A client's abdominal aortic aneurysm (AAA) has ruptured. Which intervention is the highest priority for the nurse?

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.