The nurse understands that chest pain related to pericarditis is classically relieved by

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.

A. Apply transcutaneous pacemaker pads: While this is a potential intervention for symptomatic or severe bradycardia unresponsive to medications, it is premature as a first step in this scenario. The client is stable with a heart rate of 50 bpm and no mention of hemodynamic compromise.

B. Place the client in Trendelenburg position: This position is used to improve venous return in hypotensive patients, but there is no evidence of hypotension or poor perfusion. It is not an appropriate response to mild bradycardia in this context.

C. Call the doctor for an order to decrease the infusion rate: Diltiazem is a calcium channel blocker that slows AV node conduction, potentially causing bradycardia. Since the heart rate has dropped to 50 bpm, the most appropriate first action is to contact the provider to adjust the infusion rate, which may be too high for the client’s current rhythm.

D. Administer a dose of atropine: Atropine is used for symptomatic bradycardia. If the client is asymptomatic and the bradycardia is mild and medication-induced, adjusting or discontinuing the offending agent should be attempted before administering atropine.