A nurse is teaching a client about risk factors for developing artrial flutter. Which of the following clients should the nurse understand is at highest risk for developing atrial flutter?

A. The client who is out of work and has been experiencing increased stress: Emotional stress can contribute to transient increases in sympathetic activity, which may precipitate palpitations or arrhythmias in susceptible individuals. However, stress alone is not the strongest risk factor for sustained atrial flutter. B. The client who is recovering from recurrent illness that caused vomiting and diarrhea: Electrolyte imbalances from vomiting or diarrhea (e.g., hypokalemia, hypomagnesemia) can trigger arrhythmias. While this increases risk temporarily, it is generally less significant than structural heart disease or myocardial injury. C. The client whose mother and uncle were diagnosed with the same condition: A family history may indicate genetic susceptibility to some arrhythmias. However, atrial flutter is primarily associated with acquired heart disease rather than hereditary factors, so this patient is at moderate rather than highest risk. D. The client who had a myocardial infarction and required stent placement: Myocardial infarction causes structural and electrical remodeling of atrial tissue, creating reentry circuits that predispose the patient to atrial flutter. This post-MI population has the highest risk among the options due to direct cardiac injury and conduction pathway disruption.