A client has been on daily, high-dose prednisone therapy to treat an exacerbation of rheumatoid arthritis. His prescription runs out before his next paycheck. He decides to skip his prednisone for a few days. What is likely to happen to this patient when he abruptly stops taking prednisone?

A. Floaters and flashes of light are classic symptoms of retinal detachment. When the retina begins to detach from the underlying tissue, it can cause these visual disturbances. Floaters are small, shadowy shapes that move across the field of vision, while flashes of light can occur due to the retina being stretched or pulled.
B. Cataracts primarily cause blurred vision, difficulty seeing at night, and sensitivity to light, rather than floaters or flashes of light.
C. AMD generally affects central vision and can cause symptoms such as distorted vision, difficulty seeing in low light, and a loss of central vision. While AMD can cause vision changes, it is not typically associated with seeing floaters and flashes of light.
D. Open-angle glaucoma usually progresses slowly and is often asymptomatic in its early stages. It primarily affects peripheral vision, leading to a gradual loss of vision in the periphery.

A. Cardiac catheterization is often used in the management of an acute myocardial infarction to assess the extent of coronary artery disease and to determine the need for interventions such as angioplasty and stenting. This procedure is crucial for reperfusion therapy, especially in the context of ST-elevation MI (STEMI). Given the client’s symptoms and diagnostic findings, preparing for cardiac catheterization is an appropriate order.
B. While an echocardiogram can be useful for evaluating cardiac function and determining the extent of myocardial damage, it is not typically the immediate priority in the acute management of an MI. The focus is usually on rapid reperfusion therapy and stabilizing the patient. Therefore, this option is less urgent compared to others like administering oxygen and preparing for cardiac catheterization.
C. Warfarin is an oral anticoagulant used for long-term anticoagulation management and is not typically used in the acute setting of an MI. In acute MI management, other anticoagulants such as heparin or low molecular weight heparin are preferred for immediate anticoagulation. Administering warfarin in the acute setting is not appropriate.
D. Furosemide is a diuretic used to manage fluid overload and reduce symptoms of heart failure. It is not indicated as an immediate intervention in acute MI unless there is evidence of significant fluid overload or heart failure symptoms. The client’s current presentation does not suggest an immediate need for furosemide.
E. Supplemental oxygen is important in the management of acute myocardial infarction to ensure
adequate oxygen delivery to the myocardium and to alleviate hypoxia, especially since the client’s oxygen saturation is low at 92%. Providing supplemental oxygen is a standard intervention in the acute management of MI.
F. Sublingual nitroglycerin is commonly used to relieve chest pain in myocardial infarction by causing vasodilation. However, it should be used with caution in the presence of hypotension or other contraindications. Given the client’s symptoms and high heart rate, nitroglycerin could be appropriate,
but should be carefully monitored for effects on blood pressure.
G. A clear liquid diet is not an immediate priority in the management of acute myocardial infarction. Diet modification may be considered later in the course of treatment, but it is not a critical intervention in the acute phase.