Patient Care

Question 1

In reviewing a patient’s blood chemistry, which of the following blood urea nitrogen (BUN) ranges is considered normal?

Answer 1

8 to 25 mg/100 mL

Question 2

Honor Code violations that can prevent a radiography student from meeting ARRT certification requirements include

1. failing one or more courses in the radiography program
2. being suspended from the radiography program
3. being dismissed/expelled from a radiography program

Answer 2

2 and 3 only

Question 3

To “excuse” suboptimal images, a radiographer makes a note on the exam requisition claiming that the patient “was uncooperative.” That radiographer can legally be found guilty of

Answer 3

libel.

EXPLANATION: Malpractice refers to an action taken by a health care professional that results in patient injury and that fails to meet reasonable standard of care guidelines. If a health care professional communicates false information to a third party, that health care professional can be found guilty of defamation. Spoken defamation is slander; written defamation is libel.

Question 4

When medications are administered parenterally, they are given

Answer 4

by a route other than orally

EXPLANATION: Some medications cannot be taken orally. They may be destroyed by the GI juices or may irritate the GI tract. Medications that are administered by any route other than orally are said to be given parenterally. This can include intravenous, intramuscular, topical, intrathecal, or subcutaneous modes of medication administration.

Question 5

All the following statements regarding the use of iodinated contrast agents with patients taking metformin hydrochloride are true except

Answer 5

metformin should be withheld for 48 hours after IV iodinated contrast studies.

EXPLANATION: Metformin hydrochloride (Glucophage) is used as an adjunct to appropriate diet to lower blood glucose levels in patients who have type 2 diabetes and whose hyperglycemia is not being managed satisfactorily with diet alone. Patients on Glucophage who are having intravascular iodinated contrast studies can develop an acute alteration of renal function or acute acidosis. It is recommended that patients on Metformin hydrochloride (Glucophage) have it withheld 48 hours after the examination

Question 6

When performing cardiopulmonary resuscitation (CPR) on an infant, it is recommended that the number of compressions per minute, compared with that for an adult,

Answer 6

increase.

EXPLANATION: The heart rate of an infant is much faster than that of an adult; therefore, the number of compressions per minute is also greater. Infant CPR requires five compressions to one breath. There should be at least 100 compressions/min.

Question 7

Which of the following conditions must be met in order for patient consent to be valid?

1. The patient must sign the consent form before receiving sedation.
2. The physician named on the consent form must perform the procedure.
3. All the blanks on the consent form must be filled in before the patient signs the form.

Answer 7

1, 2, and 3

EXPLANATION: All the statements in the question are true and necessary in order for patient consent to be valid. The patient must sign the consent form before receiving sedation. The physician named on the consent form must perform the procedure; no other physician should perform it. Also, the consent form should be complete prior to being signed; there should be no blank spaces on the consent form when the patient signs it. In the case of a minor, a parent or guardian is required to sign the form. If a patient is not competent, then the legally appointed guardian should sign the consent form. Remember that obtaining consent is the physician’s responsibility, so the explanation of the procedural risks should be performed by the physician, not by the radiographer.

Question 8

When caring for the elderly, it is important to remember that, as one ages, there is often a decrease in:

1. reaction time
2. strength
3. long-term memory

Answer 8

1 and 2 only

EXPLANATION: Aging is a broad concept that certainly includes physical change, but is a very individual and variable process. The major complaints of the elderly include weight gain, fatigue, decreased bone mass, joint stiffness, and loneliness. As we observe elderly patients we must be mindful that they might experience some decrease in balance, coordination, strength, and reaction time. A decrease in short-term memory can be demonstrated in the elderly, while they still retain remarkable long-term memory.

Question 9

Rapid onset of severe respiratory or cardiovascular symptoms after ingestion or injection of a drug, vaccine, contrast agent, or food, or after an insect bite, best describes

Answer 9

anaphylaxis.

EXPLANATION: Anaphylaxis is an acute reaction characterized by the sudden onset of urticaria, respiratory distress, vascular collapse, or systemic shock, sometimes leading to death. It is caused by ingestion or injection of a sensitizing agent such as a drug, vaccine, contrast agent, or food, or by an insect bite. Asthma and rhinitis are examples of allergic reactions. Myocardial infarction (MI) is caused by partial or complete occlusion of a coronary artery.

Question 10

The complete killing of all microorganisms is termed

Answer 10

sterilization.

EXPLANATION: The complete killing of all microorganisms is termed sterilization. Surgical asepsis refers to the technique used to prevent contamination when performing procedures. Medical asepsis refers to practices that reduce the spread of microbes, and therefore the chance of spreading disease or infection. Hand washing is an example of medical asepsis. It reduces the spread of infection, but does not eliminate all microorganisms. Disinfection involves the use of chemicals to either inactivate or inhibit the growth of microbes.

Question 11

A nosocomial infection is a(n)

Answer 11

infection acquired in a hospital.

EXPLANATION: Nosocomial diseases are those acquired in hospitals, especially by patients whose resistance to infection has been diminished by their illness. Cleanliness is essential to decrease the number of nosocomial infections. The x-ray table must be cleaned and the pillowcase changed between patients. The most common nosocomial infection is the urinary tract infection (UTI).

Question 12

Demonstration of which anatomic structures require(s) ingestion of barium sulfate suspension?

1. Duodenum
2. Pylorus
3. Ilium

Answer 12

1 and 2 only

EXPLANATION: Oral administration of barium sulfate is used to demonstrate the upper digestive system—the esophagus, fundus, body, and pylorus of the stomach—and barium progression through the small bowel. The small bowel includes the duodenum, jejunum, and ileum (ilium is part of the pelvis).

Question 13

In which of the following conditions is a double-contrast BE essential for demonstration of the condition?

1. Polyps
2. Colitis
3. Diverticulosis

Answer 13

1 and 2 only

EXPLANATION: Double-contrast studies of the large bowel are particularly useful for demonstration of the bowel wall and anything projecting into it, for example, polyps. Polyps are projections of the bowel wall mucous membrane into the bowel lumen. Colitis is inflammation of the large bowel, often associated with ulcerations of the mucosal wall. A single-contrast study most likely would obliterate these mucosal conditions, but coating of the bowel mucosa with barium and subsequent filling of the bowel with air (double contrast) provide optimal delineation. Single-contrast studies will demonstrate projections/outpouchings from the intestinal wall such as diverticulitis.

Question 14

What type of precautions prevent the spread of infectious agents in droplet form?

Answer 14

Airborne precautions

EXPLANATION: Category-specific isolations have been replaced by transmission-based precautions: airborne, droplet, and contact. Under these guidelines, some conditions or diseases can fall into more than one category. Airborne precautions are employed with patients suspected or known to be infected with tubercle bacillus (TB), chickenpox (varicella), or measles (rubeola). Airborne precautions require that the patient wear a mask to avoid the spread of bronchial secretions or other pathogens during coughing. If the patient is unable or unwilling to wear a mask, the radiographer must wear one. The radiographer should wear gloves, but a gown is required only if flagrant contamination is likely. Patients under airborne precautions require a private, specially ventilated (negative-pressure) room. A private room is also indicated for all patients on droplet precautions, that is, with diseases transmitted via large droplets expelled from the patient while speaking, sneezing, or coughing. The pathogenic droplets can infect others when they come in contact with mouth or nasal mucosa or conjunctiva. Rubella (“German measles”), mumps, and influenza are among the diseases spread by droplet contact; a private room is required for the patient, and health care practitioners should use gowns and gloves. Any diseases spread by direct or close contact, such as MRSA, conjunctivitis, and hepatitis A, require contact precautions. Contact precautions require a private patient room and the use of gloves, masks, and gowns for anyone coming in direct contact with the infected individual or his or her environment.

Question 15

The legal document or individual authorized to make an individual’s health care decisions, should the individual be unable to make them for himself or herself, is the

1. advance health care directive.
2. living will.
3. health care proxy.

Answer 15

1, 2, and 3

EXPLANATION: The patient’s rights can be exercised on the patient’s behalf by a designated surrogate or proxy decision maker if the patient lacks decision-making capacity, is legally incompetent, or is a minor. Many people believe that potential legal and ethical issues can be avoided by creating an advance health care directive or living will. Since all persons have the right to make decisions regarding their own health care, this legal document preserves that right in the event an individual is unable to make those decisions. An advance health care directive, or living will, names the health care proxy authorized to make all health care decisions and can include specifics regarding DNR (Do not resuscitate), DNI (Do not intubate), and/or other end-of-life decisions.

Question 16

Hirschsprung disease, or congenital megacolon, is related to which of the following age groups?

Answer 16

Neonate

EXPLANATION: Hirschsprung disease, or congenital megacolon, is caused by the absence of some or all of the bowel ganglion cells—usually in the rectosigmoid area but occasionally more extensively. Hirschsprung disease is the most common cause of lower GI obstruction in neonates and is treated surgically by excision of the affected area followed by reanastomosis with normal, healthy bowel. Hirschsprung disease is diagnosed by barium enema or, in mild cases, by rectal biopsy.

Question 17

Which of the following is another name for an intermittent injection port?

Answer 17

Heparin lock

EXPLANATION: Another name for an intermittent injection port is a heparin lock. As the name suggests, heparin locks are used for patients who will require sporadic injections. An intravenous catheter is placed in the vein, and an external adapter with a diaphragm allows for repeated injections. Heparin locks provide more freedom than an IV infusion, which also allows for repeated access. Hypodermic needles are usually used for drawing blood or drawing up fluids, whereas a butterfly needle is usually used for venipuncture.

Question 18

A patient with an upper respiratory tract infection is transported to the radiology department for a chest examination. Who should be masked?

1. Technologist
2. Transporter
3. Patient

Answer 18

3 only

EXPLANATION: A patient with a respiratory disease can transmit infectious organisms via airborne contamination (if the patient sneezes or coughs). Therefore, patients with upper respiratory tract infection should be transported wearing a mask to prevent the possibility of airborne contamination. It is not necessary for the radiographer to be masked.

Question 19

Hypochlorite bleach (Clorox) and Lysol are examples of

Answer 19

disinfectants.

EXPLANATION: Hypochlorite bleach (Clorox) and Lysol are examples of disinfectants. Disinfectants are used in radiology departments to clean equipment and to remove microorganisms from areas such as radiographic tables. Antiseptics are also used to stop the growth of microorganisms, but they are often applied to the skin, not to radiographic equipment. Antifungal medications can be administered systemically or topically to treat or prevent fungal infections. Antibacterial medications (bacteriostatics) also can be administered systemically or externally. Tetracycline is a systemic antibacterial medication.

Question 20

In what order should the following examinations be performed?

1. Upper GI series
2. IVU
3. BE

Answer 20

2, 3, 1

EXPLANATION: When scheduling patient examinations, it is important to avoid the possibility of residual contrast medium covering areas that will be of interest on later examinations. The IVU [also referred to as an intravenous pyelogram (IVP)] should be scheduled first because the contrast medium used is excreted rapidly. The BE should be scheduled next. Finally, the upper GI series is scheduled. There should not be enough barium remaining from the previous BE to interfere with the examination of the stomach or duodenum, although a preliminary scout image should be taken in each case.

Question 21

With a patient suffering abdominal pain, it is frequently helpful to

1. elevate the head slightly with a pillow.
2. perform the examination in the Trendelenburg position.
3. place a support under the knees.

Answer 21

1 and 3 only

Strain on the abdominal muscles may be minimized by placing a pillow under the patient’s head and a support under the patient’s knees. The pillow also relieves neck strain, reduces the chance of aspiration in the nauseated patient, and allows the patient to observe his or her surroundings. The Trendelenburg position causes the diaphragm to assume a higher position and can cause a patient to become short of breath.

Question 22

When radiographing the elderly, it is helpful to

1. move quickly.
2. address them by their full name.
3. give straightforward instructions.

Answer 22

2 and 3 only

EXPLANATION: Elderly patients (actually, most people) dislike being rushed or hurried along. They appreciate the radiographer who is caring and respectful enough to take the extra few moments necessary to progress at a slower speed. Some elderly patients are easily confused, and it is best to address them by their full name and keep instructions simple and direct. The elderly require the same respectful, dignified care as all other patients.

Question 23

A patient suffering from orthopnea would experience the least discomfort in which body position?

Answer 23

Erect

EXPLANATION: Orthopnea is a respiratory condition in which the patient has difficulty breathing (dyspnea) in any position other than erect. The patient is usually comfortable in the erect, standing, or seated position. The Trendelenburg position places the patient’s head lower than the rest of the body, the Fowler position is a semierect position, and the recumbent position is lying down.

Question 24

How many rights do patients have?

Answer 24

12

EXPLANATION: The AHA published a Patient’s Bill of Rights that detailed 12 specific areas of patients’ rights and the health care professional’s ethical (and often legal) responsibility to adhere to these rights. The Patient’s Bill of Rights is summarized as follows:

1. The right to considerate and respectful care
2. The right to be informed completely and understandably
3. The right to refuse treatment
4. The right to have an advance directive (e.g., a living will or health care proxy)
5. The right to privacy
6. The right to confidentiality
7. The right to review one’s records
8. The right to request appropriate and medically indicated care and services
9. The right to know about institutional business relationships that could influence treatment and care
10. The right to be informed of, consent to, or decline participation in proposed research studies
11. The right to continuity of care
12. The right to be informed of hospital policies and procedures relating to patient care, treatment, and responsibilities

Although it is the patient’s right to appropriate and medically indicated care and services, only the physician may order an x-ray procedure—just as it is only the physician who may order prescription drugs. The AHA recently replaced the Patient’s Bill of Rights with The Patient Care Partnership—Understanding Expectations, Rights and Responsibilities. This plain-language brochure includes the essentials of the Patient’s Bill of Rights and reviews what patients can and should expect during a hospital stay.

Question 25

Guidelines for cleaning contaminated objects or surfaces include which of the following?

1. Clean from the least contaminated to the most contaminated areas.
2. Clean in a circular motion, starting from the center and working outward.
3. Clean from the top down.

Answer 25

1 and 3 only

EXPLANATION: Because hospitals are the refuge of the sick, they can also be places of disease transmission unless proper infection control guidelines are followed. When cleaning contaminated objects or surfaces such as the radiographic table, it is important to clean from the least contaminated to the most contaminated area and from the top down. Soiled gowns and linens should be folded from the outside in and disposed of properly. When the patient’s skin is being prepared for surgery, it is often cleaned in circular motion starting from the center and working outward; however, this motion is not used for objects or surfaces.

Question 26

A patient developed hives several minutes after injection of an iodinated contrast agent. What type of drug should be readily available?

Answer 26

Antihistamine

EXPLANATION: When a contrast medium is injected, histamines are produced to protect the body from the foreign substance. An antihistamine (such as diphenhydramine [Benadryl]) blocks the action of the histamine and reduces the body’s inflammatory response to the contrast medium. An analgesic (such as aspirin) relieves pain. An anti-inflammatory drug (such as ibuprofen) suppresses the inflammation of tissue. Antibiotics (such as penicillin) help fight bacterial infections.

Question 27

Which of the following medical equipment is used to determine blood pressure?

1. Pulse oximeter
2. Stethoscope
3. Sphygmomanometer

Answer 27

2 and 3 only

EXPLANATION: A stethoscope and a sphygmomanometer are used together to measure blood pressure. The first sound heard is the systolic pressure, and the normal range is 110 to 140 mm Hg. When the sound is no longer heard, the diastolic pressure is recorded. The normal diastolic range is 60 to 90 mm Hg. Elevated blood pressure is called hypertension. Hypotension, or low blood pressure, is not of concern unless it is caused by injury or disease; in that case, it can result in shock. A pulse oximeter is used to measure a patient’s pulse rate and oxygen saturation level.

Question 28

Which blood vessels are best suited for determination of pulse rate?

Answer 28

Superficial arteries

Question 29

The type of shock often associated with pulmonary embolism or myocardial infarction is classified as

Answer 29

cardiogenic.

EXPLANATION: Cardiogenic shock is related to cardiac failure and results from interference with heart function. It can occur in cases of cardiac tamponade, pulmonary embolus, or myocardial infarction. Hypovolemic shock is related to loss of large amounts of blood, either from internal bleeding or from hemorrhage associated with trauma. The type of shock associated with the pooling of blood in the peripheral vessels is classified as neurogenic shock. This occurs in cases of trauma to the central nervous system that result in decreased arterial resistance and pooling of blood in peripheral vessels. Septic shock, along with anaphylactic shock, generally is classified as vasogenic shock.

Question 30

The medical abbreviation meaning “after meals” is

Answer 30

pc.

Question 31

Which of the following legal phrases defines a circumstance in which both the health care provider’s and the patient’s actions contributed to an injurious outcome?

Answer 31

Contributory negligence

EXPLANATION: A circumstance in which both the health care provider’s and the patient’s actions contribute to an injurious outcome is termed contributory negligence. An example would be a patient who fails to follow the physician’s orders or fails to show up for follow-up care and then sues when the condition causes permanent damage. Another example would be a patient who deliberately gives false information about the ingestion of drugs, leading to adverse effects from medications administered. Most states do not completely dismiss injury if there has been negligence on the part of the health care institution, even if the patient’s actions contributed substantially to the injury. Rather, comparative negligence is applied, where the percentage of the injury owing to the patient’s actions is compared with the total amount of injury. A jury may decide that a physician was negligent in his or her actions, but because the patient lied about using an illegal street drug that contributed to the injurious outcome, the patient is 80% responsible for his or her condition. The party suing may be awarded $100,000 for injuries but actually would receive only $20,000. Gross negligence occurs when there is willful or deliberate neglect of the patient. Assault, battery, invasion of privacy, false imprisonment, and defamation of character all fall under the category of intentional misconduct. Corporate negligence occurs when a corporation (i.e. hospital) fails to meet its legal obligations to its clients (patients). (Ehrlich and Daly, 7th ed., p. 70)

Question 32

The medical term for congenital clubfoot is

Answer 32

talipes.

EXPLANATION: Talipes is the term used to describe congenital clubfoot. There are several types of talipes, generally characterized by a deformed talus and a shortened Achilles tendon, giving the foot a clubfoot appearance. Osteochondritis (Osgood–Schlatter disease) is a painful incomplete separation of the tibial tuberosity from the tibial shaft. It is often seen in active adolescent boys. Coxa plana (Legg–Calvé–Perthes disease) is ischemic necrosis leading to flattening of the femoral head. Muscular dystrophy is a congenital disorder characterized by wasting of skeletal muscles. (Frank et al., 11th ed., vol. 1, p. 273)

Question 33

While measuring blood pressure, the first pulse that is heard is recorded as the

Answer 33

systolic pressure.

EXPLANATION: With the blood pressure cuff wrapped snugly around the patient’s brachial artery and the pump inflated to approximately 180 mm Hg, the valve is opened only slightly to release pressure very slowly. With the stethoscope over the brachial artery, listen for the pulse while watching the mercury column (gauge). Note the point at which the first pulse is heard as the systolic pressure. As the valve is opened further, the sound is louder; the point at which it suddenly becomes softer is recorded as the diastolic pressure. (Torres et al., 6th ed., p. 149)