The nurse is assessing a client who received a heart transplant 6 months ago for cardiomyopathy. What assessment finding would lead the nurse to suspect the transplant is being rejected?

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.