What will the nurse include when caring for a child in Buck’s extension?

Choice A reason: Placing the client in a high-Fowler position may improve breathing but does not assess the cause of shortness of breath. Post-femur repair, pulmonary embolism (PE) is a risk due to fat emboli or thromboembolism, requiring objective data like oxygen saturation first.
Choice B reason: New-onset shortness of breath and tachypnea post-femur repair suggest possible pulmonary embolism or fat embolism syndrome. Documenting oxygen saturation provides objective data to assess hypoxia severity, guiding urgent interventions and communication with the healthcare provider for suspected life-threatening conditions.
Choice C reason: Starting oxygen therapy assumes hypoxia without confirmation. While it may be needed, assessing oxygen saturation first ensures the intervention is appropriate. Unwarranted oxygen administration could delay critical diagnostic steps for conditions like pulmonary embolism, which require anticoagulation or other therapies.
Choice D reason: Contacting the provider is important but secondary to assessing oxygen saturation, which provides critical data to report. Without objective findings, the nurse cannot convey the urgency or specifics of the client’s condition, potentially delaying life-saving interventions for suspected embolism.

Choice A reason: The wearing-off phenomenon in Parkinson’s occurs when levodopa’s effect diminishes before the next dose, causing symptom fluctuations. This results from progressive dopamine neuron loss, reducing storage capacity, and shorter levodopa half-life, leading to rapid swings in motor control as plasma levels fluctuate.
Choice B reason: Intolerance to medications may cause side effects (e.g., nausea), but the wearing-off phenomenon is due to disease progression and levodopa’s pharmacokinetics, not patient tolerance. Symptoms return as drug levels drop, not because of inability to tolerate the dose.
Choice C reason: Medications like levodopa remain effective, but wearing-off occurs due to shorter duration of action as Parkinson’s progresses, not loss of drug efficacy. Neuron loss reduces dopamine storage, causing symptoms to re-emerge between doses, not a failure of the drug itself.
Choice D reason: The liver metabolizes levodopa minimally; carbidopa prevents peripheral breakdown. Wearing-off is due to central nervous system changes (loss of dopamine neurons), not liver dysfunction, which does not significantly alter levodopa’s pharmacokinetics in Parkinson’s disease.