NCLEX Question of the Day – Tuesday, June 30, 2026

Today’s question focuses on priority action in a changing patient condition. This skill matters because nurses often see early signs of trouble before anyone else does. On a real shift, knowing what to do first can prevent a small problem from becoming an emergency.

Clinical Scenario

A nurse on a medical-surgical unit is caring for a 68-year-old client who had a transurethral resection of the prostate earlier today. The client has a three-way indwelling urinary catheter with continuous bladder irrigation running. Four hours after surgery, the client reports increasing lower abdominal pressure and says, “I feel like I need to urinate, but nothing is coming out.”

The nurse notes that the drainage bag has had very little output in the last 30 minutes. The urine in the tubing appears dark red, and several small clots are visible near the catheter. On assessment, the client’s lower abdomen is firm and tender above the pubic area. Vital signs are: temperature 37.1 C, heart rate 104/min, blood pressure 146/88 mm Hg, respiratory rate 18/min, and oxygen saturation 97% on room air.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Increase the rate of the continuous bladder irrigation
2. B. Administer a prescribed opioid analgesic for pain
3. C. Check the catheter tubing for kinks and dependent loops
4. D. Notify the surgeon that the client may be hemorrhaging

Correct Answer

C. Check the catheter tubing for kinks and dependent loops

Detailed Rationale

This is a post-op urinary drainage problem until proven otherwise. The key clues are bladder pressure, low output, visible clots, and a firm tender bladder. Together, these suggest that urine and irrigation fluid are not draining well. After a TURP, clot obstruction is a common reason for sudden discomfort and decreased outflow.

The nurse should first assess the system for a simple mechanical cause. That means checking for kinks, compression under the client, closed clamps, and dependent loops where fluid can collect and block drainage. This step is fast, safe, and directly targets the most likely problem. It also follows the nursing process: assess before intervening in a more aggressive way.

If the tubing is kinked or the drainage bag is positioned poorly, correcting that can quickly restore flow and relieve bladder distention. A blocked outflow tract can also worsen bleeding because the bladder becomes overdistended and irritated. That is why the first action is not just about comfort. It helps prevent further complications.

After checking the tubing, the nurse should continue with focused assessment and action. The nurse should evaluate the amount of irrigation solution infused versus the amount returned, because true urine output cannot be measured unless the irrigant is subtracted. The nurse should inspect the color of drainage, monitor for increasing clot burden, reassess suprapubic fullness, and watch vital signs for signs of instability.

If the tubing is patent but drainage remains poor, the nurse would then follow the provider’s orders and agency policy for managing catheter obstruction, which may include adjusting irrigation to maintain patency or manually irrigating if specifically prescribed and allowed. The nurse should also monitor pain response, because relief of pressure after restoring flow is an important sign that the blockage was the cause.

The bigger clinical point is this: in a client with continuous bladder irrigation, low output plus bladder distention usually means impaired drainage first, not simply pain or bleeding alone. The nurse must think mechanically and systematically.

Why the Other Options Are Wrong

A. Increase the rate of the continuous bladder irrigation

This may sound reasonable because clots are present, but it is not the first action. If the tubing is kinked or obstructed, increasing inflow can make bladder distention worse. More fluid going in without adequate drainage can increase pain and pressure. First confirm that the system is draining properly.

B. Administer a prescribed opioid analgesic for pain

Pain treatment matters, but this pain likely has a cause that needs immediate correction. Giving an opioid before addressing obstruction can delay recognition of worsening retention and does not fix the problem. In this case, the nurse should treat the source of the pain first.

D. Notify the surgeon that the client may be hemorrhaging

Bleeding is a concern after TURP, and the nurse should monitor for it. However, the current findings point more directly to clot retention and blocked drainage than to uncontrolled hemorrhage as the first issue to address. Dark red urine can be expected early after surgery. If the client had rapidly rising pulse, dropping blood pressure, large amounts of bright red drainage, or continued poor output after troubleshooting the catheter, then escalation would be appropriate.

Key Takeaways

• After TURP, sudden suprapubic pain and low catheter output often mean clot obstruction.
• Always check the drainage system first: kinks, clamps, bag position, and dependent loops.
• Do not increase irrigation blindly if outflow is blocked. That can worsen bladder distention.
• Pain medicine does not replace fixing the cause of post-op urinary retention.
• Measure output carefully by accounting for irrigation volume.

• On-shift mini-checklist: assess pain and bladder fullness, inspect tubing and bag position, compare irrigant in versus drainage out, watch urine color and clots, reassess after restoring flow, and report persistent obstruction or hemodynamic changes promptly.

Quick Practice Extension

1. A client with continuous bladder irrigation has light pink drainage, no suprapubic pain, and output that matches the irrigant rate. What finding would tell you the therapy is working as intended?
2. After troubleshooting the catheter, the client still has no drainage and increasing bladder distention. What should the nurse do next based on a typical post-op order set and unit policy?

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