# A client with symptomatic hyponatremia is beginning tolvaptan. Which order should the nurse question?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522892&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client with symptomatic hyponatremia is beginning tolvaptan. Which order should the nurse question?

## Option

1. Initiate therapy in a hospital with frequent sodium monitoring.
2. Allow access to water according to thirst during the initial correction period unless another urgent indication changes the plan.
3. Monitor for overly rapid sodium correction and neurologic change.
4. Restrict all oral fluid during the first 24 hours to accelerate sodium correction. **✔ Correct answer**

**Correct answer: 4**

## Explanation

Tolvaptan must be initiated or reinitiated in a hospital. Fluid restriction during the first 24 hours can increase the risk of overly rapid sodium correction and should generally be avoided.

## In-depth explanation

Quick answer
Prevent overcorrection by monitoring sodium and avoiding early forced fluid restriction.

Why this is correct
Rapid correction can cause osmotic demyelination, so the desired endpoint is controlled rather than maximal aquaresis.

Easy analogy or mental picture
Build a medication-safety chain: identify the new cue, connect it to the drug mechanism or labeled limitation, stop preventable exposure, stabilize the client, and verify a measurable response.

Memory hook
Drug, urgent cue, protective action, and reassessment endpoint.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving indicated treatment and required monitoring.

Why the other choices are wrong
Options that continue a suspect exposure, normalize a labeled danger cue, substitute an unauthorized dose, or delay escalation leave the client at risk.References
1DailyMed: SAMSCA (tolvaptan)Hospital initiation and prevention of overly rapid sodium correction

## Clinical scenario

Medication-safety review
Verify indication, current assessment, dose and route, organ function, interactions, urgent toxicity cues, authorized action, and measurable follow-up.

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