Burns’ Pediatric Primary Care (8th Ed.) — Complete Chapter-
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 23, Section: Developmental Management of
Adolescents
Question Stem:
A 16-year-old female presents for a sports physical. She is
healthy, on no medications, and has normal vital signs. During
the confidential interview, she reports being sexually active with
one male partner for the past 4 months. She states they use
withdrawal for pregnancy prevention "most of the time." What
is the most appropriate initial action by the primary care
provider?
Options:
A. Prescribe a combined oral contraceptive pill and provide
condoms.
B. Order a pregnancy test and sexually transmitted infection
(STI) screening panel.
,C. Counsel her on the high failure rate of withdrawal and the
risks of STIs.
D. Schedule a follow-up appointment with her and her parent
to discuss sexual health.
Correct Answer: C
Rationales:
• Correct C: The initial action is to provide non-judgmental,
evidence-based counseling on the inefficacy of withdrawal
for pregnancy prevention and the lack of protection
against STIs. This engages the patient in shared decision-
making before moving to testing or prescribing.
• Incorrect A: While prescribing contraception may be an
outcome of the visit, it should not be the initial action
before counseling and assessing the patient's
understanding and preferences.
• Incorrect B: Testing is a critical component of care but
should be performed after counseling and with the
patient's consent, not as the very first step.
• Incorrect D: Breaching confidentiality by involving a parent
without the adolescent's consent is ethically inappropriate
and jeopardizes the therapeutic relationship, unless a
safety concern is present.
Teaching Point: The HEADS® assessment guides confidential,
developmentally appropriate adolescent counseling to promote
safe behaviors.
,Question 2
Reference: Ch. 20, Section: Developmental Management of the
School-Age Child
Question Stem:
A 7-year-old is brought to the clinic by his father, who is
concerned about bedwetting. The child has been toilet-trained
during the day since age 3 but has never been consistently dry
at night. The physical exam is unremarkable. What is the most
appropriate initial management step?
Options:
A. Prescribe desmopressin acetate to manage nocturnal
enuresis.
B. Order a renal ultrasound and urinalysis.
C. Initiate a motivational system with a star chart for dry nights.
D. Recommend limiting fluid intake after 6 PM and voiding
before bed.
Correct Answer: D
Rationales:
• Correct D: For primary monosymptomatic nocturnal
enuresis, first-line management involves non-
pharmacologic interventions, including educating the
family on limiting evening fluids and ensuring the child
voids before bedtime.
, • Incorrect A: Pharmacotherapy is considered only after
behavioral interventions have failed and is not a first-line
treatment.
• Incorrect B: Further diagnostic workup is not indicated
initially for primary monosymptomatic enuresis with a
normal physical exam.
• Incorrect C: Motivational therapy can be part of a
comprehensive plan, but simple environmental and
behavioral modifications like fluid management are the
foundational first step.
Teaching Point: Primary nocturnal enuresis is often
maturational; initial management focuses on simple behavioral
strategies.
Question 3
Reference: Ch. 44, Section: Asthma
Question Stem:
A 9-year-old with persistent asthma, well-controlled on
fluticasone/salmeterol 100/50 one puff twice daily, presents for
a follow-up. Over the past two weeks, she has required her
albuterol inhaler 3-4 times per week for symptoms. According
to the NAEPP EPR-3 guidelines, what is the most appropriate
next step in management?
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 23, Section: Developmental Management of
Adolescents
Question Stem:
A 16-year-old female presents for a sports physical. She is
healthy, on no medications, and has normal vital signs. During
the confidential interview, she reports being sexually active with
one male partner for the past 4 months. She states they use
withdrawal for pregnancy prevention "most of the time." What
is the most appropriate initial action by the primary care
provider?
Options:
A. Prescribe a combined oral contraceptive pill and provide
condoms.
B. Order a pregnancy test and sexually transmitted infection
(STI) screening panel.
,C. Counsel her on the high failure rate of withdrawal and the
risks of STIs.
D. Schedule a follow-up appointment with her and her parent
to discuss sexual health.
Correct Answer: C
Rationales:
• Correct C: The initial action is to provide non-judgmental,
evidence-based counseling on the inefficacy of withdrawal
for pregnancy prevention and the lack of protection
against STIs. This engages the patient in shared decision-
making before moving to testing or prescribing.
• Incorrect A: While prescribing contraception may be an
outcome of the visit, it should not be the initial action
before counseling and assessing the patient's
understanding and preferences.
• Incorrect B: Testing is a critical component of care but
should be performed after counseling and with the
patient's consent, not as the very first step.
• Incorrect D: Breaching confidentiality by involving a parent
without the adolescent's consent is ethically inappropriate
and jeopardizes the therapeutic relationship, unless a
safety concern is present.
Teaching Point: The HEADS® assessment guides confidential,
developmentally appropriate adolescent counseling to promote
safe behaviors.
,Question 2
Reference: Ch. 20, Section: Developmental Management of the
School-Age Child
Question Stem:
A 7-year-old is brought to the clinic by his father, who is
concerned about bedwetting. The child has been toilet-trained
during the day since age 3 but has never been consistently dry
at night. The physical exam is unremarkable. What is the most
appropriate initial management step?
Options:
A. Prescribe desmopressin acetate to manage nocturnal
enuresis.
B. Order a renal ultrasound and urinalysis.
C. Initiate a motivational system with a star chart for dry nights.
D. Recommend limiting fluid intake after 6 PM and voiding
before bed.
Correct Answer: D
Rationales:
• Correct D: For primary monosymptomatic nocturnal
enuresis, first-line management involves non-
pharmacologic interventions, including educating the
family on limiting evening fluids and ensuring the child
voids before bedtime.
, • Incorrect A: Pharmacotherapy is considered only after
behavioral interventions have failed and is not a first-line
treatment.
• Incorrect B: Further diagnostic workup is not indicated
initially for primary monosymptomatic enuresis with a
normal physical exam.
• Incorrect C: Motivational therapy can be part of a
comprehensive plan, but simple environmental and
behavioral modifications like fluid management are the
foundational first step.
Teaching Point: Primary nocturnal enuresis is often
maturational; initial management focuses on simple behavioral
strategies.
Question 3
Reference: Ch. 44, Section: Asthma
Question Stem:
A 9-year-old with persistent asthma, well-controlled on
fluticasone/salmeterol 100/50 one puff twice daily, presents for
a follow-up. Over the past two weeks, she has required her
albuterol inhaler 3-4 times per week for symptoms. According
to the NAEPP EPR-3 guidelines, what is the most appropriate
next step in management?
