A corticotropin-secreting pituitary tumor would cause high corticotropin and high cortisol levels.

Option A: Cortisol levels should also be elevated in corticotropin-secreting pituitary adenoma.
Option B: Low corticotropin and high cortisol levels would be seen if there was a primary defect in the adrenal glands.
Option D: A low corticotropin level with a low cortisol level would be associated with hypocortisolism.

The nurse should perform capillary glucose testing every 4 hours because excess cortisol may cause insulin resistance, placing the client at risk for hyperglycemia.

Option A: Urine ketone testing isn’t indicated because the client does secrete insulin and, therefore, isn’t at risk for ketosis.
Option B: Urine specific gravity isn’t indicated because although fluid balance can be compromised, it usually isn’t dangerously imbalanced.
Option C: Temperature regulation may be affected by excess cortisol and isn’t an accurate indicator of infection.

Regular insulin, which is a short-acting insulin, has an onset of 15 to 30 minutes and a peak of 2 to 4 hours. Because the nurse gave the insulin at 2 p.m., the expected onset would be from 2:15 p.m. to 2:30 p.m. and the peak from 4 p.m. to 6 p.m.

Option A: 2 p.m. is when the insulin was given; onset does not occur at the same time as the medication was given
Option B: The peak starts 2 to 4 hours after the insulin was given, which will be at 4 p.m.
Option D: Onset of 4 p.m. is very late; 15 to 30 minutes is the expected onset of insulin. Peak shoud start at 4 p.m.

In the TSH test, failure of the TSH level to rise after 30 minutes confirms hyperthyroidism.

Option B: A decreased TSH level indicates a pituitary deficiency of this hormone.
Option C: If the TSH level rises after 30 minutes, then the client has no hyperthyroidism.
Option D: Below-normal levels of T3 and T4, as detected by radioimmunoassay, signal hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease and may result from the administration of phenytoin and certain other drugs.

The nurse should instruct the client to rotate injection sites within the same anatomic region. Rotating sites among different regions may cause excessive day-to-day variations in the blood glucose level; also, insulin absorption differs from one region to the next.

Option A: Insulin should be injected only into healthy tissue lacking large blood vessels, nerves, or scar tissue, or other deviations.
Option C: Injecting insulin into areas of hypertrophy may delay absorption. The client shouldn’t inject insulin into areas of lipodystrophy (such as hypertrophy or atrophy); to prevent lipodystrophy, the client should rotate injection sites systematically.
Option D: Exercise speeds drug absorption, so the client shouldn’t inject insulin into sites above muscles that will be exercised heavily.