A nurse is collecting data from a client who has Cushing's syndrome. Which of the following findings should the nurse expect?

Choice A rationale Cushing’s syndrome is characterized by muscle wasting and atrophy, particularly in the extremities, rather than hypertrophy. This occurs because chronic hypercortisolism leads to the breakdown of proteins for gluconeogenesis. Excessive cortisol levels cause the body to enter a catabolic state, where muscle tissue is mobilized for energy. This results in the characteristic thin appearance of the arms and legs, which often contrasts sharply with the central obesity and fat redistribution seen in the trunk and neck. Choice B rationale A positive Chvostek's sign is an indicator of hypocalcemia, characterized by facial twitching when the facial nerve is tapped. While Cushing’s syndrome can affect electrolyte balance, hypocalcemia is not a primary or expected finding. Instead, Cushing’s often involves hypernatremia and hypokalemia due to the mineralocorticoid effects of high cortisol levels. Cortisol at high concentrations can bind to mineralocorticoid receptors, promoting sodium retention and potassium excretion, which is unrelated to the neuromuscular irritability signaled by Chvostek's sign. Choice C rationale A butterfly rash is the hallmark clinical sign of systemic lupus erythematosus, an autoimmune disorder. It is a malar rash that spreads across the cheeks and the bridge of the nose. While patients with Cushing’s syndrome may exhibit facial flushing or plethora due to increased vascularity and thinning of the skin, they do not typically present with the specific, fixed inflammatory butterfly rash. The skin in Cushing’s is more likely to show purple striae, bruising, and poor wound healing. Choice D rationale A moon face is a classic clinical manifestation of Cushing’s syndrome caused by the redistribution of adipose tissue. High levels of glucocorticoids stimulate fat deposition in specific areas, including the face and the supraclavicular region, known as a buffalo hump. This results in a rounded, full facial appearance. Cortisol levels above the normal range of 5 to 23 micrograms per deciliter disrupt lipid metabolism, leading to this distinctive centripetal obesity that is a primary diagnostic indicator for the condition.