,Primary Care Versus Primary Prevention
Key Concept: Levels of prevention and role of primary care in
anticipatory guidance
Stem: A 9-month-old infant presents for a well-child visit. The
nurse plans anticipatory guidance for the parents regarding
feeding, safety, and immunizations. Which action best
represents primary prevention in this visit?
A. Teaching parents how to recognize signs of dehydration in
illness
B. Administering scheduled routine immunizations to the infant
C. Screening the infant for developmental delay using a
standardized tool
D. Referring to early intervention after identifying concerning
developmental signs
Correct answer: B
Rationale (correct): Administering routine immunizations
prevents disease before exposure and is a hallmark of primary
prevention (Burns, Chapter 1 — Primary Care vs Primary
Prevention). Immunizations are also recommended by CDC/AAP
as core preventive measures in primary care.
Why the distractors are wrong:
A. Teaching recognition of dehydration is health
promotion/anticipatory guidance but primarily supports early
identification and self-management rather than preventing the
initial disease exposure.
C. Screening for developmental delay is secondary prevention
,(early detection), not primary prevention.
D. Referral to early intervention after delay is tertiary/secondary
care to reduce disability, not primary prevention.
Teaching Point: Primary prevention prevents disease before it
occurs (e.g., immunizations).
Question 2
Chapter & Subtopic: Chapter 1 — Unique Issues in Pediatrics:
Growth & Development Surveillance
Key Concept: Use of developmental surveillance plus screening
tools
Stem: At a 15-month well visit, the nurse notes that the toddler
uses few single words and does not point to request. The
parents say they are worried. Which is the nurse’s best next
action?
A. Reassure the parents that language milestones vary and
schedule the next well visit in 6 months
B. Complete a standardized developmental screening tool now
and document findings
C. Begin speech therapy immediately without further
assessment
D. Advise the parents to reduce screen time and return if no
improvement in 3 months
Correct answer: B
, Rationale (correct): Combining surveillance with a validated
developmental screening tool at the point of concern is best
practice to identify delays early (Burns, Chapter 1 — Unique
Issues). Early standardized screening triggers timely referral and
intervention per AAP developmental surveillance/screening
guidance.
Why the distractors are wrong:
A. Waiting 6 months risks delayed identification and
intervention for a potential developmental disorder.
C. Initiating therapy without assessment and proper
referral/authorization is premature; screening and referral are
required first.
D. Advising behavioral changes alone is insufficient when a
developmental concern is present; prompt screening is
indicated.
Teaching Point: Use surveillance plus validated screening when
parents or clinicians have developmental concerns.
Question 3
Chapter & Subtopic: Chapter 1 — Caring for Children & Youth
With Special Healthcare Needs (CYSHCN)
Key Concept: Care coordination and medical home principles
Stem: A 7-year-old child with cerebral palsy and frequent clinic
visits requires multiple therapy referrals and school
accommodations. Which nurse-led action best supports the
Key Concept: Levels of prevention and role of primary care in
anticipatory guidance
Stem: A 9-month-old infant presents for a well-child visit. The
nurse plans anticipatory guidance for the parents regarding
feeding, safety, and immunizations. Which action best
represents primary prevention in this visit?
A. Teaching parents how to recognize signs of dehydration in
illness
B. Administering scheduled routine immunizations to the infant
C. Screening the infant for developmental delay using a
standardized tool
D. Referring to early intervention after identifying concerning
developmental signs
Correct answer: B
Rationale (correct): Administering routine immunizations
prevents disease before exposure and is a hallmark of primary
prevention (Burns, Chapter 1 — Primary Care vs Primary
Prevention). Immunizations are also recommended by CDC/AAP
as core preventive measures in primary care.
Why the distractors are wrong:
A. Teaching recognition of dehydration is health
promotion/anticipatory guidance but primarily supports early
identification and self-management rather than preventing the
initial disease exposure.
C. Screening for developmental delay is secondary prevention
,(early detection), not primary prevention.
D. Referral to early intervention after delay is tertiary/secondary
care to reduce disability, not primary prevention.
Teaching Point: Primary prevention prevents disease before it
occurs (e.g., immunizations).
Question 2
Chapter & Subtopic: Chapter 1 — Unique Issues in Pediatrics:
Growth & Development Surveillance
Key Concept: Use of developmental surveillance plus screening
tools
Stem: At a 15-month well visit, the nurse notes that the toddler
uses few single words and does not point to request. The
parents say they are worried. Which is the nurse’s best next
action?
A. Reassure the parents that language milestones vary and
schedule the next well visit in 6 months
B. Complete a standardized developmental screening tool now
and document findings
C. Begin speech therapy immediately without further
assessment
D. Advise the parents to reduce screen time and return if no
improvement in 3 months
Correct answer: B
, Rationale (correct): Combining surveillance with a validated
developmental screening tool at the point of concern is best
practice to identify delays early (Burns, Chapter 1 — Unique
Issues). Early standardized screening triggers timely referral and
intervention per AAP developmental surveillance/screening
guidance.
Why the distractors are wrong:
A. Waiting 6 months risks delayed identification and
intervention for a potential developmental disorder.
C. Initiating therapy without assessment and proper
referral/authorization is premature; screening and referral are
required first.
D. Advising behavioral changes alone is insufficient when a
developmental concern is present; prompt screening is
indicated.
Teaching Point: Use surveillance plus validated screening when
parents or clinicians have developmental concerns.
Question 3
Chapter & Subtopic: Chapter 1 — Caring for Children & Youth
With Special Healthcare Needs (CYSHCN)
Key Concept: Care coordination and medical home principles
Stem: A 7-year-old child with cerebral palsy and frequent clinic
visits requires multiple therapy referrals and school
accommodations. Which nurse-led action best supports the
