Test Bank for Burns' Pediatric Primary Care 8th Edition by
Dawn Lee Garzon questions for academic year 2026
Comprehensive examination covering advanced pediatric primary care concepts, including developmental
surveillance, evidence-based screening, management of acute and chronic conditions, and integration of family-
centered care. Content aligns with the latest edition of Burns' Pediatric Primary Care and current national
guidelines. It contains 140 multiple-choice questions, each with four distractors and a fully worked rationale that
explains why the keyed answer is correct. Questions are organized into clearly labelled sections that mirror the
major content areas of the course. Targeted learning outcomes include: Critically analyze pediatric primary care
scenarios to formulate evidence-based management plans.; Integrate developmental, behavioral, and
psychosocial considerations into clinical decision-making.; Evaluate the effectiveness of screening tools and
interventions using current evidence.; Apply pharmacologic principles and safety considerations in pediatric
prescribing.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that students
can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
teaching notes. The recommended writing time is 3 hours, with a passing score of 80%. Aligned with Meets
standards of the American Nurses Credentialing Center and the National Organization of Nurse Practitioner
Faculties for graduate-level nursing education. standards and reflects the question style commonly seen on
Section 1: General (Questions 1-140)
1 In the context of the 2022 CDC developmental surveillance guidelines, which
combination of screening practices best aligns with recommendations for autism
spectrum disorder (ASD) and developmental delays?
A) General developmental screening at 9, 18, and 30 months; ASD-specific
screening at 18 and 24 months; additional screening whenever concerns arise.
B) ASD-specific screening at 9, 18, and 24 months; general developmental
screening only if concerns are present.
C) General developmental screening at every well-child visit; ASD-specific
screening only when a sibling has ASD.
D) ASD-specific screening at 12 and 18 months; general developmental
screening at 24 and 36 months.
Answer: A
Rationale: The 2022 AAP/CDC algorithm recommends developmental screening at
9 , 18, and 30 months, with ASD-specific screening at 18 and 24 months, and
additional screening whenever concerns are raised. Option B omits general
screening at 30 months and starts ASD too early; C omits routine ASD screening; D
misaligns timing.
,2 A previously healthy school-age child presents with acute-onset respiratory distress,
stridor, and a barking cough. Which finding most strongly indicates a need for
immediate airway intervention beyond standard management?
A) Mild intercostal retractions
B) Oxygen saturation of 94% on room air
C) Agitation and lethargy alternating
D) White blood cell count of 15,000/µL
Answer: C
Rationale: Agitation and lethargy alternating indicate impending respiratory failure
and the need for emergent airway management. Mild retractions and SpO2 94% may
be managed conservatively; leukocytosis is not an indicator for immediate
intubation.
3 Which physiological principle best explains why infants are more susceptible to the
respiratory depressant effects of opioids compared to older children?
A) Immature blood-brain barrier allows higher central nervous system opioid
concentrations.
B) Reduced hepatic glucuronidation capacity leads to prolonged drug half-life.
C) Increased proportion of body water alters opioid distribution volume.
D) Higher metabolic rate increases opioid receptor sensitivity.
Answer: A
Rationale: Infants have an immature blood-brain barrier, permitting greater CNS
penetration of opioids, enhancing depressant effects. While hepatic metabolism and
body water composition affect pharmacokinetics, the primary reason for heightened
CNS depression is the blood-brain barrier permeability.
4 A child presents with a history of recurrent fractures, blue sclera, and dental
imperfections. Which molecular defect is most likely responsible?
A) Defective osteoclast function leading to dense bones
B) Mutation in COL1A1 or COL1A2 genes encoding type I collagen
C) Impaired vitamin D receptor signaling causing rickets
D) Excess osteoprotegerin inhibiting bone resorption
Answer: B
,Rationale: The triad of fractures, blue sclera, and dental abnormalities is classic for
osteogenesis imperfecta, which results from mutations in type I collagen genes (
COL1A1/COL1A2). Defective osteoclasts cause osteopetrosis; vitamin D receptor issues
cause rickets; excess osteoprotegerin is not a recognized cause.
5 Which combination of findings is most consistent with a diagnosis of attention-
deficit/hyperactivity disorder (ADHD) per DSM-5 criteria?
A) Inattention symptoms present in two or more settings for at least 6 months,
with onset before age 12
B) Hyperactivity-impulsivity symptoms present for 3 months, with onset after
age 10
C) Inattention symptoms only during academic tasks, with no impairment in
social functioning
D) Oppositional behavior and defiance present since early childhood, with no
inattention
Answer: A
Rationale: DSM-5 requires inattention and/or hyperactivity-impulsivity symptoms
for 6 months, in multiple settings, with onset before age 12, and clear impairment.
Option B has too short a duration and late onset; C lacks pervasiveness and
impairment; D describes oppositional defiant disorder.
6 Which of the following represents the most significant change in the 2024 AAP clinical
practice guideline for the management of childhood obesity?
A) Recommendation of bariatric surgery as first-line therapy for all adolescents
with BMI 35
B) Emphasis on intensive health behavior and lifestyle treatment (IHBLT) with
26 contact hours
C) Use of BMI percentile alone to diagnose obesity without clinical assessment
D) Authorization of anti-obesity medications only after failure of lifestyle
interventions in all ages
Answer: B
Rationale: T h e 2 0 2 4 g u i d e l i n e e m p h a s i z e s I H B L T a s t h e f o u n
d contact hours, and adds pharmacotherapy for ages 12 when IHBLT is insufficient. Surgery
is reserved for severe obesity with comorbidities, not all adolescents. BMI is used but with
clinical evaluation; medications are not limited to ages 12 only.
, 7 A 4-year-old is brought in with a 3-day history of fever, rhinorrhea, and a rash that
started on the face and spread to the trunk. The rash is maculopapular, and the child
has a history of measles vaccination. Which test is most appropriate to confirm the
diagnosis?
A) Measles IgM antibody in serum
B) Viral culture from nasopharyngeal swab
C) Polymerase chain reaction (PCR) on throat swab and urine
D) IgG antibody titers drawn 2 weeks apart
Answer: C
Rationale: PCR is the preferred method for confirming measles, as IgM may be false-
negative in vaccinated individuals and viral culture is less sensitive. PCR from
respiratory specimens and urine is reliable. IgG titers are not diagnostic in acute
illness.
8 Which of the following best describes the role of the school nurse in the medical home
model for children with special health care needs?
A) Primary care provider who manages all medical conditions
B) Liaison who facilitates communication between the family, school, and healthcare
providers
C) Case manager who coordinates only educational services
D) Consultant who provides direct medical treatment during school hours
Answer: B
Rationale: The school nurse acts as a liaison, ensuring that health care plans are
integrated with educational plans and facilitating communication among all parties.
They do not replace the primary care provider or limit their role to educational
services.
9 In a child with suspected non-accidental trauma, which finding is most indicative of
abusive head trauma (AHT) rather than accidental injury?
A) Subdural hemorrhage without a history of significant trauma
B) Linear skull fracture from a fall
C) Epidural hematoma due to a motor vehicle accident
D) Simple scalp hematoma with a clear mechanism
Answer: A
Dawn Lee Garzon questions for academic year 2026
Comprehensive examination covering advanced pediatric primary care concepts, including developmental
surveillance, evidence-based screening, management of acute and chronic conditions, and integration of family-
centered care. Content aligns with the latest edition of Burns' Pediatric Primary Care and current national
guidelines. It contains 140 multiple-choice questions, each with four distractors and a fully worked rationale that
explains why the keyed answer is correct. Questions are organized into clearly labelled sections that mirror the
major content areas of the course. Targeted learning outcomes include: Critically analyze pediatric primary care
scenarios to formulate evidence-based management plans.; Integrate developmental, behavioral, and
psychosocial considerations into clinical decision-making.; Evaluate the effectiveness of screening tools and
interventions using current evidence.; Apply pharmacologic principles and safety considerations in pediatric
prescribing.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that students
can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
teaching notes. The recommended writing time is 3 hours, with a passing score of 80%. Aligned with Meets
standards of the American Nurses Credentialing Center and the National Organization of Nurse Practitioner
Faculties for graduate-level nursing education. standards and reflects the question style commonly seen on
Section 1: General (Questions 1-140)
1 In the context of the 2022 CDC developmental surveillance guidelines, which
combination of screening practices best aligns with recommendations for autism
spectrum disorder (ASD) and developmental delays?
A) General developmental screening at 9, 18, and 30 months; ASD-specific
screening at 18 and 24 months; additional screening whenever concerns arise.
B) ASD-specific screening at 9, 18, and 24 months; general developmental
screening only if concerns are present.
C) General developmental screening at every well-child visit; ASD-specific
screening only when a sibling has ASD.
D) ASD-specific screening at 12 and 18 months; general developmental
screening at 24 and 36 months.
Answer: A
Rationale: The 2022 AAP/CDC algorithm recommends developmental screening at
9 , 18, and 30 months, with ASD-specific screening at 18 and 24 months, and
additional screening whenever concerns are raised. Option B omits general
screening at 30 months and starts ASD too early; C omits routine ASD screening; D
misaligns timing.
,2 A previously healthy school-age child presents with acute-onset respiratory distress,
stridor, and a barking cough. Which finding most strongly indicates a need for
immediate airway intervention beyond standard management?
A) Mild intercostal retractions
B) Oxygen saturation of 94% on room air
C) Agitation and lethargy alternating
D) White blood cell count of 15,000/µL
Answer: C
Rationale: Agitation and lethargy alternating indicate impending respiratory failure
and the need for emergent airway management. Mild retractions and SpO2 94% may
be managed conservatively; leukocytosis is not an indicator for immediate
intubation.
3 Which physiological principle best explains why infants are more susceptible to the
respiratory depressant effects of opioids compared to older children?
A) Immature blood-brain barrier allows higher central nervous system opioid
concentrations.
B) Reduced hepatic glucuronidation capacity leads to prolonged drug half-life.
C) Increased proportion of body water alters opioid distribution volume.
D) Higher metabolic rate increases opioid receptor sensitivity.
Answer: A
Rationale: Infants have an immature blood-brain barrier, permitting greater CNS
penetration of opioids, enhancing depressant effects. While hepatic metabolism and
body water composition affect pharmacokinetics, the primary reason for heightened
CNS depression is the blood-brain barrier permeability.
4 A child presents with a history of recurrent fractures, blue sclera, and dental
imperfections. Which molecular defect is most likely responsible?
A) Defective osteoclast function leading to dense bones
B) Mutation in COL1A1 or COL1A2 genes encoding type I collagen
C) Impaired vitamin D receptor signaling causing rickets
D) Excess osteoprotegerin inhibiting bone resorption
Answer: B
,Rationale: The triad of fractures, blue sclera, and dental abnormalities is classic for
osteogenesis imperfecta, which results from mutations in type I collagen genes (
COL1A1/COL1A2). Defective osteoclasts cause osteopetrosis; vitamin D receptor issues
cause rickets; excess osteoprotegerin is not a recognized cause.
5 Which combination of findings is most consistent with a diagnosis of attention-
deficit/hyperactivity disorder (ADHD) per DSM-5 criteria?
A) Inattention symptoms present in two or more settings for at least 6 months,
with onset before age 12
B) Hyperactivity-impulsivity symptoms present for 3 months, with onset after
age 10
C) Inattention symptoms only during academic tasks, with no impairment in
social functioning
D) Oppositional behavior and defiance present since early childhood, with no
inattention
Answer: A
Rationale: DSM-5 requires inattention and/or hyperactivity-impulsivity symptoms
for 6 months, in multiple settings, with onset before age 12, and clear impairment.
Option B has too short a duration and late onset; C lacks pervasiveness and
impairment; D describes oppositional defiant disorder.
6 Which of the following represents the most significant change in the 2024 AAP clinical
practice guideline for the management of childhood obesity?
A) Recommendation of bariatric surgery as first-line therapy for all adolescents
with BMI 35
B) Emphasis on intensive health behavior and lifestyle treatment (IHBLT) with
26 contact hours
C) Use of BMI percentile alone to diagnose obesity without clinical assessment
D) Authorization of anti-obesity medications only after failure of lifestyle
interventions in all ages
Answer: B
Rationale: T h e 2 0 2 4 g u i d e l i n e e m p h a s i z e s I H B L T a s t h e f o u n
d contact hours, and adds pharmacotherapy for ages 12 when IHBLT is insufficient. Surgery
is reserved for severe obesity with comorbidities, not all adolescents. BMI is used but with
clinical evaluation; medications are not limited to ages 12 only.
, 7 A 4-year-old is brought in with a 3-day history of fever, rhinorrhea, and a rash that
started on the face and spread to the trunk. The rash is maculopapular, and the child
has a history of measles vaccination. Which test is most appropriate to confirm the
diagnosis?
A) Measles IgM antibody in serum
B) Viral culture from nasopharyngeal swab
C) Polymerase chain reaction (PCR) on throat swab and urine
D) IgG antibody titers drawn 2 weeks apart
Answer: C
Rationale: PCR is the preferred method for confirming measles, as IgM may be false-
negative in vaccinated individuals and viral culture is less sensitive. PCR from
respiratory specimens and urine is reliable. IgG titers are not diagnostic in acute
illness.
8 Which of the following best describes the role of the school nurse in the medical home
model for children with special health care needs?
A) Primary care provider who manages all medical conditions
B) Liaison who facilitates communication between the family, school, and healthcare
providers
C) Case manager who coordinates only educational services
D) Consultant who provides direct medical treatment during school hours
Answer: B
Rationale: The school nurse acts as a liaison, ensuring that health care plans are
integrated with educational plans and facilitating communication among all parties.
They do not replace the primary care provider or limit their role to educational
services.
9 In a child with suspected non-accidental trauma, which finding is most indicative of
abusive head trauma (AHT) rather than accidental injury?
A) Subdural hemorrhage without a history of significant trauma
B) Linear skull fracture from a fall
C) Epidural hematoma due to a motor vehicle accident
D) Simple scalp hematoma with a clear mechanism
Answer: A
