Exam 5: Positioning the Patient for Surgery

Number the sequence of steps for positioning a patient in prone position. a.The arms are placed on armboards or secured at the sides,lower legs are elevated on a pillow with gel padding under the knees and toes off of the bed surface;a leg strap is placed across thighs. b.The transport vehicle is locked adjacent to the locked OR bed. c.Pressure points are checked:the cheeks,eyes,ears,female breasts,male genitalia,knees,and toes. d.Anesthesia is induced with the patient in supine position on the transport vehicle. e.The anesthesia provider supports the head and neck during the turn. f.Four people using the "log-roll" technique turn the supine patient to prone onto the OR bed prepared with gel rolls placed at the location for the patient's shoulders and iliac crests.

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Question 1

Correct Answer:

Verified

1 = B
2 = D
3 = F
4 = E
5 = A
6 = C
Anesthesia is induced with the patient in supine position,usually on the locked transport vehicle adjacent to the locked OR bed.Four people using the "log-roll" technique can accomplish turning the supine patient to prone position safely,smoothly,and gently.The anesthesia provider supports the head and neck during the turn.The arms are placed on armboards or secured at the sides.The following pressure points are checked:the cheeks,eyes,ears,female breasts,male genitalia,knees,and toes.

While Fowler's position offers the best respiratory excursion for the patient,the patient is at higher risk for because of dependent pooling in the hips and legs.

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(Multiple Choice)

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Question 2

Correct Answer:

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Number the sequence of steps for positioning a patient in lithotomy position. a.With the patient supine,the legs are raised simultaneously and abducted to expose the perineal region. b.The leg section of the OR bed is removed and the leg section platform is lowered. c.The thighs are elevated to the appropriate degree for the planned procedure. d.Stirrups are checked before use to ensure they are securely fastened to the side rails of the OR bed. e.The legs are placed in stirrups to maintain this position. f.The sacral area is padded with a gel or foam pad.

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Question 3

Correct Answer:

Verified

1 = D
2 = A
3 = E
4 = C
5 = F
6 = B
Stirrups should be checked before use to ensure they are securely fastened to the side rails of the OR bed and are evenly measured to fit the patient's leg length.With the patient supine,the legs are raised simultaneously and abducted to expose the perineal region.The legs are placed in stirrups to maintain this position.The thighs are elevated approximately 30,45,or 90 degrees.The thighs are flexed toward the abdomen,the calves are suspended vertically,and the pelvis is flexed vertically at the spine,propped upward on a pillow or pad.When the legs are secured in the stirrups,the mattress of the leg section of the OR bed is removed and the leg section platform is lowered.

After Mr.Jennings was asleep and intubated,the surgeon requested the patient to be placed in lithotomy position for a sigmoidoscopy before the open procedure.The team of five nonscrubbed persons lifted the patient with the lift sheet,slid the patient down toward the foot of the OR bed,and placed him into position.After the sigmoidoscopy,the perioperative nurse had the team roll the patient to his side for a skin assessment of his back before he was repositioned supine.What injury was the perioperative nurse concerned that she might see?

(Multiple Choice)

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Question 4

The lateral kidney position allows approach to the retroperitoneal area of the flank.To render the kidney region readily accessible,the ___ is raised,and the bed flexed so that the area between the twelfth rib and the iliac crest is elevated.Compression of the can occur when the flank is raised too high.

(Multiple Choice)

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Question 5

The perioperative nurse visited Mr.Jennings in the ICU the next day and noticed abrasions on his elbows.Mr.Jennings told her that the ICU nurses had difficulty pulling him back up in bed every time he slid down toward the bottom and he was not able to be much help in moving himself.This skin injury was probably the result of which physical force?

(Multiple Choice)

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Question 6

Select the nursing activity that would reduce the impact of an extrinsic factor that could cause a pressure injury to the patient.

(Multiple Choice)

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Question 7

Number the sequence of steps for positioning a patient in lateral position for a right nephrectomy. a.After induction,intubation,and urinary catheter insertion,prepare for lifting. b.Transfer patient to locked OR bed and place in supine position. c.Slowly elevate kidney bridge,flex bed to lower legs,and create horizontal line between hip and shoulder;tape hip to OR bed underside. d.Using at least 4 people,lift patient and turn lateral,left side down with iliac crest below lumbar break. e.Select OR bed and check mobility/operation of kidney bridge before patient transfer. f.Place leg strap across mid thighs and abduct arms less than 90 degrees. g.Secure right arm in an elevated armboard. h.Elevate right leg with pillows,maintaining straight alignment;bend left leg and pad dependent bony prominences;secure with leg strap.

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Question 8

Lateral,lateral chest,and lateral kidney positions all place pressure on structures of the dependent side:ears,shoulder,ribs,hips,greater femoral head,knees,and ankles.The potential for injury to the patient is significant,based on these pressure areas.Which resultant injury or harm could be related to these lateral positions?

(Multiple Choice)

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Question 9

Morton White,a 68-year-old,ASA PS-2 male with early-stage prostatic cancer,was intubated and positioned for a robotic-assisted laparoscopic radical prostatectomy.The initial position for insertion of the trocars was supine with arms tucked and secured within under-mattress sled arm positioners padded with gel.His hands were placed in a natural position with the fingers wrapped around gauze rolls and touching his lateral thighs.The new anesthesia provider,who had never seen a robotic prostatectomy,was concerned about anesthesia implications when the patient would be repositioned into extreme Trendelenburg for the dissection and anastomosis.The circulating nurse assured her that they would implement protective measures and work together to ensure the best patient outcome.Select all of the potentially harmful effects of extreme 45-degree Trendelenburg in a robotic procedure.

(Multiple Choice)

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Question 10

While tucking the arms at the sides of the patient in supine position offers comfort,safety,and easy access to the patient by the scrubbed team,improper positioning and securing of the arms can result in significant injury.Injury can be avoided by tucking the draw sheet the arm and under the _.

(Multiple Choice)

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Question 11

Myrna Powers is a frail and thin 91-pound,83-year-old woman scheduled for a right pneumonectomy for non-small cell lung cancer.She will be positioned in left lateral position for her procedure.Based on the perioperative nurse's preoperative assessment,identify three position-related nursing diagnoses _ for this procedure and four relevant nursing interventions_ __.Select from the options to fill in the blanks.

(Multiple Choice)

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Question 12

Select the positioning device and accessory commonly used for neurosurgical procedures.

(Multiple Choice)

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Question 13

David Reese,a 14-year-old patient with marked scoliosis,is in prone position with gel rolls,gel pads,and pillows for a spinal fusion.Before the skin prep is begun,the perioperative nurse should check the positioning for pressure areas of the:

(Multiple Choice)

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Question 14

Maria Faulkner is a 92-year-old frail nursing home patient admitted for dehydration,anemia,and respiratory symptoms.She has type 2 diabetes and low albumin levels,is underweight,and continues to smoke cigarettes when she is at home.Mrs.Faulkner is on complete bed rest in a hospital bed with an alternating pressure mattress overlay.She is not able to turn herself in bed and must be assisted to change position.Based on this description of Mrs.Faulkner,which factor classification dominates her vulnerability and risk for injury?

(Multiple Choice)

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Question 15

The circulating nurse and anesthesia provider employed protective measures for their patient positioned in extreme 45-degree Trendelenburg for a robotic-assisted laparoscopic radical prostatectomy.These measures included (select all that apply):

(Multiple Choice)

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Question 16

Susan Graton is a 52-year-old and 425-pound patient scheduled for surgery at the bariatric surgery center in 3 days.She has osteoarthritis and had a spinal fusion when she was 13.Cheryl,her long-time neighbor and a perioperative nurse at the bariatric center,has asked to be Susan's circulating nurse and is contemplating Susan's plan of care.Susan shared with Cheryl her concern that she would not be able to move herself over to the OR bed and would be embarrassed if the nurses could not lift her.Based on this information,Cheryl has identified this nursing diagnosis:_ and these three positioning-relevant nursing interventions:_ _ _.Select from the options to fill in the blanks.

(Multiple Choice)

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Question 17

A patient undergoing a laparoscopic Nissen fundoplication procedure will be positioned in both high and low lithotomy during the procedure.After the patient is repositioned into low lithotomy,the perioperative nurse should:

(Multiple Choice)

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Question 18

Mrs.Faulkner's Braden scale score is 11.This places her at __ risk.

(Multiple Choice)

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Question 19

Positioning devices should be used according to the original equipment manufacturer's instructions to reduce the capillary interface pressure to below:

(Multiple Choice)

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Question 20

Showing 1 - 20 of 30

While Fowler's position offers the best respiratory excursion for the patient,the patient is at higher risk for because of dependent pooling in the hips and legs.

Select the nursing activity that would reduce the impact of an extrinsic factor that could cause a pressure injury to the patient.

While tucking the arms at the sides of the patient in supine position offers comfort,safety,and easy access to the patient by the scrubbed team,improper positioning and securing of the arms can result in significant injury.Injury can be avoided by tucking the draw sheet the arm and under the _.

Select the positioning device and accessory commonly used for neurosurgical procedures.

David Reese,a 14-year-old patient with marked scoliosis,is in prone position with gel rolls,gel pads,and pillows for a spinal fusion.Before the skin prep is begun,the perioperative nurse should check the positioning for pressure areas of the:

The circulating nurse and anesthesia provider employed protective measures for their patient positioned in extreme 45-degree Trendelenburg for a robotic-assisted laparoscopic radical prostatectomy.These measures included (select all that apply):

A patient undergoing a laparoscopic Nissen fundoplication procedure will be positioned in both high and low lithotomy during the procedure.After the patient is repositioned into low lithotomy,the perioperative nurse should:

Mrs.Faulkner's Braden scale score is 11.This places her at __ risk.

Positioning devices should be used according to the original equipment manufacturer's instructions to reduce the capillary interface pressure to below:

Concepts Basic to Perioperative Nursing

Patient Safety and Risk Management

Infection Prevention and Control in the Perioperative Setting

Anesthesia

Sutures, Needles, and Instruments

Surgical Modalities

Wound Healing, Dressings, and Drains

Postoperative Patient Care and Pain Management

Gastrointestinal Surgery

Surgery of the Liver, Biliary Tract, Pancreas, and Spleen

Repair of Hernias

Gynecologic and Obstetric Surgery

Genitourinary Surgery

Thyroid and Parathyroid Surgery

Breast Surgery

Ophthalmic Surgery

Otorhinolaryngologic Surgery

Orthopedic Surgery

Neurosurgery

Plastic and Reconstructive Surgery

Thoracic Surgery

Vascular Surgery

Cardiac Surgery

Pediatric Surgery

Geriatric Surgery

Trauma Surgery

Interventional Radiology

Integrated Health Practices:Complementary and Alternative Therapies

Workplace Issues and Staff Safety

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