• NSG 550 Exams 09/07/2026
TEST BANK 1 Burns' Pediatric Primary Care 8th
Edition(2026) Actual Questions, Verified
Answers with Study Guide | Take & Pass
1. The primary care pediatric nurse practitioner is examining a 15-year-old female who reports having
her first period at age 13. She states that she has had five periods in the last year, with the last one 2
months prior. She participates in basketball at school. Which action is correct?
a. Perform biometric screening to determine lean body mass.
b. Prescribe oral contraceptives pills to regulate her periods.
c. Reassure her that this is perfectly normal at her age.
d. Refer her to an endocrinologist for hormonal evaluation. –
Correct Answer :ANS: A
P 1
, • NSG 550 Exams 09/07/2026
Although it can take 18 to 24 months for adolescents to establish regulatory cycles, periods can also be
affected by athletic activity that decreases body fat. The PNP should assess the percentage of lean body
mass, which should be 75% or less to maintain regular ovulatory cycles. OCPs are useful for regulating
periods if this persists and other causes are ruled out. It is not necessary to refer her to an endocrinologist
unless problems persist in spite of standard management.
2. The parent of a 14-year-old child tells the primary care pediatric nurse practitioner that the child skips
classes frequently in spite of various disciplinary measures, such as grounding and extra homework
and is earning Cs and Ds in most classes. What will the nurse practitioner recommend?
a. Counseling for emotional problems
b. Development of an Individual Education Plan
c. Evaluation for possible learning disorders
d. Referral for a behavioral disorder - Correct Answer :ANS: C
Frequent school absenteeism, class skipping, and other types of school avoidance may indicate a problem
with cognitive ability and should be assessed. When cognitive disorders are ruled out, other issues, such
as behavioral and emotional problems may be considered. IEPs are used for children who have identified
special physiological or cognitive needs and may be useful if a cognitive disorder is identified.
3. The primary care pediatric nurse practitioner is performing a well child exam on a 12-year-old female
who has achieved early sexual maturation. The mother reports that she spends more time with her
older sister's friends instead of her own classmates. What will the nurse practitioner tell this parent?
a. Early-maturing girls need to identify with older adolescents to feel a sense of belonging.
b. Girls who join an older group of peers may become sexually active at an earlier age.
c. Spending time with older adolescents indicates a healthy adjustment to her maturing body.
d. The association with older adolescents will help her daughter to gain social maturity. –
Correct Answer :ANS: B
P 2
, • NSG 550 Exams 09/07/2026
While it is true that early maturing females may join an older group of peers to feel that they fit in, the
ones who do put themselves at risk for risky behaviors, including sexual activity. Although many teens
feel awkward when they mature at different rates than their peers, joining a group of older peers
demonstrates a poor adjustment and does not promote social maturity.
4. The primary care pediatric nurse practitioner is performing a well child assessment on a 13-year-old
female whose mother asks when her daughter's periods may start. Which information will the nurse
practitioner use to help estimate the onset of periods?
a. The age of the mother's menarche
b. The patient's age at thelarche
c. When adrenarche occurred
d. Whether linear growth has stopped - Correct Answer :ANS: B
Thelarche, or the development of breast budding, generally precedes menarche by 2.5 years, so this
should be determined when attempting to predict this milestone. The age of the mother at menarche is not
a reliable indicator. Adrenarche is related to adrenal and not gonadal development and is less valid than
other secondary sex characteristics in assessing sexual maturation. Rapid linear growth usually begins
after thelarche and peaks about a year later but is not used to predict menarche.
5. The mother of a 15-year-old adolescent female tells the primary care pediatric nurse practitioner that
her daughter has extreme mood swings prior to her periods, which the adolescent vehemently denies.
When asked if she notices anything different just before her periods, the adolescent points to her
mother and says, "She gets really hard to live with." This demonstrates which characteristic of
adolescent thinking?
a. Apparent hypocrisy
b. Imaginary audience
c. Overthinking
d. Personal fable - Correct Answer :ANS: A
Apparent hypocrisy is the notion that rules apply differently to adolescents than to others. The adolescent
who chalks up the conflict with her mother related to her premenstrual mood swings does not see her own
P 3
, • NSG 550 Exams 09/07/2026
role in the conflict. Imaginary audience is the perception that everyone is thinking about them. Personal
fable is the idea that they are special. Overthinking involves making things more complicated than they
need to be.
6. During a well child assessment of a 13-year-old male, the primary care pediatric nurse practitioner
notes small testicles and pubic and axillary hair. To further evaluate these findings, the nurse
practitioner will ask the patient about
a. alcohol and tobacco use.
b. changes in voice.
c. increase in height and weight.
d. participation in sports. - Correct Answer :ANS: D
The initial sign of puberty in males is testicular enlargement. If this does not precede other changes, the
PNP should consider whether the boy is taking exogenous anabolic steroids, common among those who
wish to improve athletic ability. These findings are not concerning for alcohol or tobacco use. Voice
changes and rapid growth may occur with pubic hair development, but the primary concern is anabolic
steroid use.
7. The parent of an adolescent reports noting cutting marks on the teen's arms and asks the primary care
pediatric nurse practitioner what it means. What will the nurse practitioner tell this parent?
a. Cutting is a way of dealing with emotional distress.
b. It is a method of fitting in with other adolescents.
c. The behavior is common and will usually stop.
d. This type of behavior is a type of suicide attempt. - Correct Answer :ANS: A
Self-injurious behavior (SIB) is used as a coping strategy to relieve distress, anger, and stress. It is not
commonly done among adolescents and is not a way of fitting in with a peer group. Because it indicates
underlying distress, adolescents must get help identifying these causes. Many have a history of physical,
sexual, or emotional abuse. Although individuals who engage in SIB are more likely to attempt suicide in
the future, the act itself is not a suicide attempt.
P 4
TEST BANK 1 Burns' Pediatric Primary Care 8th
Edition(2026) Actual Questions, Verified
Answers with Study Guide | Take & Pass
1. The primary care pediatric nurse practitioner is examining a 15-year-old female who reports having
her first period at age 13. She states that she has had five periods in the last year, with the last one 2
months prior. She participates in basketball at school. Which action is correct?
a. Perform biometric screening to determine lean body mass.
b. Prescribe oral contraceptives pills to regulate her periods.
c. Reassure her that this is perfectly normal at her age.
d. Refer her to an endocrinologist for hormonal evaluation. –
Correct Answer :ANS: A
P 1
, • NSG 550 Exams 09/07/2026
Although it can take 18 to 24 months for adolescents to establish regulatory cycles, periods can also be
affected by athletic activity that decreases body fat. The PNP should assess the percentage of lean body
mass, which should be 75% or less to maintain regular ovulatory cycles. OCPs are useful for regulating
periods if this persists and other causes are ruled out. It is not necessary to refer her to an endocrinologist
unless problems persist in spite of standard management.
2. The parent of a 14-year-old child tells the primary care pediatric nurse practitioner that the child skips
classes frequently in spite of various disciplinary measures, such as grounding and extra homework
and is earning Cs and Ds in most classes. What will the nurse practitioner recommend?
a. Counseling for emotional problems
b. Development of an Individual Education Plan
c. Evaluation for possible learning disorders
d. Referral for a behavioral disorder - Correct Answer :ANS: C
Frequent school absenteeism, class skipping, and other types of school avoidance may indicate a problem
with cognitive ability and should be assessed. When cognitive disorders are ruled out, other issues, such
as behavioral and emotional problems may be considered. IEPs are used for children who have identified
special physiological or cognitive needs and may be useful if a cognitive disorder is identified.
3. The primary care pediatric nurse practitioner is performing a well child exam on a 12-year-old female
who has achieved early sexual maturation. The mother reports that she spends more time with her
older sister's friends instead of her own classmates. What will the nurse practitioner tell this parent?
a. Early-maturing girls need to identify with older adolescents to feel a sense of belonging.
b. Girls who join an older group of peers may become sexually active at an earlier age.
c. Spending time with older adolescents indicates a healthy adjustment to her maturing body.
d. The association with older adolescents will help her daughter to gain social maturity. –
Correct Answer :ANS: B
P 2
, • NSG 550 Exams 09/07/2026
While it is true that early maturing females may join an older group of peers to feel that they fit in, the
ones who do put themselves at risk for risky behaviors, including sexual activity. Although many teens
feel awkward when they mature at different rates than their peers, joining a group of older peers
demonstrates a poor adjustment and does not promote social maturity.
4. The primary care pediatric nurse practitioner is performing a well child assessment on a 13-year-old
female whose mother asks when her daughter's periods may start. Which information will the nurse
practitioner use to help estimate the onset of periods?
a. The age of the mother's menarche
b. The patient's age at thelarche
c. When adrenarche occurred
d. Whether linear growth has stopped - Correct Answer :ANS: B
Thelarche, or the development of breast budding, generally precedes menarche by 2.5 years, so this
should be determined when attempting to predict this milestone. The age of the mother at menarche is not
a reliable indicator. Adrenarche is related to adrenal and not gonadal development and is less valid than
other secondary sex characteristics in assessing sexual maturation. Rapid linear growth usually begins
after thelarche and peaks about a year later but is not used to predict menarche.
5. The mother of a 15-year-old adolescent female tells the primary care pediatric nurse practitioner that
her daughter has extreme mood swings prior to her periods, which the adolescent vehemently denies.
When asked if she notices anything different just before her periods, the adolescent points to her
mother and says, "She gets really hard to live with." This demonstrates which characteristic of
adolescent thinking?
a. Apparent hypocrisy
b. Imaginary audience
c. Overthinking
d. Personal fable - Correct Answer :ANS: A
Apparent hypocrisy is the notion that rules apply differently to adolescents than to others. The adolescent
who chalks up the conflict with her mother related to her premenstrual mood swings does not see her own
P 3
, • NSG 550 Exams 09/07/2026
role in the conflict. Imaginary audience is the perception that everyone is thinking about them. Personal
fable is the idea that they are special. Overthinking involves making things more complicated than they
need to be.
6. During a well child assessment of a 13-year-old male, the primary care pediatric nurse practitioner
notes small testicles and pubic and axillary hair. To further evaluate these findings, the nurse
practitioner will ask the patient about
a. alcohol and tobacco use.
b. changes in voice.
c. increase in height and weight.
d. participation in sports. - Correct Answer :ANS: D
The initial sign of puberty in males is testicular enlargement. If this does not precede other changes, the
PNP should consider whether the boy is taking exogenous anabolic steroids, common among those who
wish to improve athletic ability. These findings are not concerning for alcohol or tobacco use. Voice
changes and rapid growth may occur with pubic hair development, but the primary concern is anabolic
steroid use.
7. The parent of an adolescent reports noting cutting marks on the teen's arms and asks the primary care
pediatric nurse practitioner what it means. What will the nurse practitioner tell this parent?
a. Cutting is a way of dealing with emotional distress.
b. It is a method of fitting in with other adolescents.
c. The behavior is common and will usually stop.
d. This type of behavior is a type of suicide attempt. - Correct Answer :ANS: A
Self-injurious behavior (SIB) is used as a coping strategy to relieve distress, anger, and stress. It is not
commonly done among adolescents and is not a way of fitting in with a peer group. Because it indicates
underlying distress, adolescents must get help identifying these causes. Many have a history of physical,
sexual, or emotional abuse. Although individuals who engage in SIB are more likely to attempt suicide in
the future, the act itself is not a suicide attempt.
P 4
