The nurse should anticipate difficulty locating the point of maximal impulse (PMI) in which client? Reference Range: Body mass index [(BMI) Normal or healthy weight (18.5 kg/m2 to 24.9 kg/m2)]

A. A 75-year-old with a pneumothorax and a chest tube. With appropriate chest tube management and resolution of the pneumothorax, the PMI may return to its normal position. While this can be a valid challenge, it is transient and less likely to make PMI consistently difficult to locate. B. A 45-year-old long-distance runner with a body mass index (BMI) of 18 kg/m2. Despite a low BMI, there are no factors here that would inherently make locating the PMI difficult. C. A 2-year-old who is demonstrating diaphragmatic breathing. While diaphragmatic breathing is common in young children, it does not necessarily obscure the PMI. D. A 54-year-old who is 5 feet (152.4 cm) tall and weighs 300 pounds (136.1 kg). This client is significantly obese, which can make it difficult to palpate and locate the PMI due to the excess adipose tissue.