Burns’ Pediatric Primary Care (8th Ed.) — Complete Chapter-
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 8, Section: Developmental Management
Question Stem:
A 4-year-old child is brought to the clinic for a well-child visit.
The parent is concerned because the child often stutters,
repeating whole words and initial syllables. The child becomes
frustrated when trying to tell a story. What is the most
appropriate initial action by the primary care provider?
Options:
A. Refer the child immediately to a pediatric neurologist for
evaluation.
B. Explain that this is typical dysfluency for this age and advise
the parent to model slow, relaxed speech.
C. Prescribe a speech-language pathology evaluation to assess
for a true fluency disorder.
D. Instruct the parent to correct the child's speech immediately
each time the stuttering occurs.
Correct Answer: B
Rationales:
, • Correct (B): During the preschool years, language explodes
and cognitive processes often outpace motor skills, leading
to normal dysfluency. This includes repetitions of whole
words, phrases, and initial syllables. Management involves
reassuring parents and advising them to avoid drawing
attention to the dysfluency, maintain natural eye contact,
and model a slow, unhurried speech rate.
• Incorrect (A): Immediate referral to a neurologist is not
indicated without red flags (e.g., associated neurological
signs, a sudden onset following a traumatic event). Typical
developmental dysfluency does not warrant a neurological
workup.
• Incorrect (C): While a speech evaluation may be needed if
dysfluencies persist or worsen, it is not the initial action for
typical developmental patterns. The provider should first
provide anticipatory guidance and monitor.
• Incorrect (D): Correcting the child can increase anxiety and
focus on the speech, potentially exacerbating the
dysfluency and damaging the child's self-esteem.
Teaching Point: Typical preschool dysfluency is managed with
parent education and a supportive, non-critical environment.
Question 2
Reference: Ch. 23, Section: Asthma
,Question Stem:
A 7-year-old with persistent asthma is being re-evaluated. They
use a low-dose inhaled corticosteroid (ICS) daily but still require
their albuterol inhaler 3-4 times per week for symptoms.
According to the stepwise approach to management, what is
the most appropriate next step?
Options:
A. Discontinue the ICS and initiate a leukotriene receptor
antagonist (LTRA).
B. Increase the dose of the current inhaled corticosteroid to a
medium-dose range.
C. Continue the current ICS dose and add a scheduled daily
long-acting beta2-agonist (LABA).
D. Refer the patient to a pulmonologist for consideration of
biologic therapy.
Correct Answer: B
Rationales:
• Correct (B): The stepwise approach for managing
persistent asthma in children dictates that if control is not
achieved on a low-dose ICS, the preferred step-up is to a
medium-dose ICS. This patient's ongoing need for a SABA
3-4 times/week indicates inadequate control.
• Incorrect (A): Discontinuing the controller medication (ICS)
would likely worsen control. An LTRA is an alternative, not
, a superior, controller and is not the recommended step-up
from a low-dose ICS.
• Incorrect (C): Adding a LABA is an option, but in children,
increasing the ICS dose is often the preferred first step
before adding combination therapy, especially at this age.
• Incorrect (D): Referral for biologics is reserved for severe,
persistent asthma that is uncontrolled on high-dose ICS
plus a second controller, such as a LABA.
Teaching Point: For uncontrolled persistent asthma on low-dose
ICS, the first step is often increasing to a medium-dose ICS.
Question 3
Reference: Ch. 10, Section: Injury Prevention and Health
Promotion
Question Stem:
During a 6-month well-child visit, the primary care provider
discusses age-appropriate safety. Which parental statement
requires immediate correction and further education?
Options:
A. "We just moved her to a convertible car seat, but it's still
rear-facing."
B. "We started giving her small pieces of soft, cooked vegetables
to feed herself."
C. "We have not yet lowered the mattress in her crib, as she
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 8, Section: Developmental Management
Question Stem:
A 4-year-old child is brought to the clinic for a well-child visit.
The parent is concerned because the child often stutters,
repeating whole words and initial syllables. The child becomes
frustrated when trying to tell a story. What is the most
appropriate initial action by the primary care provider?
Options:
A. Refer the child immediately to a pediatric neurologist for
evaluation.
B. Explain that this is typical dysfluency for this age and advise
the parent to model slow, relaxed speech.
C. Prescribe a speech-language pathology evaluation to assess
for a true fluency disorder.
D. Instruct the parent to correct the child's speech immediately
each time the stuttering occurs.
Correct Answer: B
Rationales:
, • Correct (B): During the preschool years, language explodes
and cognitive processes often outpace motor skills, leading
to normal dysfluency. This includes repetitions of whole
words, phrases, and initial syllables. Management involves
reassuring parents and advising them to avoid drawing
attention to the dysfluency, maintain natural eye contact,
and model a slow, unhurried speech rate.
• Incorrect (A): Immediate referral to a neurologist is not
indicated without red flags (e.g., associated neurological
signs, a sudden onset following a traumatic event). Typical
developmental dysfluency does not warrant a neurological
workup.
• Incorrect (C): While a speech evaluation may be needed if
dysfluencies persist or worsen, it is not the initial action for
typical developmental patterns. The provider should first
provide anticipatory guidance and monitor.
• Incorrect (D): Correcting the child can increase anxiety and
focus on the speech, potentially exacerbating the
dysfluency and damaging the child's self-esteem.
Teaching Point: Typical preschool dysfluency is managed with
parent education and a supportive, non-critical environment.
Question 2
Reference: Ch. 23, Section: Asthma
,Question Stem:
A 7-year-old with persistent asthma is being re-evaluated. They
use a low-dose inhaled corticosteroid (ICS) daily but still require
their albuterol inhaler 3-4 times per week for symptoms.
According to the stepwise approach to management, what is
the most appropriate next step?
Options:
A. Discontinue the ICS and initiate a leukotriene receptor
antagonist (LTRA).
B. Increase the dose of the current inhaled corticosteroid to a
medium-dose range.
C. Continue the current ICS dose and add a scheduled daily
long-acting beta2-agonist (LABA).
D. Refer the patient to a pulmonologist for consideration of
biologic therapy.
Correct Answer: B
Rationales:
• Correct (B): The stepwise approach for managing
persistent asthma in children dictates that if control is not
achieved on a low-dose ICS, the preferred step-up is to a
medium-dose ICS. This patient's ongoing need for a SABA
3-4 times/week indicates inadequate control.
• Incorrect (A): Discontinuing the controller medication (ICS)
would likely worsen control. An LTRA is an alternative, not
, a superior, controller and is not the recommended step-up
from a low-dose ICS.
• Incorrect (C): Adding a LABA is an option, but in children,
increasing the ICS dose is often the preferred first step
before adding combination therapy, especially at this age.
• Incorrect (D): Referral for biologics is reserved for severe,
persistent asthma that is uncontrolled on high-dose ICS
plus a second controller, such as a LABA.
Teaching Point: For uncontrolled persistent asthma on low-dose
ICS, the first step is often increasing to a medium-dose ICS.
Question 3
Reference: Ch. 10, Section: Injury Prevention and Health
Promotion
Question Stem:
During a 6-month well-child visit, the primary care provider
discusses age-appropriate safety. Which parental statement
requires immediate correction and further education?
Options:
A. "We just moved her to a convertible car seat, but it's still
rear-facing."
B. "We started giving her small pieces of soft, cooked vegetables
to feed herself."
C. "We have not yet lowered the mattress in her crib, as she
