Editing Medical-Surgical Nursing – RN Practice Questions (section)

==Question 5==
Six hours after casting of a tibial fracture, a patient reports severe pain that is unrelieved by two doses of intravenous morphine and worsens sharply when the toes are passively extended. The toes are warm with a palpable pedal pulse and capillary refill of two seconds. What is the nurse's priority action?
# Document the findings and reassess in one hour, since the pulse and perfusion are intact.
# Elevate the extremity well above the level of the heart and apply ice.
# Notify the provider immediately about possible compartment syndrome.
# Administer an additional dose of morphine and encourage relaxation techniques.

'''Answer:''' Option 3, notify the provider immediately about possible compartment syndrome.

''Rationale:'' Pain out of proportion to the injury, unrelieved by opioids and increased by passive stretch, is the earliest and most reliable indicator of compartment syndrome. A palpable pulse does not rule it out, because pulselessness is a very late finding after irreversible tissue damage has begun. Option 1 delays a limb-threatening emergency. Option 2 is harmful, because elevating above heart level further reduces arterial perfusion; the extremity is kept at heart level. Option 4 masks the key assessment finding without addressing the cause.