The nurse should anticipate difficulty locating the point of maximal impulse (PMI) in which client?

Choice A rationale A 75-year-old with a pneumothorax and a chest tube may have a displaced PMI due to the pneumothorax, but it is not necessarily difficult to locate. The chest tube may also cause some displacement, but it is not the primary factor affecting PMI location. Choice B rationale A 54-year-old who is 5 feet (152.4 cm) tall and weighs 300 pounds (136.1 kg) is likely to have difficulty locating the PMI due to the increased adipose tissue. Obesity can make it challenging to palpate the PMI as the excess tissue can obscure the heart’s apex. Choice C rationale A 2-year-old who is demonstrating diaphragmatic breathing may have a PMI that is slightly higher and more medial than in adults, but it is generally not difficult to locate. Choice D rationale A 45-year-old long-distance runner with a body mass index (BMI) of 18 kg/m² is likely to have a more prominent PMI due to a leaner body composition and a potentially enlarged heart from athletic conditioning.