The nurse is caring for several clients on a medical unit, and recognizes that which of the following factors increases a client's risk for thromboembolism? Select all that apply

A. A high-sodium diet is associated with hypertension and fluid retention but is not a direct independent risk factor for the formation of venous thromboembolism (VTE). While it impacts cardiovascular health, it does not fulfill any of the criteria of Virchow's Triad (venous stasis, endothelial injury, or hypercoagulability). Therefore, dietary sodium intake is not a primary assessment focus for determining immediate VTE risk. B. Recent surgery is a major risk factor for thromboembolism due to the combination of vessel wall injury during the procedure and the resulting immobility during recovery. Surgical trauma triggers the systemic coagulation cascade as part of the healing process, which can lead to inappropriate clot formation. This fulfills the endothelial injury component of Virchow's Triad, significantly increasing the patient's clinical risk profile. C. Hormone replacement therapy (HRT), specifically involving estrogen, increases the risk of thromboembolism by promoting a hypercoagulable state. Estrogen alters the levels of various clotting factors in the blood, making the patient more susceptible to deep vein thrombosis and pulmonary embolism. This is a critical factor the nurse must consider when reviewing the medical history of a client with suspected VTE. D. Impaired mobility, such as bed rest or paralysis, leads to venous stasis, where blood pools in the lower extremities due to the lack of skeletal muscle pump activity. This stagnation allows clotting factors to accumulate and initiate the formation of a thrombus. It is one of the most common risk factors encountered in the hospital setting, necessitating the use of sequential compression devices and early ambulation. E. Cigarette smoking contributes to thromboembolism by causing chronic endothelial damage and increasing blood viscosity and platelet aggregation. The toxins in tobacco smoke promote a pro-thrombotic environment throughout the vascular system, significantly elevating the risk of both arterial and venous clots. Smoking cessation is a primary educational intervention for reducing the risk of life-threatening cardiovascular and pulmonary events. F. Warfarin therapy is an anticoagulant treatment used specifically to prevent and treat thromboembolism. Rather than increasing risk, it decreases the blood's ability to clot by interfering with vitamin K-dependent clotting factors. A patient on therapeutic levels of warfarin has a significantly lower risk of developing a new VTE compared to a patient who is not receiving anticoagulation.