# A 70-year-old client is in rehabilitation for mild left-leg weakness from an ischemic stroke 3 weeks ago. Left-leg strength is 4/5, unchanged from yesterday and from admission, and speech and facial symmetry are at baseline. The client uses a single-point cane with the handle below wrist level, holds it in the left hand, advances the cane together with the right leg, and looks down at the feet. After 15 m of walking the client reports left-hip fatigue and has one near-fall. The client denies hip pain or dizziness. Blood pressure is 132/78 mm Hg sitting and 128/76 mm Hg standing. Complete the diagram by selecting the condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=617425&lang=en > language: en > subject: Assistive Devices > category: BCC ## Question A 70-year-old client is in rehabilitation for mild left-leg weakness from an ischemic stroke 3 weeks ago. Left-leg strength is 4/5, unchanged from yesterday and from admission, and speech and facial symmetry are at baseline. The client uses a single-point cane with the handle below wrist level, holds it in the left hand, advances the cane together with the right leg, and looks down at the feet. After 15 m of walking the client reports left-hip fatigue and has one near-fall. The client denies hip pain or dizziness. Blood pressure is 132/78 mm Hg sitting and 128/76 mm Hg standing. Complete the diagram by selecting the condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress. Condition Select 1 Unsafe cane fit and gait sequence Extension of the stroke with new weakness Orthostatic hypotension during ambulation Osteoarthritis flare of the left hip Actions to take Select 2 Switch to a quad cane held on the left side Request an urgent neurologic assessment Move the cane to the right hand Have the client dangle before walking Raise the handle to the wrist crease Parameters to monitor Select 2 Orthostatic blood pressure Distance walked before fatigue NIH Stroke Scale score each shift Gait sequence on return demo Left hip passive range of motion ## Explanation The weakness is unchanged, blood pressure does not drop on standing, and there is no hip pain, so the fatigue and near-fall come from how the cane is used. The cane belongs in the hand opposite the weak leg, with the handle at the wrist crease, advancing with the weak leg. Walking tolerance and a correct return demonstration show whether teaching worked. ## In-depth explanation Quick answer Unsafe cane fit and gait sequence. Move the cane to the right hand and raise the handle to the wrist crease. Monitor the distance walked before fatigue and the cane-and-weak-leg sequence on return demonstration. Why this is correct Strength of 4/5 is unchanged and speech and face are at baseline, which rules out an extending stroke. Standing blood pressure falls only 4 mm Hg, which rules out orthostatic hypotension, and there is no hip pain to suggest an arthritis flare. The problem is the device: a short cane on the weak side that moves with the strong leg gives no support to the left leg. Holding it in the right hand at wrist height lets the cane share the load with the weak leg. Walking distance and a correct sequence on return demonstration measure the result. Easy analogy or mental picture The cane is a crutch for the weak leg that works from the other side, like a friend who walks on your good side and lends a shoulder when your bad leg steps. Memory hook Cane in the good hand, moves with the bad leg, handle at the wrist. NCLEX decision rule When a mobility problem appears, compare with the baseline neurologic and hemodynamic data; if they are unchanged, correct the device and technique before escalating. Why the other choices are wrong A quad cane adds stability, but on the weak side it still fails to unload the left leg. An urgent neurologic assessment and NIH Stroke Scale tracking fit stroke extension, but strength and speech are unchanged. Dangling before walking and orthostatic blood pressure fit orthostatic hypotension, which the sitting and standing readings exclude. Hip range of motion fits an osteoarthritis flare, but the client has fatigue, not pain. References 1MedlinePlus — Using a CaneCane fit at wrist level, use in the hand opposite the weak leg, and step sequence 22026 NCLEX-RN Test Plan (NCSBN)Mobility and assistive devices within Basic Care and Comfort ## Clinical scenario Scenario A client with stable left-leg weakness uses a cane that is too short, in the left hand, and advances it with the strong leg; hip fatigue and a near-fall follow, without new neurologic signs, pain, or orthostatic change. ## Key concepts - **Single-point cane** — A cane with one tip, used in the hand opposite the weaker leg for mild balance or strength deficits. - **Return demonstration** — The client performs a taught skill while the nurse observes, to confirm learning. - **Orthostatic hypotension** — A drop of at least 20 mm Hg systolic or 10 mm Hg diastolic within 3 minutes of standing. ## Related questions - [A client with a weaker left leg is learning to walk with a standard walker and may bear we…](https://mymerci.kr/pages/nclex_q.php?qn_id=396624&lang=en) - [A client with left-leg weakness is learning to walk with a cane. 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