NCLEX Question of the Day – Monday, February 23, 2026

Today’s question targets clinical prioritization and device management in a common post-op urology situation. You’ll use assessment data, interpret intake and output, and act fast to prevent a dangerous complication. In real nursing, knowing what to do first with continuous bladder irrigation (CBI) can mean the difference between safe recovery and acute urinary retention or hemorrhage.

Clinical Scenario

A 72-year-old man is on the surgical floor after a transurethral resection of the prostate (TURP). History: hypertension, benign prostatic hyperplasia, no anticoagulants. A 3-way Foley is in place with continuous bladder irrigation (normal saline) running at a moderate rate. One hour ago his urine was light pink. Now the urine in the drainage bag is bright red with small clots. He reports cramping and “pressure” in the lower abdomen and is restless. The suprapubic area appears full on inspection. In the last hour, CBI inflow was 1200 mL and the drainage bag shows 650 mL. Vitals: BP 138/82, HR 108, RR 20, SpO2 96% on room air.

The Question

Which action is the nurse’s priority?

Answer Choices

1. A. Increase the CBI rate to flush out clots.
2. B. Manually irrigate the catheter with sterile normal saline using aseptic technique per protocol.
3. C. Administer the prescribed oxybutynin for bladder spasms.
4. D. Notify the surgeon of possible hemorrhage.

Correct Answer

B. Manually irrigate the catheter with sterile normal saline using aseptic technique per protocol.

Detailed Rationale

The data point that matters most is the mismatch between inflow (1200 mL) and outflow (650 mL) paired with suprapubic fullness and spasms. Intake greater than output means fluid is likely retained in the bladder. Bright red urine with clots suggests that small clots may be obstructing the catheter ports. This is dangerous because retained urine increases intravesical pressure, causes pain, and can precipitate bleeding and bladder rupture if severe.

The immediate goal is to restore catheter patency and drainage. That removes the cause of distention and helps clear clots. The safest, fastest nursing intervention is to check for kinks and, if ordered and per facility protocol, perform manual irrigation with sterile normal saline. Manual irrigation can physically dislodge and remove a clot that increasing the CBI rate will not move. Doing this first directly treats the problem.

How to do it safely (typical steps; follow your policy and orders):

• Pause or clamp the CBI temporarily to prevent backflow while you irrigate.
• Use sterile technique. Attach a sterile 50–60 mL syringe with normal saline to the appropriate port.
• Gently instill 30–60 mL, then aspirate to remove clots. Repeat until return is pink and flows freely, or per the maximum allowed by policy.
• Unclamp and resume CBI at the rate needed to keep urine light pink, not clear and not bright red.
• Reassess: suprapubic fullness, pain, output volume vs inflow, and urine color.
• Document volumes instilled and returned and the patient’s response.

Continue to monitor for signs of active hemorrhage (tachycardia, dropping blood pressure, persistent bright red bleeding that does not respond to irrigation) and notify the provider if bleeding persists or the catheter cannot be cleared. The patient’s current BP is stable; HR is elevated but can be explained by pain and anxiety. That supports intervening to relieve obstruction before calling.

Why the Other Options Are Wrong

• A. Increase the CBI rate – This increases pressure but does not remove a lodged clot. It can worsen bladder distention and spasms and risk overdistention. First, clear the obstruction.
• C. Give oxybutynin – Antispasmodics treat the symptom (spasms) but not the cause (obstruction). Masking pain while the bladder remains distended is unsafe.
• D. Notify the surgeon – Call if irrigation fails, bleeding persists, or the patient becomes unstable. Right now, a nursing action can correct the problem faster and prevents deterioration, so act before you call.

Key Takeaways

• With CBI, compare inflow to outflow each hour. Inflow greater than outflow plus distention or spasms means likely obstruction.
• First fix mechanical problems: unkink tubing and manually irrigate per protocol to restore patency.
• Adjust CBI to keep urine light pink. Bright red with clots suggests bleeding; clear urine may mean over-irrigation.
• Use isotonic saline for CBI to avoid fluid shifts.
• Escalate if bleeding persists or the patient becomes unstable (falling BP, rising HR, dizziness).

• On-shift mini-checklist:
  • Hourly: check color, clots, and compare inflow vs outflow.
  • Assess suprapubic fullness and pain/spasms.
  • Ensure tubing is not kinked or under traction against the meatus.
  • Manually irrigate with sterile NS as ordered if obstruction suspected.
  • Reassess vitals and document response; notify provider if unresolved.

Quick Practice Extension

• You clear several clots with manual irrigation, but urine remains bright red with new dizziness and BP 92/56. What are your next two actions?
• Which provider order would you question for a patient with CBI after TURP: hypotonic irrigation fluid, manual irrigation PRN, or monitoring intake and output hourly? Why?

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com