A nurse is teaching a client who is postoperative following the insertion of a permanent pacemaker. Which of the following instructions should the nurse include? (Select all that apply)

Choice A reason: Counting the pulse for 60 seconds daily helps monitor pacemaker function, ensuring it maintains the prescribed heart rate. This allows early detection of device malfunction, such as failure to pace, which could lead to bradycardia or inadequate cardiac output, supporting safe post-implantation care. Choice B reason: Avoiding a microwave oven in the home is unnecessary, as modern pacemakers are shielded against electromagnetic interference from household appliances. This outdated restriction does not apply, and clients can safely use microwaves without risking device malfunction, making this instruction incorrect for pacemaker care. Choice C reason: Notifying airport security of the pacemaker is essential, as metal detectors may trigger alerts, and security wands could interfere with device function. Informing security ensures safe screening methods (e.g., pat-downs) are used, preventing potential pacemaker disruption and ensuring safe travel for the client. Choice D reason: Resuming physical activities that cause bumping or jolting should be avoided, as they risk dislodging pacemaker leads or damaging the device, especially early post-implantation. Such activities could cause lead displacement, leading to ineffective pacing or arrhythmias, making this an inappropriate instruction. Choice E reason: Avoiding tight clothing over the insertion area is correct, as it prevents pressure on the pacemaker site, reducing irritation, infection risk, or lead dislodgement. Loose clothing promotes healing and device stability, ensuring proper function and comfort during the post-implantation recovery period.