Difficulty: Medium
Average Score: 69%
Simulated
Passage / Scenario
A client with an indwelling urinary catheter.The nurse notes that the client's indwelling urinary catheter bag has had no urine output since being emptied 1 hour ago. What should the nurse's first action be?
Correct answer
B
Rationale
The correct answer is B: Check for kinks in the tubing. This is the first action the nurse should take because a kink in the tubing could be obstructing urine flow, causing the lack of urine output. By checking for kinks, the nurse can quickly resolve the issue and ensure proper drainage. Asking the client to bear down (choice A) is unnecessary and may not address the underlying problem. Increasing fluid intake (choice C) is not the immediate solution to the lack of urine output. Inserting a new catheter (choice D) is an invasive procedure that should only be considered if other interventions do not resolve the issue.