Free NCLEX-RN® Nursing Sample Questions
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Your Free NCLEX Question
The nurse is caring for a client immediately following left rotator cuff repair surgery. In which position will the nurse place the client?
- A. Right side-lying with affected arm supported
- B. Dorsal recumbent with affected arm elevated
- C. Semi-Fowler’s with pillows to prop up affected arm
- D. Trendelenburg with elbow bent and hand elevated
The Answer and Explanation
Did you get it right? The correct answer is: C
Immediately following rotator cuff surgery, the client is positioned in semi-Fowler’s position with the arm propped up to reduce the tension on the suture line and the rotator cuff and to promote client comfort. A sling and swathe or a shoulder immobilizer is used to support the shoulder and limit shoulder movement. The shoulder is exercised by physical therapy beginning the first post-operative day to prevent frozen shoulder.
Fowler’s Position: Head of bed is elevated.
High Fowler’s position: the head of the bed is elevated at almost a 90-degree angle.
Semi Fowler’s position: the head of bead is elevated to 30- 45 degrees.
Low Fowler’s position: the head of the bed is elevated below 30 degrees.
The rotator cuff is located in the shoulder and its function allows the shoulder to be stable and freely move. The cuff is made up of the supraspinatus muscle and tendon, infraspinatus muscle, teres minor muscle, and subscapularis muscle and tendon. The rotator cuff can tear from repetitive movements, trauma, aging, and impingement.
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Rotator Cuff Tear
| Clinical Findings | Shoulder weaknessPainDecreased mobilityGrating or cracking sounds on movement |
| Treatments | RestNSAIDsPhysical TherapyUltrasonic TreatmentsCortisone InjectionsSurgery (if conservative treatments fail) |
| Key Nursing Considerations | Pain ReductionMobility Maintenance and RestorationClient Education: Exercises Medication as prescribed Follow-up |
| Prevention | Preventing rotator cuff tear injuries may include: Avoid overuseUse correct body mechanics and techniques to avoid injury to rotator cuffPerform exercises to maintain muscle strength in the shouldersUse warm up and cool down exercises when using the shoulder muscles such as swimming, tennis, or other activity. |
Incorrect Answer Explanations
Answer A: The nurse will not position the client with left rotator cuff surgery in the right side-lying with affected arm supported as this will increase pressure/weight on the rotator cuff repair.
Answer B: The nurse will not position the client with left rotator cuff surgery in the dorsal recumbent with affected arm lying elevated as this will increase pressure on the rotator cuff repair.
Answer D: The nurse will not position the client with left rotator cuff surgery in the Trendelenburg with elbow bent and hand elevated as this will increase pressure/weight on the rotator cuff repair.
Bottom Line
Immediately following rotator cuff repair surgery, the client will be positioned in the semi-Fowler’s position with the affected arm supported with pillows, sling and swathe, or a shoulder immobilizer.
For more information, see:
Graham, P. (2018). Rotator cuff tear. Orthopedic Nursing, 37(2). doi: 10.1097/NOR.0000000000000441
Lewis, S., Bucher, L., Heitkemper, M., & Harding, M. (2018). Medical-surgical nursing: Assessment and management of clinical problems (10th ed., pp. 1466-1467). St. Louis, MO: Elsevier.
Ignatavicius, D. (2021). Concepts of care for patients with musculoskeletal trauma. In Ignatavicius, D., Workman D., Rebar, C., & Heimgartner, N. (Eds.), Medical-surgical nursing: Concepts for Interprofessional collaborative care, (10th ed., p. 1054). St. Louis, MO: Elsevier
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