# A nurse is teaching a client who has a right leg fracture how to use crutches safely. Which instruction should the nurse emphasize to prevent falls and injury?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541020  
> language: ko  
> subject: Adult Health

## 문제

A nurse is teaching a client who has a right leg fracture how to use crutches safely. Which instruction should the nurse emphasize to prevent falls and injury?

## 보기

1. Place both crutches on the affected side when going up stairs
2. Keep the crutches close to the body and maintain three-point contact **✔ 정답**
3. Lean forward significantly when walking to maintain balance
4. Place full weight on the crutch handles when standing

**정답: 2**

## 해설

Proper crutch safety requires maintaining three-point contact (both crutches plus the unaffected leg) and keeping crutches close to the body for stability and balance. Incorrect techniques like leaning forward or placing weight on axillae increase fall risk.

## 심화 해설

Clinical Judgment
This question assesses the ability to identify the most core safety principle in patient education. While all options are instructions related to crutch use, the most direct and fundamental principle for preventing falls and injuries is maintaining three-point contact and keeping the crutches close to the body. This is the foundation for ensuring stability during crutch walking. The other options include dangerous actions that can actually cause instability or lead to injury.

Memory Tip:
The core of crutch safety is **T**hree-point **C**ontact & **C**lose to body. Remember it as **TCC**. "Safe crutches mean **T**hree-point, **C**lose, **C**ontact!"

KR vs US:
The basic principles of crutch walking (three-point contact, avoiding pressure on the axillary area) are the same in both Korea and the US. However, in the US NCLEX, Patient Safety is the top priority, and questions frequently ask you to 'emphasize' the most important instruction during teaching. Compared to Korean exams, there is a tendency to ask more specifically about the 'priority of safety principles'.

## 임상 시나리오

Clinical Practice Guide
*   **Going Upstairs**: "Good leg goes up first" → "Then bring up the crutches and bad leg together" (Memory aid: **G**ood up to **H**eaven, **B**ad up to **B**ring)
*   **Going Downstairs**: "Crutches and bad leg go down first" → "Then bring down the good leg" (Memory aid: **B**ad down to **B**ring, **G**ood down to **G**round)
*   **Fitting**: When standing, adjust the crutch tips to be about 15 cm (6 inches) to the outside and front of each foot, and set the handgrip height so the elbow bends at a 30-degree angle.

Caution:
*   If the patient supports their weight on the armpits, it can cause axillary nerve injury or blood vessel compression. Weight must be borne through the hands and the good leg.
*   The instruction "place the crutch on the affected side when going up stairs" is completely wrong and very dangerous. It causes a total loss of balance.

## 핵심 개념

- **Three-point Gait** — The most common crutch gait used during non-weight bearing walking. It moves by forming a "three-point" contact with the ground using both crutches and the healthy leg.
- **Non-weight bearing** — A state where no weight is placed on the injured area. When using crutches, ensure the injured leg does not touch the floor.
- **Axillary Crutch** — The most common type of crutch with an armpit support. When using it, weight should be placed on the hands, not the armpits, to prevent nerve damage.
- **Tripod Position** — Stable basic standing posture. Position the tips of both crutches and the unaffected foot to form a triangle.
- **Patient Safety** — The highest priority in healthcare delivery. In this scenario, fall prevention and education on the correct use of assistive devices are applicable.

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