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Understanding Pathophysiology 6th Edition Huether McCance Test Bank

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Understanding Pathophysiology 6th Edition Huether McCance Test Bank

ISBN-13: 978-0323354097

ISBN-10: 0323354092

 

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Understanding Pathophysiology 6th Edition Huether McCance Test Bank

ISBN-13: 978-0323354097

ISBN-10: 0323354092

 

 

 

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Free Nursing Test Questions:

Chapter 37: Alterations of Digestive Function in Children

Huether & McCance: Understanding Pathophysiology, 6th Edition

 

MULTIPLE CHOICE

 

  1. The family learns that a 3D ultrasound of a 9-week fetus shows incomplete fusion of the nasomedial process. What is this defect commonly called?
a. Cleft lip
b. Nasal passage atresia
c. Esophageal atresia
d. Lack of dentition

 

 

ANS:  A

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

 

REF:   p. 950

 

  1. What term is used to document the condition that exists when the esophagus ends in a blind pouch?
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; 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. 951

 

  1. 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 mothers of affected infants because of alterations in fetal swallowing. Esophageal malformations are not associated with enlarged placentas, short umbilical cords, or vaginal discharge.

 

REF:   p. 951

 

  1. A 2-week-old infant vomits forcefully immediately after feeding for no apparent reason and is frequently constipated. These signs support which diagnosis?
a. Pyloric stenosis
b. Meconium ileus
c. Esophageal atresia
d. Galactosemia

 

 

ANS:  A

Between 2 and 8 weeks after birth, an infant who has fed well and gained weight begins forceful, nonbilious vomiting immediately after feeding. Constipation occurs because little food reaches the intestine. The signs do not support a diagnosis of meconium ileus, esophageal atresia, or galactosemia.

 

REF:   p. 952

 

  1. 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 70-90% of infants with pyloric stenosis. Pyloric stenosis is not associated with diarrhea, bile regurgitation, or ascites.

 

REF:   p. 952

 

  1. 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 gas bubbles in the intestines. 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. Radiographic films of the abdomen and barium studies show intestinal gas bubbles and distention proximal to the site of obstruction. This assessment data does not support a diagnosis of ileocecal displacement. 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. 953

 

  1. Meconium ileus (MI) 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 not associated with pyloric stenosis, esophageal atresias, or esophagitis.

 

REF:   p. 953

 

  1. A 2-month-old is diagnosed with Hirschsprung disease with the resulting development of a megacolon. What is the most likely cause of this condition?
a. Absence of intrinsic ganglion cells resulting in impaired peristalsis
b. The use of cow’s milk instead of formula
c. Excessive use of glycerin suppositories to promote bowel elimination
d. Additional ganglion cells throughout the length of the colon

 

 

ANS:  A

Congenital aganglionic megacolon is caused by the absence of the intrinsic ganglion cells (submucosal and myentric plexuses) along a variable length of the colon, resulting in inadequate peristaltic movement in the bowels. The resulting distention of the proximal colon results in the term megacolon. Megacolon is a functional anatomic disorder not related to formula or use of suppositories.

 

REF:   p. 954

 

  1. The primary complication of enterocolitis associated with Hirschsprung disease is related to which neonatal finding?
a. Fecal impaction
b. Pancreatic insufficiency
c. Hyperactive peristalsis
d. Ileal atresia

 

 

ANS:  A

The most serious complication of Hirschsprung disease in the neonatal period is enterocolitis related to fecal impaction. Enterocolitis is not related to pancreatic insufficiency or hyperactive peristalsis but to slowed peristalsis or ileal atresia.

 

REF:   p. 954

 

  1. 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. Which term is used to describe this type of obstruction?
a. Prolapse
b. Pyloric stenosis
c. Intussusception
d. Imperforation

 

 

ANS:  C

In intussusception, the ileum commonly telescopes into the cecum and part of the ascending colon by collapsing through the ileocecal valve. The classic symptoms of intussusception include colicky abdominal pain, irritability, knees drawn to the chest, abdominal mass, vomiting, and bloody (currant jelly) stools. The assessment data does not support a diagnosis of prolapse, pyloric stenosis, or of imperforation.

 

REF:   p. 956

 

  1. An 8-week-old is diagnosed with a congenital heart disease and Down syndrome. The infant is at risk for the development of which gastrointestinal disorder?
a. Intussusception
b. Imperforate anus
c. Meckel diverticulum
d. Cystic fibrosis (CF)

 

 

ANS:  B

Approximately 40% of infants with anorectal malformations have other developmental anomalies (i.e., Down syndrome, Hirschsprung disease, and duodenal atresia). The risk is not present for intussusception, Meckel diverticulum, or cystic fibrosis.

 

REF:   p. 954

 

  1. What is the most common symptom of Meckel diverticulum observed in children?
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. Intestinal obstruction, intussusception, and volvulus can occur, more commonly in adults. Meckel diverticuli is not associated with constipation, vomiting, or ascites.

 

REF:   p. 953

 

  1. Occurrence of gastroesophageal reflux (GER) 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. Frequency is not associated with Down syndrome, cystic fibrosis, or esophageal atresia.

 

REF:   p. 954

 

  1. An 8-week-old male was recently diagnosed with cystic fibrosis (CF). Which of the following digestive alterations would be expected?
a. Insufficient bile production
b. Gastric atrophy
c. Hypersecretion of stomach acid
d. Nutrient malabsorption

 

 

ANS:  D

Approximately 85% of those with CF present early in life with pancreatic insufficiency (PI). PI is the cause of nutrient malabsorption and failure to thrive in children with CF. Infants with CF have normal bile production; they experience pancreatic enzyme deficiency. Diagnosed infants do not experience gastric atrophy or hypersecretion of stomach acid.

 

REF:   p. 956

 

  1. 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, the walls of smooth muscle, or sphincters.

 

REF:   p. 957

 

  1. 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 not associated with a dietary deficiency of fat-soluble vitamins, carbohydrates, or minerals such as calcium and magnesium.

 

REF:   p. 959

 

  1. Marasmus is most common in children of which age group?
a. Younger than 1 year
b. 1-2 years
c. 5-6 years
d. 12-15 years

 

 

ANS:  A

Marasmus is most common in children younger than 1 year.

 

REF:   p. 959

 

  1. A 1-week-old female is brought to her pediatrician for abdominal distention and unstable temperature. Physical examination reveals bradycardia and apnea. Tests reveal portal venous gas and an intestinal perforation. This condition is referred to as:
a. infective enteropathy.
b. necrotizing enterocolitis (NEC).
c. mucoviscidosis.
d. ileus.

 

 

ANS:  B

NEC includes feeding intolerance, abdominal distention, and bloody stools after 8-10 days of age, septicemia with elevated white blood cells, and falling platelet counts. Unstable temperature, bradycardia, and apnea are nonspecific signs. 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. 960

 

  1. 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. The danger is not due to lower adipose reserves or microbial resistance. Children have higher metabolic rates.

 

REF:   p. 961

 

  1. When a newborn has a lack of bilirubin uptake, what does the nurse suspect is occurring in the patient?
a. Biliary hypertrophy
b. Physiologic jaundice
c. Hepatitis A
d. Infantile cirrhosis

 

 

ANS:  B

Physiologic jaundice (newborn jaundice or neonatal bilirubinemia) is a frequently encountered problem in otherwise healthy newborns caused by lack of maturity in bilirubin uptake and conjugation. Impaired excretion of bilirubin does not lead to biliary hypertrophy, hepatitis A, or cirrhosis.

 

REF:   p. 961

 

  1. A 7-month-old female presents with jaundice, clay-colored stool, and an enlarged liver. 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

Biliary atresia (BA) is a rare congenital malformation (1 in 8000 to 1 in 18,000 live births) characterized by the absence or obstruction of intrahepatic or extrahepatic bile ducts. Jaundice is the primary clinical manifestation of biliary atresia, along with hepatomegaly and acholic (clay-colored) stools. The presenting symptomatology does not support any of the other options.

 

REF:   p. 962

 

  1. A newborn is diagnosed with biliary atresia. What is the long-term treatment for this disorder?
a. Immunoglobulins
b. Liver transplant
c. Bone marrow transplant
d. Dietary modifications

 

 

ANS:  B

The treatment for biliary atresia is liver transplant. Long-term treatment for biliary atresia is not associated with immunoglobulins, bone marrow transplant, or dietary modifications.

 

REF:   p. 962

 

  1. 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. Anemia is not associated with biliary atresia. Hypobilirubinemia is not associated with this disorder. Ascites occurs with other liver disorders but not atresia.

 

REF:   p. 962

 

  1. Outbreaks of hepatitis _____ often occur in young children attending daycare centers and can be attributed to poor handwashing.
a. A
b. B
c. C
d. D

 

 

ANS:  A

Outbreaks of hepatitis A occur in condition where poor handwashing occurs. Hepatitis B is blood-borne and not related to handwashing. Hepatitis C is blood-borne and not related to handwashing. Hepatitis D is blood-borne and depends on an active HIV infection.

 

REF:   p. 962

 

  1. 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 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. 963

 

  1. Early identification and treatment for metabolic disorders are 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. 963

 

  1. 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. 964, Table 37-2

 

MULTIPLE RESPONSE

 

  1. Which of the following are complications of gastroesophageal reflux disease (GERD)? (select all that apply)
a. Esophagitis
b. Barrett esophagus (BE)
c. Cough
d. Recurrent otitis media (OM)
e. Bloody vomitus

 

 

ANS:  A, B, C, D

Esophageal complications of GER can be significant, such as esophagitis; hemorrhage; stricture; Barrett esophagus (BE) (see Chapter 36); and, rarely, adenocarcinoma. Extraesophageal symptoms include cough and wheezing, laryngitis, pharyngitis, dental erosions, sinusitis, recurrent otitis media, and Sandifer’s syndrome (a neurologic disorder). Bloody vomitus is not a complication of gastroesophageal reflux disease.

 

REF:   p. 955

 

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