Difficulty: Medium
Average Score: 74%
Simulated
A male client has right-sided hemiplegia following a left cerebrovascular accident (CVA). His sitting balance has improved, and he is now able to sit in a wheelchair. To assist the client in transferring from the bed to a wheelchair, which action should the nurse take?
Correct answer
B
Rationale
After a left CVA, the client has right-sided weakness (hemiplegia). The wheelchair should be placed on the client's strong side (the left side) to allow the client to use the unaffected limbs for support and pushing during the transfer. Having the client put arms around the nurse's neck is unsafe and can cause nurse injury. Instructing the client to look at their feet can cause flexion of the neck and back, increasing fall risk. Breathing instructions are not the primary focus.