AORN Surgical Positioning 2 — Questions and Answers
Question 1: Which nerve is most at risk during prolonged lithotomy position due to compression at the fibular head?
- Femoral nerve
- Obturator nerve
- Common peroneal nerve (Correct answer)
- Sciatic nerve
Correct answer: Common peroneal nerve
The common peroneal nerve wraps around the fibular head and is highly susceptible to compression injury in lithotomy position.
Question 2: When positioning a patient in the lateral decubitus position, an axillary roll is placed to protect which structure?
- Brachial plexus (Correct answer)
- Radial nerve
- Subclavian artery
- Cephalic vein
Correct answer: Brachial plexus
The axillary roll is placed just caudal to the axilla to prevent brachial plexus compression from the weight of the thorax.
Question 3: A patient in reverse Trendelenburg position is at greatest risk for which complication?
- Increased intracranial pressure
- Venous pooling in the lower extremities (Correct answer)
- Pulmonary edema
- Facial edema
Correct answer: Venous pooling in the lower extremities
In reverse Trendelenburg, gravity causes blood to pool in dependent lower extremities, reducing venous return and cardiac output.
Question 4: Which positioning device is specifically recommended by AORN to protect the ulnar nerve at the elbow?
- Gel pad over the medial epicondyle (Correct answer)
- Arm board angled above 90 degrees
- Tight elbow wrap with elastic bandage
- Foam padding under the lateral forearm only
Correct answer: Gel pad over the medial epicondyle
AORN recommends padding the medial epicondyle with gel or foam to protect the ulnar nerve from direct pressure.
Question 5: In the prone position, which abdominal positioning frame or roll placement is critical to prevent increased intra-abdominal pressure?
- Rolls placed directly under the abdomen
- Chest and iliac crest support that frees the abdomen (Correct answer)
- Single roll under the umbilicus only
- Foam wedge under the thorax only
Correct answer: Chest and iliac crest support that frees the abdomen
Supports must be placed at the chest and iliac crests so the abdomen hangs free, reducing IVC compression and epidural venous bleeding.
Question 6: Which assessment finding in a post-operative patient who was in lithotomy position most suggests compartment syndrome of the lower leg?
- Mild ankle swelling
- Pain out of proportion to the procedure and firmness of the calf (Correct answer)
- Numbness in the great toe only
- Redness over the tibial crest
Correct answer: Pain out of proportion to the procedure and firmness of the calf
Disproportionate pain combined with tense compartment firmness are hallmark early signs of compartment syndrome requiring immediate evaluation.
Question 7: When a patient is positioned in the sitting (beach chair) position, which cerebrovascular risk is most important to monitor?
- Increased cerebral venous pressure
- Cerebral hypoperfusion due to reduced mean arterial pressure at brain level (Correct answer)
- Venous air embolism only
- Hypertensive crisis
Correct answer: Cerebral hypoperfusion due to reduced mean arterial pressure at brain level
The brain is above heart level in the sitting position, so effective cerebral perfusion pressure drops approximately 2 mmHg per 2.5 cm of height above the heart.
AORN Surgical Positioning 2
Which nerve is most at risk during prolonged lithotomy position due to compression at the fibular head?