Patient Care: Patient Interactions and Management Flashcards
1: The patient has a right to be informed of medical information pertaining to the procedure they are to undergo. Informed consent is required for all procedures and encompasses:
A. Written consent
B. Oral consent
C. Implied consent
D. A and B
E. A, B, and C
Correct Answer: E. A, B, and C
All procedures require some level of informed consent. This may be written, oral, or implied, determined based upon the level of associated risk. For instance, a high-risk procedure, such as the administration of iodinated contrast in which there is a potential for allergic reaction to occur, would require written consent.
2: For a low-risk procedure, such as an upright X-ray of the abdomen, which form of consent is appropriate?
A. Verbal
B. Written
C. Implied
D. A and B
E. A, B, and C
Correct Answer: A. Verbal
All procedures require some level of informed consent. This may be written, oral, or implied, determined based upon the level of associated risk. Oral consent is also termed verbal consent. For instance, a low-risk procedure, such as a radiographic projection for imaging of the chest or abdomen, would require verbal consent. In female patients of child-bearing age, the radiographer should always ensure there is no possibility the patient is pregnant.
3: For implied consent to be valid, the radiographer must ensure each of the following except:
A. Risks associated with the procedure are reviewed when the radiographer deems the risk significant
B. The patient is provided with adequate information on which to continue with the examination or treatment
C. The patient is aware of the purpose and nature of the procedure
D. Information provided is in generic terms the patient understands
Correct Answer: A. Risks associated with the procedure are reviewed when the radiographer deems the risk significant
All procedures require some level of informed consent. This may be written, oral, or implied, determined based upon the level of associated risk. For consent to be gained, the patient must be aware of the purpose and nature of the examination to be performed, must be provided with adequate information on which to base consent for such examination or treatment, and must be provided with information which is comprehendible. All associated risks of the examination should be disclosed. If the patient has no further questions for the radiographer and decides to move forward with a general, noninvasive radiographic examination, consent is implied.
4: In accordance with the American Hospital Association Patient Care Partnership, the patient has the right to:
A. A clean and safe environment
B. Confidentiality of protected health information
C. Refuse treatment to the extent permitted by law
D. A and B
E. A, B, and C
Correct Answer: E. A, B, and C
The American Hospital Association (AHA) Patients’ Bill of Rights has been replaced with The Patient Care Partnership, informing patients of their rights and responsibilities pertaining to their medical care in the hospital setting. Patients have a right to high quality patient care, a clean and safe environment, involvement in their health care decisions including refusing treatment or services to the extent permitted by law, protection of privacy, and assistance with billing claims and transition of care.
5: Which of the following establishes the national standards to protect individuals’ medical records and other individually identifiable health information?
A. AHA Patient Care Partnership
B. Health Insurance Portability and Accountability Act
C. Advance Directive
D. AHA Bill of Rights
Correct Answer: B. Health Insurance Portability and Accountability Act
Protected health information (PHI) encompasses an individual’s medical records and other individually identifiable information related to the patient’s health care. This includes any health information generated or received by healthcare personnel which identifies the patient and relates to the patient’s past, present, or future mental and/or physical health condition, or financial component for health care services. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) sets national standards to protect the disclosure of such PHI.
6: Who can authorize the decision for alteration of patient extent of care, such as DNR?
A. The patient
B. A proxy
C. A designated surrogate
D. An attending provider
E. A, B, and C
Correct Answer: E. A, B, and C
While competent, a patient can designate a surrogate or proxy to make decisions on the patient’s behalf in situations where the patient becomes legally incompetent or lacks the capacity to make informed decisions for oneself. This is carried out through a document called a living will or advance health care directive. Additionally, a parent, designated surrogate or proxy can make decisions for minor patients regarding the minor’s health care.
7: The patient bill of rights outlines the patient’s rights and responsibilities, which include all of the following, except:
A. Withholding information from the provider relating to reason for treatment
B. Research participation
C. Access to information
D. Autonomy
Correct Answer: A. Withholding information from the provider relating to reason for treatment
The American Hospital Association (AHA) Patients’ Bill of Rights has been replaced with The Patient Care Partnership, informing patients of their rights and responsibilities pertaining to their medical care in the hospital setting. Patients have a right to high quality patient care, a clean and safe environment, involvement in their health care decisions including refusing treatment or services to the extent permitted by law, protection of privacy, and assistance with billing claims and transition of care. Additionally, patients have a right to receive response to inquiries related to their healthcare services, a right to be informed of who will provide their medical services, a right to be informed of available support services, a right to know what rules and regulations apply to the patient’s conduct, the right to participate in research studies, and a right to information including their diagnosis, course of treatment, knowledge of alternatives, risks, and prognosis.
The patient is responsible for providing healthcare personnel an accurate and complete information relative to all medical complaints, medications, illnesses, hospitalizations, and other information related to the patient’s healthcare which could alter the course of treatment. The patient is also responsible for reporting changes in their condition to their attending provider and must understand the planned course of action and what is expected of them throughout the duration of the treatment process.
8: A designated surrogate or proxy can exercise rights on the patient’s behalf in each of the following situations, except:
A. The patient is a minor
B. The patient lacks decision making capacity
C. The patient’s native language differs from the healthcare staff performing the examination
D. The patient is legally incompetent
Correct Answer: C. The patient’s native language differs from the healthcare staff performing the examination
While competent, a patient can designate a surrogate or proxy to make decisions on the patient’s behalf in situations where the patient becomes legally incompetent or lacks the capacity to make informed decisions for oneself. This is carried out through a document called a living will or advance health care directive. Additionally, a parent, designated surrogate or proxy can make decisions for minor patients regarding the minor’s health care. In the situation a patient’s native language differs from that of the healthcare personnel performing an examination, healthcare staff should ensure that a hospital-provided translator service is available. This allows the patient to be provided adequate information pertaining to the procedure so the patient may provide informed consent.
9: Which of the following is true regarding experimental research?
A. The patient has a right to be informed if medical treatment is for the purpose of experimental research
B. The patient must provide consent or refusal to participate in experimental research
C. Verbal or implied consent for experimental research is acceptable
D. A, B, and C
E. A and B
Correct answer: E. A and B
The patient’s bill of rights and responsibilities summarizes the rights of any patient receiving medical care, including patient rights relative to experimental research. A patient has the right to be informed if medical treatment is for the purposes of experimental research and must provide written consent, which is documented in the patient’s chart if the patient chooses to participate in any experimental study. The patient also has the right to refuse medical treatment for the purposes of experimental research.
10: In keeping with standards set forth by The Joint Commission, all of the following must be documented on the patient’s permanent health record, except:
A. Diagnostic and therapeutic reports.
B. Identifying patient information.
C. Consent forms.
D. Patient’s method of payment for medical services.
Correct answer: D. Patient’s method of payment for medical services.
The Joint Commission which accredits healthcare institutions throughout the United States outlines standards for medical record keeping, noting that patient identification information, diagnostic and therapeutic reports, and consent forms must be kept on file in the patient’s permanent record to ensure a high level of care and communication between health care providers.
11: A requisition is necessary to perform a radiographic examination and the order must be relative to the clinical indication. Who is authorized to write an order for a radiographic examination?
A. A physician
B. A nurse
C. A radiographer
D. A, B, and C
Correct answer: A. A physician
A medical doctor with valid credentials is authorized to order a radiographic examination. While a medical assistant, nurse, or radiographer can take a temporary verbal order from an attending physician, or the physician may appoint a nurse to sign an order, it is still the legal responsibility of the physician to ensure the patient’s safety and care. The requisition must include the patient’s full name, requisition date, the full name of the ordering physician, the region or part to be imaged, and a confirmed or suspected diagnosis or diagnosis code.
12: An infliction of physical harm or offensive touching in the medical setting is termed:
A. Medical battery
B. Nonmaleficence
C. Tort
D. Malpractice
Correct answer: A. Medical battery
The infliction of harm which results in injury, or an offensive touching which insults an individual’s dignity, is termed battery. When these actions occur in the medical setting, the terminology medical battery is used.
13: A radiographer is transporting a patient from the patient’s room to the imaging department. The radiographer does not ensure that the bed rails are up during patient transport and the patient falls from the bed while the bed is in motion. This would be considered:
A. Nonmaleficence
B. Malpractice
C. Negligence
D. Beneficence
Correct Answer: C. Negligence
An unintentional misconduct, termed negligence, involves injury sustained because of misperformance by a reasonably credentialed healthcare professional. Examples may include failure to assess patient identifiers and radiographing the incorrect patient, failure to assess possibility of pregnancy and exposing a pregnant patient to ionizing radiation, or a weak patient sustaining a fall while left unsecured and unattended (i.e., on a stretcher without guard rails up or on an x-ray table).
14: Four elements must be present for negligent tort liability. Which of the following is not one of these four elements?
A. Function
B. Breach
C. Duty
D. Injury sustained
Correct Answer: A. Function
Negligence involves a combination of elements, including (1) duty of the healthcare professional to ensure patient safety, (2) breach, which is a deviation from such duty, (3) injury sustained by the party who was harmed, and (4) cause, which is the result of the breach of duty. Negligence is an unintentional misconduct which involves injury sustained because of misperformance by a reasonably credentialed healthcare professional. Examples may include failure to assess patient identifiers and radiographing the incorrect patient, failure to assess possibility of pregnancy and exposing a pregnant patient to ionizing radiation, or a weak patient sustaining a fall while left unsecured and unattended (i.e., on a stretcher without guard rails up or on an x-ray table).
15: The ethical principle which pertains to actions carried out by healthcare personnel for the patient’s benefit is:
A. Veracity
B. Beneficence
C. Nonmaleficence
D. Autonomy
Correct answer: B. Beneficence
Ethical principles relative to healthcare include beneficence, nonmaleficence, autonomy, justice, veracity, and fidelity. Healthcare personnel have an ethical obligation to avoid or reduce the probability of harm, respect the patient and their values, and to carry out tasks to the patient’s benefit. Beneficence describes the obligation of healthcare staff to act in the best interests of the patient by minimizing patient risk.
16: Which legal doctrine implies, “the thing speaks for itself”?
A. Habeas corpus
B. Res ipsa loquitur
C. Respondeat superior
D. Nonmaleficence
Correct Answer: B. Res ipsa loquitur
Res ipsa loquitur is a legal doctrine relative to negligence, meaning, “the thing speaks for itself”. In tort litigation, res ipsa loquitur infers blatant negligence imparted by a member of healthcare staff involving circumstantial evidence of undue accident or injury.
17: All of the following are immobilization devices intended to reduce or eliminate motion artifact on radiograph, except:
A. Foam wedge
B. Pigg-o-stat™
C. Sandbag
D. Columbus board
Correct answer: A. Foam wedge
The foam wedge is a positioning aid. Comparatively, the Pigg-o-stat™, sandbag, and Columbus board are immobilization devices intended to temporarily restrain an anatomic part for the reduction or elimination of radiographic motion artifact.
18: A graphic representation which demonstrates pixel value distribution is called a:
A. Histogram
B. Processing algorithm
C. Voxel
D. Matrix
Correct Answer: A. Histogram
A histogram is a graphic representation of pixel value distribution generated by a computed radiography (CR) laser scanner. The histogram can vary in appearance based on SID, OID, collimation, changes in scatter, and selected processing algorithm. The processing algorithm selected should match the examination being performed (i.e., lumbar spine, abdomen, hand).
19: Which ARRT governing document articulates the behavior expected of radiologic technologists and describes nontolerable behaviors?
A. ARRT Standards of Ethics
B. ARRT Rules and Regulations
C. ARRT Bylaws
D. ARRT Code of Ethics
Correct Answer: A. ARRT Standards of Ethics
The ARRT Standards of Ethics is one of ARRT’s governing documents which outlines expected behavior for R.T.s. The ARRT Standards of Ethics encompasses the Rules and Code of Ethics, which should be reassessed each year by R.T.s to ensure compliance.
20: The patient’s chart can serve as a method of communication between multiple healthcare providers. A radiographer would expect to find all of the following within a patient’s chart, except:
A. Therapeutic reports
B. The patient’s gender identity
C. Patient identifying information
D. Consent forms
Correct answer: B. The patient’s gender identity
Communication is a key aspect of healthcare, and a fluid communication and trade off between healthcare personnel allows for the patient to receive a high level of patient care. A patient chart or electronic health record can serve as a method of communication between multiple healthcare providers and may include information such as a patient’s medical history including recent lab work or medical imaging examinations, identifying patient information, therapeutic and diagnostic reports, and consent forms. A patient’s assigned (biologic) sex would fall under the scope of patient identifying information; personal sense of gender identity differs from assigned (biologic) sex.
21: Which method of communication involves a firm, but calm, expression of words and mannerisms often necessary when interacting with a patient who is reluctant?
A. Assertiveness
B. Meta-communication
C. Bargaining
D. Empathy
Correct answer: A. Assertiveness
Assertiveness is a direct form of verbal communication in which an individual is both firm and honest, without being ill-mannered. This form of communication is productive in the scenario of a reluctant patient and can both decrease conflict and enhance working relationships between healthcare staff.
22: All of the following present challenges in communication between healthcare personnel and the patient, except:
A. Altered state of consciousness
B. Cultural differences
C. Understanding of medical terminology
D. Mundane situations
Correct answer: D. Mundane situations
It is not uncommon for healthcare providers to be presented with challenges in communication between themselves and patients who are in their care. Some challenges in communication are related to patient characteristics, the need to explain medical terminology, and implementation of strategies to ensure the patient understands the nature of their care. Some challenges that fall under the scope of patient characteristics include a difference in age, cultural or socioeconomic status, language, physical and mental status such as altered state of consciousness, and impairment of vision, speech, or hearing. Additionally, stressful or critical situations can present challenges in communication.
23: The radiographer can ensure patient understanding by:
A. Explaining the procedure and patient expectations
B. Permitting the patient to ask questions and responding to patient inquiries
C. Asking the patient to verify their requisition
D. A and B
E. A, B, and C
Correct answer: D. A and B
While asking the patient to verify their requisition will allow the patient to read the name of the examination ordered by their provider and ensure that their identifying information is correct, this would not ensure patient understanding of the nature of the examination. It is the responsibility of the technologist to thoroughly explain what the procedure entails and the patient expectations which must be followed to carry out the examination. The technologist should also permit the patient to ask questions for clarification and respond to any patient inquiries.
24: During explanation of a procedure, the radiographer should:
A. Describe how the patient can assist in completing the procedure
B. Ensure that dietary restrictions necessary for the procedure were followed
C. Disclose the length of the procedure
D. A and C
E. A, B, and C
Correct answer: E. A, B, and C
Part of preparing a patient for a procedure involves taking a patient history along with relaying examination expectations of the patient. The radiographer should ensure that dietary restrictions were followed along with explanation of the procedure.
25: It is within the radiographer’s scope of practice to educate patients on which of the following?
A. Procedural length of time
B. Expected radiation dose
C. Use of laxatives and cleansing enemas
D. Diagnosis
E. A, B, and C
Correct answer: E. A, B, and C
It is not within the radiographer’s scope of practice to provide the patient a diagnosis, this is the responsibility of the radiologist or patient’s attending provider. The radiographer may educate the patient of the nature of the procedure to be performed or respond to inquiries about other health care related services (i.e., basic concepts of computed tomography, sonography, etc.). Procedural explanation may include patient prep such as use of a laxative or cleansing enema, dietary restrictions, procedural length and what is required of the patient during the examination.
26: What information about post-examination care and expectations should be provided to a patient by the technologist for the days following their imaging procedure?
A. Use a laxative or enema kit to empty the colon post-procedure
B. Temporarily discontinue use of anticoagulation medication for up to 3 days following their procedure
C. Nothing to eat or drink for 8 hours following their procedure
D. For up to 3 days it is not uncommon for stool to appear white
Correct answer: D. For up to 3 days it is not uncommon for stool to appear white
When a barium sulfate contrast medium is used for a radiographic or fluoroscopic examination, it is insoluble by water and scantly absorbed by the body. Therefore, it will be expelled from the gastrointestinal tract much like it was administered, and the patient’s stool may appear white or lighter in color. The radiographer should inform the patient of this and explain the importance of hydration to reduce side effects such as constipation. The patient should also be aware of risk factors associated with the use of barium and when to call their provider (i.e., severe abdominal pain, difficulty or lack of bowel movement). Pre-examination instructions may include temporary discontinuation of anticoagulation medication before a biopsy or interventional procedure, use of a laxative as a preparation for a procedure (i.e., contrast enema), or remaining NPO for a gastrointestinal study.
27: Which of the following describes improper body mechanics?
A. Using a wide base of support during a patient transfer
B. Bending at the knees to pick up a box of supplies
C. Holding a box of supplies close to the trunk while carrying it to the department
D. Twisting the trunk while lifting a patient
Correct answer: D. Twisting the trunk while lifting a patient
The radiographer should avoid bending or twisting the trunk while lifting or carrying an object or patient to decrease the potential of musculoskeletal injury. A wide base of support with one foot slightly in front of the other offers stability. Weight should be held close to the trunk, the radiographer should avoid reaching, and bending at the knees versus the back can reduce the incidence of low back injury.
28: A radiographer is asked to assist with a patient transfer. Which transfer technique would reduce the risk for musculoskeletal strain or injury?
A. Keeping the back straight while log rolling a patient with spinal injury
B. Leaving the wheelchair unlocked for ease of movement
C. Using a narrow base of support to lift a patient from wheelchair to the exam table
D. Keeping the feet together while pulling a patient on a slide board
Correct answer: A. Keeping the back straight while log rolling a patient with spinal injury
The radiographer should keep their back straight and avoid bending or twisting the torso while lifting or carrying an object or patient to decrease the potential of musculoskeletal injury. A wide base of support with one foot slightly in front of the other offers stability. Weight should be held close to the trunk, the radiographer should avoid reaching, and bending at the knees versus the back can reduce the incidence of low back injury.
29: Each of the following are considered patient transport or ancillary equipment, except:
A. Slide board
B. Stretcher
C. Bucky
D. Gait belt
Correct answer: C. Bucky
Equipment used for safe patient transport includes wheelchairs with locking capability, stretchers with side rails up, straps and gait belts, slide boards, and step stools with rubber feet or locking wheels. A bucky is a component of the X-ray equipment
30: It may be necessary for a radiographer to care for a patient with medical equipment. Which medical equipment involves the use of weights which apply a mechanical pulling on an anatomic part?
A. Swan-Ganz catheters
B. Tracheostomy
C. Sphygmomanometer
D. Orthopedic traction
Correct answer: D. Orthopedic traction
The radiographer may encounter patients who require a variety of medical equipment, like tracheotomies, tracheostomies, nasoenteric or nasogastric (NG) tubes, closed chest drainage, Swan-Ganz catheters, nasal or urinary catheters, oxygen mask or cannulas, or orthopedic traction. The radiographer should understand how to care for such patients and be aware of what each type of medical equipment is used for. For instance, orthopedic traction involves the use of weights which mechanically pull on an anatomic part (e.g., used for long bones, spinal injuries).
31: Many types of equipment are used for routine patient monitoring. Which type of equipment measures a patient’s blood pressure?
A. Thermometer
B. Stethoscope
C. Holter monitor
D. Sphygmomanometer
Correct Answer: D. Sphygmomanometer
A sphygmomanometer is a device used to measure a patient’s blood pressure. This is a basic component of routine patient monitoring. The normal systolic pressure in an adult ranges between 110 to 140 millimeters of mercury (mmHg) and the normal diastolic range is between 60 to 80 mmHg.
32: Body temperature greater than 105.8° Fahrenheit is called:
A. Hypothermia
B. Euphemia
C. Pyrexia
D. Hyperpyrexia
Correct answer: D. Hyperpyrexia
The normal adult oral temperature is 98.6° Fahrenheit (F). A temperature <96.8° F is termed hypothermia, between 98.6-105.8° F is pyrexia, and >105.8° F is hyperpyrexia. Hyperpyrexia is life-threatening.
33: Which type of paralysis often results from a stroke, affecting motor control on one-half of the body?
A. Paraplegia
B. Hemiplegia
C. Biplegia
D. Quadriplegia
Correct answer: B. Hemiplegia
Trauma to the lower spinal column can result in paraplegia involving loss of motor control inferior to the waist. Damage to the cervical spinal level can result in loss of motor control inferior to the neck, termed quadriplegia. Hemiplegia is affliction of unilateral motor control, often a result of a stroke.
34: Which medical emergency does radiographers most commonly encounter?
A. Petite mal seizure
B. Syncope
C. Hypoglycemia
D. Epistaxis
Correct answer: B. Syncope
One of the most common medical emergencies experienced by imaging technologists is patient falls resulting from syncope. The results from a decrease of oxygenated blood perfusing the brain. The radiographer can prevent falls associated with syncope by ensuring the patient is in a secure position while reviewing images (i.e., lying flat on the X-ray table, in stretcher with side rails up).
35: Which of the following is associated with a contrast reaction?
A. Hypotension
B. Tachycardia
C. Pallor
D. Dyspnea
E. All of the above
Correct Answer: E. All of the above
A contrast reaction can exhibit a variety of symptoms, depending on if the reaction is mild, moderate, or severe. These include a decrease in blood pressure, itching, vomiting, sneezing, pallor or flushing, shortness of breath, convulsions, increased pulse rate, anxiousness, weakness, vasovagal response, shock, cool and clammy skin, and cardiac or respiratory arrest. All patient reactions should be documented in the patient’s chart.
36: If the patient exhibits cardiac or respiratory arrest while in the radiographer’s care, the radiographer should:
A. Assess patient respiration
B. Assess patient circulation
C. Signal for an AED
D. A and C
E. A, B, and C
Correct answer: E. A, B, and C
In as short as 3 to 5 minutes, deoxygenation can cause irreversible brain damage. It is essential the radiographer be skilled in CPR/BLS techniques while working in the healthcare setting. A patient who is in respiratory or cardiac arrest should be assessed for a clear airway, breathing, and adequate circulation. A single rescuer should signal for help and an AED for every patient, requiring 80 to 100 compressions per minute for a single rescuer technique, with 2 ventilations for every 30 compressions.
37: An environment in which a pathogenic organism can live and multiply is termed a:
A. Fomite
B. Aqueduct
C. Reservoir
D. Vector
Correct answer: C. Reservoir
A bacterial or viral pathogenic organism must live and multiply in an environment, termed a reservoir. This reservoir can be any susceptible host, like a human, animal, or body of water. An animal which acts as a host is termed a vector, whereas an object which comes in direct contact with a pathogenic organism (i.e., medical equipment), is called a fomite.
38: Which of the following is considered a direct mode of transmission?
A. Contaminated dust
B. Mosquito
C. Contaminated droplets
D. Needlestick injury
Correct answer: D. Needlestick injury
With a needlestick injury, a blood-borne pathogen from a reservoir comes in direct contact with susceptible tissues (i.e., blood of the susceptible host). Other examples of direct contact infections include streptococcic and staphylococcic infections.
39: Which of the following diseases is likely to be caused by an indirect mode of transmission?
A. Hepatitis-B virus
B. Staphylococcus infection
C. Malaria
D. Streptococcus infection
Correct answer: C. Malaria
Malaria is a disease which is commonly spread by way of a vector, such as a mosquito. Infectious organisms develop within a vector, before the vector spreads the infectious organism to a new host.
40: The cycle of infection can be disrupted by:
A. Handwashing
B. Correctly using personal protective equipment
C. Vaccinations
D. A and C
E. A, B, and C
Correct Answer: E. A, B, and C
The chain of infection consists of the infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and 1 the susceptible host. There are multiple opportunities for the cycle of infection to be disrupted and thus prevent the spread of the infectious agent. Examples include decreasing susceptibility of the host, such as ensuring immunizations are up to date, sterilizing equipment or use of pest control services to break the chain at reservoir-level, and use of personal protective equipment (PPE) and hand hygiene to break the chain at portal of exit or portal of entry
41: When scrubbing in for a sterile procedure, how long is handwashing required?
A. 2 minutes
B. 1 minute
C. 5 minutes
D. 20 seconds
Correct Answer: C. 5 minutes
Disinfection and sterilization in the healthcare setting can prevent the spread of nosocomial (hospital-acquired) infection. Handwashing should be performed before and after every imaging procedure and the technologist should wash their hands for a minimum of 20 full seconds. When scrubbing in for a sterile procedure, the time requirement for handwashing is 5 minutes.
42: When preparing a sterile tray for a procedure, which of the following is appropriate?
A. The first flap of the sterile pack is opened away from the technologist
B. The first flap of the sterile pack is opened toward the technologist
C. The technologist should refrain from reaching across the sterile tray
D. B and C
E. A and C
Correct answer: E. A and C
To prepare a sterile tray for a procedure, the first flap of the sterile pack should be opened away from the technologist, and the technologist should refrain from reaching over or touching the inner contents of the sterile pack to reduce contamination.
43: Which type of transmission-based precaution would involve the need for respiratory protection and negative ventilation?
A. Droplet precaution
B. Contact precaution
C. Airborne precaution
D. Enteric precaution
Correct Answer: C. Airborne precaution
Airborne precaution is recommended to prevent the spread of infection through miniscule particles which are smaller than droplets. This may necessitate use of a mask and negative ventilation, such as to prevent the spread of tuberculosis.
44: The best method to avoid the spread of microorganisms is:
A. Proper use of personal protective equipment
B. Maintaining a healthy diet
C. Remaining current on immunizations
D. Correct hand hygiene
Correct Answer: D. Correct hand hygiene
While proper use of personal protective equipment and remaining current on immunizations can interrupt the chain of infection, it is not the best method to prevent the spread of microorganisms; immunizations do not protect against every bacterium or virus. A crucial component of medical asepsis and the best practice to prevent nosocomial infection is handwashing before and after every procedure for a minimum of 20 seconds using soapy running water.
45: Federal regulations set forth by the Occupational Safety and Health Administration (OSHA) mandate that healthcare institutions:
A. Provide hepatitis B immunizations at no cost to healthcare personnel who may be exposed to blood or bodily fluids
B. Ensure readily accessible personal protective equipment for employees
C. Enforce the use of standard precautions
D. Provide follow-up care to staff exposed to a needlestick injury
E. All of the above
Correct answer: E. All of the above
OSHA has developed a set of guidelines and regulations for healthcare organizations, mandating, under penalty of law, that healthcare personnel have access to personal protective equipment, hepatitis B immunizations, and follow-up care if inadvertently exposed to blood and bodily fluid-borne pathogens (i.e., needlestick injury). Additionally, healthcare organizations must provide impermeable puncture-proof containers for the storage and transport of dirty needles and syringes and must enforce standard and transmission-based precautions.
46: Which of the following is an appropriate way to dispose of or handle contaminated materials?
A. A used needle is inserted into a sharps container syringe-end first
B. Recapping sharps before disposal in a puncture-proof container
C. Placing soiled linens in an impermeable water-proof bag
D. Disinfection of bedpans before reusing for another patient
Correct answer: C. Placing soiled linens in an impermeable water-proof bag
While sharps should be disposed of in a puncture-proof container, they should never be recapped to avoid needlestick injuries. All used needles should be discarded into a puncture-proof container needle-end first. If urinals or bedpans are reused, the should be appropriately sterilized to destroy the presence of all microorganisms. Disinfection will reduce, but not eliminate all microorganisms.
47: An “IV push” describes a(n):
A. Infiltration
B. Infusion
C. Bolus
D. Drip
Correct Answer: C. Bolus
A bolus injection is the term used for an intravenous push of a large quantity of contrast media or medication. Upon administration of a bolus, the patient should be monitored closely, and administration is stopped immediately in the scenario of adverse reactions (i.e., cardiac or respiratory arrest).
48: Which of the following is true regarding safe handling and disposal of toxic or hazardous materials?
A. Employees should be trained on proper handling of such materials to minimize exposure risk
B. It is acceptable to discard hazardous liquid waste down a sink drain
C. Standard operating procedures must be in place for safe use of chemical agents
D. A and C
E. A, B, and C
Correct Answer: D. A and C
Healthcare personnel may be required to handle toxic or hazardous materials (i.e., chemotherapy drug agents, chemical sterilants) and should be trained on safe handling practices to avoid exposure risk. Healthcare organizations must have standard operating procedures in place for safe use of chemical agents, such as where chemical agents may be safely discarded. Hazardous agents should be disposed of in authorized waste disposal containers, in compliance with local, state, and federal regulations.
49: Why is proper and complete medical documentation necessary?
A. Establishes a patient history
B. Prevents potential allergic reactions (i.e., to contrast media)
C. Decreases workload for the radiologist
D. A, B, and C
E. A and B
Correct answer: E. A and B
Part of the radiographer’s responsibilities involves complete and proper documentation for all procedures, especially those which involve starting an intravenous line and contrast administration. Documentation is required regardless of patient reaction; it establishes a patient history and notifies technologists of the likelihood of future allergic reactions. While a patient history is beneficial for the radiologist, it does not necessarily decrease the radiologist’s workload.
50: Which of the following may be administered to a patient experiencing a moderate reaction to contrast media?
A. Emetic agent
B. Pseudoephedrine
C. Beta blocker
D. Antihistamine
Correct answer: D. Antihistamine
A contrast reaction can exhibit a variety of symptoms, depending on if the reaction is mild, moderate, or severe. These include a decrease in blood pressure, itching, vomiting, sneezing, pallor or flushing, shortness of breath, convulsions, increased pulse rate, anxiousness, weakness, vasovagal response, shock, cool and clammy skin, and cardiac or respiratory arrest. All patient reactions should be documented in the patient’s chart. Administration of an antihistamine medication is used to control a bodily response to a moderate adverse reaction to contrast media.
51: Which medication may be administered prior to an IV bolus of iodinated contrast media to reduce the likelihood of a systemic adverse effect?
A. Diphenhydramine hydrochloride (Benadryl)
B. Propofol
C. Heparin
D. A and B
E. A, B, and C
Correct answer: A. Diphenhydramine hydrochloride (Benadryl)
Diphenhydramine hydrochloride (Benadryl) is an antihistamine, which is a type of medication used to control the effects of a mild to moderate allergic reaction (i.e., to contrast media). A patient with a known allergy to iodinated contrast may be premedicated with an antihistamine prior to the examination; this medication can also be kept on hand within the imaging department for administration following the onset of an adverse systemic reaction.
52: Part of the radiographer’s responsibilities include interdepartmental communication with other imaging modalities to ensure correct imaging sequence for a patient with multiple ordered exams. Which of the following imaging sequences would be appropriate for optimal exam diagnosticity?
A. Abdominal ultrasound, lower GI series, barium swallow
B. Barium swallow, lower GI series, abdominal CT
C. Abdominal CT, upper GI series, abdominal ultrasound
D. Abdominal CT, barium swallow, lower GI series
Correct Answer: B. Barium swallow, lower GI series, abdominal CT
Examinations which require administration of contrast media should be performed following an adjunctive examination in the same region, to reduce interference and obscuring of pertinent anatomy by the contrast. Performing an abdominal ultrasound, lower GI series, then barium swallow would be the most appropriate sequence of the given choices; the lower GI series is unlikely to interfere with anatomy in the region assessed during a barium swallow.
53: Which contrast administration route is used to demonstrate the upper digestive tract?
A. Oral
B. Intravenous
C. Rectal
D. A and C
Correct Answer: A. Oral
Oral administration of imaging contrast (i.e., barium sulfate) aids in demonstration of the upper digestive tract, including the esophagus, stomach, and small intestine. The lower digestive tract (i.e., colon) is visualized via rectal administration of contrast material.
54: Which of the following may be administered to prepare for a barium enema examination?
A. Anticholinergic
B. Diuretic
C. Cathartic
D. Emetic
Correct answer: C. Cathartic
A cathartic is a class of medication which promotes defecation (i.e., laxatives, purgatives). These can be in the form of stimulants, bulk formers, emollients, and so forth. Cleansing of the colon is a preparatory step before rectal contrast administration.
55: Radiographic demonstration of urinary function involving the kidneys, ureters, and bladder involves administration of contrast agents through which parenteral route?
A. Intravenous
B. Intramuscular
C. Subcutaneous
D. Intrathecal
Correct answer: A. Intravenous
An intravenous pyelogram (IVP), also called intravenous urogram, is a radiographic examination involving an intravenous injection of contrast material to assess the urinary system, including the kidneys, ureters, and bladder. This examination assesses the function of the urinary system.
56: Which of the following would be considered when calculating contrast media dose and concentration?
A. Patient body weight
B. Renal function
C. Patient hydration
D. A and C
E. A, B, and C
Correct Answer: E. A, B, and C
When calculating contrast media dose and concentration for administration, the patient’s renal function and body weight should be considered. Assessing the patient’s renal lab work (i.e., serum creatinine, GFR) can provide crucial information pertaining to renal status and the probability of contrast-associated acute kidney injury (CA-AKI). The patient’s hydration status (i.e., isotonic volume expansion) is also relative to administration of contrast. When prophylaxis is warranted, volume expansion may be fixed or weight-based and process of saline administration generally starts one hour prior to and between 3- and 12-hours following administration of an intravenous contrast media. Increased length of hydration time has proven to decrease the risk of CA-AKI when contrast media is necessary for an examination.
57: Which of the following is an iodinated contrast media?
A. Iothalamate (Conray and Cysto-Conray™)
B. Barium sulfate (E-Z-Paque, Entero Vu, Liquid Polibar)
C. Iopamidol (Isovue®)
D. A and C
E. A, B, and C
Correct answer: D. A and C
Iodinated contrast media is a drug which contains iodine and can be administered through numerous routes (i.e., intravenously, intrathecally, intraarterially, intraabdominally). Many types of iodinated contrast media exist for a variety of radiographic examinations. Iodinated contrast media is absorbed and excreted by the body.
58: Water-soluble contrast media is preferred for use in all of the following situations, except:
A. A patient with previous history of colon obstruction
B. Upper GI on a patient who recently underwent bariatric surgery
C. Upper GI immediately preceding an endoscopy
D. Upper GI with small bowel follow through on a patient with potential bowel perforation
Correct answer: A. A patient with previous history of colon obstruction
A non-ionic, low-osmolar water-soluble contrast is preferred when a perforation or potential for extravasation is suspected. It is also preferred if the patient has suspected gastric outlet or intestinal obstruction, immediately following bariatric surgery, or an endoscopic examination is scheduled to follow the contrast examination. Use of a water-soluble contrast reduces the risk of associated complications, should contrast extravasate into the pleural space, mediastinum, or peritoneal space. A transparent contrast medium also allows the gastroenterologist performing an endoscopy optimal visualization of the gastrointestinal tract. Prior history of colon obstruction does not negate the use of non-water-soluble contrast media for future examinations once the obstruction has been resolved.
59: A barium-sulfate compound contrast media can be used to assess which of the following?
A. Esophageal function
B. Stricture of the upper digestive tract
C. Lower gastrointestinal tract ulceration
D. A and B
E. A, B, and C
Correct Answer: E. A, B and C
Barium-sulfate (BaSO4) is a water-insoluble contrast medium which is minimally absorbed by the body; it lacks toxicity, is a high X-ray attenuator, and because it is minimally absorbed, this makes it a preferred contrast media for gastrointestinal examinations. A pitfall to use of barium is its potential to cause peritonitis in the scenario it is introduced to the peritoneal space. Therefore, when bowel perforation is suspected, a non-ionic, low-osmolar water-soluble contrast is preferred.
60: Which of the following is an ionic contrast media?
A. Iothalamate (Cysto-Conray®)
B. Iohexol (Omnipaque®)
C. Iopamidol (Isovue®)
D. Barium sulfate (Liquid Polibar)
Correct answer: A. Iothalamate (Cysto-Conray®)
Cysto-Conray™ is an iodinated contrast media with an osmolality of -400. This contrast is specifically manufactured for retrograde cystography and cystourethrography. Osmolality of a contrast medium and molecular size and complexity plays a role in the likelihood a contrast reaction will occur. Low-osmolality, nonionic monomers generate lower levels of bodily histamine release from mast cells and basophils, and thus exhibit decreased probability of contrast reaction following administration.
61: A bowel perforation in the upper gastrointestinal tract is suspected in a pediatric patient with renal impairment. Which contrast media would be most appropriate to use in this setting?
A. Low osmolality iodinated contrast
B. Barium sulfate
C. High osmolality iodinated contrast
D. B and C
E. A, B, and C
Correct answer: A. Low osmolality iodinated contrast
Barium-sulfate (BaSO4) is a nontoxic, water-insoluble contrast medium which is minimally absorbed by the body, making it a preferred contrast media for gastrointestinal (GI) examinations; however, it has the potential to cause peritonitis in the scenario it is introduced to the peritoneal space. When GI tract perforation is suspected, an iodinated contrast agent is preferred. Hyperosmolality iodinated contrast agents can cause fluid shifts (i.e., between bowel wall and lumen and between extravascular soft tissues and vasculature). Neonates, very low birthweight (VLBW) infants, and pediatric patients with cardiac conditions and renal disease are more susceptible to fluid shifts related to high osmolality iodinated contrast. In this patient population, low- or iso-osmolality contrast agents are preferred when imaging the upper GI tract.
62: Prior to administration of contrast media, the patient’s age, weight, and laboratory values should be reviewed. All of the following situations places the patient at greater risk for gastrointestinal fluid shift following oral or rectal administration of iodinated contrast media, except:
A. Neonate with cardiac impairment
B. Congenital adrenal hyperplasia
C. Gastrointestinal perforation
D. Very low birth weight (VLBW) infants
E. Pediatric patient with poor renal function
Correct Answer: C. Gastrointestinal perforation
When GI tract perforation is suspected, an iodinated contrast agent is preferred over barium-sulfate to reduce the risk of peritonitis. Hyperosmolarity iodinated contrast agents can cause fluid shifts (i.e., between bowel wall and lumen, and between extravascular soft tissues and vasculature). Neonates, very low birthweight (VLBW) infants, and pediatric patients with cardiac conditions and renal disease are more susceptible to fluid shifts related to high osmolarity iodinated contrast.
63: A patient is scheduled for a radiographic examination involving use of iodinated intravenous contrast media. During the examination, the contrast media leaks from the vein into the surrounding tissues. This is termed:
A. Extravasation
B. Phlebitis
C. Intravasation
D. Defiltration
Correct Answer: A. Extravasation
Extravasation is the leakage of contrast media from the vein into the surrounding tissues. When injected material diffuses into the adjacent tissues this is called infiltration.
64: Which systemic contrast media reaction is considered mild?
A. Urticaria
B. Dyspnea
C. Bradycardia
D. Wheezing
Correct Answer: A. Urticaria
Mild adverse reactions to contrast media may display in the form of itching, flushing of the skin, or hives (urticaria). Moderate and severe reactions range from sneezing and wheezing to acute bronchospasm, laryngeal edema, and hypovolemic shock.
65: Which of the following would not be found in a crash cart?
A. Epinephrine
B. Contrast media
C. Bag valve mask
D. Defibrillator
Correct answer: B. Contrast media
A crash cart is a cart which contains a variety of equipment and medications necessary for rapid treatment of a patient experiencing a medical emergency. Crash carts are tailored to the setting or department in which they are located (i.e., in the radiology department would contain equipment necessary to treat an adverse reaction to radiographic contrast media). Crash carts generally contain basic airway and intravenous access equipment, a defibrillator, and medications used to treat allergic reactions, cardiac dysrhythmias, and arrest.
66: Which type of adverse contrast reaction should be documented in the patient’s electronic medical record?
A. Mild reaction
B. Moderate reaction
C. Severe reaction
D. B and C
E. A, B, and C
Correct answer: E. A, B, and C
The radiographer must document all adverse reactions related to administration of contrast media in the patient’s chart, regardless of severity. This may include symptoms as mild as hives or as severe as laryngeal edema.
