A patient with hypothyroidism recently completed a 13–14-hour flight. Which of the following factors contribute to the risk of developing pulmonary deep vein thrombosis (DVT)?

A. Prolonged immobilization due to long flights

B. Smoking

C. Hypothyroidism

D. Oral contraceptive pills (OCP). Choose the correct combination:

1. A

   C, D

2. B

   A, B

3. C

   A, B, D

4. D

   A, B, C, D

Appeared in: INI-CET EXAM -2025

Explanation

• The correct option combines the three most significant and well-established risk factors for DVT presented: prolonged immobilization, smoking, and oral contraceptive use.
• Prolonged immobilization from a long flight leads to venous stasis, a core component of Virchow's triad.
• Smoking contributes to both endothelial injury and a hypercoagulable state, increasing DVT risk.
• Oral contraceptive pills are a major risk factor as they induce a hypercoagulable state by increasing the levels of clotting factors.

Why Other Options Were Wrong

• Option A: This option is incomplete. It correctly identifies oral contraceptives (D) as a risk factor but omits the major risks of prolonged immobilization (A) and smoking (B).
• Option B: This option is incomplete. While prolonged immobilization (A) and smoking (B) are correct risk factors, it omits the significant risk posed by oral contraceptive pills (D).
• Option D: This option incorrectly includes hypothyroidism (C) as a primary risk factor. While some studies suggest a minor link, it is not considered a major, independent risk factor for DVT like immobilization, smoking, or OCP use.

Related Visual

• Visual 1: Diagram - An illustration of Virchow's Triad, showing the three pillars (venous stasis, endothelial injury, hypercoagulability) and listing common causes under each, such as immobility, smoking, and OCPs.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Risk factors for Deep Vein Thrombosis (DVT) based on Virchow's Triad to guide bedside assessment, documentation, and the next nursing action.
• Nurses must assess all patients, especially those admitted to the hospital or preparing for long-distance travel, for DVT risk factors.
• Patient education is crucial. Nurses should advise at-risk individuals on preventive measures like in-flight exercises, hydration, avoiding smoking, and discussing medication risks (like OCPs) with their provider.
• What if? If the patient were male and not taking OCPs, the risk would be lower. However, the combination of a long flight (prolonged immobilization) and smoking would still place him at a significant risk for developing DVT.

How to Approach the Question

• First, understand the core concept behind DVT formation, which is Virchow's triad (stasis, vessel wall injury, hypercoagulability).
• Evaluate each of the four listed factors (A, B, C, D) to see how they fit into Virchow's triad.
• A. Prolonged immobilization (long flight) directly causes venous stasis.
• B. Smoking is known to cause endothelial injury and hypercoagulability.
• D. OCPs are a classic cause of a hypercoagulable state.
• C. Consider if hypothyroidism is a well-known, primary risk factor. It is generally not classified with the others.

Concept Tested & Keywords

• Concept Tested: Risk factors for Deep Vein Thrombosis (DVT) based on Virchow's Triad.
• Stem keywords: deep vein thrombosis, DVT, risk factors, prolonged immobilization, long flights, smoking, hypothyroidism, oral contraceptive pills
• Lead-in keywords: contribute to the risk
• Clinical cues: A patient who recently completed a 13-14 hour flight, indicating prolonged immobilization.
• Clinical cues: The patient has hypothyroidism, a potential but not primary risk factor.

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