# A 34-year-old client with central diabetes insipidus is starting desmopressin (DDAVP) intranasal spray. Which client statement indicates correct understanding of self-monitoring at home?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375122&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 34-year-old client with central diabetes insipidus is starting desmopressin (DDAVP) intranasal spray. Which client statement indicates correct understanding of self-monitoring at home?

## Option

1. I will drink at least 3 liters of water daily and monitor my intake closely to make sure I stay hydrated because if the medication wears off I could lose too much fluid, which could lead to symptoms like dizziness and weakness.
2. Once my excessive thirst and frequent urination have stopped, I can stop using the desmopressin because my body will be making enough antidiuretic hormone on its own, and I won't need medication any longer.
3. I will weigh myself daily, track urine output and intake, and report headache, nausea, confusion, or weight gain because they may signal water intoxication and hyponatremia. **✔ Correct answer**
4. I know the medication is working well if my urine output remains around 8 liters each day, which is normal for someone with central diabetes insipidus and shows that the dose is correct.

**Correct answer: 3**

## Explanation

Desmopressin (DDAVP) is a synthetic vasopressin analogue used for central diabetes insipidus, primary nocturnal enuresis, and von Willebrand disease/hemophilia A. In central DI it replaces ADH and reduces urine output by acting on V2 receptors in renal collecting ducts. Key teaching: (1) effective therapy reduces urine to a normal range — persistent polyuria of 8 L/day means inadequate dose; (2) the principal hazard is water intoxication and dilutional hyponatremia (Na less than 135) because water is retained — daily weight, intake/output diary, and reporting headache, nausea, vomiting, confusion, lethargy, seizures, or sudden weight gain are essential; (3) drink only to thirst, not preemptively, while on therapy; (4) intranasal route requires correct technique: clear nostril, prime if new bottle, alternate nostrils, store upright; oral and SC routes are alternatives; (5) periodic serum sodium is checked; (6) do not stop abruptly because polyuria and dehydration return rapidly; (7) avoid concurrent NSAIDs, SSRIs, carbamazepine, and chlorpropamide which potentiate antidiuresis. Stopping when symptoms improve, drinking excess water, or accepting 8 L/day output are all unsafe.

## In-depth explanation

The single most important DDAVP teaching point is the hyponatremia/water intoxication warning. Daily weight plus intake/output plus neurologic symptom reporting is the home monitoring trio.

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