# A 65-year-old is post-op day 1 from a hip arthroplasty. Which nursing action best supports DVT prophylaxis based on current evidence?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373882&lang=en  
> language: en  
> subject: NCLEX-RN  
> category: ROR

## Question

A 65-year-old is post-op day 1 from a hip arthroplasty. Which nursing action best supports DVT prophylaxis based on current evidence?

## Option

1. Massage the calf vigorously every 2 hours to promote venous return.
2. Maintain strict bed rest for 7 days post-op to allow the surgical site to heal.
3. Administer the prescribed enoxaparin subcutaneously daily, apply SCDs when in bed, and assist the patient to ambulate as soon as the provider clears for activity (typically post-op day 1 for hip arthroplasty). **✔ Correct answer**
4. Hold enoxaparin if the patient ambulates so the patient receives only one form of prophylaxis at a time.

**Correct answer: 3**

## Explanation

Post-op DVT prophylaxis after hip arthroplasty combines pharmacologic (LMWH such as enoxaparin, DOAC, or fondaparinux) with mechanical (SCDs when in bed) AND early ambulation as cleared by surgery. Choice 1 (massage) can dislodge an undetected clot and is dangerous. Choice 2 (strict bed rest) maximizes Virchow's triad (stasis) and INCREASES DVT risk. Choice 4 (hold one if doing the other) is wrong — multimodal prophylaxis is additive in high-risk patients (hip, knee, hip fracture, major cancer surgery).

## In-depth explanation

Hip and knee arthroplasty are the highest-risk procedures for DVT — multimodal prophylaxis is standard. The "stop one prophylaxis when starting another" trap is wrong; pharmacologic AND mechanical AND early ambulation are added together. The single most lethal DVT prevention error remains "patient is ambulating now, hold the LMWH" — it is not.

## Clinical scenario

**65-year-old, post-op day 1 from total hip arthroplasty**. Pain controlled with PCA. The provider has ordered **enoxaparin 40 mg subcutaneously daily** and **sequential compression devices (SCDs)** when not ambulating.

## Key concepts

- **Multimodal DVT prophylaxis** — Pharmacologic (LMWH/DOAC/fondaparinux) + mechanical (SCDs) + early ambulation in high-risk surgery.
- **Virchow triad** — Stasis, endothelial injury, hypercoagulability — the three pillars of thrombus formation.
- **Hip arthroplasty DVT risk** — Highest among orthopedic procedures; prophylaxis recommended for ≥ 10-35 days postoperatively.

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