Burns’ Pediatric Primary Care (8th Ed.) — Complete Chapter-
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 10, Section: Developmental Management
Question Stem:
A 4-year-old child is brought to the clinic for a well-child visit.
The parent expresses concern that the child, while very verbal
and able to climb and run well, cannot yet copy a circle or a
cross when drawing. Based on developmental surveillance,
what is the nurse practitioner's best initial action?
Options:
A. Reassure the parent that this is a normal finding for a 4-year-
old.
B. Refer the child immediately to a developmental pediatrician.
C. Administer a standardized developmental screening tool to
,gather more objective data.
D. Instruct the parent to provide more practice opportunities
with coloring books at home.
Correct Answer: C
Rationales:
• Correct (C): The ability to copy a circle is a 3-year-old
milestone, and copying a cross is a 4-year-old milestone.
The concern raised by the parent, combined with a
potential delay in fine motor skills, warrants further
investigation using a validated, standardized
developmental screening tool as the next step in the
surveillance process.
• Incorrect (A): This is not a normal finding. A 4-year-old
should be able to copy a circle (a 3-year skill) and is
developing the ability to copy a cross.
• Incorrect (B): Immediate referral is premature before a
standardized assessment is completed to quantify and
better understand the nature of the delay.
• Incorrect (D): While practice is beneficial, this response
dismisses a legitimate developmental concern that
requires formal assessment.
Teaching Point: Always use standardized screening tools to
investigate developmental concerns raised by parents.
,Question 2
Reference: Ch. 23, Section: Newborn Nutrition
Question Stem:
A breastfeeding mother of a 5-day-old newborn calls the clinic
concerned about the infant's frequent feeding and yellow,
seedy stools. The infant has 8 wet diapers in 24 hours and is
back to birth weight. What is the nurse practitioner's best
interpretation of these findings?
Options:
A. Signs of adequate milk intake and effective breastfeeding.
B. Indicators of possible lactose overload.
C. Early symptoms of hyperbilirubinemia.
D. Concerning for insufficient breast milk supply.
Correct Answer: A
Rationales:
• Correct (A): Frequent feeding, the return to birth weight
by day 10-14, and the presence of multiple wet diapers
and transitional (yellow, seedy) stools are all key indicators
of successful breastfeeding and adequate milk transfer.
• Incorrect (B): Lactose overload typically presents with
explosive, watery, green stools and significant fussiness,
which is not described.
, • Incorrect (C): Hyperbilirubinemia would present with
jaundice and possibly poor feeding or lethargy, not this
positive clinical picture.
• Incorrect (D): The output (wet diapers, stools) and weight
gain are the primary indicators of sufficient supply, and
they are all within expected norms.
Teaching Point: Assess breastfeeding adequacy by weight gain,
urine output, and stool patterns.
Question 3
Reference: Ch. 24, Section: Sleep
Question Stem:
The parents of a 9-month-old infant report difficulty with
bedtime. The infant falls asleep while being rocked but wakes
up crying 2-3 times each night and will only fall back asleep
when rocked. What is the most appropriate advice from the
nurse practitioner regarding a strategy to improve sleep?
Options:
A. Recommend putting the infant to bed with a bottle of milk to
promote self-soothing.
B. Advise the parents to let the infant "cry it out" without any
intervention.
C. Educate the parents on establishing a consistent bedtime
routine and putting the infant to bed drowsy but awake.
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 10, Section: Developmental Management
Question Stem:
A 4-year-old child is brought to the clinic for a well-child visit.
The parent expresses concern that the child, while very verbal
and able to climb and run well, cannot yet copy a circle or a
cross when drawing. Based on developmental surveillance,
what is the nurse practitioner's best initial action?
Options:
A. Reassure the parent that this is a normal finding for a 4-year-
old.
B. Refer the child immediately to a developmental pediatrician.
C. Administer a standardized developmental screening tool to
,gather more objective data.
D. Instruct the parent to provide more practice opportunities
with coloring books at home.
Correct Answer: C
Rationales:
• Correct (C): The ability to copy a circle is a 3-year-old
milestone, and copying a cross is a 4-year-old milestone.
The concern raised by the parent, combined with a
potential delay in fine motor skills, warrants further
investigation using a validated, standardized
developmental screening tool as the next step in the
surveillance process.
• Incorrect (A): This is not a normal finding. A 4-year-old
should be able to copy a circle (a 3-year skill) and is
developing the ability to copy a cross.
• Incorrect (B): Immediate referral is premature before a
standardized assessment is completed to quantify and
better understand the nature of the delay.
• Incorrect (D): While practice is beneficial, this response
dismisses a legitimate developmental concern that
requires formal assessment.
Teaching Point: Always use standardized screening tools to
investigate developmental concerns raised by parents.
,Question 2
Reference: Ch. 23, Section: Newborn Nutrition
Question Stem:
A breastfeeding mother of a 5-day-old newborn calls the clinic
concerned about the infant's frequent feeding and yellow,
seedy stools. The infant has 8 wet diapers in 24 hours and is
back to birth weight. What is the nurse practitioner's best
interpretation of these findings?
Options:
A. Signs of adequate milk intake and effective breastfeeding.
B. Indicators of possible lactose overload.
C. Early symptoms of hyperbilirubinemia.
D. Concerning for insufficient breast milk supply.
Correct Answer: A
Rationales:
• Correct (A): Frequent feeding, the return to birth weight
by day 10-14, and the presence of multiple wet diapers
and transitional (yellow, seedy) stools are all key indicators
of successful breastfeeding and adequate milk transfer.
• Incorrect (B): Lactose overload typically presents with
explosive, watery, green stools and significant fussiness,
which is not described.
, • Incorrect (C): Hyperbilirubinemia would present with
jaundice and possibly poor feeding or lethargy, not this
positive clinical picture.
• Incorrect (D): The output (wet diapers, stools) and weight
gain are the primary indicators of sufficient supply, and
they are all within expected norms.
Teaching Point: Assess breastfeeding adequacy by weight gain,
urine output, and stool patterns.
Question 3
Reference: Ch. 24, Section: Sleep
Question Stem:
The parents of a 9-month-old infant report difficulty with
bedtime. The infant falls asleep while being rocked but wakes
up crying 2-3 times each night and will only fall back asleep
when rocked. What is the most appropriate advice from the
nurse practitioner regarding a strategy to improve sleep?
Options:
A. Recommend putting the infant to bed with a bottle of milk to
promote self-soothing.
B. Advise the parents to let the infant "cry it out" without any
intervention.
C. Educate the parents on establishing a consistent bedtime
routine and putting the infant to bed drowsy but awake.
