A patient with spinal cord injury has altered-mobility, which increases the risk of deep vein thrombosis (DVT). Which of the following would be included as an appropriate nursing intervention to prevent DVT formation?
Applying a sequential compression device
Administering an antifibrinolytic agent
Placing the patient on a fluid restriction
Assisting the patient with passive ROM exercises
The Correct Answer is A
A. Applying a sequential compression device. – Correct Answer. SCDs help prevent venous stasis, reducing the risk of DVT in immobile patients.
B. Administering an antifibrinolytic agent. – Incorrect. Antifibrinolytics promote clot formation and are used for bleeding disorders, not DVT prevention.
C. Placing the patient on a fluid restriction. – Incorrect. Adequate hydration is important to prevent blood viscosity and clot formation.
D. Assisting the patient with passive ROM exercises. – Incorrect. Passive ROM helps circulation, but SCDs provide more effective DVT prevention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Platelets 110,000 mm³ – Correct Answer. A low platelet count (thrombocytopenia) increases the risk of bruising and bleeding. Normal platelet range is 150,000–400,000 mm³.
B. WBC 8,000 mm³ – Normal white blood cell count; does not explain increased bruising.
C. Hemoglobin 13.0 g/dL – Normal hemoglobin level; not related to bruising.
D. RBC 4.6 million/mm³ – Normal RBC count; does not indicate a bleeding risk.
Correct Answer is C
Explanation
A. Inserting an indwelling urinary catheter – Incorrect. While catheterization may be necessary, it is not the highest priority for an unconscious patient.
B. Putting a nasogastric (NG) tube in place – Incorrect. NG tube placement can be useful for feeding or decompressing the stomach, but airway management takes precedence.
C. Maintaining a patent airway – Correct Answer. Airway patency is the top priority in an unconscious patient to prevent aspiration, hypoxia, or respiratory failure.
D. Administering an enema daily – Incorrect. This is not a priority in unconscious patients.
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