NURS 571 MIDTERM EXAM QUESTIONS & ANSWERS
Jasper, a young and otherwise healthy patient has just been diagnosed with an acute
distal DVT of the left popliteal vein. The Well's score categorizes her at low risk for
complications. Which of the following is the first-line treatment for acute DVT?
A. Warfarin (Coumadin)
B. Low Molecular Weight Heparin
C. Aspirin
D. Rivaroxaban (Xarelto) - Answers -CORRECT: Rivaroxaban (Xarelto)
Rationale: Patients at low risk for complications can effectively be managed in the
outpatient setting. These include patients who are young, with no comorbidities, and
who are reliable to maintain follow-up visits. Direct-acting oral anticoagulants are
recommended for the treatment of stable DVT, due to its efficacy and safety profile.
Jacinda, a 52-year-old, presents to the emergency department with complaints of acute
pain in the right calf that started 4-5 days ago with progressive worsening. Physical
examination reveals that the right calf is warm, tender, red, and has moderate pitting
edema. The left leg appears normal. The NP strongly suspects cellulitis based on the
patient's history, however, VTE is also a concern. Which of the following findings from
Jacinda's history should increase the NP's suspicion for DVT?
A. Current chemotherapy
B. Minor laceration to the affected leg 7 days ago
C. Hospital admission for community-acquired pneumonia 1 year ago without
complication
D. Menopause without symptoms or pharmacological treatment - Answers -
CORRECT: Current chemotherapy
Rationale: Malignancy is a risk factor for DVT and since Jacinda is receiving
chemotherapy, malignancy can be assumed. A laceration in the days before the start of
leg pain would strongly support cellulitis. Previous admission for pneumonia without
complication does not increase a person's risk for VTE. While hormone replacement
should raise the NP's suspicion for VTE, there is no indication that the patient is being
treated with HRT for asymptomatic menopause.
Eleanor, a 39-year-old, presents to the emergency department for severe pain and
swelling in her left calf that began yesterday. Significant history includes the following: a
20-pack-year smoking; breast cancer (completed chemotherapy 4 months ago); and
travel from Europe (8-hour flight) within days before pain onset. She takes no
medications, has no known medication allergies, and no previous VTE history. She
denies fever, chest pain, and shortness of breath. Physical exam reveals severe,
unilateral left lower extremity swelling (8 cm greater than the non-affected side) with
pitting edema, and exquisite localized tenderness along the popliteal region. Vital signs
are within normal limits. Which of the following is the appropriate next step?
, A. Start warfarin (Coumadin) and adjust to target INR of 2.0-3.0
B. Order a left lower extremity compression ultrasound
C. Obtain a ventilation-perfusion scan (V/Q)
D. Administe - Answers -CORRECT: Administer enoxaparin (Lovenox)
Rationale: Since the likelihood of DVT increases in patients with multiple risk factors,
the Wells DVT score should be used to evaluate patients with suspected 1st-time acute
DVT. The tool stratifies patients according to pretest probability (0=low, 1-2=moderate,
> 3=high) for clot and is helpful when used in combination with other diagnostic tests in
clinical decision-making. Eleanor's history, symptoms, and exam findings are consistent
with DVT and probability is high (>3 risk factors). Suspicion is low for PE because she
has no respiratory symptoms, therefore, V/Q scanning is not necessary at this time.
Since the patient's history and clinical findings are consistent with DVT, and Wells score
shows high probability, treatment should be initiated before diagnostic testing is
performed, unless contraindicated. Direct-acting anticoagulation is the 1st line treatment
but is not an option in this scenario. Warfarin can be used but takes 5-7 days to reach a
therapeutic level and must be administered with LMWH until the goal is reached.
Differential Dx for VTE - Answers -include but are not limited to :
cellulitis
injury
baker's cyst
superficial thrombophlebitis.
what are the 3 categories according to pathophysiological states for VTE risk factors -
Answers -hypercoagulability, vascular damage, and venous stasis.
What are the risk factors for VTE in hypercoagulability? - Answers -Hereditary & non-
hereditary coagulopathies
Autoimmune disorders (SLE, RA, hyperthyroidism, IBD, etc.)
Estrogen (OCPs, HRT, etc.)
What are the risk factors for VTE in vascular damage? - Answers -Smoking
Atherosclerotic plaque
Prolonged elevated BP
Femoral line catheterization
Surgery
What are the risk factors for VTE in venous stasis? - Answers -Prolonged immobility or
hospitalization
Obesity
Paralysis of lower extremities
Pregnancy & until 12 wks. postpartum
Malignancy & chemotherapy
Jasper, a young and otherwise healthy patient has just been diagnosed with an acute
distal DVT of the left popliteal vein. The Well's score categorizes her at low risk for
complications. Which of the following is the first-line treatment for acute DVT?
A. Warfarin (Coumadin)
B. Low Molecular Weight Heparin
C. Aspirin
D. Rivaroxaban (Xarelto) - Answers -CORRECT: Rivaroxaban (Xarelto)
Rationale: Patients at low risk for complications can effectively be managed in the
outpatient setting. These include patients who are young, with no comorbidities, and
who are reliable to maintain follow-up visits. Direct-acting oral anticoagulants are
recommended for the treatment of stable DVT, due to its efficacy and safety profile.
Jacinda, a 52-year-old, presents to the emergency department with complaints of acute
pain in the right calf that started 4-5 days ago with progressive worsening. Physical
examination reveals that the right calf is warm, tender, red, and has moderate pitting
edema. The left leg appears normal. The NP strongly suspects cellulitis based on the
patient's history, however, VTE is also a concern. Which of the following findings from
Jacinda's history should increase the NP's suspicion for DVT?
A. Current chemotherapy
B. Minor laceration to the affected leg 7 days ago
C. Hospital admission for community-acquired pneumonia 1 year ago without
complication
D. Menopause without symptoms or pharmacological treatment - Answers -
CORRECT: Current chemotherapy
Rationale: Malignancy is a risk factor for DVT and since Jacinda is receiving
chemotherapy, malignancy can be assumed. A laceration in the days before the start of
leg pain would strongly support cellulitis. Previous admission for pneumonia without
complication does not increase a person's risk for VTE. While hormone replacement
should raise the NP's suspicion for VTE, there is no indication that the patient is being
treated with HRT for asymptomatic menopause.
Eleanor, a 39-year-old, presents to the emergency department for severe pain and
swelling in her left calf that began yesterday. Significant history includes the following: a
20-pack-year smoking; breast cancer (completed chemotherapy 4 months ago); and
travel from Europe (8-hour flight) within days before pain onset. She takes no
medications, has no known medication allergies, and no previous VTE history. She
denies fever, chest pain, and shortness of breath. Physical exam reveals severe,
unilateral left lower extremity swelling (8 cm greater than the non-affected side) with
pitting edema, and exquisite localized tenderness along the popliteal region. Vital signs
are within normal limits. Which of the following is the appropriate next step?
, A. Start warfarin (Coumadin) and adjust to target INR of 2.0-3.0
B. Order a left lower extremity compression ultrasound
C. Obtain a ventilation-perfusion scan (V/Q)
D. Administe - Answers -CORRECT: Administer enoxaparin (Lovenox)
Rationale: Since the likelihood of DVT increases in patients with multiple risk factors,
the Wells DVT score should be used to evaluate patients with suspected 1st-time acute
DVT. The tool stratifies patients according to pretest probability (0=low, 1-2=moderate,
> 3=high) for clot and is helpful when used in combination with other diagnostic tests in
clinical decision-making. Eleanor's history, symptoms, and exam findings are consistent
with DVT and probability is high (>3 risk factors). Suspicion is low for PE because she
has no respiratory symptoms, therefore, V/Q scanning is not necessary at this time.
Since the patient's history and clinical findings are consistent with DVT, and Wells score
shows high probability, treatment should be initiated before diagnostic testing is
performed, unless contraindicated. Direct-acting anticoagulation is the 1st line treatment
but is not an option in this scenario. Warfarin can be used but takes 5-7 days to reach a
therapeutic level and must be administered with LMWH until the goal is reached.
Differential Dx for VTE - Answers -include but are not limited to :
cellulitis
injury
baker's cyst
superficial thrombophlebitis.
what are the 3 categories according to pathophysiological states for VTE risk factors -
Answers -hypercoagulability, vascular damage, and venous stasis.
What are the risk factors for VTE in hypercoagulability? - Answers -Hereditary & non-
hereditary coagulopathies
Autoimmune disorders (SLE, RA, hyperthyroidism, IBD, etc.)
Estrogen (OCPs, HRT, etc.)
What are the risk factors for VTE in vascular damage? - Answers -Smoking
Atherosclerotic plaque
Prolonged elevated BP
Femoral line catheterization
Surgery
What are the risk factors for VTE in venous stasis? - Answers -Prolonged immobility or
hospitalization
Obesity
Paralysis of lower extremities
Pregnancy & until 12 wks. postpartum
Malignancy & chemotherapy
