A nurse teaches a client with a new permanent pacemaker. Which instructions would the nurse include in this client’s teaching? (Select all that apply)
“Until your incision is healed, do not submerge your pacemaker. Only take showers.”
“Report any pulse rates lower than your pacemaker settings.”
“If you feel weak, apply pressure over your generator.”
“Have your pacemaker turned off before having magnetic resonance imaging (MRI).”
“Do not lift your left arm above the level of your shoulder for 8 weeks.”
Correct Answer : A,B,E
Choice A reason: Avoiding submersion until the incision heals prevents infection in a new pacemaker site. This aligns with post-implant care, making it a correct instruction the nurse would include to ensure proper healing and device safety for the client.
Choice B reason: Reporting pulse rates below pacemaker settings indicates potential device failure, requiring prompt evaluation. This aligns with pacemaker monitoring, making it a correct instruction the nurse would teach the client to ensure device function and cardiac stability.
Choice C reason: Applying pressure over the generator doesn’t address weakness and may harm the device. Reporting low pulse rates is correct, making this incorrect, as it’s not a valid instruction for the nurse to include in pacemaker teaching.
Choice D reason: Pacemakers aren’t turned off for MRI; MRI-compatible devices or alternatives are used. Arm movement restriction is correct, making this incorrect, as it’s inaccurate compared to the nurse’s proper instructions for pacemaker care and MRI safety.
Choice E reason: Avoiding arm lifting above the shoulder for 8 weeks prevents lead dislodgement in a new pacemaker. This aligns with post-implant restrictions, making it a correct instruction the nurse would include to protect the device’s integrity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: A low-fat diet benefits gallbladder issues, not acute diverticulitis, which requires reduced bowel stimulation. A low-fiber diet prevents irritation, making this incorrect, as it’s less relevant than the nurse’s anticipated prescription for managing acute diverticulitis symptoms effectively.
Choice B reason: A low-fiber diet is prescribed for acute diverticulitis to rest the colon and reduce irritation of inflamed diverticula. This aligns with gastrointestinal treatment protocols, making it the correct diet the nurse would anticipate for the client’s acute diverticulitis management.
Choice C reason: A high-protein diet supports healing but isn’t specific for acute diverticulitis, which needs low fiber to avoid irritation. Low-fiber is correct, making this incorrect, as it’s not the primary diet the nurse expects for managing acute diverticulitis symptoms.
Choice D reason: A high-carbohydrate diet may increase bowel activity, worsening acute diverticulitis. A low-fiber diet reduces stimulation, making this incorrect, as it’s inappropriate compared to the nurse’s anticipated prescription for a diet to manage acute diverticulitis effectively.
Correct Answer is D
Explanation
Choice A reason: Leafy greens contain iron, but water doesn’t enhance absorption; vitamin C does. Calf’s liver with orange juice maximizes absorption, making this incorrect, as it lacks the vitamin C component the nurse should teach to improve iron uptake in anemia.
Choice B reason: Apples and carrots have minimal iron and no vitamin C to enhance absorption. Calf’s liver with orange juice is optimal, making this incorrect, as it doesn’t provide iron or absorption enhancers compared to the nurse’s teaching for iron deficiency anemia.
Choice C reason: Steak is iron-rich, but mushrooms don’t significantly enhance absorption like vitamin C. Orange juice with liver is better, making this incorrect, as it’s less effective than the nurse’s recommendation to pair iron with a vitamin C source for anemia.
Choice D reason: Calf’s liver is high in iron, and orange juice’s vitamin C enhances non-heme iron absorption. This aligns with nutritional education for iron deficiency anemia, making it the correct choice for the nurse to teach the client to improve iron absorption effectively.
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