Alex

"I really need to get up, right now, please!"

She seems frantic. You assist her to the bedside commode.

Take Card #38

Card 38 back
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Assessment

You emphasize it is important that you assess her abdomen, but she tenses up.

Alex

"I really don't want anyone examining me down there. Can we just skip that part?"

How should you respond?

Skipping the assessment doesn't address why Alex is uncomfortable, and it leaves a potential problem unassessed. Try again.

Rushing past her concern without acknowledging it can increase anxiety rather than ease it. Try again.

Naming her discomfort, explaining the reason for the assessment, and reassuring her about privacy addresses her anxiety directly instead of brushing past it, and makes it more likely she'll tolerate the exam you actually need to do.

Recognize Cues

Assessment

What Do You Notice?

Select all findings that are relevant to your concern right now.

Distended, firm lower abdomen

Relevant: a firm, distended abdomen fits the pattern you're concerned about.

Voiding only small amounts frequently since surgery

Relevant: frequent, small-volume voids are a key part of this pattern.

Mild swelling at the incision edges

Worth tracking, but this points toward a wound issue, not the pattern you're seeing here.

Temperature of 99.8°F

Worth tracking, but a mild temperature elevation on its own doesn't fit this pattern.

Restlessness and reported discomfort

Relevant: restlessness and discomfort are part of the picture you're piecing together.

Decreased bowel sounds

Worth tracking, but this points toward a bowel issue, not the pattern you're seeing here.

Analyze Cues / Prioritize Hypotheses

Assessment

What's Going On?

Given these cues, and knowing she's voided only small amounts since surgery, what is the priority hypothesis to investigate?

Frequent, small-volume voids paired with a distended, uncomfortable abdomen is a classic overflow pattern: the bladder is full, but only small amounts escape at a time. That fits this picture more precisely than the alternatives.

Bowel patterns can absolutely cause abdominal discomfort, but the finding that stands out most here is her voiding pattern, not her bowel history. Try again.

An infection could cause discomfort, but nothing here points specifically to her incision, and there's no significant fever to support it yet. Try again.

Ileus is a reasonable post-op concern, but the cue that stands out most here is her urinary pattern, not bowel function. Try again.

Generate Solutions

Assessment

What Would You Check Next?

Match each next step to what it would help you determine.

Palpate the lower abdomen

Palpating the abdomen helps you feel for firmness and distention consistent with a full bladder.

Ask about her voiding pattern since surgery

A history of frequent, small voids supports overflow from an incompletely emptying bladder.

Check her temperature trend over the shift

Tracking her temperature helps you decide if infection is a concern here.

Review her bowel sounds and last bowel movement

This helps you decide if constipation is a concern here.

Knowledge Check

Urinary Retention

Alex is experiencing urinary retention. Select all findings that contributed to this.

Increased oral fluid intake

Not a cause of retention. More intake affects how much urine is produced, not whether the bladder empties properly.

Opioid analgesia via PCA

Relevant: opioids are a well-known cause of urinary retention.

Urinary tract infection

Not typically a cause of retention. A UTI usually causes urgency and frequency rather than difficulty emptying.

Recent surgery involving epidural anesthesia

Relevant: epidural anesthesia can temporarily blunt the nerves that signal bladder fullness and control emptying.

Younger adult age

Not a risk factor here. Urinary retention risk factors like this are more associated with older age, not younger adults.

Prolonged bed rest since surgery

Relevant: reduced mobility can make it harder to fully relax and empty the bladder.