,Pediatric Primary Care: Primary Care vs Primary Prevention —
Role definition
Stem: A 3-year-old comes for a well-child visit. Which activity
best represents primary care beyond treating acute illness?
A. Prescribing antibiotics for otitis media only when infection is
present
B. Conducting developmental surveillance and arranging early
intervention when concerns arise
C. Immediately referring any parental concern to a specialist
without follow-up
D. Administering vaccines without discussing anticipatory
guidance with the family
Correct answer: B
Rationale — Correct: Primary care includes comprehensive,
continuous functions such as developmental surveillance and
coordination/referral for early intervention. (Burns — Chapter
1: Pediatric Primary Care; Primary care roles). (Google Books)
Distractors:
A — Managing acute illness is part of care but limited compared
with developmental surveillance; not the best example of the
broader primary-care role.
C — Unnecessary immediate referral bypasses primary care’s
coordination and case-management role.
D — Vaccination is essential but providing anticipatory guidance
is central to primary prevention and family education, so
omission is not best.
,Teaching point: Primary care = continuous, comprehensive care
including surveillance and coordination.
2) Chapter 1 – Pediatric Primary Care: Unique Issues in
Pediatrics — Communication & family-centered care
Stem: During a clinic visit, a parent requests that the nurse
practitioner speak directly to only the child about medication
choices. Best first nursing action?
A. Respect parental request and never include parents in
decision-making
B. Encourage family-centered discussion that involves both child
(as appropriate) and parent
C. Tell the child to choose and document the parent's refusal to
participate
D. Delay medications until the child reaches legal adulthood
Correct answer: B
Rationale — Correct: Pediatric practice emphasizes family-
centered care and shared decision-making; the clinician should
facilitate age-appropriate involvement of the child while
engaging caregivers. (Burns — Chapter 1: Unique issues; family-
centered care). (Google Books)
Distractors:
A — Excluding parents is usually inappropriate unless parental
rights are legally restricted.
C — Forcing the child only to decide ignores developmental
, capacity and family context.
D — Delaying needed treatment is unsafe and not a reasonable
option.
Teaching point: Use family-centered, developmentally
appropriate shared decision-making.
3) Chapter 1 – Pediatric Primary Care: Caring for Children &
Youth With Special Healthcare Needs (CSHCN) — Identification
Stem: A 7-year-old has chronic asthma requiring daily controller
medications and missed school for exacerbations. According to
MCHB/CSHCN criteria, which statement is true?
A. This child meets criteria for CSHCN because of ongoing
health consequences requiring services
B. Asthma never qualifies as a special health care need
C. Only children with genetic diagnoses are CSHCN
D. School absences alone disqualify the child from CSHCN
classification
Correct answer: A
Rationale — Correct: The MCHB definition identifies CSHCN by
consequences (need for ongoing services/medication) not only
diagnoses; asthma commonly meets criteria. (Burns — Chapter
1: Caring for Children & Youth With Special Healthcare Needs;
HRSA/MCHB). (Google Books, mchb.hrsa.gov)
Distractors:
B — Asthma is a common chronic condition included under
Role definition
Stem: A 3-year-old comes for a well-child visit. Which activity
best represents primary care beyond treating acute illness?
A. Prescribing antibiotics for otitis media only when infection is
present
B. Conducting developmental surveillance and arranging early
intervention when concerns arise
C. Immediately referring any parental concern to a specialist
without follow-up
D. Administering vaccines without discussing anticipatory
guidance with the family
Correct answer: B
Rationale — Correct: Primary care includes comprehensive,
continuous functions such as developmental surveillance and
coordination/referral for early intervention. (Burns — Chapter
1: Pediatric Primary Care; Primary care roles). (Google Books)
Distractors:
A — Managing acute illness is part of care but limited compared
with developmental surveillance; not the best example of the
broader primary-care role.
C — Unnecessary immediate referral bypasses primary care’s
coordination and case-management role.
D — Vaccination is essential but providing anticipatory guidance
is central to primary prevention and family education, so
omission is not best.
,Teaching point: Primary care = continuous, comprehensive care
including surveillance and coordination.
2) Chapter 1 – Pediatric Primary Care: Unique Issues in
Pediatrics — Communication & family-centered care
Stem: During a clinic visit, a parent requests that the nurse
practitioner speak directly to only the child about medication
choices. Best first nursing action?
A. Respect parental request and never include parents in
decision-making
B. Encourage family-centered discussion that involves both child
(as appropriate) and parent
C. Tell the child to choose and document the parent's refusal to
participate
D. Delay medications until the child reaches legal adulthood
Correct answer: B
Rationale — Correct: Pediatric practice emphasizes family-
centered care and shared decision-making; the clinician should
facilitate age-appropriate involvement of the child while
engaging caregivers. (Burns — Chapter 1: Unique issues; family-
centered care). (Google Books)
Distractors:
A — Excluding parents is usually inappropriate unless parental
rights are legally restricted.
C — Forcing the child only to decide ignores developmental
, capacity and family context.
D — Delaying needed treatment is unsafe and not a reasonable
option.
Teaching point: Use family-centered, developmentally
appropriate shared decision-making.
3) Chapter 1 – Pediatric Primary Care: Caring for Children &
Youth With Special Healthcare Needs (CSHCN) — Identification
Stem: A 7-year-old has chronic asthma requiring daily controller
medications and missed school for exacerbations. According to
MCHB/CSHCN criteria, which statement is true?
A. This child meets criteria for CSHCN because of ongoing
health consequences requiring services
B. Asthma never qualifies as a special health care need
C. Only children with genetic diagnoses are CSHCN
D. School absences alone disqualify the child from CSHCN
classification
Correct answer: A
Rationale — Correct: The MCHB definition identifies CSHCN by
consequences (need for ongoing services/medication) not only
diagnoses; asthma commonly meets criteria. (Burns — Chapter
1: Caring for Children & Youth With Special Healthcare Needs;
HRSA/MCHB). (Google Books, mchb.hrsa.gov)
Distractors:
B — Asthma is a common chronic condition included under
