The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles, and the nurse suspects pulmonary edema. The nurse immediately asks another nurse to contact the healthcare provider and prepares to implement which priority interventions? (Select all that apply.)

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 : Delegating the NG tube placement to a more experienced nurse does not address the client's refusal of the procedure. The nurse must respect the client's autonomy and decision-making rights.

Choice B reason : While a referral to Social Services may be appropriate in some cases, it does not directly address the immediate concern of the client's refusal of the NG tube placement.

Choice C reason : Seeking consent from the client's spouse is not appropriate as the client is competent and has the right to refuse treatment. The client's autonomy must be respected.

Choice D reason : Documenting the client's wishes and notifying the physician is the correct action. The nurse must respect the client's right to refuse treatment and communicate this decision to the physician so that alternative management can be considered.