PATHOPHYSIOLOGY MIDTERM NP 2023-2024 QUESTIONS AND ANSWERS
1. Incomplete fusion of the na- somedial and intermaxillary process during the fourth week of
... [Show More] embryonic develop- ment causes which condition in an infant?
a. Sinus dysfunction
b. Esophageal malformation
c. Cleft lip
d. Cleft palate
2. Increased gastrin secretion by the mother in the last trimester of pregnancy may cause which condition in the infant?
a. Galactosemia
b. Esophageal atresis
c. Meconium ileus
d. Pyloric stenosis
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 pre- pare to educate the parent on?
a. Wheat-free diet
b. A gastric feeding tube
c. Corrective surgery
d. Lactose-free diet
4. Which term is used to identify a condition in which the de-
C. Cleft lip
Rationale: A cleft lip is caused by the in- complete fusion of the nasomedial and in- termaxillary process during the fourth week of embryonic development.
d. Pyloric stenosis
Rationale: Increased gastrin secretion by the mother in the last trimester of preg- nancy 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 moth- er. Increased gastrin secretion does not lead to meconium ileus, esophageal atresia, or galactosemia.
c. Corrective surgery
Rationale: This infant is displaying symp- toms of pyloric stenosis. The key treatment for pyloric stenosis is corrective surgery, usually a laparoscopic pyloromyotomy. A feeding tube is not needed; a wheat-free diet would be indicated for celiac disease or nonceliac gluten sensitivity; lactose-free diet would be beneficial in lactose sensitivity.
d. Intestinal malrotation
veloping colon remains in the upper right quadrant instead of moving to its normal loca- tion?
a. Ileocecal displacement
b. Duodenal obstruction
c. Pyloric stenosis
d. Intestinal malrotation
5. Which term is used to iden- tify an intestinal obstruction caused by meconium formed in utero that is abnormally sticky and adheres firmly to the mucosa of the small in- testine?
a. Meconium cecum
b. Meconium obstruction
c. Meconium ileus
d. Meconium vivax
6. A newborn has meconium ileus. What diagnostic test does the healthcare profes- sional advise the parents about?
a. A sweat test
b. Pulmonary function stud- ies
c. Colonoscopy
d. Nerve conduction studies
7. Congenital aganglionic megacolon (Hirschsprung's disease) involves inadequate motility of the colon caused by neural malformation of which nervous system?
a. Sympathetic
Rationale: 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, where an abnormal membrane may press on and obstruct the duodenum.
c. Meconium ileus
Rationale: Meconium ileus is the term used to identify an intestinal obstruction caused by meconium formed in utero that is ab- normally sticky and adheres firmly to the mucosa of the small intestine, resisting pas- sage beyond the terminal ileum. The cause is usually a lack of digestive enzymes during fetal life.
a. A sweat test
Rationale: Meconium 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 education the parents on a colonoscopy, pulmonary function stud- ies, or nerve conduction studies.
d. Parasympathetic
Rationale: A malformation related to the parasympathetic nervous system causes congenital aganglionic megacolon.
b. Somatic
c. Central
d. Parasympathetic
8. An infant has been diag- nosed with intussusception and the student asks the healthcare professional to explain the condition. What explanation by the profes- sional is MOST accurate?
a. Fibrosis increases the re- sistance to blood flow within the portal system.
b. One part of the intestine telescopes into another sec- tion of the intestine.
c. Poor colonic motility due to a problem in the PNS.
d. The colon stats in the up- per right quadrant instead of moving to its normal loca- tion.
9. An infant suddenly develops abdominal pain, becomes ir- ritable, and draws up the knees. Vomiting occurs soon afterward. The mother re- ports that the infant passed a normal stool, followed by one that looked like currant jelly. What treatment does the healthcare professional pre- pare the infant for?
a. Corrective surgery
b. Anal dilation
c. Gastric decompression
d. Reduction enema
b. One part of the intestine telescopes into another of the intestine.
Rationale: Intussusception is the telescop- ing or invagination of portion of the intes- tine into another section of intestine. Usu- ally, the ileum invaginates the cecum and part of the ascending colon by collapsing through the ileocecal valve. A problem with the PNS 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 quad. Increased reisistance to blood flow in the portal system leads to portal hypertension
d. Reduction enema
Rationale: Based 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.
10. Cystic fibrosis is character- ized by which symptom?
a. Excessive mucus produc- tion
b. Low sodium content in per- spiration
c. Abnormally thin exocrine secretions
d. Elevated blood glucose levels
11. A child has cystic fibrosis (CF). Which medication does the healthcare professional teach the parents about?
a. Salt tablets
b. Pancreatic enzymes
c. Anti-hypertensives
d. Antibiotics
12. What causes a person with cystic fibrosis to experience an exocrine pancreatic insuf- ficiency?
a. Pancreatic ducts are ob- structed with mucus.
b. Impaired blood supply to the pancreas causes is- chemia.
c. The pancreas has a volvu- lus at the ampulla of Vater.
d. A genetically impaired pan-
a. Excessive mucus production
Rationale: Excessive mucus production characterizes cystic fibrosis. However, the pathophysiologic triad that is the hallmark of cystic fibrosis includes (1) pancreatic en- zyme deficiency, which causes maldiges- tion; (2) overproduction of mucus in the res- piratory tract and an inability to clear se- cretions, which cause progressive COPD; and (3) abnormally ELEVATED sodium and chloride concentrations in sweat. Exocrine secretions tend to be abnormally THICK and precipitate in the glandular ducts, obstruct- ing flow. An elevated blood glucose level is not associated with this disorder.
b. Pancreatic enzymes
Rationale: Pancreatic replacement enzymes are administered to people with CF before or with meals. Salt tablets and anti-hyperten- sives are not associated with this disorder. Antibiotics would be used for an infection; people with CF have frequent respiratory infections.
a. Pancreatic ducts are obstructed with mu- cus.
Rationale: Approximately 85% of individuals with CF experience pancreatic insufficien- cy. Obstruction of the pancreatic ducts with thick mucus blocks the flow of pancreatic enzymes and causes degenerative and fi- brotic changes in the pancreas. Pancreatic insufficiency is not related to ischemia, the inability to produce digestive enzymes, or the presence of volvulus.
creas is unable to produce di- gestive enzymes.
13. A student asks the professor to explain the characteristic appearance of stools in peo- ple with cystic fibrosis. What explanation by the professor is BEST?
a. Ischemia due to sodi-
um blockages causes bloody stools.
b. Deficiency of pancreatic enzymes leads to steator- rhea.
c. Mechanical obstruction causes narrow, ribbon-like stool.
d. Bile ducts obstructed with mucus, leading to clay col- ored stools.
14. Which disorder is character- ized by damage to the mu- cosa of the duodenum and jejunum and impaired secre- tion of secretin, cholecys- tokinin, and pancreatic en- zymes?
a. Gluten-sensitive enteropa- thy
b. Cystic fibrosis
c. Galactosemia
d. Wilson disease
b. Deficiency of pancreatic enzymes leads to steatorrhea.
Rationale: Severe problems with maldiges- tion of proteins, carbohydrates, and fats oc- cur because of the insufficient secretion of pancreatic enzymes. This leads to steator- rhea, or stools that are fatty and bulky. Bil- iary atresia would manifest with clay-col- ored stools. Thin, ribbon-like stools would be caused by a partial mechanical obstruction. Bloody stools are not seen in CF.
a. Gluten-sensitive enteropathy Rationale: Gluten-sensitive enteropathy is
characterized by damage to the mucosa of the duodenum and jejunum and has sec- ondary effects that exacerbate malabsorp- tion. The secretion of intestinal hormones, such as secretin and cholecystokinin, may be diminished. Because these chemical messengers are scarce, secretion of pan- creatic enzymes and expulsion of bile from the gallbladder decrease. Wilson disease (hepatolenticular degeneration) is an auto- somal recessive defect of copper metabo- lism. Cystic fibrosis (CF) is an autosomal recessive disease of the exocrine glands.
15. An infant has gluten-sensi- tive enteropathy and the par- ents ask the healthcare pro- fessional to explain why the baby bruises so easily. The professional explains that the baby has which deficit?
a. Bone marrow function de- pression
b. Prescription daily warfarin
c. Vitamin K deficiency from fat malabsorption
d. Iron, folate, and B12 defi- ciency anemias
16. What does the student learn distinguishes kwash- iorkor from marasmus?
a. Physical growth of children is stunted in kwashiorkor but not in marasmus.
Galactosemia is a disorder in which the body is unable to metabolize galactose.
c. Vitamin K deficiency from fat malabsorp- tion
Rationale: Deficiencies of fat-soluble vita- mins (such as vitamin K) are common in chil- dren with gluten-sensitive enteropathy, also known as celiac disease or celiac sprue.
Vitamin K malabsorption leads to hypopro- thrombinemia, causing the child to bruise and bleed easily. Bone marrow function de- pression would characterize aplastic ane- mia; anemias can have many different caus- es and children with celiac disease can be- come anemic. There is no indication that this infant is on warfarin; it is not a treatment for this disorder.
c. Subcutaneous fat, hepatomegaly, and fat- ty liver are present in kwashiorkor.
Rationale: The presence of subcutaneous fat, hepatomegaly, and fatty liver distinguish- es kwashiorkor from marasmus. These man-
b. All nutrients, proteins, fats, ifestations are missing in marasmus be-
and carbohydrates are re- duced in kwashiorkor.
c. Subcutaneous fat, he- patomegaly, and fatty liver are present in kwashiorkor.
d. Muscle wasting, diarrhea, low hemoglobin and infection characterize kwashiorkor.
17. Why is prolonged diarrhea more severe in children than it is in adults?
cause caloric intake is not sufficient to sup- port fat synthesis and storage. None of the other options accurately describes the differ- ences between these conditions.
d. Fluid reserves are smaller in children.
Rationale: Infants have low fluid reserves
a. Children ha1. Incomplete fusion of the na- somedial and intermaxillary process during the fourth week of embryonic develop- ment causes which condition in an infant?
a. Sinus dysfunction
b. Esophageal malformation
c. Cleft lip
d. Cleft palate
2. Increased gastrin secretion by the mother in the last trimester of pregnancy may cause which condition in the infant?
a. Galactosemia
b. Esophageal atresis
c. Meconium ileus
d. Pyloric stenosis
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 pre- pare to educate the parent on?
a. Wheat-free diet
b. A gastric feeding tube
c. Corrective surgery
d. Lactose-free diet
4. Which term is used to identify a condition in which the de-
C. Cleft lip
Rationale: A cleft lip is caused by the in- complete fusion of the nasomedial and in- termaxillary process during the fourth week of embryonic development.
d. Pyloric stenosis
Rationale: Increased gastrin secretion by the mother in the last trimester of preg- nancy 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 moth- er. Increased gastrin secretion does not lead to meconium ileus, esophageal atresia, or galactosemia.
c. Corrective surgery
Rationale: This infant is displaying symp- toms of pyloric stenosis. The key treatment for pyloric stenosis is corrective surgery, usually a laparoscopic pyloromyotomy. A feeding tube is not needed; a wheat-free diet would be indicated for celiac disease or nonceliac gluten sensitivity; lactose-free diet would be beneficial in lactose sensitivity.
d. Intestinal malrotation
veloping colon remains in the upper right quadrant instead of moving to its normal loca- tion?
a. Ileocecal displacement
b. Duodenal obstruction
c. Pyloric stenosis
d. Intestinal malrotation
5. Which term is used to iden- tify an intestinal obstruction caused by meconium formed in utero that is abnormally sticky and adheres firmly to the mucosa of the small in- testine?
a. Meconium cecum
b. Meconium obstruction
c. Meconium ileus
d. Meconium vivax
6. A newborn has meconium ileus. What diagnostic test does the healthcare profes- sional advise the parents about?
a. A sweat test
b. Pulmonary function stud- ies
c. Colonoscopy
d. Nerve conduction studies
7. Congenital aganglionic megacolon (Hirschsprung's disease) involves inadequate motility of the colon caused by neural malformation of which nervous system?
a. Sympathetic
Rationale: 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, where an abnormal membrane may press on and obstruct the duodenum.
c. Meconium ileus
Rationale: Meconium ileus is the term used to identify an intestinal obstruction caused by meconium formed in utero that is ab- normally sticky and adheres firmly to the mucosa of the small intestine, resisting pas- sage beyond the terminal ileum. The cause is usually a lack of digestive enzymes during fetal life.
a. A sweat test
Rationale: Meconium 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 education the parents on a colonoscopy, pulmonary function stud- ies, or nerve conduction studies.
d. Parasympathetic
Rationale: A malformation related to the parasympathetic nervous system causes congenital aganglionic megacolon.
b. Somatic
c. Central
d. Parasympathetic
8. An infant has been diag- nosed with intussusception and the student asks the healthcare professional to explain the condition. What explanation by the profes- sional is MOST accurate?
a. Fibrosis increases the re- sistance to blood flow within the portal system.
b. One part of the intestine telescopes into another sec- tion of the intestine.
c. Poor colonic motility due to a problem in the PNS.
d. The colon stats in the up- per right quadrant instead of moving to its normal loca- tion.
9. An infant suddenly develops abdominal pain, becomes ir- ritable, and draws up the knees. Vomiting occurs soon afterward. The mother re- ports that the infant passed a normal stool, followed by one that looked like currant jelly. What treatment does the healthcare professional pre- pare the infant for?
a. Corrective surgery
b. Anal dilation
c. Gastric decompression
d. Reduction enema
b. One part of the intestine telescopes into another of the intestine.
Rationale: Intussusception is the telescop- ing or invagination of portion of the intes- tine into another section of intestine. Usu- ally, the ileum invaginates the cecum and part of the ascending colon by collapsing through the ileocecal valve. A problem with the PNS 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 quad. Increased reisistance to blood flow in the portal system leads to portal hypertension
d. Reduction enema
Rationale: Based 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.
10. Cystic fibrosis is character- ized by which symptom?
a. Excessive mucus produc- tion
b. Low sodium content in per- spiration
c. Abnormally thin exocrine secretions
d. Elevated blood glucose levels
11. A child has cystic fibrosis (CF). Which medication does the healthcare professional teach the parents about?
a. Salt tablets
b. Pancreatic enzymes
c. Anti-hypertensives
d. Antibiotics
12. What causes a person with cystic fibrosis to experience an exocrine pancreatic insuf- ficiency?
a. Pancreatic ducts are ob- structed with mucus.
b. Impaired blood supply to the pancreas causes is- chemia.
c. The pancreas has a volvu- lus at the ampulla of Vater.
d. A genetically impaired pan-
a. Excessive mucus production
Rationale: Excessive mucus production characterizes cystic fibrosis. However, the pathophysiologic triad that is the hallmark of cystic fibrosis includes (1) pancreatic en- zyme deficiency, which causes maldiges- tion; (2) overproduction of mucus in the res- piratory tract and an inability to clear se- cretions, which cause progressive COPD; and (3) abnormally ELEVATED sodium and chloride concentrations in sweat. Exocrine secretions tend to be abnormally THICK and precipitate in the glandular ducts, obstruct- ing flow. An elevated blood glucose level is not associated with this disorder.
b. Pancreatic enzymes
Rationale: Pancreatic replacement enzymes are administered to people with CF before or with meals. Salt tablets and anti-hyperten- sives are not associated with this disorder. Antibiotics would be used for an infection; people with CF have frequent respiratory infections.
a. Pancreatic ducts are obstructed with mu- cus.
Rationale: Approximately 85% of individuals with CF experience pancreatic insufficien- cy. Obstruction of the pancreatic ducts with thick mucus blocks the flow of pancreatic enzymes and causes degenerative and fi- brotic changes in the pancreas. Pancreatic insufficiency is not related to ischemia, the inability to produce digestive enzymes, or the presence of volvulus.
creas is unable to produce di- gestive enzymes.
13. A student asks the professor to explain the characteristic appearance of stools in peo- ple with cystic fibrosis. What explanation by the professor is BEST?
a. Ischemia due to sodi-
um blockages causes bloody stools.
b. Deficiency of pancreatic enzymes leads to steator- rhea.
c. Mechanical obstruction causes narrow, ribbon-like stool.
d. Bile ducts obstructed with mucus, leading to clay col- ored stools.
14. Which disorder is character- ized by damage to the mu- cosa of the duodenum and jejunum and impaired secre- tion of secretin, cholecys- tokinin, and pancreatic en- zymes?
a. Gluten-sensitive enteropa- thy
b. Cystic fibrosis
c. Galactosemia
d. Wilson disease
b. Deficiency of pancreatic enzymes leads to steatorrhea.
Rationale: Severe problems with maldiges- tion of proteins, carbohydrates, and fats oc- cur because of the insufficient secretion of pancreatic enzymes. This leads to steator- rhea, or stools that are fatty and bulky. Bil- iary atresia would manifest with clay-col- ored stools. Thin, ribbon-like stools would be caused by a partial mechanical obstruction. Bloody stools are not seen in CF.
a. Gluten-sensitive enteropathy Rationale: Gluten-sensitive enteropathy is
characterized by damage to the mucosa of the duodenum and jejunum and has sec- ondary effects that exacerbate malabsorp- tion. The secretion of intestinal hormones, such as secretin and cholecystokinin, may be diminished. Because these chemical messengers are scarce, secretion of pan- creatic enzymes and expulsion of bile from the gallbladder decrease. Wilson disease (hepatolenticular degeneration) is an auto- somal recessive defect of copper metabo- lism. Cystic fibrosis (CF) is an autosomal recessive disease of the exocrine glands.
15. An infant has gluten-sensi- tive enteropathy and the par- ents ask the healthcare pro- fessional to explain why the baby bruises so easily. The professional explains that the baby has which deficit?
a. Bone marrow function de- pression
b. Prescription daily warfarin
c. Vitamin K deficiency from fat malabsorption
d. Iron, folate, and B12 defi- ciency anemias
16. What does the student learn distinguishes kwash- iorkor from marasmus?
a. Physical growth of children is stunted in kwashiorkor but not in marasmus.
Galactosemia is a disorder in which the body is unable to metabolize galactose.
c. Vitamin K deficiency from fat malabsorp- tion
Rationale: Deficiencies of fat-soluble vita- mins (such as vitamin K) are common in chil- dren with gluten-sensitive enteropathy, also known as celiac disease or celiac sprue.
Vitamin K malabsorption leads to hypopro- thrombinemia, causing the child to bruise and bleed easily. Bone marrow function de- pression would characterize aplastic ane- mia; anemias can have many different caus- es and children with celiac disease can be- come anemic. There is no indication that this infant is on warfarin; it is not a treatment for this disorder.
c. Subcutaneous fat, hepatomegaly, and fat- ty liver are present in kwashiorkor.
Rationale: The presence of subcutaneous fat, hepatomegaly, and fatty liver distinguish- es kwashiorkor from marasmus. These man-
b. All nutrients, proteins, fats, ifestations are missing in marasmus be-
and carbohydrates are re- duced in kwashiorkor.
c. Subcutaneous fat, he- patomegaly, and fatty liver are present in kwashiorkor.
d. Muscle wasting, diarrhea, low hemoglobin and infection characterize kwashiorkor.
17. Why is prolonged diarrhea more severe in children than it is in adults?
cause caloric intake is not sufficient to sup- port fat synthesis and storage. None of the other options accurately describes the differ- ences between these conditions.
d. Fluid reserves are smaller in children.
Rationale: Infants have low fluid reserves
a. Children ha [Show Less]