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NCLEX Question of the Day

July 17, 2026 Physiological Adaptation

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Physiological Adaptation QID 1200

A nurse is caring for a client 24 hours after sustaining multiple fractures, including a femur fracture. The client suddenly becomes confused, tachypneic, and reports shortness of breath. Petechiae are noted across the client's chest and axillae. Which complication does the nurse suspect?

  1. Hemorrhagic shock

  2. Compartment syndrome

  3. Pulmonary embolism from deep vein thrombosis

  4. Correct answer Fat embolism syndrome

Rationale

Fat embolism syndrome (FES) is a serious complication often associated with fractures of long bones (like the femur) or pelvic fractures. Fat globules travel from the fractured bone marrow into the bloodstream, occluding small vessels primarily in the lungs, brain, and skin. The classic triad includes respiratory distress (tachypnea, dyspnea, hypoxemia), neurological changes (confusion, restlessness, altered consciousness), and a petechial rash (typically on the chest, axillae, and neck), usually appearing 24-72 hours post-injury. While a PE from a DVT is possible post-fracture, the neurological symptoms and petechial rash are more specific to FES. Hemorrhagic shock would present with hypotension, tachycardia, and pale, cool skin, not typically petechiae or acute confusion without significant blood loss signs. Compartment syndrome involves increased pressure within a muscle compartment, causing severe pain, pallor, pulselessness, paresthesia, and paralysis localized to the affected limb.

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