• NSG 550 Exams 09/07/2026
TEST BANK 4 Burns' Pediatric Primary Care 8th
Edition(2026) Actual Questions, Verified
Answers with Study Guide | Take & Pass
1. The parent of a 3-year-old child tells the primary care pediatric nurse practitioner that after falling
asleep in the living room and being awakened to go to bed one evening, the child appeared confused
and disoriented for a period of time. What will the nurse practitioner counsel this parent?
a. That if this occurs again, to question the child about nightmares
b. That this is a sign of sleep walking and could be dangerous
c. That this is a type of sleep terror which will resolve over time
d. That this is probably a benign, temporary type of a sleep disorder –
Correct Answer :ANS: D
P 1
, • NSG 550 Exams 09/07/2026
This child most likely exhibits confusional arousal, which occurs when a child is awakened from a deep
sleep during the first part of the night. It is most likely benign and temporary, usually diminishing by age
5 years. It is not a sign of nightmares or night terrors. It may be the start of sleep walking but is less
likely.
2. The primary care pediatric nurse practitioner is counseling the parents of a toddler about sleep. The
parents report that the toddler has recently begun resisting sleep and is often more irritable during the
day. What will the nurse practitioner recommend?
a. Co-sleeping with the child to help alleviate possible nighttime fears
b. Referral to a sleep disorders clinic for evaluation of sleep-disordered breathing
c. Reintroducing a second, morning nap time to compensate for lost sleep
d. Understanding that sleep resistance is a common developmental problem –
Correct Answer :ANS: D
Toddlers may develop sleep resistance as a normal part of their behaviors associated with increased
autonomy or may have nighttime fears or night terrors. Parents should understand that this is common and
transient. Co-sleeping may be practiced in some cultures but is not recommended. It is not necessary to
refer to a sleep disorders clinic unless there are specific symptoms, such as snoring or restless sleep or
sleepiness in spite of adequate sleep.
3. During a well child examination, the primary care pediatric nurse practitioner learns that a 5-year-old
child has had several episodes of walking out of the bedroom after falling asleep, looking dazed, with
open eyes, and saying things that don't make sense. What will the nurse practitioner recommend?
a. Establishing a graduated extinction program and good sleep hygiene
b. Making sure that stairs are blocked and doors are locked
c. Referral to a sleep disorder clinic for evaluation of a parasomnia
d. To awaken the child when these occur and asking about nightmares –
P 2
, • NSG 550 Exams 09/07/2026
Correct Answer :ANS: B
Parents of children with sleep walking should be assured that this is relatively benign but should make
sure the house is secure so the child will not cause self-harm. Graduated extinction and sleep hygiene are
used for children who have difficulty initiating or maintaining sleep. Referral to a sleep disorder clinic
may be warranted if the child has an episode of leaving the house or some other dangerous activity. The
child should be guided back to bed without awakening.
4. The parent of a 4-year-old who has difficulty initiating and maintaining sleep has tried several
nonpharmacological methods with variable success and asks about medications. What will the
primary care pediatric nurse practitioner recommend?
a. Diphenhydramine
b. Lorazepam
c. Melatonin
d. Zolpidem –
Correct Answer :ANS: C
Medications to treat dyssomnias are generally discouraged in children, since they have side effects and
since the mainstay of treatment is behavioral therapy and sleep hygiene. If medications are used,
melatonin is the most commonly prescribed. Diphenhydramine can lead to parasomnias in some children.
Benzodiazepines, such as lorazepam, can cause dependence. Sedatives, such as zolpidem, have high
levels of side effects.
5. A child with Down syndrome who has sleep-disordered breathing with obstructive sleep apnea
continues to have symptoms in spite of tonsillectomy and adenoidectomy and treatment with a
leukotriene receptor antagonist medication and a nasal steroid spray. The primary care pediatric nurse
practitioner will refer the child to a sleep disorder clinic to discuss which therapy?
a. Craniofacial surgery
b. Oral appliances
c. Positive airway pressure therapy
P 3
, • NSG 550 Exams 09/07/2026
d. Supplemental oxygen –
Correct Answer :ANS: C
Positive airway pressure therapy can be used to treat sleep-disordered breathing in children who have
failed other therapies and even developmentally delayed children show improvement in behaviors after
this therapy. Craniofacial surgery may be used in the presence of maxillofacial deformities that affect
sleep-disordered breathing but is a last option. Oral appliances may be used if deformities can be
corrected in this manner. Supplemental oxygen helps with oxygen saturations but not with disordered
breathing patterns themselves.
6. The primary care pediatric nurse practitioner is counseling a new parent about ways to reduce the risk
of sudden infant death syndrome (SIDS). What will the nurse practitioner include when discussing
SIDS?
a. Bed-sharing with infants greatly increases the risk of SIDS.
b. Breastfeeding does not appear to have any influence on SIDS risk.
c. Infants who attend day care have a higher than usual incidence of SIDS.
d. There is no difference in SIDS rates in immunized versus non-immunized infants. –
Correct Answer :ANS: A
Bed-sharing with infants has been shown to have a five-fold increase in the incidence of SIDS, even with
non-drug using and non-smoking parents
smoking, alcohol, and drug use increase this risk even further.
Breastfeeding is recommended and is associated with a reduced risk of SIDS. Day care is not mentioned
as increasing SIDS risk. Infants who are immunized have a 50% reduction in SIDS risk, according to
research evidence. - Correct Answer :
7. The primary care pediatric nurse practitioner is performing a well baby examination on a 2-week-old
infant. The parent is concerned that the infant sleeps too much. The nurse practitioner asks the parent
P 4
TEST BANK 4 Burns' Pediatric Primary Care 8th
Edition(2026) Actual Questions, Verified
Answers with Study Guide | Take & Pass
1. The parent of a 3-year-old child tells the primary care pediatric nurse practitioner that after falling
asleep in the living room and being awakened to go to bed one evening, the child appeared confused
and disoriented for a period of time. What will the nurse practitioner counsel this parent?
a. That if this occurs again, to question the child about nightmares
b. That this is a sign of sleep walking and could be dangerous
c. That this is a type of sleep terror which will resolve over time
d. That this is probably a benign, temporary type of a sleep disorder –
Correct Answer :ANS: D
P 1
, • NSG 550 Exams 09/07/2026
This child most likely exhibits confusional arousal, which occurs when a child is awakened from a deep
sleep during the first part of the night. It is most likely benign and temporary, usually diminishing by age
5 years. It is not a sign of nightmares or night terrors. It may be the start of sleep walking but is less
likely.
2. The primary care pediatric nurse practitioner is counseling the parents of a toddler about sleep. The
parents report that the toddler has recently begun resisting sleep and is often more irritable during the
day. What will the nurse practitioner recommend?
a. Co-sleeping with the child to help alleviate possible nighttime fears
b. Referral to a sleep disorders clinic for evaluation of sleep-disordered breathing
c. Reintroducing a second, morning nap time to compensate for lost sleep
d. Understanding that sleep resistance is a common developmental problem –
Correct Answer :ANS: D
Toddlers may develop sleep resistance as a normal part of their behaviors associated with increased
autonomy or may have nighttime fears or night terrors. Parents should understand that this is common and
transient. Co-sleeping may be practiced in some cultures but is not recommended. It is not necessary to
refer to a sleep disorders clinic unless there are specific symptoms, such as snoring or restless sleep or
sleepiness in spite of adequate sleep.
3. During a well child examination, the primary care pediatric nurse practitioner learns that a 5-year-old
child has had several episodes of walking out of the bedroom after falling asleep, looking dazed, with
open eyes, and saying things that don't make sense. What will the nurse practitioner recommend?
a. Establishing a graduated extinction program and good sleep hygiene
b. Making sure that stairs are blocked and doors are locked
c. Referral to a sleep disorder clinic for evaluation of a parasomnia
d. To awaken the child when these occur and asking about nightmares –
P 2
, • NSG 550 Exams 09/07/2026
Correct Answer :ANS: B
Parents of children with sleep walking should be assured that this is relatively benign but should make
sure the house is secure so the child will not cause self-harm. Graduated extinction and sleep hygiene are
used for children who have difficulty initiating or maintaining sleep. Referral to a sleep disorder clinic
may be warranted if the child has an episode of leaving the house or some other dangerous activity. The
child should be guided back to bed without awakening.
4. The parent of a 4-year-old who has difficulty initiating and maintaining sleep has tried several
nonpharmacological methods with variable success and asks about medications. What will the
primary care pediatric nurse practitioner recommend?
a. Diphenhydramine
b. Lorazepam
c. Melatonin
d. Zolpidem –
Correct Answer :ANS: C
Medications to treat dyssomnias are generally discouraged in children, since they have side effects and
since the mainstay of treatment is behavioral therapy and sleep hygiene. If medications are used,
melatonin is the most commonly prescribed. Diphenhydramine can lead to parasomnias in some children.
Benzodiazepines, such as lorazepam, can cause dependence. Sedatives, such as zolpidem, have high
levels of side effects.
5. A child with Down syndrome who has sleep-disordered breathing with obstructive sleep apnea
continues to have symptoms in spite of tonsillectomy and adenoidectomy and treatment with a
leukotriene receptor antagonist medication and a nasal steroid spray. The primary care pediatric nurse
practitioner will refer the child to a sleep disorder clinic to discuss which therapy?
a. Craniofacial surgery
b. Oral appliances
c. Positive airway pressure therapy
P 3
, • NSG 550 Exams 09/07/2026
d. Supplemental oxygen –
Correct Answer :ANS: C
Positive airway pressure therapy can be used to treat sleep-disordered breathing in children who have
failed other therapies and even developmentally delayed children show improvement in behaviors after
this therapy. Craniofacial surgery may be used in the presence of maxillofacial deformities that affect
sleep-disordered breathing but is a last option. Oral appliances may be used if deformities can be
corrected in this manner. Supplemental oxygen helps with oxygen saturations but not with disordered
breathing patterns themselves.
6. The primary care pediatric nurse practitioner is counseling a new parent about ways to reduce the risk
of sudden infant death syndrome (SIDS). What will the nurse practitioner include when discussing
SIDS?
a. Bed-sharing with infants greatly increases the risk of SIDS.
b. Breastfeeding does not appear to have any influence on SIDS risk.
c. Infants who attend day care have a higher than usual incidence of SIDS.
d. There is no difference in SIDS rates in immunized versus non-immunized infants. –
Correct Answer :ANS: A
Bed-sharing with infants has been shown to have a five-fold increase in the incidence of SIDS, even with
non-drug using and non-smoking parents
smoking, alcohol, and drug use increase this risk even further.
Breastfeeding is recommended and is associated with a reduced risk of SIDS. Day care is not mentioned
as increasing SIDS risk. Infants who are immunized have a 50% reduction in SIDS risk, according to
research evidence. - Correct Answer :
7. The primary care pediatric nurse practitioner is performing a well baby examination on a 2-week-old
infant. The parent is concerned that the infant sleeps too much. The nurse practitioner asks the parent
P 4
