Nclexrn Quiz: Neurovascular Checks And Cast Compartment Concerns
20 questions · exam conditions
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Neurovascular Checks And Cast Compartment ConcernsQuestion 1 of 20

A 40-year-old client is in an orthopedic unit with a circumferential cast for a left radius fracture placed yesterday. The client reports increasing pain and numbness; assessment reveals fingers pale, capillary refill 5 seconds, decreased sensation, and pain with passive finger stretch. What is the PRIORITY nursing intervention?

Request an order for an anti-inflammatory medication to reduce swelling
Perform frequent neurovascular checks and notify the provider immediately of findings consistent with compartment syndrome
Encourage increased oral fluids to prevent constipation from opioids
Reposition the client and provide distraction to reduce pain perception
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Nclexrn Quiz: Neurovascular Checks And Cast Compartment Concerns

Practice Neurovascular Checks And Cast Compartment Concerns in Nclexrn with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

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This quiz focuses on Neurovascular Checks And Cast Compartment Concerns, giving you a quick way to practice the rules, question types, and explanations that matter most for Nclexrn.

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Question 1

A 40-year-old client is in an orthopedic unit with a circumferential cast for a left radius fracture placed yesterday. The client reports increasing pain and numbness; assessment reveals fingers pale, capillary refill 5 seconds, decreased sensation, and pain with passive finger stretch. What is the PRIORITY nursing intervention?

  1. Request an order for an anti-inflammatory medication to reduce swelling
  2. Perform frequent neurovascular checks and notify the provider immediately of findings consistent with compartment syndrome (correct answer)
  3. Encourage increased oral fluids to prevent constipation from opioids
  4. Reposition the client and provide distraction to reduce pain perception

Explanation: This question tests recognition and intervention of neurovascular compromise in a client with an arm cast. The priority concern is circulation aligned with the ABCs, as pallor and delayed refill with pain on stretch indicate compartment syndrome. Performing frequent neurovascular checks and notifying the provider immediately is the best immediate action to monitor and intervene promptly. Requesting anti-inflammatories (A) addresses swelling secondarily; encouraging fluids (C) prevents other issues; repositioning (D) is supportive but not priority. The clinical decision-making principle involves the 6 Ps for systematic assessment. Continuous monitoring ensures early detection of progression. A transferable strategy is to educate clients on reporting numbness and perform passive movement tests during checks to identify compartment issues early.

Question 2

A 72-year-old client on a medical-surgical unit is 1 day after a right ankle fracture with a fiberglass short-leg cast. The client reports new tightness and tingling in the right foot; assessment shows increasing swelling, pain with passive toe extension, capillary refill 4 seconds, and decreased sensation over the toes; vital signs are temperature 37.0°C (98.6°F), heart rate 104/min, blood pressure 148/86 mm Hg, respiratory rate 18/min, oxygen saturation 97% on room air. What is the PRIORITY nursing intervention?

  1. Administer the prescribed as-needed opioid analgesic and reassess in 1 hour
  2. Loosen restrictive dressings if present and notify the health care provider of suspected compartment syndrome (correct answer)
  3. Apply a warm blanket to the affected foot to improve circulation
  4. Teach the client to keep the cast dry and to report any foul odor from the cast

Explanation: This question tests recognition and intervention of neurovascular compromise in an elderly client with a recent ankle fracture and cast. The priority concern is circulation per the ABCs, as delayed capillary refill and swelling suggest impaired blood flow risking tissue ischemia. Loosening restrictive dressings and notifying the provider of suspected compartment syndrome is the best immediate action to relieve pressure and restore perfusion urgently. Administering opioids (A) addresses pain but not the underlying ischemia; applying a warm blanket (C) could worsen swelling; teaching cast care (D) is educational but not priority for acute compromise. The clinical decision-making principle centers on identifying compartment syndrome signs like pain on passive stretch and tachycardia as a stress response. Prompt intervention prevents irreversible damage such as nerve injury or contractures. A transferable strategy is to assess the 6 Ps routinely and maintain the limb at heart level to optimize perfusion while awaiting medical evaluation.

Question 3

A 67-year-old client is 2 days after hip fracture repair and has a splint on the lower leg for an associated fibula fracture. The client reports severe pain in the lower leg that is worsening; assessment shows pain with passive toe extension, paresthesia, pallor, and a decreasing pedal pulse compared with prior checks; vital signs are temperature 36.9°C (98.4°F), heart rate 118/min, blood pressure 162/94 mm Hg. Which action should the nurse take FIRST?

  1. Notify the health care provider immediately and prepare for emergent evaluation of compartment syndrome (correct answer)
  2. Apply sequential compression devices to prevent deep vein thrombosis
  3. Document the findings and reassess in 2 hours per protocol
  4. Delegate assessment of pedal pulses to the unlicensed assistive personnel

Explanation: This question tests recognition and intervention of neurovascular compromise in a postoperative client with a leg splint. The priority concern is circulation per the ABCs, as paresthesia and decreasing pulse with pain on extension signal ischemia. Notifying the provider immediately and preparing for emergent evaluation is the best immediate action for compartment syndrome to prevent tissue loss. Applying compression devices (B) risks worsening pressure; documenting and reassessing (C) delays care; delegating pulses (D) is unsafe for critical changes. The clinical decision-making principle prioritizes tachycardia and hypertension as signs of distress. Urgent notification facilitates interventions like fasciotomy. A transferable strategy is to trend vital signs with neurovascular assessments and position the limb neutrally while awaiting surgical consult.

Question 4

A 62-year-old client is 18 hours after a cast was applied for a lower-leg fracture. The client reports increasing pain and tingling; assessment shows pain with passive toe movement, paresthesia, pallor, and capillary refill 5 seconds; pedal pulse is present but weaker than earlier. Which action should the nurse take FIRST?

  1. Notify the provider immediately and anticipate interventions to relieve pressure within the cast (correct answer)
  2. Elevate the extremity above the heart and encourage bed rest
  3. Apply petroleum gauze to protect the skin at the cast edges
  4. Ask the unlicensed assistive personnel to obtain the client's daily weight

Explanation: This question tests recognition and intervention of neurovascular compromise in a client with a leg cast. The priority concern is circulation aligned with the ABCs, as paresthesia and pallor with delayed refill indicate ischemia. Notifying the provider immediately and anticipating interventions is the best immediate action to relieve cast pressure. Elevating above heart (B) may impair flow; applying gauze (C) protects skin; obtaining weight (D) is unrelated. The clinical decision-making principle focuses on pain with passive movement as diagnostic. Timely relief preserves function. A transferable strategy is to keep the limb at heart level and perform serial assessments, notifying for any deterioration in the 6 Ps.

Question 5

A 70-year-old client with diabetes is 4 hours after a short-leg cast was applied for a foot fracture. The client reports new burning pain and numbness; assessment shows decreased sensation, toes cool and pale, and capillary refill 6 seconds; the cast is dry and intact. What is the PRIORITY nursing intervention?

  1. Notify the health care provider immediately of neurovascular compromise and continue frequent neurovascular checks (correct answer)
  2. Encourage the client to increase dietary fiber to prevent constipation
  3. Schedule blood glucose checks before meals and at bedtime
  4. Apply lotion to the toes to prevent dry skin

Explanation: This question tests recognition and intervention of neurovascular compromise in an elderly diabetic client with a foot cast. The priority concern is circulation per the ABCs, as pale toes with delayed refill and numbness suggest ischemia, exacerbated by diabetes. Notifying the provider immediately and continuing neurovascular checks is the best immediate action for suspected compartment syndrome evaluation. Encouraging fiber (B) prevents constipation; scheduling glucose checks (C) manages diabetes; applying lotion (D) addresses skin care. The clinical decision-making principle accounts for comorbidities like diabetes increasing risk. Frequent monitoring detects changes early. A transferable strategy is to consider underlying conditions in assessments and position limbs to promote circulation without constriction.

Question 6

A 12-year-old child is in the emergency department with a new short-leg cast for a tibial fracture. The caregiver reports the child's toes look "white" and the child says the cast feels too tight; assessment shows toes pale and cool, capillary refill 5 seconds, and decreased sensation. Which action should the nurse take FIRST?

  1. Reassure the caregiver that discoloration is normal after a fracture
  2. Notify the provider immediately and maintain the extremity at heart level while awaiting evaluation (correct answer)
  3. Elevate the leg above the heart and instruct the child to wiggle toes hourly
  4. Delegate a full neurovascular assessment to the unlicensed assistive personnel

Explanation: This question tests recognition and intervention of neurovascular compromise in a pediatric client with a leg cast. The priority concern is circulation per the ABCs, as pale, cool toes with delayed refill signal impaired flow. Notifying the provider immediately and maintaining the extremity at heart level is the best immediate action for evaluation of compartment syndrome. Reassuring about discoloration (A) dismisses concerns; elevating above heart (C) may hinder arterial flow; delegating assessment (D) is inappropriate. The clinical decision-making principle prioritizes caregiver reports in pediatrics. Timely action prevents pediatric-specific risks like limb length discrepancy. A transferable strategy is to instruct caregivers to monitor color and sensation, and nurses to use distraction-free assessments for accurate findings.

Question 7

A 58-year-old client is 6 hours post-operative after ankle surgery with a splint and compression wrap. The client reports severe pain not relieved by medication and numbness; assessment shows increasing swelling, pain with passive toe movement, and diminished sensation; pedal pulse is present by Doppler. What is the PRIORITY nursing intervention?

  1. Loosen the outer wrap if allowed by protocol and notify the surgeon immediately of suspected compartment syndrome (correct answer)
  2. Encourage the client to deep breathe and use guided imagery
  3. Apply heat to the toes to improve perfusion
  4. Request a diet order change to clear liquids in case of nausea

Explanation: This question tests recognition and intervention of neurovascular compromise in a postoperative client with an ankle splint. The priority concern is circulation aligned with the ABCs, as numbness and pain on movement with swelling indicate compartment syndrome. Loosening the outer wrap and notifying the surgeon immediately is the best immediate action to reduce pressure and restore circulation. Encouraging breathing techniques (B) manages anxiety; applying heat (C) could increase swelling; requesting diet change (D) is unrelated. The clinical decision-making principle focuses on Doppler-confirmed pulses amid symptoms. Rapid response averts muscle ischemia. A transferable strategy is to loosen external wrappings per protocol while notifying, and reassess perfusion every 15-30 minutes until stable.

Question 8

A 49-year-old client is on an orthopedic floor with a cast after a displaced wrist fracture. The nurse notes the client has increasing pain, paresthesia, and pain with passive finger stretch; fingers are cool with delayed capillary refill. Which action should the nurse take FIRST?

  1. Call the health care provider immediately to report suspected compartment syndrome (correct answer)
  2. Document the neurovascular findings and continue to monitor every 4 hours
  3. Offer the client a warm drink and adjust room temperature for comfort
  4. Teach the client to inspect the cast daily for soft spots and cracks

Explanation: This question tests recognition and intervention of neurovascular compromise in a client with a wrist cast. The priority concern is circulation using the ABCs, as cool fingers with delayed refill and paresthesia indicate ischemia. Calling the provider immediately to report suspected compartment syndrome is the best immediate action to facilitate urgent intervention. Documenting and monitoring (B) delays care; offering a warm drink (C) addresses comfort; teaching inspection (D) is preventive. The clinical decision-making principle involves pain on passive stretch as a key indicator. Escalation prevents permanent wrist dysfunction. A transferable strategy is to integrate pain assessment with neurovascular checks and notify for any progression beyond baseline.

Question 9

A 7-year-old child is in an urgent care clinic 1 day after a forearm fracture was casted. The caregiver reports the child has increasing pain, refuses to move the fingers, and says the hand feels a0"pins and needles"; assessment shows fingers swollen, skin pale and cool, capillary refill 5 seconds, decreased ability to wiggle fingers, and the child cries with passive finger extension; vital signs are stable for age. Which finding requires IMMEDIATE intervention by the nurse?

  1. Itching under the cast with no drainage or odor noted
  2. Pain that increases with passive finger extension and decreased finger movement (correct answer)
  3. Caregiver reports the cast feels heavy when the child lifts the arm
  4. Child reports being bored and wanting to go home

Explanation: This question tests recognition and intervention of neurovascular compromise in a pediatric patient. The priority concern is circulatory impairment threatening tissue perfusion and potential permanent damage, addressing physiological needs. Pain that increases with passive finger extension and decreased finger movement (B) requires immediate intervention as these are hallmark signs of compartment syndrome—passive stretch pain indicates muscle ischemia and decreased movement suggests nerve involvement. Itching under the cast (A) is common and non-urgent; cast heaviness (C) is expected; and boredom (D) is a psychosocial concern. The clinical principle is that compartment syndrome presents with pain out of proportion to injury, worsening with passive stretch, and progressive neurovascular compromise. When assessing pediatric patients for compartment syndrome, remember that children may not articulate symptoms clearly, making objective findings like passive stretch pain and decreased movement critical indicators requiring immediate action.

Question 10

A 60-year-old client with a short-leg cast for an ankle fracture is on a surgical unit. The provider writes new orders: (1) a0"Elevate right leg above heart level for swelling," (2) a0"Apply ice to cast 20 minutes every hour," (3) a0"Assess neurovascular status every 4 hours," and (4) a0"Administer opioid analgesic as needed for pain." The client is now reporting increasing pain unrelieved by medication and numbness in the toes; toes are pale and cool with capillary refill 5 seconds and pain with passive toe movement. The nurse should QUESTION which order?

  1. Assess neurovascular status every 4 hours
  2. Administer opioid analgesic as needed for pain
  3. Apply ice to cast 20 minutes every hour
  4. Elevate right leg above heart level for swelling (correct answer)

Explanation: This question tests recognition and intervention of neurovascular compromise and appropriate orders. The priority concern is developing compartment syndrome with orders that could worsen the condition. The nurse should question elevating the leg above heart level (D) because this positioning reduces arterial perfusion and can worsen compartment syndrome when signs of neurovascular compromise are present. Neurovascular assessment (A) is appropriate but may need increased frequency; analgesics (B) are needed though may not fully relieve compartment syndrome pain; ice application (C) is appropriate for swelling. The clinical principle is that elevation above heart level is contraindicated when compartment syndrome is suspected because it reduces arterial pressure and worsens ischemia. When evaluating orders for patients with neurovascular compromise, critically analyze each intervention's impact on perfusion, recognizing that standard fracture care may be contraindicated when compartment syndrome develops.

Question 11

A 43-year-old client is 2 days after a humerus fracture with a cast applied and is being discharged from an ambulatory surgery center. The client reports new tingling in the fingers and increasing pain; assessment shows fingers cool and pale, capillary refill 4 seconds, decreased sensation, and pain with passive finger extension; radial pulse is present; vital signs: HR 102, BP 136/82, RR 16. Which action should the nurse take FIRST?

  1. Provide discharge teaching about keeping the cast dry and scheduling a follow-up appointment
  2. Notify the provider immediately and request evaluation for cast pressure/compartment syndrome before discharge (correct answer)
  3. Encourage the client to take over-the-counter ibuprofen at home and rest the arm
  4. Apply lotion under the cast to reduce skin irritation and itching

Explanation: This question tests recognition and intervention of neurovascular compromise at discharge. The priority concern is sending home a patient with developing compartment syndrome, risking permanent damage or limb loss. Notifying the provider immediately and requesting evaluation before discharge (B) is the best immediate action because the patient shows signs of compartment syndrome: new paresthesias, increasing pain, coolness, pallor, delayed capillary refill, decreased sensation, and passive stretch pain. Discharge teaching (A) ignores the emergency; home ibuprofen (C) won't address compartment pressure; applying lotion under cast (D) is contraindicated and doesn't address the emergency. The clinical principle is that compartment syndrome can develop days after casting and must be addressed before discharge to prevent devastating outcomes. When preparing orthopedic patients for discharge, perform thorough neurovascular assessment and never discharge patients with signs of compartment syndrome—immediate evaluation and intervention are required.

Question 12

A 46-year-old client is 8 hours post-total knee arthroplasty with a long-leg dressing and immobilizer. The client reports severe pain unrelieved by medication and new tingling in the foot; assessment reveals increasing calf firmness, foot pale and cool, capillary refill 5 seconds, decreased dorsiflexion strength, and pain with passive toe extension; dorsalis pedis pulse is difficult to palpate but present by Doppler; vital signs: T 37.2a0b0C (99.0a0b0F), HR 118, RR 22, BP 158/92. Which action should the nurse take FIRST?

  1. Increase the rate of the intravenous fluids to improve perfusion to the extremity
  2. Notify the orthopedic provider immediately and keep the limb at heart level while preparing for emergent evaluation (correct answer)
  3. Document the findings and recheck neurovascular status with the next routine assessment
  4. Delegate assessment of toe movement and sensation to the UAP while the nurse calls the family

Explanation: This question tests recognition and intervention of neurovascular compromise following knee surgery. The priority concern is impaired perfusion threatening limb viability, addressing physiological needs in Maslow's hierarchy. Notifying the orthopedic provider immediately and keeping the limb at heart level (B) is the best immediate action because the patient shows signs of compartment syndrome: unrelieved severe pain, paresthesias, compartment firmness, pallor, coolness, delayed capillary refill, weakness, and passive stretch pain. Increasing IV fluids (A) won't address local compartment pressure; documenting without action (C) delays critical care; delegating assessment to UAP (D) is inappropriate for this emergency. The clinical principle is that post-surgical compartment syndrome can occur even without casting due to bleeding, edema, or tight dressings. For post-operative neurovascular compromise, implement immediate assessment and intervention: recognize compartment syndrome signs, maintain limb at heart level, notify the surgeon emergently, and prepare for fasciotomy if conservative measures fail.

Question 13

A 45-year-old client is 8 hours post-operative after open reduction and internal fixation of a left forearm fracture with a splint and wrap. The client reports severe pain 10/10 with passive finger extension and new paresthesia; fingers are pale with capillary refill 4 seconds and radial pulse is present but weaker than the right side; vital signs are temperature 36.8°C (98.2°F), heart rate 112/min, blood pressure 156/92 mm Hg. Which action should the nurse take FIRST?

  1. Administer the prescribed opioid analgesic and apply ice to the surgical site
  2. Notify the surgeon immediately of suspected compartment syndrome and anticipate emergent intervention (correct answer)
  3. Elevate the arm above heart level to reduce swelling
  4. Delegate neurovascular checks to the unlicensed assistive personnel every 2 hours

Explanation: This question tests recognition and intervention of neurovascular compromise in a postoperative client with a forearm splint. The priority concern is circulation per the ABCs, as paresthesia and pallor with delayed refill threaten limb viability. Notifying the surgeon immediately and anticipating emergent intervention is the best immediate action to address suspected compartment syndrome and prevent necrosis. Administering opioids and ice (A) manages symptoms but not the cause; elevating the arm (C) reduces swelling but delays critical notification; delegating checks (D) is inappropriate for unstable findings. The clinical decision-making principle focuses on pain disproportionate to injury and weakened pulses as red flags. Tachycardia and hypertension reflect compensatory responses to pain and ischemia. A transferable strategy is to document baseline neurovascular status post-surgery and escalate if changes like increased pain on passive movement occur, preparing for fasciotomy if needed.

Question 14

A 29-year-old client is 3 hours after a short-leg cast was applied for a right ankle fracture in the emergency department. The client reports numbness in the toes and increasing pain despite medication; toes are cool and pale with capillary refill 4 seconds, and the client has difficulty dorsiflexing the toes. Which action should the nurse take FIRST?

  1. Assess the client's temperature and obtain a complete pain history
  2. Contact the health care provider urgently for evaluation of neurovascular compromise (correct answer)
  3. Teach the client to elevate the leg and return to the clinic in 24 hours if symptoms persist
  4. Ask the unlicensed assistive personnel to apply ice packs and document the client's response

Explanation: This question tests recognition and intervention of neurovascular compromise in a client with a recent ankle cast. The priority concern is circulation per the ABCs, as numbness and cool toes with delayed refill suggest ischemia. Contacting the provider urgently for evaluation is the best immediate action to facilitate prompt intervention for neurovascular compromise. Assessing temperature and pain history (A) gathers data but delays action; teaching elevation and return (C) risks progression; delegating ice application (D) is not priority for severe symptoms. The clinical decision-making principle involves recognizing difficulty with movement as a sign of impending paralysis in compartment syndrome. Rapid escalation is key to preserving nerve and muscle function. A transferable strategy is to perform the 5 Ps assessment (pain, pulses, pallor, paresthesia, paralysis) hourly initially and document trends for early detection.

Question 15

A 35-year-old client is 3 hours after a closed reduction of a displaced wrist fracture with a circumferential cast applied in the emergency department. The client reports increasing pain and numbness in the fingers; assessment shows fingers pale and cool, capillary refill 4 seconds, decreased sensation, and pain with passive finger extension; radial pulse is present; vital signs: HR 108, BP 142/90, RR 18, SpO2 98%. What is the PRIORITY nursing intervention?

  1. Instruct the client to perform frequent hand exercises and return if symptoms persist tomorrow
  2. Prepare to remove the cast in the treatment room without a provider order
  3. Notify the provider urgently and anticipate cast splitting/bivalving to relieve pressure (correct answer)
  4. Apply a warm compress over the cast to promote vasodilation

Explanation: This question tests recognition and intervention of neurovascular compromise following fracture reduction. The priority concern is circulatory compromise threatening permanent tissue damage, addressing physiological needs. Notifying the provider urgently and anticipating cast splitting/bivalving (C) is the best immediate action because the patient exhibits classic compartment syndrome signs: increasing pain, numbness, pallor, coolness, delayed capillary refill, decreased sensation, and passive stretch pain. Instructing exercises and delaying care (A) risks permanent damage; removing the cast without orders (B) exceeds nursing scope; applying warmth (D) is contraindicated. The clinical principle is that circumferential casts pose high risk for compartment syndrome, especially within hours of application when swelling peaks. When managing acute compartment syndrome, follow the emergency protocol: recognize the signs, notify the provider immediately, prepare for cast splitting/bivalving, maintain extremity at heart level, and monitor continuously until pressure is relieved.

Question 16

A 54-year-old client is 6 hours post-open reduction and internal fixation of the right ankle with a posterior splint and bulky dressing on an orthopedic unit. The client reports severe, worsening pain and tingling in the right foot; assessment shows increasing swelling, foot pale and cool, capillary refill 4 seconds, diminished sensation to light touch, pain with passive toe movement, and a weak posterior tibial pulse compared with the left; vital signs: T 36.8a0b0C (98.2a0b0F), HR 104, RR 20, BP 138/84. What is the PRIORITY nursing intervention?

  1. Loosen the outer wrap per facility protocol and keep the extremity at the level of the heart while notifying the surgeon (correct answer)
  2. Apply a heating pad to improve circulation and reassess in 1 hour
  3. Encourage the client to ambulate with assistance to reduce swelling
  4. Obtain a full set of admission history details and update the care plan before calling the provider

Explanation: This question tests recognition and intervention of neurovascular compromise following orthopedic surgery. The priority concern is impaired tissue perfusion threatening limb viability, addressing physiological needs in Maslow's hierarchy. Loosening the outer wrap per protocol and keeping the extremity at heart level while notifying the surgeon (A) is the best immediate action because it provides immediate pressure relief while maintaining appropriate positioning and ensuring provider notification. Applying heat (B) is contraindicated as it increases metabolic demand; ambulation (C) is inappropriate and could worsen swelling; obtaining admission history (D) delays critical intervention. The clinical principle is that post-surgical dressings can cause compartment syndrome, and nurses can initiate pressure relief per protocol while obtaining emergent provider evaluation. For post-surgical neurovascular compromise, use the nursing process: assess for compartment syndrome signs, implement immediate pressure relief per protocol, maintain limb at heart level (not elevated), and ensure rapid provider notification for definitive treatment.

Question 17

An 82-year-old client on a medical-surgical unit has a new short-leg cast for a nondisplaced ankle fracture placed earlier today. The client reports the cast feels a0"too tight" with new tingling in the toes; assessment shows toes cool with mottled pallor, capillary refill 4 seconds, decreased sensation, and pain rated 8/10 that worsens when the nurse passively dorsiflexes the toes; pedal pulse is present but weaker than the other leg; vital signs: T 36.6a0b0C (97.9a0b0F), HR 96, RR 16, BP 150/86. Which action should the nurse take FIRST?

  1. Administer the prescribed as-needed analgesic and reassess in 45 minutes
  2. Elevate the leg above heart level and apply ice directly to the toes
  3. Maintain the extremity at heart level and notify the provider immediately of suspected compartment syndrome (correct answer)
  4. Teach the client to increase fluid intake to reduce swelling

Explanation: This question tests recognition and intervention of neurovascular compromise in an elderly patient with a new cast. The priority concern is impaired circulation threatening tissue viability, addressing physiological needs in Maslow's hierarchy. Maintaining the extremity at heart level and notifying the provider immediately (C) is the best immediate action because the patient shows clear signs of compartment syndrome: cast tightness, paresthesias, coolness, pallor, delayed capillary refill, decreased sensation, and passive stretch pain. Administering analgesics (A) delays critical intervention; elevating above heart level (B) reduces arterial flow and worsens compartment syndrome; teaching about fluids (D) is inappropriate for this emergency. The clinical principle is that compartment syndrome requires immediate pressure relief, and extremity positioning at heart level optimizes both arterial inflow and venous outflow. For elderly patients with casts, maintain heightened vigilance for compartment syndrome as they may have compromised circulation at baseline, making early recognition and intervention essential to prevent tissue damage.

Question 18

A 19-year-old client is admitted to an orthopedic unit after a motorcycle crash with a newly casted left lower leg. Four hours after admission, the client reports a0"burning pain" in the leg and numbness in the foot; assessment shows pain 10/10, pallor, paresthesia, capillary refill 6 seconds, inability to dorsiflex the foot, and absent dorsalis pedis pulse; vital signs: HR 124, BP 152/94, RR 20, SpO2 99%. Which finding requires IMMEDIATE intervention by the nurse?

  1. Absent dorsalis pedis pulse with inability to dorsiflex the foot (correct answer)
  2. Heart rate of 124 beats/minute
  3. Client reports nausea after receiving opioid medication
  4. Client requests assistance to reposition in bed

Explanation: This question tests recognition and intervention of neurovascular compromise following trauma. The priority concern is absent circulation with paralysis, representing late-stage compartment syndrome threatening limb loss, addressing physiological needs. Absent dorsalis pedis pulse with inability to dorsiflex the foot (A) requires immediate intervention as these are late, ominous signs of compartment syndrome indicating severe neurovascular compromise. Tachycardia (B) is concerning but expected with severe pain; nausea (C) is a medication side effect; repositioning requests (D) are routine care. The clinical principle is that pulselessness and paralysis are late signs of compartment syndrome indicating critical ischemia requiring emergency fasciotomy. When assessing trauma patients with casts, use systematic neurovascular checks focusing on the "6 P's," recognizing that progression to pulselessness and paralysis represents a limb-threatening emergency requiring immediate surgical intervention.

Question 19

A 10-year-old child arrives to the emergency department 6 hours after a lower-leg cast was applied for a fracture. The caregiver reports the child has worsening pain despite medication and the toes look a0"white"; assessment shows toes pale and cool, capillary refill 6 seconds, decreased sensation, pain with passive toe extension, and the child cannot wiggle the toes; vital signs: T 37.1a0b0C (98.8a0b0F), HR 120, RR 20, BP 118/70, SpO2 99%. What is the PRIORITY nursing intervention?

  1. Place the limb in a dependent position to increase arterial blood flow and reassess in 30 minutes
  2. Administer the next dose of prescribed pain medication and apply a warm blanket
  3. Notify the provider immediately and prepare for emergent cast splitting/bivalving while maintaining the limb at heart level (correct answer)
  4. Delegate neurovascular checks to the caregiver and instruct them to return if toes become blue

Explanation: This question tests recognition and intervention of neurovascular compromise in pediatric patients. The priority concern is acute compartment syndrome threatening permanent damage in a child, addressing physiological needs. Notifying the provider immediately and preparing for cast splitting/bivalving while maintaining heart level positioning (C) is the best immediate action because the child exhibits severe compartment syndrome signs: worsening pain despite medication, pallor, coolness, significantly delayed capillary refill, decreased sensation, passive stretch pain, and paralysis. Dependent positioning (A) won't relieve compartment pressure and may worsen edema; medication and warmth (B) delay critical intervention; delegating to caregivers (D) is inappropriate for this emergency. The clinical principle is that pediatric compartment syndrome progresses rapidly due to smaller compartment size and requires immediate surgical intervention. For pediatric cast complications, maintain high suspicion for compartment syndrome when pain is disproportionate to injury, and remember that children's inability to fully communicate symptoms makes objective findings like the "6 P's" critical for timely intervention.

Question 20

A 28-year-old client is in the emergency department 2 hours after a closed tibia-fibula fracture was reduced and a long-leg fiberglass cast was applied. The client reports escalating pain rated 9/10 that is not relieved by prescribed opioid analgesics and has new numbness in the toes; assessment shows toes cool and pale, capillary refill 5 seconds, pain increases with passive toe extension, dorsalis pedis pulse is faint by Doppler, and the cast feels tight without cracks or drainage; vital signs: T 37.0a0b0C (98.6a0b0F), HR 112, RR 18, BP 146/88, SpO2 99% on room air. Which action should the nurse take FIRST?

  1. Elevate the affected leg above the level of the heart and apply ice packs around the cast
  2. Notify the provider immediately of suspected acute compartment syndrome and prepare for cast splitting/bivalving per protocol (correct answer)
  3. Reassess pain level and neurovascular status in 30 minutes after administering the next scheduled analgesic dose
  4. Delegate checking pedal pulses and capillary refill to the unlicensed assistive personnel (UAP) while the nurse updates the chart

Explanation: This question tests recognition and intervention of neurovascular compromise, specifically acute compartment syndrome. The priority concern is circulatory compromise threatening tissue perfusion and potential permanent damage, placing this at the physiological needs level of Maslow's hierarchy. Notifying the provider immediately and preparing for cast splitting/bivalving (B) is the best immediate action because the client exhibits classic signs of compartment syndrome: unrelieved pain, numbness, coolness, pallor, delayed capillary refill, and pain with passive movement. Elevating the leg above heart level (A) would worsen compartment syndrome by reducing arterial flow; reassessing in 30 minutes (C) delays critical intervention; and delegating assessment to UAP (D) is inappropriate for this emergency. The clinical principle is that compartment syndrome is a surgical emergency requiring immediate pressure relief to prevent permanent neurovascular damage. When assessing for compartment syndrome, remember the "6 P's": Pain (out of proportion), Pressure, Pallor, Paresthesias, Pulselessness, and Paralysis—with early intervention crucial before the late signs of pulselessness and paralysis occur.