# An adult with a closed tibial fracture is receiving serial neurovascular checks. Click the earliest displayed assessment that should prompt immediate evaluation for acute compartment syndrome, without waiting for loss of the distal pulse.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=582087&lang=en  
> language: en  
> subject: Physiological Adaptation  
> category: PA

## Question

An adult with a closed tibial fracture is receiving serial neurovascular checks. Click the earliest displayed assessment that should prompt immediate evaluation for acute compartment syndrome, without waiting for loss of the distal pulse.

![](https://mymerci.kr/data/nclex/hotspot/replacement_20260909/HSR545.svg)

## Explanation

B is the earliest assessment showing escalating pain despite analgesia, pain with passive stretch, and a tense compartment; a palpable pulse does not exclude acute compartment syndrome.

## In-depth explanation

Quick answer
B. The 09:00 assessment is the first cluster strongly concerning for acute compartment syndrome.
Why this is the best choice
At 09:00, pain rises from 5 to 8 despite prescribed analgesia, passive toe extension produces marked pain, and the lower-leg compartment is tense. These findings require immediate escalation even though sensation and the dorsalis pedis pulse remain intact. Serial change and the combination of cues matter more than any single finding.
Clinical picture
Acute compartment syndrome can develop after a tibial fracture. Early recognition should occur before pallor, paralysis, or pulselessness, which are late findings and may signal advanced ischemia.
Memory hook
Rising pain + passive-stretch pain + tense compartment: escalate before the pulse disappears.
Decision rule
Use serial trends and early symptom clusters; a present distal pulse does not rule out compartment syndrome.
Why the other regions do not fit
A shows pain relief and a soft compartment. C is also concerning but occurs after B and adds paresthesia. D shows late progression with weakness and pulselessness; waiting for D would be unsafe.
**Sources**
- AAOS identifies acute compartment syndrome after traumatic extremity injury as requiring evidence-based diagnosis and timely management.

- Early findings include severe pain, pain with passive stretch, and a tense compartment; pulselessness and paralysis are typically late findings, and a palpable pulse does not exclude the condition.

## Key concepts

- **Acute compartment syndrome** — Rising pressure within a closed fascial compartment can impair tissue perfusion and requires urgent evaluation.
- **Pain with passive stretch** — A concerning early assessment finding when paired with escalating pain and a tense compartment.
- **Late pulse loss** — Distal pulses can remain present after compartment syndrome has developed; pulselessness is a late finding.

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