A nurse is caring for a client who is postoperative and is at risk for developing venous thromboembolism (VTE). The nurse should instruct the client to avoid which of the following unsafe actions?

Choice A rationale Early ambulation is one of the most effective ways to prevent venous thromboembolism. Walking encourages the skeletal muscle pump in the legs to push venous blood back toward the heart, preventing stasis. Stasis is a primary component of Virchow’s triad, which leads to clot formation. Therefore, encouraging the client to walk is a safe and highly recommended postoperative nursing intervention. Choice B rationale Flexing the ankles, often called ankle pumps or calf exercises, promotes venous return while the client is in bed. These movements contract the gastrocnemius and soleus muscles, which compresses the deep veins and moves blood upward. This action reduces the risk of blood pooling in the lower extremities. This is a standard preventive measure for clients who have limited mobility after surgery. Choice C rationale Elevating the feet above the level of the heart facilitates venous drainage through gravity. This helps reduce edema and prevents the sluggish blood flow that contributes to thrombus formation. It is a safe practice for clients at risk for VTE, provided there are no contraindications like severe arterial disease. Elevating the legs is a proactive way to manage venous pressure in the postoperative period. Choice D rationale Massaging the legs is extremely dangerous for a client at risk for VTE. If a blood pool has already begun to form a clot, the mechanical pressure and friction of a massage could dislodge the thrombus. Once dislodged, the clot can travel through the venous system to the lungs, causing a life-threatening pulmonary embolism. Clients must be taught never to massage their calves.