A nurse is caring for a client admitted to the intensive care unit. Assessment findings are BP: 160/90, HT: 100, RR: 27, SpO2: 89% Central Venous Pressure (CVP) 18 mmHg Pulmonary Arterial Wedge Pressure (PAWP) 21 mmHg Echocardiogram: Ejection Fraction 30% BNP 1300 pg/mL What is the nurse's priority action?

A. Lower the head of the client's bed in Trendelenburg position.: Trendelenburg positioning increases venous return to the heart, which can worsen preload in a client who already has elevated filling pressures (CVP 18 mmHg, PAWP 21 mmHg). In reduced left ventricular function (EF 30%), this can exacerbate pulmonary congestion and hypoxemia, compromising respiratory and cardiac status. B. Document CVP and continue to monitor.: While accurate documentation and monitoring are important, they do not address the client’s acute hemodynamic instability. The elevated CVP and PAWP, along with hypoxemia (SpO₂ 89%) and tachypnea, indicate fluid overload and impending pulmonary edema, requiring immediate therapeutic intervention. C. Increase IV fluid infusion per protocol.: Increasing IV fluids would further elevate preload and worsen fluid overload in this client. The combination of elevated filling pressures, low ejection fraction, and high BNP (1300 pg/mL) indicates decompensated heart failure, where excess fluid is already impairing cardiac function and gas exchange. D. Administer IV diuretic medication.: Loop diuretics (e.g., furosemide) are the priority intervention in acute decompensated heart failure with volume overload. Elevated CVP and PAWP reflect increased preload, while high BNP indicates ventricular stretch. Diuretics reduce intravascular volume, decrease pulmonary congestion, improve oxygenation, and reduce cardiac workload, directly addressing the underlying pathophysiology.