NCLEX · Basic Care and Comfort

A client is immobile after hip replacement surgery. Which position is contraindicated and must be AVOIDED to prevent hip dislocation?

Correct answer

Hip flexion greater than 90 degrees, adduction (crossing legs), and internal rotation — these movements can dislocate the new prosthetic hip joint; the hip must be kept in a neutral or slightly abducted position

  1. A Supine with legs slightly abducted
  2. B Hip flexion greater than 90 degrees, adduction (crossing legs), and internal rotation — these movements can dislocate the new prosthetic hip joint; the hip must be kept in a neutral or slightly abducted position
  3. C Elevating the head of the bed to 30 degrees
  4. D Ambulating with weight-bearing on the operative side

Why this is the answer

TOTAL HIP REPLACEMENT (THR) PRECAUTIONS are critical for preventing prosthetic hip dislocation — a serious complication requiring surgical revision. HIP PRECAUTIONS — THE THREE PROHIBITIONS: (1) NO HIP FLEXION GREATER THAN 90 DEGREES: Do not bend the hip past a right angle; no leaning forward in a chair; use a raised toilet seat; no low chairs or couches; (2) NO ADDUCTION (crossing the legs): No crossing legs at knees or ankles; use an abduction pillow between legs when lying in bed; (3) NO INTERNAL ROTATION: No turning toes inward; no lying on the operative side without pillow support; PRACTICAL APPLICATIONS: Dressing: use long-handled adaptive equipment; do not bend to put on socks/shoes; SIT TO STAND: Keep operated leg straight; use chair arm rests to push up; do not lean forward; TOILET: Use elevated toilet seat or bedside commode; SLEEPING: Abduction pillow between legs; avoid lying on operative side initially; DRIVING: No driving until cleared by surgeon (usually 4-8 weeks); these movements require hip flexion beyond 90 degrees; ANTERIOR vs POSTERIOR APPROACH: Hip precautions are traditionally associated with POSTERIOR approach; ANTERIOR approach has fewer or modified precautions — always follow the surgeon's specific orders; PN ROLE: Reinforce precautions with every interaction; set up environment to support compliance; document teaching; report any signs of dislocation (sudden severe pain, leg in shortened and internally rotated position).
Source: NCLEX-PN Test Plan: Physiological — Basic Care, Hip Replacement Precautions