- A 74-year-old client with diabetic neuropathy and decreased proprioception is being fitted for a walker prior to discharge. The client has lower-extremity strength 4/5 but demonstrates unsteady gait and delayed reaction time; upper-extremity strength is 4/5. Which action should the nurse take to ensure the walker is correctly fitted?
Answer: Ensure the walker height allows about 20–30 degrees of elbow flexion when the client grasps the hand grips
The correct walker fit is established by aligning the hand grips so the client's elbows flex about 20 to 30 degrees when grasping the handles; this gives relaxed arm position, effective weight bearing, and better stability when proprioception is diminished. Teaching where to place a cane tip applies to cane use, not to fitting a walker, so it cannot ensure correct walker fit. Asking the provider to prescribe a rolling walker with hand brakes changes the equipment type instead of addressing the current walker's fit, and it does not establish the needed grip height. Adjusting the hand grips above the client's waist places the walker too high, which can stress the shoulders and reduce control rather than produce a safe fit. Only checking the elbow flexion angle directly verifies that the walker is correctly fitted.
- A 29-year-old client with a right fibular fracture is using crutches and is ordered non–weight-bearing. Assessment: mild dizziness when standing and difficulty coordinating the crutch sequence. What is the most important safety instruction for this client using crutches?
Answer: Use a three-point gait: move both crutches forward, then swing the noninjured leg forward while keeping weight off the injured leg
This question tests knowledge of the fit and safe use of assistive devices. Proper fit and safe use of assistive devices are important in nursing practice to enforce weight-bearing restrictions, manage symptoms like dizziness, and promote coordinated mobility. Option A ensures safe use by describing the three-point gait, which keeps weight off the injured leg while maintaining balance. Option B is incorrect as axilla pads should not bear weight; C is wrong because advancing the injured leg first violates NWB; D is less optimal without assessing current needs. A transferable principle is to match gait patterns to weight-bearing status for crutches. Another principle is to address symptoms like dizziness with rest breaks during instruction. One strategy for educating clients is to break down gait sequences and practice in short segments.
- A 58-year-old client with progressive multiple sclerosis uses a manual wheelchair due to lower-extremity weakness (2/5) and poor standing balance; upper-extremity strength is 4/5 with mild tremor. The client can perform a partial stand-pivot transfer with one-person assistance. The nurse notes the client's feet cannot rest flat on the footplates and the thighs are not supported by the seat. The nurse should prioritize which assessment finding related to the wheelchair?
Answer: The client's feet do not rest fully on the footplates with knees and hips flexed about 90 degrees
This question tests the fit and safe use of assistive devices, specifically identifying improper wheelchair fit that compromises safety and function. Proper wheelchair fit is critical in nursing practice to prevent pressure injuries, maintain postural alignment, and ensure safe mobility for clients with chronic conditions. The correct answer (C) identifies the priority safety concern - feet not resting fully on footplates with improper knee and hip positioning, which can lead to pressure injuries, poor circulation, and unsafe transfers. Options A and B describe proper positioning techniques; option D addresses transfer safety but not the wheelchair fit issue. The key principle is that proper wheelchair fit requires feet flat on footplates with hips and knees at 90-degree angles to prevent sliding, pressure points, and circulatory compromise. When educating clients, nurses should emphasize daily skin checks and the importance of reporting any discomfort or positioning difficulties to prevent complications.
- A 41-year-old client with a left knee injury is using a cane for short distances. Assessment: cane height appears too tall; the client's shoulder on the cane side is elevated and elbow is nearly straight when holding the cane. Which action should the nurse take to ensure the device is correctly fitted?
Answer: Lower the cane so the handgrip aligns with the client's wrist crease when standing with arms relaxed
The cane is too tall: the client's shoulder is elevated and the elbow is nearly straight. Correct fit requires lowering the cane so the handgrip is level with the wrist crease when the arm hangs relaxed; this allows about 15–30 degrees of elbow flexion and a neutral shoulder. Raising the cane to the waist would make the handgrip even higher and worsen the elevated shoulder and straight elbow. Asking the provider to prescribe a walker is an unnecessary escalation; the cane height can be adjusted, and the nurse should fit the device before considering a different one. Adding extra padding to the handle does not change the height of the cane, so it cannot correct the shoulder elevation or elbow extension. The nurse's first action is to adjust the cane height using the wrist-crease landmark.
- A 70-year-old client with Parkinson disease uses a wheelchair for longer distances due to shuffling gait and freezing episodes. Assessment shows mild tremor, slowed coordination, and intact cognition; the client performs transfers with contact-guard assistance. Which action should the nurse take to ensure safe wheelchair transfers?
Answer: Lock the wheelchair brakes and swing the footrests out of the way before the client stands to transfer
This question tests knowledge of the fit and safe use of assistive devices. Proper fit and safe use of assistive devices are vital in nursing practice to facilitate independent transfers, prevent falls, and accommodate movement disorders like freezing in Parkinson disease. Option A ensures safe transfers by securing the wheelchair and clearing obstacles, reducing the risk of slips. Option B is incorrect as raising armrests may not provide needed leverage; C is wrong because axillae should not bear weight; D is less optimal as a lift is unnecessary for this assistance level. A transferable principle is to always lock brakes and remove footrests before any wheelchair transfer. Another principle is to assess cognition and coordination to tailor transfer assistance. One strategy for educating clients is to break down transfers into steps and use verbal reminders during practice.
- A 33-year-old client with a left knee ligament injury is using a cane for short distances. The client has mild quadriceps weakness (4/5) and good balance but reports wrist discomfort when using the cane. On observation, the client's elbow is nearly straight when holding the cane and the shoulder is elevated. Which action should the nurse take to ensure the cane is correctly fitted?
Answer: Adjust the cane height so the hand grip is at the level of the wrist crease with the elbow flexed about 15–30 degrees
This question tests the fit and safe use of assistive devices, specifically proper cane height adjustment to prevent wrist strain. Correct cane fit is crucial in nursing practice to prevent repetitive strain injuries, ensure effective weight distribution, and promote proper biomechanics during ambulation. The correct answer (A) ensures proper fit by adjusting height so the hand grip aligns with the wrist crease, allowing 15-30 degrees of elbow flexion for optimal force transmission and comfort. Option B incorrectly suggests holding the cane on the injured side; option C unnecessarily changes to crutches; option D adds unnecessary equipment before addressing basic fit. The key principle is that proper cane height allows slight elbow flexion to absorb shock and reduce strain on joints while maintaining effective support. When educating clients, nurses should teach the "wrist crease rule" and have clients practice checking their own cane height to ensure consistent proper use.
- A 64-year-old client with multiple sclerosis uses a manual wheelchair due to lower-extremity weakness (hip flexion 2/5 bilaterally) and poor endurance. The client can perform a pivot transfer with minimal assistance but has decreased trunk control when fatigued. Which action should the nurse take to ensure the wheelchair is correctly fitted?
Answer: Position the client so there is about 1–2 finger widths between the back of the knees and the front edge of the wheelchair seat
This question tests knowledge of the fit and safe use of assistive devices. Proper fit and safe use of assistive devices are vital in nursing practice to prevent pressure injuries, improve comfort, and facilitate safe transfers for clients with limited mobility. Option A ensures proper fit by providing adequate seat depth, which supports the thighs and prevents sliding or shear forces. Option B is incorrect as it addresses cane use, not wheelchair fitting; C is less optimal without first optimizing the current chair; D is wrong because elevating knees above hips can increase pressure on the sacrum and reduce stability. A transferable principle is to check for 1-2 finger widths of space behind the knees to ensure correct seat depth. Another principle is to evaluate trunk control and fatigue when assessing overall wheelchair suitability. One strategy for educating clients is to explain the rationale for adjustments and encourage them to report discomfort during use.
- A 22-year-old client with a recent leg injury is using a cane and reports wrist pain after practice. Assessment: the cane is set too high, causing shoulder elevation and minimal elbow flexion. Which action should the nurse take to ensure the device is correctly fitted?
Answer: Lower the cane height so the elbow is slightly flexed (about 15–30 degrees) when the client holds the handgrip
This question tests knowledge of the fit and safe use of assistive devices. Proper fit and safe use of assistive devices are crucial in nursing practice to alleviate pain, correct ergonomic issues, and enhance comfort during rehabilitation. Option A ensures proper fit by lowering the height for elbow flexion, reducing wrist strain from improper positioning. Option B is incorrect as heat doesn't address fit; C is less optimal without adjustments; D is wrong because raising shifts strain elsewhere. A transferable principle is to ensure 15-30 degrees elbow flexion for cane users. Another principle is to monitor for pain as an indicator of poor fit. One strategy for educating clients is to demonstrate height adjustments and confirm relief through trial walks.
- A 26-year-old client has a right ankle sprain and is weight-bearing as tolerated. The client has 5/5 upper-extremity strength, intact coordination, and ambulates slowly with a cane but frequently places it on the right side. The nurse observes mild limping and reports pain 6/10 when stepping. What is the most important safety instruction for this client using a cane?
Answer: Hold the cane on the left (uninjured) side and advance the cane with the right (injured) leg.
For a single cane, the safe pattern is to hold the cane on the side opposite the injured leg and move it forward with the injured leg. Holding it on the left (uninjured) side while stepping with the right (injured) leg gives a wider base of support and reduces force on the sprained ankle. Keeping the cane on the right (injured) side is wrong because the support is then lined up with the weak ankle rather than with the stronger body side, so it does not provide the needed counterbalance. Moving both crutches forward and swinging the body through describes a two-crutch gait, not a single-cane pattern, so it cannot answer what to teach this client about cane use. Asking the provider to change the prescription to non-weight-bearing before teaching is not the needed safety instruction: the client is currently weight-bearing as tolerated, and correct cane use can be taught safely; if pain continues or worsens, the nurse should reassess and notify the provider afterward. Therefore the correct instruction is to hold the cane on the left side and advance it with the right leg.
- A 72-year-old client is learning to use a front-wheeled walker after a recent fall. Assessment: the client tends to push the walker far ahead and then takes quick steps to catch up; lower-extremity strength is 4/5. What is the most important safety instruction for this client using a walker?
Answer: Keep the walker close and take small, controlled steps rather than pushing it far ahead
This question tests knowledge of the fit and safe use of assistive devices. Proper fit and safe use of assistive devices are crucial in nursing practice to correct unsafe habits, build strength, and reduce fall risks after incidents. Option A ensures safe use by promoting controlled movements, preventing the client from overreaching and losing balance. Option B is incorrect as lifting increases effort and instability; C is wrong because holding furniture reduces device reliance; D is less optimal as sedatives could impair judgment. A transferable principle is to keep walkers close for controlled steps in all users. Another principle is to observe gait patterns for rushing tendencies. One strategy for educating clients is to use slow-motion practice and positive reinforcement for corrections.
- A 58-year-old client is being taught to use crutches after an Achilles tendon repair and is ordered non–weight-bearing. Assessment: the client is 6 feet 3 inches tall and the crutches appear too short; the client leans forward and reports shoulder fatigue. Which action should the nurse take to ensure the device is correctly fitted?
Answer: Adjust the crutch length so the top is about 2–3 finger widths below the axilla when the client stands upright
This question tests knowledge of the fit and safe use of assistive devices. Proper fit and safe use of assistive devices are important in nursing practice to accommodate height variations, reduce fatigue, and enforce non-weight-bearing status. Option A ensures proper fit by adjusting length for adequate axilla clearance, improving posture and reducing shoulder strain. Option B is incorrect as axilla placement causes injury; C is less optimal without trying adjustments; D is wrong because full extension limits function. A transferable principle is to fit crutches with 2-3 finger widths below the axilla. Another principle is to evaluate height and fatigue in tall clients. One strategy for educating clients is to measure and adjust in front of them, explaining each step.
- An 80-year-old client with chronic obstructive pulmonary disease is discharged with a walker for energy conservation and stability. Assessment: the client becomes dyspneic with exertion and has limited endurance but can follow instructions. Which action should the nurse take to promote safe walker use at home?
Answer: Teach the client to sit and rest when short of breath rather than leaning heavily forward on the walker
For a client with COPD, safe walker use includes pacing and stopping to rest when dyspnea occurs. Teaching the client to sit and rest rather than leaning heavily forward on the walker is the correct action because it conserves energy, reduces dyspnea, and prevents the walker from becoming unstable. The cane option is incorrect because it teaches cane technique, not the walker the client was discharged with. The oxygen option is premature unless exercise-related hypoxemia has been assessed; it does not address safe walker technique. The speed option is unsafe because increasing walking speed during exercise increases oxygen demand and may worsen dyspnea and fall risk. Therefore the best action is to teach seated rest and pacing during walker use.
- An 82-year-old client with chronic heart failure and generalized weakness is being discharged with a standard walker (no wheels). The client has slow gait, needs frequent rest breaks, and has hand strength 3/5 with mild arthritis pain. The nurse should prioritize which assessment finding related to the walker?
Answer: The client's elbows flex about 15–30 degrees when holding the walker handgrips while standing upright
This question tests knowledge of the fit and safe use of assistive devices. Proper fit and safe use of assistive devices are essential in nursing practice to support weak clients, prevent joint strain, and enhance endurance during ambulation. Option A should be prioritized as it confirms proper walker height, allowing ergonomic elbow flexion and safe weight distribution. Option B is less relevant as stair climbing may not be feasible with weakness; C is important but secondary to fit; D addresses convenience but not directly walker safety. A transferable principle is to assess elbow flexion at 15-30 degrees for all upper-limb assistive devices. Another principle is to evaluate grip strength and pain that may impact device handling. One strategy for educating clients is to provide written instructions with illustrations and review them during follow-up visits.
- A 35-year-old client is postoperative after knee surgery and is using crutches with partial weight-bearing. Assessment: the client repeatedly looks down at the crutch tips and loses balance when approaching door thresholds. Which client statement indicates a need for further teaching about their crutches?
Answer: "I will use my armpits to support my weight so my hands don't get tired."
This question tests knowledge of the fit and safe use of assistive devices. Proper fit and safe use of assistive devices are important in nursing practice to maintain balance, avoid obstacles, and support partial weight-bearing postoperatively. Option C indicates a need for further teaching because armpits should not bear weight, risking injury, whereas hands should. Option A promotes safe forward gaze; B ensures tip integrity; D describes correct gait. A transferable principle is to avoid axilla weight-bearing in crutch use. Another principle is to assess visual scanning and balance at thresholds. One strategy for educating clients is to simulate obstacles and provide corrective feedback during practice.
- A 23-year-old client is learning to use crutches after a left ankle fracture and is ordered partial weight-bearing. The client has good upper-body strength but poor coordination when initiating gait. Which action should the nurse take to ensure the crutches are correctly fitted?
Answer: Ensure there are about 2–3 finger widths between the axilla and the top of the crutch when standing
This question tests knowledge of the fit and safe use of assistive devices. Proper fit and safe use of assistive devices are essential in nursing practice to prevent nerve compression, improve coordination, and support weight-bearing orders. Option A ensures proper fit by providing space below the axilla, allowing weight on hands and reducing injury risk. Option B is incorrect as full elbow extension reduces shock absorption; C is unnecessary without first fitting properly; D is wrong because tips should be lateral for stability. A transferable principle is to maintain 2-3 finger widths below the axilla for crutch fitting. Another principle is to assess upper-body strength and coordination for gait initiation. One strategy for educating clients is to fit devices in standing position and confirm comfort through trial ambulation.
- A 44-year-old client is post-operative day 1 after open reduction and internal fixation of a left tibia fracture and is prescribed non-weight-bearing on the left leg. The client has 5/5 upper-extremity strength but becomes unsteady when attempting to stand with axillary crutches; coordination is intact. The nurse notes redness developing in both axillae after practice. Which action should the nurse take to ensure the crutches are correctly fitted?
Answer: Adjust the crutches so there is a 2-finger-width space between the axilla and the top of the crutch when standing.
The correct response is to adjust the crutches so that, with the client standing, there is a two-finger-width space between the axilla and the top of the crutch. This fit keeps weight on the hands and arms rather than the axillae, preventing compression of the brachial plexus and blood vessels—the cause of the redness and unsteadiness. Teaching the client to place weight through the axillae would directly produce the nerve and tissue injury that correct fitting avoids. Encouraging larger steps with the unaffected leg addresses step length, not crutch fit; it can increase energy demands and fall risk rather than reduce fatigue. Requesting a provider order to change to weight-bearing as tolerated contradicts the prescribed non-weight-bearing status and is not a response to a fit problem. The issue is crutch height and placement, not the weight-bearing prescription. Therefore, the nurse should adjust the crutches to maintain the finger-width space when standing.
- A 79-year-old client with a history of stroke (mild left-sided weakness, 4/5) is discharged with a quad cane. Assessment: mild left foot drop, slow gait, and fair balance. Which client statement indicates a need for further teaching about their cane?
Answer: "I will place most of my body weight through my armpit on the cane when I feel tired."
This question tests knowledge of the fit and safe use of assistive devices. Proper fit and safe use of assistive devices are essential in nursing practice to address residual weakness from strokes, improve balance, and prevent compensatory injuries. Option D indicates a need for further teaching because canes do not support weight via armpits, which could imply misuse and risk nerve damage. Option A is correct for side placement; B describes proper advancement; C ensures stability with quad tips. A transferable principle is to clarify that weight goes through hands, not upper body, for canes. Another principle is to assess for foot drop and gait speed. One strategy for educating clients is to correct misconceptions immediately and reinforce with return demonstrations.
- A 52-year-old client is postoperative after foot surgery and is using crutches with a non–weight-bearing order. Assessment: the client is able to follow directions but has decreased hand strength (3/5) due to arthritis. The nurse should prioritize which assessment finding related to crutch fit?
Answer: The handgrips allow about 20–30 degrees of elbow flexion when the client holds them
This question tests knowledge of the fit and safe use of assistive devices. Proper fit and safe use of assistive devices are important in nursing practice to support postoperative recovery, accommodate hand weakness, and enforce weight-bearing restrictions. Option A should be prioritized as it confirms ergonomic fit, allowing proper elbow flexion despite arthritis. Option B is less relevant as carrying loads isn't advised; C is incorrect for axilla weight-bearing; D addresses pain but not fit. A transferable principle is to ensure 20-30 degrees elbow flexion in crutch fitting. Another principle is to consider comorbidities like arthritis in assessments. One strategy for educating clients is to integrate pain management with device training sessions.
- A 79-year-old client with heart failure and generalized weakness (lower-extremity strength 3/5) is learning to use a standard walker at home after hospitalization. The client's coordination is intact; the client reports dizziness when standing quickly. The nurse observes the client lifting the walker and placing it far ahead before stepping. Which client statement indicates a need for further teaching about their walker?
Answer: "I will lift the walker and set it as far forward as I can to take bigger steps."
This question tests the fit and safe use of assistive devices, specifically identifying unsafe walker technique that increases fall risk. Safe walker use is essential in nursing practice to prevent falls, maintain stability, and promote independence in clients with cardiac conditions and weakness. The correct answer (C) identifies unsafe technique - lifting the walker and placing it far ahead encourages overreaching and loss of balance, particularly dangerous for someone with weakness and potential orthostatic changes. Options A, B, and D all describe safe practices: keeping walker legs on the floor, managing orthostatic symptoms, and wearing appropriate footwear. The fundamental principle is that walkers should be advanced a comfortable arm's length (6-8 inches) while maintaining all four legs on the ground for maximum stability. When educating clients, nurses should emphasize "small steps for safety" and practice the proper sequence: advance walker, step with weaker leg, then stronger leg.
- A 61-year-old client with Parkinson disease uses a wheelchair for longer distances due to freezing episodes and fatigue; lower-extremity strength is 4/5, and upper-extremity strength is 4/5 with mild rigidity. The nurse is teaching safe transfers from the wheelchair to the bed with one-person assistance. What is the most important safety instruction for this client using a wheelchair during transfers?
Answer: Lock the wheelchair brakes and move the footrests out of the way before standing to transfer
This question tests the fit and safe use of assistive devices, specifically safe wheelchair transfer techniques for clients with movement disorders. Proper transfer safety is critical in nursing practice to prevent falls, especially for clients with Parkinson's disease who experience unpredictable freezing and rigidity. The correct answer (A) ensures safety by locking brakes and moving footrests before transfers, preventing wheelchair movement and tripping hazards during the critical transition period. Option B creates excessive distance increasing fall risk; option C may interfere with proper transfer mechanics; option D suggests unnecessary restraints. The fundamental principle is that wheelchair preparation (brakes locked, footrests moved) must occur before any transfer attempt to create a stable, obstacle-free environment. When educating clients with Parkinson's, nurses should emphasize taking time for each step and using verbal cues to overcome freezing episodes during transfers.
