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    Paediatrics and maternity proctored exam (examplify)

    An adolescent has right femur fracture from a motor vehicle accident and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action would the nurse take?

    Explanation & Rationale

    Rationale: A. Applying ice does not address the absence of a pulse and may worsen circulation. B. Absence of dorsalis pedis pulse indicates possible compromised circulation or vascular injury and requires immediate physician notification. C. Administering analgesics manages pain but does not address the critical vascular issue. D. Releasing skin traction without physician order may cause further injury; this is not appropriate.

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