,Pediatric Primary Care, Primary Care Versus Primary
Prevention
Key concept: Primary prevention in pediatric primary care
(immunizations, anticipatory guidance)
Stem: A 15-month-old toddler presents for a well visit. The
caregiver asks which actions are primary prevention measures
to reduce future illness and injury. Which of the following is the
best example of primary prevention?
A. Scheduling lead-level testing because the child attends a
daycare in an old building.
B. Teaching car-seat installation and ensuring the family has an
age/size-appropriate restraint.
C. Starting inhaled corticosteroid after the third wheezing
episode.
D. Ordering an audiology referral for speech delay.
Correct answer: B
Rationale — correct: Teaching and ensuring correct car-seat use
prevents injury before it occurs and is classic primary prevention
taught in pediatric primary care (anticipatory guidance;
immunizations and safety counseling are primary prevention).
Burns: Chapter 1 — Pediatric Primary Care, Primary Prevention.
(Evolve)
Rationale — incorrect:
A. Lead testing is a screening (secondary prevention) to detect
exposure early; not directly an action that prevents exposure
itself.
,C. Initiating controller therapy for recurrent wheeze is disease
management (tertiary/secondary prevention), not primary
prevention.
D. Audiology referral is diagnostic/specialty evaluation
(secondary/tertiary action) rather than primary prevention.
Teaching point: Primary prevention stops harm before it occurs
(e.g., immunizations, safety counseling).
2
Chapter & Subtopic: Chapter 1 – Pediatric Primary Care,
Primary Care Versus Primary Prevention
Key concept: Scope of primary care — role of anticipatory
guidance and screening
Stem: A 4-year-old attends a well visit. The nurse-practitioner
documents anticipatory guidance. Which entry best reflects
anticipatory guidance rather than routine screening?
A. Record BMI percentile and screen for obesity risk factors.
B. Provide guidance on sleep routines and preschool separation
anxiety.
C. Perform vision screening with Lea symbols.
D. Order a lead level because of the child’s urban residence.
Correct answer: B
Rationale — correct: Anticipatory guidance focuses on teaching
caregivers about expected developmental behaviors (sleep
routines, separation anxiety) and prevention strategies — core
, primary care activity. Burns: Chapter 1 — Anticipatory guidance
and scope. (Evolve)
Rationale — incorrect:
A. BMI percentile and risk screening are screening/assessment
tasks.
C. Vision screening is a standardized screening test.
D. Lead level ordering is targeted screening based on risk — not
anticipatory counseling.
Teaching point: Anticipatory guidance educates families about
expected development and prevention.
3
Chapter & Subtopic: Chapter 1 – Pediatric Primary Care,
Unique Issues in Pediatrics
Key concept: Physiologic differences that alter assessment and
interventions
Stem: Compared with adults, which physiologic characteristic in
infants most affects medication dosing and fluid management?
A. Lower basal metabolic rate
B. Larger body surface area relative to mass
C. Decreased total body water
D. Increased gastric acid production
Correct answer: B
Prevention
Key concept: Primary prevention in pediatric primary care
(immunizations, anticipatory guidance)
Stem: A 15-month-old toddler presents for a well visit. The
caregiver asks which actions are primary prevention measures
to reduce future illness and injury. Which of the following is the
best example of primary prevention?
A. Scheduling lead-level testing because the child attends a
daycare in an old building.
B. Teaching car-seat installation and ensuring the family has an
age/size-appropriate restraint.
C. Starting inhaled corticosteroid after the third wheezing
episode.
D. Ordering an audiology referral for speech delay.
Correct answer: B
Rationale — correct: Teaching and ensuring correct car-seat use
prevents injury before it occurs and is classic primary prevention
taught in pediatric primary care (anticipatory guidance;
immunizations and safety counseling are primary prevention).
Burns: Chapter 1 — Pediatric Primary Care, Primary Prevention.
(Evolve)
Rationale — incorrect:
A. Lead testing is a screening (secondary prevention) to detect
exposure early; not directly an action that prevents exposure
itself.
,C. Initiating controller therapy for recurrent wheeze is disease
management (tertiary/secondary prevention), not primary
prevention.
D. Audiology referral is diagnostic/specialty evaluation
(secondary/tertiary action) rather than primary prevention.
Teaching point: Primary prevention stops harm before it occurs
(e.g., immunizations, safety counseling).
2
Chapter & Subtopic: Chapter 1 – Pediatric Primary Care,
Primary Care Versus Primary Prevention
Key concept: Scope of primary care — role of anticipatory
guidance and screening
Stem: A 4-year-old attends a well visit. The nurse-practitioner
documents anticipatory guidance. Which entry best reflects
anticipatory guidance rather than routine screening?
A. Record BMI percentile and screen for obesity risk factors.
B. Provide guidance on sleep routines and preschool separation
anxiety.
C. Perform vision screening with Lea symbols.
D. Order a lead level because of the child’s urban residence.
Correct answer: B
Rationale — correct: Anticipatory guidance focuses on teaching
caregivers about expected developmental behaviors (sleep
routines, separation anxiety) and prevention strategies — core
, primary care activity. Burns: Chapter 1 — Anticipatory guidance
and scope. (Evolve)
Rationale — incorrect:
A. BMI percentile and risk screening are screening/assessment
tasks.
C. Vision screening is a standardized screening test.
D. Lead level ordering is targeted screening based on risk — not
anticipatory counseling.
Teaching point: Anticipatory guidance educates families about
expected development and prevention.
3
Chapter & Subtopic: Chapter 1 – Pediatric Primary Care,
Unique Issues in Pediatrics
Key concept: Physiologic differences that alter assessment and
interventions
Stem: Compared with adults, which physiologic characteristic in
infants most affects medication dosing and fluid management?
A. Lower basal metabolic rate
B. Larger body surface area relative to mass
C. Decreased total body water
D. Increased gastric acid production
Correct answer: B
