A nurse assesses a client who presents to the provider's office to evaluate multiple nevi. Which finding should the nurse identify to the provider as possible sign of malignancy?

A) Cyanosis:
Cyanosis, which is a bluish discoloration of the skin and mucous membranes, typically occurs with severe hypoxia or oxygen deprivation, usually when oxygen saturation levels drop below 85%. Cyanosis is a late sign of hypoxia, not an early sign. In the early stages of hypoxia, the body attempts to compensate, and cyanosis does not typically appear until oxygen levels are significantly low.

B) Hypotension:
While hypotension can be a consequence of severe or prolonged hypoxia, it is generally a late sign. In the early stages of hypoxia, the body compensates through mechanisms such as tachycardia and vasoconstriction, so hypotension would not be expected at this stage. Hypotension in a hypoxic patient usually signals progression to severe respiratory or circulatory failure.

C) Bradycardia:
Bradycardia (slow heart rate) is not typically associated with early hypoxia. Instead, the body tries to compensate for reduced oxygen levels by increasing heart rate (tachycardia) in the early stages. Bradycardia can occur in more severe stages of hypoxia, particularly if the body begins to struggle with compensating or if the patient progresses to a more critical state. However, it is not an early sign of hypoxia.

D) Tachycardia:
Tachycardia (an elevated heart rate) is an early compensatory mechanism that the body employs when oxygen levels are insufficient. The heart increases its rate to pump more blood (and thus oxygen) to vital organs and tissues. Tachycardia is one of the earliest signs of hypoxia and occurs as the body attempts to compensate for the decreased oxygen levels in the bloodstream.

A) Improved bladder function:
Diphenhydramine, an antihistamine, has anticholinergic properties, meaning it blocks acetylcholine, which can cause side effects like urinary retention and dry mouth. While it may increase urinary retention, it is not primarily used to treat bladder function issues in Parkinson's disease.

B) Relief of depression:
Diphenhydramine is not prescribed for the treatment of depression in Parkinson's disease. It is an antihistamine used to treat allergic reactions and motion sickness, and sometimes for its anticholinergic effects in Parkinson's disease. While it may cause sedation, it does not address the neurochemical imbalances in the brain that cause depression, which is often treated with antidepressants such as SSRIs or SNRIs.

C) Decreased tremors:
Diphenhydramine has anticholinergic properties, which can help reduce tremors in patients with Parkinson's disease. Parkinson's disease is associated with a dopamine deficit, but acetylcholine also plays a role in motor control. The use of anticholinergic medications, such as diphenhydramine, can help restore balance between dopamine and acetylcholine in the brain, leading to decreased tremors.

D) Delay in disease progression:
There is no evidence that diphenhydramine can delay the progression of Parkinson's disease. The disease is caused by the degeneration of dopamine-producing neurons in the brain, and current treatments, such as levodopa/carbidopa or dopamine agonists, primarily aim to manage symptoms rather than prevent progression.