NCLEX Question Strategies: 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 nurse. These topics are also important on the NCLEX- RN® 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 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 imagining the various positions.

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

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


Before you read the answers, let’s go through the four steps outlined above.
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 anatomy, physiology, and pathophysiology. 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 his 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.
Let’s look at another question.


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. Thinkabouttheprinciplesofanatomy,physiology, and pathophysiology. 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.
(1) “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.
(2)  “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.
(3)  “Supine with the right 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 for consideration.
(4)  “High Fowler’s with her 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 can apply your knowledge to select the correct answer by just thinking about it.

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.