Burns Pediatric Primary Care Study Guide PDF |
Pediatric Burn Assessment & Management
Notes | Thermal, Chemical & Electrical Burns
in Children | Fluid Resuscitation, Wound Care,
Pain Management & Emergency Nursing Exam
Prep Bundle
Question 1: Which developmental milestone is typically achieved by a 6-month-old infant according to
standard pediatric developmental sequences?
A. Walking independently
B. Pincer grasp with thumb and forefinger
C. Rolling from back to front
D. Saying two-word phrases
CORRECT ANSWER: C. Rolling from back to front
RATIONALE: By 6 months of age, most infants can roll from back to front and front to back. Walking
independently typically occurs around 12-15 months, pincer grasp develops around 9-12 months, and
two-word phrases emerge around 18-24 months.
Question 2: A pediatric nurse practitioner is conducting a well-child visit for a 2-week-old newborn.
Which finding requires immediate referral for further evaluation?
A. Mild jaundice limited to the face
B. Weight loss of 8% from birth weight
C. Absent red reflex in one eye
D. Umbilical cord still attached
CORRECT ANSWER: C. Absent red reflex in one eye
RATIONALE: An absent red reflex may indicate serious ocular pathology such as congenital cataract,
retinoblastoma, or retinal detachment, requiring urgent ophthalmologic evaluation. Mild facial jaundice,
8% weight loss, and an attached umbilical cord at 2 weeks are within normal variations.
Question 3: According to the Bright Futures guidelines, at what age should developmental screening
using a validated tool first be performed?
A. At birth
B. At 2 months
C. At 9 months
D. At 24 months
CORRECT ANSWER: C. At 9 months
,RATIONALE: Bright Futures and the American Academy of Pediatrics recommend standardized
developmental screening at 9, 18, and 30 months, with autism-specific screening at 18 and 24 months.
Screening at 9 months allows early identification of delays when interventions are most effective.
Question 4: Which vaccine is contraindicated in a child with a history of severe allergic reaction to
neomycin?
A. Hepatitis B vaccine
B. MMR vaccine
C. DTaP vaccine
D. PCV13 vaccine
CORRECT ANSWER: B. MMR vaccine
RATIONALE: The MMR vaccine contains trace amounts of neomycin and is contraindicated in children
with anaphylactic reactions to this antibiotic. Hepatitis B, DTaP, and PCV13 vaccines do not contain
neomycin and can be administered safely.
Question 5: A 4-year-old child presents with a barking cough, stridor, and low-grade fever. Which
diagnosis is MOST likely?
A. Epiglottitis
B. Croup (laryngotracheobronchitis)
C. Bacterial pneumonia
D. Foreign body aspiration
CORRECT ANSWER: B. Croup (laryngotracheobronchitis)
RATIONALE: Croup typically presents with a barking cough, inspiratory stridor, hoarseness, and low-
grade fever, often following a viral upper respiratory infection. Epiglottitis presents with high fever,
drooling, and tripod positioning; pneumonia with focal findings; and foreign body aspiration with
sudden onset without prodrome.
Question 6: Which feeding recommendation is appropriate for a healthy term infant at 4 months of
age?
A. Introduction of iron-fortified rice cereal
B. Exclusive breastfeeding or formula feeding
C. Introduction of pureed fruits and vegetables
D. Transition to whole cow's milk
CORRECT ANSWER: B. Exclusive breastfeeding or formula feeding
RATIONALE: The AAP recommends exclusive breastfeeding or formula feeding for the first 6 months.
Solid foods, including iron-fortified cereals, are typically introduced around 6 months when infants show
developmental readiness. Whole cow's milk should not be introduced before 12 months.
Question 7: A 15-month-old child has not yet begun walking independently. The parent is concerned
about developmental delay. What is the MOST appropriate initial response by the pediatric provider?
,A. Refer immediately to pediatric neurology
B. Reassure that this is within normal variation and continue monitoring
C. Order brain MRI to rule out structural abnormalities
D. Diagnose cerebral palsy and initiate physical therapy
CORRECT ANSWER: B. Reassure that this is within normal variation and continue monitoring
RATIONALE: Independent walking typically occurs between 9-15 months, with some normal variation
up to 18 months. At 15 months without other concerning findings, reassurance and continued
monitoring with developmental surveillance is appropriate. Referral is warranted if walking has not
occurred by 18 months or if other red flags are present.
Question 8: Which finding during a newborn physical examination is considered a normal variant?
A. Asymmetric Moro reflex
B. Mongolian spots on the lower back
C. Persistent tonic neck reflex beyond 6 months
D. Absent plantar grasp reflex
CORRECT ANSWER: B. Mongolian spots on the lower back
RATIONALE: Mongolian spots are benign, bluish-gray pigmented areas commonly found on the lower
back or buttocks of infants with darker skin tones. They typically fade over time and require no
intervention. Asymmetric reflexes, persistent primitive reflexes, or absent reflexes may indicate
neurological concerns.
Question 9: A 7-year-old child presents with recurrent abdominal pain, no red flag symptoms, and
normal physical examination. Which management approach is MOST appropriate?
A. Immediate referral to pediatric gastroenterology
B. Order abdominal ultrasound and complete blood count
C. Provide reassurance, maintain normal activities, and schedule follow-up
D. Prescribe proton pump inhibitor therapy
CORRECT ANSWER: C. Provide reassurance, maintain normal activities, and schedule follow-up
RATIONALE: Recurrent abdominal pain without red flags (weight loss, fever, blood in stool, localized
pain) is often functional. Initial management includes reassurance, maintaining normal routines, and
monitoring for evolving symptoms. Extensive testing or specialist referral is not indicated without
concerning features.
Question 10: Which statement by a parent indicates understanding of safe sleep practices for a 3-
month-old infant?
A. "I place my baby on their side to sleep to prevent choking."
B. "I use a soft mattress with bumper pads in the crib."
C. "I place my baby on their back on a firm sleep surface with no loose bedding."
D. "I co-sleep with my baby to facilitate breastfeeding."
CORRECT ANSWER: C. "I place my baby on their back on a firm sleep surface with no loose bedding."
, RATIONALE: The AAP recommends placing infants on their back on a firm sleep surface without soft
bedding, bumper pads, or toys to reduce SIDS risk. Side sleeping is unstable and not recommended. Co-
sleeping increases SIDS risk, though room-sharing without bed-sharing is encouraged.
Question 11: A 2-year-old child presents with a 2-day history of fever, irritability, and pulling at the
right ear. Otoscopic examination reveals a bulging, erythematous tympanic membrane with
decreased mobility. What is the MOST appropriate initial management?
A. Immediate tympanostomy tube placement
B. Observation with analgesics for 48-72 hours
C. High-dose amoxicillin therapy
D. Referral to otolaryngology for myringotomy
CORRECT ANSWER: C. High-dose amoxicillin therapy
RATIONALE: This presentation is consistent with acute otitis media. For children 6-23 months with
bilateral AOM or severe symptoms (fever ≥39°C, severe otalgia), immediate antibiotic therapy with high-
dose amoxicillin is recommended. Observation may be considered for older children with mild,
unilateral symptoms.
Question 12: Which screening test is recommended annually for all adolescents beginning at age 12
according to Bright Futures guidelines?
A. Lipid panel
B. Depression screening
C. Tuberculosis skin test
D. Urinalysis
CORRECT ANSWER: B. Depression screening
RATIONALE: The USPSTF and AAP recommend annual depression screening for adolescents aged 12-18
years using validated tools. Lipid screening is recommended once between ages 9-11 and again between
17-21. TB testing and urinalysis are not universally recommended annually.
Question 13: A 5-year-old child presents with a pruritic, erythematous, scaly rash in the antecubital
and popliteal fossae. The child has a family history of asthma. Which diagnosis is MOST likely?
A. Contact dermatitis
B. Atopic dermatitis
C. Tinea corporis
D. Psoriasis
CORRECT ANSWER: B. Atopic dermatitis
RATIONALE: Atopic dermatitis commonly presents in flexural areas (antecubital, popliteal fossae) with
pruritus, erythema, and scaling. The personal or family history of atopic conditions (asthma, allergic
rhinitis) supports this diagnosis. Contact dermatitis typically has a more localized distribution related to
exposure.
Question 14: Which immunization is recommended for all infants at birth?
Pediatric Burn Assessment & Management
Notes | Thermal, Chemical & Electrical Burns
in Children | Fluid Resuscitation, Wound Care,
Pain Management & Emergency Nursing Exam
Prep Bundle
Question 1: Which developmental milestone is typically achieved by a 6-month-old infant according to
standard pediatric developmental sequences?
A. Walking independently
B. Pincer grasp with thumb and forefinger
C. Rolling from back to front
D. Saying two-word phrases
CORRECT ANSWER: C. Rolling from back to front
RATIONALE: By 6 months of age, most infants can roll from back to front and front to back. Walking
independently typically occurs around 12-15 months, pincer grasp develops around 9-12 months, and
two-word phrases emerge around 18-24 months.
Question 2: A pediatric nurse practitioner is conducting a well-child visit for a 2-week-old newborn.
Which finding requires immediate referral for further evaluation?
A. Mild jaundice limited to the face
B. Weight loss of 8% from birth weight
C. Absent red reflex in one eye
D. Umbilical cord still attached
CORRECT ANSWER: C. Absent red reflex in one eye
RATIONALE: An absent red reflex may indicate serious ocular pathology such as congenital cataract,
retinoblastoma, or retinal detachment, requiring urgent ophthalmologic evaluation. Mild facial jaundice,
8% weight loss, and an attached umbilical cord at 2 weeks are within normal variations.
Question 3: According to the Bright Futures guidelines, at what age should developmental screening
using a validated tool first be performed?
A. At birth
B. At 2 months
C. At 9 months
D. At 24 months
CORRECT ANSWER: C. At 9 months
,RATIONALE: Bright Futures and the American Academy of Pediatrics recommend standardized
developmental screening at 9, 18, and 30 months, with autism-specific screening at 18 and 24 months.
Screening at 9 months allows early identification of delays when interventions are most effective.
Question 4: Which vaccine is contraindicated in a child with a history of severe allergic reaction to
neomycin?
A. Hepatitis B vaccine
B. MMR vaccine
C. DTaP vaccine
D. PCV13 vaccine
CORRECT ANSWER: B. MMR vaccine
RATIONALE: The MMR vaccine contains trace amounts of neomycin and is contraindicated in children
with anaphylactic reactions to this antibiotic. Hepatitis B, DTaP, and PCV13 vaccines do not contain
neomycin and can be administered safely.
Question 5: A 4-year-old child presents with a barking cough, stridor, and low-grade fever. Which
diagnosis is MOST likely?
A. Epiglottitis
B. Croup (laryngotracheobronchitis)
C. Bacterial pneumonia
D. Foreign body aspiration
CORRECT ANSWER: B. Croup (laryngotracheobronchitis)
RATIONALE: Croup typically presents with a barking cough, inspiratory stridor, hoarseness, and low-
grade fever, often following a viral upper respiratory infection. Epiglottitis presents with high fever,
drooling, and tripod positioning; pneumonia with focal findings; and foreign body aspiration with
sudden onset without prodrome.
Question 6: Which feeding recommendation is appropriate for a healthy term infant at 4 months of
age?
A. Introduction of iron-fortified rice cereal
B. Exclusive breastfeeding or formula feeding
C. Introduction of pureed fruits and vegetables
D. Transition to whole cow's milk
CORRECT ANSWER: B. Exclusive breastfeeding or formula feeding
RATIONALE: The AAP recommends exclusive breastfeeding or formula feeding for the first 6 months.
Solid foods, including iron-fortified cereals, are typically introduced around 6 months when infants show
developmental readiness. Whole cow's milk should not be introduced before 12 months.
Question 7: A 15-month-old child has not yet begun walking independently. The parent is concerned
about developmental delay. What is the MOST appropriate initial response by the pediatric provider?
,A. Refer immediately to pediatric neurology
B. Reassure that this is within normal variation and continue monitoring
C. Order brain MRI to rule out structural abnormalities
D. Diagnose cerebral palsy and initiate physical therapy
CORRECT ANSWER: B. Reassure that this is within normal variation and continue monitoring
RATIONALE: Independent walking typically occurs between 9-15 months, with some normal variation
up to 18 months. At 15 months without other concerning findings, reassurance and continued
monitoring with developmental surveillance is appropriate. Referral is warranted if walking has not
occurred by 18 months or if other red flags are present.
Question 8: Which finding during a newborn physical examination is considered a normal variant?
A. Asymmetric Moro reflex
B. Mongolian spots on the lower back
C. Persistent tonic neck reflex beyond 6 months
D. Absent plantar grasp reflex
CORRECT ANSWER: B. Mongolian spots on the lower back
RATIONALE: Mongolian spots are benign, bluish-gray pigmented areas commonly found on the lower
back or buttocks of infants with darker skin tones. They typically fade over time and require no
intervention. Asymmetric reflexes, persistent primitive reflexes, or absent reflexes may indicate
neurological concerns.
Question 9: A 7-year-old child presents with recurrent abdominal pain, no red flag symptoms, and
normal physical examination. Which management approach is MOST appropriate?
A. Immediate referral to pediatric gastroenterology
B. Order abdominal ultrasound and complete blood count
C. Provide reassurance, maintain normal activities, and schedule follow-up
D. Prescribe proton pump inhibitor therapy
CORRECT ANSWER: C. Provide reassurance, maintain normal activities, and schedule follow-up
RATIONALE: Recurrent abdominal pain without red flags (weight loss, fever, blood in stool, localized
pain) is often functional. Initial management includes reassurance, maintaining normal routines, and
monitoring for evolving symptoms. Extensive testing or specialist referral is not indicated without
concerning features.
Question 10: Which statement by a parent indicates understanding of safe sleep practices for a 3-
month-old infant?
A. "I place my baby on their side to sleep to prevent choking."
B. "I use a soft mattress with bumper pads in the crib."
C. "I place my baby on their back on a firm sleep surface with no loose bedding."
D. "I co-sleep with my baby to facilitate breastfeeding."
CORRECT ANSWER: C. "I place my baby on their back on a firm sleep surface with no loose bedding."
, RATIONALE: The AAP recommends placing infants on their back on a firm sleep surface without soft
bedding, bumper pads, or toys to reduce SIDS risk. Side sleeping is unstable and not recommended. Co-
sleeping increases SIDS risk, though room-sharing without bed-sharing is encouraged.
Question 11: A 2-year-old child presents with a 2-day history of fever, irritability, and pulling at the
right ear. Otoscopic examination reveals a bulging, erythematous tympanic membrane with
decreased mobility. What is the MOST appropriate initial management?
A. Immediate tympanostomy tube placement
B. Observation with analgesics for 48-72 hours
C. High-dose amoxicillin therapy
D. Referral to otolaryngology for myringotomy
CORRECT ANSWER: C. High-dose amoxicillin therapy
RATIONALE: This presentation is consistent with acute otitis media. For children 6-23 months with
bilateral AOM or severe symptoms (fever ≥39°C, severe otalgia), immediate antibiotic therapy with high-
dose amoxicillin is recommended. Observation may be considered for older children with mild,
unilateral symptoms.
Question 12: Which screening test is recommended annually for all adolescents beginning at age 12
according to Bright Futures guidelines?
A. Lipid panel
B. Depression screening
C. Tuberculosis skin test
D. Urinalysis
CORRECT ANSWER: B. Depression screening
RATIONALE: The USPSTF and AAP recommend annual depression screening for adolescents aged 12-18
years using validated tools. Lipid screening is recommended once between ages 9-11 and again between
17-21. TB testing and urinalysis are not universally recommended annually.
Question 13: A 5-year-old child presents with a pruritic, erythematous, scaly rash in the antecubital
and popliteal fossae. The child has a family history of asthma. Which diagnosis is MOST likely?
A. Contact dermatitis
B. Atopic dermatitis
C. Tinea corporis
D. Psoriasis
CORRECT ANSWER: B. Atopic dermatitis
RATIONALE: Atopic dermatitis commonly presents in flexural areas (antecubital, popliteal fossae) with
pruritus, erythema, and scaling. The personal or family history of atopic conditions (asthma, allergic
rhinitis) supports this diagnosis. Contact dermatitis typically has a more localized distribution related to
exposure.
Question 14: Which immunization is recommended for all infants at birth?
