A nurse is teaching a 75-year-old client how to properly use a walker. Which instruction should the nurse provide first?

Adjusting walker height so elbows are slightly bent ensures proper ergonomics and safety before teaching movement techniques. Other instructions are important but secondary to correct fit.

Core Nursing Explanation Key Concept Analysis: This question assesses the priority of nursing interventions when teaching a client to use an assistive device. The core principle is patient safety and proper body mechanics. Before any mobility instruction can be safely and effectively given, the equipment must be correctly fitted to the individual. An improperly sized walker can lead to poor posture, instability, falls, and injury.

Answer Rationale: Key Point! The first and most fundamental step in teaching any assistive device is ensuring the equipment is correctly sized for the patient. For a walker, the standard is to adjust the height so the patient's elbows are flexed at approximately 15-30 degrees when their hands are on the grips. This allows for optimal weight-bearing, stability, and energy-efficient movement. This step must be completed before teaching the gait sequence.

Distractor Analysis: Watch out for confusion! While option ② describes a common gait pattern (walker forward, then step with weaker leg), this instruction cannot be safely given until the walker is properly fitted. Teaching gait first puts the cart before the horse in terms of safety.
Option ③, placing tennis balls, is a non-standard and potentially unsafe modification for a standard walker. It can reduce stability and is not a recommended practice for initial patient education.
Option ④ is incorrect and dangerous. Walkers should be used on firm, level, non-slippery surfaces. Thick carpets can catch the walker's legs, causing trips and falls.

Related Concepts: This prioritization follows the nursing process: Assessment (checking fit) comes before Implementation (teaching gait). It also aligns with safety principles, where correcting environmental/equipment hazards is a primary nursing responsibility. Concept Summary

Concept	Key Point
Assistive Device Education	Priority is always proper fit and safety check before teaching use.
Walker Height Adjustment	Handles at wrist crease level; elbows slightly bent (15-30° flexion).
Walker Gait Sequence	Lift or roll walker forward -> Step forward with weaker/affected leg -> Step forward with stronger leg.
Safety with Walkers	Use on level, dry surfaces. Ensure rubber tips are intact. Avoid throw rugs.

Side-by-Side Comparison!

Assistive Device	Key Fitting Principle	Common Gait Pattern
Walker	Elbows slightly bent (15-30°).	Device -> weaker leg -> stronger leg.
Crutches (Axillary)	2-3 finger-widths between axilla and pad. Elbows bent 20-30°.	Varies (2-point, 3-point, swing-through).
Cane	Handle at hip joint level; elbow bent 15-30°.	Cane advances with opposite weaker leg.

Anatomy, Physiology & Pharmacology Points Proper walker fit promotes ergonomics and prevents strain on the shoulders, wrists, and back. It allows the upper body to share weight-bearing load effectively, reducing stress on lower extremities. In geriatric clients, this is crucial for preventing falls and subsequent injuries like hip fractures. Memory Tips ABCs of Mobility Aids: Always Begin with Correct fit!
Walker Walk Sequence: "Walker, Weak, Well" (Walker moves first, then the weak leg, then the well/stronger leg). High-Frequency NCLEX Topics Prioritization of nursing actions is a classic NCLEX theme. "What should the nurse do first?" questions often test the ability to sequence care based on safety and fundamental principles (like checking equipment before use). Geriatric safety and fall prevention are also high-yield areas. Watch Out for Question Variations! * Instead of "first instruction," the question could ask: "The nurse is evaluating a client using a walker. Which observation indicates the walker needs adjustment?" (Correct answer would relate to poor posture or elbow position). * The scenario could involve a post-operative client (e.g., after total hip replacement) where specific gait precautions (like non-weight-bearing) modify the standard walker instruction.

Nursing Clinical Practice Guide Clinical Scenario: Mr. Johnson, 75, is being discharged after a hospitalization for congestive heart failure (CHF) exacerbation. He reports generalized weakness and unsteadiness. The physical therapist has recommended a standard walker for home use. You are preparing him for discharge.

Nursing Intervention Strategy: 1. Assessment & Fit: Have Mr. Johnson stand with arms relaxed at his sides. Adjust the walker legs so the hand grips align with the crease of his wrist. Have him grip the handles; assess for approximately 15-30 degrees of elbow flexion. Check that all knobs are locked and rubber tips are intact. 2. Education & Demonstration: Once fit is confirmed, demonstrate the gait: "Lift the walker and place it a short distance ahead. Then, step forward with your right leg (his weaker side), placing your foot in the center of the walker. Finally, bring your left leg forward to meet it." Use the "Walker, Weak, Well" cue. 3. Environment & Safety: Educate on removing throw rugs, ensuring good lighting, and keeping pathways clear. Instruct him to avoid wet floors and to wear non-skid footwear. 4. Evaluation: Observe Mr. Johnson perform the sequence independently. Ask him to verbalize key safety points.

Patient Safety and Precautions: Never modify a walker with tennis balls or other items that compromise stability. For clients with significant cognitive impairment, involve a family member in all training and ensure home safety modifications are in place before discharge. Nursing Procedure & Medication Flow Procedure: Teaching Walker Use 1. Perform safety check of equipment (locks, tips). 2. Adjust height to patient (Priority Step). 3. Position patient standing in the walker. 4. Teach and demonstrate gait sequence. 5. Supervise return demonstration. 6. Provide written instructions and safety tips. A Word from Your Senior Nurse "Remember, in the real world, we never hand a patient a piece of equipment without first making sure it's set up correctly for them. That walker isn't one-size-fits-all. Taking those extra two minutes to adjust the height isn't just a step in a procedure—it's an act of prevention. You're preventing a fall, a fracture, and a readmission. On the NCLEX, when you see 'first,' think 'foundation' or 'safety.' Get the basics right, and the rest follows."