Chapter 14 (Urinary System & Venipuncture) Flashcards
Which abdominal muscles run on each side of, and medial and posterior to, the kidneys?
a. Rectus abdominis
b. External obliques
c. Right and left psoas major
d. Erector spinae
Right and left psoas major
The average adult kidney measures ____ in length.
a. 2 to 3 inches (5 to 7 cm)
b. 4 to 5 inches (10 to 12 cm)
c. 6 to 8 inches (15 to 20 cm)
d. 8 to 10 inches (20 to 25 cm)
4 to 5 inches (10 to 12 cm)
What structure enables the kidneys to be visualized on plain abdominal radiographs?
a. Adipose capsule
b. Renal pyramids
c. Major and minor calyces
d. High volume of blood within the kidney
Adipose capsule
Which of the following functions is not performed by the urinary system?
a. Removing nitrogenous wastes
b. Regulating water levels in tissues
c. Regulating the acid-base and electrolyte balance
d. Producing and releasing adrenaline
Producing and releasing adrenaline
The term describing the total functioning portions of the kidney is the:
a. renal collecting system.
b. nephron.
c. glomerular capsule.
d. renal parenchyma
Renal parenchyma
Urine will travel from the major calyces to the:
a. renal pelvis.
b. ureter.
c. minor calyces.
d. renal pyramids.
Renal pelvis
The glomeruli, glomerular capsule, and proximal and distal convoluted tubules are located in the ____ of the kidney.
a. medulla
b. cortex
c. collecting system
d. fibrous capsule
Cortex
The structural and functional unit of the kidney is:
a. Bowman capsule.
b. the calyx.
c. the nephron.
d. the glomerulus.
The nephron
Which structure of the kidney is labeled 3?
a) Minor calyx
b) Major calyx
c) Renal pelvis
d) Renal pyramid
Major calyx
Which structure and/or region of the kidney is labeled 1?
a) Minor calyx
b) Major calyx
c) Renal sinus
d) Medulla
Medulla
Which structure is labeled 2?
a) Renal pelvis
b) Ureterovesical junction
c) Ureteropelvis junction
d) Pelvic brim
Renal pelvis
What is the structure labeled 6?
a) Renal pelvis
b) Ureterovesical junction
c) Renal sinus
d) Trigone
Renal sinuses
One of the three constricted points along each ureter is the pelvic brim. The location of this constricted point is:
a. where the bladder meets the symphysis pubis.
b. at the level of the ischial spines.
c. where the iliac blood vessels cross over the ureters.
d. where the distal ureters connect to the bladder.
Where the iliac blood vessels cross over the ureters
What is the total capacity of the average adult bladder?
a. 350 to 500 mL
b. 100 to 250 mL
c. 500 to 750 mL
d. 1000 to 1200 mL
350 to 500 mL
Which term describes the act of voiding under voluntary control?
a. Urination
b. Urinary release
c. Incontinence
d. Anuria
Urination
The numerous mucosal folds located within the urinary bladder are termed:
a. trigone.
b. mucosa.
c. rugae.
d. vesical mucosa.
Rugae
Which of the following compounds is a common cation (+) found in ionic contrast media?
a. Diatrizoate
b. Iodine
c. Meglumine
d. Benzoic acid
Meglumine
Which component of an ionic contrast media increases its solubility?
a. Cation
b. Anion
c. Benzoic acid
d. Iodine
Cation
Which of the following is true with nonionic-type contrast media?
a. Low osmolality
b. The inability to dissociate into two separate ions
c. Less chance of reaction
d. All of the options
All of the options
Which of the following occurs in many patients and is defined as an expected outcome to the introduction of iodinated contrast media?
a. Moderate itching and sneezing
b. Metallic taste in mouth and a temporary hot flash
c. Mild condition of urticaria (hives)
d. All of the options
Metallic taste in mouth and a temporary hot flash
The American College of Radiology recommends that metformin (a drug used for diabetes mellitus) be withheld for ____ hour(s) prior to and following a contrast media procedure.
a. 1
b. 8
c. 24
d. 48
48
The normal creatinine level (diagnostic indication of kidney function) for an adult is _____ mg/dL.
a. 0.1 to 0.5
b. 0.6 to 1.5
c. 3 to 4.5
d. 6 to 7.5
0.6 to 1.5
Normal BUN (blood urea nitrogen) levels in adults should not exceed ____ mg per 100 mL.
a. 1.5
b. 5
c. 10
d. 25
25
What is the primary purpose of the premedication procedure before an iodinated contrast media study?
a. Reduces anxiety.
b. Permits greater contrast enhancement of kidneys during an intravenous urography
(IVU).
c. Reduces the severity of a possible contrast media reaction.
d. Decreases blood pressure.
Reduces the severity of a possible contrast media reaction
Which of the following drugs is often given before an IVU to reduce the risk of a contrast media reaction?
a. Diazepam
b. Benadryl and prednisone
c. Fluoxetine
d. Verapamil
Benadryl and prednisone
Which of the following symptoms is classified as “mild” during a systematic contrast media reaction?
a. Itching
b. Hypotension
c. Extravasation
d. Angioedema
Itching
If a patient experiences tachycardia (>100 heartbeats/min) following a systemic contrast media injection, he or she is experiencing a ____ reaction.
a. mild
b. moderate
c. severe
d. vasovagal
Moderate
If a patient experiences laryngeal swelling following a contrast media injection, he or she is experiencing a ____ level reaction.
a. mild
b. moderate
c. severe
d. local
Severe
The drug Lasix is classified as a:
a. contrast agent.
b. cathartic.
c. diuretic.
d. salicylate.
Diuretic
A brief loss of consciousness caused by reduced cerebral blood flow is termed:
a. syncope.
b. brachycardia.
c. hypotension.
d. angioedema.
Syncope
A region or area of subcutaneous swelling caused by allergic reaction to foods or drugs is termed:
a. oliguria.
b. micturition.
c. syncope.
d. angioedema.
Angioedema
Which of the following symptoms is considered a severe reaction to contrast media and is a life-threatening condition requiring life-saving measures?
a. Tachycardia (rapid heartbeat)
b. Excessive urticaria (hives)
c. Extravasation at the injection site
d. Cardiac arrhythmias
Cardiac arrhythmias
Which of the following conditions is considered to be higher risk (a contraindication) for a contrast media reaction?
a. Hematuria
b. Congestive heart failure
c. Urinary tract infection
d. Renal calculi
Congestive heart failure
What is the correct course of action for the technologist when, during an injection of contrast media, a patient experiences a side effect of mild hot flashes and some metallic taste in his mouth?
a. Call for a physician to complete the injection.
b. Stop the injection of contrast media immediately.
c. Stop the injection but continue the normal imaging sequence.
d. Reassure the patient and continue the injection and imaging sequence while
observing the patient for a possible more severe reaction to follow.
Reassure the patient and continue the injection and imaging sequence while observing the patient for a possible more severe reaction to follow
Which term describes the leakage of contrast media from a vein into the surrounding tissues of the arm? a. Extravasation
b. Filtration
c. Exudation
d. Micturition
Extravasation
Which level of contrast media reaction has occurred when the patient develops moderate urticaria?
a. Normal side effect
b. Mild reaction
c. Moderate reaction
d. Severe reaction
Moderate reaction
Which of the following is considered as a contraindication for an IVU procedure?
a. Hypertension
b. Anuria
c. Hematuria
d. All of the options
Anuria
Which of the following conditions is considered a moderate-level contrast media reaction requiring treatment?
a. Nausea and vomiting
b. Syncope
c. Tachycardia
d. None of the options
Tachycardia
What is the recommended treatment protocol for extravasation?
a. Give the patient diphenhydramine (Benadryl).
b. Elevate the limb and apply cold compress over injection site.
c. Increase IV fluids.
d. Give the patient Lasix immediately.
Elevate the limb and apply cold compress over injection site
The rapid introduction of contrast agents into the vascular system is termed:
a. rapid-fire injection.
b. rapid-drip infusion.
c. bolus injection.
d. IV infusion.
Bolus injection
In preparation for a venipuncture, a tourniquet should be applied ____ above or proximal to the site of injection.
a. 1 to 2 inches (2.5 to 5 cm)
b. 3 to 4 inches (7.5 to 10 cm)
c. 6 to 7 inches (15 to 18 cm)
d. 8 to 10 inches (20 to 25 cm)
3 to 4 inches (7.5 to 10 cm)
The most common size needle used for bolus injection of contrast agents for adult patients is _____ gauge.
a. 23 to 25
b. 14 to 16
c. 18 to 22
d. 28
18 to 22
Which of the following veins is not normally used during venipuncture?
a. Median cubital
b. Axillary
c. Cephalic
d. Basilic
Axillary
Patchy blunting of the calyces is a radiographic sign of:
a. polycystic kidney disease.
b. renal hypertension.
c. chronic pyelonephritis.
d. ectopic kidney.
Chronic pyelonephritis
Ureteric compression is contraindicated for patients with a history of:
a. hematuria.
b. abdominal mass.
c. hypertension.
d. flank pain.
Abdominal mass
How is contrast media normally introduced during a retrograde cystogram?
a. Intravenously
b. With an injection through the urethra with a large syringe and catheter
c. Gravity flow through a catheter
d. Either with an injection through the urethra with a large syringe and catheter or
gravity flow through a catheter
Gravity flow through a catheter
What is the recommended position for a male retrograde urethrogram?
a. 30-degree right posterior oblique (RPO)
b. 45-degree RPO
c. Lateral
d. 2-degree left anterior oblique (LAO)
30-degree right posterior oblique (RPO)
With automatic exposure control (AEC), which ionization chamber(s) should be activated for an AP projection taken during an IVU?
a. Left and right upper chambers
b. Center chamber
c. Left chamber
d. Center and right upper chamber
Left and right upper chambers
Which one of the following veins is NOT selected for venipuncture during an IVU?
a. Basilic
b. Cephalic
c. Axillary
d. Median cubital
Axillary
Where is the central ray (CR) centered for a nephrotomogram of the kidneys?
a. At the xiphoid process
b. At the iliac crest
c. Midway between the iliac crest and the xiphoid process
d. Midway between the ASIS and the iliac crest
Midway between the iliac crest and the xiphoid process
A nephrogram taken during an IVU demonstrates that the renal parenchyma is poorly visualized, but the calyces are contrast enhanced. What is the most likely reason for this radiographic outcome?
a. The kVp may have been too high.
b. The contrast media was diluted.
c. The patient has hypertension.
d. The exposure was not taken soon enough following the injection.
The exposure was not taken soon enough following the injection
A radiograph of a left posterior oblique (LPO) position taken during an IVU reveals that the right kidney is foreshortened and superimposed over the spine. What must the technologist do to correct this error during the repeat exposure?
a. Decrease rotation.
b. Increase rotation.
c. Increase CR angulation.
d. Place the patient in the RPO position to better demonstrate the right kidney.
Decrease rotation
A radiograph of an AP projection taken during a retrograde cystogram reveals that the floor of the bladder is superimposed over the symphysis pubis. What error led to this radiographic finding?
a. Excessive CR angulation
b. Rotation of the pelvis
c. Insufficient CR angulation
d. Excessive filling of the bladder with contrast media
Insufficint CR angulation
A patient comes to radiology for an IVU. During the procedure, the radiologist suspects nephroptosis. Which of the following positions best demonstrates this condition?
a. Erect
b. Prone
c. Supine with ureteric compression
d. RPO and LPO
Erect
A patient comes to radiology for an IVU. The clinical history states that the patient may have an enlarged prostate gland (benign prostatic hyperplasia). Which of the following positions best demonstrates this condition?
a. AP erect, prevoiding and voiding
b. PA prone, CR perpendicular
c. AP supine with a 15-degree CR caudad angle
d. 30-degree RPO
AP erect, prevoiding and voiding
A patient comes to radiology, after surgery of the abdomen, for an IVU with an order for ureteric compression to enhance pelvicalyceal filling. What should the technologist do?
a. Use mild ureteric compression only.
b. Place the patient into a Trendelenburg position instead of compression.
c. Perform all projections erect.
d. Raise the Foley bag above the tabletop to keep the contrast media in the kidneys
longer.
Place th patient into a Trendelenburg position instead of compression
A patient comes to radiology for an IVU. He has a clinical history of renal hypertension. How should the IVU procedure be altered for this patient?
a. Keep ureteric compression inflated for all projections.
b. Give the patient a diuretic agent before the procedure.
c. Provide images every 30 minutes after the injection.
d. Shorten the time between exposures.
Shorten the time between exposures
A patient comes to radiology with a history of vesicourethral reflux. The patient states that she is highly sensitive to iodinated contrast media. Which of the following alternative procedures could be performed to demonstrate this condition?
a. Radionuclide scan
b. Sonography
c. CT
d. MRI (magnetic resonance imaging)
Radionuclide scan
A male patient comes to radiology for a voiding cystourethrogram. Which of the following projections and/or positions would be performed for this procedure?
a. 30-degree RPO
b. Erect lateral
c. Recumbent lateral
d. Erect PA
30-degree RPO
A patient, during an injection of contrast media, complains about pain at the injection site. The radiographer notices a moderate degree of swelling beneath the skin. The radiographer stops the injection and suspects the needle has slipped out of the vein. What should the radiographer do after removing the needle to alleviate the patient’s discomfort?
a. Give the patient diphenhydramine (Benadryl).
b. Elevate the limb and place a cold compress over the injection site.
c. Place ice over the injection site.
d. Flex and extend the elbow to increase absorption of contrast media into the soft
tissues.
Elevate the limb and place a cold compress over the injection site
A patient comes to radiology for an IVU. His laboratory report indicates a creatinine level of 0.7 mg/dL. What should be the technologist’s next step?
a. Proceed with the study.
b. Notify the radiologist of an elevated creatinine level.
c. Notify the erring physician of an elevated creatinine level.
d. Escort the patient to the emergency department (ED) right away.
Proceed with the study
A patient with a possible ureteric stone comes from the emergency department (ED) for an IVU. She has a blood urea nitrogen (BUN) level of 50. Which of the following imaging modalities is recommended for this patient?
a. IVU using ionic contrast media
b. Sonography
c. CT
d. MRI
CT
During an IVU, the patient develops severe urticaria. What should be the next action taken by the technologist?
a. Call a code emergency.
b. Comfort the patient; this is a common side effect.
c. Give the patient diphenhydramine (Benadryl).
d. Get medical assistance.
Get medical assistance
A patient experiences a hot flash after the injection of an iodinated contrast media. What should be the next action taken by the technologist?
a. Call a code emergency.
b. Comfort the patient; this is a common side effect.
c. Give the patient diphenhydramine (Benadryl).
d. Get medical assistance.
Comfort the patient; this is a common side effect
(T/F) The suprarenal glands are part of the endocrine system.
False
(T/F) The left kidney is generally slightly lower, or more inferior, than the right.
False
(T/F) Ionic contrast agents use a parent compound of a carboxyl group (benzoic acid).
True
(T/F) Nonionic contrast agents create a hypertonic condition in the blood plasma as compared with ionic contrast agents.
False
(T/F) Nonionic contrast agents may increase the severity of side effects as compared with ionic contrast agents.
False
(T/F) Nonionic contrast agents contain no positively charged cations.
True
(T/F) A vasovagal contrast media reaction can be a life-threatening condition.
True
(T/F) A medical emergency must be declared if the patient experiences a moderate contrast media reaction.
True
(T/F) Extravasation is classified as a local reaction.
True
(T/F) Phlebitis is considered to be a systemic contrast media reaction.
False
(T/F) Venipuncture procedures may be performed by a technologist only if a physician is present in the room or is in an adjoining room.
False
(T/F) Patients (or legal guardian) must sign an informed consent form before a venipuncture procedure.
True
(T/F) The bevel of the needle must be facing downward during the actual puncture into a vein.
False
(T/F) If available, the technologist should use a central line catheter to introduce contrast agents into the patient.
False
(T/F) Over-the-needle catheters are often used for drip infusion studies.
True
(T/F) The technologist should leave a butterfly needle in the vein for the first part of the IVU following injection.
True
(T/F) CT (computed tomography) of the kidney for renal calculi does not require the use of intravenous contrast media.
True
(T/F) Laboratory tests are an effective method of confirming cystitis.
True
(T/F) If an IVU is performed on a female, a pregnancy screening history must be obtained.
True
(T/F) Generally, female patients cannot be shielded during an IVU (except for nephrotomography).
True
(T/F) It is recommended to inject contrast media through a shunt when one is present in the patient.
False
(T/F) If both procedures are ordered on the same day, a barium enema must be performed before an IVU.
False
(T/F) All reactions, regardless to their severity, must be documented.
True
(T/F) A true allergic reaction is also called an anaphylactic reaction.
True
