NGN DVT and Pulmonary Embolism Case Study: Post-Op Complications

On the NCLEX, the issue is deciding what matters, what to report, what to do first, what cannot be delegated, and how to evaluate whether the client is improving. This NGN-style case follows the NCSBN Clinical Judgment Measurement Model (NCJMM), often shortened in study materials to CJMM — recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, and evaluate outcomes. It is one example in the NGN case studies series, and each case is built around the six steps in the clinical judgment framework.

Patient chart exhibit

Relevant history

Morning assessment: 0800

Focused extremity assessment

• New aching pain in the left calf, different from surgical-site pain
• Left calf circumference 38 cm
• Right calf circumference 34 cm
• Left calf warm to touch
• Mild erythema and pitting edema in the left calf
• Pedal pulses 2+ bilaterally
• Client reluctant to continue ambulation because of calf discomfort
• Surgical dressing clean, dry, and intact

Question 1 — Recognize cues

Question 2 — Analyze cues

Classify each finding.

Question 3 — Prioritize hypotheses

Nursing actions for suspected DVT

The RN should anticipate or initiate actions such as:

• assess pain, swelling, skin color, warmth, pulses, and respiratory status
• notify the provider or follow the facility VTE pathway
• anticipate ordered diagnostic testing such as venous duplex ultrasound
• maintain safety and follow provider/protocol activity orders
• avoid massage of the affected leg
• avoid applying SCDs to the affected limb until DVT is ruled out or orders clarify use
• monitor for PE symptoms such as sudden dyspnea, pleuritic chest pain, tachycardia, hemoptysis, or syncope
• teach the client to report chest pain, shortness of breath, or worsening symptoms immediately

Do not teach strict bed rest as a blanket rule. Activity should follow provider orders, protocol, anticoagulation status, and client stability.

Clinical progression: 4 hours later

Venous duplex ultrasound confirms a proximal DVT in the left popliteal vein. A heparin infusion is started per protocol. Four hours later, the nurse is called to the bedside.

Updated vital signs: 1200

Current labs

Question 4 — Generate solutions

Question 5 — Take action

Question 6 — Evaluate outcomes

Thirty minutes later, the nurse reassesses the client.

Delegation and scope of practice

When the client develops sudden dyspnea and pleuritic chest pain, the RN must assess directly. Routine tasks for other stable clients can be delegated while the RN remains focused on the unstable client. For more on the RN role, see the RN NCLEX prep path; PN candidates focus on recognizing and reporting changes rather than independent management (see PN NCLEX prep).

Common NCLEX traps in DVT/PE cases

How to keep practicing

After each DVT/PE case, ask yourself:

• Which cues suggested DVT?
• Which cues suggested PE?
• Did I escalate early enough?
• Did I stay within nursing scope?
• Did I avoid unsafe distractors such as massage?
• Did I monitor for both clot progression and bleeding?
• Did I delegate only routine tasks?

The NCLEX question types overview explains the matrix, multiple-response, and ordered-response formats this case uses, and a structured NCLEX study plan helps you turn case practice into a routine. When you are ready to drill, explore the adaptive NGN practice features.

Key takeaway

In post-op DVT/PE questions, the NCLEX is testing early recognition and safe escalation. Use this pattern: identify the unilateral DVT cues, watch for sudden PE symptoms, prioritize airway, breathing, and circulation, escalate acute changes early, verify anticoagulation safety, monitor for bleeding and deterioration, and delegate routine tasks only — keep RN assessment and interpretation with the RN.

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