# 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. After 3 days of treatment, which finding BEST shows that his condition is improving?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630415  
> 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.

After 3 days of treatment, which finding BEST shows that his condition is improving?

## 보기

1. He is oriented, and his headache has eased **✔ 정답**
2. Weight has risen by 1.5 kg since admission
3. Urine specific gravity has risen to 1.030
4. Urine output has fallen to 20 mL per hour

**정답: 1**

## 해설

The symptoms of hyponatremia from SIADH — headache, confusion, and lethargy — follow the sodium level, so clearing confusion and easing headache show that water balance is improving. Falling urine output, weight gain, and more concentrated urine show continued water retention.

## 심화 해설

The finding that shows improvement
After 3 days of treatment for SIADH, the best evidence of improvement is clinical. The symptoms of hyponatremia from SIADH, such as headache, confusion, and lethargy, follow the sodium level, so clearing confusion and easing headache show that water balance is improving. The client who is now oriented with an eased headache is responding to treatment.

Why neurologic symptoms track sodium
When serum sodium falls, water moves from the blood into brain cells by osmosis, causing cerebral edema. This produces headache, nausea, confusion, lethargy, and, if severe, seizures and coma. As fluid restriction and other treatment remove excess free water and sodium rises, the water shift reverses and brain swelling resolves. Neurologic improvement is therefore a direct reflection of correcting the underlying imbalance. The nurse also confirms improvement with serum sodium levels and watches that correction is not too rapid.

| Finding | Meaning | Improvement? |
| --- | --- | --- |
| Oriented; headache eased | Sodium and water balance improving | Yes |
| Weight up 1.5 kg | More water retained | No |
| Urine specific gravity 1.030 | Persistent inappropriate concentration | No |
| Urine output 20 mL/h | Kidneys still retaining water | No |

Why the other findings show continued retention
Weight gain of 1.5 kg shows more water retained, which worsens dilutional hyponatremia. A urine specific gravity of 1.030 indicates highly concentrated urine, showing that the inappropriate antidiuretic effect continues. Urine output of 20 mL per hour shows that the kidneys are still holding water under excess antidiuretic hormone. In successful treatment of SIADH, urine output tends to rise, urine becomes less concentrated, and weight falls toward baseline.

Nursing application
The nurse continues neurologic checks, daily weights under standardized conditions, strict intake and output, and serial sodium levels. Rapid correction of chronic hyponatremia can cause osmotic demyelination, so the nurse reports a sodium that rises faster than the ordered target. Seizure precautions remain in place until sodium is stable.

Exam takeaway
Key point In SIADH, improvement means better mentation, rising urine output, less concentrated urine, and falling weight. Findings of retention mean the problem persists.

## 임상 시나리오

Evaluating SIADH TreatmentSigns that water balance is improving
Headache and confusion in SIADH result from cerebral edema caused by low sodium. When the client becomes oriented and the headache eases, sodium and water balance are improving.

Weight gain, a urine specific gravity of 1.030, and urine output of 20 mL/h all show continued water retention, not improvement.

CautionCorrect chronic hyponatremia gradually. Report a sodium rising faster than the ordered target because of the risk of osmotic demyelination.

## 핵심 개념

- **Cerebral edema** — Swelling of brain tissue, which in hyponatremia results from water moving into brain cells.
- **Urine specific gravity** — A measure of urine concentration; high values indicate concentrated urine.
- **Osmotic demyelination** — Brain injury that can occur when chronic hyponatremia is corrected too rapidly.
- **Hyponatremia** — Serum sodium below the normal range, commonly below 135 mEq/L.

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