# 情境 45歲紅斑性狼瘡個案長期服用prednisone 15 mg daily，主訴新出現圓臉、肩胛間脂肪堆積、中心性腹部增重、紫色腹部妊娠紋、易瘀青。護理師最適當的回應為何?

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

## 題目

情境 45歲紅斑性狼瘡個案長期服用prednisone 15 mg daily，主訴新出現圓臉、肩胛間脂肪堆積、中心性腹部增重、紫色腹部妊娠紋、易瘀青。護理師最適當的回應為何?

## 選項

1. 此為長期類固醇造成的cushingoid特徵，依處方繼續，並於下次回診討論劑量最小化、鈣/維他命D、低鈉飲食、負重運動、跌倒預防與監測。 **✔ 正確答案**
2. 這些表現表示類固醇劑量過高；您應該停止服用 prednisone，我們將以較安全的免疫抑制劑如 mycophenolate mofetil 來取代，以控制您的紅斑狼瘡而不產生這些作用。
3. 這些變化與類固醇無關；它們是活動性紅斑狼瘡的典型表現，因此我們應該將您轉介給皮膚科醫師處理皮膚變化，並轉介給風濕免疫科醫師加強您的免疫抑制治療。
4. 這些症狀顯示您的紅斑狼瘡在目前的 prednisone 劑量下未獲得適當控制；您應該現在將劑量加倍，並立即聯繫您的醫療提供者關於添加另一種免疫抑制劑。

**正確答案: 1**

## 解析

長期全身性皮質類固醇造成Cushingoid(醫源性庫欣)特徵：月亮臉、水牛肩、中心性肥胖加上四肢纖細、紫色腹紋、易瘀青與皮膚變薄、多毛、痤瘡、水腫、近端肌肉萎縮。長期傷害另包含骨質疏鬆與骨折風險、白內障/青光眼、消化性潰瘍、兒童生長抑制、情緒與睡眠變化、高血壓、高血糖、腎上腺抑制。處置：(1) 解釋此變化為預期藥理效應，非過敏或治療失敗；(2) 與處方者討論劑量最小化、可行時隔日服用、或使用類固醇節省藥物；(3) 鈣1000~1200 mg、維他命D 800~1000 IU、負重運動、DEXA骨密度監測；(4) 低鈉飲食減少水腫；(5) 跌倒與骨折預防；(6) 年度眼科、BP、血脂、血糖監測；(7) 因皮膚脆弱加強保護。突然停藥或加倍均為禁忌。

## 深入解析

可見的Cushingoid症候群是慢性prednisone最常考的副作用群組。處置為劑量最小化加上骨、眼、情緒、皮膚監測，而非停藥或加倍。

## 重要概念

- **cushingoid features** — 月亮臉、水牛肩、中心性肥胖、紫色條紋、易瘀青、多毛、痤瘡
- **steroid-induced osteoporosis** — 長期類固醇骨吸收增、骨形成減、以DEXA與鈣/維他命D加運動預防
- **dose minimization** — 在維持療效下使用最低有效劑量、隔日或類固醇節省藥物

## 相同主題題目

- [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=zh-tw)
- [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=zh-tw)
- [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=zh-tw)
- [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=zh-tw)
- [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=zh-tw)
- [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=zh-tw)
- [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=zh-tw)
- [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=zh-tw)

## 以其他語言閱讀

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=375108&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=375108&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=375108&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=375108&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=375108&lang=vi)

---

More free questions: [NCLEX-RN 題庫](https://mymerci.kr/pages/nclex_bank.php?lang=zh-tw)

_僅供學習參考。實際臨床請遵循最新指引與所屬機構規範。_