The nurse is caring for a client who has been prescribed prednisone. The nurse checks the patient’s medical history knowing that this therapy is contraindicated in which disorder?

Choice A reason: Monitoring alone is insufficient with elevated ALT and AST, indicating liver dysfunction. Metronidazole is metabolized by the liver, and hepatotoxicity is a known risk. Administering it to a patient with pre-existing liver damage could worsen hepatic injury, making this action inadequate.

Choice B reason: Elevated ALT and AST suggest liver dysfunction, and metronidazole, metabolized hepatically, can exacerbate hepatotoxicity. Avoiding administration prevents further liver damage, as the drug’s nitroimidazole structure undergoes hepatic reduction, producing toxic metabolites that stress an already compromised liver, necessitating alternative therapy.

Choice C reason: Reducing the metronidazole dose is not recommended without medical consultation. Elevated liver enzymes indicate impaired hepatic function, and even reduced doses may worsen hepatotoxicity. Alternative antibiotics with less hepatic metabolism should be considered, making dose reduction an unsafe choice.

Choice D reason: Administering metronidazole as prescribed is dangerous with elevated ALT and AST, signaling liver dysfunction. Metronidazole’s hepatic metabolism can exacerbate liver injury, increasing the risk of severe hepatotoxicity. The nurse should withhold the drug and consult the prescriber for safer alternatives.

Choice A reason: Moon face, a hallmark of long-term prednisone use, results from fat redistribution due to corticosteroid-induced metabolic changes. Prednisone promotes lipogenesis in facial and neck areas, causing a rounded, puffy appearance. This Cushingoid feature is a common, visible side effect of prolonged systemic corticosteroid therapy.

Choice B reason: Weight loss is not typical with long-term prednisone therapy. Prednisone increases appetite and promotes fat deposition, leading to weight gain, not loss. Catabolic effects on muscle may occur, but overall weight gain, including fluid retention, is more characteristic, making this incorrect.

Choice C reason: Pale skin color is not a common effect of prednisone. Corticosteroids can cause skin thinning or bruising due to reduced collagen synthesis, but pallor is not typical. Hyperpigmentation may occur in some cases, but moon face is the primary appearance-related side effect of long-term use.

Choice D reason: Hair loss is not a primary side effect of prednisone. Corticosteroids may cause hirsutism or thinning skin, but hair loss is more associated with chemotherapy or other drugs. Prednisone’s metabolic effects lead to fat redistribution, like moon face, rather than alopecia, making this incorrect.