Practice Question
A nurse is assisting with the care for a client who has a new cast on their left forearm and reports severe pain in the affected arm with numbness in the fingers. The nurse finds the skin is pale and cold with sluggish capillary refill. Which of the following fracture complications should the nurse suspect?
Answer Choices:
Correct Answer:
Compartment syndrome
Rationale:
🔹 Compartment syndrome occurs when increased pressure within a fascial compartment impairs circulation and nerve function, often after a cast or trauma.
🔹 Classic signs include severe pain out of proportion, pain unrelieved by medication, paresthesia (numbness/tingling), pallor, cool skin, and delayed capillary refill.
🔹 The presence of pale, cold skin with sluggish cap refill indicates compromised arterial blood flow distal to the cast.
🔹 Numbness in the fingers suggests nerve compression due to rising compartment pressure.
🔹 These findings together strongly indicate compartment syndrome, a limb-threatening emergency that requires immediate provider notification and cast adjustment or fasciotomy.
Fat embolism
🔹 Fat embolism typically occurs after long bone fractures (like femur) and presents with respiratory distress, tachypnea, hypoxia, confusion, and petechial rash on chest or upper body.
🔹 This client’s symptoms are localized to the affected arm—pain, numbness, pallor—not systemic respiratory or neurological symptoms.
🔹 There is no mention of shortness of breath, confusion, chest petechiae, or hypoxemia, which would be expected in fat embolism.
🔹 While fat embolism is a serious complication, it does not explain the cold, pale limb with sluggish capillary refill.
🔹 Therefore, fat embolism is not the best match for this presentation.
Deep vein thrombosis (DVT)
🔹 DVT typically presents with unilateral swelling, warmth, redness, and pain in a limb, most often in the lower extremities.
🔹 The problem here is cold, pale skin and neurovascular compromise under a cast, not swelling and warmth.
🔹 DVT does not usually cause numbness in the fingers or sluggish cap refill distal to a cast.
🔹 The timing and symptoms fit better with local compartment pressure rather than venous clot formation.
🔹 So, DVT is not the correct complication in this context.
Osteomyelitis
🔹 Osteomyelitis is a bone infection that usually presents with localized bone pain, warmth, swelling, redness, and systemic signs like fever and elevated WBC.
🔹 This scenario describes acute neurovascular compromise (pallor, coolness, altered cap refill) rather than infection signs.
🔹 Osteomyelitis is not an immediate, within-hours complication of a new cast; it typically develops over days to weeks, especially after open fractures or surgery.
🔹 The priority concern here is blood flow obstruction, not infection.
🔹 Therefore, osteomyelitis is not the most likely complication.
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This question is from ATI PN Adult Medical Surgical Online Practice 2023 B which contains 87 questions.
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From Exam
ATI PN Adult Medical Surgical Online Practice 2023 B
87 Questions
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- Category: LPN Nursing Exam(s)
- Subcategory: LPN ATI Exams
- Domain: Medical-Surgical
- Answer Choices: 4