The home health nurse is visiting a patient who was just discharged from the hospital yesterday for diabetic ketoacidosis. The patient has renal failure and diabetes and gets dialysis via his left dialysis shunt in the forearm. When the patient's spouse enters the room, she becomes upset immediately. What causes the spouse to be upset? Mark the area that is concerning to the spouse. Select your answer by clicking the desired location on the image below. To move a pin, click another location on the image. To remove a pin, click it once. (HOT-SPOT)

The spouse is upset because the nurse is measuring the patient’s blood pressure on the left forearm where the dialysis shunt is located. For patients with an arteriovenous (AV) shunt or fistula, it is contraindicated to use that arm for blood pressure measurement, venipuncture, or IV insertion. Doing so can damage the shunt, compromise blood flow, or increase the risk of clotting and infection. The correct nursing action would be to measure blood pressure on the opposite arm (or another appropriate site if both arms are restricted) and to protect the dialysis access site at all times.