Burns’ Pediatric Primary Care (8th Ed.) — Complete Chapter-
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 9, 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, is not yet able to copy a
circle or a cross. Based on typical developmental milestones,
what is the nurse practitioner's best response?
Options:
A. "This is a significant delay; a referral to early intervention is
necessary."
B. "This is typical development; copying a cross is not expected
until age 5."
C. "This is typical development; copying a circle is the expected
milestone for a 4-year-old."
,D. "This is a mild delay; we should re-evaluate this skill in 6
months."
Correct Answer: C
Rationales:
• Correct: According to developmental milestones, a 4-year-
old child should be able to copy a circle. Copying a cross is
a milestone typically achieved by age 5. The child's verbal
and block-building skills are also age-appropriate.
• Incorrect A: This is not a significant delay that warrants an
immediate early intervention referral, as copying a circle is
the expected milestone for this age.
• Incorrect B: While copying a cross is expected at age 5, the
ability to copy a circle is the relevant milestone for a 4-
year-old, and this child has not met it, making this
statement inaccurate for the scenario.
• Incorrect D: This is not a delay at all; it is typical
development. The child is meeting the expected milestone
of copying a circle.
Teaching Point: A 4-year-old should copy a circle; a 5-year-old
copies a cross.
Question 2
Reference: Ch. 44, Section: Asthma
,Question Stem:
A 7-year-old with persistent asthma is being reassessed. They
use a low-dose inhaled corticosteroid (ICS) daily but still have
nighttime symptoms twice a week. According to the stepwise
approach to asthma management, what is the most appropriate
next step?
Options:
A. Continue the current low-dose ICS and add a short-acting
beta-agonist (SABA) at bedtime.
B. Discontinue the ICS and switch to a leukotriene receptor
antagonist (LTRA).
C. Increase the dose of the inhaled corticosteroid to a medium-
dose regimen.
D. Refer the patient to a pulmonologist for consideration of
biologic therapy.
Correct Answer: C
Rationales:
• Correct: The stepwise approach recommends increasing
the controller therapy if asthma is not well-controlled on
the current step. For a patient on a low-dose ICS with
persistent symptoms, stepping up to a medium-dose ICS is
the preferred action.
• Incorrect A: Adding a SABA at bedtime is reactive, not
preventive. It addresses symptoms but does not improve
underlying inflammation and control.
, • Incorrect B: Discontinuing an effective controller
medication (ICS) is inappropriate and would likely worsen
control. An LTRA may be an option as monotherapy for
mild persistent asthma, but not when stepping up from an
ICS.
• Incorrect D: Referral for biologics is reserved for severe,
persistent asthma that is not controlled with high-dose ICS
and other controllers, which is not the case here.
Teaching Point: For uncontrolled persistent asthma on low-dose
ICS, step up therapy to medium-dose ICS.
Question 3
Reference: Ch. 24, Section: Health Promotion
Question Stem:
The parent of a 2-month-old infant, due for their first DTaP, IPV,
PCV13, and RV vaccines, tells the nurse practitioner they are
worried about "overloading the baby's immune system." What
is the most effective, evidence-based response?
Options:
A. "We can delay the rotavirus vaccine until the next visit to
reduce the number of shots."
B. "I understand your concern, but your baby's immune system
is capable of handling many more antigens than are in these
vaccines."
C. "You are right to be concerned; we will spread these vaccines
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 9, 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, is not yet able to copy a
circle or a cross. Based on typical developmental milestones,
what is the nurse practitioner's best response?
Options:
A. "This is a significant delay; a referral to early intervention is
necessary."
B. "This is typical development; copying a cross is not expected
until age 5."
C. "This is typical development; copying a circle is the expected
milestone for a 4-year-old."
,D. "This is a mild delay; we should re-evaluate this skill in 6
months."
Correct Answer: C
Rationales:
• Correct: According to developmental milestones, a 4-year-
old child should be able to copy a circle. Copying a cross is
a milestone typically achieved by age 5. The child's verbal
and block-building skills are also age-appropriate.
• Incorrect A: This is not a significant delay that warrants an
immediate early intervention referral, as copying a circle is
the expected milestone for this age.
• Incorrect B: While copying a cross is expected at age 5, the
ability to copy a circle is the relevant milestone for a 4-
year-old, and this child has not met it, making this
statement inaccurate for the scenario.
• Incorrect D: This is not a delay at all; it is typical
development. The child is meeting the expected milestone
of copying a circle.
Teaching Point: A 4-year-old should copy a circle; a 5-year-old
copies a cross.
Question 2
Reference: Ch. 44, Section: Asthma
,Question Stem:
A 7-year-old with persistent asthma is being reassessed. They
use a low-dose inhaled corticosteroid (ICS) daily but still have
nighttime symptoms twice a week. According to the stepwise
approach to asthma management, what is the most appropriate
next step?
Options:
A. Continue the current low-dose ICS and add a short-acting
beta-agonist (SABA) at bedtime.
B. Discontinue the ICS and switch to a leukotriene receptor
antagonist (LTRA).
C. Increase the dose of the inhaled corticosteroid to a medium-
dose regimen.
D. Refer the patient to a pulmonologist for consideration of
biologic therapy.
Correct Answer: C
Rationales:
• Correct: The stepwise approach recommends increasing
the controller therapy if asthma is not well-controlled on
the current step. For a patient on a low-dose ICS with
persistent symptoms, stepping up to a medium-dose ICS is
the preferred action.
• Incorrect A: Adding a SABA at bedtime is reactive, not
preventive. It addresses symptoms but does not improve
underlying inflammation and control.
, • Incorrect B: Discontinuing an effective controller
medication (ICS) is inappropriate and would likely worsen
control. An LTRA may be an option as monotherapy for
mild persistent asthma, but not when stepping up from an
ICS.
• Incorrect D: Referral for biologics is reserved for severe,
persistent asthma that is not controlled with high-dose ICS
and other controllers, which is not the case here.
Teaching Point: For uncontrolled persistent asthma on low-dose
ICS, step up therapy to medium-dose ICS.
Question 3
Reference: Ch. 24, Section: Health Promotion
Question Stem:
The parent of a 2-month-old infant, due for their first DTaP, IPV,
PCV13, and RV vaccines, tells the nurse practitioner they are
worried about "overloading the baby's immune system." What
is the most effective, evidence-based response?
Options:
A. "We can delay the rotavirus vaccine until the next visit to
reduce the number of shots."
B. "I understand your concern, but your baby's immune system
is capable of handling many more antigens than are in these
vaccines."
C. "You are right to be concerned; we will spread these vaccines
