The client has been taking glucocorticoids for three months now. What clinical manifestation indicates the client may be experiencing adverse effects from long term therapy? Select all that apply.

Rationale: A. Multiple fractures of the bones: Long-term glucocorticoid therapy decreases calcium absorption, suppresses osteoblast activity, and increases bone resorption, leading to osteoporosis and a higher risk of pathological fractures. Repeated fractures can indicate significant bone density loss due to chronic steroid use. B. Prolonged healing time of small wounds: Glucocorticoids suppress the inflammatory response and impair collagen synthesis, which slows the normal wound healing process. Delayed healing of even minor cuts or abrasions is a common adverse effect of extended steroid therapy. C. Round face and hump on upper back: Chronic glucocorticoid use can cause fat redistribution, resulting in characteristic features such as moon face and dorsocervical fat pad (buffalo hump). These physical changes are hallmark signs of Cushingoid appearance associated with long-term steroid therapy. D. Hypoglycemia and weight loss: Glucocorticoids typically increase gluconeogenesis and insulin resistance, often causing hyperglycemia and weight gain rather than hypoglycemia or weight loss. Low blood sugar and weight loss are not consistent with steroid-related adverse effects. E. Weight gain and edema of lower extremities: Glucocorticoids promote sodium and water retention, leading to peripheral edema, and stimulate appetite, often resulting in weight gain. These findings are common signs of fluid imbalance and metabolic changes associated with long-term therapy.