A patient suspected of having acromegaly has an elevated plasma growth hormone (GH) level. In acromegaly, what would the nurse also expect the patient's diagnostic results to indicate?

Correct Answer: D

Rationale: In acromegaly, a patient typically has an adenoma of the pituitary gland that results in elevated growth hormone (GH) levels. The correct answer is D) Elevated levels of plasma insulin-like growth factor-1 (IGF-1). This is because GH stimulates the liver to produce IGF-1, which is a key mediator of the growth-promoting effects of GH. Therefore, in acromegaly, elevated GH levels lead to increased IGF-1 levels. Option A) Hyperinsulinemia is not typically associated with acromegaly. While GH can affect glucose metabolism, it usually leads to insulin resistance rather than hyperinsulinemia. Option B) A plasma glucose level of <70 mg/dL is indicative of hypoglycemia, which is not a typical finding in acromegaly. Acromegaly is more commonly associated with insulin resistance and hyperglycemia. Option C) Decreased GH levels with an oral glucose challenge test would be seen in individuals with normal pituitary function, not in those with acromegaly where GH levels are elevated. Educationally, understanding the relationship between GH, IGF-1, and acromegaly is crucial for healthcare professionals to recognize the diagnostic patterns associated with this condition and provide appropriate care and management for affected individuals. This knowledge helps in interpreting diagnostic results accurately and in formulating effective treatment plans to address the underlying hormonal imbalance.

Correct Answer: C

Rationale: In a patient undergoing bilateral adrenalectomy, the correct answer is C) Increased to promote an adequate response to the stress of surgery. Rationale: - The adrenal glands produce cortisol, a vital hormone for stress response and regulation of metabolism. Removal of both adrenal glands necessitates exogenous corticosteroid administration to prevent adrenal crisis. - Following adrenalectomy, the body lacks endogenous cortisol production, making exogenous corticosteroid replacement crucial to manage the body's response to stressors like surgery. - Increasing corticosteroid administration postoperatively is essential to mimic the body's natural stress response and prevent complications like hypotension, electrolyte imbalances, and shock. Incorrect options: - A) Reduced to promote wound healing: Incorrect because reducing corticosteroid administration postoperatively can lead to adrenal insufficiency and compromise stress response. - B) Withheld until symptoms of hypocortisolism appear: Incorrect as waiting for symptoms to appear delays necessary treatment, potentially leading to life-threatening adrenal crisis. - D) Reduced because excessive hormones are released during surgical manipulation of adrenal glands: Incorrect because surgery-induced hormone release underscores the need for increased corticosteroid replacement to manage stress response. Educational Context: Understanding the significance of corticosteroid administration post-bilateral adrenalectomy is crucial for nurses caring for these patients. This knowledge ensures appropriate care to prevent adrenal crisis and optimize patient outcomes. Nurses must monitor corticosteroid dosing closely, assess for signs of adrenal insufficiency, and educate patients on lifelong corticosteroid replacement therapy post-adrenalectomy.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) rotate injection sites. When administering insulin injections to prevent tissue hypertrophy or atrophy in an insulin-dependent diabetic, rotating injection sites is crucial. This practice helps to ensure that the same area is not repeatedly exposed to the insulin, which can lead to tissue damage or changes in fat distribution. Option A) using cold insulin is incorrect because the temperature of the insulin does not impact tissue hypertrophy or atrophy. Cold insulin may cause discomfort but does not address the issue of tissue changes. Option C) injecting the insulin directly into the fat is incorrect as it can lead to localized fat accumulation and uneven insulin absorption, which can affect blood sugar control. Option D) avoiding contaminating the needle is important for infection prevention but does not directly address the issue of tissue changes associated with insulin injections. Educationally, it is essential to teach patients about proper insulin injection techniques to prevent complications like tissue hypertrophy or atrophy. Emphasizing the importance of rotating injection sites during patient education can help promote optimal insulin absorption, reduce the risk of tissue damage, and improve overall diabetes management. This knowledge empowers patients to take control of their health and effectively manage their condition.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) An ear infection following swimming. This is the correct choice because individuals with diabetes are more prone to infections due to their compromised immune system. An ear infection following swimming can be a sign of a more serious issue, such as a fungal infection, which can worsen quickly in a diabetic patient. Option A) A weight loss of 2 lb may not be alarming in a general context, but for a newly diagnosed diabetic, unexpected weight loss can be a symptom of uncontrolled blood sugar levels or other underlying health issues that need immediate medical attention. Option B) Having an occasional alcoholic drink can be a concern for diabetic patients due to its impact on blood sugar levels, but it is not as urgent as reporting a potential infection. Option C) Planning to play in a tennis tournament is not an immediate concern unless it involves significant physical exertion that could affect blood sugar levels, which can be managed with appropriate adjustments to insulin or medication. Educationally, it is crucial for diabetic patients to understand the importance of promptly reporting any signs of infection or unusual symptoms to their physician to prevent complications and ensure timely treatment. Teaching patients to recognize and act on such warning signs is essential for their overall health management and well-being.

Correct Answer: B

Rationale: In the case of Mr. B, who has hypothyroidism and is starting thyroid hormone therapy, the indicator that the treatment is effective would be having normal serum thyroid hormone levels. This is the correct answer because the goal of thyroid hormone therapy in hypothyroidism is to restore the levels of thyroid hormones in the body to within the normal range. Normal serum thyroid hormone levels indicate that the therapy is successfully supplementing the deficient thyroid hormones in the body, thereby addressing the underlying cause of hypothyroidism. Option A, a decrease in weight, is not necessarily a direct indicator of effective treatment for hypothyroidism. While weight gain is a common symptom of hypothyroidism, weight loss may not be immediate or significant even with effective treatment. Option C, relief of fatigue, is a symptom of hypothyroidism that can improve with thyroid hormone therapy. However, it is a subjective measure and can be influenced by various factors other than the effectiveness of the treatment. Option D, increased appetite, is not a typical indicator of effective treatment for hypothyroidism. In fact, hypothyroidism is more commonly associated with a decreased appetite, so an increase in appetite would not necessarily indicate successful treatment. Educationally, understanding the rationale behind monitoring serum thyroid hormone levels in hypothyroidism is crucial for healthcare providers managing patients with this condition. It reinforces the importance of objective measures in assessing treatment efficacy and guides healthcare professionals in making informed decisions based on evidence-based practices.