# A 45-year-old client with lupus on long-term prednisone 15 mg daily reports new round face, increased fat between the shoulders, central abdominal weight gain, purplish abdominal stretch marks, and easy bruising. Which response by the nurse is most appropriate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375108&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 45-year-old client with lupus on long-term prednisone 15 mg daily reports new round face, increased fat between the shoulders, central abdominal weight gain, purplish abdominal stretch marks, and easy bruising. Which response by the nurse is most appropriate?

## Option

1. These are cushingoid features from long-term steroid use; continue as prescribed and discuss possible dose minimization, calcium and vitamin D, low sodium diet, weight-bearing exercise, fall prevention, and monitoring at the next visit. **✔ Correct answer**
2. These manifestations indicate the steroid dose is too high; you should stop taking prednisone and we will replace it with a safer immunosuppressant like mycophenolate mofetil to control your lupus without these effects.
3. These changes are unrelated to the steroid; they are typical manifestations of active lupus, so we should refer you to a dermatologist for the skin changes and a rheumatologist to intensify your immunosuppressive regimen.
4. These symptoms suggest your lupus is not adequately controlled on the current prednisone dose; you should double the dose now and contact your provider about adding another immunosuppressive agent right away.

**Correct answer: 1**

## Explanation

Long-term systemic corticosteroids cause Cushingoid (iatrogenic Cushing) features: moon face, buffalo hump, central truncal obesity with thin extremities, purple abdominal striae, easy bruising and skin thinning, hirsutism, acne, edema, and proximal muscle wasting. Additional long-term harms include osteoporosis with fracture risk, cataracts and glaucoma, peptic ulcer, growth suppression in children, mood and sleep changes, hypertension, hyperglycemia, and adrenal suppression. Management: (1) reassure that the changes are expected pharmacologic effects, not allergy or treatment failure, (2) work with the prescriber on dose minimization, alternate-day dosing when feasible, or steroid-sparing agents, (3) calcium 1000 to 1200 mg and vitamin D 800 to 1000 units daily, weight-bearing exercise, and DEXA bone-density monitoring, (4) low sodium diet to limit fluid retention, (5) fall and fracture precautions, (6) annual eye exam, BP, lipids, and glucose surveillance, (7) skin protection because of fragility. Stopping abruptly or doubling the dose are both contraindicated.

## In-depth explanation

The visible Cushingoid syndrome is the most commonly tested adverse-effect cluster of chronic prednisone. The intervention is dose minimization plus bone, eye, mood, and skin surveillance, not stopping or doubling.

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