,Pediatric Primary Care; Primary Care vs Primary Prevention
Stem: A 4-month-old well-child visit includes scheduled
immunizations and discussion about safe sleep. Which nursing
action best represents primary prevention?
A. Screen for developmental delay with an age-appropriate tool
B. Administer the scheduled DTaP vaccine and counsel on safe
sleep practices
C. Order a lead level because older sibling had lead exposure
D. Refer the family to early intervention services for hypotonia
noted on exam
Correct answer: B
Rationale — correct: Primary prevention prevents disease
before it occurs; administering recommended immunizations
and counseling on safe sleep reduces risk of vaccine-
preventable disease and SIDS. (Burns Ch. 1 — Pediatric Primary
Care: Primary care & prevention). (Google Books)
Rationales — incorrect:
A. Developmental screening is secondary prevention (early
detection).
C. Ordering lead level after exposure is targeted screening
(secondary), not universal primary prevention.
D. Referral for an identified problem is tertiary/secondary
intervention rather than primary prevention.
Teaching point: Primary prevention prevents disease
occurrence (immunizations, safety counseling).
,2
Chapter & Subtopic: Chapter 1 – Pediatric Primary Care; Scope
& Alignment of Primary Care
Stem: A clinic uses a patient-centered medical home model for
children. Which expected outcome best demonstrates the
model’s value?
A. Shorter initial visit times by limiting anticipatory guidance
B. Improved care coordination and fewer preventable
hospitalizations
C. Exclusive use of telehealth for all well visits
D. Referral to subspecialty without primary care follow-up
Correct answer: B
Rationale — correct: The medical home improves coordination
of services and reduces preventable hospitalizations and
fragmented care. (Burns Ch. 1 — role of primary care; AAP:
medical home model). (Google Books, aap.org)
Rationales — incorrect:
A. Shorter visits that omit guidance reduce preventive benefit.
C. Telehealth is a tool but not appropriate alone for all well
visits.
D. Referrals without primary care follow-up fragment care and
contradict medical home principles.
Teaching point: The medical home emphasizes coordination,
continuity, and preventive care.
, 3
Chapter & Subtopic: Chapter 2 – Unique Issues in Pediatrics;
Communication & Consent
Stem: A 16-year-old asks for confidential counseling about
contraception during a clinic visit and asks the nurse not to tell
parents. Best nursing action?
A. Inform parents immediately—minors cannot consent.
B. Provide counseling and services according to state minor
consent laws and clinic policy.
C. Refuse the request and require parental presence for
counseling.
D. Tell the adolescent you will only discuss general healthy
lifestyle topics.
Correct answer: B
Rationale — correct: Adolescents often have rights to
confidential sexual/reproductive health services per state law;
nurses must follow legal/clinic protocol while ensuring safety.
(Burns Ch. 2 — Unique issues: adolescent confidentiality).
(Google Books)
Rationales — incorrect:
A. Automatically informing parents may breach adolescent
rights and discourage care.
C. Requiring parental presence can impede access to needed
services.
Stem: A 4-month-old well-child visit includes scheduled
immunizations and discussion about safe sleep. Which nursing
action best represents primary prevention?
A. Screen for developmental delay with an age-appropriate tool
B. Administer the scheduled DTaP vaccine and counsel on safe
sleep practices
C. Order a lead level because older sibling had lead exposure
D. Refer the family to early intervention services for hypotonia
noted on exam
Correct answer: B
Rationale — correct: Primary prevention prevents disease
before it occurs; administering recommended immunizations
and counseling on safe sleep reduces risk of vaccine-
preventable disease and SIDS. (Burns Ch. 1 — Pediatric Primary
Care: Primary care & prevention). (Google Books)
Rationales — incorrect:
A. Developmental screening is secondary prevention (early
detection).
C. Ordering lead level after exposure is targeted screening
(secondary), not universal primary prevention.
D. Referral for an identified problem is tertiary/secondary
intervention rather than primary prevention.
Teaching point: Primary prevention prevents disease
occurrence (immunizations, safety counseling).
,2
Chapter & Subtopic: Chapter 1 – Pediatric Primary Care; Scope
& Alignment of Primary Care
Stem: A clinic uses a patient-centered medical home model for
children. Which expected outcome best demonstrates the
model’s value?
A. Shorter initial visit times by limiting anticipatory guidance
B. Improved care coordination and fewer preventable
hospitalizations
C. Exclusive use of telehealth for all well visits
D. Referral to subspecialty without primary care follow-up
Correct answer: B
Rationale — correct: The medical home improves coordination
of services and reduces preventable hospitalizations and
fragmented care. (Burns Ch. 1 — role of primary care; AAP:
medical home model). (Google Books, aap.org)
Rationales — incorrect:
A. Shorter visits that omit guidance reduce preventive benefit.
C. Telehealth is a tool but not appropriate alone for all well
visits.
D. Referrals without primary care follow-up fragment care and
contradict medical home principles.
Teaching point: The medical home emphasizes coordination,
continuity, and preventive care.
, 3
Chapter & Subtopic: Chapter 2 – Unique Issues in Pediatrics;
Communication & Consent
Stem: A 16-year-old asks for confidential counseling about
contraception during a clinic visit and asks the nurse not to tell
parents. Best nursing action?
A. Inform parents immediately—minors cannot consent.
B. Provide counseling and services according to state minor
consent laws and clinic policy.
C. Refuse the request and require parental presence for
counseling.
D. Tell the adolescent you will only discuss general healthy
lifestyle topics.
Correct answer: B
Rationale — correct: Adolescents often have rights to
confidential sexual/reproductive health services per state law;
nurses must follow legal/clinic protocol while ensuring safety.
(Burns Ch. 2 — Unique issues: adolescent confidentiality).
(Google Books)
Rationales — incorrect:
A. Automatically informing parents may breach adolescent
rights and discourage care.
C. Requiring parental presence can impede access to needed
services.
