in diagnosing
thromboses of larger or
more superficial veins
Magnetic resonance • To diagnose a thrombus in the
imaging vena cava or pelvic
veins
Ascending contrast • To assess the location and
venography extent of venous Collaboration: Prophylaxis
thrombosis Some clients need extra prophylactic measures to avoid
• Contrast medium injected to
the occurrence of DVT. These include clients who are
assess venous
thrombosis immobilized, postoperative, and postpartum.
• Expensive, invasive, and Prophylactic measures that may prevent a DVT include:
uncomfortable but the • Administering low-molecular-weight heparin injections
most accurate • Elevating the client's feet with the knees slightly bent
diagnostic test for a • Avoiding pillows under the client's knees
DVT • Encouraging the client to use a recliner or footstool
• Used when less invasive testswhen sitting
give an unclear • Encouraging early ambulation after surgery
diagnosis1
• Teaching ankle flexion and extension exercises
• Instructing the client to wear elastic stockings, use pneumatic compression devices, or both
• Instructing the client to avoid crossing the legs in bed or when sitting
Collaboration: Pharmacologic Therapies
Pharmacologic therapies used in treatment of DVT include
the following:
• Anticoagulant medications prevent clot formation or
growth and allow the body's lytic system to dissolve
existing clots.
• Fibrinolytic medications speed up clot lysis and prevent
damage to venous valves.
• Thrombolytic medications dissolve clots.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce
inflammation and relieve client symptoms.
Drugs used to treat peripheral vascular disease are detailed in the following table.
Medication Indications

Aspirin • Inhibits platelet aggregation


Clopidogrel bisulfate (Plavix) • Inhibits platelet aggregation
Cilostazol (Pletal) • Inhibits platelets to improve claudication
Pentoxifylline (Trental) • Decreases blood viscosity
• Increases red blood cell flexibility
Prostaglandins • Decrease pain
• Facilitate healing in severe limb ischemia
• Used long term
Medications specifically used to treat DVT include:
• Intravenous heparin
• Oral anticoagulation for at least 3 months
• NSAIDs for pain.
Heparin dosage is calculated to maintain the activated partial thromboplastin time (aPTT) at approximately twice the
control of normal value. Warfarin (Coumadin) doses are adjusted to maintain the International Normalized Ratio (INR)
at 2.0 to 3.0.3

Collaboration: Surgeries
Venous thrombosis is usually treated with anticoagulation and conservative measures.
However, surgery is sometimes required to treat venous thrombosis. The purpose of surgery is
to remove the thrombus, prevent it from entering deep veins, or prevent embolization.
Surgical options include:
• Venous thrombectomy, which removes thrombi from the femoral vein to improve
venous circulation and prevent pulmonary embolism or gangrene.
• Insertion of a filter in the vena cava to capture emboli from the pelvis and lower
extremities. This procedure is used when venous thrombosis is recurrent and anticoagulant
therapy is contraindicated. Two types of filters are the Greenfield filter and the Nitinol filter.
• Ligation and division of the saphenous vein where it joins the femoral vein. The vein that is affected by a septic
venous thrombosis is excised to control infection. This procedure prevents clots from entering the deep venous
system. The surgical procedure is accompanied by antibiotic therapy.

Collaboration: Clinical Therapies


Clinical therapies for DVT are instituted to relieve symptoms and reduce inflammation. Treatments for DVT include:
• Application of warm, moist compresses over the affected vein
• Bed rest: The degree of leg edema determines how much time the
client should spend in bed.
• Elevation of the legs at a 15- to 20-degree angle with the knees slightly
flexed above the level of the heart. This aids venous return and inhibits
venous pooling.
• Use of elastic antiembolism stockings, which aid the return of blood to
the heart by stimulating the muscle-pumping mechanism
• Use of pneumatic compression devices
• Walking when able
• Avoidance of prolonged standing or sitting
• Avoidance of leg crossing
• Avoidance of tight-fitting or binding garments and stockings
NURSING PROCESS
Nursing Process: Assessment
During the assessment phase of the nursing process, the nurse collects and
documents data related to the client's health history, medication regimen, and
current health status. These data are used to identify actual and potential health
alterations, to promote wellness, and to target client-specific outcomes.
Selected considerations related to focused assessment of the client with DVT are outlined in the following table.
Assessment Considerations Related to Clients with Deep Venous Thrombosis
Health history • History of venous thrombosis or other clotting disorders
• Complaints of leg or calf pain
• Duration of leg or calf pain
• Characteristics of the pain
• Effect of the pain on walking
• Current medications
Physical examination • Body temperature
• Redness of the affected extremity
• Edema of the affected extremity
• Tenderness on palpation
• Warmth on palpation
• Cord-like structures rare on palpation

Nursing Process: Diagnosis


During the diagnosis phase of the nursing process, the nurse analyzes and synthesizes assessment data to formulate
client-specific nursing diagnoses. The nurse also identifies emergent and urgent problems that require immediate
attention and provides prompt client care as indicated. Nursing diagnoses that are reflective of safety risks or
infectious disease transmission should be addressed immediately.
Nursing diagnoses may address actual problems, potential problems (risks), or
opportunities to enhance the client's wellness.
Nursing diagnoses that may be appropriate for inclusion in the plan of care for the
client with DVT address a variety of problems, including:
• Impaired tissue perfusion
• Alterations in comfort
• Potential for ineffective protection
• Increased risk for impaired physical mobility.

Nursing Process: Planning


The planning phase of the nursing process includes formulating client goals and outcomes
as well as selecting evidence-based nursing interventions that support the client's
achievement of the identified goals and outcomes.
Client goals and outcomes should be measurable. In addition, client goals and outcomes
should be client-specific and tailored to meet the client's needs. General examples of
client goals and outcomes that may be appropriate for inclusion in the plan of care for the
client with DVT include:
• The client will demonstrate increased tissue perfusion.
• The client will not have complications from thrombus embolization.
• The client will rate pain at ≤3 on a 1–10 pain scale.
Nursing interventions include independent and collaborative interventions. Independent
interventions may be performed by the nurse, as needed. Collaborative interventions, such
as medication administration, require a primary care provider's order. Nursing interventions
are chosen during the planning phase and carried out during the implementation phase of
the nursing process. Nursing interventions related to the care of the client with DVT are
discussed in the following section.

Nursing Process: Implementation


During the implementation phase of the nursing process, the nurse carries out independent
and collaborative nursing interventions that support the client's achievement of the
identified client goals and outcomes.
For the client with DVT, nursing interventions are aimed at increasing tissue perfusion,
improving patient comfort, maintaining circulation, and other considerations. Interventions
that may be appropriate for inclusion in the plan of care for the client with DVT include:
• Assessing pain location and characteristics and reporting increasing pain or changes in pain location
• Measuring calf and thigh diameter of the affected extremity and reporting any increases
• Applying warm, moist heat to the affected extremity at least four times a day
• Maintaining the client on bed rest as ordered, with the leg elevated and an egg-crate mattress or sheepskin as
needed
• Assessing peripheral pulses, skin integrity, capillary refill, and color of extremities at least every 8 hours
• Encouraging frequent position changes
• Assessing respiratory status frequently and initiating oxygen therapy as needed
• Monitoring laboratory results and reporting values outside the desired range
• Assisting with deep breathing and coughing
• Encouraging range-of-motion (ROM) exercises and providing passive ROM as needed
• Assisting with ambulation as needed
• Performing daily hygiene on the affected leg using mild soaps and a non-alcohol-based moisturizer
• Encouraging diversional activities to help the client avoid inertia.

Nursing Process: Evaluation


During the evaluation phase, the nurse evaluates:
• The client's response to all nursing interventions
• The degree to which the client goals and outcomes were achieved
• The need for revising the client's plan of care, including modifying, adding, or
discontinuing nursing diagnoses and interventions.
For the client with a DVT who successfully achieves the identified client goals and outcomes, examples of nursing
observations during the evaluation phase may include:
• The client demonstrated increased tissue perfusion.
• The client did not have complications from thrombus embolization.
• The client rated pain at ≤3 on a 1–10 pain scale.
The nursing process operates as a feedback loop. That is, each step is influenced by the preceding and following step.
Although the nursing process is presented as a linear, five-step process, in practice it is dynamic and multidirectional.
As such, the nurse is continually assessing the client and evaluating the client's response to nursing interventions.

HOMEWORK: 16.5 REMEMBER

1. Which is a risk factor for development of a DVT? A,B,D. Hormone therapy, lung cancer, and immobilization are
(Select all that apply.) all risk factors for the development of DVT.
A. Immobilization Hypercholesterolemia and diabetes mellitus are risk factors for
B. Lung cancer peripheral vascular disease, not DVT.
C. Hypercholesterolemia
D. Diabetes mellitus
E. Hormone therapy
2. Which pathological factors, or parts of the Virchow triad, A,D,E. The Virchow triad involves blood stasis, increased blood
are associated with thrombophlebitis? coagulability, and vessel damage. An embolism is a vascular
(Select all that apply.) occlusion. Lysis is the dissolution or destruction of cells, the
A. Stasis of blood opposite of what happens when thrombi form.
B. Lysis
C. Embolism
D. Vessel damage
E. Increased blood coagulability
3. Which action helps prevent development of a DVT? A,B,C,E. Actions to prevent development of a DVT include
(Select all that apply.) avoiding prolonged standing orsitting, avoiding leg crossing,
A. Avoiding crossing the legs and avoiding tight-fitting or binding garments and stockings.
B. Avoiding prolonged standing Avoiding extreme exercise does not prevent development of a
C. Avoiding prolonged sitting DVT.
D. Avoiding extreme exercise
E. Avoiding tight-fitting clothing or stockings
4. Which test is used to diagnose a DVT? A,B,E. Duplex venous ultrasonography, magnetic resonance
(Select all that apply.) imaging, and plethysmography are used to diagnose a DVT.
A. Plethysmography Color-flow Doppler ultrasound and magnetic resonance
B. Duplex venous ultrasonography angiography are used to diagnose peripheral vascular disease.
C. Color-flow Doppler ultrasound
D. Magnetic resonance angiography
E. Magnetic resonance imaging
5. What is assessed during the physical examination of a B,C,D,E. When conducting the physical examination of a client
client with a DVT? with a DVT, assess bodytemperature, redness of the affected
(Select all that apply.) extremity, edema of the affected extremity, and the presence
A. Muscle atrophy of the affected extremity of warmth on palpation. Muscle atrophy is not a manifestation
B. Edema of the affected extremity associated with a DVT.
C. Redness of the affected extremity
D. Body temperature
E. Warmth on palpation
6. Which nursing diagnosis is used to guide the care for a A,B,C,D. Nursing diagnoses that may be appropriate for
client with a DVT? inclusion in the plan of care for a client with a DVT include
(Select all that apply.) impaired tissue perfusion, alterations in comfort, potential for
A. Impaired tissue ineffective protection, and Increased risk for impaired physical
perfusion mobility. A DVT does not affect oxygenation.
B. Increased risk for impaired physical mobility
C. Alterations in comfort
D. Potential for ineffective protection
E. Ineffective oxygenation

HOMEWORK: 16.5 APPLY

1. Mrs. Kim, a 58-year-old client, is hospitalized with A. Mrs. Kim already shows two of the three
symptoms of DVT. The latest test results indicate pathological factors, known as the Virchow triad,
stasis of blood, and the healthcare provider associated with venous thrombi: stasis of blood and
suspects that Mrs. Kim has developed venous symptoms of blood vessel damage. Increased blood
thrombi. What other pathological factor should coagulability is the third pathological factor
the nurse use to determine whether Mrs. Kim has associated with venous thrombi. Tissue hypoxia and
a DVT? anoxia are not pathological factors of DVT, and DVT
A. Increased blood coagulability does not affect blood pressure.
B. Tissue hypoxia
C. Increased blood pressure
D. Tissue anoxia
2. Samuel Lewis, an 84-year-old client, is admitted C. Low-molecular-weight heparin, administered in the
for testing to rule out a DVT. While the nurse fatty tissue of the abdomen, is used as a prophylactic
prepares an injection oflow-molecular-weight measure to prevent the formation of blood clots in
heparin, Mr. Lewis asks why he needs injections in those who are at risk for developing deep venous
his stomach if the problem is in his leg. How thrombosis. It does not dissolve any currently formed
should the nurse respond? clots. People over the age of 80 do not need to
A. "Didn't your doctor tell you that you need to receivelow-molecular-weight heparin, nor does this
take these shots in your stomach for the rest medication prevent pooling of blood in the lower
of your life?" extremities. These injections do not need to be
B. "This medication dissolves any clots in your provided to the client for the rest of his life.
legs but must be given in your stomach."
C. "Low-molecular weight heparin prevents
blood clots from forming in your leg but must
be given in yourstomach."
D. "People over the age of 80 should be
receiving this medication in their stomach so
that blood doesn't pool in the legs."
3. Janice Jaworski, a 50-year-old client, is being C. The client should take frequent breaks to prevent
discharged after treatment for a DVT. Ms. long periods of uninterrupted sitting. Standing for long
Jaworski is a freelance writer and spends periods is not advised because this can potentiate the
prolonged periods of time working at a computer. development of future DVT. The client should also
What instruction should the nurse provide to Ms. avoid crossing the legs and wearing tight-fitting
Jaworski to reduce the risk of future DVT clothing and stockings.
development?
A. "Standing is preferred over sitting, so think
about altering your work environment."
B. "Sitting is permitted as long as the legs are
not crossed."
C. "Take frequent breaks to prevent sitting for
prolonged periods of time at the computer."
D. "It is best to stand and wear tight-fitting hose
when working."
TEST: 16.5 POSTTEST DEEP VENOUS THROMBOSIS

1. The nurse is planning care for a client who has been B,D. Prophylactic measures that may prevent a DVT include
prescribed bed rest after abdominal surgery. Which action elevating the feet with the knees slightly bent and practicing
by the nurse helps to prevent development of a DVT in this ankle flexion and extension exercises. Avoid pillows under the
client? (Select all that apply.) knees and crossing the legs. Limiting fluids and restricting
A. Limiting fluids and restricting caloric intake caloric intake do not prevent development of a DVT.
B. Elevating the client's feet with the knees slightly bent
C. Teaching the proper way to cross the legs
D. Reviewing ankle extension and flexion exercises
E. Placing a pillow under the client's knees
2. During a home visit, the nurse evaluates care provided to a B. The client should be wearing antiembolism stockings as
client recovering from a DVT. Which observation indicates prescribed; this observation indicates that additional teaching
that additional teaching is required? is required. Taking warfarin as prescribed, elevating the legs,
A. The client is sitting with the legs elevated. and frequent position changes indicate that teaching has been
B. The client has removed the antiembolism stockings. effective.
C. The client is taking warfarin as prescribed.
D. The client frequently changes position.
3. A client with a history of DVT reports a sudden onset of A. With this client's history of venous thrombosis, the
severe pain in the pelvis. Which diagnostic test should the healthcare provider would order an MRI to diagnose a thrombus
nurse expect to be prescribed for this client? in a pelvic vein. Ascending contrast venography assesses the
A. Magnetic resonance imaging location and extent of venous thrombosis. Plethysmography
B. Ascending contrast venography measures changes in blood flow through the veins. Duplex
C. Plethysmography venous ultrasonography visualizes the vein and measures the
D. Duplex venous ultrasonography velocity of blood flow.
4. The nurse is preparing discharge instructions for a client D. Warfarin (Coumadin) can cause bleeding even if the
prescribed warfarin (Coumadin) for a DVT. What should the laboratory tests used to measure the effectiveness are in the
nurse include in this teaching? therapeutic range; the healthcare provider must be notified of
A. "Take the warfarin at bedtime each day." any bleeding so that the dosage can be adjusted. The client
B. "Omit warfarin on the days when laboratory tests are should use a soft-bristled toothbrush to prevent gum injury and
ordered." bleeding. Warfarin can be taken at any time of day; however,
C. "Use a hard-bristled toothbrush." it must be taken at the same time each day. Clients taking
D. "Notify the healthcare provider of bleeding or warfarin should not omit a dose without the healthcare
bruising." provider's knowledge.
5. The nurse is teaching a 25-year-old female client who is A. Use of oral contraceptives places the client at increased risk
taking oral contraceptives. Which instruction should the for DVT. Being sedentary also increases the risk for DVT. There
nurse include to minimize the risk for developing aDVT? is no link between alcohol consumption and thrombosis in
A. "Include periods of activity when traveling." women who take oral contraceptives. A low-fat diet will not
B. "Decrease your alcohol consumption." directly minimize the risk for DVT, and a high sodium intake is
C. "Consume a low-fat diet." associated with hypertension in those taking oral
D. "Avoid high-sodium foods." contraceptives.
6. While conducting an assessment, the nurse determines
that a client is at risk for developing a DVT. What did the
nurse assess to make this conclusion? (Select all that
apply.)
A. The client is taking over-the-counter medication for
arthritis.
B. The client controls type 2 diabetes mellitus with
dietary intake and exercise.
C. The client has a history of atrial fibrillation.
D. The client is being treated for bladder cancer.
E. The client experienced a myocardial infarction 2 years
ago.

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