Chapter 7

Strategies For Positioning Questions

Because many illnesses affect body alignment and mobility, you must be able to safely care for these clients in order to be an effective LPN/LVN. These topics are also important on the NCLEX-PN^® exam. The successful test taker must correctly answer questions about impaired mobility and positioning.

Immobility occurs when a client is unable to move about 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.

Many graduate LPN/LVNs are not comfortable answering these questions because:

• They don’t understand the “whys” of positioning.
• They don’t know the terminology.
• They have difficulty imagining the various positions.

If you have difficulty answering positioning questions, the following strategy will assist you in selecting the correct answer.

Step 1. Decide if the position for the client is designed to prevent something or promote something.

Step 2. Identify what it is you are trying to prevent or promote.

Step 3. Think about anatomy, physiology, and pathophysiology (“A&P”).

Step 4. Which position best accomplishes what you are trying to prevent or promote?

Does this sound a little confusing? Hang in there. Let’s walk through a question using this strategy.

1. Immediately after a percutaneous liver biopsy, the LPN/LVN should place the client in which of the following positions?
   1. Supine.
   2. Right side-lying.
   3. Left side-lying.
   4. Semi-Fowler’s.

Before you read the answers, let’s go through the four steps.

Step 1. By positioning the client after a liver biopsy, are you trying to prevent something or promote something? Think about what you know about a liver biopsy. You position a client after this procedure to prevent something.

Step 2. What are you trying to prevent? The most serious and important complication after a percutaneous liver biopsy is hemorrhage.

Step 3. Think about the principles of A&P. What do you do to prevent hemorrhage? You apply pressure. Where would you apply pressure? On the liver. Where is the liver? On the right side of the abdomen under the ribs.

Step 4. How should the client be positioned to prevent hemorrhage from the liver, which is on the right side of the body? Look at your answer choices.

1. Supine. If you lay the client flat on his back, no pressure will be applied to the right side. Eliminate.
2. Right side-lying. If you lay the client in a right side-lying position, will pressure be applied to the right side? Yes. Keep it in for consideration.
3. Left side-lying. No pressure is applied to the right side. Eliminate.
4. Semi-Fowler’s. If you lay the client on the back with head partially elevated, no pressure is applied to the right side. Eliminate.

The correct answer is (2). Some students select (3) because they don’t know normal anatomy and physiology. Some students select (4) because semi-Fowler’s position is used for a lot of reasons.