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NCLEX · Basic Care and Comfort

When positioning a client who had a left-sided stroke resulting in right-sided hemiplegia (weakness/paralysis), which position is contraindicated?

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Correct answer

Lying on the affected (right) side without adequate protection — the hemiplegic side has reduced sensation and reduced ability to reposition; lying directly on the affected extremities without padding and correct alignment can cause pressure injuries, joint damage, shoulder subluxation, and skin breakdown

  1. A Supine with foot board
  2. B Semi-Fowler's with right arm supported
  3. C Lying on the affected (right) side without adequate protection — the hemiplegic side has reduced sensation and reduced ability to reposition; lying directly on the affected extremities without padding and correct alignment can cause pressure injuries, joint damage, shoulder subluxation, and skin breakdown
  4. D Supported side-lying on the unaffected (left) side

Why this is the answer

Hemiplegia positioning: The AFFECTED SIDE requires special protection because: reduced or absent sensation (cannot feel pain from poor positioning); reduced motor function (cannot shift weight normally); increased muscle tone in abnormal patterns (spasticity); RISKS OF IMPROPER POSITIONING ON AFFECTED SIDE:

Shoulder subluxation: Shoulder joint may partially dislocate under the weight of the flaccid arm without support; use arm supports in sitting.

Contractures: Without proper positioning and ranging, affected limbs contract in abnormal positions.

Pressure injuries: Bony prominences on the affected side are at highest risk — use pressure-redistributing surfaces.

Correct positioning: Affected side up: use pillows to support arm in 90-degree shoulder abduction with elbow extended, wrist neutral; Affected side down (possible if turning): brief; requires full padding of shoulder, arm, knee, ankle.

General principles: Neutral joint alignment; no dependent positioning of affected extremities; regular 2-hour repositioning; passive ROM; splints/positioning devices as ordered.

Source: NCLEX-PN Test Plan: Physiological — Hemiplegia Positioning

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About this topic: Basic Care and Comfort

Basic care and comfort questions cover hygiene, mobility and positioning, nutrition and hydration, elimination, sleep, and non-pharmacological comfort measures — the daily care an LPN/LVN provides. This is one of 16 PN: Physiological Integrity questions on basic care and comfort, each with a full explanation on a single study page.

New to this exam? Our NCLEX exam guide explains the format, scoring, and how to prepare.

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