A 5-year-old child with cystic fibrosis (CF) is being seen for a follow-up visit. The parents report that the child has difficulty gaining weight despite a high- calorie diet and frequently experiences loose, fatty stools. The healthcare provider prescribes pancreatic enzyme replacement therapy (PERT) to assist with digestion. Which of the following statements best explains why children with CF require digestive enzymes?
Pancreatic enzyme replacement is only required when children develop diabetes, a common complication of CF
Digestive enzymes are needed to break down fat, which children with CF can digest more efficiently than carbohydrates
Children with CF have an overproduction of digestive enzymes, leading to malabsorption
CF causes thickened mucus that obstructs the pancreas, preventing the release of digestive enzymes
The Correct Answer is D
A. Pancreatic enzyme replacement therapy (PERT) is not tied to the development of diabetes. While CF-related diabetes can occur due to progressive pancreatic damage, enzyme therapy is required much earlier to address malabsorption caused by blocked pancreatic ducts. Waiting for diabetes to develop would allow continued nutrient deficiencies, poor weight gain, and fat-soluble vitamin deficiencies (A, D, E, K).
B. Children with CF do not digest fats more efficiently than carbohydrates. In fact, fat digestion is particularly impaired because pancreatic lipase is insufficient due to duct obstruction. Proteins and carbohydrates are also affected to a lesser extent. PERT provides a mix of lipase, amylase, and protease to compensate for this deficiency and ensure adequate nutrient absorption.
C. CF does not cause an overproduction of digestive enzymes. On the contrary, thick mucus blocks pancreatic ducts, preventing enzymes from reaching the intestines. This blockage leads to enzyme deficiency in the gastrointestinal tract, resulting in malabsorption, steatorrhea (fatty stools), abdominal bloating, and poor growth.
D. In CF, mutations in the CFTR gene lead to thick, sticky mucus production in multiple organs, including the pancreas. This mucus obstructs the pancreatic ducts, preventing digestive enzymes such as lipase, amylase, and protease from reaching the small intestine. Without these enzymes, fats, proteins, and carbohydrates are incompletely digested, causing nutrient malabsorption, fatty stools, and poor weight gain. PERT replaces the missing enzymes, allowing proper digestion and absorption of nutrients, improving growth, and reducing gastrointestinal symptoms. Regular dosing with meals and snacks is essential to optimize nutrient absorption and support normal growth and development in children with CF.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. EMLA cream (a eutectic mixture of local anesthetics) applied 30–60 minutes before a procedure under an occlusive dressing provides effective topical anesthesia, reducing pain at the venipuncture site. This is evidence-based practice for minimizing procedural pain in children and is particularly effective for needle insertions.
B. Administering a sugar solution (sucrose) is effective primarily for infants under 12 months and is most beneficial when given before or during painful procedures, not after. In a 5-year-old, it has minimal analgesic effect.
C. Applying a cold pack can provide some temporary numbing, but it is less effective than topical anesthetic creams for reducing pain during venipuncture. Additionally, short-duration cold application may not penetrate deep enough to anesthetize the vein adequately.
D. Distraction with toys can reduce anxiety and perceived pain but does not directly numb the insertion site. While helpful as a complementary measure, it is not as effective as topical anesthesia in reducing procedural pain.
Correct Answer is B
Explanation
A. Placenta previa typically presents with painless bleeding, not pain. Abdominal pain with bleeding is more suggestive of placental abruption, not previa.
B. Placenta previa is characterized by bright red, painless vaginal bleeding during the second or third trimester, often without uterine tenderness or contractions. The bleeding occurs because the placenta implants over or near the cervical os, which disrupts vascular integrity as the cervix begins to efface or dilate.
C. This presentation is more consistent with abruptio placentae, where the placenta separates prematurely, leading to painful bleeding and a firm, tender uterus.
D. This describes bloody show, which is a sign of labor onset, not placenta previa. It is associated with cervical effacement and dilation rather than abnormal placental implantation.
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