Chapter 13: Positioning the Patient

Question 1

Which of the following is a goal of patient positioning?

a. Maintaining circulation
b. Maintaining the patient’s comfort and privacy
c. Protecting the patient from injury
d. Providing exposure for the surgical site
e. All of the above

Answer 1

e. All of the above

Maintaining circulation, Maintaining the patient’s comfort and privacy, protecting the patient from injury and providing exposure for the surgical site

Question 2

The goal of the perioperative nurse in positioning the patient is to:

a. Provide an accurate patient assessment
b. Prevent injuries
c. Serve as the surgeon’s assistant
d. Maintain communication methods

Answer 2

b. Prevent injuries

Question 3

What is most important for the team approach to patient care?

a. Cooperation
b. Communication
c. Education
d. Economics

Answer 3

b. Communication

Question 4

Which of the following is the optimal position for the patient’s head and neck during surgery?

a. Flexed
b. Laterally rotated
c. Medially rotated
d. Neutral

Answer 4

d. Neutral

Question 5

Where should the perioperative RN place the safety strap for a patient in the supine position?

a. Below the knees
b. Directly over the knees
c. 2 inches above the knees
d. Upper thighs

Answer 5

c. 2 inches above the knees

Question 6

Which of the following positions is used for most abdominal procedures?

a. Supine
b. Lateral
c. Prone
d. Lithotomy

Answer 6

a. Supine

Question 7

In the lithotomy position, legs must be raised and lowered slowly in order to:

a. Prevent the patient from falling off the bed
b. Allow blood volume changes to adjust and prevent torsion injuries
c. Reduce the potential for nerve damage to the brachial plexus
d. Allow adequate lung expansion

Answer 7

b. Allow blood volume changes to adjust and prevent torsion injuries

Question 8

The lithotomy position causes which of the following physiologic changes?

a. Decreased venous return
b. Decreased leg perfusion
c. Decreased cardiac output
d. Decreased pressure on the diaphragm

Answer 8

b. Decreased leg perfusion

Question 9

Chest rolls or special frames must allow for:

a. Maximum chest expansion
b. Free abdominal movement
c. Venous return through the inferior vena cava
d. All of the above

Answer 9

d. All of the above

Maximum chest expansion, free abdominal movement, and venous return through the inferior vena cava.

Question 10

Parallel forces to soft tissue may damage peripheral blood vessels and/or cause abrasions. This can be caused by pulling instead of lifting a patient and is called:

a. Bruising
b. Scraping
c. Shearing
d. Torsion

Answer 10

c. Shearing

Question 11

A common nerve injury for patients placed in the supine position is:

a. Brachial plexus injury
b. Obturator nerve injury
c. Heel decubitus
d. Pulmonary emboli

Answer 11

a. Brachial plexus injury

Question 12

Padding the elbows protects the _____ nerve.

a. Brachial
b. Ulnar
c. Radial
d. Popliteal

Answer 12

b. Ulnar

Question 13

In the lateral position, the dependent leg is _____ and the other leg is _____.

a. Extended, flexed
b. Flexed, extended
c. Flexed, flexed
d. Extended, extended

Answer 13

b. Flexed, extended

Question 14

Diaphragmatic movement is most adversely affected by which of the following positions?

a. Trendelenburg
b. Lateral
c. Modified Fowler’s
d. Dorsal recumbent/supine

Answer 14

a. Trendelenburg

Question 15

Which of the following devices are suitable for patients in the Trendelenburg position?

a. Arm boards (arms should be tucked or secured with arm guards. Extension on fixed armboards can lead to injury if the patient slides toward the head of the bed)
b. Circumferential wrist restraints (can injure the brachial plexus)
c. Shoulder braces (can cause compression and injury to the brachial plexus and should be avoided whenever possible)
d. Vacuum-packed positioning devices
e. None of the above

Answer 15

d. Vacuum-packed positioning devices

Question 16

Which of the following is likely to cause injury to the brachial plexus? (Goodman & Spry, 145).

a. Tucking the arms too tightly at the patient’s sides
b. Hyperextension of the arm on an armboard
c. An automatic blood pressure cuff cycling too often
d. Pressure on the acromion process of the elbow

Answer 16

b. Hyperextension of the arm on an armboard

Question 17

In the lateral position, preventive measures include:

a. Pillows between the knees and feet
b. Axillary support on top of the patient’s up-facing thorax
c. Padding under the dependent ankle and knee
d. A and C
e. All of the above

Answer 17

d. A and C

Pillows between the knees and feet and padding under the dependent ankle and knee.

Question 18

Which of the following statements about the axillary support is most accurate?

a. A bag of IV fluids is the ideal axillary roll.
b. It should be made out of a rolled sheet or towel.
c. It should be placed in the axilla.
d. It should be wide enough to spread over several ribs.

Answer 18

d. It should be wide enough to spread over several ribs.

Question 19

How can blankets and sheets be used in positioning the patient? Select all that apply

1. Draw sheet to reposition the patient
2. To provide patient privacy
3. Rolled up to provide support
4. To provide patient warmth

a. 1, 3
b. 1, 2, 3
c. 1, 2, 4
d. All of the above

Answer 19

c. 1, 2, 4

Draw the sheet to reposition the patient, to provide patient privacy, and to provide warmth.

Question 20

Which of the following is a suitable surface for patient positioning?

a. Multiple layers of blankets
b. Multiple layers of sheets
c. Surfaces specially designed to redistribute pressure
d. Warming blankets

Answer 20

c. Surfaces specially designed to redistribute pressure

Question 21

Which of the following are acceptable for use as positioning devices?

a. Blankets
b. Pillows
c. Sheets
d. Towels
e. All of the above

Answer 21

b. Pillows

Question 22

When putting joints through their range of motion, caution should be used in order to:

a. Avoid increased venous return
b. Prevent stretching of the nerves
c. Prevent shearing
d. Prevent maceration

Answer 22

b. Prevent stretching of the nerves

Question 23

Documentation of the nursing care delivered related to positioning should include:

a. Skin assessment pre- and postoperatively
b. Type and location of equipment used
c. Patient position and personnel participating
d. All of the above

Answer 23

d. All of the above

Skin assessment pre- and postoperatively, type and location of equipment used, and patient position and personnel participating

Question 24

Safe practices for tucking a patient’s arms at the sides and securing them with a draw sheet include
that the
a. draw sheet should extend from the mid-upper arm to the fingertips.
b. elbows should be extended as much as possible.
c. palms should face away from the body.
d. sheet should be tucked between the mattress and the OR bed platform

Answer 24

a. draw sheet should extend from the mid-upper arm to the fingertips.

Question 25

Safe practices for extending a patient’s arms on arm boards include that the

a. arm boards should be lower than the level of the OR bed. (should be at same height as OR bed)
b. arms and wrists should be maintained in neutral alignment.
c. arms should be abducted at least 90 degrees. (at or less than 90 degrees)
d. palms of the hand should face down. (should be up)

Answer 25

b. arms and wrists should be maintained in neutral alignment.

Question 26

Describe the 3 basic surgical positions and the positions that are modifications of these 3 basic positions

Answer 26

Supine = on back. Modifications - trendelenburg, reverse trendelenburg, sitting, semi/sitting, lithotomy

Lateral = on side. Modifications - lateral recumbent

Prone = on stomach. Modifications - jack-knife/Kraske

Question 27

Explain why the perioperative nurse would not just look at a picture of a surgical position with instructions for a specific surgical procedure and follow that to the letter

Answer 27

You have to assess factors related to the procedure, pressure injury risk and patient specific factors such as ROM limitations that could increase patient’s risk for positioning injury

Question 28

What types of circulatory and respiratory physiological effects result from positioning a patient in the lithotomy position?

Answer 28

Patient may have circulatory pooling in lumbar region, decreased blood pressure if legs are lowered too quickly. The circulatory system may be compromised due to compression of abdominal contents on inferior vena cava and abdominal aorta, compression of thighs against abdomen may produce damage to external iliac arteries.
Pressure from the thighs against the abdomen and pressure from the diaphragm on abdominal viscera can decrease respiratory efficiency and lung tissue can become engorged with blood which will decrease lung capacity.

Question 29

Describe the positioning precautions, including positioning devices you would use, when positioning a patient in the prone position

Answer 29

Keep this position for the shortest time possible, use 5-10 degree trendelenburg if possible. Use two chest supports, face positioner, arm boards, padding under knees and shins, safety strap. Keep eyes padded and pressure avoided, arms not above the head and rotated slowly, ensure that breasts, abdomen and genitals are free from torsion and pressure. Takes 4 people to position patient.

Question 30

Why can you say that the duration of pressure is more important than the intensity of the pressure when it comes to positioning considerations?

Answer 30

Greater pressure for a short period of time can be tolerated better than lower pressure for a long period of time because of the longer period of diminished tissue perfusion

Question 31

Explain the difference between shearing and friction – give examples

Answer 31

Shearing = when tissue layers move on each other, can cause blood vessels and tissues to stretch, angulate and become damaged. The patient’s skin is stationary and underlying tissues shift or move. Example - Trendelenburg position without body support can cause torso to slide down with shearing motion

Friction = skin surfaces rub over a rough, stationary surface, can harm the epidermis and increase risk for pressure injury. Example - moving a patient without a board

Question 32

Why is the preoperative assessment of the patient for functional limitations and skin conditions so important for a patient with arthritis?

Answer 32

Various position changes can produce stress on the musculoskeletal system. After anesthesia, physical indicators of pain/pressure that warn when limits of stretching or twisting have been reached are no longer active. Muscles are relaxed after anesthesia and a patient with arthritis may have potentially harmful movements.