# A client receiving pembrolizumab reports frequent watery stools above baseline. Classify each finding by the decision it supports.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522095&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client receiving pembrolizumab reports frequent watery stools above baseline. Classify each finding by the decision it supports.

|  | Immune-mediated colitis cue | Volume-loss cue | Requires prompt treatment-team escalation |
| --- | --- | --- | --- |
| Frequent watery stools above baseline during the past 24 hours |  |  |  |
| New cramping abdominal pain |  |  |  |
| Dry mucous membranes with HR 112/min |  |  |  |
| Creatinine increased from 0.8 to 1.4 mg/dL |  |  |  |
| Diarrhea began after pembrolizumab treatment |  |  |  |
| A formed stool after oral hydration |  |  |  |

## Explanation

New frequent diarrhea and abdominal pain suggest immune-mediated colitis; dry mucosa, tachycardia, and creatinine rise show volume loss; the pattern requires prompt oncology evaluation rather than self-treatment alone.

## In-depth explanation

Quick answer
Link immune toxicity, perfusion impact, and escalation.

Why this is correct
Immune-mediated colitis may occur during or after checkpoint-inhibitor treatment and can require withholding therapy, diagnostic evaluation, and corticosteroid treatment according to severity.

Easy analogy or mental picture
Treat medication safety like airway triage: identify the threat, interrupt exposure, support physiology, and verify a durable response.

Memory hook
Cue, risk, action, response, recurrence check.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving reassessment and escalation.

Why the other choices are wrong
Options that normalize deterioration, add interacting medication, or delay rescue leave the safety loop open.References
1DailyMed: KEYTRUDA (pembrolizumab)Immune-mediated colitis, diarrhea assessment, treatment interruption, and corticosteroid management

## Clinical scenario

Medication safety review
Verify the indication, current assessment, respiratory and neurologic status, interactions, authorized rescue action, and measurable follow-up.

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