The nurse is assessing a client who received a heart transplant 6 months ago for cardiomyopathy. What assessment finding would lead the nurse to suspect the transplant is being rejected?

A. Inserting an indwelling urinary catheter for strict intake and output: While monitoring urine output is important to assess renal perfusion, it is not the immediate priority in a client with a ruptured AAA. Initial focus should be on stabilizing circulation and preventing shock.

B. Instruct the client not to strain when having a bowel movement: Preventing increased intra-abdominal pressure is important for aneurysm management before rupture, but after rupture, the priority is rapid hemodynamic stabilization, not bowel precautions.

C. Obtaining a STAT electrocardiogram (EKG): An EKG may be useful if myocardial ischemia is suspected, but it does not address the immediate life-threatening hemorrhage and hypovolemic shock caused by a ruptured AAA.

D. Ensure the client has a large bore peripheral intravenous catheter: Establishing rapid vascular access with large-bore IVs is the highest priority to allow fluid resuscitation and blood product administration. Prompt volume replacement is critical to maintain perfusion and prevent death from hemorrhagic shock.

A. Prepare for transcutaneous pacing: Transcutaneous pacing is used to treat symptomatic bradycardia or heart block, which are not primary concerns in hypertrophic cardiomyopathy. HCM typically involves obstruction of ventricular outflow and risk for arrhythmias, but pacing is not a first-line intervention.

B. Instructing the client to start an aerobic exercise plan: Aerobic exercise may increase the risk of sudden cardiac death in clients with HCM due to potential arrhythmias and increased myocardial oxygen demand. Exercise recommendations are usually individualized and often limited rather than broadly prescribed.

C. Instruct the client to perform a Valsalva maneuver: The Valsalva maneuver transiently decreases venous return and can exacerbate left ventricular outflow obstruction in HCM, potentially worsening symptoms. It is generally contraindicated rather than recommended.

D. Preparing for a cardiac catheterization: Cardiac catheterization may be indicated to assess the severity of left ventricular outflow obstruction, measure intracardiac pressures, and evaluate coronary anatomy in HCM. It is a diagnostic intervention that guides treatment planning, making it an anticipated order for newly admitted clients.