Study guide · concept · General patient care
Patient exam positions for the CCMA
Sims' (left side-lying) is used for rectal exams, lithotomy (on the back with feet in stirrups) for pelvic exams, Fowler's (sitting up) for the chest and breathing, and Trendelenburg (feet higher than the head) is the classic textbook answer for shock.
- positions to know
- 9
- lie on the back
- 4
- General Patient Care items of 150
- 28
§01
Each position in one line
Picture the body shape first. The use usually follows from it.
- Supine
Flat on the back. Used to examine the front of the body and the abdomen.
- Dorsal recumbent
On the back with knees bent and feet flat on the table. Used for abdominal and perineal procedures.
- Lithotomy
On the back with feet in stirrups. Used for the pelvic exam and Pap test.
- Fowler's
Sitting up. Semi-Fowler's reclines about 30–45°. Used for the chest and lung exam, breathing comfort and general comfort.
- Sims'
On the left side with the upper knee drawn up. Used for rectal procedures.
- Prone
Face down. Used to examine the back.
- Knee-chest
Kneeling with the chest down on the table. Used for sigmoidoscopy and other proctologic exams.
- Trendelenburg
Lying flat with the feet higher than the head. It's the answer the exam keys for shock and low blood pressure; current AHA and Red Cross first-aid guidance lays the patient flat with the legs raised instead, so know both.
- Lateral recumbent
On the side with knees drawn up and chin tucked. This opens the spaces between the vertebrae, for example for a lumbar puncture.
§02
Four families of positions
Positions in the same family differ in one detail. Learn that detail.
| Family | Positions | What separates them |
|---|---|---|
| On the back | Supine, dorsal recumbent, lithotomy, Trendelenburg | The legs: straight, knees bent with feet flat, feet in stirrups, or feet higher than the head |
| On the side | Sims', lateral recumbent | Sims' is on the left with the upper knee drawn up. Lateral recumbent curls the whole spine forward. |
| Face down | Prone, knee-chest | Whether the patient lies flat or kneels with the hips raised |
| Sitting | High Fowler's, semi-Fowler's | How far the back is reclined |
§03
Getting the patient there safely
Positioning questions also test safety and dignity.
Prepare the table
Lock the wheels, pull out the step and set the stirrups or headrest before the patient climbs on.
Explain and drape
Tell the patient what position is needed and why. Expose only the area being examined and keep the rest covered.
Move in stages
Help the patient into position one step at a time. Positions that lower the head or raise the legs can leave someone lightheaded when they sit up.
Bring them back slowly
Afterwards, have the patient sit for a moment before standing, and stay close while they step down.
§04
Working through a stem
Translate the stem into an organ or a problem, then pick.
“Prepare the patient for a lumbar puncture”
The needle has to pass between vertebrae, so the spine needs to curve open. Use lateral recumbent with knees drawn up and chin tucked. Prone looks plausible because the spine faces up, but it keeps the spine flat.
“The provider will perform a sigmoidoscopy”
A scope into the sigmoid colon calls for knee-chest. The organ decides the position, and rectal-area positions differ by how deep the provider needs to go.
“The provider will palpate the abdomen”
The front of the body faces up and the muscles are relaxed, so use supine. Bent knees (dorsal recumbent) can relax the abdominal wall further when the provider asks for it.
§05
Three distinctions
Is Sims' position on the left or the right side?
The left side, with the upper (right) knee drawn up toward the chest.
What separates dorsal recumbent from lithotomy?
Both are on the back with the knees bent. In dorsal recumbent the feet are flat on the table. In lithotomy they're in stirrups.
Where does positioning sit on the CCMA test plan?
In General Patient Care, the largest area of the test plan at 28 of 150 scored items, alongside injections and sterile technique. The whole area is laid out on the General Patient Care page.
§06
Positioning questions
8 questions. Pick an answer to see why it is right or wrong.
Turn each stem into an organ or a problem first, then pick the position.
Which position is used for a female patient during urinary catheterization?
Answer & explanation
Answer: D. Dorsal recumbent
In the dorsal recumbent position the patient lies on her back with knees flexed and feet flat, which exposes the perineum for catheterization. Sims' is a left side-lying position used for rectal exams and enemas, which makes it the tempting choice for a perineal procedure. Knee-chest is for proctologic exams, and prone gives access to the back.
- Prone, lying face down, gives no access to the urethral opening for catheterization.
- Sims' left lateral position is used for rectal exams and enemas, not female catheterization.
- Knee-chest is used for proctologic exams and is hard to hold for the length of a catheterization.
- Correct: dorsal recumbent, supine with knees bent and feet flat, gives good access and comfort for female catheterization.
A patient in anaphylaxis feels faint and her blood pressure is falling, but she is breathing comfortably. While the provider prepares epinephrine, how should the MA position her?
Answer & explanation
Answer: C. Lying flat with her legs elevated
When a patient is in shock but breathing comfortably, lying flat with the legs raised helps return blood to the heart and brain. High Fowler's is the right choice only when breathing is the main problem, and sitting or standing a hypotensive patient can cause collapse. Prone positioning prevents monitoring of her airway and face.
- Sitting upright helps breathing problems but worsens falling blood pressure and fainting.
- Prone positioning does not support circulation and makes watching the airway harder.
- Correct: lying flat with legs raised helps blood return to the heart and brain while pressure is falling.
- Standing a fainting, hypotensive patient risks a fall and lets her blood pressure drop further.
A patient suddenly becomes short of breath in the exam room. Which position will make breathing easiest?
Answer & explanation
Answer: D. High Fowler's
High Fowler's (sitting upright at about 60–90°) lets the diaphragm drop and the chest expand, so it eases breathing. Trendelenburg tilts the head down and pushes the abdominal organs against the diaphragm, which makes breathing harder; it is used for shock. Dorsal recumbent and Sims' are lying positions for exams, not for respiratory distress.
- Dorsal recumbent keeps the patient lying back, which makes it harder for the lungs to expand.
- Trendelenburg lowers the head and pushes abdominal organs against the diaphragm, worsening breathing.
- Sims' is a side-lying position for rectal exams and does not ease shortness of breath.
- Correct: high Fowler's sits the patient upright, letting the diaphragm drop and the lungs expand more easily.
Which position should the MA assist a patient into for a pelvic exam and Pap test?
Answer & explanation
Answer: B. Lithotomy
In the lithotomy position the patient lies on her back with her feet in stirrups, which gives the provider access for a pelvic exam and Pap test. Sims' is a left side-lying position used for rectal exams and enemas, the usual confusion because both involve the perineum. Knee-chest is for proctologic exams, and prone gives access to the back.
- Sims' left lateral position is for rectal exams and enemas, not routine pelvic exams.
- Correct: lithotomy, supine with feet in stirrups, gives the provider access for pelvic exams and Pap tests.
- Prone positioning is used for back and spine exams, not pelvic exams.
- Knee-chest is used for proctologic exams, not routine pelvic exams and Pap tests.
A patient in respiratory distress cannot lie flat for the EKG. How should the medical assistant position them?
Answer & explanation
Answer: D. In a semi-Fowler's (semi-upright) position
A semi-Fowler's position lets a patient in respiratory distress breathe more comfortably while still allowing a usable tracing, which should be noted as a non-standard position. Trendelenburg, prone, and Sims' positions are used for other purposes and would worsen breathing or be unsuitable.
- Trendelenburg lowers the head and makes breathing harder for a patient already in distress.
- Lying prone makes breathing harder and prevents proper chest lead placement.
- Sims' side-lying position does not ease breathing and gets in the way of chest lead placement.
- Correct: semi-Fowler's lets the patient breathe more easily while leads are placed; note the position on the tracing.
The provider needs to examine a patient's spine. Which position should the MA assist the patient into?
Answer & explanation
Answer: D. Prone
In the prone position the patient lies face down, exposing the back and spine for examination. Supine is the opposite, face-up position used for the chest and abdomen, which is the common mix-up. Lithotomy is for pelvic exams, and knee-chest is for proctologic exams.
- Knee-chest is used for rectal or sigmoid exams, not a routine spine exam.
- Lithotomy is for pelvic exams and Pap tests, not examining the back.
- Supine places the patient on their back, hiding the spine from view.
- Correct: prone, lying face down, exposes the back so the provider can examine the spine.
A patient who is 32 weeks pregnant becomes lightheaded and nauseated while lying flat on her back on the exam table. What should the MA do?
Answer & explanation
Answer: C. Turn her onto her left side
Late in pregnancy the uterus can press on the inferior vena cava when the patient lies flat, reducing blood return to the heart; turning her onto her left side moves the uterus off the vessel. Raising the legs while she stays flat is the usual fainting position, but it leaves the uterus on the vena cava. The vena cava lies to the right, so the left side relieves it best, and sitting upright can worsen lightheadedness.
- Sitting her up may help a little, but turning to the left side relieves the compression fastest.
- Keeping her flat continues the pressure of the uterus on the vena cava, even with legs raised.
- Correct: turning onto the left side lifts the uterus off the inferior vena cava, restoring blood return to the heart.
- The right side can still compress the vena cava, so the left side is preferred.
A provider orders an enema for an adult patient in the office. Which position should the MA help the patient into?
Answer & explanation
Answer: C. Sims' (left lateral)
Sims' position (lying on the left side with the right knee drawn up) is used for enemas, rectal exams, and rectal temperatures, because it follows the path of the descending and sigmoid colon. Knee-chest is the tempting choice, but it is reserved for proctologic exams such as sigmoidoscopy.
- Lithotomy is for pelvic exams, Pap tests, and childbirth.
- Knee-chest is used for sigmoidoscopy and proctologic exams.
- Correct: left lateral Sims' is the enema and rectal position.
- Dorsal recumbent is for abdominal exams and catheterization.
That is the whole set. Open any card to re-read its explanation, or start over.