OCC OCC Neurovascular Assessment & Monitoring 1 — Questions and Answers
Question 1: The classic '5 P's' of neurovascular assessment include all of the following EXCEPT:
- Pain
- Pallor
- Paresthesia
- Perspiration (Correct answer)
Correct answer: Perspiration
The 5 P's are Pain, Pallor, Paresthesia, Pulselessness, and Paralysis/Paresis — perspiration is not included.
Question 2: A capillary refill time greater than how many seconds is considered abnormal in a casted extremity?
- 1 second
- 2 seconds (Correct answer)
- 4 seconds
- 6 seconds
Correct answer: 2 seconds
Capillary refill greater than 2 seconds indicates impaired peripheral perfusion and requires prompt evaluation.
Question 3: Which nerve is assessed by testing sensation in the first dorsal web space (between the thumb and index finger) of the hand?
- Ulnar nerve
- Median nerve
- Superficial radial nerve (Correct answer)
- Anterior interosseous nerve
Correct answer: Superficial radial nerve
The superficial radial nerve provides sensory innervation to the first dorsal web space and dorsolateral hand.
Question 4: Which sign or symptom is typically the EARLIEST indicator of acute compartment syndrome?
- Pulselessness
- Paralysis of affected muscles
- Pain with passive stretch of muscles in the compartment (Correct answer)
- Pallor of the distal extremity
Correct answer: Pain with passive stretch of muscles in the compartment
Pain with passive stretch is the earliest and most sensitive clinical indicator of compartment syndrome, preceding pulselessness and paralysis.
Question 5: Pallor of the fingers in a patient with a freshly applied long arm cast most likely indicates:
- Adequate venous return
- Venous congestion
- Arterial compromise (Correct answer)
- Normal post-application swelling
Correct answer: Arterial compromise
Pallor signifies lack of oxygenated blood reaching the digits, indicating arterial compromise that requires immediate intervention.
Question 6: The radial pulse is best assessed in a patient with a short arm cast by palpating at the:
- Antecubital fossa
- Lateral wrist at the base of the thumb (Correct answer)
- Medial aspect of the wrist
- Dorsum of the hand
Correct answer: Lateral wrist at the base of the thumb
The radial pulse is palpated at the radial aspect of the wrist, proximal to the base of the thumb, just lateral to the flexor carpi radialis tendon.
Question 7: Which assessment finding in a casted lower extremity requires IMMEDIATE notification of the supervising provider?
- Mild swelling of the toes
- Warm and pink toes with brisk capillary refill
- Absence of the dorsalis pedis pulse (Correct answer)
- Slight itching sensation under the cast
Correct answer: Absence of the dorsalis pedis pulse
Absence of a pedal pulse indicates potential vascular occlusion and is an emergency requiring immediate physician notification.
OCC OCC Neurovascular Assessment & Monitoring 1
The classic '5 P's' of neurovascular assessment include all of the following EXCEPT: