A nurse is caring for a client who recently had surgery for insertion of a permanent pacemaker. Which of the following orders should the nurse clarify with the provider?

Choice A reason: Ordering serum cardiac enzyme levels is appropriate post-pacemaker insertion to monitor for myocardial injury, as the procedure involves lead placement in the heart. Elevated troponin or CK-MB could indicate complications like perforation, making this a reasonable order that does not require clarification in this context. Choice B reason: An MRI of the heart and great vessels must be clarified, as most pacemakers are not MRI-compatible due to risks of device malfunction or lead heating, which could cause arrhythmias or tissue damage. Clarification ensures the MRI is safe for the specific pacemaker model, prioritizing patient safety post-implantation. Choice C reason: A low-sodium diet is appropriate for a client with a pacemaker, especially if they have heart failure or hypertension, as it reduces fluid retention and cardiac workload. This order aligns with standard cardiac care and does not require clarification, as it supports overall cardiovascular health management. Choice D reason: Low-impact physical therapy is suitable post-pacemaker insertion to promote mobility without stressing the implantation site. It helps prevent complications like shoulder stiffness while avoiding vigorous movements that could dislodge leads, making this a reasonable order that does not require clarification.