A patient recovering from thoracic surgery is on long-term mechanical ventilation and becomes very frustrated when he tries to communicate. What intervention should the nurse perform to assist the patient?

Rationale:
A. The patient says her right leg aches all night is incorrect. While pain is an important subjective symptom, it is less specific than objective signs. The physician will want concrete findings that indicate possible recurrent or worsening DVT, not just general discomfort.

B. The right calf is warm to the touch and is larger than the left calf is correct. These are classic objective signs of deep vein thrombosis (DVT), which is especially concerning given her recent history of DVT and pulmonary embolism. Calf swelling, warmth, and asymmetry indicate possible thrombus progression or recurrence, which is a medical emergency that requires immediate physician notification for anticoagulation or further imaging.

C. The patient is unable to remember her husband's name is incorrect in this context. Memory loss may indicate cognitive impairment, delirium, or infection, but it is not directly related to her recent thromboembolic history. While important to document, it is not the most urgent finding to communicate regarding DVT risk.

D. There are multiple ecchymotic areas on the patient's arms is incorrect. Ecchymosis may suggest bruising from trauma, anticoagulation, or bleeding disorders, but in isolation it does not indicate an acute thromboembolic event. While noteworthy, the priority concern in this patient is signs of recurrent DVT, given her history.

Rationale:
A. Assist/control ventilation is incorrect because in this mode, the ventilator delivers a set tidal volume or pressure for every breath, either initiated by the patient or by the machine. The patient does not breathe spontaneously in between ventilator breaths independently; each initiated breath triggers the ventilator.

B. Controlled ventilation is incorrect because the ventilator delivers all breaths at a set rate and tidal volume, regardless of patient effort. There is no allowance for spontaneous breathing.

C. Synchronized intermittent mandatory ventilation (SIMV) is correct. SIMV delivers a preset number of mechanical breaths per minute while allowing the patient to take additional spontaneous breaths at their own tidal volume. This mode supports oxygenation and ventilation while promoting muscle activity and patient-initiated breathing, which is helpful for weaning from the ventilator.

D. Positive end-expiratory pressure (PEEP) is incorrect because PEEP is not a ventilation mode; it is a ventilator setting used to maintain positive pressure in the lungs at the end of expiration to improve oxygenation and alveolar recruitment. It does not control breath delivery.