Burns’ Pediatric Primary Care (8th Ed.) — Complete Chapter-
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 10, Section: Developmental Management
Question Stem:
A 4-year-old child is brought to the clinic for a well-child visit.
The parent expresses concern that the child, while very verbal
and able to build a tower of 10 blocks, cannot accurately copy a
circle. Based on typical developmental milestones, what is the
nurse practitioner's best response?
Options:
A. "This is a significant delay; a referral to occupational therapy
is warranted."
B. "This skill is not expected until age 5; let's monitor it at the
next visit."
C. "This is a normal finding for a 4-year-old; copying a circle is a
3-year-old skill."
D. "The ability to copy a circle is a developmental milestone
expected for a 4-year-old."
Correct Answer: D
Rationales:
, • Correct: The ability to copy a circle is a fine motor and
visual-motor milestone typically achieved by age 4. This is
a normal finding and requires no intervention.
• Incorrect A: This is not a significant delay. Referring to
occupational therapy would be an unnecessary use of
resources for a typically developing child.
• Incorrect B: Copying a circle is expected by age 4, not age
5. This response would fail to reassure the parent
accurately.
• Incorrect C: Copying a circle is a 4-year-old milestone, not
a 3-year-old milestone. A 3-year-old can typically copy a
vertical line.
Teaching Point: Copying a circle is a key visual-motor milestone
expected by age 4.
Question 2
Reference: Ch. 24, Section: Otitis Media
Question Stem:
A 22-month-old, otherwise healthy child presents with 48 hours
of fussiness and fever to 38.9°C (102°F). Otoscopic examination
reveals a bulging, red, immobile tympanic membrane with
obscured landmarks. What is the most appropriate initial
management?
,Options:
A. Prescribe a 10-day course of high-dose amoxicillin.
B. Recommend ibuprofen for fever and pain and advise
watchful waiting for 48-72 hours.
C. Prescribe a 5-day course of amoxicillin-clavulanate.
D. Administer a single dose of intramuscular ceftriaxone and
schedule a follow-up in 3 days.
Correct Answer: A
Rationales:
• Correct: This presentation is consistent with acute otitis
media (AOM). For children over 2 years or with severe
symptoms (fever >39°C, severe otalgia), immediate
antibiotic treatment is indicated. High-dose amoxicillin (80-
90 mg/kg/day) is the first-line therapy.
• Incorrect B: Watchful waiting may be appropriate for mild,
unilateral AOM in children over 2 years, but this child is
under 2 and has a fever, making antibiotics the standard of
care.
• Incorrect C: Amoxicillin-clavulanate is a second-line agent,
reserved for treatment failure after 48-72 hours or in areas
with high rates of beta-lactamase resistant H. influenzae.
• Incorrect D: Ceftriaxone is typically reserved for cases
where oral antibiotics are not feasible or have failed.
Teaching Point: High-dose amoxicillin is first-line for AOM in
young children with severe symptoms.
, Question 3
Reference: Ch. 44, Section: Infant Nutrition
Question Stem:
A breastfeeding mother of a healthy 4-month-old infant asks
when she can introduce solid foods, specifically rice cereal. The
infant has good head control, shows interest in family meals,
and is exclusively breastfed. What is the most appropriate
recommendation?
Options:
A. "You can start rice cereal mixed with formula or breastmilk
now."
B. "Solid foods, including iron-fortified cereal, should be
introduced around 6 months of age."
C. "Since she is showing interest, begin with pureed fruits and
vegetables immediately."
D. "Rice cereal is not recommended; start with small pieces of
soft table foods."
Correct Answer: B
Rationales:
• Correct: The AAP and textbook recommend exclusive
breastfeeding for about 6 months, with the introduction of
iron-fortified foods around 6 months of age when
developmental readiness signs are consistently present.
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 10, Section: Developmental Management
Question Stem:
A 4-year-old child is brought to the clinic for a well-child visit.
The parent expresses concern that the child, while very verbal
and able to build a tower of 10 blocks, cannot accurately copy a
circle. Based on typical developmental milestones, what is the
nurse practitioner's best response?
Options:
A. "This is a significant delay; a referral to occupational therapy
is warranted."
B. "This skill is not expected until age 5; let's monitor it at the
next visit."
C. "This is a normal finding for a 4-year-old; copying a circle is a
3-year-old skill."
D. "The ability to copy a circle is a developmental milestone
expected for a 4-year-old."
Correct Answer: D
Rationales:
, • Correct: The ability to copy a circle is a fine motor and
visual-motor milestone typically achieved by age 4. This is
a normal finding and requires no intervention.
• Incorrect A: This is not a significant delay. Referring to
occupational therapy would be an unnecessary use of
resources for a typically developing child.
• Incorrect B: Copying a circle is expected by age 4, not age
5. This response would fail to reassure the parent
accurately.
• Incorrect C: Copying a circle is a 4-year-old milestone, not
a 3-year-old milestone. A 3-year-old can typically copy a
vertical line.
Teaching Point: Copying a circle is a key visual-motor milestone
expected by age 4.
Question 2
Reference: Ch. 24, Section: Otitis Media
Question Stem:
A 22-month-old, otherwise healthy child presents with 48 hours
of fussiness and fever to 38.9°C (102°F). Otoscopic examination
reveals a bulging, red, immobile tympanic membrane with
obscured landmarks. What is the most appropriate initial
management?
,Options:
A. Prescribe a 10-day course of high-dose amoxicillin.
B. Recommend ibuprofen for fever and pain and advise
watchful waiting for 48-72 hours.
C. Prescribe a 5-day course of amoxicillin-clavulanate.
D. Administer a single dose of intramuscular ceftriaxone and
schedule a follow-up in 3 days.
Correct Answer: A
Rationales:
• Correct: This presentation is consistent with acute otitis
media (AOM). For children over 2 years or with severe
symptoms (fever >39°C, severe otalgia), immediate
antibiotic treatment is indicated. High-dose amoxicillin (80-
90 mg/kg/day) is the first-line therapy.
• Incorrect B: Watchful waiting may be appropriate for mild,
unilateral AOM in children over 2 years, but this child is
under 2 and has a fever, making antibiotics the standard of
care.
• Incorrect C: Amoxicillin-clavulanate is a second-line agent,
reserved for treatment failure after 48-72 hours or in areas
with high rates of beta-lactamase resistant H. influenzae.
• Incorrect D: Ceftriaxone is typically reserved for cases
where oral antibiotics are not feasible or have failed.
Teaching Point: High-dose amoxicillin is first-line for AOM in
young children with severe symptoms.
, Question 3
Reference: Ch. 44, Section: Infant Nutrition
Question Stem:
A breastfeeding mother of a healthy 4-month-old infant asks
when she can introduce solid foods, specifically rice cereal. The
infant has good head control, shows interest in family meals,
and is exclusively breastfed. What is the most appropriate
recommendation?
Options:
A. "You can start rice cereal mixed with formula or breastmilk
now."
B. "Solid foods, including iron-fortified cereal, should be
introduced around 6 months of age."
C. "Since she is showing interest, begin with pureed fruits and
vegetables immediately."
D. "Rice cereal is not recommended; start with small pieces of
soft table foods."
Correct Answer: B
Rationales:
• Correct: The AAP and textbook recommend exclusive
breastfeeding for about 6 months, with the introduction of
iron-fortified foods around 6 months of age when
developmental readiness signs are consistently present.
