Chapter 35: Alterations of Digestive Function in Children My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 35: Alterations of Digestive Function in Children

Test Bank

MULTIPLE CHOICE

1. The family learns that a 3D ultrasound of a 9-week fetus shows incomplete fusion of the nasomedial or intermaxillary process. The family will be told that the child will be born with:

a.

Cleft lip

b.

Nasal passage atresia

c.

Esophageal atresia

d.

Lack of dentition

ANS: A

Cleft lip is caused by the incomplete fusion of the nasomedial or intermaxillary process beginning the fourth week of embryonic development, a period of rapid development.

Cleft lip, not nasal passage atresia, occurs when there is lack of or incomplete fusion of the nasomedial or intermaxillary process.

In esophageal atresia, the esophagus ends in a blind pouch. It is not associated with nasomedial processes.

Lack of dentition is not due to incomplete fusion of the processes.

REF: p. 938

2. Examination of a newborn female revealed that the esophagus ends in a blind pouch. This condition is referred to on the chart as:

a.

Esophageal atresia

b.

Tracheoesophageal stenosis

c.

Esophagitis

d.

Pyloric stenosis

ANS: A

.

When the esophagus ends in a blind pouch, the condition is referred to as esophageal atresia.

When the esophagus ends in a blind pouch, the condition is referred to as esophageal atresia; the trachea is not involved.

Esophagitis is inflammation of the esophagus.

Pyloric stenosis is a narrowing of the connection between the stomach and the duodenum.

REF: p. 939

3. Which condition should the nurse assess for in mothers carrying fetuses affected by esophageal malformations?

a.

Enlarged placentas

b.

Excessive amniotic fluid

c.

Short umbilical cords

d.

Foul smelling vaginal discharge

ANS: B

Polyhydramnios (excessive amniotic fluid) is reported to occur in 14% to 90% of mothers of affected infants because of alterations in fetal swallowing.

Excessive amniotic fluid, not an enlarged placenta, is a possible manifestation of fetuses with esophageal malformations.

Excessive amniotic fluid, not a short umbilical cord, is a possible manifestation of fetuses with esophageal malformations.

Excessive amniotic fluid, not foul smelling vaginal discharge, is a possible manifestation of fetuses with esophageal malformations.

REF: p. 939

4. A mother brings her 2-week-old infant to the pediatrician because he vomits forcefully for no apparent reason and food sometimes is regurgitated as though undigested. The infant is most likely suffering from:

a.

Pyloric stenosis

b.

Meconium ileus

c.

Esophageal atresia

d.

Galactosemia

ANS: A

Pyloric stenosis is manifested by forceful vomiting.

Pyloric stenosis is manifested by forceful vomiting, not meconium ileus.

Pyloric stenosis is manifested by forceful vomiting, not esophageal atresia.

Pyloric stenosis is manifested by forceful vomiting, not galactosemia.

REF: p. 940

5. A sign that a newborn infant may have pyloric stenosis is:

a.

Diarrhea

b.

Bile regurgitation

c.

Olive-sized mass in the upper abdomen

d.

Ascites with a fluid wave visible across the abdomen

ANS: C

A firm, small, movable mass, approximately the size of an olive, is felt in the right upper quadrant in 70% to 90% of infants with pyloric stenosis.

Diarrhea is not a sign of pyloric stenosis.

Bile regurgitation is not a sign of pyloric stenosis.

Ascites is not a sign of pyloric stenosis.

REF: p. 940

6. A 2-month-old female is brought to the emergency room (ER) for persistent bile-stained vomiting after feeding. Physical examination reveals dehydration, and x-ray reveals that the colon is located in the upper right quadrant. What is the most likely cause of this condition?

a.

Malrotation

b.

Ileocecal displacement

c.

Pyloric stenosis

d.

Meconium ileus

ANS: A

In infants, malrotation obstruction causes intermittent or persistent bile-stained vomiting after feedings.

In infants, malrotation obstruction, not ileocecal displacement, causes intermittent or persistent bile-stained vomiting after feedings.

Pyloric stenosis is manifested by vomiting, but it is not bile stained and the colon is not displaced.

In meconium ileus, there is an intestinal obstruction caused by meconium formed in utero.

REF: p. 941

7. Meconium ileus is associated with which of the following disorders?

a.

Pyloric stenosis

b.

Esophageal atresia

c.

Cystic fibrosis

d.

Esophagitis

ANS: C

Meconium ileus is associated with cystic fibrosis.

Meconium ileus is associated with cystic fibrosis, not pyloric stenosis.

Meconium ileus is associated with cystic fibrosis, not esophageal atresias.

Meconium ileus is associated with cystic fibrosis, not esophagitis.

REF: p. 941

8. Intussusception is treated initially by:

a.

Bowel resection

b.

An air enema

c.

Laxative

d.

Doubling fluid intake

ANS: B

Reduction is an emergency procedure using an air enema.

Bowel resection is not indicated unless the enema is ineffective.

Laxatives are not indicated in the treatment of intussusception.

Doubling fluid intake would not help treat intussusception.

REF: p. 944

9. A 2-month-old female with Down syndrome is diagnosed with Hirschsprung disease following family complaints of chronic constipation. The most likely cause of these symptoms is:

a.

Absence of ganglia along the length of the colon

b.

The use of cows milk instead of formula

c.

Excessive use of glycerin suppositories to promote bowel elimination

d.

Additional ganglia throughout the length of the colon

ANS: A

Congenital aganglionic megacolon is caused by the absence of the enteric ganglia (Meissner and Auerbach plexuses) along a variable length of the colon, resulting in inadequate motility.

Megacolon is a functional anatomic disorder not related to formula.

Megacolon is a functional anatomic disorder not related to use of suppositories.

Megacolon is not due to additional ganglia, but an absence of ganglia.

REF: p. 942

10. The primary complication of enterocolitis associated with Hirschsprung disease is related to which finding?

a.

Fecal impaction

b.

Pancreatic insufficiency

c.

Hyperactive peristalsis

d.

Ileal atresia

ANS: A

The most serious complication in the neonatal period is enterocolitis related to fecal impaction.

The most serious complication in the neonatal period is enterocolitis related to fecal impaction. It does not result in pancreatic insufficiency.

The most serious complication in the neonatal period is enterocolitis related to fecal impaction. It does not result in hyperactive peristalsis, but slowed peristalsis.

The most serious complication in the neonatal period is enterocolitis related to fecal impaction, not ileal atresia.

REF: p. 942

11. A 6-month-old male infant is brought to the ER after the sudden development of abdominal pain, irritability, and vomiting followed by passing of currant jelly stool. Ultrasound reveals intestinal obstruction in which the ileum collapsed through the ileocecal valve and invaginated into the large intestine. This type of obstruction is referred to as:

a.

Prolapse

b.

Pyloric stenosis

c.

Intussusception

d.

Imperforation

ANS: C

These are symptoms of intussusception.

These are symptoms of intussusception, not prolapse.

These are symptoms of intussusception, not stenosis, which would be vomiting.

These are symptoms of intussusception, not imperforation, which would be a closed anal opening.

REF: p. 942

12. An 8-week-old female is diagnosed with a congenital heart disease and Down syndrome. Her parents report that she has difficulty defecating. X-ray reveals anorectal malformation that causes complete obstruction often referred to as:

a.

Intussusception

b.

Imperforate anus

c.

Meckel diverticulum

d.

Megacolon

ANS: B

Deformities that cause complete obstruction are known collectively as imperforate anus.

Intussusception is manifested by red jelly-like stools.

Meckel diverticulum is a congenital malformation of the gastrointestinal (GI) tract involving all layers of the small intestinal wall usually in the ileum.

Megacolon is due to lack of nerve innervations.

REF: p. 942

13. Occurrence of gastroesophageal reflux is highest in which pediatric population?

a.

Premature infants

b.

Infants with Down syndrome

c.

Children with cystic fibrosis

d.

Children with esophageal atresia

ANS: A

The frequency of reflux is highest in premature infants and decreases during the first 6 to 12 months of life.

The frequency of reflux is highest in premature infants, not infants with Down syndrome.

The frequency of reflux is highest in premature infants, not children with cystic fibrosis.

The frequency of reflux is highest in premature infants, not infants with esophageal atresia.

REF: p. 944

14. An 8-week-old male was recently diagnosed with cystic fibrosis. Which of the following digestive alterations would be expected?

a.

Insufficient bile production

b.

Gastric atrophy

c.

Hypersecretion of stomach acid

d.

Malabsorption

ANS: D

Cystic fibrosis results in malabsorption.

Infants with cystic fibrosis have normal bile production; they experience pancreatic enzyme deficiency.

Infants with cystic fibrosis experience malabsorption, not gastric atrophy.

Infants with cystic fibrosis experience malabsorption; they do not have hypersecretion of stomach acid.

REF: p. 944

15. A 13-month-old infant presents with vomiting; abdominal pain; and pale, bulky, greasy, and foul-smelling stools. A possible diagnosis the clinician would document on the chart might be:

a.

Failure to thrive

b.

Gluten-sensitive enteropathy

c.

Gastroesophageal reflux

d.

Meconium ileus

ANS: B

Infants with gluten-sensitive enteropathy experience greasy stools.

Infants with failure to thrive experience weight loss, but not abnormal stools.

Infants with gastroesophageal reflux do not experience bulky, greasy stools.

Infants with meconium ileus do not experience bulky, greasy stools.

REF: p. 945

16. Celiac disease, or sprue, is caused by alterations of the intestinal:

a.

Glands

b.

Villi

c.

Smooth muscle wall

d.

Sphincters

ANS: B

Gluten-sensitive enteropathy, formerly called celiac sprue or celiac disease, is an autoimmune disease that damages small intestinal villous epithelium.

Celiac disease affects the villi, not the glands.

Celiac disease affects the villi, not the smooth muscle wall.

Celiac disease affects the villi, not the sphincters.

REF: p. 946

17. Kwashiorkor is a severe dietary deficiency of:

a.

Fat-soluble vitamins

b.

Carbohydrates

c.

Protein

d.

Calcium and magnesium

ANS: C

Kwashiorkor is a severe dietary deficiency of protein.

Kwashiorkor is a severe dietary deficiency of protein, not fat-soluble vitamins.

Kwashiorkor is a severe dietary deficiency of protein, not carbohydrates.

Kwashiorkor is a severe dietary deficiency of protein, not minerals such as calcium and magnesium.

REF: p. 946

18. Marasmus is most common in children of which age group?

a.

Younger than one

b.

1 to 2 years

c.

5 to 6 years

d.

12 to 15 years

ANS: A

Marasmus is most common in children younger than one.

Marasmus is most common in children younger than one, not 1 to 2 years.

Marasmus is most common in children younger than one, not 5 to 6 years.

Marasmus is most common in children younger than one, not 12 to 15 years.

REF: p. 946

19. A 1-week-old female is brought to her pediatrician for abdominal distention and unstable temperature. Physical examination reveals bradycardia and apnea. Tests reveal hypoxic injury to the bowel resulting in bacterial invasion and perforation. This condition is referred to as:

a.

Infective enteropathy

b.

Necrotizing enterocolitis (NEC)

c.

Mucoviscidosis

d.

Ileus

ANS: B

NEC is an ischemic, inflammatory condition of the bowel that causes necrosis, perforation, and death, if untreated.

NEC is an ischemic, inflammatory condition of the bowel that causes necrosis, perforation, and death, if untreated. Infective enteropathy may be related to infection, but it is not necrotic.

Mucoviscidosis is related to cystic fibrosis.

Ileus is manifested by decreased bowel sounds, but not ischemia.

REF: p. 947

20. Prolonged diarrhea is more serious in children than adults because:

a.

Children have lower adipose reserves.

b.

Fluid reserves are lower in children.

c.

Children have a lower metabolic rate.

d.

Children are more resistant to antimicrobial therapy.

ANS: B

Prolonged diarrhea is more dangerous in children because they have much smaller fluid reserves than adults.

Prolonged diarrhea is more dangerous in children because they have much smaller fluid reserves than adults, not due to lower adipose reserves.

Prolonged diarrhea is more dangerous in children because they have much smaller fluid reserves than adults. Children have higher metabolic rates.

Prolonged diarrhea is more dangerous in children because they have much smaller fluid reserves than adults. It is not due to microbial resistance.

REF: p. 948

21. When an infant has increased bilirubin production and impaired hepatic excretion of bilirubin, what does the nurse suspect is occurring in the patient?

a.

Biliary hypertrophy

b.

Physiologic jaundice

c.

Hepatitis A

d.

Infantile cirrhosis

ANS: B

Impaired excretion of bilirubin can lead to physiologic jaundice.

Impaired excretion of bilirubin can lead to physiologic jaundice, not biliary hypertrophy.

Impaired excretion of bilirubin can lead to physiologic jaundice, not hepatitis A.

Impaired excretion of bilirubin can lead to physiologic jaundice, not cirrhosis.

REF: p. 948

22. A 7-month-old female presents with jaundice, clay-colored stool, and failure to gain weight. Testing reveals the absence of intrahepatic bile ducts. This condition is referred to as _____ atresia.

a.

Hepatic

b.

Portal

c.

Sinusoidal

d.

Biliary

ANS: D

Jaundice is the primary clinical manifestation of biliary atresia, along with hepatomegaly and acholic (clay-colored) stools.

Jaundice is the primary clinical manifestation of biliary atresia, not hepatic atresia, along with hepatomegaly and acholic (clay-colored) stools.

Jaundice is the primary clinical manifestation of biliary atresia, not portal atresia, along with hepatomegaly and acholic (clay-colored) stools.

Jaundice is the primary clinical manifestation of biliary atresia, not sinusoidal atresia, along with hepatomegaly and acholic (clay-colored) stools.

REF: p. 949

23. A 7-month-old female presents with jaundice, clay-colored stool, and failure to gain weight. She is diagnosed with biliary atresia. The nurse realizes the treatment for this disorder will most likely be:

a.

Immunoglobulins

b.

Liver transplant

c.

Bone marrow transplant

d.

Dietary modifications

ANS: B

The treatment for biliary atresia is liver transplant.

The treatment for biliary atresia is liver transplant, not immunoglobulins.

The treatment for biliary atresia is liver transplant, not bone marrow transplant.

The treatment for biliary atresia is liver transplant, not dietary modifications.

REF: p. 949

24. The nurse assessing the patient with biliary atresia would expect to find which primary clinical manifestation?

a.

Anemia

b.

Jaundice

c.

Hypobilirubinemia

d.

Ascites

ANS: B

The primary clinical manifestation is jaundice.

The primary clinical manifestation is jaundice, not anemia.

The primary clinical manifestation is jaundice, not hypobilirubinemia; it would be hyperbilirubinemia.

The primary clinical manifestation is jaundice; ascites occurs with other liver disorders, but not atresia.

REF: p. 949

25. Outbreaks of hepatitis _____ often occur in young children attending day care centers and can be attributed to poor hand washing.

a.

A

b.

B

c.

C

d.

D

ANS: A

Outbreaks of hepatitis A occur in condition where poor hand washing occurs.

Hepatitis B is blood borne and not related to hand washing.

Hepatitis C is blood borne and not related to hand washing.

Hepatitis D is blood borne and depends on an active HIV infection.

REF: p. 949

26. Where does the nurse expect the obstruction to be in a patient with extrahepatic portal hypertension?

a.

Sinusoids

b.

Bile ducts

c.

Hepatic portal vein

d.

Hepatic artery

ANS: C

Extrahepatic (prehepatic) portal venous obstruction causes 50% to 70% of extrahepatic portal hypertension in children.

Sinusoids can be inflamed, but would not lead to hypertension.

Obstruction of the bile ducts would lead to interruption in the flow of bile to the duodenum; it would not cause hypertension.

The obstruction is in the vein, not the artery.

REF: p. 949

27. Early identification and treatment for metabolic disorders is important because:

a.

Permanent damage to vital organs can be prevented.

b.

Surgery is usually necessary.

c.

Cure rates are higher with early detection.

d.

Death usually occurs within the first month.

ANS: A

The earliest possible identification of metabolic disorders is essential because early treatment may prevent permanent damage to vital organs, such as the liver or brain.

Surgery is not the treatment in most of the metabolic disorders; they are controlled by dietary modifications.

A cure is not possible in most disorders.

Death does not occur in the first month; dietary control is effective.

REF: p. 951

28. A 3-month-old female presents with intention tremors, dystonia, greenish-yellow rings in the cornea, and hepatomegaly. Tests reveal a defect on chromosome 13. Which of the following is the most likely diagnosis?

a.

Galactosemia

b.

Fructosemia

c.

Wilson disease

d.

Cirrhosis

ANS: C

Wilson disease is manifested by dystonia and greenish-yellow rings in the cornea.

Galactosemia is manifested by high levels of blood galactose and vomiting.

Fructosemia is manifested by high levels of blood fructose and hepatomegaly, but not dystonia and rings in the cornea.

Cirrhosis is manifested by hepatomegaly, but not dystonia and greenish-yellow rings in the cornea.

REF: p. 951

29. A 27-year-old male presents with fever, GI bleeding, hepatomegaly, and transient joint pain. He reports that as a child he received blood transfusions following a motor vehicle accident. He also indicates he was vaccinated against hepatitis B. Which of the following types of hepatitis does the clinician think he most likely has?

a.

A

b.

B

c.

C

d.

D

ANS: C

Hepatitis C virus is transmitted with blood transfusions.

Hepatitis A is transmitted in situations where there are unsanitary conditions or poor hand washing.

Hepatitis B is transmitted by blood transfusions, but the individual has been vaccinated to this type of hepatitis.

Hepatitis D is dependent upon the presence of hepatitis B infection.

REF: p. 949

30. The nurse would correctly identify the most common symptom of Meckel diverticulum as:

a.

Constipation

b.

Vomiting

c.

Rectal bleeding

d.

Ascites

ANS: C

Although most Meckel diverticuli are asymptomatic, the most common symptom is painless rectal bleeding.

The most common symptom of Meckel diverticuli is rectal bleeding, not constipation.

The most common symptom of Meckel diverticuli is rectal bleeding, not vomiting.

The most common symptom of Meckel diverticuli is rectal bleeding, not ascites.

REF: p. 942

MULTIPLE RESPONSE

1. A newborn male is diagnosed with cleft palate. The pediatrician counsels the parents that complications of cleft palate include (select all that apply):

a.

Tonsil hypertrophy

b.

Recurrent paranasal infections

c.

Difficulty breathing

d.

Excessive dental decay

e.

Hearing loss

ANS: A, B, D, E

Children with cleft palate tend to have tonsil hypertrophy, tend to have repeated infections of the paranasal sinuses, do not experience difficulty breathing, experience excessive dental decay, and experience hearing loss.

REF: p. 939

2. Which of the following are complications of gastroesophageal reflux? (Select all that apply.)

a.

Aspiration pneumonia

b.

Anemia

c.

Weight loss

d.

Delayed growth

e.

Hepatomegaly

ANS: A, B, C, D

Aspiration pneumonia develops in one-third of infants with gastroesophageal reflux. In cases that persist into childhood, chronic cough, wheezing, and recurrent pneumonia are common. Inadequate retention of nutrients can adversely impact growth and weight gain. Esophagitis resulting from exposure of the esophageal mucosa to acidic gastric contents is manifested by pain, bleeding, and eventually stricture formation and abnormal motility. Approximately 25% have iron deficiency anemia caused by frank or occult blood loss. Hepatomegaly is not a complication of gastroesophageal reflux.

REF: p. 944

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

 

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