Fracture — NCLEX Cheat Sheet
5 P's = neurovascular checkAlso known as: broken bone · bone break · cracked bone
Use this quick-reference guide to spot, treat, and prevent Fracture on the NCLEX. Keep it handy during review and on exam day!
🩺📒 The 1-minute cheat sheet
🩺 Signs
- pain, deformity, swelling, crepitus
- loss of function, bruising
🩺 Assess
- 5 P's: Pain, Pallor, Pulse
- Paresthesia, Paralysis
- check distal to injury
🚩 Report
- fat embolism: SOB, petechiae, confusion
- compartment syndr: ↑pain unrelieved
- no pulse, cold pale limb
✅ Do
- immobilize, ice, elevate
- neurovascular checks q1-2h
- traction: weights hang FREE
📚 Fracture — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Key points
Understand these first- Classic signs are pain, swelling, deformity, loss of function, bruising, and crepitus (grating sound or feeling).
- Open (compound) fractures break the skin and carry a high risk of osteomyelitis and tetanus.
- Femur and pelvic fractures can cause major internal blood loss leading to hypovolemic shock.
- Long bone fractures (femur, pelvis) raise the risk of fat embolism syndrome within 24 to 72 hours.
- Bone healing stages are hematoma, fibrocartilage, callus formation, ossification, and remodeling.
- Delayed union, nonunion, and avascular necrosis are late complications of poor healing.
Nursing priorities
What to do, in order- Immobilize the affected part and splint above and below the joint before moving; do not realign bone ends.
- Perform neurovascular checks (the 5 P's: pain, pallor, pulselessness, paresthesia, paralysis) distal to the injury.
- Apply ice and elevate the extremity above heart level to reduce swelling.
- Cover open fractures with a sterile moist dressing and prepare for antibiotics and tetanus prophylaxis.
- Manage pain and assess circulation, motion, and sensation before and after casting or splinting.
Red flags — report now
Escalate immediately- Sudden increase in pain unrelieved by opioids, especially with a tight cast, signals compartment syndrome.
- Loss of distal pulse, pallor, coolness, or numbness indicates arterial compromise and needs immediate report.
- Dyspnea, confusion, and petechiae over the chest after a long bone fracture suggest fat embolism.
- Never elevate the limb or apply ice once compartment syndrome is suspected, as both reduce perfusion.
Labs & values
Numbers to know- Hemoglobin: 12 to 18 g/dL (drops with internal bleeding)
- Hematocrit: 37 to 52 percent
- WBC: 5,000 to 10,000/mm3 (rises with infection in open fractures)
Patient teaching
What patients must know- Report increasing pain, numbness, tingling, or a foul odor or drainage from the cast.
- Keep the cast clean and dry; never insert objects to scratch under it.
- Wiggle fingers or toes and elevate the limb to control swelling at home.
❓ Fracture: NCLEX FAQs
What are the priority nursing interventions for Fracture?
Immobilize the affected part and splint above and below the joint before moving; do not realign bone ends. Perform neurovascular checks (the 5 P's: pain, pallor, pulselessness, paresthesia, paralysis) distal to the injury. Apply ice and elevate the extremity above heart level to reduce swelling. Cover open fractures with a sterile moist dressing and prepare for antibiotics and tetanus prophylaxis.
What are the warning signs of Fracture a nurse must report?
Sudden increase in pain unrelieved by opioids, especially with a tight cast, signals compartment syndrome. Loss of distal pulse, pallor, coolness, or numbness indicates arterial compromise and needs immediate report. Dyspnea, confusion, and petechiae over the chest after a long bone fracture suggest fat embolism. Never elevate the limb or apply ice once compartment syndrome is suspected, as both reduce perfusion.
What do I need to know about Fracture for the NCLEX?
Classic signs are pain, swelling, deformity, loss of function, bruising, and crepitus (grating sound or feeling). Open (compound) fractures break the skin and carry a high risk of osteomyelitis and tetanus. Femur and pelvic fractures can cause major internal blood loss leading to hypovolemic shock. Long bone fractures (femur, pelvis) raise the risk of fat embolism syndrome within 24 to 72 hours.
What patient teaching is important for Fracture?
Report increasing pain, numbness, tingling, or a foul odor or drainage from the cast. Keep the cast clean and dry; never insert objects to scratch under it. Wiggle fingers or toes and elevate the limb to control swelling at home.
Quick Tip
Classic signs are pain, swelling, deformity, loss of function, bruising, and crepitus (grating sound or feeling).
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