A nurse is caring for a client who is 12 hours postoperative following a transurethral resection of the prostate (TURP) and has a 3-way urinary catheter with continuous irrigation. The nurse notes there has not been any urinary output in the last hour. Which of the following actions should the nurse perform first?

Choice A rationale Offering oral fluids increases the overall fluid load, which is generally helpful for increasing urinary output and flushing the urinary tract; however, the client is currently experiencing zero urinary output with continuous bladder irrigation (CBI). Before adding more fluid, the immediate priority is to ensure the outflow tract is clear; otherwise, the fluid will back up into the bladder, causing distention and pain. Choice B rationale Notifying the provider is a necessary step if the immediate measures to restore patency fail. A period of anuria post-TURP with CBI suggests a possible clot obstruction that could lead to severe bladder distention, pain, and potential bladder rupture. However, the nurse must first independently assess and attempt to correct the most common cause (occlusion) before escalation. Choice C rationale Administering an analgesic may temporarily alleviate pain associated with bladder spasms or distention caused by an occluded catheter. However, addressing the underlying mechanical problem (lack of output/obstruction) is the primary concern, as pain is a symptom of the blockage, not the cause. Restoring patency prevents complications and is the immediate priority. Choice D rationale The absence of urinary output with continuous bladder irrigation (CBI) strongly suggests the 3-way catheter is occluded, most likely by a blood clot or tissue fragments following the TURP. The first action is to determine patency by checking for kinks and attempting to gently manually irrigate the catheter using an aseptic technique and 30-50 mL of sterile normal saline solution per protocol to dislodge the obstruction.