A nurse is teaching a client about skin cancer prevention. Which of the following statements by the client indicates an understanding of the teaching?

Rationale for Correct Choices:

• Decreased cardiac output: The client is post–myocardial infarction and experiences chest pain with minimal exertion, tachycardia (HR 112/min), and signs of anxiety and fear. These findings suggest that myocardial function may be compromised. Decreased cardiac output is a significant risk in post-MI clients due to potential for reinfarction, ischemia, or left ventricular dysfunction.
• Respiratory failure: The client has COPD, an elevated respiratory rate (32/min), and oxygen saturation of 87% on room air, which indicates significant hypoxemia. The productive cough, fatigue, and shortness of breath increase the risk for decompensation into respiratory failure without prompt oxygen therapy and pulmonary support.

Rationale for Incorrect Choices:

• Pancytopenia: This condition involves a reduction in red blood cells, white blood cells, and platelets. There is no evidence of bone marrow suppression, recent chemotherapy, or hematologic disorder in this client’s history.
• Neurogenic shock: Neurogenic shock results from spinal cord injury or disruption of sympathetic nervous system control. The client has no evidence of trauma or spinal pathology, and the elevated heart rate contradicts the expected bradycardia of neurogenic shock.
• Hepatic encephalopathy: This is caused by liver dysfunction, typically in clients with advanced liver disease. There are no signs of altered mental status, liver disease, or elevated ammonia levels in this case.

Rationale:

A. First-degree atrioventricular block: A first-degree AV block is characterized by a prolonged but consistent P-R interval greater than 0.20 seconds. A P-R interval of 0.35 seconds with no dropped beats is a classic sign of this dysrhythmia.

B. Atrial fibrillation: Atrial fibrillation presents with an irregularly irregular rhythm and absent distinct P waves. The presence of a consistent P-R interval rules out atrial fibrillation.

C. Premature atrial complexes: PACs are identified by early P waves that may look different from sinus P waves, often followed by a normal QRS complex. They do not cause consistently prolonged P-R intervals.

D. Complete heart block: Complete (third-degree) heart block involves no association between P waves and QRS complexes. The atria and ventricles beat independently, which contradicts the presence of a consistent P-R interval.