# A client with a lower leg cast reports severe pain unrelieved by prescribed opioid medication. The toes are pale and the client reports numbness. Which complication should the nurse suspect?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=397277&lang=en  
> language: en  
> subject: Complications of Procedures  
> category: ROR

## Question

A client with a lower leg cast reports severe pain unrelieved by prescribed opioid medication. The toes are pale and the client reports numbness. Which complication should the nurse suspect?

## Option

1. Expected cast discomfort.
2. Compartment syndrome. **✔ Correct answer**
3. Venous stasis dermatitis.
4. Mild muscle strain.

**Correct answer: 2**

## Explanation

Severe pain unrelieved by opioids with pallor and numbness after casting suggests compartment syndrome, a limb-threatening emergency. This is not expected cast discomfort. Prompt neurovascular assessment and provider notification are needed.

## In-depth explanation

Clinical Judgment
Use the client cues, timing, labs, and safety risks to select the response that best fits Cast neurovascular compromise.

Memory Tip
Match the strongest cue cluster to the safest nursing judgment.

KR vs US
NCLEX items reward cue-based priority thinking rather than isolated recall.

## Clinical scenario

Clinical Practice Guide
For Cast neurovascular compromise, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.

Caution
Do not choose an action from one isolated cue when the full scenario changes priority or safety.

## Key concepts

- **Compartment Syndrome** — Increased pressure in a closed muscle compartment that reduces perfusion.
- **Neurovascular Assessment** — Evaluation of circulation, sensation, movement, pain, and pulses.
- **Cast** — A rigid device used to immobilize an injured bone or joint.

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