A nurse is caring for a client who is receiving continuous bladder irrigation following a transurethral resection of the prostate. The client reports bladder spasms and the nurse observes decreased urinary output. Which of the following actions should the nurse take?

Rationale: A. Decrease traction on the catheter: Traction is commonly applied after a transurethral resection of the prostate to provide pressure on the prostatic fossa and minimize bleeding. While excessive traction can contribute to discomfort, bladder spasms accompanied by reduced drainage more strongly suggest obstruction from blood clots rather than traction-related irritation. B. Remove the indwelling urinary catheter: The three-way indwelling catheter is essential for maintaining continuous bladder irrigation and preventing clot retention after prostate surgery. Removing the catheter would interrupt irrigation, increase the risk of urinary retention, and potentially worsen bleeding. Catheter removal is contraindicated unless prescribed by provider. C. Administer ibuprofen 400 mg for pain relief: Although bladder spasms cause discomfort, nonsteroidal anti-inflammatory drugs do not address the underlying cause of decreased urinary output in this context. Treating pain alone without correcting possible obstruction could lead to bladder distention and further complications. D. Flush the catheter manually with 0.9% sodium chloride: Decreased urinary output and bladder spasms during continuous bladder irrigation commonly indicate obstruction from blood clots within the catheter lumen. Manual irrigation with sterile 0.9% sodium chloride helps dislodge clots and restore catheter patency. Prompt restoration of flow reduces bladder distention, alleviates spasms, and prevents increased intravesical pressure.