CNOR VTE Prophylaxis Practice Questions

When positioning a patient with a history of deep vein thrombosis in the Fowler position, the nurse must prioritize interventions that promote venous return and prevent nerve stretching. Documenting the application of soft padding beneath the knees and heels is essential because this position increases pressure on the ischial tuberosities and heels while risking sciatic nerve stretch if the knees are not slightly flexed and supported. Option A is incorrect because arms should never be placed across the chest without padding, as this can restrict respiration and cause pressure injuries. Option B is incorrect because a footboard must always be padded to protect the soles of the feet. Option D is incorrect because sequential compression devices should be maintained and documented, especially for a patient with a known history of vascular issues.

Mechanical sequential compression devices should never be placed directly over fragile skin grafts, as the repetitive inflation and deflation cycles can cause significant shear, friction, and subsequent graft failure. When bilateral lower extremity sleeves are contraindicated due to compromised skin integrity or recent surgical wounds, the use of plantar venous compression devices on the feet is a highly effective alternative. This method promotes adequate venous return without endangering the newly grafted areas on the patient's legs. Applying knee-high or thigh-high sleeves directly over the grafts risks severe tissue damage and surgical failure. Furthermore, graduated static compression stockings pose a significant risk of shearing forces during the application process and do not provide the active venous return required for effective intraoperative prophylaxis.

A firm, swollen thigh after a revision total hip arthroplasty combined with oliguria and borderline hypotension indicates significant covert hemorrhage into the tissue compartments. The thigh can hold a massive volume of blood, leading rapidly to hypovolemic shock. Preparing for emergency surgical exploration is the best action to achieve hemostasis and evacuate the hematoma. Elevating the extremity does not stop arterial bleeding and may worsen compartment pressures. Administering a loop diuretic is contraindicated because the oliguria is compensatory for hypovolemia, not fluid overload. Applying sequential compression devices is inappropriate and potentially harmful when a large, expanding hematoma is present.

Early mobilization is a key ERAS component that reduces pulmonary complications and venous thromboembolism. However, when a patient experiences dizziness upon head elevation, the nurse must balance protocol goals with patient safety to prevent falls. Gradually elevating the head allows the patient's cardiovascular system to accommodate postural changes while continuing to progress toward the mobilization goal. Proceeding with dangling despite moderate dizziness ignores a clear safety risk and could result in syncope. Rapidly administering intravenous fluids is inappropriate without first assessing for actual hypovolemia, as it could disrupt the goal-directed fluid therapy central to ERAS. Canceling the mobilization plan entirely for the day is an overreaction to a common, often transient symptom and unnecessarily delays the patient's functional recovery.

Heparin-induced thrombocytopenia is a severe, immune-mediated adverse drug reaction that strictly contraindicates the future use of any heparin-based products. The perioperative nurse must actively advocate for patient safety by recognizing this critical allergy and requesting an order change to a non-heparin pharmacological alternative, such as fondaparinux or a direct thrombin inhibitor. Administering the ordered unfractionated heparin could trigger a life-threatening systemic thrombotic event. Requesting a medication change to a low molecular weight heparin is also incorrect, as these specific medications have a remarkably high rate of cross-reactivity and are equally contraindicated in this patient population. Lastly, administering intravenous corticosteroids does not prevent or mitigate the complex immune response associated with heparin re-exposure, making it an unsafe and ineffective nursing action.

The Fowler's position causes significant venous pooling in the lower extremities due to gravity. For a patient undergoing shoulder arthroscopy who is experiencing frequent episodes of hypotension, this pooling severely decreases venous return and cardiac output. Applying sequential compression devices promotes venous return and helps stabilize the patient's hemodynamic status. Option A is incorrect because while fluid boluses treat hypotension, administering them is primarily the anesthesia provider's role, whereas applying compression devices is a direct nursing positioning intervention. Option C is incorrect because the knees should be slightly flexed, not in strict extension, to prevent stretching the sciatic nerve and compressing the popliteal vein. Option D is incorrect because placing the blood pressure cuff on the calf will yield a falsely high reading, masking the true severity of the cerebral hypotension.

When preparing a patient with a demyelinating disease like multiple sclerosis for spinal anesthesia, establishing a precise neurological baseline is essential. The nurse must carefully evaluate and document the exact extent of the motor weakness to distinguish preexisting disease symptoms from potential postoperative anesthetic complications or disease exacerbation. Option A is the correct nursing action. Option B is incorrect because multiple sclerosis is not an absolute contraindication to spinal anesthesia, and canceling the procedure is not the nurse's decision. Option C is wrong because sequential compression devices should be applied to both legs to prevent venous thromboembolism, regardless of unilateral weakness, unless specifically contraindicated by local conditions. Option D is incorrect because administering corticosteroids is a medical treatment for an acute flare-up, not a routine preoperative nursing intervention.

Manufacturer instructions for use for sequential compression devices list severe peripheral arterial disease as a strict contraindication. Applying external compression to these extremities can further compromise already impaired arterial blood flow, potentially leading to severe tissue ischemia or necrosis. The nurse must withhold the device and collaborate with the provider for alternative venous thromboembolism prophylaxis, such as pharmacological agents. Options A, B, and C all involve applying the device in some capacity, which directly violates the instructions for use and places the patient's ischemic limbs at significant risk for irreversible vascular injury.

A patient presenting with a Caprini score of 8 falls into the highest possible risk category for perioperative venous thromboembolism, a risk that is further compounded by a previous unprovoked event. Current evidence-based perioperative guidelines strongly recommend that high-risk surgical patients receive combined prophylactic therapy, which involves utilizing both mechanical and pharmacological interventions simultaneously. Relying on sequential compression devices alone or pharmacological prophylaxis alone provides inadequate protection for this specific high-risk clinical profile. While early postoperative ambulation is an undeniably important component of overall surgical recovery and helps prevent venous stasis, it is completely insufficient as a primary or sole prophylactic intervention for a patient with such a significantly elevated Caprini score undergoing a major surgical procedure.

The Perioperative Nursing Data Set (PNDS) prioritizes outcomes where the patient is free from positioning injury. The cues of rheumatoid arthritis and the reverse Trendelenburg position indicate a high risk for joint stress and downward sliding. Using a padded footboard and padding prominences directly intervenes to prevent shearing and joint hyperextension. While applying sequential compression devices (Option B) is an important safety measure for deep vein thrombosis, it does not address the immediate mechanical risks of this specific posture. Maintaining normothermia (Option C) falls under the physiologic domain rather than the positioning safety domain. Assessing baseline range of motion (Option D) is a necessary preoperative assessment step, but it is not an active nursing intervention that prevents intraoperative injury.

A low mobility score combined with severe contractures means the patient cannot assist with positioning and has altered anatomical alignment. The safest approach is to accommodate the deformity by padding the extremities in their natural resting position using customized foam wedges, which distributes pressure evenly without straining the joints. Forcing contracted limbs into a standard neutral position can cause severe joint trauma, muscle tearing, and intense focal pressure points. Applying sequential compression devices directly over severe contractures is often impractical and can cause localized skin breakdown due to uneven mechanical pressure. Securing the limbs tightly with adhesive tape will likely cause epidermal stripping and restrict whatever minimal perfusion is present, significantly increasing the risk of pressure injuries.

Throbbing calf pain and swelling after major orthopedic surgery strongly suggest a deep vein thrombosis. The nurse must escalate this finding to the surgeon immediately for diagnostic evaluation. Option A and Option B are contraindicated because manipulating or heating the leg could dislodge a venous thromboembolism. Option D masks the critical symptoms of a life-threatening complication without addressing the underlying emergency.

The conversion to an open procedure and extended surgical time significantly increase the risk for hypothermia and pressure injuries, especially with a high BMI. Initiating active warming and adding padding directly modifies the care plan to address these new physiological threats. Option B is a required procedural step but does not modify the individualized patient care plan for physiological outcomes. Option C is anesthesia's role or requires a physician's order, and SCD settings would not typically change. Option D is incorrect because Trendelenburg is not indicated for an open cholecystectomy and does not address the primary risks of the extended open procedure.

An operative hysteroscopy requires continuous fluid distention of the uterus, which carries a significant risk of systemic fluid intravasation. A patient with a low ejection fraction has impaired ventricular function and cannot tolerate sudden increases in intravascular volume, placing them at severe risk for acute pulmonary edema. Option A is correct because strict monitoring of the fluid deficit allows the team to halt the procedure before volume overload occurs. Option B is incorrect because a steep Trendelenburg position increases venous return and intrathoracic pressure, worsening heart failure symptoms. Option C is incorrect because sequential compression devices do not significantly alter systemic volume to a dangerous degree. Option D is incorrect because a fluid bolus would directly exacerbate the patient's risk for volume overload.

When uncontrolled vessel bleeding occurs during a laparoscopic cholecystectomy, the procedure will likely convert to an open approach to secure the vessel. The perioperative nurse must continuously re-evaluate the surgical progression and obtain a major laparotomy instrument tray to facilitate immediate access. Preparing additional trocars (B) is incorrect because the laparoscopic approach is failing and adding ports will not resolve the obscured field. Requesting a blood salvage unit (C) might be contraindicated in cases involving potential bile spillage and does not address the immediate need for surgical instruments to achieve hemostasis. Retrieving a sequential compression device (D) is a baseline deep vein thrombosis prophylaxis intervention that should have been implemented prior to induction, not a modification for this acute surgical emergency.