A long-term-care client with a history of benign prostatic hyperplasia presents with several assessment findings. Which finding requires the most immediate action?

• A. Trouble starting his urinary stream
• B. Not voided since juice 4 hours ago
• C. A palpable bladder above the pubic symphysis with restlessness
• D. Elevated prostate-specific antigen

Answer: (C)

The key idea is recognizing acute urinary retention from benign prostatic hyperplasia. A bladder that is palpable above the pubic symphysis with restlessness shows the bladder is distended and the client cannot void, which can rapidly lead to kidney damage if not relieved. This is an emergent situation requiring immediate bladder drainage, typically with catheterization, to decompress the bladder and prevent complications.

The other findings may reflect BPH symptoms or associated concerns but do not carry the same immediate threat. Trouble starting a stream is common with BPH but doesn’t by itself indicate urgent obstruction. Not voiding for a few hours is important to monitor, but the palpable, distended bladder confirms an urgent need for drainage. Elevated PSA is important for cancer screening and planning but is not an immediate emergency requiring decompression.