Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 43: Alterations of Digestive Function in ChildrenMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. Incomplete fusion of the nasomedial and intermaxillary process during the fourth week of embryonic development causes which condition in an infant?a. Cleft palateb. Sinus dysfunctionc. Cleft lipd. Esophageal malformationANS: CA cleft lip is caused by the incomplete fusion of the nasomedial and intermaxillary process during the fourth week of embryonic development.PTS: 1 DIF: Cognitive Level: Remembering 2. Increased gastrin secretion by the mother in the last trimester of pregnancy may cause which condition in the infant?a. Pyloric stenosisb. Meconium ileusc. Esophageal atresiad. GalactosemiaANS: AIncreased gastrin secretion by the mother in the last trimester of pregnancy increases the likelihood of pyloric stenosis in the infant. The overproduction of gastric secretions in the infant may be caused by stress-related factors in the mother. Increased gastrin secretion does not lead to meconium ileus, esophageal atresia, or galactosemia.PTS: 1 DIF: Cognitive Level: Remembering 3. Parents report their 3-week-old infant who eats well and has gained weight began to vomit forcefully for no apparent reason. What treatment option does the healthcare professional prepare to educate the parents on?a. A gastric feeding tubeb. Wheat-free dietc. Corrective surgeryd. Lactose-free dietANS: CThis infant is displaying symptoms of pyloric stenosis is corrective surgery, usually a laparoscopic pyloromyotomy. A feeding tube is not needed. A wheat-free diet would be used in celiac disease or nonceliac gluten sensitivity. Lactose sensitivity would benefit from the elimination of lactose from the diet.PTS: 1 DIF: Cognitive Level: Applying 4. Which term is used to identify a condition in which the developing colon remains in the upper right quadrant instead of moving to its normal location?a. Intestinal malrotationb. Ileocecal displacementc. Duodenal obstructiond. Pyloric stenosisANS: AIntestinal malrotation is the term used to identify a condition in which rotation does not occur and the colon remains in the upper right quadrant, where an abnormal membrane may press on and obstruct the duodenum.PTS: 1 DIF: Cognitive Level: Remembering 5. Which term is used to identify an intestinal obstruction caused by meconium formed in utero that is abnormally sticky and adheres firmly to the mucosa of the small intestine?a. Meconium cecumb. Meconium ileusc. Meconium obstructiond. Meconium vivaxANS: BMeconium ileus is the term used to identify an intestinal obstruction caused by meconium formed in utero that is abnormally sticky and adheres firmly to the mucosa of the small intestine, resisting passage beyond the terminal ileum. The cause is usually a lack of digestive enzymes during fetal life.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 6. A newborn has meconium ileus. What diagnostic test does the healthcare professional advise the parents about?a. Colonoscopyb. Pulmonary function studiesc. A sweat testd. Nerve conduction studiesANS: CMeconium ileus is seen in 20% of children who have cystic fibrosis, so the newborn needs a sweat test and genetic screening for this disorder. There is no need for the professional to educate the parents on a colonoscopy, pulmonary function studies, or nerve conduction studies.PTS: 1 DIF: Cognitive Level: Applying 7. Congenital aganglionic megacolon (Hirschsprung’s disease) involves inadequate motility of the colon caused by neural malformation of which nervous system?a. Centralb. Parasympatheticc. Sympatheticd. SomaticANS: BA malformation related to the parasympathetic nervous system causes congenital aganglionic megacolon.PTS: 1 DIF: Cognitive Level: Remembering 8. An infant has been diagnosed with intussusception and the student asks the healthcare professional to explain the condition. What explanation by the professional is most accurate?a. Poor colonic motility due to a problem in the parasympathetic nervous systemb. The colon stays in the upper right quadrant instead of moving to its normal location.c. One part of the intestine telescopes into another section of the intestine.d. Fibrosis increases the resistance to blood flow within the portal system.ANS: CIntussusception is the telescoping or invagination of one portion of the intestine into another section of intestine. Usually, the ileum invaginates the cecum and part of the ascending colon by collapsing through the ileocecal valve. A problem with the parasympathetic nervous system in Hirschsprung’s disease leads to poor colonic motility. Intestinal malrotation is the term used to identify a condition in which rotation does not occur and the colon remains in the upper right quadrant. Increased resistance to blood flow in the portal system leads to portal hypertension.PTS: 1 DIF: Cognitive Level: Understanding 9. An infant suddenly develops abdominal pain, becomes irritable, and draws up the knees. Vomiting occurs soon afterward. The mother reports that the infant passed a normal stool, followed by one that looked like currant jelly. What treatment does the healthcare professional prepare the infant for?a. Corrective surgeryb. Reduction enemac. Gastric decompressiond. Anal dilationANS: BBased on these data, the nurse should suspect intussusception. A standard therapy for this disorder is a reducing enema so the professional should prepare the infant (and parents) for this procedure. Corrective surgery, gastric decompression, and anal dilation are not needed.PTS: 1 DIF: Cognitive Level: Applying 10. Cystic fibrosis is characterized by which symptom?a. Excessive mucus productionb. Elevated blood glucose levelsc. Low sodium content in perspirationd. Abnormally thin exocrine secretionsANS: AExcessive mucus production characterizes cystic fibrosis. However, the pathophysiologic triad that is the hallmark of cystic fibrosis includes (1) pancreatic enzyme deficiency, which causes maldigestion; (2) overproduction of mucus in the respiratory tract and an inability to clear secretions, which cause progressive chronic obstructive pulmonary disease; and (3) abnormally elevated sodium and chloride concentrations in sweat. Exocrine secretions tend to be abnormally thick and precipitate in the glandular ducts, obstructing flow.
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