NCLEX : Identifying Musculoskeletal Conditions
Study concepts, example questions & explanations for NCLEX
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Example Questions
Example Question #1142 : Nclex
You are a nurse in an emergency department and a patient presents following a bicycle accident in which he fractured his right radius and ulna. The patient complains that he cannot feel his extremity distal to the fracture. The right upper extremity is pale, painful, pulseless, and cool to the touch, and the patient complains of occasional "pins and needles" within and distal to the injury. You note a great deal of swelling around the fracture site. Which of the following is the most likely diagnosis?
Vasculitis
Lupus
Fat embolism
Compartment syndrome
Limb necrosis
Compartment syndrome
The correct answer is "compartment syndrome." Compartment syndrome is a surgical emergency in which an injury results in hemorrhage or swelling in an enclosed space that causes dangerously high pressures to build within the enclosed space, resulting in compromised bloodflow to the muscles and nerves within and distal to the space. The symptoms include a cool, pale, pulseless extremity that may also experience paresthesias, and that is visibly swollen and tense. In this case, the patient's right arm exhibits all of these characteristics, and this presentation is highly consistent with compartment syndrome.
The other choices are incorrect. Vasculitis and lupus are both autoimmune conditions that may result in limb swelling, but would be unlikely causes of this patient's presentation, especially in the setting of a recent local trauma to the affected limb. Fat embolism would not account for the patient's constellation of symptoms.There is no evidence of limb necrosis at this stage of the patient's injury. Should the compartment syndrome not be addressed and vascular flow remain compromised by persistently high pressures, then limb ischemia and consequent necrosis could be a downstream effect.
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