A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be preformed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take?
Notify the health care provider (HCP)
Administer an analgesic
Release the skin traction
Apply ice to the extremity
The Correct Answer is A
A. The absence of the dorsalis pedis pulse in the right foot is concerning and could indicate compromised circulation to the extremity. It is essential to notify the healthcare provider promptly so that further assessment and intervention can be initiated to address the circulation issue and prevent potential complications such as ischemia or tissue damage.
B. Administering an analgesic may be necessary to manage the child's pain, especially if they are experiencing discomfort due to the femur fracture. However, addressing the absent dorsalis pedis pulse takes priority as it suggests a potential vascular problem that requires immediate attention.
C. Releasing the skin traction may not be appropriate at this point without further assessment and guidance from the healthcare provider. Skin traction is often used to temporarily stabilize fractures and reduce pain, and releasing it without proper evaluation could potentially exacerbate the injury or compromise the child's comfort and stability.
D. Applying ice to the extremity is not indicated in this situation. Ice application is typically used for acute injuries to reduce swelling and inflammation, but it is not appropriate when there is concern about compromised circulation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Amblyopia occurs when one eye has weaker vision than the other due to abnormal visual development early in life. Patching the good eye helps to encourage the brain to rely more on the weaker eye, stimulating its visual development. This treatment aims to improve vision in the affected eye and restore visual acuity.
B. Patching the affected eye is not a common treatment for amblyopia. In fact, patching the affected eye would further decrease visual input to that eye and could potentially exacerbate the condition. The goal of treatment for amblyopia is to strengthen the weaker eye by encouraging its use, rather than resting it.
C. Corticosteroids are not typically used to treat amblyopia unless there is a specific underlying condition causing inflammation of the optic nerve. Amblyopia is primarily a developmental issue rather than an inflammatory condition, so corticosteroids would not be the first-line treatment for this condition.
D. This is not a common treatment for amblyopia. In fact, the goal of treatment for amblyopia is to improve vision in the affected eye, not to intentionally blur the vision in the good eye. Glasses prescribed for amblyopia typically aim to correct refractive errors (such as nearsightedness, farsightedness, or astigmatism) and provide clear vision to both eyes, which can help support visual development in the weaker eye.
Correct Answer is D
Explanation
D. Pancreatic enzymes should not be mixed with acidic foods or liquids, as this can reduce their effectiveness. Instead, the enzymes should be sprinkled on soft, non-acidic foods or swallowed whole with a glass of water or juice.
A. Pancreatic enzymes are generally safe and well-tolerated when taken as prescribed but they can cause side effects in some individuals. Common side effects may include abdominal pain, diarrhea, constipation, nausea, and bloating.
B. Pancreatic enzymes help individuals with cystic fibrosis digest fat, as well as proteins and carbohydrates. In cystic fibrosis, the pancreas does not produce enough digestive enzymes, leading to malabsorption of nutrients, particularly fat. Supplemental pancreatic enzymes help compensate for this deficiency and improve nutrient absorption.
C. Pancreatic enzymes are typically taken with meals or snacks to aid in digestion. However, if the child is consuming a small meal or snack that contains minimal fat, the enzymes may not be necessary. It's important for the mother to follow the healthcare provider's instructions regarding when and how to administer the enzymes.
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