Total Hip Replacement — NCLEX Cheat Sheet
No flexion > 90° hipAlso known as: hip replacement · hip arthroplasty · new hip · THR · THA
Use this quick-reference guide to spot, treat, and prevent Total Hip Replacement on the NCLEX. Keep it handy during review and on exam day!
🩺📒 The 1-minute cheat sheet
📌 Avoid
- No hip flexion > 90°
- No crossing legs / adduction
- No internal rotation, low chairs
✅ Do
- Abduction pillow between legs
- Elevated toilet seat, raised chair
- Early ambulation per PT
🚩 Report
- Dislocation: shortening, ext rotation
- Sudden pain, "pop", can't move leg
🩺 Watch
- VTE/DVT: calf pain, swelling
- Neurovascular checks distal limb
📚 Total Hip Replacement — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Key points
Understand these first- With the posterior approach, key precautions are no hip flexion beyond 90 degrees, no adduction past midline, and no internal rotation.
- Signs of prosthesis dislocation include sudden severe pain, a shortened leg, and external or internal rotation of the affected leg.
- An abduction pillow keeps the legs apart and prevents the leg from crossing midline.
- VTE (DVT and pulmonary embolism) is a major risk due to immobility and surgical trauma.
- Early ambulation with physical therapy is started to prevent complications and restore function.
- Patients should avoid low chairs, toilets, and bending to put on shoes during recovery.
Nursing priorities
What to do, in order- Maintain hip precautions: keep the legs abducted with a pillow and avoid flexion past 90 degrees.
- Assess neurovascular status of the affected leg and monitor the surgical drain and dressing.
- Administer prescribed anticoagulants and apply sequential compression devices to prevent VTE.
- Assist with early ambulation and physical therapy using assistive devices as ordered.
- Monitor for and immediately report signs of dislocation.
Red flags — report now
Escalate immediately- Sudden severe hip pain, leg shortening, and rotation indicate dislocation and require immediate report.
- Calf pain, swelling, warmth, or sudden dyspnea suggests DVT or PE and needs urgent action.
- Never flex the operative hip beyond 90 degrees, cross the legs, or turn the leg inward.
Labs & values
Numbers to know- Hemoglobin: 12 to 18 g/dL (monitor for surgical blood loss)
- Hematocrit: 37 to 52 percent
- INR: 2.0 to 3.0 if on warfarin prophylaxis
Patient teaching
What patients must know- Use a raised toilet seat, reachers, and a long-handled shoehorn; avoid bending at the hip past 90 degrees.
- Do not cross your legs, sit in low chairs, or turn the operative leg inward.
- Report increasing pain, a leg that appears shorter or rotated, or signs of infection.
❓ Total Hip Replacement: NCLEX FAQs
What are the priority nursing interventions for Total Hip Replacement?
Maintain hip precautions: keep the legs abducted with a pillow and avoid flexion past 90 degrees. Assess neurovascular status of the affected leg and monitor the surgical drain and dressing. Administer prescribed anticoagulants and apply sequential compression devices to prevent VTE. Assist with early ambulation and physical therapy using assistive devices as ordered.
What are the warning signs of Total Hip Replacement a nurse must report?
Sudden severe hip pain, leg shortening, and rotation indicate dislocation and require immediate report. Calf pain, swelling, warmth, or sudden dyspnea suggests DVT or PE and needs urgent action. Never flex the operative hip beyond 90 degrees, cross the legs, or turn the leg inward.
What do I need to know about Total Hip Replacement for the NCLEX?
With the posterior approach, key precautions are no hip flexion beyond 90 degrees, no adduction past midline, and no internal rotation. Signs of prosthesis dislocation include sudden severe pain, a shortened leg, and external or internal rotation of the affected leg. An abduction pillow keeps the legs apart and prevents the leg from crossing midline. VTE (DVT and pulmonary embolism) is a major risk due to immobility and surgical trauma.
What patient teaching is important for Total Hip Replacement?
Use a raised toilet seat, reachers, and a long-handled shoehorn; avoid bending at the hip past 90 degrees. Do not cross your legs, sit in low chairs, or turn the operative leg inward. Report increasing pain, a leg that appears shorter or rotated, or signs of infection.
Quick Tip
With the posterior approach, key precautions are no hip flexion beyond 90 degrees, no adduction past midline, and no internal rotation.
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