Ch. 14 Urinary System and Venipuncture Workbook Flashcards
which specific position, taken during an IVU, places the left kidney parallel to the IR
RPO
any disruption in the physiologic functions of the body that may lead to a contrast media reaction is the basis for what theory
chemotoxic theory
which type of reaction is caused by the stimulation of the vagus nerve by the introduction of a contrast medium, which causes heart rate and blood pressure to fall
vasovagal reaction
a large stone that grows and completely fills the renal pelvis
staghorn calculus
how much obliquity is required for the left/right posterior oblique projections taken during an IVU
30 degrees
which position best demonstrates possible nephroptosis
erect position
where are the kidneys and ureters located in relation to the peritoneum
retroperitoneal
at what stage of an IVU is the renal parenchyma best seen
within 1 minute after injection
T/F - contrast media should never be injected into the bladder under pressure but should be allowed to fill slowly by gravity in the presence of an attendent
true
T/F - vasovagal reactions are not considered to be life threatening
false
where is the CR centered for a nephrotomogram
midway between xiphoid and iliac crest
what category of systemic contrast media reaction results in temporary renal failure
severe
what category of systemic contrast media reaction results in bradycardia (<50 beats/min)
severe
what CR angle is used for the AP projection taken during cystogram
10-15 degrees caudad
what type of patient is a likely candidate for the premedication procedure before a contrast media study
asthmatic patient
increased blood pressure to the kidneys resulting from atherosclerosis
renal hypertension
a condition characterized by regions or areas of subcutaneous swelling caused by an allergic reaction to food or drugs is called what
angioedema
the peripheral or outer portion of the kidney is called what
cortex
what is the term that describes the total functioning portion of the kidney
renal parenchyma
what category of systemic contrast media reaction results in tachycardia (>100 beats/min)
moderate
these are located directly superior to the kidneys
suprarenal (adrenal) glands
what category of systemic contrast media reaction results in angioedema
moderate
act of voiding
micturition
T/F - the glomerular capsule and proximal and distal convoluted tubules are located in the medulla of the kidney
false - cortex
what portion of the kidney is the collecting tubule in
medulla
what category of systemic contrast media reaction results in lightheadedness
mild
what category of systemic contrast media reaction results in hypotension (systolic blood pressure <80 mmHg
severe
contraction of the muscles within the walls of the bronchis and bronchioles, producing a restriction of air passing through them, is a condition called what
bronchospasm
what is the total capacity for the average adult bladder
350-500 mL
loss of consciousness resulting from reduced cerebral blood flow is called what
syncope
what are the two most common types of needles used for bolus injection of contrast media
- butterfly
- over-the-needle catheter
normal kidney that fails to ascend into the abdomen but remains in the pelvis
ectopic kidney
what category of systemic contrast media reaction results in laryngeal swelling
severe
rapid excretion of contrast media radiographically
renal hypertension
what category of systemic contrast media reaction results in cardiac arrest
severe
what category of systemic contrast media reaction results in mild hives
mild
T/F - mild level contrast media reactions do not usually require medication or medical assistance
true
what are the 6 steps followed during a venipuncture procedure
- wash hands and put on gloves
- select site, apply tourniquet, cleanse site
- initiate puncture
- confirm entry
- prepare and proceed with injection
- remove needle or catheter
T/F - urticaria is the formal term for excessive vomiting
false - hives
an eruption of wheals (hives), often caused by a hpyersensitivity to food or drugs is a condition called what
urticaria
what type of iodinated contrast media uses a parent compound of an amide or glucose group
nonionic
mucosal changes within bladder radiographic appearance
cystitis
what type of iodinated contrast media uses a parent compound of a benzoic acid
ionic
what compounds are a common anion found in ionic contrast media
diatrizoate or iothalamate
convulsions is a symptom of what type of contrast media reaction
severe systemic
an expected outcome to the introduction of contrast media is described as what
side effect
metallic taste is a symptom of what type of contrast media reaction
side effect
angioedema is a symptom of what type of contrast media reaction
moderate systemic
bradycardia is a symptom of what type of contrast media reaction
severe systemic
itching is symptom of what type of contrast media reaction
mild systemic
T/F - the patient should void before an IVU to prevent possible rupture of the bladder if compression is applied
true
signs of obstruction of urinary bladder radiographic appearance
renal calculi
what are the 5 step imaging sequence for a routine IVU
- 1 min nephrogram or nephrotomogram
- 5 min full KUB
- 10-15 min full KUB
- 20 min L + R PO
- postvoid (prone PA or erect AP)
what drug is often given to the patient as part of the premedication procedure
combination of Benadryl and prednisone
temporary hot flash is a symptom of which type of contrast media reaction
side effect
what are the two general categories of contrast media reactions
- local
- systemic
respiratory arrest is a symptom of what type of contrast media reaction
severe systemic
pulmonary edema is a symptom of which type of contrast media reaction
severe systemic
severe urticaria is a symptom of which type of contrast media reaction
moderate systemic
what is the primary purpose of ureteric compression
to enhance filling of the renal pelvic calyceal system and proximal ureters with contrast media
what should the tech do first when a patient is experiencing either a moderate or severe level contrast media reaction
call for medical assistance
when does the timing for an IVU exam start
at the start of the injection of contrast media
what is the primary purpose of the premedication procedure before an iodinated contrast media procedure
to reduce the severity of contrast media reactions
T/F - acute renal failure may occur 48 hours after an iodinated contrast media procedure
true
a trademark name for a diuretic drug is what
lasix
what type of reaction is a true allergic response to iodinated contrast media
anaphylactic reaction
what is IVU (intravenous urogram) an exam of
kidneys, ureters and bladder
in which department are most retrograde urograms performed
surgery (inpatient or outpatient facility)
which structures create a 20 degree angle between upper and lower poles of the kidney
psoas major muscles
what degree of rotation from supine is required to place the kidneys parallel to the IR
30 degrees
extravasation is a symptom of what type of contrast media reaction
local
T/F - the Brodney clamp is used for male and female retrograde cystourethrograms
false - males only
what type of iodinated contrast media will not significantly increase the osmolarity of the blood plasma
nonionic
what type of iodinated contrast media incorporates sodium or maglumine to increase solubility of the contrast media
ionic
in addition to notifying a nurse or physician when contrast media has extravasated into the soft tissue, what should the tech first do to increase absorption
elevate the affected extremity or use a cold compress followed by a warm compress
T/F - tissue inflammation from extravasated contrast media peaks 1-2 hours after the incident
false - 24-48 hours
which two landmarks can be palpated to locate the kidneys
xiphoid process and iliac crest
what are 10 contraindications that may prevent a patient from having a contrast media procedure performed
- hypersensitivity to iodinated contrast
- anuria
- multiple myeloma
- diabetes mellitus
- severe hepatic or renal disease
- congestive heart failure
- pheochromocytoma
- sickle cell anemia
- patients taking metformin or similar med
- renal failure, acute or chronic
what term describes an abnormal drop of the kidneys when the patient is placed erect
nephroptosis
what are the 3 functions of the urinary system
- remove nitrogenous waste
- regulate water levels
- regulate acid-base balance and electrolyte levels in the blood
a buildup of nitrogenous waste in the blood is called what
uremia
what is the microscopic functional and structural unit of the kidney
nephron
T/F - the efferent arterioles carry blood to the glomeruli
false - afferent arterioles
what is another (older) term for the glomerular capsule
Bowman capsule
which structure of the medulla is made up of a collection of tubules that drain into the minor calyx
renal pyramids
what portion of the kidney is the loop of Henle in
medulla
what portion of the kidney is the distal convoluted tubule in
cortex
what is IVP (intravenous pyelogram) a study of
renal pelvis
which involves a direct introduction of contrast media into the structure being studied
- retrograde urogram
- retrograde cystogram
- retrograde urethrogram
- all of the above
all of the above
irregular appearance of renal parenchyma or collecting system radiographic appearance
renal cell carcinoma
what specific aspect of the kidney is visualized during an IVU
collecting system (major and minor calyces, renal pelvis, proximal ureters)
what condition is a common pathologic indication for an IVU
hematuria
what condition is described as a rare tumor of the adrenal gland
pheochromocystoma
inability to void
retention
what alternate imaging modality is not routinely used to diagnose renal calculi
MRI
what portion of the kidney is the afferent arteriole in
cortex
what portion of the kidney is the efferent arteriole in
cortex
diminished amount of urine being excreted
oliguria
indicated by the presence of uremia, oliguria, or anuria
acute renal failure
what portion of the kidney is the glomerular capsule in
cortex
constant or frequent involuntary passage of urine
urinary incontinence
absence of a functioning kidney
renal agenisis
T/F - urinary studies on pediatric patients should be scheduled early in the morning to minimize the risk for dehydration
true
complete cessation of urinary secretions
anuria
enlargement of the prostate gland
benign prostatic hyperplasia (BPH)
multiple cysts in one or both kidneys
polycystic kidney disease
signs of abnormal fluid collections radiographic appearance
vesicorectal fistula
abnormal rotation of the kidney radiographic appearance
malrotation
what portion of the kidney is the proximal convoluted tubule in
cortex
what portion of the kidney is the descending limb in
medulla
elevated or indented floor of bladder radiographic appearance
benign prostatic hyperplasia (BPH)
what type of renal calculi is often associated with chronic urinary tract infections
staghorn calculi
what portion of the kidney is the ascending limb in
medulla
what are the 6 conditions that could contraindicate the use of ureteric compression
- possible ureteric stones
- abdominal mass
- abdominal aortic aneurysm
- recent abdominal surgery
- severe abdominal pain
- acute abdominal trauma
which two processes move urine through the ureters to the bladder
- peristalsis
- gravity
what is the primary difference between a standard and a hypertensive IVU
hypertensive IVU requires a shorter time span between images
what structure is located most anterior
- proximal ureters
- kidneys
- urinary bladder
- suprarenal glands
urinary bladder
T/F - a retrograde urogram examines the anatomy and function of the pelvicalyceal system
false - nonfunctional study
what is the name of the inner, posterior region of the bladder formed by the two ureters entering and the urethra exiting
trigone
what is the name of the small gland found just inferior to the male bladder
prostate gland
which of the following structures is considered most posterior
- ovaries
- urethra
- vagina
- kidneys
kidneys
how can intravenous contrast media be administered by
- bolus
- drip infusion
exposure factors used during a CT procedure can be adjusted to compensate for a decrease or increase in body size according to what
height and weight
T/F - a patient does not require extensive bowel preparation before a CT scan for renal calculi
true
T/F - nuclear medicine is highly effective in demonstrating signs of vesicoureteral reflux
true
T/F - the parent (or legal guardian) must sign an informed consent form before a venipuncture procedure is performed on a pediatric patient
true
where should the pneumatic paddle be placed for the ureteric compression phase of an IVU
just medial to ASIS and lateral to spine (over the outer pelvic brim)
for most IVUs veins located where are recommended for venipuncture
antecubital fossa
what can be done to enhance filling of the calyces of the kidney if ureteric compression is contraindicated
place patient in a 15 degree Trendelenburg position
what are the 4 reasons a scout projection is taken before the injection of contrast media for an IVU
- verify patient prep
- determine whether exposure factors are acceptable
- verify positioning
- detect any abnormal calcifications
passage of a large volume of urine
polyuria
what is the most common size of needle used for bolus injections on adults
18-22 gauge
presence of glucose in urine
glucosuria
excess urea and creatinine in the blood
uremia
what type of iodinated contrast media creates a hypertonic condition in the blood plasma
ionic
what type of iodinated contrast media is more expensive
nonionic
T/F - the bevel of the needle must face downward during the actual puncture into a vein
false - forward
presence of gas in urine
pneumouria
what is the specific name for the mass of fat that surrounds each kidney
perirenal fat or adipose capsule
what type of iodinated contrast media produces less severe reactions
nonionic
backward return flow of urine
urinary reflux
fusion of the lower poles of kidneys during the development of the fetus
horseshoe kidney
what type of iodinated contrast media is a near-isotonic solution
nonionic
T/F - if extravasation occurs during the puncture, the tech should slightly retract the needle and then push it forward again
false - needle should be withdrawn and pressure applied
which specific position is recommended for a male patient during a voiding cystourethrogram
30 degree RPO
T/F - if unsuccessful during the initial puncture a new needle should be used during the second attempt
true
T/F - the radiologist is responsible for documenting all aspects of the venipuncture procedure in the patient’s chart
false - tech or person performing the venipuncture
what kVp range is recommended for an IVU
80-85
what type of iodinated contrast media poses a greater risk for disrupting homeostasis
ionic
T/F - the number of retrograde urography procedures for urethral calculi has been reduced as a result of the increased use of CT
true
which imaging modality is used to detect subtle tissue changes following a renal transplant
MRI
how will an enlarged prostate gland appear on a postvoid radiograph taken during an IVU
prostate gland will indent the floor of the bladder
what type of iodinated contrast media may increase the severity of side effects
ionic
a retrograde pyelogram is primarily a nonfunctional study of what
renal pelvis - major and minor calyces of the kidney
what specific anatomy is examined during a retrograde ureterogram
primarily the ureters
T/F - there is a change in SID recommendations when placing a patient erect v. supine for an IVU AP projection
false
what is the normal creatinine level range for an adult
0.6-1.5 mg/dL
T/F - male and female patients should have the gonads shielded for an AP scout projection
false - not female
what is the normal blood urea nitrogen (BUN) level range for an adult
8-25 mg/100mL
T/F - nephrotomograms produced during an IVU most commonly use an exposure angle of < or equal to 10 degrees
true
metformin hydrochloride is a drug that is taken for the management of what
diabetes mellitus
how many tomograms (or focal levels) are usually produced during a routine IVU
3 tomograms or focal levels
the ACR recommends that metformin be withheld for how many hours after a contrast medium procedure in patients with known acute renal injury stage IV or V renal disease, or an estimated glomerular filtration rate of < 30, resumed only if kidney function is again determine to be within normal limits
48 hours
the longitudinal fissure found along the central medial border of the kidney is called what
hilum
what is the name of the junction found between the distal ureters and the urinary bladder
ureterovesical junction (UVJ)
inflammation of the capillary loops of the glomeruli of the kidneys
glomerulonephritis
the leakage of contrast media from a vessel into the surrounding soft tissues is called what
extravasation (infiltration)
artificial opening between the urinary bladder and aspects of the large intestine
vesicorectal fistula
vomiting is a symptom of which type of contrast media reaction
mild systemic
bilateral small kidneys with blunted calyces radiographic appearance
chronic bright disease
