# 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. Which statement before discharge shows that her teaching was effective?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630390  
> 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.

Which statement before discharge shows that her teaching was effective?

## 보기

1. "I can stop the stool softener as soon as I have one bowel movement."
2. "I will try not to cough, even if phlegm builds up in my chest."
3. "I should stay in bed for most of the first 2 weeks to protect the mesh."
4. "I will avoid heavy lifting for the time my surgeon set, pain or not." **✔ 정답**

**정답: 4**

## 해설

After hernia repair, clients avoid heavy lifting and strenuous activity for the period the surgeon advises, even when pain has gone, while walking daily. They prevent straining with fiber and laxatives as ordered and splint the incision when coughing rather than suppressing the cough.

## 심화 해설

The statement that shows effective teaching
After hernia repair, the main goal of discharge teaching is to protect the repair while it heals. Clients avoid heavy lifting and strenuous activity for the period the surgeon advises, even when pain has gone. The statement that she will avoid heavy lifting for the time her surgeon set, pain or not, shows she understands that the absence of pain does not mean the tissues have regained full strength.

Why pain is not a safe guide
Pain usually settles well before the repair reaches its full strength. Tissues and mesh need time to integrate, and sudden increases in intra-abdominal pressure from lifting, straining, or forceful exertion stress the repair during this period. If the client resumes heavy lifting as soon as she feels well, she risks recurrence. Following the surgeon's time frame, rather than her own comfort, is therefore the correct principle.

Other parts of the teaching plan
Several other measures also limit pressure on the repair. Straining is prevented with fiber, fluids, and stool softeners or laxatives as ordered, and these continue throughout healing. When she needs to cough, she splints the incision with a pillow rather than suppressing the cough, because retained secretions raise the risk of pneumonia, especially in an older adult. Walking daily is encouraged to prevent clots, constipation, and lung complications.

| Statement | Assessment | Correct teaching |
| --- | --- | --- |
| Stop the stool softener after one bowel movement | Needs correction | Continue bowel measures to prevent straining during healing |
| Try not to cough | Needs correction | Cough and deep breathe while splinting the incision |
| Stay in bed for most of 2 weeks | Needs correction | Walk daily; bed rest increases complications |
| Avoid heavy lifting for the set time, pain or not | Correct | Lifting limits follow the surgeon's advice |

Why the other statements are wrong
Stopping the stool softener after one bowel movement removes protection against straining too early. Suppressing a cough allows secretions to accumulate. Prolonged bed rest increases the risk of deep vein thrombosis, pneumonia, constipation, and deconditioning, and it does not protect the mesh.

Exam takeaway
Key point After hernia repair: no heavy lifting for the surgeon's time frame, prevent straining, splint when coughing, and walk daily. Answers that rely on pain as the guide or on bed rest are distractors.

## 임상 시나리오

Discharge Teaching After Hernia RepairProtecting the repair while it heals
The client avoids heavy lifting and strenuous activity for the period the surgeon sets, even after pain resolves, because tissue strength returns more slowly than comfort.

Straining is prevented with fiber, fluids, and stool softeners as ordered. She splints the incision with a pillow when coughing and walks daily to prevent complications.

CautionBed rest and cough suppression are not protective; they increase the risk of clots, pneumonia, and constipation.

## 핵심 개념

- **Splinting** — Supporting an incision with a pillow or hands during coughing to reduce pain and strain on the wound.
- **Hernia recurrence** — Return of a hernia at the site of a previous repair, often after early strain on healing tissue.
- **Stool softener** — A medicine that draws water into stool to prevent hard stool and straining.
- **Intra-abdominal pressure** — Pressure within the abdomen, which rises with lifting, straining, and coughing.

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