Patient Care Review Notes for Radiography Exam PDF

Review Notes for the RADIOGRAPHY EXAM Appelton Chapter 1: Patient Care (150 Q & Ans.) 1. The legal doctrine res ipsa locquitur means which of the following? (A) Let the master answer. (B) The thing speaks for itself. (...

Review Notes for the RADIOGRAPHY EXAM Appelton Chapter 1: Patient Care (150 Q & Ans.) 1. The legal doctrine res ipsa locquitur means which of the following? (A) Let the master answer. (B) The thing speaks for itself. (C) A thing or matter settled by justice. (D) A matter settled by precedent. ————————————————————————— The legal doctrine; Res ipsa locquitur relates to a thing or matter that speaks for itself. o For instance, if a patient went into the hospital to have a kidney stone removed and ended up with an appendectomy, that speaks for itself, and negligence can be proven. Respondeat superior is the phase meaning "let the master answer" or "the one ruling is responsible." o If a radiographer was negligent, there may be an attempt to prove that the radiologist was responsible, because the radiologist oversees the radiographer. Res judicata means a thing or matter settled by justice. Stare decisis refers to a matter settled by precedent. (Gurley & Callaway, p 194) Ans B 2. When reviewing patient blood chemistry levels, what is considered the normal creatinine range? (A) 0.6 to 1.5 mg/100 mL (B) 4.5 to 6 mg/100 mL (C) 8 to 25 mg/100 mL (D) Up to 50 mg/100 mL ————————————————————————— Creatinine is a normal alkaline constituent of urine and blood, but increased quantities of creatinine are present in advanced stages of renal disease.  Creatinine and BUN blood chemistry levels should be checked prior to beginning an intravenous pyelogram.  Increased levels may forecast an increased possibility of contrast-media induced renal effects and poor visualization of the renal collecting systems. o The normal Creatinine range is 0.6 to 1.5 mg/100 mL. o The normal BUN range is 8 to 25 mg/100 mL. (Ballinger & Frank, vol 2, p 126) Ans. A 3. The condition of slow heart rate, below 60 beats per minute (bpm), is termed (A) hyperthermia. (B) hypotension. (C) hypoxia. (D) bradycardia. —————————————————————————  The condition in which a patient's heart rate slows to below 60 bpm is Bradycardia.  Hyperthermia is the condition in which the patient's temperature is well above the normal average range (97.7 to 99.5ºF).  Hypotension occurs if the blood pressure drops below the normal ranges (110 to 140/60 to ).  Hypoxia is a condition in which there is decreased oxygen supply to body tissues. Reviewer A&R Question & Answer 1 Review Notes for the RADIOGRAPHY EXAM Appelton (Adler & Carlton, p 181) Ans. D 4. During a grand mal seizure, the patient should be (A) protected from injury. (B) placed in a semiupright position to prevent aspiration of vomitus. (C) allowed to thrash freely. (D) given a sedative to reduce jerky body movements and reduce the possibility of injury. ————————————————————————— When a patient is experiencing a seizure, he or she should be protected from striking any hard surfaces or falling. The patient exhibits uncontrollable body movements. Any attempt to place the patient in a semierect position or to administer a sedative would prove futile. Following the seizure, it is important to place the patient on his or her side (to prevent aspiration of any vomitus or oral secretions). (Torres, p 167) Ans. A 5. Diseases whose mode of transmission is through the air include 1. tuberculosis. 2. mumps. 3. rubella. (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3 ————————————————————————— Diseases that are transmitted through the air include TB, rubella ("German measles"), mumps, and influenza.  Airborne precautions require the patient to wear a mask to avoid the spread of acid-fast bacilli (in the bronchial secretions of TB patients) 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 infected with diseases calling for airborne precautions require a private, specially ventilated (negative-pressure) room.  A private room is also indicated for all patients on droplet precautions, i.e., with diseases that are 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 the 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 must use gown and gloves. (Adler & Carlton, p 115) Ans. D 6. You have encountered a person who is apparently unconscious. Although you open his airway, Reviewer A&R Question & Answer 2 Review Notes for the RADIOGRAPHY EXAM Appelton there is no rise and fall of the chest, and you can hear no breath sounds. You should (A) begin mouth-to-mouth rescue breathing, giving two full breaths. (B) proceed with the Heimlich maneuver. (C) begin external chest compressions at a rate of 80 to 100 per minute. (D) begin external chest compressions at a rate of at least 100 per minute. ————————————————————————— The victim's airway should first be opened. This is accomplished by tilting back the head and lifting the chin. However, if the victim may have suffered a spinal cord injury, the spine should not be moved and the airway should be opened using the jaw-thrust method. The rescuer next listens for breathing sounds and watches for the rise and fall of the chest to indicate breathing. If there is no breathing, the rescuer pinches the victim's nose and delivers two full breaths via mouth-to-mouth rescue breathing. If rise and fall of the chest is still not present, the Heimlich maneuver is instituted. If ventilation does not take place during the two full breaths, the victim's circulation is checked next (using the carotid artery). If there is no pulse, external chest compressions are begun at a rate of 80 to 100/min for adults and at least 100/min for infants. (Taber's, pp 1868-1869) Ans. A 7. To reduce the back strain associated with transferring patients from stretcher to x-ray table, the radiographer should (A) pull the patient. (B) push the patient. (C) hold the patient away from his or her body and lift. (D) bend at the waist and pull. ————————————————————————— When transferring patients from stretcher to x-ray table, there are several rules that will reduce back strain. o Pull, do not push, the patient; pushing increases friction and makes the transfer more difficult. o Do not bend at the waist and pull; use your biceps for pulling the patient. o Draw the patient as close to you as possible and then lift if necessary. (Torres, p 74) Ans. A 8. The least toxic contrast medium listed below is (A) barium sulfate. (B) metrizamide. (C) ethiodized oil. (D) meglumine diatrizoate. ————————————————————————— The inert characteristics of barium sulfate render it the least toxic contrast medium. Iodinated contrast media are absorbed by the body, (whereas barium sulfate is not). Metrizamide, ethiodized oil, and meglumine diatrizoate are iodinated contrast media that could cause anaphylactic shock and death in the allergic patient. (Torres, p 200) Reviewer A&R Question & Answer 3 Review Notes for the RADIOGRAPHY EXAM Appelton Ans. A 9. An esophagogram might be requested for patients with which of the following esophageal disorders/symptoms? 1. Varices 2. Achalasia 3. Dysphasia (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3 ————————————————————————— 1.) Dilated twisted veins (Varices), of the esophagus are frequently associated with obstructive liver disease or cirrhosis of the liver. o These esophageal veins enlarge and can rupture, causing serious hemorrhage. 2.) Achalasia is dilation of the esophagus as a result of the cardiac sphincter's failure to relax and allow food to pass into the stomach. 3.) Dysphagia refers to difficulty swallowing and is the most common esophageal complaint. 4.) Hiatal hernia is another common esophageal problem; it is characterized by protrusion of a portion of the stomach through the cardiac sphincter.  It is a common condition, and many individuals with the condition are asymptomatic.  Each of these conditions of the esophagus may be evaluated with an esophagogram.  Positions usually include the posteroanterior, right anterior oblique, and right lateral.  Dysphasia is a speech impairment resulting from a brain lesion; it is unrelated to the esophagus. (Linn-Watson, pp 102, 107) Ans. B 10. Which of the following diastolic pressure readings might indicate hypertension? (A) 50 mmHg (B) 70 mmHg (C) 90 mmHg (D) 110 mmHg —————————————————————————  The diastolic number is the bottom number in a blood pressure reading.  The normal range for diastolic pressure is 60 to 90 mmHg. A diastolic pressure reading of 110 mmHg might indicate Hypertension. A diastolic pressure of 50 mmHg might indicate shock.  The systolic number is the top number in a blood pressure reading.  The normal systolic pressure range is 110 to 140 mmHg. (Torres, p 139) Ans. D 11. All of the following statements regarding osteoarthritis are true except (A) Osteoarthritis is a progressive disorder. (B) Osteoarthritis is an inflammatory disorder. (C) Osteoarthritis involves deterioration of the articular cartilage. (D) Osteoarthritis involves the formation of bony spurs. ————————————————————————— Reviewer A&R Question & Answer 4 Review Notes for the RADIOGRAPHY EXAM Appelton  Osteoarthritis is a progressive degenerative joint disorder characterized by deterioration of the articular cartilage. o Once the subchondral bone is exposed, friction between adjacent bone occurs, and new bone formation begins. o This bone tissue forms spurs, which get progressively larger and function to decrease joint space and restrict movement. Osteoarthritis is a noninflammatory disorder. Rheumatoid arthritis is an inflammatory disorder. (Tortora & Grabowski, p 267) Ans. B 12. Abnormal accumulation of air in pulmonary tissues, resulting in overdistention of the alveolar spaces, is (A) emphysema. (B) empyema. (C) pneumothorax. (D) pneumoconiosis. ————————————————————————— Overdistention of the alveoli with air is emphysema. o The condition is often a result of many years of smoking and is characterized by dyspnea, especially when recumbent. Empyema is pus in the thoracic cavity; Pneumothorax is air or gas in the pleural cavity. Pneumoconiosis is a condition of the lungs characterized by particulate matter having been deposited in lung tissue; it sometimes results in Emphysema. (Tortora & Grabowski, p 844) Ans. A 13. In which of the following situations should a radiographer wear protective eye gear (goggles)? 1. When performing an upper gastrointestinal radiography examination 2. When assisting the radiologist during an angiogram 3. When assisting the radiologist in a biopsy / aspiration procedure (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3 —————————————————————————  It is recommended that a radiographer wear protective eye gear (goggles) during any procedure in which there might be splattering of blood or body fluids. o This includes both angiography and biopsy / aspiration procedures. o This would not be expected during a routine upper gastrointestinal examination. (Torres, p 57) Ans. C 14. Possible side effects of an iodinated contrast medium that is administered intravenously include all of the following except (A) a warm feeling. (B) altered taste. (C) nausea. Reviewer A&R Question & Answer 5 Review Notes for the RADIOGRAPHY EXAM Appelton (D) hypotension. ————————————————————————— Nonionic, low-osmolality iodinated contrast agents are associated with far fewer side effects and reactions than ionic, higher-osmolality contrast agents. A side effect is an effect that is unintended but possibly expected and fundamentally not harmful. An adverse reaction is a harmful unintended effect. Possible side effects of iodinated contrast agents include 1.) a warm, flushed feeling, 2.) a metallic taste in the mouth, 3.) a nausea, headache, 4.) a pain at the injection site. Adverse reactions include a.) itching, b.) anxiety, c.) rash or hives, d.) vomiting, e.) sneezing, f.) dyspnea and g.) hypotension. (Adler & Carlton, p 328) Ans. D 15. A diabetic patient who is prepared for a fasting radiographic exam is susceptible to a hypoglycemic reaction. This is characterized by 1. shaking and nervousness. 2. cold, clammy skin. 3. cyanosis (A) 1 only (B) 2 only (C) 1 and 2 only (D) 1, 2, and 3 —————————————————————————  Hypoglycemic reactions can be very severe and should be treated with an immediate dose of sugar (e.g., in juice). o Early symptoms of an insulin reaction are a.) shaking, b.) nervousness, c.) dizziness, d.) cold and clammy skin,e.) blurred vision, and f.) slurred speech.  Convulsions and coma may result if the patient is not treated.  Cyanosis is the lack of oxygenated blood, which is a symptom of shock. (Torres, p 158) Ans. C 16. Nitroglycerin is used (A) to relieve pain from angina pectoris. (B) to prevent a heart attack. (C) as a vasoconstrictor. (D) to increase blood pressure. —————————————————————————  Angina pectoris is a crushing chest pain caused by acirculatory disturbance of the coronary arteries. o Nitroglycerin is used to dilate blood vessels (vasodilation) and decrease blood pressure in the treatment of pain from angina pectoris. o Nitroglycerin is usually given sublingually, and thus is absorbed directly into the bloodstream. (Adler & Carlton, p 292) Ans. A Reviewer A&R Question & Answer 6 Review Notes for the RADIOGRAPHY EXAM Appelton 17. In reviewing a patient's blood chemistry, which of the following blood urea nitrogen (BUN) ranges is considered normal? (A) 0.6 to 1.5 mg/100 mL (B) 4.5 to 6 mg/100 mL (C) 8 to 25 mg/100 mL (D) Up to 50 mg/100 mL ————————————————————————— The BUN level indicates the quantity of nitrogen in the blood in the form of urea. o The normal concentration is 8 to 25 mg/100 mL.  BUN and creatinine blood chemistry levels should be checked prior to beginning an intravenous pyelogram.  An increase in the BUN level often indicates decreased renal function.  Increased BUN and/or creatinine levels may forecast an increased possibility of contrast media-induced renal effects and poor visualization of the renal collecting systems. o The normal creatinine range is 0.6 to 1.5 mg/mL. (Ballinger & Frank, vol 2, p 176) Ans. C 18. Which of the following may be used to effectively reduce the viscosity of contrast media? (A) Warming (B) Refrigeration (C) Storage at normal room temperature (D) Storage in a cool, dry place —————————————————————————  Iodinated contrast material can become somewhat viscous (thick and sticky) at normal room temperatures. o This makes injection much more difficult.  Warming the contrast medium to body temperature serves to reduce viscosity. o This may be achieved by placing the vial in warm water or putting it into a special warming oven. (Adler & Carlton, p 322) Ans. A 19. Which of the following is a violation of correct sterile techniques? (A) Gowns are considered sterile in the front down to the waist, including the arms. (B) Sterile gloves must be kept above the waist level. (C) Persons in sterile dress should pass each other face to face. (D) A sterile field should not be left unattended. ————————————————————————— 1) Persons in sterile dress should not pass each other face to face. o Rather, they should pass each other back to back, to avoid contaminating each other. 2) Gowns are considered sterile in the front down to the waist, including the arms. 3) Sterile gloves must be kept above the waist level. o If the hands are accidentally lowered or placed behind the back, they are no longer sterile. 4) A sterile field should not be leftunattended. o Sterile fields should be set up immediately prior to a procedure, and should be covered Reviewer A&R Question & Answer 7 Review Notes for the RADIOGRAPHY EXAM Appelton with a sterile drape if a few moments are to elapse before the procedure can begin. 5) A sterile field should be constantly monitored to be certain that it has not been contaminated. (Adler & Carlton, p 234) Ans. C 20. While performing mobile radiography on a patient, you note that the requisition is for a chest film to check placement of a Swan-Ganz catheter. A Swan-Ganz catheter is a(n) (A) pacemaker. (B) chest tube. (C) intravenous catheter. (D) urinary catheter. ————————————————————————— A Swan-Ganz catheter is a specific type of intravenous catheter used to measure the pumping ability of the heart, to obtain pressure readings, and to introduce medications and intravenous fluids. A pacemaker is a device that is inserted under the patient's skin to regulate heart rate. o Pacemakers may be permanent or temporary. Chest tubes are used to remove fluid or air from the pleural cavity. o Any of these items may be identified on a chest radiograph, provided the cassette is properly positioned and the correct exposure factors are employed. o If the physician is interested in assessing the proper placement of a Swan-Ganz catheter, the lungs may have to be slightly overexposed in order to clearly delineate the proper placement of the tip of the Swan-Ganz catheter, which will overlap the denser cardiac silhouette. A urinary catheter will not appear on a chest radiograph. (Adler & Carlton, p 246) Ans. C 21. Sterile technique is required when contrast agents are administered (A) rectally. (B) orally. (C) intrathecally. (D) through a nasogastric tube. ————————————————————————— Sterile technique is required for the administration of contrast media by the intravenous and intrathecal (intraspinal) methods. o Sterile technique is also required for injection of contrast media during arthrography. Aseptic technique is used for administration of contrast media by means of the oral and rectal routes, as well as through the nasogastric tube. (Torres, p 246) Ans. C 22. An ambulatory patient is one who (A) is able to walk. (B) is unable to walk. (C) has difficulty breathing. (D) arrives by ambulance. —————————————————————————  An Ambulatory patient is one who is able to walk with minimal or no assistance. Reviewer A&R Question & Answer 8 Review Notes for the RADIOGRAPHY EXAM Appelton  Outpatients are usually ambulatory, as are many inpatients.  Patients who are not ambulatory are usually transported to the radiology department via stretcher. (Adler & Carlton, p 161) Ans. A 23. The medical term for nosebleed is (A) vertigo. (B) epistaxis. (C) urticaria. (D) aura. ————————————————————————— The medical term for nosebleed is Epistaxis. Vertigo refers to a feeling of "whirling" or a sensation that the room is spinning. o Some possible causes of vertigo include inner ear infection and acoustic neuroma. Urticaria is a vascular reaction resulting in dilated capillaries and edema and causing the patient to break out in hives. An Aura may be classified as either a feeling or a motor response (such as flashing lights, tasting metal, smelling coffee) that precedes an episode such as a seizure or a migraine headache. (Adler & Carlton, p 274) Ans. B 24. Which of the following must be included in the patient's medical record or chart? 1. Diagnostic and therapeutic orders 2. Medical history 3. Informed consent (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3 ————————————————————————— The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) is the organization that accredits health-care organizations in the United States.  The JCAHO sets forth certain standards for medical records. o In keeping with those standards, all diagnostic and therapeutic orders must appear on the patient's medical record or chart. o Additionally, patient identification information, medical history, consent forms and any diagnostic and therapeutic reports should also be part of the patient's permanent record. o The patient's chart is a means of communication between various health-care providers. (Torres, p 14) Ans. D 25. Chemical substances that are used to kill pathogenic bacteria are called 1. antiseptics. 2. germicides. 3. disinfectants. (A) 1 only (B) 1 and 2 only Reviewer A&R Question & Answer 9 Review Notes for the RADIOGRAPHY EXAM Appelton (C) 2 and 3 only (D) 1, 2, and 3 —————————————————————————  Some chemical agents used in health-care facilities function to kill pathogenic microorganisms, while others function to inhibit the growth / spread of pathogenic microorganisms. Germicides and disinfectants are used to kill pathogenic microorganisms, whereas Antiseptics (like alcohol) are used to stop their growth / spread. Sterilization is another associated term; it refers to the killing of all microorganisms and their spores. (Ballinger & Frank, vol 1, p 15) Ans. C 26. A small bottle containing a single dose of medication is termed (A) an ampule. (B) a vial. (C) a bolus. (D) a carafe. —————————————————————————  Injectable medications are available in two different kinds of containers; 1) An ampule is a small container that usually holds a single dose of medication. 2) A vial is a larger container that holds several doses of the medication.  The term bolus is used to describe an amount of fluid to be injected.  A carafe is a narrow-mouthed container; it is not likely to be used for medical purposes. (Adler & Carlton, pp 294-295) Ans. A 27. Forms of intentional misconduct include 1. slander. 2. invasion of privacy. 3. negligence. (A) 1 only (B) 2 only (C) 1 and 2 only (D) 1, 2, and 3 ————————————————————————— Verbal defamation of another, or slander, is a type of intentional misconduct. Invasion of privacy (that is, public discussion of privileged and confidential information) is intentional misconduct.  However, if a radiographer leaves a weak patient standing alone in order to check films or get supplies, and that patient falls and sustains an injury, that would be considered unintentional misconduct or negligence. (Saia, p 8) Ans. C 28. Instruments required to assess vital signs include; 1. a thermometer. 2. a tongue blade. Reviewer A&R Question & Answer 10 Review Notes for the RADIOGRAPHY EXAM Appelton 3. a watch with a second hand. (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3 —————————————————————————  The four vital signs are temperature, pulse, respiration, and blood pressure.  Because radiographers may be required to take vital signs in an emergency, they should practice these skills. A thermometer is required to take the patient's temperature. A watch with a second hand is required to take the patient's pulse and respiration. To measure blood pressure, a blood pressure cuff, sphygmomanometer, and stethoscope are required.  This is the skill that the radiographer should practice most frequently, as it is the one most likely to be needed in an emergency situation. A tongue blade is used to depress the tongue for inspection of the throat and is not used in vital sign assessment. (Torres, p 128) Ans. C 29. An inanimate object that has been in contact with an infectious microorganism is termed a (A) vector. (B) fomite. (C) host. (D) reservoir. ————————————————————————— A fomite is an inanimate object that has been in contact with an infectious microorganism. A reservoir is a site where an infectious organism can remain alive and from which transmission can occur.  Although an inanimate object can be a reservoir for infection, living objects (such as humans) can also be reservoirs.  For infection to spread, there must be a host environment.  Although an inanimate object may serve as a temporary host where microbes can grow, microbes flourish on and in the human host, where there are plenty of body fluids and tissues to nourish and feed the microbes. A vector is an animal host of an infectious organism that transmits the infection via bite or sting. (Torres, p 46) Ans. B 30. What type of precautions prevents the spread of infectious agents in aerosol form? (A) Strict isolation (B) Protective isolation (C) Airborne precautions (D) Contact precautions ————————————————————————— Category-specific isolations have been replaced by transmission-based precautions: airborne, droplet, and contact. Reviewer A&R Question & Answer 11 Review Notes for the RADIOGRAPHY EXAM Appelton 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 the 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. o The radiographer should wear gloves, but a gown is required only if flagrant contamination is likely. o Patients under airborne precautions require a private, specially ventilated (negative- pressure) room.  A private room is also indicated for all patients on droplet precautions, i.e., 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. o 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 gown and gloves.  Contact precautions require a private patient room and the use of gloves, mask, and gown for anyone coming in direct contact with the infected individual or his or her environment. o Any diseases spread by direct or close contact, such as MRSA (methicillin-resistant Staphylococcus aureus), conjunctivitis, and hepatitis A, require contact precautions. (Adler & Carlton, p 215) Ans. C 31. The complete killing of all microorganisms is termed (A) surgical asepsis. (B) medical asepsis. (C) sterilization. (D) disinfection. ————————————————————————— a. The complete killing of all Microorganisms is termed sterilization. b. Surgical asepsis refers to the technique used to prevent contamination when performing procedures. c. Medical asepsis refers to practices that reduce the spread of microbes, and therefore the chance of spreading disease or infection. o Handwashing is an example of medical asepsis. It reduces the spread of infection, but does not eliminate all microorganisms. d. Disinfection involves the use of chemicals to either inactivate or inhibit the growth of microbes. (Adler & Carlton, p 200) Ans. C 32. Anaphylactic shock manifests early symptoms that include 1. dysphagia. 2. itching of palms and soles. 3. constriction of the throat. (A) 1 only (B) 2 only Reviewer A&R Question & Answer 12 Review Notes for the RADIOGRAPHY EXAM Appelton (C) 2 and 3 only (D) 1, 2, and 3 —————————————————————————  Adverse reactions to the intravascular administration of iodinated contrast are not uncommon, and although the risk of a life-threatening reaction is relatively low, the radiographer must be alert to recognize the situation and deal with it effectively should a serious reaction occur. o A minor reaction is characterized by flushed appearance and nausea, and occasionally by vomiting and a few hives. o Early symptoms of a possible anaphylactic reaction include constriction of the throat, possibly because of laryngeal edema, dysphagia (difficulty swallowing), and itching of the palms and soles.  The radiographer must maintain the patient's airway, summon the radiologist, and call a "code." (Adler & Carlton, p 267) Ans. D 33. The usual patient preparation for an upper GI exam is (A) NPO 8 h before the exam. (B) light breakfast only on the morning of the exam. (C) clear fluids only on the morning of the exam. (D) 2 oz castor oil and enemas until clear. —————————————————————————  In order to obtain a diagnostic examination of the stomach, it must first be empty.  The usual preparation is NPO (nothing by mouth) after midnight (approximately 8 hrs. before the exam).  Any material in the stomach can simulate the appearance of disease. (Torres, p 211) Ans. A 34. A drug's chemical name is called its (A) generic name. (B) trade name. (C) brand name. (D) proprietary name. ————————————————————————— A drug's generic name identifies its chemical family.  A particular generic drug can be manufactured by several different companies and be given different trade names (brand or proprietary names). o For example, the drug with the chemical / generic name acetaminophen is known by the trade or brand name Tylenol. o Drugs can be classified by either their generic name or their trade name. (Ehrlich et al, p 184) Ans. A 35. A patient whose systolic blood pressure is less than 90 mmHg is usually considered (A) hypertensive. (B) hypotensive. (C) average / normal. Reviewer A&R Question & Answer 13 Review Notes for the RADIOGRAPHY EXAM Appelton (D) baseline. ————————————————————————— Systolic blood pressure describes the pressure during contraction ofthe heart. It is expressed as the top number when recording blood pressure. Diastolic blood pressure is the reading during relaxation of the heart and is placed on the bottom when recording blood pressure.  A patient is considered hypertensive when systolic pressure is consistently above 140 mmHg, and hypotensive when the systolic pressure is lower than 90 mmHg. (Adler & Carlton, p 181) Ans. B 36. In what order should the following exams be performed? 1. Upper GI 2. Intravenous pyelogram (IVP) 3. Barium enema (A) 3, 1, 2 (B) 1, 3, 2 (C) 2, 1, 3 (D) 2, 3, 1 ————————————————————————— 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 IVP should be scheduled first because the contrast medium used is excreted rapidly. The barium enema should be scheduled next. Finally, the upper GI 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 film should be taken in each case. (Torres, p 212) Ans. D 37. You receive a patient who is complaining of pain in the area of the left fourth and fifth metatarsals; however, the requisition asks for a left ankle exam. What should you do? (A) Perform a left foot exam. (B) Perform a left ankle exam. (C) Perform both a left foot and a left ankle exam. (D) Check with the referring physician. ————————————————————————— Although it is never the responsibility of the radiographer to diagnose, it is the responsibility of every radiographer to be alert. The patient should not be subjected to unnecessary radiation from an unwanted exam. Rather, it is the radiographer's responsibility to check with the referring physician and report the patient's complaint. (Ehrlich & McCloskey, p 14) Ans. D 38. All of the following statements regarding handwashing and skin care are correct except (A) Hands should be washed after each patient examination. (B) Faucets should be opened and closed with paper towels. (C) Hands should be smooth and free from chapping. Reviewer A&R Question & Answer 14 Review Notes for the RADIOGRAPHY EXAM Appelton (D) Any cracks or abrasions should be left uncovered to facilitate healing. —————————————————————————  In the practice of aseptic technique, handwashing is the most important precaution. o The radiographer's hands should be thoroughly washed with warm, soapy running water after each patient examination. o To avoid contamination of, or contamination by, the faucets, they should be opened and closed using paper towels. o Care should be taken to avoid chapped handsby the use of hand cream. o Skin function is a major factor in protecting bodies from the invasion of bacteria and infection.  Any cuts, abrasions, or other breaks in the continuity of this protective barrier should be protected from bacterial invasion with a bandage. (Torres, p 54) Ans. D 39. Which of the following body fluids is (are) potential carrier(s) of HIV? 1. Semen 2. Vaginal secretions 3. Blood (A) 1 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3 —————————————————————————  Blood and all other body fluids are carriers of HIV in infected individuals. Standard precautions are taken to avoid contact with any blood or body fluids. o However, HIV cannot be transmitted via inanimate objects, such as drinking fountains and glassware. (Torres, p 51) Ans. D 40. 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? (A) Intentional misconduct (B) Contributory negligence (C) Gross negligence (D) None of the above ————————————————————————— 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 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, with the percentage of the injury due to the patient's actions is compared with the total amount of injury. A jury may decide that a doctor was negligent in his actions, but because the patient lied about Reviewer A&R Question & Answer 15 Review Notes for the RADIOGRAPHY EXAM Appelton using an illegal street drug that contributed to the injurious outcome, the patient is 80 percent responsible for her condition. The party suing may be awarded $100,000 for injuries, but would actually 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. (Ehrlich, McCloskey, & Daly, p 57) Ans. B 41. Log rolling is a method of moving patients with suspected (A) head injury. (B) spinal injury. (C) bowel obstruction. (D) extremity fracture. ————————————————————————— Patients arriving from the emergency department (ED) with suspected spinal injury should not be moved. AP and horizontal lateral projections of the suspected area should be evaluated and a decision made about the advisability of further films. For a lateral projection, the patient should be moved along one plane, that is, rolled like a log. It is imperative that twisting motions be avoided. (Torres, pp 78-79) Ans. B 42. A patient in a recumbent position with the head lower than the feet is said to be in which of the following positions? (A) Trendelenburg (B) Fowler's (C) Sims (D) Stenver's ————————————————————————— The patient is said to be in the Trendelenburg position when the head is positioned lower than the feet. o This position is helpful in several radiographic procedures, such as separating redundant bowel loops and demonstration of hiatal hernias. o It is also used in treating shock. In Fowler's position, the head is higher than the feet. The Sims position is the left posterior oblique (LPO) position with the right leg flexed up for insertion of the enema tip. Stenver's is a radiographic position for mastoids. (Taber's, p 2234) Ans. A 43. An informed consent is required before performing which of the following exams? (A) Upper GI (B) Lower GI (C) Sialogram (D) Renal arteriogram ————————————————————————— Reviewer A&R Question & Answer 16 Review Notes for the RADIOGRAPHY EXAM Appelton Informed consent is required before any examination that involves greater-than-usual risk. Routine procedures such as sialography and upper and lower GI series are examples of lower- risk procedures, for which the consent given on admission to the hospital is sufficient. (Adler & Carlton, p 366) Ans. D 44. Blood pressure may be expressed as 120/95. What does 95 represent? 1. The phase of relaxation of the cardiac muscle tissue 2. The phase of contraction of the cardiac muscle tissue 3. A higher-than-average diastolic pressure (A) 1 only (B) 2 only (C) 1 and 3 only (D) 2 and 3 only —————————————————————————  The normal blood pressure range for men and women is 110 to 140 mmHg systolic reading (top number) and 60 to 80 mmHg diastolic reading (bottom number). Systolic pressure is the contraction phase of the left ventricle. Diastolic pressure is the relaxation phase in the heart cycle. (Torres, p 139) Ans. C 45. For which of the following radiographic examinations is a consent form usually required? 1. Angiogram 2. GI series 3. Skeletal survey (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3 ————————————————————————— Although patient consent for all routine procedures is implied upon admission to the hospital, specific informed consent forms are required for procedures that involve significant risk. Routine procedures such as GI series and skeletal surveys do not involve significant patient risk, but invasive procedures such as angiography do, and thereforea consent form must be signed for such procedures. A family member may sign for a patient who is incompetent or too ill to sign. (Ehrlich et al, p 125) Ans. A 46. Increased pain threshold, breakdown of skin, and atrophy of fat pads and sweat glands are all important considerations when working with which group of patients? (A) Infants (B) Children (C) Adolescents (D) Geriatric patients ————————————————————————— Increased pain threshold, breakdown of skin, and atrophy of fat pads and sweat glands are all important considerations when working with Geriatric patients. Reviewer A&R Question & Answer 17 Review Notes for the RADIOGRAPHY EXAM Appelton Many changes occur as our bodies age. Although muscle is replaced with fat, the amount of subcutaneous fat is decreased, and the skin atrophies. Therefore, the geriatric patient requires extra-gentle treatment. A mattress pad should always be placed on the radiographic table to help prevent skin injury or abrasions. If tape is required, paper tape should be used instead of adhesive. Geriatric patients are also more sensitive to hypothermia because of breakdown of the sweat glands and should always be kept covered, both to preserve modesty and for extra warmth. Loss of sensation in the skin increases pain tolerance, and so the geriatric patient may not be aware of excessive stress on bony prominences like the elbow, wrist, coccyx, and ankles. (Dowd & Wilson, vol 2, p 1026) Ans. D 47. The advantages of using nonionic, water-soluble contrast media include 1. cost-containment benefits. 2. low toxicity. 3. fewer adverse reactions. (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3 ————————————————————————— The relatively low-osmolality and nonionic, water-soluble contrast media available to radiology departments have outstanding advantages, especially for patients with a history of allergic reaction. They were originally used for intrathecal injections (myelography), but they were quickly accepted for intravascular injections as well. Side effects and allergic reactions are less likely and less severe with these media. Their one very significant disadvantage is their high cost compared to ionic contrast media. (Adler & Carlton, p 328) Ans. C 48. A vasodilator would most likely be used for (A) angina. (B) cardiac arrest. (C) bradycardia. (D) antihistamine. —————————————————————————  Anginal pain, caused by constriction of blood vessels, may be relieved with the administration of a vasodilator such as nitroglycerin.  Bradycardia (abnormally slow heartbeat) and Cardiac arrest are treated with vasoconstrictors such as dopamine or epinephrine to increase blood pressure.  Antihistamines such as diphenhydramine (Benadryl) are used to treat allergic reactions and anaphylactic shock. (Adler & Carlton, p 292) Ans. A 49. According to the CDC (Centers for Disease Control and Prevention), all of the following Reviewer A&R Question & Answer 18 Review Notes for the RADIOGRAPHY EXAM Appelton precaution guidelines are true, except (A) Airborne precautions require that the patient wear a mask. (B) Masks are indicated when caring for patients on MRSA precautions. (C) Patients under MRSA precautions require a negative-pressure room. (D) Gloves are indicated when caring for a patient on droplet precautions. ————————————————————————— 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. 1) Airborne precautions are employed with patients suspected or known to be infected with the tubercle bacillus (TB), chickenpox (varicella), or measles (rubeola). o Airborne precautions require that the patient wear a mask to avoid the spread of bronchial secretions or other pathogens during coughing. o If the patient is unable or unwilling to wear a mask, the radiographer must wear one. o The radiographer should wear gloves, but a gown is required only if flagrant contamination is likely. o Patients under airborne precautions require a private, specially ventilated (negative- pressure) room. 2) A private room is also indicated for all patients on droplet precautions, i.e., with diseases transmitted via large droplets expelled from the patient while speaking, sneezing, or coughing. o 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 gown and gloves. 3) Contact precautions require a private patient room and the use of gloves, mask, and gown for anyone coming in direct contact with the infected individual or his or her environment. o Any diseases spread by direct or close contact, such as MRSA (methicillin-resistant Staphylococcus aureus), conjunctivitis, and hepatitis A, require contact precautions. (Adler & Carlton, p 215) Ans. C 50. Which of the following medical equipment is used to determine blood pressure? 1. Pulse oximeter 2. Stethoscope 3. Sphygmomanometer (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3 —————————————————————————  A stethoscope and a sphygmomanometer are used together to measure blood pressure. o The first sound heard is the systolic pressure, and the normal range is 110 to 140 mmHg. When the sound is no longer heard, the diastolic pressure is recorded. o The normal diastolic range is 60 to 90 mmHg. o Elevated blood pressure is called hypertension. o 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. Reviewer A&R Question & Answer 19 Review Notes for the RADIOGRAPHY EXAM Appelton (Adler & Carlton, p 181) Ans. C 51. The patient is placed in the lithotomy position for which of the following procedures? (A) Myelography (B) Venography (C) T-tube cholangiography (D) Hysterosalpingography —————————————————————————  The lithotomy position is generally employed for hysterosalpingography. o The lithotomy position requires that the patient lie on the back with buttocks at the edge of the table. o The hips are flexed, the knees are flexed and resting on leg supports, and the feet rest in stirrups. (Adler & Carlton, p 221) Ans. D 52. A patient experiencing an episode of syncope should be placed in which of the following positions? (A) Dorsal recumbent with head elevated (B) Dorsal recumbent with feet elevated (C) Lateral recumbent (D) Seated with feet supported —————————————————————————  Syncope, or fainting, is the result of a drop in blood pressure caused by insufficient blood (oxygen) flow to the brain. o The patient should be helped into a dorsal recumbent position with feet elevated in order to facilitate blood flow to the brain. (Ehrlich et al, p 239) Ans. B 53. When a radiographer is obtaining a patient history, both subjective and objective data should be obtained. An example of subjective data is (A) The patient appears to have a productive cough. (B) The patient has a blood pressure of 130/95. (C) The patient states that he experiences extreme pain in the upright position. (D) The patient has a palpable mass in the right upper quadrant of the left breast. ————————————————————————— Obtaining a complete and accurate history from the patient for the radiologist is an important aspect of a radiographer's job. Both subjective and objective data should be collected.  Objective data include signs and symptoms that can be observed, such as a cough, a lump, or elevated blood pressure.  Subjective data relate to what the patient feels, and to what extent. o A patient may experience pain, but is it mild or severe? Is it localized or general? Does the pain increase or decrease under different circumstances?  A radiographer should explore this with a patient and document the information on the requisition for the radiologist. (Adler & Carlton, p 137) Ans. C Reviewer A&R Question & Answer 20 Review Notes for the RADIOGRAPHY EXAM Appelton 54. A nosocomial infection is a(n) (A) infection acquired at a large gathering. (B) upper respiratory infection. (C) infection acquired in a hospital. (D) type of rhinitis. —————————————————————————  Nosocomial diseases are those acquired in hospitals, especially by patients whose resistance to infection has been diminished by their illness. o Cleanliness is essential to decrease the number of nosocomial infections. o The x-ray table must be cleaned and the pillowcase changed between patients. o The most common nosocomial infection is the urinary tract infection (UTI). (Gurley & Callaway, pp 178-179) Ans. C 55. You and a fellow radiographer have received an unconscious patient from a motor vehicle accident. As you perform the examination, it is important that you 1. refer to the patient by name. 2. make only those statements that you would make with a conscious patient. 3. reassure the patient about what you are doing. (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3 ————————————————————————— An unconscious patient is frequently able to hear and understand all that is going on, even though he or she is unable to respond. Therefore, while performing the exam, the radiographer should always refer to the patient by name and take care to continually explain what is being done and reassure the patient. (Adler & Carlton, p 126) Ans. D 56. Hypochlorite bleach (Clorox) and Lysol are examples of (A) antiseptics. (B) bacteriostatics. (C) antifungal agents. (D) disinfectants. —————————————————————————  Hypochlorite bleach (Clorox) and Lysol are examples of disinfectants. a) Disinfectants are used in radiology departments to clean equipment and to remove microorganisms from areas such as radiographic tables. b) Antiseptics are also used to stop the growth of microorganisms, but they are often applied to the skin, not to radiographic equipment. c) Antifungal medications can be administered systemically or topically to treat or prevent fungal infections. d) Antibacterial medications (bacteriostatics) can also be administered systemically or externally. Tetracycline is a systemic antibacterial medication. (Ehrlich et al, p 153) Ans. D Reviewer A&R Question & Answer 21 Review Notes for the RADIOGRAPHY EXAM Appelton 57. Conditions in which there is a lack of normal bone calcification include 1. rickets. 2. osteomalacia. 3. osteoarthritis. (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3 —————————————————————————  Rickets and osteomalacia are disorders in which there is softening of bone. a) Rickets results from a deficiency of vitamin D and usually is found affecting the growing bones of young children. The body's weight on the soft bones of the legs results in bowed and misshapen legs. b) Osteomalacia is an adult condition in which new bone fails to calcify. It is a painful condition and can result in easily fractured bones, especially in the lower extremities.  Osteoarthritis is often seen in the elderly and is characterized by degeneration of articular cartilage in adjacent bones. The resulting rubbing of bone against bone results in pain and deterioration. (Tortora & Grabowski, p 181) Ans. B 58. What is the most common means of spreading infection? (A) Improperly disposed of contaminated waste (B) Instruments that are improperly sterilized (C) Soiled linen (D) Human hands ————————————————————————— Microorganisms are most commonly spread from one person to another by human hands and can be prevented from spreading by handwashing. Contaminated waste products, soiled linen, and improperly sterilized instruments are all ways in which microorganisms can travel. Not every patient will come into contact with these items. However, the health-care worker is in constant contactwith the patient and is therefore a constant threat for the spread of infection. (Torres, p 54) Ans. D 59. Which of the following statements are true regarding a two-member team performing mobile radiography on a patient with MRSA (methicillin-resistant Staphyloccus aureus) precautions? 1. One radiographer rema patient. 2. The radiographer who positions the mobile unit also makes the exposure. 3. The radiographer who positions the cassette also retrieves the cassette and removes it from its plastic protective cover. (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only Reviewer A&R Question & Answer 22 Review Notes for the RADIOGRAPHY EXAM Appelton (D) 1, 2, and 3 ————————————————————————— When a two-member team of radiographers is performing mobile radiography on a patient with contact precautions, such as an MRSA patient, one radiographer remains "clean" she has no physical contact with the patient. The clean radiographer will position the mobile unit and make the exposure. The other member of the team will position the cassette and retrieve the cassette. As the two radiographers fold down the cassette's protective plastic cover, the clean radiographer will remove the cassette from the plastic. Both radiographers should be protected with gowns, gloves, and masks if the patient is on contact precautions. Additionally, after the exam is completed, the mobile unit should be cleaned with a disinfectant. Conditions requiring the use of contact precautions also include hepatitis A and varicella. (Torres, pp 61-66) Ans. A 60. In which of the following conditions is a double-contrast barium enema (BE) essential for demonstration of the condition? 1. Polyps 2. Colitis 3. Diverticulosis (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3 ————————————————————————— Double-contrast studies of the large bowel are particularly useful for demonstration of the bowel wall, and anything projecting from it, as in diverticulosis. 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 would most likely obliterate these mucosal conditions, but coating the bowel mucosa with barium and subsequent filling the bowel with air (double contrast) provides optimal delineation. (Ballinger & Frank, vol 2, p 128) Ans. B 61. The type of shock associated with pooling of blood in the peripheral vessels is classified as (A) neurogenic. (B) cardiogenic. (C) hypovolemic. (D) septic. ————————————————————————— 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 results in decreased arterial resistance and pooling of blood in peripheral vessels. Cardiogenic shock is related to cardiac failure and results from interference with heart function. o It can occur in cases of cardiac tamponade, pulmonary embolus, or myocardial infarction. Reviewer A&R Question & Answer 23 Review Notes for the RADIOGRAPHY EXAM Appelton Hypovolemic shock is related to loss of large amounts of blood, either from internal bleeding or from hemorrhage associated with trauma. Septic shock, along with anaphylactic shock, is generally classified as vasogenic shock. (Adler & Carlton, p 266) Ans. A 62. The chemical agent alcohol can be used effectively as a(n) (A) antiseptic. (B) germicide. (C) disinfectant. (D) antibiotic. ————————————————————————— Some chemical agents used in health-care facilities function to kill pathogenic microorganisms, while others function to inhibit the growth / spread of pathogenic microorganisms. Germicides and disinfectants are used to kill pathogenic microorganisms, whereas antiseptics (like alcohol) are used to stop their growth / spread. Sterilization is another associated term; it refers to the killing of all microorganisms and their spores. (Ballinger & Frank, vol 1, p 15) Ans. A 63. Anaphylaxis is the term used to describe (A) an inflammatory reaction. (B) bronchial asthma. (C) acute chest pain. (D) allergic shock. —————————————————————————  A severe allergic reaction affecting several tissue functions is referred to as anaphylaxis or anaphylactic shock. o It is characterized by dyspnea (difficulty breathing) caused by rapid swelling of the respiratory tract and a sharp drop in blood pressure. o Individuals who are sensitive to bee stings and certain medications, including iodinated contrast agents, are candidates for this reaction. (Adler & Carlton, p 267) Ans. D 64. What instructions might a patient receive upon completing a barium enema (BE) examination? 1. Drink plenty of fluids. 2. Take a mild laxative. 3. Withhold fluids for 6 h. (A) 1 and 2 only (B) 2 and 3 only (C) 2 only (D) 3 only ————————————————————————— Barium can dry and harden in the large bowel, causing symptoms ranging from mild constipation to bowel obstruction. It is thereforeessential that the radiographer provide clear instructions, especially to outpatients, on follow-up care, along with the rationale for this care. Reviewer A&R Question & Answer 24 Review Notes for the RADIOGRAPHY EXAM Appelton In order to avoid the possibility of fecal impaction, the patient should drink plenty of fluids for the nextfew days and take a mild laxative such as milk of magnesia. (Torres, pp 211-212) Ans. A 65. Physical changes characteristic of gerontologic patients usually include 1. loss of bone calcium. 2. loss of hearing. 3. loss of mental alertness. (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3 ————————————————————————— Gerontology, or geriatrics, is the study of the elderly. While bone demineralization and loss of muscle mass occur to a greater or lesser degree in most elderly individuals, the radiographer must not assume that all gerontologic patients are hard of hearing, clumsy, or not mentally alert. Today many elderly people remain very active, staying mentally and physically agile well into their so-called golden years. The radiographer must keep this in mind as he or she provides age-specific care to the gerontologic patient. (Torres, p 181) Ans. A 66. The pain experienced by an individual whose coronary arteries are not conveying sufficient blood to the heart is called (A) tachycardia. (B) bradycardia. (C) angina pectoris. (D) syncope. —————————————————————————  An individual whose coronary arteries are not carrying enough blood to the heart muscle (myocardium), as a result of partial or complete blockage of a cardiac vessel, experiences crushing pain in the chest, frequently radiating to the left jaw and arm. o This is termed angina pectoris. o It may be relieved by the drug nitroglycerin, which dilates the coronary arteries, thus facilitating circulation.  Tachycardia refers to rapid heart rate, and bradycardia to slow heart rate.  Syncope is fainting. (Adler & Carlton, p 292) Ans. C 67. 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 (A) asthma. (B) anaphylaxis. (C) myocardial infarction. (D) rhinitis. Reviewer A&R Question & Answer 25 Review Notes for the RADIOGRAPHY EXAM Appelton —————————————————————————  Anaphylaxis is an acute reaction characterized by the sudden onset of urticaria, respiratory distress, vascular collapse, or systemic shock, sometimes leading to death. o 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. o Asthma and rhinitis are examples of allergic reactions.  Myocardial Infarction (MI) is caused by partial or complete occlusion of a coronary artery. (Torres, p 155) Ans. B 68. The radiographer must perform which of the following procedures prior to entering a contact isolation room with a mobile x-ray unit? 1. Put on gown and gloves only. 2. Put on gown, gloves, mask, and cap. 3. Clean the mobile x-ray unit. (A) 1 only (B) 2 only (C) 1 and 3 only (D) 2 and 3 only ————————————————————————— When performing bedside radiography in a contact isolation room, the radiographer should wear a gown, gloves, mask, and cap. The cassettes are prepared for the examination by placing a pillowcase over them to protect them from contamination. Whenever possible, one person should manipulate the mobile unit and remain "clean" while the other handles the patient. The mobile unit should be cleaned with a disinfectant upon exiting the patient's room, not prior to entering. (Torres, pp 61-66) Ans. B 69. Following a barium enema (BE) examination, the patient should be given which of the following instructions? 1. Increase fluid and fiber intake for several days. 2. Changes in stool color will occur until all barium has been evacuated. 3. Contact a physician if no bowel movement occurs in 24 h (A) 1 only (B) 2 only (C) 1 and 3 only (D) 1, 2, and 3 —————————————————————————  Physicians often prescribe a mild laxative to aid in the elimination of barium sulfate. o If a laxative is not given, the patient should be instructed to increase dietary fluid and fiber and to monitor bowel movements (the patient should have at least one within 24 h).  Patients should also be aware of the white-colored appearance of their stool that will be present until all barium is expelled. (Torres, p 208) Ans. D Reviewer A&R Question & Answer 26 Review Notes for the RADIOGRAPHY EXAM Appelton 70. A patient suffering from orthopnea would experience the least discomfort in which body position? (A) Fowler's (B) Trendelenburg (C) Recumbent (D) Erect —————————————————————————  Orthopnea is a respiratory condition in which the patient has difficulty breathing (dyspnea) in any position other than erect. o The patient is usually comfortable in the erect, standing, or seated position. Trendelenburg position places the patient's head lowerthan the rest of the body. Fowler's position is a semierect position Recumbent position is lying down. (Ehrlich et al, p 127) Ans. D 71. Which statement(s) would be true regarding tracheostomy patients? 1. Tracheostomy patients have difficulty speaking. 2. A routine chest x-ray requires the tracheostomy tubing to be rotated out of view. 3. Audible rattling sounds indicate a need for suction. (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3 ————————————————————————— The tracheostomy patient will have difficulty speaking as a result of the redirection of the air past the vocal cords. Gurgling or rattling sounds coming from the trachea indicate an excess accumulation of secretions, requiring suction with sterile catheters. Any rotation or movement of the tracheostomy tube may cause the tube to become dislodged, and an obstructed airway could result. (Torres, p 228) Ans. C 72. What is the most widely used method of vascular catheterization? (A) Doppler (B) Moniz (C) Grandy (D) Seldinger ————————————————————————— With the Seldinger technique, a needle with an inner cannula is used to pierce an artery (usually the femoral). The inner cannula is then removed, a flexible guidewire is inserted, the needle is removed, and a catheter is slippedover the guidewire into the artery. The guidewire is then removed, leaving the catheter in the artery. The Seldinger technique reduces the risk of extravasation (compared to that from a direct needle stick). The patient may be positioned as required, andthe radiographs may be inspected while the catheter remains safely in place. Reviewer A&R Question & Answer 27 Review Notes for the RADIOGRAPHY EXAM Appelton The axial or brachial arteries may be used, but the femoral is the most common approach. Doppler is an ultrasonography term referring to the detection of movement (e.g., blood flow through blood vessels). The Grandy method describes the routine lateral projection of the cervical spine. Egaz Moniz introduced cerebral angiography in 1927. (Ballinger & Frank, vol 3, pp 30-31) Ans. D 73. A diuretic is used to (A) induce vomiting. (B) stimulate defecation. (C) promote elimination of urine. (D) inhibit coughing. ————————————————————————— Diuretics are used to promote urine elimination in individuals whose tissues are retaining excessive fluid. Emetics induce vomiting, and cathartics stimulate defecation. Antitussives are used to inhibit coughing. (Torres, p 257) Ans. C 74. All of the following rules regarding proper handwashing technique are correct except (A) Keep hands and forearms lower than elbows. (B) Use paper towels to turn water on. (C) Avoid using hand lotions whenever possible. (D) Carefully wash all surfaces and between fingers. —————————————————————————  Frequent and correct handwashing is an essential part of medical asepsis; it is the best method for avoiding the spread of microorganisms. o If the faucet cannot be operated with the knee or a foot pedal, it should be opened and closed using paper towels. o Care should be taken to wash all surfaces of the hand and between the fingers thoroughly. o The hands and forearms should always be kept below the elbows. o Hand lotions should be used frequently to keep hands from chapping. o Unbroken skin prevents the entry of microorganisms; dry, cracked skin breaks down that defense and permits the entry of microorganisms. (Ehrlich et al, pp 153-155) Ans. C 75. Which of the following is a vasopressor and may be used for an anaphylactic reaction or cardiac arrest? (A) Nitroglycerin (B) Epinephrine (C) Hydrocortisone (D) Digitoxin ————————————————————————— Epinephrine (Adrenalin) is the vasopressor used to treat an anaphylactic reaction or cardiac arrest. Reviewer A&R Question & Answer 28 Review Notes for the RADIOGRAPHY EXAM Appelton Nitroglycerin is a vasodilator. Hydrocortisone is a steroid that may be used to treat bronchial asthma, allergic reactions, and inflammatory reactions. Digitoxin is used to treat cardiac fibrillation. (Ehrlich et al, pp 186-187) Ans. B 76. The Heimlich maneuver is used if a patient is (A) in cardiac arrest. (B) choking. (C) having a seizure. (D) suffering from hiccups. —————————————————————————  The Heimlich maneuver is used when a person is choking. If you suspect that an individual is choking, be certain that the airway is indeed obstructed before attempting the Heimlich maneuver. o A person with a completely obstructed airway will not be able to speak or cough. o If the person cannot speak or cough, then the airway is obstructed, and the Heimlich maneuver should be performed. o The proper method is to stand behind the choking victim with one hand in a fist, thumb side in, midway between the navel and the xiphoid tip. o Place the other hand over the closed fist with the palm open and apply pressure in and up. Repeat the thrust several times, until the object is dislodged.  For an infant, the procedure is modified. o Four back blows are given, midway between the scapulae, using the heel of the hand. If the object is not dislodged, the baby is turned over (being very careful to support the baby's head and spine), and four chests thrusts are performed just below the nipple line, using several fingers. (Adler & Carlton, pp 268-269) Ans. B 77. The pulse can be detected only by the use of a stethoscope in which of the following locations? (A) Wrist (B) Apex of the heart (C) Groin (D) Neck —————————————————————————  As blood pulsates through the arteries, a throb can be detected.  This throb or pulse can be readily palpated at locations where the arteries are superficial (examples are the wrist, groin, neck, and posterior surface of the knee). o The apical pulse can be detected only with a stethoscope. (Torres, p 133) Ans. B 78. The most effective method of sterilization is (A) dry heat. (B) moist heat. (C) pasteurization. Reviewer A&R Question & Answer 29 Review Notes for the RADIOGRAPHY EXAM Appelton (D) freezing. —————————————————————————  The most effective method of sterilization is moist heat, using steam under pressure. o This is known as autoclaving. Sterilization with dry heat requires higher temperatures for longer periods of time than sterilization with moist heat. Pasteurization is moderate heating with rapid cooling; it is frequently used in the commercial preparation of milk and alcoholic beverages such as wine and beer. o It is not a form of sterilization. Freezing can also kill some microbes, but it is not a form of sterilization. (Torres, p 106) Ans. B 79. An MRI procedure is contraindicated for a patient having (A) herniated disc. (B) aneurysm clips. (C) dental fillings. (D) subdural bleeding. ————————————————————————— The presence of aneurysm clips is contraindication for MRI; even slight shift can cause damage. o MRI can be performed for herniated disc and subdural bleeding. Dental fillings do not contraindicate MRI. (Ehrlich, McCloskey & Daly, p 192) Ans. B 80. Which of the following should be used to disinfect the area after a blood spill? (A) Soap and water (B) Betadine solution (C) One part bleach to ten parts water (D) One part alcohol to ten parts water ————————————————————————— The CDC considers all body substances to be potential sources of infection. It lists several precautionary measures that should be taken when dealing with body substances. Gloves must be used when wiping up bloodspills, and the area should be disinfected with a solution of one part bleach to ten parts water. (Adler & Carlton, p 214) Ans. C 81. Factors that are important to evaluate when selecting contrast media include 1. miscibility. 2. potential toxicity. 3. viscosity. (A) 1 and 2 only (B) 2 and 3 only (C) 1 and 3 only (D) 1, 2, and 3 ————————————————————————— Reviewer A&R Question & Answer 30 Review Notes for the RADIOGRAPHY EXAM Appelton  All three factors are important considerations. 1.) Miscibility describes the ability of a contrast medium to mix with blood as it is injected into the bloodstream. 2.) Potential toxicity has always been an important consideration, as side effects from contrast media can be life-threatening. o The new nonionic contrast media have considerably lower toxicity than the ionic compounds. 3.) Viscosity is a term that denotes the degree of stickiness or gumminess of the contrast medium. o A contrast medium with higher viscosity can offer considerable resistance upon injection. (Torres, p 266) Ans. D 82. When radiographing the elderly, it is helpful to 1. move quickly. 2. address them by their full name. 3. give straightforward instructions. (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3 —————————————————————————  Elderly patients dislike being pushed or hurried along.  They appreciate the radiographer who is caring enough to take the extra few minutes necessary to comfort them. o Some elderly patients are easily confused, and it is best to address them by their full name and keep instructions simple and direct. o The elderly require the same respectful, dignified care as all other patients. (Adler & Carlton, pp 129-130) Ans. C 83. Medication can be administered by which of the following routes? 1. Orally 2. Intravenously 3. Intramuscularly (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3 —————————————————————————  Medications are commonly administered orally (by mouth). o They may also be administered directly into a vein (intravenously), into a muscle (intramuscularly), or under the skin (subcutaneously). (Ehrlich, McCloskey & Daly, pp 192-193) Ans. D 84. The normal average rate of respiration for a healthy adult patient is (A) 5 to 7 breaths/min. Reviewer A&R Question & Answer 31 Review Notes for the RADIOGRAPHY EXAM Appelton (B) 8 to 12 breaths/min. (C) 12 to 20 breaths/min. (D) 20 to 30 breaths/min. —————————————————————————  The normal average rate of respiration for a healthy adult patient is between 12 and 20 breaths/min.  For children, the rate is higher, averaging between 20 and 30 breaths/min. o In addition to monitoring the respiratory rate, it is also important to monitor the depth (shallow or labored) and pattern (regularity) of respiration.  A respiratory rate greater than 20 breaths/minin an adult would be considered tachypnea. (Adler & Carlton, pp 176-177) Ans. C 85. All of the following statements are true regarding the administration of a barium enema to a patient with a colostomy, except (A) The dressing should be removed and disposed of. (B) The drainage pouch should be retained unless a fresh one can be provided. (C) The colostomy tip or catheter should be selected by the radiologist. (D) The patient should not be permitted to insert the colostomy tip. —————————————————————————  When preparing a colostomy patientfor a barium enema, the dressing should be removed and disposed of.  The drainage pouch may be retained for reuse unless the patient indicates that she or he has a fresh pouch or, if the department stocks them, the radiographer offers to provide one.  The choice of colostomy tip or catheter should be discussed with the radiologist. o If a catheter is selected, the inflation cuff must be large enough to prevent barium from leaking, yet small enough so that the stoma area is not damaged.  It is always a good idea to ask the patient if he or she would prefer to insert the colostomy tip.  Patients are often used to caring for their stoma, and they may be more comfortable if they have control of the situation. (Torres, p 209) Ans. D 86. Because of medicolegal considerations, radiographic images are required to include all the following information, except (A) the patient's name and/or identification number. (B) the patient's birth date. (C) a right or left side marker. (D) the date of the examination. ————————————————————————— Every radiographic image must include (1) the patient's name or ID number; (2) the side marker, right or left; (3) the date of the examination; and (4) the identity of the institution or office. Additional information may be included: the patient's birth date or age, the attending physician, and the time of day. When multiple exams (e.g., chest exams or small bowel images) of a patient are made on the Reviewer A&R Question & Answer 32 Review Notes for the RADIOGRAPHY EXAM Appelton same day, it becomes crucial that the time the radiographs were taken be included on the film. This allows the physician to track the patient's progress. (Ballinger & Frank, vol 1, pp 22-23) Ans. B 87. The condition that allows blood to shunt between the right and left ventricles is called (A) patent ductus arteriosus. (B) coarctation of the aorta. (C) atrial septal defect. (D) ventricular septal defect. ————————————————————————— Ventricular septal defect is a congenital heart condition characterized by a hole in the interventricular septum, which allows oxygenated and unoxygenated blood to mix. o Some interventricular septal defects are small and close spontaneously; others require surgery. Coarctation of the aorta is a narrowing or constriction of the aorta. Atrial septal defect is a small hole (the remnant of the fetal foramen ovale) in the interatrial septum. o It usually closes spontaneously in the first months of life; if it persists or is unusually large, surgical repair is necessary. A Patent ductus arteriosus is one that persists and requires surgical closure. o The ductus arteriosus is a short fetal blood vessel connecting the aorta and pulmonary artery that usually closes within 10 to 15 h after birth. (Taber's, p 2323) Ans. D 88. Which of the following statements are true regarding the proper care of a patient with a tracheostomy? 1. Employ sterile technique if you must touch a tracheostomy for any reason. 2. Before you suction a tracheostomy, the patient should be well aerated. 3. Never suction for longer than 15 s, permitting the patient to rest in between. (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3 —————————————————————————  All of the statements in the question are true regarding the proper care of a patient with a tracheostomy. If a tracheostomy needs to be touched for any reason, sterile technique should be employed to avoid the possibility of infection. Patients with tracheostomies require frequent suction. This is usually not performed by the technologist, but radiographers may be called upon to assist with suctioning, especially for patients who must be in the radiology department for lengthy procedures. Patients who are to be suctioned should be aerated beforehand (that is, oxygen should be administered prior to suctioning). o It is also important that patients be permitted to rest during suctioning. Never suction for longer than 15 s; check breath sounds with a stethoscope to ensure that the airway is clear. Reviewer A&R Question & Answer 33 Review Notes for the RADIOGRAPHY EXAM Appelton  It is the radiographer's responsibility to check the work area and ensure that the suction is working and that ample ancillary supplies (suction kit, catheters, tubing) are available. (Adler & Carlton, p 235) Ans. D 89. Skin discoloration due to cyanosis may be observed in the 1. gums. 2. nailbeds. 3. thorax. (A) 1 only (B) 1 and 2 only (C) 3 only (D) 1, 2, and 3 —————————————————————————  Cyanosis is a condition resulting from a deficiency of oxygen circulating inthe blood. o It is characterized by bluish discoloration of the gums, nailbeds, and earlobes, and around the mouth.  Cyanosis may be accompanied by labored breathing or other types of respiratory distress. (Torres, p 137) Ans. B 90. Which of the following radiographic procedures requires an intrathecal injection? (A) Intravenous pyelogram (B) Myelogram (C) Lymphangiogram (D) Computed tomography (CT) —————————————————————————  A myelogram, or radiographic examination of the spinal canal, requires an intrathecal (intraspinal) injection. o Intrathecal administration of contrast medium is usually at the level of L2/3 or L3/4.  An intravenous pyelogram is performed with an injection of contrast medium into the venous system.  A lymphangiogram requires that contrast medium be delivered into the lymphatic vessels.  A CT scan may or may not require the use of an intravenous injection. (Torres, p 306) Ans. B 91. When a patient with an arm injury needs help in undressing, the radiographer should (A) remove clothing from the injured arm first. (B) remove clothing from the uninjured arm first. (C) always remove clothing from the left arm first. (D) always cut clothing away from the injured extremity. —————————————————————————  When assisting the patient with changing, first remove clothing from the unaffected side. o If this is done, removing clothing from the affected side will require less mo