Otterbein/Grant CRNA Patient Positioning Review
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Questions and Answers
- 1.
Which of the following are goals of operative positioning?
- A.
Optimum surgical exposure
- B.
Access for monitoring
- C.
Preventing complications and injuries
- D.
Maintaining body integrity and physiological functions
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
Operative positioning aims to achieve several goals, including optimum surgical exposure, access for monitoring, preventing complications and injuries, and maintaining body integrity and physiological functions. These goals ensure that the surgical procedure can be performed effectively and safely. Optimum surgical exposure allows the surgeon to have a clear view of the surgical site, facilitating accurate and precise interventions. Access for monitoring ensures that vital signs and other parameters can be continuously monitored during the procedure. Preventing complications and injuries involves positioning the patient in a way that minimizes the risk of nerve damage, pressure ulcers, and other adverse events. Lastly, maintaining body integrity and physiological functions involves positioning the patient in a manner that does not compromise blood flow, respiration, or other bodily functions.Rate this question:
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- 2.
Please fill answer below_______
Correct Answer
N/A - 3.
The only position in which the West zones of the lung are normal in the operating room is:
- A.
Supine
- B.
Prone
- C.
Sitting
- D.
Side-lying
Correct Answer
C. SittingExplanation
The correct answer is "Sitting." When a patient is sitting, the West zones of the lung are normal in the operating room. This is because in the sitting position, gravity helps to distribute the air and blood flow more evenly throughout the lungs. In other positions such as supine, prone, or side-lying, the distribution of air and blood flow may be affected, leading to abnormal lung zones.Rate this question:
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- 4.
Please fill answer below_______
Correct Answer
N/A - 5.
Select all of the following physiological changes that apply to a patient in the supine position:
- A.
Diaphragm shifts cephalad.
- B.
Abdominal contents push against the diaphragm, decreasing FRC
- C.
The West zones of the lung shift.
- D.
The mediastinum shifts towards the head, increasing the risk for bronchial intubation.
Correct Answer(s)
A. DiapHragm shifts cepHalad.
B. Abdominal contents push against the diapHragm, decreasing FRC
C. The West zones of the lung shift.Explanation
The mediastinum shifting cephalad occurs with Trendelenberg positioning.Rate this question:
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- 6.
Your patient is in Trendelenberg position. You understand that their FRC is inversely proportional to the steepness of their positioning.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Diaphragmatic excursion decreases with the shifting of abdominal contents.Rate this question:
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- 7.
In the lithotomy position, respiratory changes are dependent on the extent to which the ____ are flexed on the abdomen
Correct Answer
legsExplanation
In normal lithotomy position w/o Trendelenberg, FRC decrease is similar to the supine position. BUT with extreme flexion of the thighs in the exaggerated litho position compresses the abdomen, shifts the abd. viscera cephalad, and limits diaphragmatic movement.Rate this question:
- 8.
In extreme lithotomy positioning, compliance and tidal volumes _______ while airway pressures ________.
- A.
Decrease, increase
- B.
Decrease, decrease
- C.
Increase, decrease
- D.
Increase, increase
Correct Answer
A. Decrease, increaseExplanation
In extreme lithotomy positioning, compliance and tidal volumes decrease because the position restricts the movement of the diaphragm and chest wall, leading to decreased lung expansion. However, airway pressures increase because the restricted movement of the chest and abdomen increases the resistance to airflow, causing an increase in pressure needed to maintain adequate ventilation.Rate this question:
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- 9.
What patient position is most preferable for ventilation?
- A.
Sitting
- B.
Supine
- C.
Prone
- D.
Side-lying
Correct Answer
A. SittingExplanation
The sitting position has less effect on V/Q redistribution and on lung volumes and it also it allows the greatest expansion of the dependent regions of the lungs.Rate this question:
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- 10.
When the patient is in the sitting position but the lower extremities are flexed at the hip, abdominal contents shift upwards against the diaphragm. This causes a change in FRC similar to the change seen in which position?
- A.
Prone
- B.
Supine
- C.
Side-lying
- D.
Trendelenberg
Correct Answer
B. SupineExplanation
When the patient is in the sitting position with flexed lower extremities, the abdominal contents shift upwards against the diaphragm. This causes a decrease in functional residual capacity (FRC), which is the volume of air remaining in the lungs after a normal exhalation. In the supine position, the abdominal contents also shift upwards due to gravity, leading to a similar decrease in FRC. Therefore, the change in FRC seen in the sitting position with flexed lower extremities is similar to the change seen in the supine position.Rate this question:
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- 11.
Patients in the lateral position are susceptible to _______ because closing volumes occur above FRC with closing occurring earlier in the dependent lung
- A.
Atelectasis
- B.
Pneumothorax
- C.
Pneumonia
- D.
ARDS
Correct Answer
A. AtelectasisExplanation
In the lateral position, the dependent lung (lower lung) is compressed due to the weight of the body, causing closing volumes to occur above the functional residual capacity (FRC). Closing volumes refer to the lung volume at which small airways begin to close during expiration. This means that the dependent lung is more prone to collapse or atelectasis, which is the partial or complete collapse of a lung or a section of it. Therefore, patients in the lateral position are susceptible to atelectasis.Rate this question:
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- 12.
Your patient is in the lateral position, you know that you should consider ______ your TV and utilizing a higher RR to prevent declines in oxygenation.
- A.
Increasing (10-12 mL/kg)
- B.
Normalizing (5-7 mL/kg)
- C.
Decreasing (4 mL/kg)
Correct Answer
B. Normalizing (5-7 mL/kg)Explanation
Patients in the lateral position may experience some decrease in oxygenation and many will attempt to correct this by using TV, increasing the risk for barotrauma and further O2 loss.Rate this question:
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- 13.
In the lateral position, the compliance of the dependent lung:
- A.
Increases
- B.
Decreases
- C.
Remains the same.
Correct Answer
B. DecreasesExplanation
Due to displacement of the diaphragm by abdominal contents as well as the downward force of the mediastinum.Rate this question:
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- 14.
In the prone position with the abdomen hanging free, FRC:
- A.
Increases
- B.
Decreases
- C.
Remains the same
Correct Answer
A. IncreasesExplanation
In the prone position, the abdomen is allowed to hang freely, which reduces the pressure on the diaphragm and allows it to move more easily. This increased mobility of the diaphragm allows for a greater expansion of the lungs during inhalation, leading to an increase in functional residual capacity (FRC). FRC is the volume of air that remains in the lungs after a normal exhalation, and it represents the amount of air available for gas exchange. Therefore, in the prone position, FRC increases.Rate this question:
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- 15.
In the prone position, what causes improvement in oxygenation?
- A.
Better matching of ventilation and perfusion.
- B.
Changes in lung volumes/capacities.
Correct Answer
A. Better matching of ventilation and perfusion.Explanation
In the prone position, the improvement in oxygenation is caused by better matching of ventilation and perfusion. This means that the air being breathed in reaches the areas of the lungs that have good blood flow, allowing for more efficient gas exchange. This position helps to optimize the distribution of air and blood within the lungs, leading to improved oxygenation. Changes in lung volumes/capacities may also have an impact on oxygenation, but the primary factor in the prone position is the improved matching of ventilation and perfusion.Rate this question:
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- 16.
You have successfully intubated your patient in the supine position. Your patient is having a procedure on their shoulder, upon raising them to the seated position what do you anticipate happening to your patient's blood pressure?
- A.
Decrease
- B.
Increase
- C.
No change
Correct Answer
A. DecreaseExplanation
When the patient is moved from a supine position to a seated position, their blood pressure is expected to decrease. This is because the change in position causes a redistribution of blood in the body. When the patient is supine, blood is evenly distributed throughout the body, but when they are seated, blood tends to pool in the lower extremities due to gravity. This pooling leads to a decrease in venous return to the heart, resulting in a decrease in cardiac output and subsequently a decrease in blood pressure.Rate this question:
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- 17.
Neuromuscular blockade increases venous return.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Venous return decreases d/t abolition of normal muscle tone.Rate this question:
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- 18.
Your patient is under general anesthesia in the sitting position. What do you expect to happen to their preload and stroke volume?
- A.
Increase
- B.
Decrease
- C.
No change.
Correct Answer
B. DecreaseExplanation
Due to blood pooling in the dependent areas of the bodyRate this question:
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- 19.
Opioids and volatile agents slow the heart rate, decreasing cardiac output and blood pressure. In healthy patients, MAP is maintained by compensatory increases in heart rate and ______
- A.
Respiratory rate
- B.
SVR
- C.
Pulmonary vascular resistance
- D.
CVP
Correct Answer
B. SVRExplanation
Elderly pts with comorbidities are less adaptive.
Compensatory mechanisms to increase HR when hypotension occurs are blunted by GA, rendering CO and BP more susceptible to gravitational (positioning) forcesRate this question:
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- 20.
___________ can be unrecognized in the lithotomy and Trendelenburg positions, because MAP can appear normal despite volume deficit d/t large amount of venous return.
Correct Answer
hypovolemia
hypotensionExplanation
In the lithotomy and Trendelenburg positions, hypovolemia can be unrecognized because the mean arterial pressure (MAP) can appear normal despite a volume deficit due to a large amount of venous return. Similarly, hypotension can also be unrecognized for the same reason. Both conditions can go unnoticed because the blood pressure may not show significant changes despite the underlying volume deficit or low blood pressure.Rate this question:
- 21.
The sitting position increases cerebral blood flow.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Decreases.Rate this question:
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- 22.
Which position puts the patient at greater risk for venous air embolism?
- A.
Prone
- B.
Supine
- C.
Sitting
- D.
Lateral
Correct Answer
C. SittingExplanation
Sitting position puts the patient at greater risk for venous air embolism. In this position, there is a higher chance of air entering the venous system through the central venous catheter or during surgical procedures. The sitting position allows air to accumulate in the right atrium, increasing the risk of air embolism.Rate this question:
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- 23.
Tourniquet pressure > _____ mmHg or longer than 2 hours increase the risk of peripheral nerve injury.
Correct Answer
400Explanation
Tourniquet pressure that exceeds 400 mmHg or is applied for longer than 2 hours can increase the risk of peripheral nerve injury. This means that if the pressure applied by the tourniquet is too high or if it is left on for too long, it can potentially damage the nerves in the affected area. Therefore, it is important to monitor and control the pressure and duration of tourniquet use to minimize the risk of nerve injury.Rate this question:
- 24.
Corneal abrasions and post-operative vision loss are complications of the prone positioning, requiring the need for meticulous attention to protection of the eyes - meaning the use of devices to ensure the eyes are kept free of pressure. The eyes should be check every 15 minutes when in the prone position.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Also need to protect the dependent eye in the lateral position.Rate this question:
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- 25.
Treatment of a venous air embolism is via removing the air via aspiration through a multiorifice central venous catheter.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The treatment of a venous air embolism involves removing the air from the affected area. This is done by using a multiorifice central venous catheter to aspirate or suction out the air. This method helps to prevent further complications and restore proper blood flow. Therefore, the statement is true.Rate this question:
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Current Version
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Mar 21, 2023Quiz Edited by
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Mar 18, 2015Quiz Created by
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