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 : The immediate safety of the client is the nurse's primary concern. Assessing the risk for immediate harm is crucial to prevent further abuse and to ensure the client's well-being. This involves evaluating the severity of the situation and the potential for future harm¹.

Choice B reason : While referring the client to a community support group is important for long-term support, it is not the immediate priority when a client reports abuse.

Choice C reason : Implementing a safety plan is a critical step, but it follows the initial assessment of immediate risk. The safety plan will be part of the ongoing support and intervention for the client.

Choice D reason : Instructing the client on how to leave the relationship is an important aspect of empowering the client; however, it is not the first action to take before assessing immediate risk and ensuring the client's safety.