A 72-year-old male presents to the outpatient department with complaints of nocturia, hesitancy, and weak urinary stream for the past 4 months. He now reports acute urinary retention since last night. On assessment, his bladder is palpable and distended. His vitals are stable. The physician diagnoses BPH with acute urinary retention. As a nurse, what is your priority action?

1. A

   Prepare the patient for immediate surgical prostatectomy

2. B

   Insert a Foley catheter to relieve bladder distention

3. C

   Administer prescribed alpha-blockers and monitor response

4. D

   Apply a hot compress over the suprapubic area to facilitate voiding

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015

Explanation

• Acute urinary retention (AUR) is a medical emergency characterized by a sudden and painful inability to urinate.
• The primary goal is immediate bladder decompression to relieve pain and prevent complications like acute kidney injury, bladder damage, and urinary tract infections.
• Inserting a Foley catheter is the most direct and effective first-line intervention to bypass the urethral obstruction caused by the enlarged prostate and drain the retained urine.
• This action provides immediate relief and stabilizes the patient before further diagnostic workup or long-term treatment planning.

Why Other Options Were Wrong

• Option A: Surgery is a definitive treatment for BPH but is not the priority for an acute emergency. The patient must be stabilized by draining the bladder first.
• Option C: Alpha-blockers (e.g., tamsulosin) are used for long-term management of BPH symptoms. They take days to weeks to achieve a therapeutic effect and are not effective for the immediate relief of an acute obstruction.
• Option D: A hot compress is a minor comfort measure that may help relax pelvic muscles but is completely ineffective for relieving a significant mechanical obstruction causing acute urinary retention.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Priority nursing management of acute urinary retention in a patient with Benign Prostatic Hyperplasia (BPH) in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Recognizing acute urinary retention as a medical emergency is a critical nursing skill. Prompt assessment (palpation, bladder scan) and intervention can prevent serious complications.
• Nurses must be prepared to perform urinary catheterization. If a standard catheter cannot be passed, a Coudé tip catheter (with a curved tip) may be required to navigate past the enlarged prostate.
• What if? - If the patient had signs of sepsis (fever, hypotension, tachycardia) along with AUR, the priority would still be catheterization, but it would be done concurrently with obtaining blood cultures and initiating IV antibiotics and fluid resuscitation.

How to Approach the Question

• Identify the core clinical problem: The patient has an acute, complete inability to urinate (acute urinary retention), confirmed by a palpable, distended bladder.
• Recognize the urgency: Acute urinary retention is a medical emergency.
• Analyze the question's requirement: It asks for the 'priority action', which means the most immediate and critical intervention.
• Evaluate the options based on the timeline of effect: Compare which action provides the most immediate relief for the life-threatening problem.
• Differentiate between immediate relief and long-term solutions. Catheterization provides immediate relief. Surgery and alpha-blockers are longer-term treatments. A hot compress is an ineffective comfort measure in this context.
• Select the option that directly and rapidly resolves the bladder distention, which is inserting a Foley catheter.

Concept Tested & Keywords

• Concept Tested: Priority nursing management of acute urinary retention in a patient with Benign Prostatic Hyperplasia (BPH).
• Stem keywords: 72-year-old male, nocturia, hesitancy, weak urinary stream, acute urinary retention, BPH, palpable bladder, distended bladder
• Lead-in keywords: priority action
• Clinical cues: Acute urinary retention since last night: Indicates an urgent medical situation requiring immediate intervention.
• Clinical cues: Palpable and distended bladder: A key physical assessment finding confirming significant urine retention.

Question ID

QFDLQjrPe2Tu_i8FPJebGY

Copy ID

Reference Book

E6 Medicine Davidson Principles Practice 24e p. 458-460