A home health nurse is teaching a client who has a new diagnosis of diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?

A: This tracing shows occasional premature ventricular contractions (PVCs) with normal QRS complexes, which is not characteristic of a paced rhythm. A permanent pacemaker typically produces consistent pacing spikes preceding the QRS complex.

B: This tracing demonstrates a very rapid, wide-complex rhythm consistent with ventricular tachycardia, not a normal paced rhythm. This is a potentially life-threatening arrhythmia requiring immediate intervention.

C: This tracing shows an irregular rhythm with abnormal QRS morphology, likely atrial fibrillation with conduction abnormalities. It does not show consistent pacemaker spikes before each QRS complex.

D: This tracing displays regular pacing spikes immediately preceding each QRS complex, which is expected in a client with a functioning permanent pacemaker. The spikes indicate the pacemaker is delivering electrical impulses to stimulate ventricular contraction.

A. Infection: The client’s temperature is only mildly elevated and WBC count is within normal range, which does not strongly suggest infection at this time. Although postoperative clients are always at risk for infection, the assessment data do not indicate this as the most immediate concern.

B. Deep vein thrombosis: The client is postoperative and has reduced mobility, which increases risk for DVT. However, her vital signs do not show signs of venous thromboembolism such as unilateral leg swelling or sudden unexplained tachycardia. While DVT remains a possibility, current findings do not indicate it as the greatest immediate risk.

C. Atelectasis: Atelectasis commonly occurs in the first 24–48 hours after surgery due to shallow breathing and reduced mobility. By postoperative day 3, her respiratory rate and oxygen saturation are stable, and breath sounds have no abnormalities reported. These findings suggest that respiratory complications are not the most urgent issue.

D. Intestinal obstruction: The client has a distended abdomen, persistent hypoactive bowel sounds, no bowel movement for several days, and severe abdominal pain. These findings are concerning for a developing bowel obstruction or postoperative ileus. Increasing distention and poorly responsive pain indicate impaired gastrointestinal motility.