A patient with a humeral fracture is returning for a 4-week checkup. The nurse explains that initial evidence of healing on x-ray is indicated by

priority. Protein aids long-term recovery by promoting bone healing, but infection control is critical to prevent systemic spread or bone necrosis. Nutritional support is secondary to addressing the acute bacterial infection driving the condition.

Choice B reason: Administering antibiotics is the priority in acute osteomyelitis, a bacterial bone infection (often Staphylococcus aureus). Prompt antibiotics target the infection, preventing sepsis, abscess formation, or chronic osteomyelitis. Delaying treatment risks bone destruction and systemic complications, making timely antibiotic administration essential to control the infection and preserve bone integrity.

Choice C reason: Teaching relaxation breathing reduces pain perception by calming the nervous system but does not address the underlying infection in osteomyelitis. Pain management is important but secondary to antibiotics, which target the bacterial cause. Without infection control, pain will persist, and complications like bone damage may worsen.

Choice D reason: Providing antipyretic therapy manages fever, a symptom of osteomyelitis, but does not treat the infection itself. Fever reflects the body’s immune response to bacteria, and while comfort is important, antibiotics are the priority to eradicate the pathogen, preventing progression to sepsis or chronic bone infection.

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 By 4 weeks, the hematoma is typically replaced by soft callus, making it an outdated sign.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.