Burns’ Pediatric Primary Care (8th Ed.) — Complete Chapter-
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 27, Section: Infant Sleep and Sleep Safety
Question Stem:
A 3-month-old infant is brought to the clinic for a well-child
visit. The parent mentions they have started placing the infant
to sleep on their side propped with a rolled blanket because the
infant spits up frequently. What is the most appropriate safety
advice based on current evidence?
Options:
A. "This is acceptable as long as the infant is closely monitored
during sleep."
B. "Side sleeping is a safe alternative if the infant has
gastroesophageal reflux."
C. "You should always place your infant on their back for every
sleep on a firm, flat surface without soft bedding."
,D. "Try using a wedge positioner instead of a rolled blanket to
keep the infant secure."
Correct Answer: C
Rationales:
• Correct (C): The American Academy of Pediatrics (AAP) and
textbook guidelines recommend supine (back) sleep for
every sleep until 1 year of age on a firm, flat surface
without soft bedding, pillows, or positioners. This is the
single most effective practice to reduce the risk of SIDS,
and it is recommended even for infants with reflux.
• Incorrect (A): Close monitoring does not mitigate the
physical risks of an unsafe sleep environment. SIDS can
occur during unobserved sleep.
• Incorrect (B): Side sleeping is an unstable position and is
not recommended. The back sleep position is not
associated with an increased risk of aspiration, even in
infants with reflux.
• Incorrect (D): Commercial wedge positioners and other
aftermarket devices are not recommended and pose a
suffocation hazard.
Teaching Point: Back to sleep, alone, on a firm, flat surface is
the non-negotiable standard for infant sleep safety.
Question 2
,Reference: Ch. 24, Section: Developmental Surveillance and
Screening
Question Stem:
During a 9-month well-child visit, the pediatric nurse
practitioner (PNP) observes that the infant does not sit without
support, has a persistent tonic neck reflex, and uses a raking
grasp. Based on developmental surveillance, what is the PNP's
most appropriate next step?
Options:
A. Reassure the parent that children develop at their own pace
and recheck at the 12-month visit.
B. Provide handouts on activities to promote sitting and fine
motor skills.
C. Schedule a formal developmental evaluation with a
specialist.
D. Administer a standardized, validated developmental
screening tool.
Correct Answer: D
Rationales:
• Correct (D): The presence of multiple red flags (loss of
skills or primitive reflexes persisting beyond typical age,
gross and fine motor delays) triggers the need for a formal
screening tool, which is more objective than surveillance
alone, to determine the need for further evaluation.
, • Incorrect (A): This cluster of findings represents significant
developmental delays and requires immediate action, not
a "watch and wait" approach.
• Incorrect (B): While parent education is always important,
these findings are beyond typical variation and require
formal assessment first.
• Incorrect (C): A specialist referral may be the eventual
outcome, but the next step in the primary care process is
to first quantify and document the delay using a
standardized screening tool.
Teaching Point: Developmental red flags require objective
screening, not just surveillance, to guide referral.
Question 3
Reference: Ch. 44, Section: Otitis Media
Question Stem:
A previously healthy 2-year-old presents with 48 hours of
fussiness, tugging at the ear, and a temperature of 38.5°C
(101.3°F). Otoscopic examination reveals a bulging, red,
immobile tympanic membrane. What is the most appropriate
initial management?
Options:
A. Prescribe amoxicillin 80-90 mg/kg/day for a 10-day course.
B. Recommend ibuprofen for pain and fever and schedule a
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 27, Section: Infant Sleep and Sleep Safety
Question Stem:
A 3-month-old infant is brought to the clinic for a well-child
visit. The parent mentions they have started placing the infant
to sleep on their side propped with a rolled blanket because the
infant spits up frequently. What is the most appropriate safety
advice based on current evidence?
Options:
A. "This is acceptable as long as the infant is closely monitored
during sleep."
B. "Side sleeping is a safe alternative if the infant has
gastroesophageal reflux."
C. "You should always place your infant on their back for every
sleep on a firm, flat surface without soft bedding."
,D. "Try using a wedge positioner instead of a rolled blanket to
keep the infant secure."
Correct Answer: C
Rationales:
• Correct (C): The American Academy of Pediatrics (AAP) and
textbook guidelines recommend supine (back) sleep for
every sleep until 1 year of age on a firm, flat surface
without soft bedding, pillows, or positioners. This is the
single most effective practice to reduce the risk of SIDS,
and it is recommended even for infants with reflux.
• Incorrect (A): Close monitoring does not mitigate the
physical risks of an unsafe sleep environment. SIDS can
occur during unobserved sleep.
• Incorrect (B): Side sleeping is an unstable position and is
not recommended. The back sleep position is not
associated with an increased risk of aspiration, even in
infants with reflux.
• Incorrect (D): Commercial wedge positioners and other
aftermarket devices are not recommended and pose a
suffocation hazard.
Teaching Point: Back to sleep, alone, on a firm, flat surface is
the non-negotiable standard for infant sleep safety.
Question 2
,Reference: Ch. 24, Section: Developmental Surveillance and
Screening
Question Stem:
During a 9-month well-child visit, the pediatric nurse
practitioner (PNP) observes that the infant does not sit without
support, has a persistent tonic neck reflex, and uses a raking
grasp. Based on developmental surveillance, what is the PNP's
most appropriate next step?
Options:
A. Reassure the parent that children develop at their own pace
and recheck at the 12-month visit.
B. Provide handouts on activities to promote sitting and fine
motor skills.
C. Schedule a formal developmental evaluation with a
specialist.
D. Administer a standardized, validated developmental
screening tool.
Correct Answer: D
Rationales:
• Correct (D): The presence of multiple red flags (loss of
skills or primitive reflexes persisting beyond typical age,
gross and fine motor delays) triggers the need for a formal
screening tool, which is more objective than surveillance
alone, to determine the need for further evaluation.
, • Incorrect (A): This cluster of findings represents significant
developmental delays and requires immediate action, not
a "watch and wait" approach.
• Incorrect (B): While parent education is always important,
these findings are beyond typical variation and require
formal assessment first.
• Incorrect (C): A specialist referral may be the eventual
outcome, but the next step in the primary care process is
to first quantify and document the delay using a
standardized screening tool.
Teaching Point: Developmental red flags require objective
screening, not just surveillance, to guide referral.
Question 3
Reference: Ch. 44, Section: Otitis Media
Question Stem:
A previously healthy 2-year-old presents with 48 hours of
fussiness, tugging at the ear, and a temperature of 38.5°C
(101.3°F). Otoscopic examination reveals a bulging, red,
immobile tympanic membrane. What is the most appropriate
initial management?
Options:
A. Prescribe amoxicillin 80-90 mg/kg/day for a 10-day course.
B. Recommend ibuprofen for pain and fever and schedule a
