# A 63-year-old client is on postoperative day 1 after a total hip arthroplasty. The indwelling urinary catheter was removed 6 hours ago. Since removal the client has voided 25 to 40 mL three times, reports lower abdominal pressure, and has firm suprapubic fullness. A bladder scan after the most recent void shows 620 mL. Oral and IV intake since catheter removal is 1,300 mL. Medications include oxycodone 5 mg every 4 hours and a transdermal scopolamine patch for nausea. Temperature is 37.0 C (98.6 F), blood pressure 132/78 mm Hg, heart rate 86/min, and the voided urine is clear yellow. The client denies burning with urination. Complete the diagram by selecting the condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=617407&lang=en  
> language: en  
> subject: Elimination  
> category: BCC

## Question

A 63-year-old client is on postoperative day 1 after a total hip arthroplasty. The indwelling urinary catheter was removed 6 hours ago. Since removal the client has voided 25 to 40 mL three times, reports lower abdominal pressure, and has firm suprapubic fullness. A bladder scan after the most recent void shows 620 mL. Oral and IV intake since catheter removal is 1,300 mL. Medications include oxycodone 5 mg every 4 hours and a transdermal scopolamine patch for nausea. Temperature is 37.0 C (98.6 F), blood pressure 132/78 mm Hg, heart rate 86/min, and the voided urine is clear yellow. The client denies burning with urination. Complete the diagram by selecting the condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Condition

Select 1
Postoperative urinary retention
Catheter-associated urinary tract infection
Hypovolemia from surgical blood loss
Oliguric acute kidney injury

Actions to take

Select 2
Obtain a urine culture specimen before any drainage
Give a prescribed 500 mL IV fluid bolus
Perform intermittent straight catheterization
Reinsert an indwelling catheter for 24 hours
Review opioid and anticholinergic medications

Parameters to monitor

Select 2
Serum creatinine level
Postvoid residual volume
Orthostatic blood pressure
Volume of each void
Urine culture result

## Explanation

Small frequent voids with suprapubic fullness and 620 mL left in the bladder indicate retention, not low urine production. The nurse drains the bladder by intermittent catheterization per protocol and reviews the opioid and anticholinergic scopolamine that impair emptying. Postvoid residual and each voided volume show whether normal emptying returns. Reinserting an indwelling catheter increases infection risk and prevents a voiding trial.

## In-depth explanation

Quick answer
Postoperative urinary retention; perform intermittent catheterization per protocol, review the opioid and anticholinergic medications, and monitor postvoid residual volume and the volume of each void.

Why this is correct
The kidneys are producing urine: 620 mL is sitting in the bladder. The problem is outflow, worsened by an opioid that reduces bladder sensation and an anticholinergic patch that weakens detrusor contraction. Intermittent catheterization relieves overdistension with less infection risk than an indwelling catheter, and addressing contributing drugs improves the chance that spontaneous voiding returns.

Easy analogy or mental picture
Picture a full water tank with a kinked outlet hose: the tank keeps filling, only a trickle escapes, and the answer is to drain the tank and unkink the hose, not to add more water.

Memory hook
Small voids + big scan = retention; drain it straight, then find the drug that caused it.

NCLEX decision rule
Decide between a production problem and an outflow problem with an objective bladder volume; if the bladder is full, drain it by the least invasive method and remove the cause.

Why the other choices are wrong
Hypovolemia and acute kidney injury both cause low urine output, but a bladder holding 620 mL rules them out, so a fluid bolus, serum creatinine, and orthostatic readings track the wrong problem. Infection is unlikely with clear urine, no fever, and no dysuria; a culture before draining delays relief of overdistension. Reinserting an indwelling catheter is a common but outdated default that increases infection risk. A culture result does not show whether the bladder is emptying.

References
1CDC — CAUTI Guideline Summary of RecommendationsConsider intermittent catheterization and bladder scanning instead of indwelling catheters for postoperative retention.
2NIDDK — Urinary RetentionMedications such as anticholinergics and opioids can cause urinary retention.

## Clinical scenario

Scenario
Six hours after catheter removal, a postoperative client voids only 25 to 40 mL at a time, has suprapubic fullness, and a 620 mL postvoid bladder scan while taking oxycodone and scopolamine.

## Key concepts

- **Postvoid residual** — The volume of urine left in the bladder immediately after voiding, measured by bladder scan or catheterization.
- **Intermittent catheterization** — Temporary insertion of a straight catheter to drain the bladder, then removal.
- **Detrusor muscle** — The bladder wall muscle whose contraction empties the bladder; anticholinergics weaken it.

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