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 terms (such as supine or Fowler’s) mean.
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, you will simply be taking a random guess at the correct answer.
If you think in images, you should form a mental image of each position. Picture yourself placing the client in each position, and then see if the position makes sense.
Let’s try another question using the strategies for positioning.
Let’s go through the steps.
Step 1.By positioning the client after an angiogram, are you trying to prevent something or promote something? You are trying to promote something.
Step 2. What are you trying to promote? Adequate circulation of the right leg.
Step 3.Think about the principles of A&P. 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 client be positioned after an angiography to prevent constriction of vessels and keep the right leg at or below the level of the heart? Look at the answer choices.
Semi-Fowler’s with the right leg bent at the knee. The head of the bed is elevated 30–45 degrees 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.
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.
Supine with leg extended. In this position, the leg is at the level of the heart. Circulation will not be constricted because the leg is straight. Keep this answer in for consideration.
High Fowler’s with 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.
If you didn’t know the specific positioning needed after an angiogram, you could apply your knowledge to select the correct answer by just thinking about it.
Let’s look at another question.
This question isn’t about positioning after a procedure. It asks how to turn the client after surgery.
Step 1. When turning the client after a laminectomy, are you trying to prevent or promote something? Promote.
Step 2.What are you trying to promote? A straight back. The client can’t bend or twist the torso.
Step 3. Think about the principles of anatomy, physiology, and pathophysiology (A&P). A laminectomy is removal of one or more vertebral laminae. After a laminectomy, the back should be kept straight.
Step 4.How should the client be turned in order to keep the back straight?
If the head of the bed is elevated 30 degrees, the back will not be straight. Eliminate.
If a pillow is placed between the legs and the body is rolled as a unit, the client’s back will be kept straight. Keep in for consideration.
If the client grabs the opposite side rail, the client’s torso will twist. The back will not be straight even though the client straightened the back before turning and twisting. Eliminate.
If the head of the bed is flat, the client’s back will be straight. If the client bends the knees and rolls to the side, the back will not be kept straight. Eliminate.
The correct answer is (2). That is a textbook description of log-rolling. But if you didn’t recall log-rolling, you were able to select the correct answer by thoughtfully considering each answer choice.
Sometimes a positioning question will be difficult to identify, such as in the following example.
As you can see, not all of the answer choices involve positioning. How should you approach this question?
First, reword the question so that you know what to focus on in the answer choices. The question really being asked is, “What should the LPN/LVN do to help this client with pain relief?” Let’s look at the answer choices.
Notifying the primary health care provider, as you know, is almost never the right answer. See if another answer choice is more appropriate.
Fowler’s position. Why change this client’s position? To promote pain relief. Will Fowler’s position decrease the client’s pain? Yes, by relieving pressure on the client’s abdomen. This answer is a possibility.
Massaging the client's abdomen will increase the client’s pain. Eliminate.
Providing the client with reading materials might distract the client from discomfort, but this is not an appropriate intervention for a client in pain. Eliminate.
The correct answer is (2).
Positioning is an important part of the NCLEX-PN® exam. You must be able to answer these questions correctly in order to prove your competence. If you use the strategies just discussed, you will be thinking about nursing principles and you will select correct answers!