Deck 7: Positioning Your Patient for Mobility

Question 1

Your patient is a 49-year-old man who sustained a spinal cord injury in a skiing accident. He is unable to move below the level of his umbilicus. You are positioning him in the bed following your treatment. Which of the following describes the most appropriate positioning for this patient?

A) On his back with a medium-sized pillow under his knees
B) On his back with a large pillow behind his shoulder blades
C) In a three-quarters supine position with pillows behind him and between his legs
D) On his stomach with a large pillow under his feet

Answer 1

C

Question 2

List three basic principles that apply to both short-term and long-term positioning.

Answer 2

Always explain to the patient what is about to happen; have the patient participate as much as possible; approximate normal positioning as closely as possible; use smart body mechanics; pay attention to the effect of the surroundings; provide appropriate supervision and/or a way for the patient to call for help

Question 3

You are working with a 94-year-old woman with severe thoracic kyphosis who fell and bruised her right hip. Which of the following patient positions would be best for inspecting the skin on her back for evidence of trauma?

A) Long sitting on the bed
B) Prone with a small pillow under her abdomen
C) Sidelying on her left side
D) Sidelying on her right side

Answer 3

C

Question 4

List two questions you should ask yourself when considering the use of restraints with a patient: ____________________

Question 5

Which of the following methods should you use to screen for patient tolerance of pressure on the skin?

A) Press firmly with one or two fingers on the skin in question, hold for 30 seconds, then release.
B) Press firmly with one or two fingers on the skin in question, hold for 1 minute, then release.
C) Press gently with one or two fingers on the skin in question and quickly release.
D) Press gently and quickly with one or two fingers on the skin in question three or four times, then release.

Question 6

List four things that you must be careful to ensure when doing long-term positioning with your patients. ____________________

Question 7

Your new patient on the rehabilitation unit is a 19-year-old man who sustained a traumatic brain injury in a bicycling accident. He is in a special bed with an air-filled mattress. Which of the following would be the most appropriate positioning protocol for this patient?

A) Reposition the patient and inspect his skin every 4 hours.
B) Reposition the patient and inspect his skin every 2 hours.
C) Reposition the patient and inspect his skin twice a day.
D) There is no need to reposition the patient while he is on a pressure-reducing mattress.

Question 8

When attempting to reestablish a patient's position, the axiom to remember is "as is the____________________, so is the body."

Question 9

Your patient is a 69-year-old man who had a stroke affecting his left side. Which of the following pillow placements would be most appropriate for the supine patient to prevent a contracture commonly associated with increased tone following a stroke?

A) Tuck a pillow under the outer aspect of the left side to prevent left hip abduction and external rotation.
B) Place a pillow under his knees to relieve pressure on his heels.
C) Place a pillow under his left shoulder blade to promote scapular protraction.
D) Tuck a pillow under his pelvis on the right side.

Question 10

Which of the following is true regarding contractures?

A) Contractures generally do not affect the strength of the muscle.
B) Contractures may result in permanent loss of joint motion that does not respond to stretching.
C) Contractures generally tend to occur in positions of extension.
D) Contractures are limited to responses within muscle tissue.

Question 11

Which of the following is true regarding spinal alignment of the seated patient?

A) Poor alignment can lead to increased mechanical loading and pain.
B) Allowing the feet to hang unsupported will decrease low-back stress.
C) In sitting, lumbar lordosis automatically self-corrects.
D) Increased thoracic kyphosis is unrelated to cervical lordosis.

Question 12

Which of the following factors must be considered for long-term positioning of patients?

A) Patient comfort is always the most important factor in long-term positioning.
B) A patient's lungs will drain optimally while he or she is in a sidelying position.
C) Patients need frequent changes of position to minimize the negative effects of immobility.
D) Patients should be positioned in supine for at least 60% of the day.

Question 13

List three bony prominences that are especially susceptible to pressure in the supine position.

Question 14

Your patient is a 64-year-old man who had a stroke and has severe right upper-extremity weakness as a result. His right hand has become very edematous. Which of the following is the best position for the patient's right arm to aid in the management of his edema?

A) Across his chest while he is lying on his left side
B) With the hand on a pillow, higher than the heart, while he is supine
C) By his side with his fingers extended and his palm facing up while he is supine
D) With the forearm supported on the armrest while he is sitting in a wheelchair

Question 15

You are working on the orthopedic floor in a large hospital. You are working with a 78-year-old woman who has undergone left shoulder arthroplasty. You have just assisted her out of bed to the bedside chair for breakfast. After breakfast she is planning to return to her bed. As you position the patient in the chair, which of the following considerations is most important?

A) Positioning the patient to prevent bilateral hip flexion contractures
B) Positioning the patient to prevent the development of pressure sores on her heels
C) Positioning the patient to promote comfort and effective swallowing while she is out of bed
D) Positioning the patient to promote lower-extremity circulation.

Question 16

Your patient is a 55-year-old man who just had a transtibial amputation secondary to a work-related accident. You are working with him on functional mobility just after his surgery. Which of the following represents the best positioning for this patient?

A) Place a pillow under the knee of the residual limb to improve comfort in supine.
B) Have him spend some time in prone each day to encourage extension of the affected hip and knee.
C) Turn the affected leg out while he is sitting to stretch the hip adductor muscles.
D) While he is sitting in the chair, position the knee in flexion to encourage circulation to the surgical site.
Short Answer

Question 17

When considering the use of restraints, which of the following is true?

A) If the device is used to protect the patient, it is not considered a restraint.
B) Using a device that the patient is able to release reduces the level of restrictiveness of a restraint.
C) Restraints are generally identified by their shape or design.
D) The application of restraints is not regulated by Medicare.

Question 18

When determining which mobility procedures to use in patient care, what is the first question you should consider?

A) How much assistance will be required for the maneuver?
B) What am I trying to accomplish with the maneuver?
C) Which movement does the patient want to practice?
D) Which movement will be the easiest for the patient?

Question 19

When testing for integumentary tolerance to pressure during positioning, observing which of the following responses to a skin-blanching test would indicate healthy tissue?

A) Light skin that turns white immediately and then becomes pink within a few seconds
B) Light skin that turns pink immediately and then becomes white within a few seconds
C) Light skin that shows no change in response to the release of pressure
D) Dark skin that shows no change in response to the release of pressure

Question 20

Your patient is a 14-year-old girl who was in a motor vehicle accident and is now comatose in the ICU. You are working with the patient's family regarding appropriate positioning for this patient. Which of the following would be most appropriate to tell them?

A) Her inability to move independently makes her more vulnerable to skin breakdown.
B) The patient needs to be repositioned every 3 hours when she is lying in bed.
C) The patient should not remain sitting with the head of the bed elevated over 45° for more than 3 hours.
D) The patient should have a pillow under her heels while she is in supine.