A nurse is reviewing a client's cardiac monitor for dysrhythmias. Which of the following findings should the nurse identify as an indication for the placement of a permanent pacemaker?

A. Sinus tachycardia with rates faster than 100/min: Sinus tachycardia is typically a physiologic response to stress, fever, or pain and is not an indication for permanent pacemaker placement. It usually resolves with treatment of the underlying cause. B. Asymptomatic second-degree AV block: Asymptomatic second-degree AV block, especially type I (Mobitz I), often does not require a pacemaker and can be monitored. Intervention is indicated primarily if symptoms develop or if there is progression to a higher-degree block. C. Vasovagal bradycardia without syncope: Vasovagal bradycardia without syncope is generally benign and does not require pacemaker placement. Treatment focuses on managing triggers rather than device therapy. D. Complete AV block with rates slower than 40/min: A complete (third-degree) AV block with significant bradycardia is an indication for permanent pacemaker placement. The pacemaker restores adequate heart rate and cardiac output, preventing symptoms such as syncope, fatigue, or heart failure.