The nurse would refrain from applying a blood pressure cuff on the affected arm of a patient who has a(n): (Select all that apply)

dialysis shunt.

2-year-old hand amputation.

previous mastectomy.

patent IV line.

Answer and Explanation

Correct Answer : A,C

A.   A dialysis shunt requires careful monitoring to avoid damaging the shunt, and blood pressure cuffs should not be applied to the arm with a shunt.
B.   A hand amputation does not affect the use of the blood pressure cuff, but care should be taken with the affected area.
C.   A previous mastectomy increases the risk of lymphedema, and using a blood pressure cuff on the affected arm could exacerbate this.
D.   A patent IV line is not a contraindication for blood pressure measurement, but the nurse should take care not to interfere with the IV.

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Correct Answer is D

Explanation

A. The date of previous diagnostic tests may be important, but it is secondary to immediate safety concerns like allergies.
B. Information about the patient's living situation can be useful for discharge planning but is not the most urgent piece of information.
C. Previous treatment for illnesses is important but does not supersede immediate health threats like allergies.
D. Knowing any allergies to medications is critical to avoid potentially harmful reactions. This is a priority when beginning care, as it informs medication administration and treatment options.

A. allows loss of body heat. B. an be reshaped more quickly. C. is wet and needs to be dried. D. has large fontanels.

Correct Answer is A

Explanation

A. The newborn’s head is a major source of heat loss due to the large surface area and insufficient
insulation. Covering the head helps maintain body temperature.
B. While the head can be reshaped, the primary reason for covering it is to prevent heat loss, not reshaping.
C. The head is not necessarily wet and doesn't require drying in all cases, making this less relevant.
D. Although the head has large fontanels, this is not the reason it is covered with a cap; preventing heat loss is the priority.

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The nurse would refrain from applying a blood pressure cuff on the affected arm of a patient who has a(n): (Select all that apply)

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Naxlex Comprehensive Predictor Exams

When performing an initial assessment on a patient, which piece of information is of highest priority?

Correct Answer is D

Explanation

The nurse covers a newborn baby's head with a cap. because the head:

Correct Answer is A

Explanation

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