What would the nurse check when assessing the patient with early to moderate rheumatoid arthritis?

Choice A reason: An oblique fracture involves a diagonal break across the bone, typically from twisting forces, not splintering into multiple pieces. Comminuted fractures, as described, involve multiple fragments. Misidentifying as oblique risks inappropriate treatment, like simple casting instead of surgical fixation, delaying healing and increasing nonunion risk in complex tibial fractures.

Choice B reason: An impacted fracture occurs when bone ends are driven together, often in compression injuries, not splintered into pieces. The described tibial fracture with multiple fragments is comminuted. Assuming impacted misguides management, potentially overlooking the need for surgical stabilization, complicating recovery and alignment in severe fractures.

Choice C reason: A comminuted fracture, where the bone splinters into multiple fragments, matches the x-ray description. Common in high-energy trauma like falls, it requires surgical fixation to align fragments and ensure healing. Accurate identification guides appropriate intervention, preventing complications like malunion or infection in complex tibial fractures.

Choice D reason: A transverse fracture is a straight, horizontal break, not involving multiple fragments. The described splintered tibia indicates a comminuted fracture. Misdiagnosing as transverse risks inadequate treatment, like casting instead of surgery, leading to poor alignment, delayed healing, or chronic pain in severe tibial injuries.

Choice A reason: Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder. Males (XY) pass their Y chromosome to sons and X to daughters, not the DMD gene. Females (XX) can pass the mutated X to offspring. This statement is incorrect, as males cannot pass the DMD gene to their children.

Choice B reason: DMD primarily affects males, as it is X-linked recessive, and males lack a second X chromosome to mask the mutation. Females are rarely affected, typically as carriers or in rare cases with skewed X-inactivation. This statement is incorrect, as patients are predominantly male, not female.

Choice C reason: Genetic testing identifies DMD gene mutations, confirming diagnosis and guiding treatment, such as corticosteroids to slow muscle degeneration or emerging gene therapies. It informs prognosis, carrier status, and family planning, making it critical for tailoring interventions and counseling families about the disease’s progression and management.

Choice D reason: Not all daughters of a carrier female will be carriers. A carrier mother has a 50% chance of passing the mutated X chromosome to each daughter, making half likely carriers. This statement is incorrect, as it overstates the genetic transmission probability for female offspring.