[Ex3] - C39 - AP

Question 1

39-1. 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

Answer 1

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.

Question 2

39-2. 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

Answer 2

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.

Question 3

39-3. 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

Answer 3

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.

Question 4

39-4. 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

Answer 4

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.

Question 5

39-5. 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.

Answer 5

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.

Question 6

39-6. 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 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

Answer 6

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.

Question 7

39-7. Meconium ileus (MI) is associated with which of the following disorders?
a. Pyloric stenosis
b. Esophageal atresia
c. Cystic fibrosis
d. Esophagitis

Answer 7

ANS: C
Meconium ileus is associated with cystic fibrosis. Meconium ileus is not associated with
pyloric stenosis, esophageal atresias, or esophagitis.

Question 8

39-8. 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

Answer 8

ANS: A

Congenital aganglionic megacolon is caused by the absence of the intrinsic ganglion cells
(submucosal and myenteric 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.

Question 9

39-9. 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

Answer 9

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.

Question 10

39-10. 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

Answer 10

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.

Question 11

39-11. 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)

Answer 11

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.

Question 12

39-12. What is the most common symptom of Meckel diverticulum observed in children?
a. Constipation
b. Vomiting
c. Rectal bleeding
d. Ascites

Answer 12

ANS: C
Although most Meckel diverticula are asymptomatic, the most common symptom is painless
rectal bleeding. Intestinal obstruction, intussusception, and volvulus can occur, more
commonly in adults. Meckel diverticula is not associated with constipation, vomiting, or
ascites.

Question 13

39-13. 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

Answer 13

ANS: A
The frequency of reflux is highest in premature infants. Frequency is not associated with
Down syndrome, cystic fibrosis, or esophageal atresia.

Question 14

39-14. 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

Answer 14

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.

Question 15

39-15. Celiac disease, or sprue, is caused by alterations of the intestinal:
a. glands.
b. villi.
c. smooth muscle wall.
d. sphincters.

Answer 15

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.

Question 16

39-16. Kwashiorkor is a severe dietary deficiency of:
a. fat-soluble vitamins.
b. carbohydrates.
c. protein.
d. calcium and magnesium.

Answer 16

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.

Question 17

39-17. 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

Answer 17

ANS: A
Marasmus is most common in children younger than 1 year.

Question 18

39-18. 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.

Answer 18

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.

Question 19

39-19. 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.

Answer 19

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.

Question 20

39-20. 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

Answer 20

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.

Question 21

39-21. 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

Answer 21

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.

Question 22

39-22. 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

Answer 22

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.

Question 23

39-23. The nurse assessing the patient with biliary atresia would expect to find which primary
clinical manifestation?
a. Anemia
b. Jaundice
c. Hypobilirubinemia
d. Ascites

Answer 23

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.

Question 24

39-24. Outbreaks of hepatitis _____ often occur in young children attending day care centers and can
be attributed to poor handwashing.
a. A
b. B
c. C
d. D

Answer 24

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.

Question 25

39-25. 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

Answer 25

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.

Question 26

39-26. 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.

Answer 26

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.

Question 27

39-27. 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

Answer 27

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.