# Situation: A 63-year-old man with small cell lung cancer is admitted with headache and mild confusion. His blood pressure is 128/80 mmHg, his mucous membranes are moist, and he has no edema. He takes sertraline for depression. He is placed on a fluid restriction of 1,000 mL per 24 hours, counting all oral and intravenous intake. By 14:00 his intake is shown below. Coffee at breakfast: 150 mL Water with tablets: 60 mL Soup at lunch: 240 mL Ice chips (measured as melted water): 90 mL Intravenous antibiotic, 2 doses: 100 mL each How much fluid, in mL, remains for the rest of the 24 hours?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630413  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 63-year-old man with small cell lung cancer is admitted with headache and mild confusion. His blood pressure is 128/80 mmHg, his mucous membranes are moist, and he has no edema. He takes sertraline for depression.

He is placed on a fluid restriction of 1,000 mL per 24 hours, counting all oral and intravenous intake. By 14:00 his intake is shown below.

Coffee at breakfast: 150 mL
Water with tablets: 60 mL
Soup at lunch: 240 mL
Ice chips (measured as melted water): 90 mL
Intravenous antibiotic, 2 doses: 100 mL each

How much fluid, in mL, remains for the rest of the 24 hours?

## 보기

1. 500
2. 460
3. 350
4. 260 **✔ 정답**

**정답: 4**

## 해설

All liquids count: 150 + 60 + 240 + 90 + (2 × 100) = 740 mL, so 1,000 − 740 = 260 mL remains. The remaining allowance is spread over the rest of the day, and thirst is eased with oral care and sugar-free gum or candy.

## 심화 해설

Calculating the remaining allowance
He is on a fluid restriction of 1,000 mL per 24 hours that counts all oral and intravenous intake. All liquids count: 150 + 60 + 240 + 90 + (2 × 100) = 740 mL, so 1,000 − 740 = 260 mL remains. The answer is 260 mL.

What counts toward the restriction
In SIADH, the problem is excess free water, so every source of fluid matters. Coffee, water taken with tablets, soup, and ice chips all count, with ice chips recorded as their melted volume. IV medication diluents and flushes are also included when the order specifies all intake. Missing any single source makes the restriction less effective and can allow sodium to keep falling. The nurse keeps a running total throughout the day so that the remaining allowance is known at any time.

| Item | Volume |
| --- | --- |
| Coffee | 150 mL |
| Water with tablets | 60 mL |
| Soup | 240 mL |
| Ice chips (melted) | 90 mL |
| IV antibiotic, 2 doses | 200 mL |
| Total | 740 mL |
| Remaining | 260 mL |

Why the other answers are wrong
500 mL results from leaving out the soup. 460 mL results from leaving out the IV antibiotic volume. 350 mL results from leaving out the ice chips. Each distractor corresponds to a source that is commonly overlooked in practice, which is the lesson of the item.

Making the restriction tolerable
The remaining allowance is spread over the rest of the day rather than consumed at once. Thirst is eased with frequent oral care, mouth rinses that are not swallowed, and sugar-free gum or hard candy. The nurse explains the purpose of the restriction to the client and family so they do not bring extra drinks, and monitors sodium, neurologic status, and weight.

Exam takeaway
Watch out In fluid-restriction math, count every source, including ice chips as melted volume and IV medication diluent. Then subtract from the daily limit.

## 임상 시나리오

Fluid Restriction in SIADHCounting every source
The restriction is 1,000 mL per 24 hours, including oral and IV intake. Coffee 150, water 60, soup 240, ice chips 90, and IV antibiotic 200 total 740 mL.

The remaining allowance is 260 mL, spread over the rest of the day. Ice chips count as melted water, and IV diluent counts when all intake is included.

CautionOverlooking soup, ice chips, or IV volume allows excess free water and can worsen hyponatremia. Ease thirst with oral care and sugar-free gum.

## 핵심 개념

- **Fluid restriction** — A limit on total daily fluid intake, used in SIADH to correct dilutional hyponatremia.
- **Intake and output** — Measurement and recording of all fluids taken in and lost over a set period.
- **Free water** — Water without solutes, which dilutes serum sodium when retained.
- **Dilutional hyponatremia** — Low serum sodium caused by excess body water rather than sodium loss.

## 같은 주제 문제

- [Situation: A 58-year-old man with alcohol-associated cirrhosis is admitted with tense asci…](https://mymerci.kr/pages/nclex_q.php?qn_id=630291)
- [Situation: A 58-year-old man with alcohol-associated cirrhosis is admitted with tense asci…](https://mymerci.kr/pages/nclex_q.php?qn_id=630292)
- [Situation: A 58-year-old man with alcohol-associated cirrhosis is admitted with tense asci…](https://mymerci.kr/pages/nclex_q.php?qn_id=630293)
- [Situation: A 58-year-old man with alcohol-associated cirrhosis is admitted with tense asci…](https://mymerci.kr/pages/nclex_q.php?qn_id=630294)
- [Situation: A 58-year-old man with alcohol-associated cirrhosis is admitted with tense asci…](https://mymerci.kr/pages/nclex_q.php?qn_id=630295)
- [Situation: A 46-year-old woman with obesity is admitted with acute cholangitis caused by a…](https://mymerci.kr/pages/nclex_q.php?qn_id=630296)
- [Situation: A 46-year-old woman with obesity is admitted with acute cholangitis caused by a…](https://mymerci.kr/pages/nclex_q.php?qn_id=630297)
- [Situation: A 46-year-old woman with obesity is admitted with acute cholangitis caused by a…](https://mymerci.kr/pages/nclex_q.php?qn_id=630298)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._