A nurse is caring for a client who is 3 hr postoperative following a total knee arthroplasty. Which of the following actions should the nurse take to prevent venous thromboembolism?

Postoperative care following a total knee arthroplasty focuses on pain control, early mobilization, and prevention of complications such as venous thromboembolism (VTE). Immobility after orthopedic surgery increases venous stasis in the lower extremities, which significantly raises the risk of deep vein thrombosis. Total knee arthroplasty requires interventions that promote venous return, maintain circulation, and prevent clot formation. Active and passive range-of-motion exercises that stimulate calf muscle pumping are essential in reducing VTE risk. Rationale: A. Limiting the client’s fluid intake to 2,000 mL daily is incorrect because adequate hydration is important in preventing venous thromboembolism. Dehydration can increase blood viscosity and promote clot formation. Unless contraindicated, encouraging appropriate fluid intake supports circulation and reduces the risk of thrombosis. B. Massaging the client’s legs every 4 hours is contraindicated because it can dislodge an existing thrombus and potentially lead to a pulmonary embolism. Direct manipulation of the lower extremities in a postoperative orthopedic client is unsafe and should be avoided. Mechanical stimulation should instead be achieved through safe, prescribed exercises. C. Keeping the client’s knees in a flexed position while in bed is incorrect because flexion can impede venous return and increase stasis in the lower extremities. Proper positioning after knee surgery typically involves maintaining extension or following surgeon-specific guidelines to promote circulation and prevent contractures. Flexed positioning increases the risk of clot formation. D. Encouraging the client to perform circumduction of the feet is appropriate because ankle and foot movements activate the calf muscle pump, improving venous return from the lower extremities. These exercises help reduce blood stasis and lower the risk of deep vein thrombosis after surgery. Early, frequent movement is a key preventive strategy for venous thromboembolism.