Difficulty: Medium
Average Score: 73%
Simulated
A nurse is caring for a client who is 6 hours postoperative following abdominal surgery and is having difficulty voiding. Which of the following actions should the nurse take?
Correct answer
D
Rationale
The correct answer is D: Insert an indwelling urinary catheter and connect it to gravity drainage. In this situation, the client is showing signs of urinary retention, which can lead to serious complications if not addressed promptly. By inserting a urinary catheter, the nurse can help relieve the client's discomfort and prevent further complications such as bladder distention or urinary tract infections. Connecting it to gravity drainage allows for proper drainage of urine.
Choice A is incorrect because simply hearing running water may not be effective in helping the client void. Choice B is incorrect as encouraging fluid intake may exacerbate the issue if the client is already having difficulty voiding. Choice C is incorrect as providing a bedpan while lying supine is not an appropriate position for voiding. It may further hinder the client's ability to void.
Choice A is incorrect because simply hearing running water may not be effective in helping the client void. Choice B is incorrect as encouraging fluid intake may exacerbate the issue if the client is already having difficulty voiding. Choice C is incorrect as providing a bedpan while lying supine is not an appropriate position for voiding. It may further hinder the client's ability to void.