When is a fat embolism most likely to occur?

Correct Answer: A

Rationale: In understanding why a fat embolism is most likely to occur 24 to 48 hours following a fractured tibia, it is essential to grasp the pathophysiology behind fat embolism syndrome (FES). FES typically presents in long bone fractures, where fat globules from the bone marrow enter the bloodstream and obstruct small vessels, leading to respiratory distress, petechial rash, and neurological symptoms. The onset of symptoms correlates with the timing of fat release into the circulation, which peaks within the first 24 to 48 hours post-injury, making option A the correct choice. Option B (36 to 72 hours following a skull fracture) is incorrect as FES is not commonly associated with skull fractures. The fat embolism phenomenon is primarily seen in long bone fractures due to the abundant bone marrow present in these bones. Option C (4 to 5 days following a fractured femur) and option D (5 to 6 days following a pelvic fracture) are also incorrect because the timeline for fat embolism development is much sooner after injury, typically within the first 48 hours. From an educational perspective, understanding the timeline of fat embolism occurrence in relation to different types of fractures is crucial for healthcare providers in assessing and managing patients with traumatic injuries. Recognizing the signs and symptoms of FES early on can lead to prompt intervention and improved patient outcomes. It underscores the importance of timely assessment and monitoring in patients with long bone fractures to prevent and manage potential complications like fat embolism syndrome.

Correct Answer: C

Rationale: The best description the RN can give to the nursing student when asked about arthroplasty is option C: Reconstruction or replacement of a joint to relieve pain and correct deformity. This option is correct because arthroplasty involves the surgical reconstruction or replacement of a damaged joint with an artificial joint to restore function, relieve pain, and correct deformity. Option A is incorrect because arthroplasty is not a surgical fusion of a joint, but rather involves replacing or reconstructing the joint. Option B is incorrect as it describes osteotomy, where a wedge or slice of bone is removed to correct bone deformity, not joint replacement. Option D is incorrect as it refers to synovectomy, which is the removal of the synovial membrane in rheumatoid arthritis, not arthroplasty. In an educational context, it is important for nursing students to understand the terminology and procedures related to orthopedic surgeries like arthroplasty as they are common interventions for musculoskeletal disorders. Understanding the purpose and process of arthroplasty helps students provide better care for patients undergoing such procedures and enhances their ability to communicate effectively with healthcare providers and patients regarding treatment options and outcomes.

Correct Answer: B

Rationale: In this question, the correct answer is B) Very malignant and metastasizes early. Osteosarcoma is a primary malignant bone tumor that arises from primitive bone-forming mesenchymal cells. It is known for its aggressive behavior, high malignancy, and tendency to metastasize early, commonly to the lungs. This option accurately describes the nature of osteosarcoma, making it the correct choice. Option A) High rate of local recurrence is incorrect because osteosarcoma is more known for its metastatic potential rather than local recurrence. While local recurrence can occur, it is not a defining characteristic of osteosarcoma. Option C) Arises in cancellous ends of long bones is incorrect because osteosarcoma commonly arises in the metaphyseal region of long bones, which is the area between the diaphysis and epiphysis, rather than specifically in the cancellous ends. Option D) Develops in the medullary cavity of long bones is incorrect because osteosarcoma typically arises in the metaphysis rather than within the medullary cavity of long bones. Educationally, understanding the characteristics of osteosarcoma is crucial for healthcare professionals, especially those working in oncology or orthopedics. Recognizing the aggressive nature of osteosarcoma and its typical presentation in long bones can aid in early diagnosis and appropriate management of this challenging condition.

Correct Answer: D

Rationale: The correct answer is D) Herniated intervertebral disc. Radicular pain that radiates down the buttock and below the knee, along the distribution of the sciatic nerve, is a classic presentation of sciatica. This condition is commonly caused by compression or irritation of the spinal nerve roots in the lumbar spine, often due to a herniated intervertebral disc. Option A) Cervical disc herniation is incorrect as cervical disc issues typically manifest as neck and arm pain, not as lower extremity pain like in the case of sciatica. Option B) Acute lumbosacral strain is incorrect because while it can cause lower back pain, it does not typically produce the characteristic radiating pain down the leg seen in sciatica. Option C) Degenerative disc disease can cause back pain, but it is not typically associated with the specific distribution of pain seen in sciatica. Understanding the different causes of radicular pain is crucial in diagnosing and managing patients with neurological symptoms. Educating healthcare providers and students about the specific patterns of symptoms associated with different conditions helps in accurate diagnosis and appropriate treatment interventions.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Adding misoprostol (Cytotec) to the patient's drug regimen. Misoprostol is a prostaglandin analog that helps protect the stomach lining from the irritating effects of NSAIDs like ibuprofen. By adding misoprostol, the patient can continue to benefit from the pain relief of ibuprofen while reducing the risk of gastrointestinal side effects such as dyspepsia and nausea. Option B) Substituting naproxen for ibuprofen may not necessarily address the issue of dyspepsia and nausea, as naproxen is also an NSAID and can cause similar gastrointestinal side effects. Option C) Increasing the dose of acetaminophen is not a suitable solution as acetaminophen is not an NSAID and does not have the same mechanism of action as ibuprofen. Additionally, exceeding the recommended daily dose of acetaminophen can lead to liver damage. Option D) Administering ibuprofen with antacids may provide temporary relief for dyspepsia, but it does not address the underlying issue of GI irritation caused by NSAIDs. Antacids may also interfere with the absorption of ibuprofen, reducing its effectiveness in providing pain relief. In an educational context, understanding the rationale behind choosing the appropriate adjunct therapy like misoprostol is crucial in managing patients with OA who require NSAID therapy but are experiencing gastrointestinal side effects. It emphasizes the importance of considering the mechanism of action of medications and how they interact with the body to make informed decisions for optimal patient care.