Positioning (Ericksen) Exam 2

Question 1

Which of the following is a primary consideration for patient positioning in the operating room?

A) Ensuring the patient’s position is comfortable for the surgical team.
B) Using protective measures to maintain perfusion and protect pressure points and nerve plexus.
C) Allowing the patient to choose their preferred position.
D) Minimizing the use of positioning devices to reduce costs.

Answer 1

B) Using protective measures to maintain perfusion and protect pressure points and nerve plexus.

Pressure points must be padded

Question 2

What is a critical aspect to consider regarding the time it takes for nerve damage and other injuries to occur during surgery?

A) These injuries are always reversible
B) It usually takes a long time for nerve damage to become significant.
C) Such injuries can occur quickly and may be irreversible.
D) Nerve damage is rare and usually not a concern.

Answer 2

C) Such injuries can occur quickly and may be irreversible.

Question 3

How should the positioning process be approached for each patient?

A) Focus primarily on aligning the patient’s head and neck.
B) Use as few positioning devices as possible to minimize complexity.
C) Consider the entire body from head to toe, the devices needed, and the level of assistance required.
D) Rely solely on the surgical team’s preferences for positioning.

Answer 3

C) Consider the entire body from head to toe, the devices needed, and the level of assistance required.

Question 4

When aligning a patient’s joints during positioning for surgery, under what condition might the usual alignment be intentionally altered?

A) When the patient’s comfort is prioritized over surgical access.
B) When aligning the joints conflicts with the surgical field requirements.
C) To accommodate for the use of additional monitoring equipment.
D) If the patient has pre-existing joint conditions that require special positioning.

Answer 4

B) When aligning the joints conflicts with the surgical field requirements.

Should be as natural as possible!

Question 5

Safety belts or straps must be used in the ____________ area to secure the patient, in addition to securing the extremities.
A) Chest/abdomen
B) Abdominal/pelvic
C) Pelvic/chest
D) Chest/pelvic

Answer 5

B) Abdominal/pelvic

Avoid placing belts/straps too tightly

Question 6

What is the most common surgical position used during procedures?

A) Lateral position
B) Supine position
C) Prone position
D) Trendelenburg position

Answer 6

B) Supine position

Question 7

In the context of surgical positioning, what are the potential respiratory implications of the supine position?

A) Increased tidal volume and functional residual capacity (FRC).
B) Increased risk of respiratory alkalosis due to hyperventilation.
C) Enhanced oxygenation and improved respiratory function.
D) Decreased tidal volume and functional residual capacity (FRC).

Answer 7

D) Decreased tidal volume and functional residual capacity (FRC)

Question 8

Which of the following correctly matches the pathophysiologic changes associated with the supine position?

A) Decreased venous return and increased tidal volume.
B) Increased preload and stroke volume, and decreased tidal volume.
C) Decreased stroke volume and increased functional residual capacity.
D) Increased preload, cardiac output and increased functional residual capacity.

Answer 8

B) Increased preload and stroke volume, and decreased tidal volume.

Question 9

When positioning a patient’s arms during surgery, at what angle should the arms be placed relative to the body when abducted?

A) Greater than 90 degrees
B) Exactly 90 degrees
C) Less than 90 degrees
D) There is no specific angle requirement

Answer 9

C) Less than 90 degrees

Question 10

What is the recommended position for a patient’s arms when they are placed on arm boards during surgery?

A) Prone (palms down)
B) Supine (palms up)
C) Neutral (palms facing each other)
D) Elevated above the head

Answer 10

B) Supine (palms up)

Question 11

Arm boards used during surgery should be padded and securely attached to the table and to the patient at the __________.

A) Axilla
B) Shoulder
C) Elbow
D) Wrist

Answer 11

A) Axilla

Question 12

It is important to pad the patient’s __________ to prevent pressure injuries when the arms are positioned on arm boards.

A) Fingers
B) Forearms
C) Wrists
D) Elbows

Answer 12

D) Elbows

Question 13

When arms are positioned tucked alongside the body during surgery (adduction), how are they typically held in place?

A) With medical tape around the wrists.
B) By a draw sheet that goes under the body and over the arm.
C) Using heavy restraints fastened to the operating table.
D) By placing the arms in stirrups.

Answer 13

Answer: B) By a draw sheet that goes under the body and over the arm.

Question 14

Adduction

In what position should the hands and forearms be placed when arms are tucked alongside the body?

A) Prone (palms down)
B) Supine (palms up) or neutral (palms toward body)
C) Just neutral (palms toward body)
D) Rotated outward (palms away from the body)

Answer 14

Answer: B) Supine (palms up) or neutral (palms toward body)

Elbows are padded!

Question 15

Why might one arm be tucked alongside the body while the other is left free during a surgical procedure?

A) To accommodate the surgeon who may need to stand on one side of the patient.
B) To provide the anesthesiologist better access to intravenous lines.
C) To maintain asymmetry in patient positioning.
D) To enhance patient comfort during long procedures.

Answer 15

Answer: A) To accommodate the surgeon who may need to stand on one side of the patient.

Question 16

What is the action of the arms in A and B?

Answer 16

A. Abduction (Away from the body)
B. Adduction (Towards the body)

Question 17

What complication can occur due to prolonged pressure on the back of the head in the supine position?

A) Alopecia areata
B) Pressure alopecia
C) Trigeminal neuralgia
D) Occipital neuralgia

Answer 17

Answer: B) Pressure alopecia

Question 18

Which nerve is at risk of injury if a patient’s arms are abducted more than 90 degrees in the supine position?

A) Radial nerve
B) Median nerve
C) Ulnar nerve
D) Brachial plexus

Answer 18

Answer: D) Brachial plexus

Question 19

In the supine position, what can lead to an ulnar nerve injury?

A) Arms abducted less than 90 degrees
B) Hand/arm is in a pronated (palm down) position
C) Arms tucked alongside the body
D) Hand/arm is in a supinated (palm up) position

Answer 19

Answer: B) Hand/arm is in a pronated (palm down) position

Question 20

What type of injury is most likely to occur when the neck is extended and the head is turned away in the supine position?

A) Carotid artery dissection
B) Cervical spine injury
C) Stretch injury to the brachial plexus
D) Thoracic outlet syndrome

Answer 20

Answer: C) Stretch injury to the brachial plexus

Question 21

A patient in the supine position complains of back pain after a surgical procedure. Which of the following is the most likely cause?

A) Pressure on the lumbar spine
B) Compression of the sciatic nerve
C) Overextension of the legs
D) Pillows under the legs

Answer 21

Answer: A) Pressure on the lumbar spine due to inadequate support

“Loss of tone with the Paraspinal muscles – wake up with a back ache”

Question 22

Which position is same as supine, but tilting the head of the patient down?

A)Trendelenburg
B) Supine
C) Reverse Trendelenburg
D) Prone

Answer 22

A) Trendelenburg

Question 23

When positioning a patient trendelenburg, what is the primary reason for using a non-sliding mattress or pad?
A) To provide extra cushioning for the patient’s comfort
B) To ensure the patient does not slide cephalad
C) To elevate the patient’s legs for better circulation
D) To ensure the patient does not slide caudad

Answer 23

B) To ensure the patient does not slide cephalad

Question 24

In the context of preventing a patient from sliding cephalad, which following tools should be avoided?
Pick 2
A) Non-sliding mattress
B) Shoulder braces
C) Foot braces
D) Bean bags

Answer 24

B) Shoulder braces
D) Bean bags

Question 25

# True/False Making a mark at the level of the patient’s head on the sheet or pad can help determine if the patient has slid during a procedure.

Answer 25

True

Question 26

What effect does the Trendelenburg position have on cardiac output (CO)? A) Decreases CO B) No effect on CO C) Increases CO D) Varies depending on the patient’s condition

Answer 26

Answer: C - Increases CO | Increased venous return from the lower extremities!!

Question 27

How does the Trendelenburg position affect intracranial pressure (ICP) and intraocular pressure (IOP)? A) Decreases ICP and IOP B) Increases ICP and IOP C) No change in ICP and IOP D) Only increases ICP, not IOP

Answer 27

Answer: B - Increases ICP and IOP

Question 28

Edema may develop in the face in Trendelenburg. Where else does this happen? A) Tongue B) Conjunctiva C) Larynx D) All of the above

Answer 28

D) All of the above | ***With increased surgical time and prescence of fluid overload.***

Question 29

What is a respiratory effect of the Trendelenburg position due to the cephalad shift of the diaphragm? A) Increased Functional Residual Capacity (FRC) and pulmonary compliance B) Decreased Functional Residual Capacity (FRC) and pulmonary compliance C) No change in FRC or pulmonary compliance D) Increased Functional Residual Capacity (FRC) and Decreased pulmonary compliance

Answer 29

Answer: B - Decreased Functional Residual Capacity (FRC) **and** pulmonary compliance

Question 30

Why might patients in the Trendelenburg position require higher pressures during mechanical ventilation? A) To prevent hyperventilation B) To achieve adequate ventilation despite reduced lung volumes C) To increase cardiac output D) To avoid hypoxia due to increased pulmonary compliance

Answer 30

Answer: B - To achieve adequate ventilation despite reduced lung volumes

Question 31

The Trendelenburg position can increase the risk of endobronchial intubation because the abdominal contents push the _______ cephalad. A) Diaphragm B) Larynx C) Carina D) Bronchioles

Answer 31

C) Carina

Question 32

How is the Reverse Trendelenburg position different from the standard supine position? A) The patient's head is tilted downward. B) The patient's head is tilted upward. C) The patient's feet are elevated above the heart. D) The patient is positioned on their side.

Answer 32

B) The patient's head is tilted upward.

Question 33

In addition to using a non-sliding mattress or pad, what else can be utilized to prevent the patient from sliding in the Reverse Trendelenburg position? A) Non-skid socks B) Duct tape C) Using a footrest or something under the feet D) Several tight abdominal/pelvic straps

Answer 33

Answer: C - Using a footrest or something under the feet.

Question 34

How does the Reverse Trendelenburg position affect venous return and what risk does this pose? A) It enhances venous return, reducing the risk of venous pooling and hypotension B) It diminishes venous return, increasing the risk of hypotension due to venous pooling C) It has no effect on venous return, posing no additional risks. D) It compresses the inferior vena cava, leading to increased risk of venous pooling and hypotension

Answer 34

Answer: B - It diminishes venous return, increasing the risk of hypotension due to **venous pooling** in the lower extremities.

Question 35

Why might the Reverse Trendelenburg position reduce perfusion to the brain? A) It increases cerebral venous pressure. B) It elevates the head above the heart, reducing arterial blood flow to the brain. C) It causes blood to pool in the upper extremities, leading to hyperperfusion. D) It compresses the carotid arteries, limiting blood flow to the brain.

Answer 35

Answer: B - It elevates the head above the heart, reducing arterial blood flow to the brain.

Question 36

The Reverse Trendelenburg position results in a downward _______ of abdominal contents and the diaphragm. A) compression B) displacement C) elevation D) stabilization

Answer 36

B) displacement

Question 37

Which position is commonly used in shoulder surgeries to minimize hip and leg flexion? A) Supine position B) Prone position C) Jack knife position D) Beach chair position

Answer 37

D) Beach chair position | Less severe hip flexion and slight leg flexion!!

Question 38

What is the recommended angle for hip flexion and knee flexion in the beach chair position during surgery? A) Hip flexed > 90 degrees, knees stabilized B) Hip flexed > 90 degrees, knee slightly flexed C) Hip flexed > 90 degrees, knee extended D) Hip flexed < 90 degrees, knee slightly flexed

Answer 38

Answer: D) Hip flexed < 90 degrees, knee slightly flexed for balance | Reduce stretching of the sciatic nerve!!

Question 39

To ensure proper positioning in the sitting position, there should be at least ____________ between the chin and sternum. A) One finger's width B) Two finger's distance C) Three finger's width D) Four finger's distance

Answer 39

B) Two finger's distance

Question 40

How is the head stabilized in the sitting position? Select 2 A) Taped to special headrest B) Non-skid gel pads C) Rigid pins drilled into the skull D) Bean bag

Answer 40

A) Taped to special headrest C) Rigid pins

Question 41

Compression stockings/wraps are applied to maintain ____________. A) arterial circulation B) block lymphatics C) venous return D) patient comfort

Answer 41

C) venous return

Question 42

Sitting for extended periods can potentially lead to which of the following risks? A) Pneumocephalus B) Quadriplegia C) Peripheral nerve injuries D) Cerebral Hypoperfusion E) All of the above

Answer 42

E) All of the above * Pneumocephalus - *pressure on the intracranial sinuses* * Quadriplegia and *spinal cord infarction* * Peripheral nerve injuries - *sciatic nerve injury* * Cerebral Hypoperfusion and *air embolism and cerebral ischemia*

Question 43

Which condition involves pressure on the intracranial sinuses due to sitting position? A) Cerebral ischemia B) Quadriplegia C) Pneumocephalus D) Sciatic nerve injury

Answer 43

C) Pneumocephalus

Question 44

What is a potential consequence of prolonged sitting leading to cerebral hypoperfusion? A) Cerebral aneurysm B) Air embolism C) Hydrocephalus D) Spinal Cord fracture E) All of the Above

Answer 44

B) Air embolism

Question 45

Due to prolonged sitting position, the spinal cord has compromised blood flow. This increased pressure can cause spinal cord ____________ and eventually lead to _______________. A) Infarction/Paraplegia B) Infarction/Hemiplegia C) Infarction/Quadriplegia D) Infarction/Tetraplegia

Answer 45

C) Infarction/Quadriplegia

Question 46

Which main peripheral nerve can be injured in the sitting position? A) Femoral Nerve B) Sural Nerve C) Peroneal Nerve D) Sciatic Nerve

Answer 46

D) Sciatic Nerve

Question 47

What is a potential consequence of reduced venous return due to prolonged sitting positions? A) Increased cardiac output B) Venous pooling in lower extremities C) Elevated mean arterial pressure (MAP) D) Enhanced cerebral perfusion pressure

Answer 47

B) Venous Pooling in lower extremities | Hypotension risk!!

Question 48

Prolonged sitting positions during surgery can lead to which of the following changes in cardiovascular parameters? A) Increased MAP, Cardiac Index (CI), and cerebral perfusion pressure B) Decreased MAP, Cardiac Index (CI), and Increased cerebral perfusion pressure C) Decreased MAP, Cardiac Index (CI), and Decreased cerebral perfusion pressure D) Enhanced peripheral perfusion

Answer 48

C) Decreased MAP, Cardiac Index (CI), and Decreased cerebral perfusion pressure

Question 49

What position is the patient in when they are lying on their stomach with legs padded and slightly flexed at the knees and hips? A) Supine B) Lithotomy C) Prone D) Lateral Decubitus

Answer 49

C) Prone

Question 50

How should the patient's arms be positioned during the prone position to maintain comfort and prevent injury? (select 2) A) Arms at side tucked B) Arms fully extended (> 90 degrees) with flexion at elbows C) Arms crossed over the chest D) Arms outstretched (< 90 degrees) with flexion at elbows

Answer 50

A) Arms at side tucked or D) Arms outstretched (< 90 degrees) with flexion at elbows

Question 51

What is the recommended sequence for intubating a patient who will be positioned prone during surgery? A) Intubate the patient while prone and then transfer to OR bed B) Intubate the patient supine on the bed and then turn prone C) Intubate the patient supine on the bed and then turn lateral D) Intubate the patient in a lateral position then turn prone

Answer 51

B) Intubate the patient supine on the bed and then turn prone

Question 52

During surgery, the patient's head is supported face down using a prone pillow, horseshoe headrest, or rigid fixation with pins in a neutral position without pressure on ____________. (Select 4) A) Cheeks B) Eyes C) Nose C) Forehead D) Chin E) Mouth F) Ears

Answer 52

B) Eyes C) Nose E) Mouth F) Ears See no evil, hear no evil, speak no evil... and smell no evil..

Question 53

What complication can occur due to inadequate padding of the **elbows** during the prone position? A) Facial and airway edema B) Nerve injuries C) Post-op visual loss D) ETT dislodgement

Answer 53

B) Nerve injuries | Ulnar Nerve if elbows are not padded!!!

Question 54

Brachial plexus injury during prone positioning typically occurs when: A) Arms are flexed at the elbow B) Arms are abducted greater than 90 degrees C) Arms are adducted close to the body D) Arms are internally rotated

Answer 54

B) Arms are abducted greater than 90 degrees

Question 55

Facial and airway edema during prone positioning are primarily due to: A) Decreased blood flow to the face B) Decreased intrathoracic pressure C) Compression of the facial tissues D) Elevated intraocular pressure

Answer 55

C) Compression of the facial tissues

Question 56

Post-operative visual loss secondary to decreased perfusion or ischemia is a concern primarily related to: A) Increased intracranial pressure B) Eye injuries r/t head position C) Decreased occipital saturation D) Ocular trauma

Answer 56

B) Eye injuries r/t head position

Question 57

Which complication is a significant risk associated with prone positioning regarding airway management? Which one is the MOST correct? (it was on the slide) A) Bronchospasm B) Endotracheal tube (ETT) dislodgement C) Laryngeal edema D) Tracheostomy tube blockage

Answer 57

B) Endotracheal tube (ETT) dislodgement

Question 58

Increased abdominal pressure during prone positioning results in which cardiovascular effect? A) Increased venous return B) Enhanced cardiac output C) Decreased venous return D) Increased preload

Answer 58

C) Decreased venous return | **Caused by compression of the inferior vena cava!!!**

Question 59

What physiological change occurs in the lungs when a patient is placed in prone position? A) Worsening ventilation B) Ventilation shifts to the dependent areas only C) Ventilation and perfusion shift to dependent lung areas D) Perfusion shifts to dependent areas only

Answer 59

C) Ventilation and perfusion shift to dependent lung areas

Question 60

Question 1: Which of the following describes the lithotomy position? A) Patient lying on their side with legs in candy cane stirrups B) Patient lying supine with legs in padded stirrups C) Patient sitting upright with legs crossed D) Patient prone with arms and legs extended

Answer 60

B) Patient lying supine with legs in padded stirrups

Question 61

When using Trendelenburg or reverse Trendelenburg positions in lithotomy, why is a non-sliding mattress necessary? A) To prevent pressure ulcers on the buttocks B) To maintain proper leg positioning C) To prevent sliding of the patient during surgery D) To ensure proper distribution of body weight

Answer 61

C) To prevent sliding of the patient during surgery

Question 62

# True/False During the lithotomy position the arms are only tucked and never on arm boards

Answer 62

False Arms are tucked or on arm boards

Question 63

What is the recommended range of hip flexion and leg abduction angles in the lithotomy position? A) Hip flexed 45-60 degrees, legs abducted 30-90 degrees B) Hip flexed 60- 100 degrees, legs abducted 30-45 degrees C) Hip flexed 80-100 degrees, legs abducted 30-45 degrees D) Hip flexed 30-60 degrees, legs abducted 30-60 degrees

Answer 63

Answer: C) Hip flexed 80-100 degrees, legs abducted 30-45 degrees

Question 64

Why is it crucial to raise and lower both lower extremities synchronously in the lithotomy position? A) To prevent foot drop syndrome B) To maintain proper alignment of the head C) To prevent torsion injury to the lumbar spine D) To reduce the risk of deep vein thrombosis (DVT)

Answer 64

Answer: C) To prevent torsion injury to the lumbar spine

Question 65

When lowering the foot of the bed in lithotomy position, what precaution should be taken regarding the patient's hands and fingers? A) Secure them with padded restraints B) Keep them elevated above the head C) Place them on soft cushions D) Protect them from crush injury

Answer 65

Answer: D) Protect them from crush injury | ** Ericken likes to pad the hands

Question 66

It is recommended to periodically lower the legs during surgeries lasting more than ________ hours in lithotomy position. A) 1-2 B) 2-3 C) 3-4 D) 4-5

Answer 66

B) 2-3

Question 67

Back pain in the lithotomy position is commonly attributed to: A) Compression of the iliac vessels B) Nerve entrapment in the lumbar spine C) Paraspinous muscle injury D) Herniation of the intervertebral discs

Answer 67

C) Paraspinous muscle injury

Question 68

What are the nerves that can be injured from lithotomy position? A) Brachial Plexus B) Ulnar nerve C) Peroneal D) Lateral femoral cutaneous E) All of the above

Answer 68

E) All of the above Big Umbrellas Protect Legs

Question 69

Which nerve injury is a known risk in lithotomy position due to compression near the fibular head? A) Radial nerve injury B) Ulnar nerve injury C) Common peroneal nerve injury D) Femoral nerve injury

Answer 69

C) Common peroneal nerve injury | ****Lies between fibular head, it compresses ***with leg support***

Question 70

Compartment syndrome is a potential complication in lithotomy position primarily due to: A) Excessive pressure on the abdomen B) Tight boots or leg supports C) Inadequate positioning of the head D) Prolonged surgical duration

Answer 70

B) Tight boots or leg supports

Question 71

Lateral femoral cutaneous nerve pass through the ________ ligament and can become impinged and become ischemic. A) Inguinal B) Iliac C) Femoral D) Peroneal

Answer 71

A) Inguinal

Question 72

Lateral femoral cutaneous nerve injury in the lithotomy position can be avoided if the legs are positioned: Select 2 A) Extended position B) Not at 90 degrees C) At 90 degrees D) Relaxed position

Answer 72

B) Not at 90 degrees D) Relaxed position

Question 73

What physiological effect does lithotomy position have on venous return, cardiac output (CO), and intracranial pressure (ICP)? A) Decreases venous return and CO, increases ICP B) Increases venous return, CO, and ICP C) Increases venous return and CO, decreases ICP D) Increases ICP, decreases venous return and CO

Answer 73

B) Increases venous return, CO, and ICP | ** Blood returning from lower extremities to head!!

Question 74

Increased intraabdominal pressure in lithotomy position primarily displaces the diaphragm: A) Caudally B) Centrally C) Laterally D) Cephalad

Answer 74

D) Cephalad | Decreases FRC!!!

Question 75

How does lithotomy position affect respiratory function? A) Increases functional residual capacity (FRC) B) Decreases lung compliance and tidal volume C) Decreases lung compliance and increases tidal volume D) Increases lung compliance and tidal volume

Answer 75

B) Decreases lung compliance and tidal volume

Question 76

In the lateral decubitus position, which side is considered the dependent side (non-operative) for surgical access? A) The side facing upward B) The side facing downward C) The side with anterior support D) Both sides equally

Answer 76

B) The side facing downward | Ex: RIGHT lateral decubitus = RIGHT side down

Question 77

To prevent pressure on the eyes or ears in the lateral decubitus position, adequate head support should ensure: A) The head is turned toward the ceiling B) The head and neck are in the prone position C) Neutral alignment of the head and neck D) The temporal regions of the head are compressed

Answer 77

C) Neutral alignment of the head and neck | Dependent ear shoudl be regularly checked!!

Question 78

What is the recommended degree of abduction for the dependent arm in the lateral decubitus position? A) >45 degrees B) < 60 degrees C) < 90 degrees D) >90 degrees

Answer 78

C) < 90 degrees

Question 79

Which support is necessary for maintaining the lateral decubitus position during surgery? A) Anterior rolls or bean bags B) Posterior rolls or bean bags C) No support is necessary D) Anterior and posterior rolls or bean bags

Answer 79

D) Anterior and posterior rolls or bean bags

Question 80

# True/False Dependent leg is straight and there must be padding between the knees

Answer 80

False Dependent leg is slightly flexed and there must be padding between the knees

Question 81

Where should an axillary roll be placed in the lateral decubitus position to prevent brachial plexus compression? Select 2 A) Above the armpit B) Between the chest wall and bed C) Below the armpit D) In the armpit

Answer 81

B) Between the chest wall and bed C) Below the armpit - **Caudal to axilla**

Question 82

Why is it crucial to place the kidney rest under the **iliac crest** if the bed is flexed in the lateral decubitus position? A) To prevent abdominal distension B) To ensure proper alignment of the spine C) To avoid inferior vena cava compression D) To facilitate arterial blood flow

Answer 82

C) To avoid inferior vena cava compression

Question 83

What is the primary respiratory benefit of using a kidney rest under the iliac crest in the lateral decubitus position? A) Allows best possible expansion of the independent lung B) Prevents nerve injuries C) Allows best possible expansion of the dependent lung D) Prevents ETT dislodgement

Answer 83

C) Allows best possible expansion of the dependent lung | There is MORE chance of ETT dislodgment; caution with LMA

Question 84

What complication can occur if the arms are abducted more than 90 degrees in the lateral decubitus position? A) Nerve entrapment B) Shoulder dislocation C) Brachial plexus injury D) Pulmonary embolism

Answer 84

C) Brachial plexus injury

Question 85

Venous pooling in the lower extremities in the lateral decubitus position can be mitigated by: A) Elevating the dependent leg B) Using compression stockings/devices C) Flexing the knees D) Abducting the non-dependent leg

Answer 85

B) Using compression stockings/devices

Question 86

-What is the primary concern regarding ventilation/perfusion (V/Q) mismatch in the lateral decubitus position? A) Inadequate ventilation to the dependent lung B) Decreased blood flow to the dependent lung C) Excessive tidal volume in the non-dependent lung D) Increased blood flow to the non-dependent lung

Answer 86

A) Inadequate ventilation to the dependent lung | V/Q mismatch is due to DECREASED blood flow to the nondependent lung

Question 87

Peripheral nerve injuries associated with patient positioning result primarily from: A) Infection at the surgical site B) Direct trauma to nerve bundles C) Prolonged anesthesia exposure D) Stretch, pressure, and/or ischemia

Answer 87

D) Stretch, pressure, and/or ischemia | Mechanism of injury unclear*

Question 88

In the lateral decubitus position, which nerve is at risk of injury if elbows are not adequately padded? A) Radial nerve B) Ulnar nerve C) Median nerve D) Brachial plexus

Answer 88

B) Ulnar nerve

Question 89

Peripheral nerve injuries can manifest in which forms? A) Motor dysfunction B) Sensory deficits C) Combined sensory and motor deficits D) Neither sensory or motor deficits

Answer 89

C) combined sensory and motor deficits *Most are sensory* | Can be temporary or PERMANENT

Question 90

When can peripheral nerve injuries occur, even with optimal positioning practices? A) During induction of anesthesia B) At most 45min C) In as little as 15min D) In as little as 30 minutes

Answer 90

D) In as little as 30 minutes | Major LEGAL cause to professional liability claims

Question 91

Which injury is associated with 14% of all positioning injuries? A) Spinal Cord B) Lumbosacral Nerve rood/cord C) Sciatic and Peroneal D) Ulnar Nerve E) Brachial Plexus

Answer 91

D) Ulnar Nerve Avoid excessive pressure on the postcondylar groove of humerus *Keep hand and forearm supinated or in a neurtal position

Question 92

Which injury is associated with 19% of all positioning injuries? A) Spinal Cord B) Lumbosacral Nerve rood/cord C) Sciatic and Peroneal D) Ulnar Nerve E) Brachial Plexus

Answer 92

E) Brachial Plexus -Avoid shoulder braces and beanbags in T-burg and avoid abduction of the arms -Avoid excessive lateral rotation of head in supine/prone -Limit abduction of the arms <90 in supine -Avoid high axillary roll in decubitus position - Use ultrasound to locate IJ for central line placement

Question 93

Which injury is associated with 25% of all positioning injuries? A) Spinal Cord B) Lumbosacral Nerve rood/cord C) Sciatic and Peroneal D) Ulnar Nerve E) Brachial Plexus

Answer 93

A) Spinal Cord - The fraction of the spinal cord injuries is increaseing d/t to use of **regional anesthesia** - Avoid severe cervical spine flextion or extension when possible - Be careful with pt on anticoagulant therapy

Question 94

Which injury is associated with 18% of all positioning injuries? A) Spinal Cord B) Lumbosacral Nerve root/cord C) Sciatic and Peroneal D) Ulnar Nerve E) Brachial Plexus

Answer 94

B) Lumbosacral Nerve root/cord

Question 95

Which injury is associated with 7% of all positioning injuries? A) Spinal Cord B) Lumbosacral Nerve rood/cord C) Sciatic and Peroneal D) Ulnar Nerve E) Brachial Plexus

Answer 95

C) Sciatic and Peroneal - Minimize time in lithotomy - use two people to coordinate simultaneous movement of both legs in and out of lithotomy - Avoid excessive flexion of hips, extension of knees, or torsion of lumbar spine - Avoid excessive pressure on peroneal nerve at fibular head