The nurse is caring for a one-month-old infant admitted for suspected congenital hypothyroidism. Which diagnostic test results should the nurse report to the healthcare provider?

Choice A reason: Obtaining a swab of secretions from the penis and urethra is not the appropriate action to take in this situation. This may be done to test for sexually transmitted infections (STIs), such as chlamydia or gonorrhea, that can cause epididymitis, an inflammation of the tube that carries sperm from the testicle. However, epididymitis usually causes gradual pain and swelling, not sudden and severe, and is unlikely to be triggered by a physical activity. Moreover, obtaining a swab may be painful and unnecessary for the adolescent.

Choice B reason: Collecting a sterile urine sample for culture and sensitivity is not the appropriate action to take in this situation. This may be done to test for urinary tract infections (UTIs) or kidney stones that can cause testicular pain. However, UTIs and kidney stones usually cause other symptoms, such as burning or difficulty urinating, blood in the urine, or lower back pain. They are also unlikely to be triggered by a physical activity. Moreover, collecting a urine sample may be difficult and uncomfortable for the adolescent.

Choice C reason: Providing the adolescent with a urinal for urinary hesitancy is not the appropriate action to take in this situation. Urinary hesitancy is the difficulty or delay in starting or maintaining a urine stream. It can be caused by various factors, such as anxiety, medication, prostate problems, or nerve damage. It is not a common symptom of testicular pain and is not related to the cause of the pain. Moreover, providing a urinal may be embarrassing and unnecessary for the adolescent. ⁷

Choice D reason: Reporting the findings immediately to the healthcare provider is the appropriate action to take in this situation. Sudden and severe testicular pain and swelling can be a sign of testicular torsion, a medical emergency that occurs when the testicle twists and cuts off its blood supply. Testicular torsion can be caused by trauma, strenuous exercise, or cold temperature. It can lead to permanent damage or loss of the testicle if not treated promptly. The adolescent needs urgent evaluation and possible surgery to untwist the testicle and restore blood flow.

Choice A reason: Luteinizing hormone (LH) levels are not relevant for the diagnosis of congenital hypothyroidism. LH is a hormone that regulates the reproductive system and is not affected by thyroid function.

Choice B reason: Thyroxine (T4) is the main hormone produced by the thyroid gland and is essential for growth and development. Low levels of T4 indicate hypothyroidism and require treatment with thyroid hormone replacement. High levels of T4 indicate hyperthyroidism and require treatment with anti-thyroid drugs.

Choice C reason: Growth hormone (GH) levels are not relevant for the diagnosis of congenital hypothyroidism. GH is a hormone that stimulates growth and metabolism and is not affected by thyroid function.

Choice D reason: Follicle stimulating hormone (FSH) levels are not relevant for the diagnosis of congenital hypothyroidism. FSH is a hormone that regulates the reproductive system and is not affected by thyroid function.