The occupational health nurse is evaluating a patient who is 3 weeks post pacemaker insertion. Which nursing intervention is MOST appropriate at this time?

Assessing the incision for any redness, swelling, or discharge

Applying wet-to-dry dressings every 4 hours to the insertion site

Reinforcing the pressure dressing as needed

Encouraging range-of-motion exercises of the involved arm

Answer and Explanation

The Correct Answer is A

A. Assessing the incision for any redness, swelling, or discharge: At 3 weeks post pacemaker insertion, the wound should be well into the healing process. Monitoring for signs of infection—such as redness, swelling, or discharge—remains a top priority to identify delayed wound complications like infection or erosion.

B. Applying wet-to-dry dressings every 4 hours to the insertion site: Wet-to-dry dressings are used for debridement of open wounds with significant drainage and necrotic tissue, not for healing surgical incisions. By 3 weeks post-procedure, the site should be dry and closed; such dressing changes would be inappropriate and potentially increase risk of infection.

C. Reinforcing the pressure dressing as needed: Pressure dressings are typically used in the immediate post-operative period to control bleeding and are not maintained weeks after insertion. Reinforcing one at this stage would suggest poor wound healing or inappropriate post-op management.

D. Encouraging range-of-motion exercises of the involved arm: While regaining full range of motion is important after pacemaker insertion, it's usually initiated gradually. Gentle arm movement may be resumed after a few weeks but early aggressive range-of-motion exercises are discouraged immediately post-insertion to prevent lead dislodgement. At the 3-week mark, movement should be cautious and per the provider’s specific clearance.

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Correct Answer is B

Explanation

A. Teach the client how to change the pacemaker dressing: Client education is important but not a priority in the immediate post-procedure phase. Dressing changes should initially be performed using sterile technique by clinical staff to prevent infection at the insertion site.

B. Immobilize the affected arm using a sling: After pacemaker insertion, the affected arm (usually on the side of the implantation) should be immobilized or limited in movement to prevent lead dislodgment. Elevating the arm above the shoulder or excessive motion can compromise pacemaker lead placement during the early healing period.

C. Arrange for ancillary personnel to feed the client: Assistance with feeding is only necessary if the client has physical or cognitive limitations. This is not a routine or priority intervention following pacemaker insertion unless clinically indicated by other assessments.

D. Monitor urine output every two hours: Frequent monitoring of urine output is not directly related to pacemaker insertion unless there are other concerns such as fluid imbalance or renal dysfunction. It's not a standard intervention in the immediate care plan for this procedure.

A. Benign Prostatic Hyperplasia B. Congestive Heart Failure C. Rheumatic Fever D. Coronary Artery Disease

Correct Answer is A

Explanation

A. Benign Prostatic Hyperplasia: Tamsulosin is an alpha-1 adrenergic blocker specifically prescribed to relieve urinary symptoms caused by benign prostatic hyperplasia (BPH). It works by relaxing the smooth muscles in the bladder neck and prostate, improving urine flow and decreasing bladder outlet obstruction.

B. Congestive Heart Failure: Tamsulosin is not indicated for heart failure management. Medications used in heart failure typically include ACE inhibitors, beta blockers, diuretics, and aldosterone antagonists not selective alpha-1 blockers like tamsulosin.

C. Rheumatic Fever: Rheumatic fever is linked to valvular heart disease, not urinary retention or prostate enlargement. Tamsulosin does not have a role in its treatment or management.

D. Coronary Artery Disease: Tamsulosin does not have any therapeutic effect in managing coronary artery disease. CAD is typically managed with medications such as beta blockers, statins, antiplatelets, and nitrates, depending on the clinical scenario.

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The occupational health nurse is evaluating a patient who is 3 weeks post pacemaker insertion. Which nursing intervention is MOST appropriate at this time?

Nursing Test Bank

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