The elderly client is admitted to the emergency room. Which symptom is the client with a fractured hip most likely to exhibit?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

Pain is the most consistent and universal symptom of a hip fracture, present in nearly all cases, regardless of the fracture type (displaced or non-displaced).
The pain is typically severe, located in the hip or groin, and is significantly worsened by any attempt to move the affected leg or bear weight.
Unlike other signs that depend on the fracture's severity or type, pain is the immediate result of the bone injury and surrounding tissue trauma.

Option B: Limb shortening and external rotation (disalignment) are classic signs, but they are typically seen only in displaced fractures. They may be absent in non-displaced or impacted fractures.
Option C: A cool extremity is a sign of arterial insufficiency or vascular compromise, which is a serious complication of a fracture, not a primary symptom of the fracture itself.
Option D: This indicates a severe blockage of arterial blood flow to the foot. It is a critical complication, not a typical initial symptom of the hip fracture itself.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Clinical assessment of hip fractures in the elderly in acute care settings.
A nurse's priority for a suspected hip fracture is to immobilize the affected limb, manage pain, and perform frequent neurovascular checks (pulses, color, temperature, sensation, movement).
Failure to recognize signs of vascular compromise (coolness, pallor, absent pulses) can lead to limb ischemia and permanent tissue damage or loss.
What if? If the patient also had pre-existing peripheral neuropathy, they might not report severe pain, making objective signs like inability to bear weight and subtle swelling more critical for diagnosis.

How to Approach the Question

First, identify the core of the question: it asks for the 'most likely' symptom of a hip fracture.
This requires you to differentiate between a universal symptom and signs that are specific to certain types or complications of the fracture.
Evaluate each option. Pain is a general response to almost any injury. Is it the most likely for a hip fracture?
Consider 'Disalignment'. Is this always present? Recall that non-displaced fractures exist.
Analyze 'Cool extremity' and 'Absence of pedal pulses'. Are these direct symptoms of the bone break, or do they indicate a complication like vascular injury?
Conclude that pain is the only symptom that is almost guaranteed to be present, making it the 'most likely' answer.

Concept Tested & Keywords

Concept Tested: Clinical assessment of hip fractures in the elderly.
Stem keywords: elderly client, fractured hip, symptom
Lead-in keywords: most likely
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.

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E6 Medicine Macleod Clinical Examination 15e p. 314-316

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 54-56

E6 Medicine Harrison 22e Part 2 p. 848-850

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.