Burns’ Pediatric Primary Care (8th Ed.) — Complete Chapter-
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Chapter 1: Pediatric Primary Care
Chapter 1 – Primary Care versus Primary Prevention
A 3-year-old arrives for a well-child visit. The nurse practitioner
(NP) explains the role of primary care to the parents. Which
statement best distinguishes primary care from primary
prevention?
A. Primary care focuses only on acute illness; primary
prevention provides routine health supervision.
B. Primary care provides continuous, relationship-based
services across life stages; primary prevention focuses on
preventing specific disease.
C. Primary care is delivered only in hospitals; primary
prevention occurs in community settings.
D. Primary care and primary prevention are interchangeable
terms.
Correct answer: B
,Rationale (correct): Primary care is continuous, comprehensive,
relationship-based care (the medical home), whereas primary
prevention targets interventions (e.g., immunizations,
anticipatory guidance) to prevent specific diseases. This
distinction is emphasized in Burns’ chapter on Pediatric Primary
Care (Chapter 1, “Primary Care vs Prevention”). Elsevier
Health+1
Incorrect:
A — Incorrect: primary care includes both acute and preventive
services, not “only acute.”
C — Incorrect: primary care is not limited to hospitals; it occurs
across settings (clinic, community, home).
D — Incorrect: terms are related but not interchangeable; they
describe different scopes.
Teaching point: Primary care = continuous relationship; primary
prevention = specific disease prevention.
2)
Chapter 1 – Pediatric Primary Care, The Pediatric Medical
Home
A parent asks why the clinic emphasizes a “medical home.”
Which NP response best reflects the AAP definition of a medical
home?
A. “It’s a single specialist who treats all your child’s conditions.”
B. “It’s a family-centered, coordinated approach providing
,accessible, continuous care.”
C. “It only focuses on urgent care needs.”
D. “It’s mainly a place for social services.”
Correct answer: B
Rationale (correct): The AAP-defined medical home is family-
centered, accessible, coordinated, comprehensive, and
continuous — core concepts in Burns’ chapter on Pediatric
Primary Care. This model emphasizes partnership between
clinicians and families. Elsevier Health+1
Incorrect:
A — Incorrect: medical home is team-based, not a single
specialist.
C — Incorrect: it includes preventive and chronic care, not only
urgent care.
D — Incorrect: social services may be part of coordination, but
the medical home is primarily clinical care integrated with
supports.
Teaching point: The pediatric medical home = coordinated,
family-centered, continuous care.
3)
Chapter 1 – Pediatric Primary Care, Levels of Care & Triage
During triage, a child with mild fever and a new rash is seen.
The nurse must decide whether immediate referral is needed.
Which finding most strongly suggests urgent referral rather than
,routine primary care follow-up?
A. Low-grade fever (38.0°C), maculopapular rash, active and
playful.
B. High fever (40.0°C), petechial rash, lethargy, and poor
perfusion.
C. Fever 38.2°C with localized diaper rash.
D. Intermittent low-grade fever with recent immunization.
Correct answer: B
Rationale (correct): Signs of petechiae, high fever, lethargy, and
poor perfusion suggest possible sepsis or meningococcemia and
require urgent referral to higher-level (secondary/tertiary)
care—consistent with Burns’ discussion of levels of care and
recognition of red flags. Elsevier Health
Incorrect:
A — Incorrect: child’s activity and low-grade fever favor routine
evaluation.
C — Incorrect: diaper rash is localized and typically managed in
primary care.
D — Incorrect: low-grade post-immunization fever is usually
self-limited.
Teaching point: Petechial rash + high fever + lethargy = urgent
escalation of care.
4)
,Chapter 1 – Pediatric Primary Care, Health Promotion &
Anticipatory Guidance
Which anticipatory guidance is most appropriate at the 2-
month well visit?
A. Begin solid foods tonight to aid sleep.
B. Discuss car-seat safety, immunization schedule, and exclusive
breastfeeding support.
C. Delay routine vaccinations until 6 months to reduce fever
risk.
D. Recommend unstructured screen time to soothe the infant.
Correct answer: B
Rationale (correct): At early well visits, anticipatory guidance
focuses on safety (car seats), feeding (breastfeeding support),
and timely immunizations per Bright Futures/CDC schedules —
a core nursing role described in Burns (Chapter 1, “Health
Promotion and Prevention”). Elsevier Health+1
Incorrect:
A — Incorrect: solids are not recommended before ~4–6
months.
C — Incorrect: delaying routine immunizations is not guideline-
concordant; CDC schedules start in infancy.
D — Incorrect: screen time is discouraged for infants.
Teaching point: Well visits combine safety, feeding support, and
on-schedule vaccinations.
,5)
Chapter 1 – Pediatric Primary Care, Scope & Alignment (Team
Roles)
A clinic policy states NPs should triage phone calls. Which action
matches appropriate scope-of-practice and safe delegation?
A. NP gives remote opioid prescriptions without evaluation.
B. NP collects a focused history, provides self-care advice, and
schedules urgent visits as indicated.
C. NP refuses to give any telephone advice, only in-person visits.
D. NP refers all calls to the physician regardless of issue.
Correct answer: B
Rationale (correct): NPs are qualified to perform telephone
triage with focused assessment and appropriate decision-
making (advice, urgent visit scheduling, or referral) consistent
with Burns’ coverage of scope and team alignment. Safe
prescribing or refusal to triage broadly would be inconsistent
with standard NP practice and clinic policies. Elsevier Health
Incorrect:
A — Incorrect: remote opioid prescribing without evaluation is
unsafe and likely out of scope.
C — Incorrect: telephone triage is a valid nursing/NP function.
D — Incorrect: automatic referral to physician can delay care
and misuses team skills.
Teaching point: Use scope-aligned triage: assess, advise, and
escalate when needed.
,6)
Chapter 1 – Pediatric Primary Care, Documentation & Legal
Issues
A 10-year-old reveals to the nurse that an adult in the home hits
them. The best immediate nursing action is:
A. Document the child’s statement and schedule a routine visit
next week.
B. Ask the child to write a note, then ignore unless parent
reports it.
C. Follow mandated-reporting laws and notify child protective
services immediately.
D. Tell the child not to tell anyone else to avoid family trouble.
Correct answer: C
Rationale (correct): Suspected child maltreatment requires
immediate action per legal mandates — document and report
to child protective services per Burns’ section on child
maltreatment and legal reporting. Nurses must follow
mandatory-reporting laws. Elsevier Health
Incorrect:
A — Incorrect: delaying or only documenting is insufficient
when abuse is suspected.
B — Incorrect: asking child to write and ignoring is unsafe and
legally inadequate.
D — Incorrect: discouraging disclosure is harmful and unethical.
,Teaching point: Suspected abuse → document facts and make a
mandatory report immediately.
7)
Chapter 2 – Unique Issues in Pediatrics, Developmental
Communication
A 6-year-old with abdominal pain sits quietly during exam.
Which communication strategy best elicits accurate assessment
of pain?
A. Ask only the parent for a history; the child will be unreliable.
B. Use developmentally appropriate, simple questions and pain
scales (faces scale) directly with the child.
C. Ignore the child’s response and proceed to medication.
D. Use complex medical terminology to test the child’s
understanding.
Correct answer: B
Rationale (correct): Pediatric assessment requires age-
appropriate communication; validated self-report tools (e.g.,
faces scale) should be used when possible. Burns emphasizes
developmentally tailored interviewing to get accurate data.
Elsevier Health
Incorrect:
A — Incorrect: parents provide useful details but child’s input is
essential when developmentally possible.
C — Incorrect: ignoring the child risks missing important clinical
,information.
D — Incorrect: complex language confuses and hinders
assessment.
Teaching point: Use developmentally appropriate tools (faces
scale) to assess pediatric pain.
8)
Chapter 2 – Unique Issues in Pediatrics, Family-Centered Care
Which statement best reflects family-centered care principles
for a hospitalized child?
A. Families should only visit during set hours to reduce
disruption.
B. Families are partners in care; involve them in decisions and
care planning.
C. Families are not allowed to participate in discharge planning.
D. Family opinions are secondary to clinician preference.
Correct answer: B
Rationale (correct): Family-centered care recognizes families as
partners and integral to planning and care—promoted in Burns’
“Unique Issues” chapter. Collaboration improves outcomes and
adherence. Elsevier Health
Incorrect:
A — Incorrect: restrictive visitation is contrary to family-
centered principles.
C — Incorrect: families should be central to discharge planning.
, D — Incorrect: family perspectives are important for culturally
competent care.
Teaching point: In pediatrics, families are partners in planning
and delivering care.
9)
Chapter 2 – Unique Issues in Pediatrics, Pain Management
A 12-year-old with a forearm fracture is anxious and reports
severe pain. Which nursing action is highest priority?
A. Provide age-appropriate explanation, administer prescribed
analgesic, and use distraction techniques.
B. Tell the teen to “tough it out” because kids recover quickly.
C. Delay analgesia until X-ray confirms fracture.
D. Offer only nonpharmacologic care like ice without
medication.
Correct answer: A
Rationale (correct): Effective pediatric pain management
combines timely pharmacologic analgesia, developmental
explanation, and complementary strategies; Burns emphasizes
prompt assessment and relief of pain. Delaying analgesia is
inappropriate. Elsevier Health
Incorrect:
B — Incorrect: minimizing pain is harmful.
C — Incorrect: pain relief should not be withheld while awaiting
imaging.
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Chapter 1: Pediatric Primary Care
Chapter 1 – Primary Care versus Primary Prevention
A 3-year-old arrives for a well-child visit. The nurse practitioner
(NP) explains the role of primary care to the parents. Which
statement best distinguishes primary care from primary
prevention?
A. Primary care focuses only on acute illness; primary
prevention provides routine health supervision.
B. Primary care provides continuous, relationship-based
services across life stages; primary prevention focuses on
preventing specific disease.
C. Primary care is delivered only in hospitals; primary
prevention occurs in community settings.
D. Primary care and primary prevention are interchangeable
terms.
Correct answer: B
,Rationale (correct): Primary care is continuous, comprehensive,
relationship-based care (the medical home), whereas primary
prevention targets interventions (e.g., immunizations,
anticipatory guidance) to prevent specific diseases. This
distinction is emphasized in Burns’ chapter on Pediatric Primary
Care (Chapter 1, “Primary Care vs Prevention”). Elsevier
Health+1
Incorrect:
A — Incorrect: primary care includes both acute and preventive
services, not “only acute.”
C — Incorrect: primary care is not limited to hospitals; it occurs
across settings (clinic, community, home).
D — Incorrect: terms are related but not interchangeable; they
describe different scopes.
Teaching point: Primary care = continuous relationship; primary
prevention = specific disease prevention.
2)
Chapter 1 – Pediatric Primary Care, The Pediatric Medical
Home
A parent asks why the clinic emphasizes a “medical home.”
Which NP response best reflects the AAP definition of a medical
home?
A. “It’s a single specialist who treats all your child’s conditions.”
B. “It’s a family-centered, coordinated approach providing
,accessible, continuous care.”
C. “It only focuses on urgent care needs.”
D. “It’s mainly a place for social services.”
Correct answer: B
Rationale (correct): The AAP-defined medical home is family-
centered, accessible, coordinated, comprehensive, and
continuous — core concepts in Burns’ chapter on Pediatric
Primary Care. This model emphasizes partnership between
clinicians and families. Elsevier Health+1
Incorrect:
A — Incorrect: medical home is team-based, not a single
specialist.
C — Incorrect: it includes preventive and chronic care, not only
urgent care.
D — Incorrect: social services may be part of coordination, but
the medical home is primarily clinical care integrated with
supports.
Teaching point: The pediatric medical home = coordinated,
family-centered, continuous care.
3)
Chapter 1 – Pediatric Primary Care, Levels of Care & Triage
During triage, a child with mild fever and a new rash is seen.
The nurse must decide whether immediate referral is needed.
Which finding most strongly suggests urgent referral rather than
,routine primary care follow-up?
A. Low-grade fever (38.0°C), maculopapular rash, active and
playful.
B. High fever (40.0°C), petechial rash, lethargy, and poor
perfusion.
C. Fever 38.2°C with localized diaper rash.
D. Intermittent low-grade fever with recent immunization.
Correct answer: B
Rationale (correct): Signs of petechiae, high fever, lethargy, and
poor perfusion suggest possible sepsis or meningococcemia and
require urgent referral to higher-level (secondary/tertiary)
care—consistent with Burns’ discussion of levels of care and
recognition of red flags. Elsevier Health
Incorrect:
A — Incorrect: child’s activity and low-grade fever favor routine
evaluation.
C — Incorrect: diaper rash is localized and typically managed in
primary care.
D — Incorrect: low-grade post-immunization fever is usually
self-limited.
Teaching point: Petechial rash + high fever + lethargy = urgent
escalation of care.
4)
,Chapter 1 – Pediatric Primary Care, Health Promotion &
Anticipatory Guidance
Which anticipatory guidance is most appropriate at the 2-
month well visit?
A. Begin solid foods tonight to aid sleep.
B. Discuss car-seat safety, immunization schedule, and exclusive
breastfeeding support.
C. Delay routine vaccinations until 6 months to reduce fever
risk.
D. Recommend unstructured screen time to soothe the infant.
Correct answer: B
Rationale (correct): At early well visits, anticipatory guidance
focuses on safety (car seats), feeding (breastfeeding support),
and timely immunizations per Bright Futures/CDC schedules —
a core nursing role described in Burns (Chapter 1, “Health
Promotion and Prevention”). Elsevier Health+1
Incorrect:
A — Incorrect: solids are not recommended before ~4–6
months.
C — Incorrect: delaying routine immunizations is not guideline-
concordant; CDC schedules start in infancy.
D — Incorrect: screen time is discouraged for infants.
Teaching point: Well visits combine safety, feeding support, and
on-schedule vaccinations.
,5)
Chapter 1 – Pediatric Primary Care, Scope & Alignment (Team
Roles)
A clinic policy states NPs should triage phone calls. Which action
matches appropriate scope-of-practice and safe delegation?
A. NP gives remote opioid prescriptions without evaluation.
B. NP collects a focused history, provides self-care advice, and
schedules urgent visits as indicated.
C. NP refuses to give any telephone advice, only in-person visits.
D. NP refers all calls to the physician regardless of issue.
Correct answer: B
Rationale (correct): NPs are qualified to perform telephone
triage with focused assessment and appropriate decision-
making (advice, urgent visit scheduling, or referral) consistent
with Burns’ coverage of scope and team alignment. Safe
prescribing or refusal to triage broadly would be inconsistent
with standard NP practice and clinic policies. Elsevier Health
Incorrect:
A — Incorrect: remote opioid prescribing without evaluation is
unsafe and likely out of scope.
C — Incorrect: telephone triage is a valid nursing/NP function.
D — Incorrect: automatic referral to physician can delay care
and misuses team skills.
Teaching point: Use scope-aligned triage: assess, advise, and
escalate when needed.
,6)
Chapter 1 – Pediatric Primary Care, Documentation & Legal
Issues
A 10-year-old reveals to the nurse that an adult in the home hits
them. The best immediate nursing action is:
A. Document the child’s statement and schedule a routine visit
next week.
B. Ask the child to write a note, then ignore unless parent
reports it.
C. Follow mandated-reporting laws and notify child protective
services immediately.
D. Tell the child not to tell anyone else to avoid family trouble.
Correct answer: C
Rationale (correct): Suspected child maltreatment requires
immediate action per legal mandates — document and report
to child protective services per Burns’ section on child
maltreatment and legal reporting. Nurses must follow
mandatory-reporting laws. Elsevier Health
Incorrect:
A — Incorrect: delaying or only documenting is insufficient
when abuse is suspected.
B — Incorrect: asking child to write and ignoring is unsafe and
legally inadequate.
D — Incorrect: discouraging disclosure is harmful and unethical.
,Teaching point: Suspected abuse → document facts and make a
mandatory report immediately.
7)
Chapter 2 – Unique Issues in Pediatrics, Developmental
Communication
A 6-year-old with abdominal pain sits quietly during exam.
Which communication strategy best elicits accurate assessment
of pain?
A. Ask only the parent for a history; the child will be unreliable.
B. Use developmentally appropriate, simple questions and pain
scales (faces scale) directly with the child.
C. Ignore the child’s response and proceed to medication.
D. Use complex medical terminology to test the child’s
understanding.
Correct answer: B
Rationale (correct): Pediatric assessment requires age-
appropriate communication; validated self-report tools (e.g.,
faces scale) should be used when possible. Burns emphasizes
developmentally tailored interviewing to get accurate data.
Elsevier Health
Incorrect:
A — Incorrect: parents provide useful details but child’s input is
essential when developmentally possible.
C — Incorrect: ignoring the child risks missing important clinical
,information.
D — Incorrect: complex language confuses and hinders
assessment.
Teaching point: Use developmentally appropriate tools (faces
scale) to assess pediatric pain.
8)
Chapter 2 – Unique Issues in Pediatrics, Family-Centered Care
Which statement best reflects family-centered care principles
for a hospitalized child?
A. Families should only visit during set hours to reduce
disruption.
B. Families are partners in care; involve them in decisions and
care planning.
C. Families are not allowed to participate in discharge planning.
D. Family opinions are secondary to clinician preference.
Correct answer: B
Rationale (correct): Family-centered care recognizes families as
partners and integral to planning and care—promoted in Burns’
“Unique Issues” chapter. Collaboration improves outcomes and
adherence. Elsevier Health
Incorrect:
A — Incorrect: restrictive visitation is contrary to family-
centered principles.
C — Incorrect: families should be central to discharge planning.
, D — Incorrect: family perspectives are important for culturally
competent care.
Teaching point: In pediatrics, families are partners in planning
and delivering care.
9)
Chapter 2 – Unique Issues in Pediatrics, Pain Management
A 12-year-old with a forearm fracture is anxious and reports
severe pain. Which nursing action is highest priority?
A. Provide age-appropriate explanation, administer prescribed
analgesic, and use distraction techniques.
B. Tell the teen to “tough it out” because kids recover quickly.
C. Delay analgesia until X-ray confirms fracture.
D. Offer only nonpharmacologic care like ice without
medication.
Correct answer: A
Rationale (correct): Effective pediatric pain management
combines timely pharmacologic analgesia, developmental
explanation, and complementary strategies; Burns emphasizes
prompt assessment and relief of pain. Delaying analgesia is
inappropriate. Elsevier Health
Incorrect:
B — Incorrect: minimizing pain is harmful.
C — Incorrect: pain relief should not be withheld while awaiting
imaging.
