The client is exhibiting sinus bradycardia, is complaining of syncope and weakness, and has the following vital signs. Which treatment would the nurse anticipate being implemented?

A. EKG showing sinus tachycardia, rate 112: After a heart transplant, the heart is denervated, and mild resting tachycardia (90–110 bpm) is common. A rate of 112 can occur and, by itself, does not specifically indicate rejection.

B. Blood pressure 154/90: Mild hypertension is common in transplant recipients due to immunosuppressive therapy (such as corticosteroids or calcineurin inhibitors). This finding alone does not strongly suggest rejection.

C. White blood cell count 11,000: A WBC count of 11,000 is only slightly elevated and may reflect stress or mild infection. It is not a specific indicator of transplant rejection.

D. Ejection fraction of 20%: A significantly decreased ejection fraction indicates poor ventricular function. In a client 6 months post–heart transplant, a marked drop in ejection fraction strongly suggests acute or chronic rejection and requires immediate evaluation and intervention.

A. Obtain a STAT electrocardiogram (EKG).: An EKG evaluates cardiac rhythm and ongoing ischemic changes but does not assess neurological status. New disorientation during alteplase infusion raises concern for intracranial hemorrhage. Cardiac monitoring is important, but it does not address the immediate neurologic emergency suggested by acute mental status changes.

B. Call the primary health care provider immediately.: Alteplase is a fibrinolytic that increases the risk of bleeding, including intracranial hemorrhage. Sudden confusion and disorientation are early neurologic signs that may indicate cerebral bleeding. Immediate provider notification is critical so the infusion can be stopped and urgent neuroimaging, such as a CT scan, can be initiated to evaluate for hemorrhage.

C. Prepare the client for percutaneous cardiac intervention (PCI).: PCI is considered if thrombolytic therapy fails or if there is persistent ischemia. Disorientation is not an indication of failed reperfusion but rather a potential bleeding complication. Preparing for PCI would delay evaluation of a potentially life-threatening neurologic event.

D. Obtain STAT cardiac enzymes.: Cardiac enzymes help evaluate myocardial injury but are not useful in assessing acute neurologic deterioration. Elevated enzymes confirm myocardial infarction but do not explain sudden changes in mental status. The priority is evaluating for a hemorrhagic complication related to thrombolytic therapy.