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 While increasing fluid intake is important for maintaining hydration and promoting urine flow after a TURP, this action will not resolve an immediate mechanical obstruction causing an abrupt cessation of output. The immediate concern is the buildup of fluid pressure in the bladder, which can lead to bladder spasm and hemorrhage. Choice B rationale A lack of output following a TURP with continuous bladder irrigation (CBI) most commonly indicates an occlusion of the catheter lumen, often by a blood clot or tissue fragments. Determining the patency, usually by gentle manual irrigation with sterile saline, is the priority to prevent dangerous bladder distension and potential hemorrhage from increased intravesical pressure. Choice C rationale Administering a prescribed analgesic may relieve pain due to bladder spasms, which can accompany obstruction, but it does not address the underlying mechanical cause. The immediate, life-threatening risk is bladder rupture or severe hemorrhage if the obstruction is not rapidly cleared. Choice D rationale Notifying the provider is a necessary step if the nurse cannot resolve the occlusion or if there are signs of escalating complications (e.g., severe hemorrhage, pain, or bladder distension). However, the nurse must first attempt to resolve the most common and immediate cause, which is a catheter blockage.