# Situation: A 72-year-old woman has had a small, soft bulge just below the right inguinal ligament for a year; it used to disappear when she lay down. She is admitted with 8 hours of severe right groin pain, and the bulge is now tense, tender, and cannot be pushed back. Soon after admission, she asks the nurse to push the bulge back in, as she used to do at home. What should the nurse do?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630387  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 72-year-old woman has had a small, soft bulge just below the right inguinal ligament for a year; it used to disappear when she lay down. She is admitted with 8 hours of severe right groin pain, and the bulge is now tense, tender, and cannot be pushed back.

Soon after admission, she asks the nurse to push the bulge back in, as she used to do at home. What should the nurse do?

## 보기

1. Help her lie flat and press gently on the bulge
2. Give sips of clear fluid to ease her nausea
3. Leave the bulge alone and notify the surgeon **✔ 정답**
4. Apply a warm pack to relax the tissue, then retry

**정답: 3**

## 해설

An incarcerated hernia may be strangulated, so the nurse does not attempt to reduce it; gentle reduction is tried only by a provider when strangulation is not suspected. The client is kept nothing by mouth (NPO) and prepared for possible emergency surgery while the nurse monitors for strangulation.

## 심화 해설

The safe action
She has a groin bulge below the inguinal ligament that used to reduce when she lay down but is now tense, tender, irreducible, and painful for 8 hours. This is an incarcerated hernia, and it may already be strangulated. The nurse does not attempt to push the bulge back; the nurse leaves it alone and notifies the surgeon. Gentle reduction is attempted only by a provider and only when strangulation is not suspected. Meanwhile she is kept nothing by mouth (NPO) and prepared for possible emergency surgery, while the nurse monitors for signs of strangulation.

Why forcing reduction is dangerous
A bulge just below the inguinal ligament in an older woman fits a femoral hernia, which has a narrow neck and a high risk of incarceration and strangulation. When bowel is trapped, its venous return is obstructed first, causing swelling, and then its arterial supply fails, causing ischemia. If the nurse forces this bowel back into the abdomen, compromised or dead bowel can be pushed out of sight, where it may perforate and cause peritonitis without obvious warning. Forcing reduction can also injure the bowel directly. The decision to reduce requires a provider's assessment of whether the bowel is still viable.

Why the other actions are wrong
Lying flat and pressing on the bulge is exactly the reduction attempt that must be avoided. Sips of clear fluid break NPO status in a client who may need emergency surgery and anesthesia. A warm pack, then retry combines an unhelpful measure with a repeated reduction attempt; heat does not make reduction safe, and the nurse should not attempt it at all.

| Hernia state | Description | Nursing response |
| --- | --- | --- |
| Reducible | Contents return with lying down or gentle pressure | Routine care and teaching |
| Incarcerated | Cannot be pushed back | Do not reduce; notify surgeon; NPO |
| Strangulated | Blood supply compromised | Surgical emergency |

Monitoring while awaiting the surgeon
The nurse assesses pain character, vital signs, vomiting, passage of flatus and stool, and the appearance of the bulge. Constant severe pain, fever, tachycardia, rising lactate, and discoloration of the skin over the hernia suggest strangulation and require urgent escalation.

Exam takeaway
Watch out A client's request to repeat what she does at home is a common trap. Once a hernia is irreducible and tender, the nurse's role is to leave it alone, keep the client NPO, and notify the surgeon.

## 임상 시나리오

Incarcerated Groin HerniaDo not push it back
A previously reducible bulge that is now tense, tender, and irreducible indicates an incarcerated hernia, which may be strangulated. Forcing it back can return ischemic bowel to the abdomen.

The nurse leaves the bulge alone, notifies the surgeon, keeps the client NPO, and prepares for possible emergency surgery. Only a provider attempts gentle reduction, and only if strangulation is not suspected.

CautionWatch for constant severe pain, fever, tachycardia, and skin discoloration over the bulge; these suggest strangulation, a surgical emergency.

## 핵심 개념

- **Incarcerated hernia** — A hernia whose contents are trapped and cannot be returned to the abdominal cavity.
- **Strangulated hernia** — An incarcerated hernia in which the blood supply to the trapped tissue is compromised.
- **Femoral hernia** — A hernia through the femoral canal below the inguinal ligament, more common in women and prone to strangulation.
- **Reduction** — Returning herniated contents to their normal position in the abdomen.

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