Assistive Devices: Fit And Safe Use

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NCLEX-RN › Assistive Devices: Fit And Safe Use

Questions 1 - 10
1

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?

“I will make sure the rubber tips are dry and not worn before I walk.”

“I will look ahead in the direction I’m walking and scan for obstacles.”

“I will use my armpits to support my weight so my hands don’t get tired.”

“I will move the crutches and my affected leg forward together, then step through with my other leg.”

Explanation

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.

2

A 33-year-old client with a left knee ligament injury is learning to use a cane for weight-bearing as tolerated. The client has good coordination and normal upper-extremity strength but reports feeling “off balance” when turning. What is the most important safety instruction for this client using a cane?

Ask the provider to prescribe crutches before practicing turns with the cane

Place the cane about 12 inches in front of the body to increase stride length

Use the cane on the injured side to prevent the knee from buckling

Keep the cane on the side opposite the injured leg and move the cane with the injured leg

Explanation

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 improve balance, reduce fall risk, and support injured limbs during rehabilitation. Option A ensures safe use by placing the cane opposite the injury for optimal support and advancing it with the affected leg. Option B is incorrect as placement should be on the stronger side; C is wrong because using the injured side increases instability; D is less optimal without assessing if crutches are needed. A transferable principle is to teach cane placement on the unaffected side for all unilateral injuries. Another principle is to observe for balance issues during turns and adjust techniques accordingly. One strategy for educating clients is to practice in a controlled environment and gradually increase complexity like turning.

3

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?

The client can climb a full flight of stairs without stopping while using the walker

The client requests a provider order for a bedside commode to reduce nighttime walking

The client’s elbows flex about 15–30 degrees when holding the walker handgrips while standing upright

The client wears supportive shoes when ambulating with the walker

Explanation

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.

4

A 60-year-old client with amyotrophic lateral sclerosis uses a wheelchair due to progressive leg weakness and fatigue. Assessment: the client’s feet do not rest fully on the footplates and the client slides forward in the seat. Which action should the nurse take to ensure the wheelchair is correctly fitted?

Increase the seat depth so the front edge presses firmly into the back of the knees to prevent sliding

Ask the provider to prescribe a reclining wheelchair before making any seating adjustments

Adjust the footrests so the client’s thighs are supported and the feet rest flat on the footplates without excessive pressure behind the knees

Remove the footrests permanently so the client can place both feet on the floor while seated

Explanation

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 sliding, support weakening muscles, and maintain positioning in progressive diseases. Option A ensures proper fit by adjusting footrests for full thigh and foot support, reducing forward sliding. Option B is incorrect as removing footrests could cause foot drag; C is less optimal without current adjustments; D is wrong because pressing into knees increases pressure. A transferable principle is to adjust footrests for flat foot placement and thigh support. Another principle is to monitor for fatigue-related positioning changes. One strategy for educating clients is to explain body mechanics and encourage daily self-checks.

5

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?

Raise the cane height further to shift pressure from the wrist to the shoulder

Ask the provider to prescribe a wrist brace before adjusting the cane

Lower the cane height so the elbow is slightly flexed (about 15–30 degrees) when the client holds the handgrip

Apply a hot pack to the wrist after walking to reduce inflammation

Explanation

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.

6

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?

Set the crutch tips directly under the client’s heels to maximize stability

Ask the provider to increase weight-bearing status before fitting the crutches

Adjust the handgrips so the elbows are fully extended when the client holds the grips

Ensure there are about 2–3 finger widths between the axilla and the top of the crutch when standing

Explanation

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.

7

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?

Keep the cane on the right side to maximize support of the injured ankle

Move both crutches forward together and then swing the body through

Hold the cane on the left (uninjured) side and advance the cane with the right (injured) leg

Ask the provider to change the prescription to non-weight-bearing before teaching cane use

Explanation

This question tests the fit and safe use of assistive devices, specifically proper cane placement during ambulation. Proper cane use is essential in nursing practice to provide stability, reduce pain, and prevent falls during recovery from lower extremity injuries. The correct answer (A) ensures safe use by instructing the client to hold the cane on the uninjured (left) side and advance it with the injured (right) leg, which provides counterbalance and support when weight-bearing on the affected side. Option B incorrectly suggests keeping the cane on the injured side; option C describes crutch technique rather than cane use; option D unnecessarily restricts weight-bearing status. The fundamental principle is that a cane should be held on the opposite side of the injury to provide a wider base of support and counterbalance during the stance phase of gait. When educating clients, nurses should use the memory aid "cane goes with the pain" (moves forward with the injured leg) while emphasizing placement on the uninjured side.

8

A 47-year-old client is post-operative day 2 after right hip arthroplasty and is using a front-wheeled walker. The client has good upper-extremity strength (5/5) but reports fear of falling; coordination is intact. The nurse observes the client stepping into the walker frame and then pushing it forward while standing inside it. Which client statement indicates a need for further teaching about their walker?

“I will push down on the hand grips to help me stand up from the chair.”

“I will use the walker to pull myself up by yanking on it while it is in front of me.”

“I will look ahead and keep pathways clear of rugs and cords.”

“I will keep the walker close and step to it rather than stepping inside the frame.”

Explanation

This question tests the fit and safe use of assistive devices, specifically identifying unsafe walker technique following hip surgery. Safe walker use is essential in nursing practice to protect surgical sites, maintain hip precautions, and prevent falls during post-operative recovery. The correct answer (C) identifies dangerous technique - using the walker to pull oneself up by yanking on it risks tipping the walker backward and violating hip precautions through excessive flexion. Options A, B, and D describe safe practices: proper stepping technique, appropriate use for standing support, and environmental safety awareness. The key principle is that clients should push down on stable surfaces (chair arms) to stand, then position the walker, rather than pulling on the walker itself. When educating post-surgical clients, nurses should demonstrate the safe standing sequence and emphasize protecting the surgical site while building confidence with the assistive device.

9

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?

Teach the client to place weight through the axillae to improve stability while stepping

Encourage the client to take larger steps to reduce fatigue during ambulation

Request a provider order to change the client to weight-bearing as tolerated before ambulation training

Adjust the crutches so there is a 2-finger-width space between the axilla and the top of the crutch when standing

Explanation

This question tests the fit and safe use of assistive devices, specifically proper axillary crutch fitting to prevent nerve damage. Correct crutch fit is vital in nursing practice to prevent brachial plexus injury, maintain stability, and promote healing during non-weight-bearing ambulation. The correct answer (B) ensures proper fit by maintaining a 2-finger-width space between the axilla and crutch top, preventing pressure on nerves and blood vessels while allowing proper weight distribution through the hands. Option A dangerously suggests weight-bearing through axillae; option C addresses gait pattern rather than fit; option D inappropriately changes the weight-bearing prescription. The critical principle is that weight should be borne through the hands and arms, never through the axillae, to prevent nerve damage and maintain circulation. When educating clients, nurses should demonstrate proper hand positioning and have clients practice bearing weight through their palms while keeping axillae free from pressure.

10

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?

“I will move the walker a short distance forward and keep all four legs on the floor before I step.”

“I will lift the walker and set it as far forward as I can to take bigger steps.”

“I will wear non-skid shoes when I walk with the walker.”

“I will stand up slowly and pause before walking if I feel dizzy.”

Explanation

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.

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