DVT (deep vein thrombosis) NCLEX questions for nursing students!
A deep vein thrombosis (DVT) is a blood clot that forms within the vein. According to Virchow’s Triad, a blood clot can form within the vein for several reasons. As the nurse, you will want to be familiar with the prevention of a blood clot (venous thromboembolism VTE), management of a DVT, and anticoagulation therapy.
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DVT (Deep Vein Thrombosis) NCLEX Questions
1. Which statement below is incorrect about a deep vein thrombosis (DVT)?
A. “Veins that are most susceptible to a deep vein thrombosis are the peroneal, posterior tibial, popliteal and superficial femoral.”
B. “DVTs tend to mostly occur in the lower extremities but can occur in the upper extremities too.”
C. “A deep vein thrombosis in the lower extremity has a low probability of becoming a pulmonary embolism.”
D. “A DVT is a type of venous thromboembolism (VTE), which is a blood clot that starts in the vein.”
The answer is C. This option is INCORRECT. All the other statements are true about a DVT. Option C is wrong because it should say: “A deep vein thrombosis in the lower extremity has a HIGH (not low) probability of becoming a pulmonary embolism.”
2. Select all the factors regarding a deep vein thrombosis that are included in Virchow’s Triad:
C. Endothelial damage
D. Stasis of venous blood
E. Excessive coagulability
F. Increased venous blood flow
The answers are C, D, and E. Virchow’s Triad details the THREE factors (hence why it called a triad) for blood clot formation within the vessel. Remember “SHE”: Stasis of Venous Blood, Hypercoagulability (means excessive coagulability), Endothelial damage.
3. Based on Virchow’s Triad, select which patients below are at RISK for the development of a deep vein thrombosis? Select all that apply:
A. A 55-year-old male with hyperlipidemia and diabetes.
B. A 70-year-old female with severe sepsis.
C. A 25-year-old male who uses intravenous drugs.
D. A 65-year-old female who is post-op day 1 after joint replacement surgery.
The answers are B, C, and D. Virchow’s Triad details the THREE factors for blood clot formation within the vessel. Remember “SHE”: Stasis of Venous Blood, Hypercoagulability (means excessive coagulability), Endothelial damage. Patients who experience sepsis are at risk for hypercoagulability of the blood. Patients who use IV drugs damage the endothelial lining of the veins and this can lead to blood clot formation. Patients who’ve had joint replacement surgery are at risk for blood clots due to stasis of venous circulation etc.
4. You’re developing a plan of care for a patient who is at risk for the development of a deep vein thrombosis after surgery. What nursing intervention below would the nurse NOT include in the patient’s plan of care to prevent DVT formation?
A. The patient will eat all meals out of the bed daily by sitting in the bedside chair.
B. The nurse will apply sequential compression devices (SCDs) per physician’s order to the patient’s lower extremities every night at bedtime.
C. The nurse will administer per physician’s order Enoxaparin in the subcutaneous tissue of the abdomen.
D. The patient will ambulate daily.
The answer is B. Yes, the nurse would apply SCDs per MD order to help prevent DVTs, BUT they are to be applied and worn by the patient anytime they are in bed or sitting. The only time a patient should not wear the SCDs is when they’re ambulating. Therefore, the nurse would NOT just apply them at bedtime but during the day too.
5. The nurse is assessing a patient, who has many risk factors for the development of a DVT, for signs and symptoms of a deep vein thrombosis. What signs and symptoms below would possibly indicate a deep vein thrombosis is present?
A. Cool extremity
B. Decreases pulses
E. Warm extremity
The answers are C, D, E, and F. Signs and symptoms of a DVT include: redness, swelling, warm extremity, pain, positive Homan’s Sign, and swelling (which can be unilateral…meaning there is more swelling in one extremity compared to the other).
6. True or False: Assessment of Homan’s Sign is the most reliable indicator of a deep vein thrombosis.
The answer is FALSE. Homan’s Sign is NOT a reliable method for assessing for a DVT. It can lead to FALSE positives.
7. A patient is receiving continuous IV Heparin for anticoagulation therapy for the treatment of a DVT. In order for this medication to have a therapeutic effect on the patient, the aPTT should be?
A. 0.5-2.5 times the normal value range
B. 2-3 times the normal value range
C. 1.5-2.5 times the normal value range
D. 1-3.5 times the normal value range
The answer is C. An aPTT should be 1.5-2.5 times the normal value range for Heparin to achieve a therapeutic effect in a patient to prevent blood clots. If the aPTT is too low, blood clots can form. If the aPTT is too high, bleeding can occur.
8. A patient, who is receiving continuous IV Heparin for the treatment of a DVT, has an aPTT of 110 seconds. What is your next nursing action per protocol?
A. Continue with the infusion because no change is needed based on this aPTT.
B. Increase the drip rate per protocol because the aPTT is too low.
C. Re-draw the aPTT STAT.
D. Hold the infusion for 1 hour and decrease the rate per protocol because the aPTT is too high.
The answer is D. The aPTT is 110 seconds, which is too high. Any aPTT value greater than 80 seconds places the patient at risk for bleeding. Most Heparin protocols dictate that the nurse would hold the infusion for 1 hour and to decrease the rate of infusion. If the aPTT is less than 60 seconds, the dose would need to be increased and a bolus may be needed. aPTT values should be around 60-80 seconds to achieve a therapeutic response for Heparin.
9. You’re educating a patient about Warfarin (Coumadin) and how it is used to treat blood clots. Which statements by the patient require you to re-educate them about how this medication works? Select all that apply:
A. “This medication will help dissolve the blood clot.”
B. “This medication will prevent another blood clot from forming.”
C. “This medication will help prevent the blood clot from becoming bigger in size.”
D. “This medication starts working immediately after the first dose.”
The answers are A and D. Warfarin (Coumadin) does NOT dissolve blood clots. It prevents blood clots from forming, and if one is present, it will help prevent it from becoming bigger. If the blood clot becomes bigger it may break off and travel in blood circulation. This can lead to a pulmonary embolism, heart attack, or stroke. Warfarin (Coumadin) does NOT start working immediately. It takes about 3-5 days of scheduled doses to start achieving a therapeutic INR level. It is very common that a patient will be on Heparin while taking Warfarin until INR levels are therapeutic.
10. A patient is prescribed Warfarin (Coumadin) for the treatment of a blood clot. What is the therapeutic INR range for this medication?
The answer is A. The therapeutic INR range is 2-3. It may be slightly higher if a patient is at a high risk for clot formation….(ex: up to 4.5)
11. Which option below is considered a positive Homan’s Sign for the assessment of a deep vein thrombosis (DVT)?
A. The patient reports pain when the foot is manually dorsiflexed.
B. The patient reports pain when the foot is manually plantarflexed.
C. The patient experiences pain when the leg is extended.
D. the patient experiences pain when the leg is flexed.
The answer is A. Homan’s Sign is NOT reliable because of false positives, but know for exams how to elicit a response. It done by manually (forced) dorsiflexing the patient’s foot (bending it up towards the shin) and if it causes the patient pain it considered a positive Homan’s Sign. However, the MD must further investigate if the patient has a DVT.
12. Your patient has a deep vein thrombosis in the left lower extremity. The patient is prescribed continuous IV Heparin. Select all the nursing interventions that are appropriate for this patient:
A. Apply cool compresses to affected extremity
B. Measure leg circumference
C. Massage affected extremity
D. Elevate affected extremity above heart level
E. Encourage frequent ambulation
F. Monitor the patient’s INR level
G. Monitor the patient’s aPTT level
H. Apply sequential compression device (SCD) to the affected extremity
The answers are B, D, G. Nursing interventions for this patient include: measuring leg circumference, elevating affected extremity above heart level, and monitoring aPTT level (for Heparin therapy). Why are the other options wrong? Option A: WARM compresses should be used, NOT cool (this will help with pain and circulation), Option C: this could dislodge the clot (NEVER massage or rub the site), Option E: the patient needs bed rest…ambulation could dislodge the clot, Option F: INR level is used to monitor Warfarin NOT Heparin, Option H: SCDs are NOT applied to an extremity with a clot because it could dislodge the clot…they are used to PREVENT blood clots.
13. A patient’s D-dimer result is <500 ng/mL. The nurse knows that the D-dimer assesses _______ and this result means?
A. fibrin degradation fragment; positive for a blood clot
B. platelet degradation protein; negative for a blood clot
C. clotting factors; positive for a blood clot
D. fibrin degradation fragment; negative for a blood clot
The answer is D. A d-dimer test assess fibrin degradation fragment. This test doesn’t tell us where the clot may be (so it not specific) so it will need to be further investigated by the MD and a positive result doesn’t necessarily mean the patient has a clot because some disease processes can cause a false positive. Also, a normal d-dimer is <500 ng/mL (FEU). However, it depends on how the lab reports the assay cut-off value for the d-dimer. Some labs have a cutoff <250 ng/mL (D-DU). However, <500 ng/mL (FEU) is equivalent to <250 ng/mL (D-DU).
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