A nurse is preparing to administer enoxaparin sodium (Lovenox) subcutaneously to a client.
Which of the following is an appropriate action by the nurse?

Choice A rationale

Applying cold packs, or cryotherapy, is primarily indicated for acute soft tissue injuries to induce vasoconstriction, thereby decreasing local blood flow, metabolism, and inflammation, which reduces pain and swelling. For chronic or recurring lower back pain prevention, heat is often more effective, as it promotes vasodilation, increasing blood flow to relax muscles and reduce stiffness, making cold less suitable as a frequent preventative strategy.

Choice B rationale

Prolonged static postures, like sitting, increase intradiscal pressure and muscle tension in the lumbar region, leading to muscle fatigue and reduced blood flow to the supporting structures, which exacerbates back pain. Regular movement and changing positions is crucial to maintain flexibility, promote circulation, and distribute mechanical stress across different structures, minimizing sustained strain on the spinal ligaments and discs.

Choice C rationale

Sleeping on a mattress that is too soft fails to provide adequate support for the spine's natural curvature (lumbar lordosis), allowing the trunk to sink, which can lead to spinal misalignment and increased strain on the back muscles and ligaments. A medium-firm mattress is generally recommended to maintain proper spinal alignment during sleep, which reduces mechanical stress and prevents morning stiffness and pain.

Choice D rationale

Asking for help when moving clients ensures the nurse can use proper body mechanics, which involves keeping the load close to the body, maintaining a wide base of support, and lifting with the legs, not the back. This principle minimizes the mechanical stress and sheer forces applied to the intervertebral discs and paraspinal muscles, significantly lowering the risk of acute muscle strains or chronic cumulative trauma to the lumbar spine.

Choice E rationale

Partial sit-ups with the knees bent strengthen the abdominal and oblique muscles, which are key components of the body's core musculature. A strong core acts as a stabilizer for the lumbar spine, increasing intra-abdominal pressure to support the vertebral column and reducing the load and mechanical strain on the lower back structures during movement and daily activities, thereby preventing injury recurrence.

Choice A rationale

Encouraging and assisting with turning every 2 hours is a standard intervention for any client with restricted mobility, including those on bedrest due to DVT. This measure helps prevent skin breakdown and pressure ulcers by relieving pressure over bony prominences and promoting circulation to compressed tissues.

Choice B rationale

Positioning the legs dependently (hanging down) would increase venous pressure and worsen venous pooling and edema distal to the DVT site due to the effects of gravity, which could potentially increase pain and swelling. The affected leg should be elevated above the level of the heart to promote venous return and reduce edema and pressure.

Choice C rationale

Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), inhibits platelet aggregation and may increase the risk of bleeding when used concurrently with therapeutic anticoagulants like heparin or warfarin, which are standard DVT treatments. Acetaminophen (Tylenol) is generally preferred for pain management due to its lower bleeding risk.

Choice D rationale

Heparin (unfractionated or low molecular weight) is a common treatment for DVT. A severe complication of heparin therapy is Heparin-Induced Thrombocytopenia (HIT), an immune reaction leading to a significant drop in platelet count (normal range 150,000–450,000/mm) and paradoxical thrombosis. Therefore, monitoring platelet levels is crucial.

Choice E rationale

Applying ice (cold) to the extremity is a vasoconstrictor that can impair circulation and may reduce pain but is not the primary intervention for an acute DVT; it could theoretically worsen flow. Moist heat application is often preferred to promote vasodilation, which may reduce muscle spasms and provide comfort.

Choice F rationale

Compression stockings (graduated compression) help to reduce edema and promote venous return from the lower extremities, thereby reducing the symptoms of Post-Thrombotic Syndrome (PTS). The nurse must evaluate the fit to ensure the stockings are not too tight (risk for impaired arterial circulation) or too loose (ineffective compression).