The nurse reviews a preoperative note for a 68-year-old client who is scheduled to have a right anterior Total Hip Arthroplasty (THA). The client has a history of several surgeries including hysterectomy, appendectomy, and cholecystectomy. The client has a 52-pack-year smoking history but quit 2 years ago, a BMI of 30.1, and a history of two deep vein thromboses (DVT). The client also has hypertension controlled by diet and drug therapy, high cholesterol controlled by statins, and GERD controlled by an antacid PRN. Which assessment findings place the client at risk for a venous thromboembolism (VTE)? Select all that apply.

The scenario requires evaluating surgical and medical history to identify specific factors that increase the probability of clot formation. Knowledge of Virchow's triad, involving venous stasis, endothelial injury, and hypercoagulability, is applied to differentiate between general health issues and specific VTE risks. Choice A rationale A history of previous deep vein thrombosis is one of the strongest predictors for future occurrences. Past events indicate a predisposition to hypercoagulability or existing vascular damage, which significantly increases the risk during periods of surgical immobilization. Choice B rationale While hypertension is a significant cardiovascular risk factor for stroke or myocardial infarction, it is not traditionally categorized as a direct independent trigger for venous thromboembolism. It affects the high-pressure arterial system rather than the venous system. Choice C rationale Remote surgical history like a cholecystectomy does not present an active risk for a current procedure. Only the immediate perioperative period of the current surgery or a very recent surgery within thirty days contributes to VTE risk. Choice D rationale Major orthopedic surgeries, specifically total hip arthroplasties, carry an extremely high risk for VTE due to extensive local tissue trauma and prolonged venous stasis. These procedures require aggressive prophylaxis because they often cause direct venous endothelial injury. Choice E rationale A Body Mass Index of 30.1 indicates obesity, which increases intra-abdominal pressure and slows venous return from the lower extremities. This venous stasis, combined with chronic systemic inflammation associated with adipose tissue, raises the risk of clot formation. Choice F rationale High cholesterol, or hyperlipidemia, is a primary driver for atherosclerosis within the arterial system. While it impacts overall vascular health, it is not a primary or direct risk factor for developing venous thromboembolism in the perioperative setting. Choice G rationale Smoking causes significant endothelial dysfunction and increases blood viscosity, even if the client quit two years ago. The long-term damage to the vascular lining and chronic changes in coagulation factors contribute to an elevated risk profile.