How do you feel about answer choices that involve positioning? Many graduate nurses are not comfortable answering these questions because:
• They don’t understand the “whys” of positioning
• They don’t know the terminology
• They have difficulty imaging the various positions
Immobility occurs when a client is unable to move around freely and independently. To answer questions on positioning, you need to know the hazards of immobility, normal anatomy and physiology, and the terminology for positioning.
What’s That Word Again? Know your terminology.
Prevent or Promote? When positioning a patient, decide what you are trying to prevent or promote.
Strategies for Positioning Questions
If you have difficulty answering positioning questions, the following strategy will assist you in selecting the correct answer.
Step1. Decide if the position for the client is designed to prevent something or promote something.
Step2. Identify what it is that you are trying to prevent or promote.
Step3. Think about anatomy, physiology, and pathophysiology.
Step4. Which position best accomplishes what you are trying to prevent or promote?
Things to Remember
• Even if you didn’t memorize what position to use before, during, and after a procedure, think about the question for a moment. You can figure out what position is needed.
• You cannot figure out the correct position if you do not know what the term means (supine, Tredelenburg, Fowler’s).
• You cannot figure out a correct position if you do not know anatomy and physiology. If you think the liver is on the left side of the body, you are in trouble!
• You cannot figure out a correct position if you do not know what you are trying to accomplish. If you couldn’t remember that a complication after a liver biopsy is hemorrhage, your best hope of selecting the correct answer would be to throw a dart.
• To those students who think in images, you should form a mental image of each position, and then see if the position makes sense.
Picture It. Visualize the position!
Don’t Just Play Twister. Know when and why certain positions are used.
Essential Positions to Know for the NCLEX-RN Exam
POSITION: THERAPEUTIC FUNCTION
Flat (supine): Avoids hip flexion, which can compress arterial flow.
Dorsal recumbent: Supine with knees flexed; more comfortable.
Side lateral: Allows drainage of oral secretions.
Side with legs bent (Sims’s): Allows drainage of oral secretions.; decreases abdominal tension.
Head elevated (Fowler’s): Increases venous return; Allows maximal lung expansion.
- High Fowler’s: 60 to 90 degrees
- Fowler’s: 45 to 60 degrees
- Semi Fowler’s: 30 to 45 degrees
- Low Fowler’s: 15 to 30 degrees
Feet elevated and head lowered
(Trendelenburg’s): Used to insert CVP line; or for treatment of umbilical cord compression.
Feet elevated 20 degrees, knees straight, trunk flat, and head slightly elevated (modified Trendelenburg’s): Increases venous return; used for shock.
Elevation of extremity: Increases venous return. Increases blood volume to extremity.
Flat on back, thighs flexed, legs abducted (lithotomy): Increases vaginal opening for examination.
Prone: Promotes extension of hip joint. Not well tolerated by persons with respiratory or cardiovascular difficulties.
Knee-chest: Provides maximal visualization of rectal area.
