Chapter 50 Medical Surgical Nursing Preparation For Practice 2nd Edition By Osborn

Chapter 50 Medical Surgical Nursing Preparation For Practice 2nd Edition By Osborn

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

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

 

Question 3

Type: MCMA

The nurse explains to a patient who is having a cast removed that the remodeling phase of fracture healing involves which changes?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Creation of the cartilage collar at the fracture sight
2. Application of stress and weight to the affected bone
3. Granulation of new bone tissue to form the connective bridge
4. Resorption of excess new bone at the site of the callus
5. Strengthening of the new bone at the site of the fracture

Correct Answer: 2,4,5

Rationale 1: A cartilage collar does form, but not in the remodeling phase.

Rationale 2: The remodeling process is directed by mechanical stress and weight bearing, causing the bone to become stronger in relation to its function.

Rationale 3: Granulation is involved in the formation of a connective bridge, but this does not occur in the remodeling phase.

Rationale 4: The remodeling process involves resorption of the excess callus in the marrow space and the external aspect of the fracture.

Rationale 5: The remodeling process involves resorption of the excess callus in the marrow space and the external aspect of the fracture. The process is directed by mechanical stress and weight bearing, causing the bone to become stronger in relation to its function.

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 4

Type: MCMA

The nurse is caring for a patient whose fractured left femur was surgically managed with intramedullary (I-M) rodding. The nurse would explain which benefits of this type of fixation?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. It results in only minimal skin scarring.
2. It does not interfere with range of motion.
3. It facilitates direct visualization of the fracture.
4. It reduces the risk of a postsurgical fat embolus.
5. It allows for early weight bearing.

Correct Answer: 1,2,5

Rationale 1: The benefits of this fixation method include small surgical scars in less obvious places than with other methods.

Rationale 2: This fixation method leaves the joint free to move so there is less interference with range of motion.

Rationale 3: If direct visualization of the fracture is required, the open reduction method of repair is chosen.

Rationale 4: There is a slightly higher risk of fat embolism with this method.

Rationale 5: Intramedullary (I-M) rodding is a method of fracture fixation that entails sliding a metal rod down the medullary canal of a long bone. This form of fixation allows for early weight bearing because it shares the load.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 50-4