A nurse is caring for a client who has an abdominal aortic aneurysm and reports a feeling of heaviness in the chest while ambulating in the hall. Which of the following actions should the nurse take first?

Choice A reason: Encouraging a final hemodialysis treatment contradicts the client’s advance directives, which refuse life-sustaining treatments. Respecting autonomy is paramount, and persuading the client undermines their decision, making this action unethical and inappropriate in this end-of-life scenario.
Choice B reason: Contacting the family to discuss the decision is unnecessary unless the client is incapacitated, which is not indicated. The client’s advance directives guide care, and family input is secondary to the client’s wishes, making this action incorrect and irrelevant.
Choice C reason: Discussing treatment options with the surrogate is inappropriate, as the client is competent and has clear advance directives refusing treatment. The surrogate’s role applies only if the client cannot decide, making this action misaligned with the client’s autonomy and directives.
Choice D reason: Discussing discharge options respects the client’s refusal of treatment and advance directives, focusing on palliative care or home arrangements. This supports autonomy and aligns with end-of-life care principles, ensuring comfort and dignity, making it the correct action.

Choice A reason: Cardiogenic shock involves reduced cardiac output, typically with low PAWP due to decreased preload from poor heart function. Elevated PAWP reflects left atrial pressure buildup, not characteristic of cardiogenic shock alone, which is distinct from heart failure, requiring specific hemodynamic management.
Choice B reason: Elevated PAWP indicates left ventricular failure, where the heart cannot pump blood effectively, causing pulmonary congestion. This increases left atrial pressure, leading to pulmonary edema, a hallmark of heart failure. Diuretics and inotropes are needed to reduce fluid overload and improve cardiac function.
Choice C reason: Hypotension is a symptom, not a direct complication of elevated PAWP. It may occur in heart failure due to reduced cardiac output, but elevated PAWP specifically signals left heart dysfunction, not hypotension itself, which is a systemic response rather than a primary cardiac issue.
Choice D reason: Hypovolemia reduces blood volume, lowering PAWP due to decreased preload. Elevated PAWP suggests fluid overload or left ventricular dysfunction, not hypovolemia, which presents with low central venous pressure and dehydration signs, requiring fluid resuscitation rather than management of heart failure.