A nurse is caring for a client with left-sided heart failure. To reduce fluid volume excess, which of the following should the nurse anticipate using?

Choice A reason : When a patient stops taking oral prednisone abruptly after prolonged use, the body may not immediately resume normal production of cortisol, which is a hormone that prednisone mimics. This can lead to adrenal insufficiency, a condition where the body produces insufficient amounts of cortisol. Symptoms can include fatigue, weakness, weight loss, abdominal pain, and low blood pressure¹². It is crucial for patients to understand the need to taper off the medication gradually under medical supervision to avoid this potentially serious condition.

Choice B reason : Memory complications are not typically associated with the sudden cessation of prednisone. While some patients may experience mood swings or cognitive changes while taking prednisone, these are not the primary concerns when discontinuing the medication.

Choice C reason : Cardiovascular complications are not directly related to the sudden stoppage of prednisone. However, adrenal insufficiency can indirectly affect cardiovascular health due to the role of cortisol in maintaining blood pressure and cardiovascular function.

Choice D reason : Psychosis is a possible side effect of taking prednisone, especially at high doses, but it is not a common withdrawal symptom. Withdrawal symptoms are more likely to include physical signs of cortisol deficiency rather than severe psychiatric symptoms.

Choice A reason : In primary hypothyroidism, the thyroid gland is underactive and does not produce sufficient thyroid hormones. As a result, the pituitary gland releases more TSH to stimulate the thyroid, leading to elevated levels of TSH in the blood⁶⁷⁸.

Choice B reason : Free T3 levels might not be elevated in primary hypothyroidism. Free T3 is the active form of triiodothyronine and could be normal or low depending on the severity and type of hypothyroidism⁶.

Choice C reason : Serum T3 levels are typically not the first indicator to change in primary hypothyroidism and may remain within normal ranges even when TSH is elevated⁶.

Choice D reason : Serum T4 levels are expected to be low in primary hypothyroidism because the thyroid gland is not producing enough of this hormone. However, the initial and most sensitive indicator of primary hypothyroidism is an elevated TSH level⁶.