NCLEX-PN Series: Strategies for Positioning Questions
The LPN is caring for the obstetrical client who is in active labor. Suddenly the fetus' umbilical cord can be seen protruding from the vagina. The LPN will immediately place the client in which of the following positions? a) Trendelenburg b) Sim's c) Prone d) Semi-Fowler's
a
The LPN is assisting with the care of a client 48 hours after right total arthroplasty. Which observation requires an intervention by the LPN? a) The client is positioned in a High-Fowler's position during meal times b) The right and left legs are slightly abducted when the client is supine c) The head of the bed is elevated 50 degrees during morning oral care. d) The assistive personnel (AP) places a pillow between the client's legs before turning
a Explanation:
The home care LPN is visiting a frail client with type 2 diabetes, osteoporosis and nighttime drooling. The client sleeps in the prone position. The nurse recognizes which of the following as an advantage of this position for the client? Select all that apply. a) It allows full extension of the hip and knee joints b) It produces lordosis in most people c) It causes plantar flexion d) It keeps saliva drainage flowing from the mouth e) It promotes better breathing f) It prevents hypoglycemia
a, d
The LPN in the long term care facility is assisting the client with chronic obstructive pulmonary disease and varicose veins. Before breakfast is served, the LPN places the client in Fowler's position. Which of the following best describes why Fowler's position would be used in this client? a) It straightens the neck, which allows client to swallow more effectively b) It pulls the diaphragm downward, which permits greater chest expansion c) It puts the back in a natural position, which relieves muscle tension d) It increases venous return, which improves circulation to the legs.
b
The LPN is assisting with the care of a client diagnosed with a 4th cervical (C4) complete spinal cord injury. Which observation most concerns the LPN? a) The assistive personnel (AP) positions the client in a 30 degree side-lying position b) The client watches television with the head of the bed at a 45 degree angle c) The assistive personnel (AP) uses warm water and gentle soap for bathing d) The client lightly rubs the skin with a bath towel after bathing to ensure dryness
b Explanation:
Immediately a percutaneous liver biopsy, the LPN should place the client in which of the following positions? a) Supine b) Right-side lying c) Left-side lying d) Semi-fowler's
b Explanation: If you lay a client on their right side to apply pressure and prevent hemorrhage on the liver. The liver is on the right side of the abdomen under the ribs. All of the other responses will not apply pressure to the liver.
The LPN is caring for a client after an appendectomy. The client continues to report discomfort to the nurse shortly after receiving an analgesic. Which of the following measures by the LPN would be most appropriate? a) Notify the primary HCP b) Place the client in Fowler's position c) Massage the client's abdomen d) Provide the client with reading material
b Explanation: Massaging the client's abdomen will increase the client's pain. Providing client with reading materials will only distract them but not relieve the pain. Changing the client's position decrease the client's pain by relieving pressure on the client's abdomen.
The LPN is preparing the female client for vaginal examination. The client is positioned to best increase the vaginal opening for examination. Which of the following features would this position include? Select all that apply. a) Soft pillow under the head b) Back flat on exam table c) Knees straight d) Elbows flexed e) Thighs abducted f) Legs adducted
b, e
The LPN is assisting with the care of a client diagnosed 2 weeks ago with right-sided stroke. When assisting the client with meals, it is most important for the LPN to take which action? a) Encourage the client to bite each food 4 times. b) Assist the client to use a straw to drink fluids with the meal c) Instruct the client to sit in a chair for 30 minutes after the meal d) Provide 8 oz. (240mL) of milk with every meal at bedtime
c Explanation: All answers relate to swallowing and eating. Stroke clients are at risk for aspiration. A) It is important to chew and swallow each bite but not necessarily 4 times. B) Using a straw and drinking thin liquids both increase the risk of choking and aspiration. Thin liquids are more difficult to swallow. The risk for choking and aspiration is increased. C) By sitting upright after a meal, gravity increases the passage of food into the stomach. D) Milk and milk products increase production of saliva and make swallowing more difficult.
An angiogram is scheduled for a client with decreased circulation in the right leg. After the angiogram, the LPN should place the client in which of the following positions? a) Semi-fowler's with right leg bent at the knee b) Side-lying with a pillow between the knees c) Supine with the right leg extended d) High-Fowler's with the right leg elevated
c Explanation: By positioning a client after an angiogram are you trying to prevent something or promote something? You are trying to promote adequate circulation of the right leg. Keeping the leg at or below the level of the heart so blood flow is not constricted. How should the client be positioned after and angiography to prevent constriction of vessels and keep the right leg at or below the level of the heart? A) The head of the bed is elevated at 30-45 degrees in this position. The leg is lower than the heart. However if the right leg is bent at the knee this could constrict arterial blood flow. B) Use of a pillow in this position could create pressure points in the right leg. You don't want the knees bent. C) In this position the leg is at the level of the heart. Circulation will not be constricted because the leg is straight. D) The head of the bed is elevated 60-90 degrees in this position. Elevating the leg promotes venous return. Side note: The client is on bed rest for 8-12 hours in a supine position after an angiogram.
The LPN in the postsurgical unit cares for the client immediately after an L4-L5 spinal fusion. The primary HCP's orders calls for the client to be turned every hour. Arrange the following steps in the order that the nurse should perform them. All options must be used. a) Place the pillow between the client's legs b) Remove the pillow from under the client's head c) Perform hand hygiene d) Document the client's repositioning e) Firmly grasp the client's draw sheet with both hands f) Move the client's body as a unit
c, b, a, e, f, d
The LPN is preparing the client with hemorrhoids with a rectal examination. Depending on the physical limitations of the client, the nurse should put the client in which of the following positions? Select all that apply. a) Prone b) Supine c) Knee-chest d) Trendelenburg e) Sim's f) Fowler's
c, e
The LPN is caring for a client diagnosed 6 months ago with a 6th thoracic (T6) spinal cord injury. The client reports a "throbbing headache," and the client's face, neck, and upper chest are flushed and diaphoretic. Which action should the LPN take first? a) Loosen the client's upper body clothing b) Check the client for fecal impaction c) Remove the indwelling urinary catheter d) Sit the client in an upright position
d Explanation: Autonomic dysreflexia is a potential complication when a client has a spinal cord injury of T6 or above. This is an emergency. Immediate action must be taken to prevent severe hypertension and stroke. Think about which action will decrease BP most quickly. A) this is an appropriate action but not the first action B) Fecal impaction may be a cause of autonomic dysreflexia The impaction should be removed. But it is not a first action. C) This is an inappropriate action. Bladder distension may be a cause of autonomic dysreflexia. If the catheter is obstructed it should be removed. But this should not be the first action. D) If you sit the client upright the client's BP will immediately decrease. This action will prevent a further increase in BP.
