Senior Practicum Basic Physical Assessment Practice Test 2026 - Free Physical Assessment Practice Questions and Study Guide

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In the case of a postoperative client who has not voided since before surgery, what is the nurse's most appropriate initial action?

Administer a diuretic

Palpate for bladder distension above the symphysis pubis

In the scenario involving a postoperative patient who has not voided since before their surgery, the most appropriate initial action is to palpate for bladder distension above the symphysis pubis. This assessment helps determine whether the bladder is full and identifies the immediate reason for the patient's inability to void.

Palpating for bladder distension is vital as it provides essential information about the patient's urinary status and guides subsequent interventions. If the bladder is distended, it indicates that the patient may not be able to void due to increased pressure or potential obstruction, necessitating further evaluation or possible intervention.

While checking the patient's IV fluid status or encouraging fluid intake may be relevant later in the assessment, these actions do not address the immediate need to assess bladder fullness. Administering a diuretic without first evaluating bladder status could lead to complications, particularly if the bladder is already distended. Therefore, palpating for distension is the most appropriate and effective initial action to take in this situation.

Encourage fluid intake

Check the patient's IV fluid status

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