Chapter 50 Osborn, Medical-Surgical Nursing, 2e

Question 1 Type: MCSA A patient who has been casted for a fracture of the left ulna asks the nurse when the cast will come off. The nurse‟s response is based on the knowledge that the cast will be removed when which physiologic parameter has been met? 1. The remodeling phase of the bone healing process has been completed, allowing for application of mechanical stress. 2. A cartilage collar can be clearly felt at the site of the original break. 3. A specific amount of time has passed, predetermined by the severity of the break. 4. The X-ray of the fractured bone shows that the ends are well joined. Correct Answer: 4 Rationale 1: Remodeling of the bone occurs after the cast is removed. Rationale 2: During cellular proliferation and callus formation, a cartilage “collar” is evident around the fracture site, but this does not signify that the bone has healed sufficiently to remove the cast. Rationale 3: While the amount of time a fracture requires casting varies, the severity of the fracture is only one factor that is considered.Rationale 4: Ossification is the final laying down of bone after the fracture has been bridged and the fragments are united. Mature bone replaces the callus, and the fracture site feels firm and appears united on radiograph. It is at this point that a cast may be removed. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-3 Question 2 Type: MCSA A patient has a dislocated hip as the result of a fall. The nurse recognizes which primary reason to quickly return the femoral head to its normal position? 1. To preserve blood flow to the head of the femur 2. To avoid damage to nerves in the affected area 3. To minimize the damage to affected ligaments 4. To eliminate the severe pain the patient is experiencing Correct Answer: 1 Rationale 1: A dislocation is a displacement of a bone from its normal position in a joint. While the dislocation requires reduction as soon as possible to reduce damage, the primary concern is interference with blood supply to the femoral head. This can lead to severe complications such as avascular necrosis (AVN). Rationale 2: Damage to nerves in the affected area is a potential complication of dislocation. This is a serious situation but is not the highest priority.Rationale 3: Damage to ligaments is a potential complication of dislocation. This is a serious situation but is not the highest priority. Rationale 4: Pain occurs with dislocation. This is a serious situation but is not the highest priority. Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 50-4