A nurse is reinforcing teaching with a client who has rheumatoid arthritis and is using a straight-legged cane for ambulation. Which of the following instructions should the nurse include?

A. "Maintain your elbow flexed at a 90-degree angle.": When fitted properly, a cane should allow for slight elbow flexion of about 20 to 30 degrees, not 90 degrees. Excessive flexion increases upper extremity fatigue and reduces mechanical advantage, making ambulation less efficient and potentially increasing joint strain. B. "Keep the cane on the stronger side of the body.": A cane is held on the stronger side to widen the base of support and reduce weight-bearing stress on the weaker or more painful limb. This positioning promotes a more natural gait pattern and decreases joint loading on the affected side, which is especially important in rheumatoid arthritis. C. "Place the cane forward 5 to 10 cm (2 to 4 in).": The cane is typically advanced approximately 15 to 25 cm (6 to 10 in) forward in coordination with the weaker leg. Advancing it only 2 to 4 inches does not provide adequate forward support or stability during the gait cycle. D. "Move the stronger leg forward first.": The correct sequence is to move the cane and the weaker leg forward together, followed by advancing the stronger leg. Moving the stronger leg first would shift weight onto the weaker extremity without support, increasing discomfort and fall risk.