# The nurse assesses a client two hours after a lower-leg cast was applied. Which findings require immediate follow-up? Highlight the findings associated with acute compartment syndrome.

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> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

The nurse assesses a client two hours after a lower-leg cast was applied. Which findings require immediate follow-up? Highlight the findings associated with acute compartment syndrome.

| Assessment area | Current finding |
| --- | --- |
| Pain | Lower-leg pain is 9/10 and persists after intravenous opioid and careful elevation. |
| Capillary refill | Capillary refill in each toe is two seconds, with skin color unchanged from the prior check. |
| Swelling | Moderate swelling at the fracture site has not increased since the cast was applied two hours ago. |
| Passive movement | Passive extension of the great toe causes intense pain deep beneath the cast. |
| Pulse | The dorsalis pedis pulse remains palpable, regular, and equal to the opposite foot. |
| Sensation | New tingling is reported across the toes and the top of the affected foot. |
| Skin | Bruising remains localized over the fracture and has not spread beyond the marked border. |
| Movement | The client can no longer lift the great toe as during the previous assessment. |
| Temperature | The toes are warm, pink, and match the skin temperature of the unaffected foot. |

## Explanation

Pain out of proportion, pain with passive stretch, new paresthesia, and new motor weakness suggest rising compartment pressure. A palpable pulse does not rule out this limb-threatening emergency.

## In-depth explanation

Quick answer
Immediately follow up on severe pain despite treatment, pain with passive toe movement, new tingling, and new toe weakness. These findings suggest increasing pressure that may damage muscle and nerves.

Why this is correct
Acute compartment syndrome causes pain greater than expected, pain that does not improve with medicine or elevation, sensory change, and weakness.[1] Waiting for a pulse to disappear is unsafe because tissue injury can advance before pulselessness occurs.

Easy analogy or mental picture
Imagine swelling inside a rigid suitcase that cannot expand. As pressure rises, soft contents and wires are squeezed; the wires are the nerves and blood supply. The image explains urgency but does not replace pressure measurement or surgical evaluation.

Memory hook
Pain, passive-stretch pain, pins-and-needles, and power loss mean pressure.

NCLEX decision rule
When pain escalates beneath a cast with sensory or motor change, think compartment syndrome; perform an immediate neurovascular check and escalate without waiting for the pulse to vanish.

Why the other choices are wrong
Two-second capillary refill, unchanged swelling, a palpable pedal pulse, localized bruising, and warm toes are useful observations but do not cancel the selected early warning pattern. Continuing routine reassessment alone would delay definitive evaluation.References

- [1]MedlinePlus: Compartment SyndromeU.S. National Library of Medicine

- [2]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

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