A nurse teaches a client with a new permanent pacemaker. Which ...

[neverstopbelieb]

A nurse teaches a client with a new permanent pacemaker. Which instructions should the nurse include in this client's teaching? (Select all that apply.)
 
  a. Until your incision is healed, do not submerge your pacemaker. Only take showers.
  b. Report any pulse rates lower than your pacemaker settings.
  c. If you feel weak, apply pressure over your generator.
  d. Have your pacemaker turned off before having magnetic resonance imaging (MRI).
  e. Do not lift your left arm above the level of your shoulder for 8 weeks.

Question 2

A nurse cares for a client with congestive heart failure who has a regular cardiac rhythm of 128 beats/min. For which physiologic alterations should the nurse assess? (Select all that apply.)
 
  a. Decrease in cardiac output
  b. Increase in cardiac output
  c. Decrease in blood pressure
  d. Increase in blood pressure
  e. Decrease in urine output
  f.
  Increase in urine output

[Liddy]

Answer to Question 1

ANS: A, B, E
The client should not submerge in water until the site has healed; after the incision is healed, the client may take showers or baths without concern for the pacemaker. The client should be instructed to report changes in heart rate or rhythm, such as rates lower than the pacemaker setting or greater than 100 beats/min. The client should be advised of restrictions on physical activity for 8 weeks to allow the pacemaker to settle in place. The client should never apply pressure over the generator and should avoid tight clothing. The client should never have MRI because, whether turned on or off, the pacemaker contains metal. The client should be advised to inform all health care providers that he or she has a pacemaker.

Answer to Question 2

ANS: A, D, E
Elevated heart rates in a healthy client initially cause blood pressure and cardiac output to increase. However, in a client who has congestive heart failure or a client with long-term tachycardia, ventricular filling time, cardiac output, and blood pressure eventually decrease. As cardiac output and blood pressure decrease, urine output will fall.