Pathophysiology: Chapter 43: Alterations of Digestive Function in Children

Question 1

Incomplete fusion of the nasomedial and intermaxillary process during the fourth week of
embryonic development causes which condition in an infant?
a. Cleft palate c. Cleft lip
b. Sinus dysfunction d. Esophageal malformation

Answer 1

ANS: C
Of the available options, only a cleft lip is caused by the incomplete fusion of the
nasomedial and intermaxillary process during the fourth week of embryonic development.

Question 2

Increased gastrin secretion by the mother in the last trimester of pregnancy may cause
which condition in the infant?
a. Pyloric stenosis c. Esophageal atresia
b. Meconium ileus d. Galactosemia

Answer 2

ANS: A
The cause is unknown but increased 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. This
statement is not true of the other options.

Question 3

At 2 or 3 weeks of age, an infant who has been well fed and has gained weight begins to
vomit for no apparent reason. The vomiting gradually becomes more forceful. These
symptoms may be indicative of which disorder?
a. Esophageal atresia
b. Congenital aganglionic megacolon
c. Pyloric stenosis
d. Galactosemia

Answer 3

ANS: C
Of the options available, only the clinical manifestations of pyloric stenosis—an infant
who has been well fed and has gained weight begins to vomit without an apparent
reason—can appear between 2 and 3 weeks after birth. The vomiting gradually becomes
more forceful.

Question 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 malrotation c. Duodenal obstruction
b. Ileocecal displacement d. Pyloric stenosis

Answer 4

ANS: A
Intestinal malrotation is the only 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.

Question 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 cecum c. Meconium obstruction
b. Meconium ileus d. Meconium vivax

Answer 5

ANS: B
Meconium ileus is the only 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.

Question 6

With which medical diagnosis is meconium ileus often associated?

a. Muscular dystrophy
b. Cerebral palsy
c. Cystic fibrosis
d. Congenital aganglionic megacolon

Answer 6

ANS: C
The detection of albumin in meconium has been used as a screening test for cystic fibrosis.
This condition is not associated with any of the other options.

Question 7

Congenital aganglionic megacolon (Hirschsprung disease) involves inadequate motility of
the colon caused by neural malformation of which nervous system?
a. Central c. Sympathetic
b. Parasympathetic d. Somatic

Answer 7

ANS: B
A malformation related only to the parasympathetic nervous system causes congenital
aganglionic megacolon.

Question 8

Which term is used to describe an intestinal obstruction caused by the invagination of the
ileum into the cecum and part of the ascending colon by collapsing through the ileocecal
valve?
a. Congenital aganglionic megacolon
b. Malrotation
c. Intussusception
d. Volvulus

Answer 8

ANS: C
Intussusception 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. The other terms are not used to
describe this event.

Question 9

An infant suddenly develops abdominal pain, becomes irritable (colicky), 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. Based on these data, which
disorder does the nurse suspect?
a. Congenital aganglionic megacolon
b. Intussusception
c. Malrotation
d. Volvulus

Answer 9

ANS: B
Based on these data, the nurse should suspect intussusception. A single normal stool may
be passed, evacuating the colon distal to the apex of the intussusception. After passing a
normal stool, 60% of infants will pass “currant jelly” stools, which appear dark and
gelatinous because of their blood and mucus content. Intussusception is the only option
that describes the symptoms listed.

Question 10

Cystic fibrosis is characterized by which symptom?

a. Excessive mucus production
b. Elevated blood glucose levels
c. Low sodium content in perspiration
d. Abnormally thin exocrine secretions

Answer 10

ANS: A
Excessive 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. An elevated blood glucose level is not associated with this disorder.

Question 11

Which medication compensates for the deficiency that occurs as a result of cystic fibrosis?

a. Salt tablets c. Antihypertensives
b. Pancreatic enzymes d. Antibiotics

Answer 11

ANS: B
Pancreatic replacement enzymes are administered before or with meals, and high-calorie,
high-protein diets with frequent snacks and vitamin supplements are used to treat the
deficiency. These statements are not true of the other options.

Question 12

What causes a person with cystic fibrosis to experience an exocrine pancreatic
insufficiency?
a. Pancreatic ducts are obstructed with mucus.
b. Impaired blood supply to the pancreas causes ischemia.
c. A genetically impaired pancreas is unable to produce digestive enzymes.
d. The pancreas has a volvulus at the ampulla of Vater.

Answer 12

ANS: A
Approximately 85% of individuals with cystic fibrosis experience pancreatic insufficiency.
Obstruction of the pancreatic ducts with thick mucus blocks the flow of pancreatic
enzymes and causes degenerative and fibrotic changes in the pancreas. This selection is
the only option that accurately describes why an exocrine pancreatic insufficiency is
observed in individuals diagnosed with cystic fibrosis.

Question 13

What is the cause of faulty digestion of fats in those diagnosed with cystic fibrosis?

a. Bile ducts obstructed with mucus, prohibiting the release of bile
b. Failure to metabolize fat-soluble vitamins
c. Deficiency of pancreatic enzymes
d. Fat malabsorption that now occurs in the jejunum

Answer 13

ANS: C
Severe problems with maldigestion of proteins, carbohydrates, and fats occur because of
the insufficient secretion of pancreatic enzymes. This selection is the only option that
accurately describes why fatty stools are observed in individuals diagnosed with cystic
fibrosis.

Question 14

Which disorder is characterized by damage to the mucosa of the duodenum and jejunum
and impaired secretion of secretin, cholecystokinin, and pancreatic enzymes?
a. Wilson disease
b. Cystic fibrosis
c. Gluten-sensitive enteropathy
d. Galactosemia

Answer 14

ANS: C
Gluten-sensitive enteropathy is characterized by damage to the mucosa of the duodenum
and jejunum and has secondary effects that exacerbate malabsorption. The secretion of
intestinal hormones, such as secretin and cholecystokinin, may be diminished. Because
these chemical messengers are scarce, secretion of pancreatic enzymes and expulsion of
bile from the gallbladder decrease. These statements are not true of the other options.

Question 15

What factor associated with gluten-sensitive enteropathy (celiac sprue) causes an infant to
bruise and bleed easily?
a. Vitamin K deficiency from fat malabsorption
b. Bone marrow function depression
c. Iron, folate, and B12 deficiency anemias
d. Prescribed daily warfarin (Coumadin)

Answer 15

ANS: A
Deficiencies of fat-soluble vitamins (such as vitamin K) are common in children with
gluten-sensitive enteropathy. Vitamin K malabsorption leads to hypoprothrombinemia,
causing the child to bruise and bleed easily. This selection is the only option that
accurately describes the mechanism that causes bruising and bleeding in children
diagnosed with celiac sprue.

Question 16

What distinguishes kwashiorkor from marasmus?
a. All nutrients, proteins, fats, and carbohydrates are reduced in kwashiorkor.
b. Physical growth of children is stunted in kwashiorkor but not in marasmus.
c. Muscle wasting, diarrhea, low hemoglobin, and infection characterize
kwashiorkor.
d. Subcutaneous fat, hepatomegaly, and fatty liver are present in kwashiorkor.

Answer 16

ANS: D
The presence of subcutaneous fat, hepatomegaly, and fatty liver distinguishes kwashiorkor
from marasmus. These manifestations are missing in marasmus because caloric intake is
not sufficient to support fat synthesis and storage. None of the other options accurately
describes the differences among these conditions.

Question 17

Why is prolonged diarrhea more severe in children than it is in adults?

a. Less water is absorbed from the colon in children.
b. Fluid reserves are smaller in children.
c. Children have a higher fluid volume intake.
d. Children have diarrhea more often than adults.

Answer 17

ANS: B
Infants have low fluid reserves and relatively rapid peristalsis and metabolism. Therefore
the danger of dehydration is great. This selection is the only option that correctly identifies
the reason prolonged diarrhea is more severe in children.

Question 18

In an infant who is 5 weeks old, an increase in bilirubin production and persistent jaundice
support which diagnosis?
a. Pathologic hyperbilirubinemia 
b. Physiologic jaundice
c. Hepatitis A 
d. Infantile cirrhosis

Answer 18

ANS: A
Physiologic jaundice develops during the second or third day after birth and usually
subsides in 1 to 2 weeks in full-term infants and in 2 to 4 weeks in premature infants. After
this development, increased bilirubin values and persistent jaundice indicate pathologic
hyperbilirubinemia. This selection is the only option that accurately identifies the
diagnosis associated with these symptoms and timeline.

Question 19

Which type of diarrhea results from lactose intolerance?

a. Secretory c. Osmotic
b. Motility d. Small volume

Answer 19

ANS: C
The malabsorption of lactose results in osmotic diarrhea, in which fluids move by osmosis
from the vascular compartment into the intestinal lumen. Of the available options, this
selection is the only type of diarrhea that results from lactose intolerance.

Question 20

Physiologic jaundice in a newborn is caused by:

a. Reabsorption of bilirubin in the small intestine
b. Impaired hepatic uptake and excretion of bilirubin
c. Increased bilirubin production
d. Mild conjugated (indirect-reacting) hyperbilirubinemia

Answer 20

ANS: D
Of the available options, physiologic jaundice in a newborn is caused by mild
unconjugated (indirect-reacting) hyperbilirubinemia.

Question 21

In children, the risk factors for hepatitis B virus (HBV) are primarily associated with:

a. Living in urban communities
b. Mothers who are hepatitis C carriers
c. Transfusion therapy for hemophilia
d. Those of Hispanic ethnic background

Answer 21

ANS: C
Risk factors for HBV infection include infants of mothers who are carriers of chronic
hepatitis B surface antigen (HBsAg), hemophiliacs who receive frequent blood
transfusions, children who abuse parenteral drugs, and children who live in residences for
those who are mentally delayed. HBV is endemic in China and other parts of Asia where
most infections occur in infants and children as a result of maternal-neonatal transmission.

Question 22

Cirrhosis causes intrahepatic portal hypertension in children as a result of which
mechanism?
a. Fibrosis that increases the resistance to blood flow within the portal system
b. Increased pressure from the twisting of the common bile ducts
c. Development of collateral circulation within the portal system
d. Shunting of fluid to the spleen or abdomen

Answer 22

ANS: A
The two basic causes of portal hypertension in children are (1) increased resistance to
blood flow within the portal system and (2) increased volume of portal blood flow. This
selection is the only option that correctly identifies the cause of intrahepatic portal
hypertension in children

Question 23

What is the most common clinical sign of portal hypertension in children?

a. Right heart failure c. Splenomegaly
b. Pulmonary edema d. Diarrhea

Answer 23

ANS: C

Splenomegaly is the most common sign of portal hypertension in children.