A patient is admitted with an open fracture of the tibia after a bicycle accident. What information would the nurse obtain when assessing the patient?
The status of tetanus immunization.
Whether the injury was exposed to dirt or gravel.
Any previous injuries to the leg.
The use of antibiotics in the last month.
The Correct Answer is A
Choice A reason: Assessing tetanus immunization status is critical for an open fracture, as wounds exposed to soil or debris risk Clostridium tetani infection. Tetanus prophylaxis (vaccine or immunoglobulin) prevents lockjaw and neuromuscular complications. This ensures timely immunization, reducing life-threatening infection risks in contaminated wounds like those from bicycle accidents.
Choice B reason: Determining exposure to dirt or gravel is essential, as open fractures are prone to bacterial contamination (e.g., Staphylococcus aureus or Pseudomonas). Contaminated wounds require urgent irrigation, debridement, and antibiotics. This assessment guides infection prevention, ensuring prompt surgical and antimicrobial interventions to minimize osteomyelitis or sepsis risks in open tibial fractures.
Choice C reason: Previous leg injuries are relevant for overall musculoskeletal history but not immediate for open fracture management. Current wound contamination and infection risk take precedence. Focusing on past injuries delays critical interventions like tetanus prophylaxis or debridement, potentially worsening outcomes in acute open fractures from bicycle accidents.
Choice D reason: Recent antibiotic use is less urgent than contamination or tetanus status in open fractures. While it may inform antibiotic resistance, it’s not a primary assessment focus. Prioritizing this risks delaying wound cleaning and prophylaxis, increasing infection risks like cellulitis or osteomyelitis in contaminated open tibial fractures.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Complications of immobility, like muscle atrophy or thromboembolism, occur with both ORIF and closed reduction, as both may require immobilization post-procedure. ORIF involves surgery, but modern protocols emphasize early mobilization, similar to closed reduction. This disadvantage is not unique to ORIF, making it an incorrect choice.
Choice B reason: ORIF involves surgical incision and hardware placement, increasing infection risk at the surgical site or deep tissues (osteomyelitis). Closed reduction is non-invasive, avoiding this risk. Infections can delay healing, require antibiotics, or necessitate hardware removal, making this a significant disadvantage of ORIF compared to closed reduction.
Choice C reason: Skin irritation can occur with both ORIF (from incisions or hardware) and closed reduction (from casts or splints). It is not a distinct disadvantage of ORIF, as both methods involve external or internal devices that may irritate skin. This choice is incorrect, as it is not unique to ORIF.
Choice D reason: Nerve impairment risks exist in both ORIF (from surgical manipulation) and closed reduction (from fracture displacement or cast pressure). Neither method uniquely predisposes to nerve damage, and careful technique minimizes this risk. This disadvantage is not specific to ORIF, making it an incorrect choice.
Correct Answer is D
Explanation
Choice A reason: Hematoma forms immediately post-fracture, initiating the healing process by providing a matrix for inflammation and cell migration. By 4 weeks, the hematoma is typically replaced by soft callus, making it an outdated sign. X-rays at this stage show callus formation, not hematoma, as the primary evidence of healing.
Choice B reason: Granulation tissue forms early in soft tissue repair, not bone healing, and is not visible on x-ray. In fractures, it may precede callus formation but is not a distinct radiologic marker by 4 weeks. Callus, a bony precursor, is the expected x-ray finding, making this choice incorrect.
Choice C reason: Complete bony union occurs months after a fracture, typically 6-12 weeks for a humerus, depending on age and health. At 4 weeks, healing is in the callus formation stage, not full union. This sign is too advanced for the timeframe, making it an incorrect indicator.
Choice D reason: Callus formation, visible on x-ray by 4 weeks, indicates initial bone healing. Fibrocartilaginous callus bridges the fracture, stabilizing it as osteoblasts lay down new bone. This radiologic sign confirms progression from hematoma to early bone remodeling, making it the expected evidence of healing at this stage.
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