1) Patient Positioning
Supine
"spine"
Neurological Problems
*HOB elevated & head midline*
Stool smear culture
Lateral recumbent
Enema
Left *Sim's position*
Lumbar Puncture (spinal tap)
*Fetal position for injection* (helps open space between vertebrae) Lay *flat for 2-3 hrs* afterwards
Liver Biopsy
*Right side for 2 hrs*
After which procedure would you position the patient in a supine position for 4-12 hours per MD order? a) Myelogram b) HIDA scan c) Lumbar Puncture d) Cardiac Stress Test
C) Lumbar Puncture After a lumber puncture the patient will need to lay flat because this decreases the chance of developing a "spinal headache"
Following myelography
Head slightly elevated
Lateral
Left Lateral Recumbent (left side-lying)
Thoracentesis
Sitting, leaning over bedside table OR Lying in bed on the *unaffected side*
An angiogram is scheduled for a client with decreased circulation in her right leg. After the angiogram, the nurse should place the client in which of the following positions? 1. Semi-Fowler's with right leg bent at the knee 2. Side-lying with a pillow between the knees 3. Supine with right leg extended 4. High Fowler's with right leg elevated
Step 1. By positioning the client after an angiogram, are you trying to prevent something or promote something? promote something. Step 2. What are you trying to promote? Adequate circulation of the right leg. Step 3. Thinkabouttheprinciplesofanatomy,physiology, and pathophysiology. What promotes adequate circulation in the right leg? Keeping the leg at or below the level of the heart so blood flow is not constricted. Step 4. How will the pt be positioned after an angiography to prevent constriction of vessels & keep the right leg at or below the level of the heart? Look at the answer choices. (1) "Semi-Fowler's with the right leg bent at the knee." The head of the bed is elevated 30-45* in this position. The leg is lower than the heart. If the right leg is bent at the knee, this could constrict arterial blood flow. Eliminate. (2) "Side-lying with a pillow between the knees." Use of a pillow in this position could create pressure points in the right leg. You don't want the knees bent. Eliminate. (3) "Supine with the right leg extended." In this position, the leg is at the level of the heart. Circulation will not be constricted bc the leg is straight. Keep for consideration. (4) "High Fowler's w/ her right leg elevated." The head of the bed is elevated 60-90 degrees in this position. Elevating the leg promotes venous return. Eliminate. The correct answer is (3). The client is on bed rest for 8-12 hours in a supine position after an angiogram.
A client has just returned to a nursing unit after a cardiac catheterization performed using the femoral artery. The nurse places the client in which position? A. Bed rest with head elevation at 30° B. Bed rest with head elevation at 45° C. Bed rest with head elevation at 60° D. Bed rest with head elevation at 90°
a) Bed rest with head elevation at 30° During a cardiac catheterization, if the femoral artery was accessed for the procedure, the client is maintained on bed rest for 4 to 6 hours and the affected extremity is maintain straight and the head is elevated of no more than 30°.
A patient is to be on bed rest for 3-4 hrs and the head of the bed is not to be higher than 30 degrees. The affected extremity is to be kept straight during this time. Which procedure below would require a patient to do the above? a) Cardiac Catheterization b) Aterial Vascular Grafting c) Amputation of the left leg d) Varicose vein surgery
a) Cardiac Catheterization A pt is required to do the above if they had a cardiac cath. This positioning helps decrease the risk of bleeding or increased pressure at the femoral artery insertion site.
Your patient is getting prepped for a lumbar puncture. What position do you assist the patient in? a) Lateral Side-lying Position b) Prone c) Head of the bed at 45 degrees d) None of the above
a) Lateral Side-lying Position It bows the back allowing easier access to spine which helps decrease the chance of incorrect puncture.
The nurse is administering a cleansing enema to a client with a fecal impaction. Before administering the enema, the client should be placed in which position? a) Left Sim's position b) Right Sim's position c) On the left side of the body, with the head of the bed elevated 45 degrees d) On the right side of the body, with the head of the bed elevated 45 degrees
a) Left Sim's position For administering an enema, the client is placed in a left Sims' position so that enema solution can flow by gravity to the natural direction of the colon.
A client with pleural effusion is scheduled to have a thoracentesis. The nurse on duty will assists the client to which position during the procedure? a) Lying in bed on the unaffected side with head of bed elevated about 45° b) Forward side lying position with head of bed flat c) Lying in bed on the affected side with HOB elevated about 45° d) Supine position with both arms extended
a) Lying in bed on the unaffected side with head of bed elevated about 45° During thoracentesis, to facilitate removal of pleural fluid from the pleural space, position the client sitting on the edge of the bed, leaning over a bedside table with the feet supported on a stool, or lying in bed on the unaffected side with head of bed elevated about 45°.
A client is being prepared for a thoracentesis. The nurse should assist the client to which position for the procedure? a) Lying in bed on the affected side b) Lying in bed on the unaffected side c) Sims position with the head of the bed flat d) Prone with the head turned to the side supported by a pillow
b) Lying in bed on the unaffected side To facilitate removal of fluid from the chest, the client is positioned sitting at the edge of the bed leaning over the bedside table, with the feet supported on a stool; or lying in bed on the unaffected side with the head of the bed elevated 30 to 45 degrees.
The nurse is caring for a client who is 1 day post op for a total hip replacement. Which is the best position in which the nurse should place the client? a) Side lying position on the operative side b) On the non-operative side with the legs abducted c) Side lying with the affected leg internally rotated d) Side lying with the affected leg externally rotated
b) On the non-operative side with the legs abducted Positioning following a total hip replacement depends on the surgical techniques used, the method of implantation, the prosthesis, and HCP preference. Abduction is maintained when the client is in a supine position or positioned on the nonoperative side.
What type of client would benefit the most from an elevated head of the bed position? A. Patient who had a hemorrhoidectomy B. Patient who had a laryngectomy C. Patient who had a liver biopsy D. Patient who had a lumbar puncture
b) Patient who had a laryngectomy Place a post-laryngectomy client with head of bed elevated at 30-45 degrees to maintain a patent airway and reduce edema. Option A: Hemorrhoidectomy: Supine position. Option C: Liver biopsy: Right side-lying position. Option D: Lumbar puncture: Supine position for at least 4 hours.
A nurse is preparing to care for a client who had undergone an above-knee amputation of the right leg. The nurse plans to allow which position for the client on the first 24 hrs? A. Supine position, with the affected limb flat on the bed B. Supine position, with the affected limb supported with pillows C. Prone position, with the affected limb on a dependent position D. Trendelenburg's position
b) Supine position, with the affected limb supported with pillows The amputated limb is usually supported with pillows on the first post-op day to promote venous return and reduces edema.
4.) How would you position the patient during a liver biopsy? a) Left lateral side position b) Supine with right arm raised and extended behind the head c) Sim's Position d) High Fowler's
b) Supine with right arm raised and extended behind the head
The nurse is preparing to insert a nasogastric tube into a client. The nurse should place the client in which position for insertion? a) Right side b) Low fowlers c) High fowlers d) Supine with the head flat
c) High fowlers During insertion of a nasogastric tube, the client is placed in a sitting or high fowlers position to facilitate insertion of the tube and reduce the risk of pulmonary aspiration of the client should vomit.
Nurse Sandra had just received a postoperative total hip replacement client from the recovery unit. Which is the best position in which she should place the client? A. Side-lying with the affected leg externally rotated B. Side-lying with the affected leg internally rotated C. On the nonoperative side with the legs abducted D. On the nonoperative side with the legs adducted
c) On the nonoperative side with the legs abducted Abduction is maintained when the client is in a supine position or positioned on the non-operative side.
A nurse is caring for a client who has returned to the recovery unit following a craniotomy. The nurse can safely place the client in which of the position? a) Trendelenburg position b) Fowler's position with the head leaning on the left side c) Semi-fowlers position with the head in a midline position d) Supine position with the neck flexed
c) Semi-fowlers position with the head in a midline position Post-craniotomy client should be placed in a semi-fowlers position &the head is in a midline position to facilitate venous drainage from the head.
Your patient has Congestive Heart Failure with pulmonary edema. The patient states he is tried of being in bed. What position is best for this patient's condition? a) Tripod position with chin down in a chair b) Sitting in a chair at 45 degree with legs elevated on a pillow c) Upright with legs dangling over the bed d) Sims Position in the beside chair
c) Upright with legs dangling over the bed This position decreases venous return and lung congestion which is very crucial for a patient in fluid overload. The heart is weak and does not pump efficiently.
The nurse is preparing to care for a client who has returned to the nursing unit following cardiac catheterization performed through the femoral artery. The nurse checks the HCP prescription and plans to allow which client position or activity following the procedure? a) Bed rest in high Fowler's position b) Bed rest with bathroom privileges only c) Bed rest with head elevation at 60 degrees d) Bed rest with head elevation no greater than 30 degrees
d) Bed rest with head elevation no greater than 30 degrees After cardiac catheterization, the extremity into which the catheter was inserted is kept straight for 4 to 6 hours. The client is maintained on bedrest for 4 to 6 hours and the client may turn from side to side. The head is elevated no more than 30 degrees and bathroom privileges are restricted in the immediate postcatherization period.
Nurse Justin is taking care a client with deep vein thrombosis. Which position should be provided to the client? A. Bed rest with the affected extremity remain flat at all times B. Bed rest with the unaffected extremity on top of the affected extremity C. Bed rest with the affected extremity in a dependent position D. Bed rest with the affected extremity elevated.
d) Bed rest with the affected extremity elevated Bed rest is indicated to prevent emboli while the elevation of the affected leg facilitates blood flow by the force of gravity and reduces pain and edema.
A patient is supine and the head of the bed is elevated to 45 to 60 degrees. What position is this called? a) Semi-Fowler's Position b) High Fowler's Position c) Sim's Position d) Fowler's Position
d) Fowler's Position The liver is located on the right side and this position provides the best exposure of the right intercostal space.
Which is the best position for a client with autonomic dysreflexia? a) Sim's Position b) Fowler's Position c) Semi-Fowler's Position d) High Fowler's Position
d) High Fowler's Position Autonomic dysreflexia = a condition in which there's a sudden onset of excessively high BP. - If it occurs, immediately place the client in a high fowler's position to promote adequate ventilation assist in preventing a hypertensive stroke
Nurse Aaron is inserting a nasogastric tube to a stroke client. He understands that the best position for the insertion is? a) Low Fowlers b) Sims position c) Trendelenburg d) High Fowlers
d) High Fowlers The best position during a nasogastric tube insertion is sitting or High fowlers position in order to prevent the risk of aspiration.
A client has just returned to a nursing unit after an above-knee amputation of the right leg. The nurse should place the client i which position? a) Prone b) Reverse Trendelenburg's c) Supine, with the amputated limb flat on the bed d) Supine, with the amputated limb supported with pillows
d) Supine, with the amputated limb supported with pillows The amputated 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 amputated limb usually is placed flat to reduce hip contracture. Edema is also controlled by limp-wrapping techniques.