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Brian Sanders Pharmacology Clinical Reasoning 2023
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Brian Sanders Pharmacology Clinical Reasoning 2023
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Brian Sanders Pharmacology Clinical Reasoning2023/2024
1. Which condition in a child should alert a nurse for increased fluid requirements?
a. Fever
b. Mechanical ventilation
c. Congestive heart failure
d. Increased intracranial pressure (ICP) - ANSWERFever
ANS: A
Fever leads to great insensible fluid loss in young children because of increased
body surface area relative to fluid volume. Respiratory rate influences insensible fluid
loss and should be monitored in the mechanically ventilated child. Congestive heart
failure is a case of fluid overload in children. Increased ICP does not lead to
increased fluid requirements in children.
2. A nurse is conducting an in-service on gastrointestinal disorders. The nurse
includes that melena, the passage of black, tarry stools, suggests bleeding from
which area?
a. Perianal or rectal area
b. Hemorrhoids or anal fissures
c. Upper gastrointestinal (GI) tract
d. Lower GI tract - ANSWERUpper gastrointestinal (GI) tract
Melena is denatured blood from the upper GI tract or bleeding from the right colon.
Blood from the perianal or rectal area, hemorrhoids, or lower GI tract would be bright
red.
3. Which type of dehydration is defined as "dehydration that occurs in conditions in
which electrolyte and water deficits are present in approximately balanced
proportion"?
a. Isotonic dehydration
b. Hypotonic dehydration
c. Hypertonic dehydration
d.All types of dehydration in infants and small childre - ANSWERIsotonic dehydration
ANS: A
Isotonic dehydration is the correct term for this definition and is the most frequent
form of dehydration in children. Hypotonic dehydration occurs when the electrolyte
deficit exceeds the water deficit, leaving the serum hypotonic. Hypertonic
dehydration results from water loss in excess of electrolyte loss and is usually
caused by a proportionately larger loss of water or a larger intake of electrolytes.
This definition is specific to isotonic dehydration.
,4. A nurse is admitting an infant with dehydration caused from water loss in excess
of electrolyte loss. Which type of dehydration is this infant experiencing?
a. Isotonic
b. Isosmotic
c. Hypotonic
d. Hypertonic - ANSWERHypertonic
Hypertonic dehydration results from water loss in excess of electrolyte loss. This is
the most dangerous type of dehydration. It is caused by feeding children fluids with
high amounts of solute. Isotonic dehydration occurs in conditions in which electrolyte
and water deficits are present in balanced proportion and is another term for isomotic
dehydration. Hypotonic dehydration occurs when the electrolyte deficit exceeds the
water deficit, leaving the serum hypotonic.
5. An infant is brought to the emergency department with dehydration. Which
physical assessment finding does the nurse expect?
a. Weight gain
b. Bradycardia
c.Poor skin turgor
d. Brisk capillary refill - ANSWERPoor skin turgor
Clinical manifestations of dehydration include poor skin turgor, weight loss, lethargy,
and tachycardia. The infant would have prolonged capillary refill, not brisk.
6. Parents call the clinic and report that their toddler has had acute diarrhea for 24
hours. The nurse should further ask the parents if the toddler has which associated
factor that is causing the acute diarrhea?
a. Celiac disease
b. Antibiotic therapy
c. Immunodeficiency
d. Protein malnutrition - ANSWERAntibiotic therapy
Acute diarrhea is a sudden increase in frequency and change in consistency of
stools and may be associated with antibiotic therapy. Celiac disease is a problem
with gluten intolerance and may cause chronic diarrhea if not identified and managed
appropriately. Immunodeficiency would occur with chronic diarrhea. Protein
malnutrition or kwashiorkor causes chronic diarrhea from lowered resistance to
infection.
7. Which pathogen is the viral pathogen that frequently causes acute diarrhea in
young children?
a. Giardia organisms
b. Shigella organisms
c. Rotavirus
d.Salmonella organisms - ANSWERANS: C
Rotavirus is the most frequent viral pathogen that causes diarrhea in young children.
Giardia (parasite) and Salmonella are bacterial pathogens that cause diarrhea.
Shigella is a bacterial pathogen that is uncommon in the United States.
, 8. Which is a parasite that causes acute diarrhea?
a. Shigella organisms
b. Salmonella organisms
c. Giardia lamblia
d. Escherichia coli - ANSWER*Giardia lamblia*
G. lamblia is a *parasite that represents 10% of non-dysenteric illness* in the United
States. Shigella, Salmonella, and E. coli are bacterial pathogens.
9. A child is admitted with bacterial gastroenteritis. Which lab results of a stool
specimen confirm this diagnosis?
a. Eosinophils
b. Occult blood
c. pH less than 6
d. Neutrophils and red blood cells - ANSWERNeutrophils and red blood cells
Neutrophils and red blood cells in stool indicate bacterial gastroenteritis.
Protein intolerance and parasitic infections are suspected in the presence of
eosinophils.
Occult blood may indicate pathogens such as
1. Shigella,
2. Campylobacter, or
3. hemorrhagic Escherichia coli strains.
A pH of less than 6 may indicate carbohydrate malabsorption or secondary lactase
insufficiency.
10. Which therapeutic management should the nurse prepare to initiate first for a
child with acute diarrhea and moderate dehydration?
a. Clear liquids
b. Adsorbents, such as kaolin and pectin
c. Oral rehydration solution (ORS)
d. Antidiarrheal medications such as paregoric - ANSWEROral rehydration solution
(ORS)
ANS: C
ORS is the first treatment for acute diarrhea. Clear liquids are not recommended
because they contain too much sugar, which may contribute to diarrhea. Adsorbents
are not recommended. Antidiarrheals are not recommended because they do not get
rid of pathogens.
11. A school-age child with diarrhea has been rehydrated. The nurse is discussing
the child's diet with the family. Which statement by the parent would indicate a
correct understanding of the teaching?
a. "I will keep my child on a clear liquid diet for the next 24 hours."
b. "I should encourage my child to drink carbonated drinks but avoid food for the next
24 hours."
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