[Ex3] - C39 - AP Flashcards
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
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.
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
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.
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
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.
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
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.
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.
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.
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
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.
39-7. 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.
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
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.
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
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.
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
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.
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)
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.
39-12. 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 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.
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
ANS: A
The frequency of reflux is highest in premature infants. Frequency is not associated with
Down syndrome, cystic fibrosis, or esophageal atresia.
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
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.
39-15. 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.
