Chapter 17: Positioning Clients
The nurse is preparing to reposition a dependent client who weighs more than 250 lb. Which interventions would the nurse use to move this client? Select all that apply. 1. Use a friction-reducing slide sheet. 2. Use a mechanical lift to move the client. 3. Place the client in Trendelenburg position. 4. Keep elbows close and work close to the body. 5. Administer oral pain medication 5 minutes before moving the client. 6. Obtain assistance of a second caregiver to assist with mechanical aids.
1. 1, 2, 4, 6 Rationale: Manually lifting or transferring clients can result in work-related injuries and back problems for health care workers. In addition, the shearing of the client's skin over bony prominences may occur when health care workers move clients independently. The nurse would seek the assistance of another caregiver, and use correct body mechanics while utilizing mechanical aids, such as a ceiling lift or friction-reducing slide sheet. Placing the client in Trendelenburg is not a useful technique for repositioning and could be harmful to the client because of the pressure this position places on the diaphragm. Administering oral pain medication may be necessary, but oral medications need to be given at least 30 minutes before the activity to provide time for the medication to work and provide relief of pain. Test-Taking Strategy: Focus on the subject, safely moving a client. Next, focus on the data in the question. This client's dependent condition and weight require extra help and use of mechanical aids.
A client has just returned to a nursing unit after an above-knee amputation of the right leg. The nurse needs to plan to place the client in which position? 1. Prone 2. Reverse Trendelenburg's 3. Supine, with the residual limb flat on the bed 4. Supine, with the residual limb supported with pillows
10. 4 Rationale: The residual limb is usually supported on pillows for the first 24 hours following surgery to promote venous return and decrease edema. After the first 24 hours, the residual limb usually is placed flat on the bed to reduce hip contracture. Edema is controlled by limb-wrapping techniques. In addition, it is important to check the surgeon's prescription(s) regarding positioning following amputation. Test-Taking Strategy: Focus on the subject, positioning following amputation, and note that the client has just returned from surgery. Using basic principles related to immediate postoperative care and preventing edema will assist in directing you to the correct option.
The nurse is assigned to assist with caring for a client after cardiac catheterization performed through the left femoral artery. The nurse needs to plan to maintain bed rest for this client in which position? 1. High Fowler's position 2. Supine with no head elevation 3. Left lateral (side-lying) position 4. Supine with head elevation no greater than 30 degrees
2. 4 Rationale: After cardiac catheterization, the extremity into which the catheter was inserted is kept straight for the prescribed time period to prevent arterial occlusion or bleeding and hematoma. With a femoral approach, the client's affected extremity is kept straight and the head elevated no more than 30 degrees (some primary health care providers prefer a lower head position or the flat position) until hemostasis is adequately achieved. The client may turn from side to side. Bathroom privileges are not allowed during the immediate postcatheterization period. High Fowler's (90-degree elevation), flat, and side lying on the puncture site are not effective in preventing complications or allowing for client comfort. Test-Taking Strategy: Focus on the subject, positioning after cardiac catheterization. Recalling that concerns after this procedure are bleeding and arterial occlusion will direct you to the correct option.
The nurse is reinforcing home-care instructions to a client and family regarding care after left cataract surgery with lens implant. Which statements made by the client indicate an understanding of the instructions? Select all that apply. 1. "I will bend over to tie my shoes." 2. "I will not sleep lying on my left side." 3. "I will sit at the table to eat breakfast." 4. "I will sit in my recliner with my feet elevated." 5. "I will not lift anything heavy according to my surgeons' order." 6. "I will resume my exercise routine including pushups."
3. 2, 3, 4, 5 Rationale: After cataract surgery, the client would not assume positions that will increase the intraocular pressure. This could lead to injury to the surgical site and damage the lens implant. The client would not sleep on the side of the body that was operated on. The client may resume activities such as sitting upright at a table or sitting in a recliner with the feet elevated. The client would be instructed to avoid lifting heavy objects, per surgeon's order. The client also is instructed to avoid activities that would increase the pressure within the eye, such as bending over to tie shoes or performing pushups. Test-Taking Strategy: Focus on the subject, activity and positioning after cataract surgery. Consider each option and determine whether the action would increase pressure within the eye. This will lead you to answer correctly.
After a client undergoes a liver biopsy, the nurse places the client in the prescribed right-side-lying position. The nurse understands that the purpose of this intervention is to accomplish which outcome? 1. Promote bile flow 2. Limit client discomfort 3. Promote hepatic glucose storage 4. Limit bleeding from the biopsy site
4. 4 Rationale: After a liver biopsy, the client is assisted with assuming a right side-lying position with a small pillow or folded towel under the puncture site for at least 3 hours to apply pressure and limit bleeding from the biopsy site. The liver produces bile that flows through the common bile duct; client discomfort may be decreased; and the liver does store glucose as glycogen, but this is not the purpose of the right side-lying position. Test-Taking Strategy: Focus on the subject, the purpose of client positioning after a liver biopsy. Think about the vascularity of the liver. Remember that the liver is on the right side of the body and that the application of pressure on the right side will minimize the escape of blood or bile through the puncture site.
The nurse is administering a cleansing enema to a client with a fecal impaction. Before administering the enema, the nurse asks the client to assume a left Sims' position. The nurse explains that this positioning is preferred because of which reason? 1. The nurse is right-handed. 2. The rectal sphincter will relax. 3. The enema will flow into the bowel easily. 4. The client is more likely to retain the enema solution.
5. 3 Rationale: When administering an enema, the client is placed in a left Sims' position so that the enema solution can flow by gravity in the natural direction of the colon. The anatomy of the colon consists of ascending on the right, transverse across, with descending on the left leading to the sigmoid and rectum. If the client lies on the left side, the enema solution will flow easily into the bowel. The hand dominance of the nurse is not a factor. The nurse assists the client to relax the rectal sphincter by asking the client to take a deep breath. The nurse assists the client to retain the enema solution by administering the enema slowly. The nurse would also use teach-back to determine the client's understanding about the reason for the enema. Test-Taking Strategy: Focus on the subject, enema administration. Recalling the anatomy of the bowel will assist you with selecting the correct option.
A client is being prepared for a thoracentesis. The nurse reinforces instructions with the client given by the registered nurse. Which points would be included in the instructions? Select all that apply. 1. The client leans over a bedside table. 2. The client would sit on the edge of the bed. 3. The procedure involves obtaining a biopsy. 4. A time-out is performed before the procedure. 5. The procedure is performed during a bronchoscopy. 6. A local anesthetic is administered before the procedure.
6. 1, 2, 4, 6 Rationale: A thoracentesis is a procedure in which fluid is removed from the pleural space. The procedure involves insertion of a needle percutaneously and then removal of the fluid by connecting the needle to a vacuum bottle. Before the thoracentesis, the nurse needs to check for allergies because a local anesthetic is administered. A time-out is performed in which the client identification, coagulation studies, and area of the pleural effusion are verified. A chest x-ray is performed after the procedure. A potential complication is a pneumothorax. The client sits on the bedside and leans over a bedside table, which exposes the area between the ribs. A lung biopsy is often done during a bronchoscopy. Test-Taking Strategy: Focus on the subject, thoracentesis. Recall that the procedure is performed percutaneously and removes pleural fluid. Consider that the area for the needle insertion is best exposed by the client sitting at the bedside while leaning over the bedside table and a local anesthetic is indicated.
The nurse is assisting with the insertion of a nasogastric tube into a client. The nurse needs to place the client in which position for insertion? 1. Right side 2. Low Fowler's position 3. High Fowler's position 4. Supine, with the head flat
7. 3 Rationale: Before insertion of a nasogastric tube the nurse places the client in a sitting or high Fowler's position to reduce the risk of pulmonary aspiration if the client begins to vomit. A pillow may be placed behind the head and shoulders to promote the client's ability to swallow during the procedure. Options 1, 2, and 4 do not facilitate the insertion of the tube or prevent aspiration. Test-Taking Strategy: Focus on the subject, insertion of a nasogastric tube. Visualize this procedure. Use the ABCs—airway, breathing, and circulation—because pulmonary aspiration is a concern with insertion of a nasogastric tube. Select the option that promotes safe insertion.
The nurse is assisting with caring for a client after a craniotomy. Which are the positions that would be used for the client? Select all that apply. 1. Prone position 2. Supine position 3. Semi-Fowler's position 4. Dorsal recumbent position 5. With the foot of the bed flat 6. With the foot of the bed elevated 30 degrees
8. 3, 5 Rationale: After a craniotomy, the client is at risk for developing complications of increased intracranial pressure and cerebral edema. The head of the bed is elevated 30 degrees (semi-Fowler's position), and the client's head is maintained in a midline, neutral position to facilitate venous drainage. The foot of the bed must be flat because flexion at the hips will impair venous drainage. Blocking venous drainage increases the risk for increased intracranial pressure and cerebral edema. Remember there are no valves in the veins that drain the head. Test-Taking Strategy: Focus on the subject, positioning after craniotomy. Use knowledge about the anatomy and physiology and effects of gravity and the development of edema to answer correctly.
The nurse is caring for a client following a craniotomy in which a large tumor was removed from the left side. In which position would the nurse safely place the bed for the client? Refer to Figures 17.1 to 17.4 . 1. Semi-Fowlers 2. Trendelenburg 3. Reverse Trendelenburg 4. Supine
9. 1 Rationale: Clients who have undergone craniotomy must have the head of the bed elevated 30 degrees to promote venous drainage from the head. The client is positioned to avoid extreme hip or neck flexion and the head is maintained in a midline, neutral position. If a large tumor has been removed, the client needs to be placed on the nonoperative side to prevent displacement of the cranial contents. A flat position or Trendelenburg's position would increase intracranial pressure. A reverse Trendelenburg's position would not be helpful and may be uncomfortable for the client. Test-Taking Strategy: Focus on the subject, positioning following a supratentorial craniotomy. Remember that a primary concern is the risk for increased intracranial pressure. Therefore, use concepts related to preventing increased intracranial pressure to answer this question.
