AORN Surgical Positioning 3 — Questions and Answers
Question 1: During a long procedure in the supine position, which area is MOST prone to pressure injury development?
- Scapulae
- Sacrum and occiput (Correct answer)
- Anterior thighs
- Posterior knees
Correct answer: Sacrum and occiput
The sacrum and occiput are the highest-pressure bony prominences in the supine patient and develop injuries most rapidly.
Question 2: AORN guidelines recommend that the arm board angle in supine positioning should not exceed how many degrees of abduction?
- 60 degrees
- 90 degrees (Correct answer)
- 110 degrees
- 120 degrees
Correct answer: 90 degrees
Arm abduction beyond 90 degrees stretches the brachial plexus and risks traction injury; AORN recommends keeping boards at or below 90 degrees.
Question 3: Which intraoperative positioning change requires re-evaluation and documentation of all pressure points?
- Minor head rotation only
- Any repositioning of the patient during the procedure (Correct answer)
- Only position changes lasting more than 30 minutes
- Changes made by the anesthesia team only
Correct answer: Any repositioning of the patient during the procedure
AORN standards require documentation of pressure point reassessment and padding any time the patient's position is changed intraoperatively.
Question 4: A patient with severe kyphosis is being positioned supine. The BEST initial accommodation is to:
- Force the patient flat and add extra padding post-induction
- Assess spine curvature pre-operatively and use custom padding to maintain anatomical alignment (Correct answer)
- Place a sandbag under the lumbar spine
- Avoid supine position entirely for all kyphotic patients
Correct answer: Assess spine curvature pre-operatively and use custom padding to maintain anatomical alignment
Pre-operative assessment of the curvature guides individualized padding that maintains the patient's natural spinal alignment without force.
Question 5: In the Trendelenburg position, pulmonary compliance decreases primarily because:
- The diaphragm is displaced cephalad by abdominal contents (Correct answer)
- Blood pools in the lung bases
- Tidal volume automatically decreases
- The patient shivers from head-down cooling
Correct answer: The diaphragm is displaced cephalad by abdominal contents
Head-down tilt shifts abdominal viscera toward the diaphragm, restricting its downward movement and reducing lung compliance and tidal volume.
Question 6: Which patient factor is an independent risk predictor for peripheral nerve injury during surgery according to AORN evidence-based practice?
- Male sex
- Pre-existing peripheral neuropathy or diabetes (Correct answer)
- Body mass index under 20
- ASA class I status
Correct answer: Pre-existing peripheral neuropathy or diabetes
Patients with pre-existing neuropathy or diabetes have compromised nerve perfusion and are significantly more vulnerable to positioning-related nerve injury.
Question 7: When using a shoulder brace in the Trendelenburg position to prevent caudal patient sliding, placement should be at the:
- Acromioclavicular joint
- Acromion tip only
- Acromial process padded to avoid direct contact with the brachial plexus (Correct answer)
- Mid-clavicle
Correct answer: Acromial process padded to avoid direct contact with the brachial plexus
Shoulder braces must be padded and positioned at the acromial process; misplacement over the clavicle or plexus risks brachial plexus compression injury.
AORN Surgical Positioning 3
During a long procedure in the supine position, which area is MOST prone to pressure injury development?