# Situation: A 27-year-old man has passed about 6 liters of urine a day for 2 months and is always thirsty, preferring ice-cold water. His serum sodium is 144 mEq/L (135–145), and his urine specific gravity is 1.002. He takes no medicines. He is admitted for a supervised water deprivation test. He is discharged on desmopressin. Which statement by the client shows that the teaching was effective?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630514  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 27-year-old man has passed about 6 liters of urine a day for 2 months and is always thirsty, preferring ice-cold water. His serum sodium is 144 mEq/L (135–145), and his urine specific gravity is 1.002. He takes no medicines. He is admitted for a supervised water deprivation test.

He is discharged on desmopressin. Which statement by the client shows that the teaching was effective?

## 보기

1. "I will drink only when thirsty and weigh myself daily." **✔ 정답**
2. "I will drink at least 3 liters of water a day, as before."
3. "I will stop the drug on days when I am not thirsty."
4. "I will take an extra dose whenever my urine looks pale."

**정답: 1**

## 해설

The main risk of desmopressin is water retention and hyponatremia, so clients drink only to thirst and weigh themselves daily. Forcing fluids or taking extra doses increases that risk, and stopping the drug brings back heavy urination.

## 심화 해설

The main risk of desmopressin
Desmopressin acts on the kidney's collecting ducts to retain water, replacing the vasopressin he lacks. That is how it controls his polyuria, but it also means his body holds onto water. If he keeps drinking large amounts out of habit, the retained water dilutes his blood and causes hyponatremia, which can lead to headache, nausea, confusion, seizures, and, in severe cases, water intoxication. Drinking only when thirsty and weighing daily protect against water retention and hyponatremia.

Why the correct statement works
Thirst is a reliable guide to water needs when the hormone is replaced. By drinking to thirst, he takes in roughly what his body needs. Daily weights detect water retention early: a rapid gain over a day or two suggests he is holding too much fluid, and he should contact his provider. He should also know the early signs of hyponatremia, such as headache, nausea, and unusual drowsiness, and report them promptly.

| Client statement | Effect | Correct? |
| --- | --- | --- |
| Drink only when thirsty and weigh daily | Prevents water retention | Yes |
| Drink at least 3 liters a day, as before | Water retention and hyponatremia | No |
| Stop the drug on days without thirst | Polyuria and dehydration return | No |
| Extra dose when urine looks pale | Water intoxication risk | No |

Why the other statements are unsafe
Before treatment he drank about as much as he urinated, around 6 liters a day; continuing to force at least 3 liters while the drug holds water in the body leads to hyponatremia. Stopping the drug on days without thirst brings back heavy urination and dehydration, because his lack of vasopressin is ongoing. Taking extra doses based on how pale the urine looks is unreliable and raises the risk of water intoxication. Watch out! After starting desmopressin, the danger shifts from dehydration to water overload, and teaching must change with it.

Exam takeaway
Desmopressin teaching includes taking it as prescribed, drinking to thirst, daily weights, recognizing signs of hyponatremia, and reporting a return of heavy urination. Key point! With desmopressin, the client drinks only to thirst and weighs daily; forcing fluids or taking extra doses causes hyponatremia.

## 임상 시나리오

Desmopressin TeachingPreventing water retention and hyponatremia
Desmopressin makes the kidneys retain water, so excess drinking leads to hyponatremia.

Teach the client to drink only when thirsty and weigh daily; report rapid weight gain, headache, nausea, or confusion.

Take doses as prescribed; do not stop on days without thirst or take extra doses based on urine color.

CautionSevere hyponatremia can cause seizures; forcing fluids while on desmopressin is unsafe.

## 핵심 개념

- **Desmopressin** — A synthetic vasopressin analog that reduces urine output by increasing water reabsorption in the kidney.
- **Hyponatremia** — A serum sodium below the normal range, often from water retention diluting body sodium.
- **Water intoxication** — Severe dilution of body fluids from excess water, causing brain swelling, confusion, and seizures.

## 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._