A nurse is assessing four clients on a medical unit. The nurse should identify which of the following clients as exhibiting positive manifestations of hypercortisolism?

Rationale: A. A client who has muscle hypertrophy: Hypercortisolism, as seen in Cushing’s syndrome, leads to muscle wasting and weakness rather than hypertrophy. Cortisol causes protein catabolism, resulting in thin extremities and loss of muscle mass. B. Moon face: Excess cortisol causes fat redistribution to the face, trunk, and upper back. The rounded “moon face” appearance is a classic physical manifestation of hypercortisolism. C. A client who has a butterfly rash on his face: A butterfly rash across the cheeks and nose is a hallmark sign of systemic lupus erythematosus, an autoimmune disorder, and is not associated with cortisol excess. D. A client who has a positive Chvostek’s sign: Chvostek’s sign indicates hypocalcemia due to neuromuscular irritability. It is not a manifestation of hypercortisolism and does not occur as a result of cortisol excess.