# 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. She undergoes open repair with mesh. Per unit protocol, the nurse catheterizes if a bladder scan shows more than 500 mL, or if the volume left in the bladder after voiding is more than 200 mL. 4 hours after surgery: bladder scan 420 mL; she then voids 300 mL 8 hours after surgery: she voids 90 mL; a bladder scan right after voiding shows 380 mL Her urine is clear yellow. Which interpretation is correct at 8 hours?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630389  
> 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.

She undergoes open repair with mesh. Per unit protocol, the nurse catheterizes if a bladder scan shows more than 500 mL, or if the volume left in the bladder after voiding is more than 200 mL.
4 hours after surgery: bladder scan 420 mL; she then voids 300 mL
8 hours after surgery: she voids 90 mL; a bladder scan right after voiding shows 380 mL
Her urine is clear yellow. Which interpretation is correct at 8 hours?

## 보기

1. No retention; the scan result stays below the 500-mL limit
2. Retention; the volume after voiding is over the limit **✔ 정답**
3. Bladder injury, shown by her small voided volume
4. Fluid deficit, shown by the falling amount voided

**정답: 2**

## 해설

At 8 hours she voided only 90 mL and 380 mL remained in the bladder. The protocol's post-void limit is 200 mL, so this is urinary retention even though the volume is under the 500-mL limit that applies before voiding. Retention is common after groin surgery; the nurse catheterizes as the protocol directs.

## 심화 해설

Correct interpretation at 8 hours
The protocol has two separate limits: catheterize if a bladder scan shows more than 500 mL, or if the volume left in the bladder after voiding is more than 200 mL. At 8 hours she voided only 90 mL, and a scan right after voiding showed 380 mL. Because this is a post-void residual, the 200-mL limit applies, so she has urinary retention even though 380 mL is below the 500-mL limit that applies before voiding. The nurse catheterizes as the protocol directs.

Applying the right limit to the right measurement
A pre-void scan measures how full the bladder is before the client tries to void; a large volume suggests she cannot start voiding effectively. A post-void residual (PVR) measures how much remains after she has voided; it tells the nurse whether the bladder is emptying. At 4 hours, the scan of 420 mL was before voiding and was below 500 mL, and she then voided a good 300 mL, so no action was needed. At 8 hours, the small void of 90 mL followed by 380 mL remaining shows incomplete emptying. The common error is comparing the post-void number with the pre-void limit.

| Time | Measurement | Limit that applies | Result |
| --- | --- | --- | --- |
| 4 hours | Scan 420 mL before voiding; voided 300 mL | Pre-void: more than 500 mL | No retention |
| 8 hours | Voided 90 mL; residual 380 mL | Post-void: more than 200 mL | Retention |

Why retention is common after groin surgery
Urinary retention after inguinal or femoral hernia repair is common. Contributing factors include anesthesia, opioid analgesia, pain and spasm near the operative site, older age, and IV fluids that fill the bladder quickly. An overdistended bladder can stretch the detrusor muscle and make later voiding harder, so timely catheterization matters.

Why the distractors are wrong
No retention applies the wrong limit. Bladder injury would typically cause hematuria or painful urination, and her urine is clear yellow. A fluid deficit is unlikely because the kidneys are clearly producing urine; 380 mL is sitting in the bladder. A small voided volume with a large residual means poor emptying, not low production.

Exam takeaway
Watch out In protocol questions, first identify whether each number is a pre-void scan or a post-void residual, then apply the matching limit.

## 임상 시나리오

Postoperative Urinary RetentionMatching the scan to the right limit
The protocol uses two limits: more than 500 mL on a pre-void scan, or more than 200 mL as a post-void residual. Each limit applies only to its own type of measurement.

At 8 hours she voided 90 mL and 380 mL remained. The post-void residual exceeds 200 mL, so this is urinary retention, and the nurse catheterizes per protocol.

CautionRetention is common after groin surgery because of anesthesia, opioids, and pain. Do not compare a post-void residual with the pre-void limit.

## 핵심 개념

- **Post-void residual** — The volume of urine remaining in the bladder immediately after voiding.
- **Bladder scan** — A portable ultrasound measurement of the volume of urine in the bladder.
- **Urinary retention** — Inability to empty the bladder completely or at all.
- **Herniorrhaphy** — Surgical repair of a hernia, often reinforced with synthetic mesh.

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