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 D
Explanation
A. This scale requires the child to understand numbers and quantify pain. A 5-year-old who has difficulty with numbers cannot reliably use this scale, making it inappropriate.
B. While FLACC is excellent for observational assessment of nonverbal or pre-verbal children, it does not allow the child to self-report pain. Since the nurse wants the child to self-report, this is not the best choice.
C. This scale requires the child to mark a point on a line representing their pain intensity. It also requires abstract thinking and fine motor skills, which may be challenging for a 5-year-old, especially if they can’t reliably understand numbers or gradients.
D. The Oucher scale uses pictures of faces showing increasing pain intensity along with a numeric scale. For children who understand pictures but struggle with numbers, this scale allows them to self-report pain by pointing to the face that matches their discomfort. It is validated for children aged 3–12 years, making it the most appropriate choice for a 5-year-old who can use pictorial cues.
Correct Answer is A
Explanation
A. Infant motor development follows a proximal-to-distal pattern, meaning control develops from the center of the body outward. At 7 months, infants first gain control of shoulders and arms, allowing them to reach with the whole hand. Later, fine motor skills like the pincer grasp (using thumb and forefinger) develop around 9–12 months, enabling the child to pick up small objects. This progression is typical and expected.
B. At 7 months, infants are still developing bilateral coordination. It is normal for a baby to favor one hand or alternate hands inconsistently. Expecting equal use of both hands at this stage reflects a misunderstanding of normal motor development.
C. Fine motor skills, such as using the thumb and forefinger to grasp small objects, emerge later. Reaching with the whole hand at 7 months is part of normal development. Labeling it as delayed is incorrect and may cause unnecessary concern.
D. The infant is following the typical developmental sequence, progressing from gross motor to fine motor control. Reaching with one hand before using the pincer grasp does not indicate skipped milestones. Developmental milestones are achieved in a predictable order, and this behavior is within normal limits.
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