Assistive-device and immobilization questions reward a few durable rules, like 'up with the good, down with the bad.' Work through these 10 practice questions on crutch, cane, and walker technique, traction, cast care and compartment syndrome, and residual-limb care after amputation, each with a full rationale.
Crutches, Canes, Walkers, Traction & Casts
For crutches, the pads sit 2-3 finger-widths (about 2 inches) below the axilla and the hand grips are set so the elbows flex roughly 30 degrees. The client bears weight on the hands and palms, never the axillae, because axillary pressure damages the brachial plexus (crutch palsy). On stairs, "good goes up to heaven, bad goes down to hell": lead UP with the strong leg and lead DOWN with the affected leg plus the crutches.
A cane is held on the STRONG (unaffected) side, advanced together with the weak leg. A standard walker is moved about 6-8 inches (roughly one step) ahead, with all four legs set flat before the client steps into it, and is never used on stairs.
Traction and casts share a safety spine: keep the client aligned, maintain countertraction, and perform frequent neurovascular checks. Traction weights must hang FREELY, never rest on the floor, and are never removed or lifted by the nurse. Skin traction (Buck's) uses lighter weights and a boot or tape; skeletal traction uses pins or wires in bone, heavier weights, and demands pin-site care with infection monitoring.
The can't-miss cast emergency is compartment syndrome: screen with the 5 P's (Pain, Pallor, Pulselessness, Paresthesia, Paralysis). Increasing deep pain unrelieved by analgesia is the earliest and most important warning; treat it as a limb-threatening emergency and notify the provider. Routine cast care means elevating above heart level with ice for the first 24-48 hours, never inserting objects to scratch (use cool air), and watching for hot spots or foul odor.
After amputation, residual-limb care avoids prolonged pillow elevation and encourages prone positioning to prevent flexion contracture. Round out the topic with CPM after knee surgery, transferring toward the client's strong side with a gait belt, and RICE for sprains.
Musculoskeletal Devices & Mobility NCLEX Practice Questions
A nurse is fitting axillary crutches for a client before discharge. Which finding indicates the crutches are fitted correctly?
- A The top of each crutch pad rests firmly against the axilla for support
- B There is a space of about 2 to 3 finger-widths between the axilla and the crutch pad
- C The elbows remain fully extended when the client grips the hand rests
- D The client rests the underarms on the pads to bear body weight while standing
Show answer & rationale
Correctly fitted axillary crutches leave roughly 2 to 3 finger-widths (about 2 inches) between the top of the pad and the axilla, with the hand grips set so the elbows flex about 30 degrees. This positioning forces weight-bearing through the hands and palms and protects the brachial plexus.
Having the pad rest firmly against the axilla is dangerous because sustained axillary pressure compresses the brachial plexus and can cause crutch palsy (radial nerve/brachial plexus injury) with wrist drop and arm numbness. Fully extended elbows mean the hand grips are set too LOW and should be raised until the elbows flex about 30 degrees, which lets the client push the body up during ambulation. Resting the underarms on the pads to bear weight is exactly the unsafe habit that compresses the radial nerve/brachial plexus (crutch palsy); weight belongs on the hands, not the armpits.
Clinical pearl: teach the client, "Weight on your hands, air under your arms." Two to three finger-widths of clearance below the axilla and about 30 degrees of elbow bend are the two numbers to memorize for crutch fitting.
A client with a non-weight-bearing right leg is learning to ascend stairs with crutches. Which instruction from the nurse is correct?
- A Step up with the strong left leg, then bring up the crutches and right leg
- B Step up with the affected right leg first, then follow with the crutches
- C Place both crutches on the upper step, then hop up with both legs together
- D Lead with both crutches onto the upper step, then pull up with the right leg
Show answer & rationale
The rule for stairs is "good goes up to heaven, bad goes down to hell." Going UP, the strong (unaffected) leg leads onto the higher step first; then the crutches and the affected leg follow up to the same step. The strong leg does the lifting work against gravity, which is safest and most stable.
Leading up with the affected (non-weight-bearing) right leg is wrong and unsafe because that leg cannot bear weight to raise the body, risking a fall. Placing both crutches on the upper step and hopping up with both legs is not a taught technique and is highly unstable, especially with a non-weight-bearing leg. Leading up with both crutches and then pulling up with the affected right leg again loads the leg that must stay non-weight-bearing, violating the prescribed status and inviting injury or a fall.
Clinical pearl: remember the strong leg "goes up to heaven" (ascending) and the weak leg plus crutches "go down to hell" (descending). On the way DOWN, the crutches and the affected leg move to the lower step first, then the strong leg follows.
A client with left-sided leg weakness after a stroke is being taught to use a single-point cane. Which instruction reflects correct cane technique?
- A Hold the cane in the left hand and advance it with the left leg
- B Hold the cane in whichever hand feels more comfortable during the day
- C Hold the cane in the right hand and advance it together with the left leg
- D Hold the cane in the right hand and advance it together with the right leg
Show answer & rationale
A cane is held on the STRONG (unaffected) side, which here is the right hand for a client with left-leg weakness. The cane and the weak (left) leg advance together, then the strong (right) leg steps forward. Holding the cane on the strong side widens the base of support and shifts weight away from the affected leg, improving balance and reducing load on the weak limb.
Holding the cane in the left hand (same side as weakness) is incorrect; it narrows support over the weak side and does not offload the affected leg. "Whichever hand feels comfortable" ignores the biomechanical principle and can promote an unsafe, unstable gait. Holding the cane in the right hand but advancing it with the right (strong) leg is wrong sequencing: the cane must move with the WEAK leg so both provide support at the same moment, then the strong leg follows.
Clinical pearl: use "COAL" (Cane Opposite the Affected Leg). Cane height is set with the elbow flexed about 15 to 30 degrees, and the top of the cane should reach the crease of the wrist when the arm hangs at the side.
The nurse is teaching a client how to use a standard (pick-up) walker. Which instruction is appropriate?
- A Use the walker to help you go up and down stairs at home
- B Push the walker several feet ahead and then walk quickly to catch up to it
- C Lean your upper body over the front bar of the walker for better balance
- D Move the walker about 6 to 8 inches forward and then step into it
Show answer & rationale
With a standard pick-up walker the client lifts and advances the walker only a short distance, about 6 to 8 inches ahead, sets all four legs flat and stable on the floor, then steps INTO the frame while holding the hand grips. Keeping the advance short keeps the walker within the base of support and preserves stability.
Using a standard walker on stairs is unsafe: walkers are not designed for stairs, and attempting it risks a serious fall. Pushing the walker several feet ahead and then hurrying to catch up places the device far outside the base of support and encourages a lunging, off-balance gait that causes falls; the walker should stay close, only about 6 to 8 inches away. Leaning the upper body over the front bar shifts the center of gravity forward beyond the support base, making the client prone to pitching forward; the client should stand upright within the frame.
Clinical pearl: walker first, then step in, and keep the advance short. A properly sized walker positions the grips so the elbows are flexed about 15 to 30 degrees, with the wrist crease at hand-grip height when the arms hang relaxed, and the client stands tall inside the frame rather than draping over it.
During rounds, the nurse notices that the weights on a client's Buck's traction are resting on the floor. Which action should the nurse take?
- A Remove the weights from the traction rope and notify the provider
- B Reposition the client higher in bed so the weights hang freely
- C Add additional weight to the rope to restore the intended pull
- D Lift the weights off the floor and hold them until help arrives
Show answer & rationale
Traction weights must hang FREELY at all times to maintain continuous, prescribed pull. When weights rest on the floor, the traction is interrupted. The correct fix is to restore free-hanging weights by realigning the client, typically by pulling the client up toward the head of the bed (with countertraction maintained) so the weights clear the floor.
Removing the weights from the traction rope is never done by the nurse; interrupting traction can cause muscle spasm, malalignment, and loss of the therapeutic effect (and, in fractures, displacement). Adding more weight is outside the nurse's scope and would change the prescribed force, potentially harming the client. Weight amounts are provider-ordered. Lifting and holding the weights only masks the problem, applies inconsistent manual force, and is not a sustainable or safe intervention; the underlying issue is client position, not the nurse's hands.
Clinical pearl: for any traction question, the safe answers keep weights hanging freely, never remove or lift the weights, maintain body alignment and countertraction, and include frequent neurovascular checks. Buck's is a form of skin traction (boot/tape, lighter weights); skeletal traction uses pins into bone with heavier weights and adds pin-site care.
Six hours after a long-arm plaster cast is applied for a forearm fracture, a client reports deep, increasing pain that is not relieved by the prescribed opioid, along with numbness and tingling in the fingers. What is the nurse's priority action?
- A Reassure the client that significant pain is expected after casting
- B Give an additional dose of analgesic and reassess the arm in one hour
- C Elevate the cast higher and apply more ice to reduce the discomfort
- D Notify the provider immediately of suspected compartment syndrome
Show answer & rationale
This client has two hallmark early signs of compartment syndrome: deep, escalating pain unrelieved by analgesia, and paresthesia (numbness/tingling). Compartment syndrome is a limb-threatening emergency in which rising pressure within a fascial compartment compromises perfusion. The priority is to notify the provider immediately; the cast may need to be bivalved or removed and pressures assessed, because irreversible muscle and nerve damage can occur within hours.
Reassuring the client that the pain is "normal" dangerously dismisses the cardinal early sign and delays limb-saving care. Giving more analgesic and waiting an hour is unsafe: pain unrelieved by opioids is itself the red flag, and a one-hour delay can cost the limb. Elevating higher and adding ice is appropriate for routine swelling, but in suspected compartment syndrome elevation above heart level can actually reduce arterial inflow and worsen ischemia, and neither measure treats the emergency.
Clinical pearl: screen with the 5 P's, namely Pain (earliest and most reliable, especially pain on passive stretch and unrelieved by opioids), Pallor, Pulselessness (late), Paresthesia, and Paralysis. Pain out of proportion is the key early finding; do not wait for pulselessness.
The nurse is teaching a client 48 hours after a below-the-knee amputation about residual-limb care. Which instruction is appropriate?
- A Keep the residual limb elevated on a pillow continuously throughout the day
- B Avoid lying in the prone position because it puts stress on the incision
- C Lie prone several times a day to prevent hip and knee flexion contractures
- D Wrap the residual limb loosely, working from the proximal end down to the distal tip
Show answer & rationale
After the first 24 hours, prolonged elevation of the residual limb on a pillow is avoided because sustained flexion promotes hip/knee flexion contractures that prevent proper prosthetic fitting. Instead, the client is taught to lie prone periodically (often several times a day, if tolerated) to extend the hip and stretch the flexors, preventing contracture.
Continuous pillow elevation is therefore incorrect; brief elevation is acceptable only in the first 24 hours to control edema, after which it becomes harmful. Telling the client to avoid prone positioning is the opposite of correct teaching; prone lying is specifically encouraged to keep the joint in extension. Wrapping loosely from proximal to distal is wrong technique: residual-limb (figure-eight) wrapping should be firm and even and applied from the DISTAL end toward the proximal to shape the limb into a tapered cone and promote venous return. Loose or reverse wrapping causes a bulbous limb and poor prosthetic fit.
Clinical pearl: "prone to prevent contracture," and wrap distal-to-proximal, snug but not tourniquet-tight. Also address phantom limb pain, which is real and treated (medications, mirror therapy), not dismissed.
A nurse is evaluating a client's understanding of crutch, cane, and walker use. Which client statements indicate correct understanding? Select all that apply.
- A I should rest the tops of the crutches snugly up in my armpits for support
- B I will support my weight on my hands and palms, not on my underarms
- C I will hold my cane on the same side as my weak leg
- D With my cane, I will move the cane and my weak leg forward at the same time
- E Going up the stairs, I will lead with my good leg first
- F When I use my walker I will step into it and never use it on stairs
Show answer & rationale
Correct statements: bearing weight on the hands/palms (not the underarms) protects the brachial plexus from crutch palsy; leading UP the stairs with the good leg follows "good goes up to heaven"; stepping into the walker and never using it on stairs is safe walker technique; and moving the cane together with the weak leg provides simultaneous support before the strong leg steps.
Incorrect statements needing correction: resting the crutch tops snugly in the armpits is exactly the unsafe habit that compresses the brachial plexus and causes crutch palsy. There should be 2 to 3 finger-widths of clearance below the axilla, with weight on the hands. Holding the cane on the same side as the weak leg is also wrong; the cane goes on the STRONG (unaffected) side (Cane Opposite Affected Leg) to widen the base of support and offload the weak limb.
Clinical pearls: "weight on hands, air under arms"; "good up to heaven, bad down to hell" for stairs; and "COAL" for cane placement.
A client is discharged home with a new plaster cast on the lower leg. Which instructions should the nurse include in cast-care teaching? Select all that apply.
- A Report any foul odor from the cast or areas that feel unusually warm (hot spots)
- B Slide a coat hanger inside the cast to scratch any skin that itches
- C Elevate the casted leg above the level of the heart for the first 24 to 48 hours
- D Apply ice packs over the cast during the first 24 to 48 hours to limit swelling
- E Handle a wet plaster cast using your fingertips to speed the drying
- F Use cool air, such as a hair dryer on the cool setting, to relieve itching
Show answer & rationale
Correct teaching: elevating the casted extremity above heart level and applying ice during the first 24 to 48 hours both reduce edema; reporting a foul odor or hot spots is essential because these signal infection or pressure necrosis under the cast; and directing cool air (hair dryer on the cool setting) at an itch is a safe alternative to scratching.
Incorrect and unsafe: inserting a coat hanger (or any object) into the cast can scratch the skin, break its integrity, and introduce infection, and the object may become lodged. Never scratch inside a cast. Handling a wet plaster cast with the fingertips is wrong because fingertips create indentations (pressure points) that can cause skin breakdown; a drying plaster cast is supported with the PALMS of the hands.
Clinical pearls: "elevate and ice early, palms not fingertips, cool air not coat hangers." Also teach petaling rough edges, keeping the cast dry, and doing neurovascular checks (the 5 P's) to catch compartment syndrome.
A client is in skeletal traction for a femur fracture. Which nursing actions are appropriate? Select all that apply.
- A Lift the weights briefly whenever the client reports discomfort
- B Provide pin-site care and monitor the pin insertion sites for signs of infection
- C Ensure the weights hang freely and never rest on the floor
- D Remove the weights each time the client is repositioned in bed
- E Perform frequent neurovascular checks of the affected extremity
- F Maintain proper body alignment and adequate countertraction
Show answer & rationale
Appropriate actions: keeping the weights hanging freely (never resting on the floor) maintains the prescribed continuous pull; skeletal traction uses pins or wires placed into bone, so pin-site care with infection monitoring (drainage, redness, fever) is essential; maintaining body alignment and countertraction preserves the therapeutic force and reduction; and frequent neurovascular checks detect compromised circulation or nerve injury early.
Inappropriate and unsafe: removing the weights when repositioning interrupts traction, causing painful muscle spasm and possible bone displacement. The nurse never removes skeletal traction weights. Likewise, lifting the weights to relieve discomfort breaks the continuous pull and applies erratic force; discomfort is managed with prescribed analgesia, repositioning within alignment, and skin care, not by lifting the weights.
Clinical pearl: skeletal traction (pins in bone, heavier weights, add pin-site care) differs from skin traction such as Buck's (boot/tape, lighter weights, no pins).
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MSK Devices & Mobility FAQ
Which side do you hold a cane on?
Hold the cane on the strong, unaffected side. Advance the cane and the weak leg forward together, then step through with the strong leg. Remember COAL – Cane Opposite the Affected Leg. Placing the cane on the strong side widens the base of support and shifts weight off the weak limb. Set cane height with the elbow flexed about 15 to 30 degrees.
What is the memory trick for using crutches on stairs?
Use "good goes up to heaven, bad goes down to hell." Going UP, lead with the strong (good) leg first, then bring up the crutches and affected leg. Going DOWN, lead with the crutches and the affected (bad) leg first, then follow with the strong leg. The strong leg always does the lifting against gravity.
Why should crutches not press into the armpits?
Resting your weight on the axillae compresses the brachial plexus and can cause crutch palsy – radial nerve injury with wrist drop, numbness, and weakness. Fit crutches with 2 to 3 finger-widths (about 2 inches) of clearance below the axilla and elbows flexed about 30 degrees, and bear all weight on your hands and palms. Think "weight on hands, air under arms."
What are the earliest signs of compartment syndrome in a casted limb?
The earliest and most important sign is deep, increasing pain that is out of proportion and unrelieved by prescribed analgesia, often with pain on passive stretch and paresthesia (numbness or tingling). Screen using the 5 P's: Pain, Pallor, Pulselessness (a late sign), Paresthesia, and Paralysis. This is a limb-threatening emergency – notify the provider immediately rather than waiting.
Sources
- MedlinePlus - Using crutches — Crutches: weight on hands not armpits; top below armpit; elbows slightly bent
- MedlinePlus - Using a cane — Cane in hand opposite the weak leg; handle at wrist level; up with good, down with bad
- MedlinePlus - Using a walker — Walker: all four tips down before stepping; avoid stairs unless trained by a therapist
- AAOS OrthoInfo - Care of Casts and Splints — Cast care: elevate above heart and ice early; never insert objects like coat hangers
- AAOS OrthoInfo - Compartment Syndrome — Acute compartment syndrome is a medical emergency; with a cast, contact the doctor now
Sources checked September 2026.