# Situation: A 74-year-old woman undergoes right total hip arthroplasty through a posterior approach for osteoarthritis. Orders include posterior hip precautions and weight bearing as tolerated. She lives with her son's family. Her son says the only toilet at home is a squat-type toilet and that the family usually sits on low stools. Which discharge plan is BEST?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630441  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 74-year-old woman undergoes right total hip arthroplasty through a posterior approach for osteoarthritis. Orders include posterior hip precautions and weight bearing as tolerated. She lives with her son's family.

Her son says the only toilet at home is a squat-type toilet and that the family usually sits on low stools. Which discharge plan is BEST?

## 보기

1. Bedside commode and a low padded sofa for resting
2. Raised toilet seat and a firm chair with armrests **✔ 정답**
3. Squat toilet with a grab bar and a firm armchair
4. Raised toilet seat and a low stool for bathing

**정답: 2**

## 해설

Posterior hip precautions forbid flexing the hip beyond 90°, which squatting, low stools, low sofas and floor sitting all do. Before discharge the nurse plans for a raised toilet seat or commode and a firm chair with armrests, and teaches the family.

## 심화 해설

Matching the home to hip precautions
After a posterior-approach total hip arthroplasty, the client must avoid hip flexion beyond 90°, adduction across the midline, and internal rotation until the capsule heals. The son reports a squat-type toilet and low stools, which both force deep hip flexion. The best discharge plan replaces low, deep-flexion surfaces with a raised toilet seat or commode and a firm chair with armrests, arranged and taught before discharge. Option 2 provides both items and keeps every daily activity within safe hip flexion.

Why each item is chosen
A raised toilet seat (or a commode set over the toilet) lifts the sitting surface so the hips stay above the knees. A firm chair with armrests of adequate height lets the client sit without sinking and push up with her arms rather than leaning forward from the hips. Because the family usually sits on low stools, the nurse identifies one suitable chair she will use at home. The family is taught the precautions, how to help her sit and stand, and how to arrange the bathroom.

Checking each option against the 90° rule
Every option includes one correct item, so the deciding question is whether both items keep flexion below 90°.

| Option | First item | Second item | Safe overall? |
| --- | --- | --- | --- |
| 1 | Bedside commode: acceptable | Low padded sofa: flexes hip beyond 90° | No |
| 2 | Raised toilet seat: safe | Firm armchair: safe | Yes |
| 3 | Squat toilet with grab bar: flexes far beyond 90° | Firm armchair: safe | No |
| 4 | Raised toilet seat: safe | Low stool for bathing: flexes beyond 90° | No |

Watch out! A grab bar helps balance but does not change the depth of a squat. And a soft, low sofa is doubly risky: the client sinks into flexion and then leans forward to rise.

Culturally sensitive teaching
Squat toilets, low stools, and floor sitting are common in many households. The nurse respects these practices while explaining why they are unsafe for the next weeks, offers practical substitutes, and checks that the equipment is available before discharge. Other aids include a long-handled reacher, sock aid, and long-handled sponge so she does not bend forward. Key point! After posterior hip replacement, avoid squatting, low seats, and floor sitting; plan a raised toilet seat and a firm chair with armrests before discharge.

## 임상 시나리오

Home Setup After Hip ReplacementKeeping hip flexion under 90°
The home has a squat-type toilet and the family sits on low stools; both flex the hip far beyond 90°.

The best plan is a raised toilet seat or commode and a firm chair with armrests, so she sits with hips above knees and rises with her arms.

The nurse arranges the equipment before discharge and teaches the family the precautions and safe transfers; reachers and sock aids prevent bending.

CautionA grab bar does not make squatting safe, and soft low sofas or stools are unsafe until the surgeon lifts the precautions.

## 핵심 개념

- **Raised toilet seat** — A device that increases toilet height so the hips stay above the knees when sitting.
- **Hip flexion** — Bending at the hip that brings the thigh toward the trunk; limited to 90 degrees after posterior hip replacement.
- **Reacher** — A long-handled grabbing tool that lets a client pick up objects without bending at the hip.
- **Discharge planning** — Preparation of the client, family, and home for safe self-care before leaving the hospital.

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