Burns’ Pediatric Primary Care (8th Ed.) — Complete Chapter-
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 23, Section: Developmental Management of
Early Childhood
Question Stem:
A 3-year-old child is brought to the clinic for a well-child visit.
The parent expresses concern that the child's speech is difficult
to understand. Which finding during your assessment would be
most consistent with a typical speech-milestone for this age?
Options:
A. The child uses pronouns (I, me, you) correctly.
B. The child's speech is 100% intelligible to strangers.
C. The child can correctly produce all vowel and consonant
,sounds.
D. The child's speech is 75% intelligible to familiar listeners.
Correct Answer: D
Rationales:
• Correct (D): By age 3, a child's speech is typically 75%
intelligible to familiar listeners. Complete intelligibility to
strangers is not expected until age 4.
• Incorrect (A): Correct use of pronouns is a language
milestone typically achieved by age 2-3, but it does not
address the parent's specific concern about speech
intelligibility.
• Incorrect (B): 100% intelligibility to strangers is a milestone
for a 4-year-old, not a 3-year-old.
• Incorrect (C): Mastery of all vowel and consonant sounds is
a gradual process that continues until age 7-8; this is not
expected of a 3-year-old.
Teaching Point: At age 3, speech is 75% intelligible to familiar
adults; 100% intelligibility occurs by age 4.
Question 2
Reference: Ch. 20, Section: Newborn Nutrition
Question Stem:
A breastfeeding mother of a 5-day-old infant calls the clinic
,concerned about the baby's frequent feeding and yellow, seedy
stools. The infant has regained birth weight and has 6-8 wet
diapers per day. The NP's best response is based on the
understanding that this pattern is:
Options:
A. indicative of potential foremilk/hindmilk imbalance and
requires block feeding.
B. a classic sign of effective breastfeeding and adequate milk
transfer.
C. suggestive of lactose overload and may require formula
supplementation.
D. a reason to assess the mother for mastitis and prescribe
antibiotics.
Correct Answer: B
Rationales:
• Correct (B): The described pattern—frequent feeding,
yellow seedy stools, adequate wet diapers, and regaining
birth weight by 10-14 days—is the hallmark of effective
breastfeeding and sufficient intake.
• Incorrect (A): Foremilk/hindmilk imbalance typically
presents with green, frothy, explosive stools and fussiness,
not the healthy pattern described.
• Incorrect (C): Lactose overload is not a standard diagnosis;
the stool pattern described is normal.
, • Incorrect (D): There are no signs of mastitis (e.g., breast
redness, fever, pain) in the scenario.
Teaching Point: Yellow, seedy stools with adequate output and
weight gain confirm successful breastfeeding.
Question 3
Reference: Ch. 45, Section: Otitis Media
Question Stem:
A 2-year-old child presents with a 48-hour history of rhinorrhea,
cough, and fussiness. Otoscopic examination reveals a bulging,
red, immobile tympanic membrane with obscured landmarks.
The child has no known drug allergies. What is the most
appropriate initial management?
Options:
A. Prescribe a 10-day course of amoxicillin at a standard dose.
B. Recommend ibuprofen and observe for 48-72 hours without
antibiotics.
C. Prescribe a 5-day course of amoxicillin-clavulanate.
D. Refer immediately to an otolaryngologist for tympanostomy
tubes.
Correct Answer: A
Rationales:
• Correct (A): This presentation meets diagnostic criteria for
acute otitis media (AOM): acute onset, middle ear
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 23, Section: Developmental Management of
Early Childhood
Question Stem:
A 3-year-old child is brought to the clinic for a well-child visit.
The parent expresses concern that the child's speech is difficult
to understand. Which finding during your assessment would be
most consistent with a typical speech-milestone for this age?
Options:
A. The child uses pronouns (I, me, you) correctly.
B. The child's speech is 100% intelligible to strangers.
C. The child can correctly produce all vowel and consonant
,sounds.
D. The child's speech is 75% intelligible to familiar listeners.
Correct Answer: D
Rationales:
• Correct (D): By age 3, a child's speech is typically 75%
intelligible to familiar listeners. Complete intelligibility to
strangers is not expected until age 4.
• Incorrect (A): Correct use of pronouns is a language
milestone typically achieved by age 2-3, but it does not
address the parent's specific concern about speech
intelligibility.
• Incorrect (B): 100% intelligibility to strangers is a milestone
for a 4-year-old, not a 3-year-old.
• Incorrect (C): Mastery of all vowel and consonant sounds is
a gradual process that continues until age 7-8; this is not
expected of a 3-year-old.
Teaching Point: At age 3, speech is 75% intelligible to familiar
adults; 100% intelligibility occurs by age 4.
Question 2
Reference: Ch. 20, Section: Newborn Nutrition
Question Stem:
A breastfeeding mother of a 5-day-old infant calls the clinic
,concerned about the baby's frequent feeding and yellow, seedy
stools. The infant has regained birth weight and has 6-8 wet
diapers per day. The NP's best response is based on the
understanding that this pattern is:
Options:
A. indicative of potential foremilk/hindmilk imbalance and
requires block feeding.
B. a classic sign of effective breastfeeding and adequate milk
transfer.
C. suggestive of lactose overload and may require formula
supplementation.
D. a reason to assess the mother for mastitis and prescribe
antibiotics.
Correct Answer: B
Rationales:
• Correct (B): The described pattern—frequent feeding,
yellow seedy stools, adequate wet diapers, and regaining
birth weight by 10-14 days—is the hallmark of effective
breastfeeding and sufficient intake.
• Incorrect (A): Foremilk/hindmilk imbalance typically
presents with green, frothy, explosive stools and fussiness,
not the healthy pattern described.
• Incorrect (C): Lactose overload is not a standard diagnosis;
the stool pattern described is normal.
, • Incorrect (D): There are no signs of mastitis (e.g., breast
redness, fever, pain) in the scenario.
Teaching Point: Yellow, seedy stools with adequate output and
weight gain confirm successful breastfeeding.
Question 3
Reference: Ch. 45, Section: Otitis Media
Question Stem:
A 2-year-old child presents with a 48-hour history of rhinorrhea,
cough, and fussiness. Otoscopic examination reveals a bulging,
red, immobile tympanic membrane with obscured landmarks.
The child has no known drug allergies. What is the most
appropriate initial management?
Options:
A. Prescribe a 10-day course of amoxicillin at a standard dose.
B. Recommend ibuprofen and observe for 48-72 hours without
antibiotics.
C. Prescribe a 5-day course of amoxicillin-clavulanate.
D. Refer immediately to an otolaryngologist for tympanostomy
tubes.
Correct Answer: A
Rationales:
• Correct (A): This presentation meets diagnostic criteria for
acute otitis media (AOM): acute onset, middle ear
