Patient Care Flashcards

C health-care institution.

-Radiographs are the property of the health-care institution and are a part of every patient's permanent medical record. They are often retained on file for about 7 years or, in the case of pediatric patients, until the patient reaches maturity. They are not the personal property of either the radiologist or the referring physician. If a patient changes doctors or needs a second opinion, copies can be requested. The patient may also borrow the originals, which must be returned, or he or she may pay for copies.

B choking.

-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. A person with a completely obstructed airway will not be able to speak or cough. If the person cannot speak or cough, then the airway is obstructed, and the Heimlich maneuver should be performed. 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. 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. 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.

B remove clothing from the uninjured arm first.

-When assisting the patient in changing, first remove clothing from the unaffected side. If this is done, removing clothing from the affected side will require less movement and effort. The patient's clothing should be cut away only as a last resort in cases of extreme emergency and with the patient's consent.

D 1, 2, and 3

-Airborne, fomite, and vector are all indirect modes of transmitting microorganisms. Direct contact involves actual touching of the infected person. A fomite is an inanimate object that has been in contact with an infectious microorganism (e.g., doorknobs or x-ray tables). Although an inanimate object may serve as a temporary host for microbes, microbes flourish on and in the human host, where plenty of body fluids and tissues nourish and feed them. A vector is an animal host of an infectious organism that transmits the infection via a bite or sting, such as the mosquito or deer tick. Airborne contamination occurs via droplets (sneeze) or dust.

B 1 and 2 only

-Any disease spread by direct or close contact, such as MRSA and Clostridium difficile (C-diff), and some wounds require contact precautions. Contact precaution procedures require a private patient room and the use of gloves and gowns for anyone coming in direct contact with the infected individual or the infected person's environment. Some facilities require health care workers to wear a mask when caring for a patient with MRSA infection.

C 1 and 2 only

-Hypoglycemic reactions can be very severe and should be treated with an immediate dose of sugar (e.g., in juice). Early symptoms of an insulin reaction are shaking, nervousness, dizziness, cold and clammy skin, blurred vision, and 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.

C 1 and 2 only

-The development of male and female reproductive stem cells has important radiation protection implications. Male stem cells reproduce continuously. However, female stem cells develop only during fetal life; women are born with all the reproductive cells they will ever have. It is exceedingly important to shield children whenever possible because they have their reproductive futures ahead of them.

B medical asepsis.

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

D 1, 2, and 3

-Body substance precaution procedures identify various body fluids as infectious or potentially infectious. These body substances include pleural, pericardial, peritoneal, and amniotic fluids; synovial fluid; cerebrospinal fluid (CSF); breast milk; and vaginal secretions, as well as nasal secretions, tears, saliva, sputum, feces, urine, and wound drainage.

D 1, 2, and 3

-All these symptoms are related to a respiratory reaction. There also may be urticaria, scratchy throat, nasal congestion. The patient who has received contrast media should be watched closely. If any symptoms arise, the radiologist should be notified immediately.

C IV catheter.

-A Swan–Ganz catheter is a specific type of IV catheter used to measure the pumping ability of the heart, to obtain pressure readings, and to introduce medications and IV fluids. A pacemaker is a device that is inserted under the patient's skin to regulate heart rate. Pacemakers may be permanent or temporary.Chest tubes are used to remove fluid or air from the pleural cavity. Any of these items may be identified on a chest radiograph, provided that the IP is properly positioned and the correct exposure factors are employed. If the physician is interested in assessing the proper placement of a Swan–Ganz catheter, the lungs may have to be slightly overexposed 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.

D 1, 2, and 3

-A tort is an intentional or unintentional act that involves personal injury or damage to a patient. Allowing a patient to be exposed to unnecessary radiation, either by neglecting to shield the patient or by performing an unwanted examination, would be considered a tort, and the radiographer would be legally accountable. Discussing a patient's condition with a third party undoubtedly would be considered a serious intentional tort.

C Disease phase

-Of the four stages of infection, the stage during which the infection is most communicable is the disease phase. In the initial phase, the latent period, the infection is introduced and lies dormant. As soon as the microbes begin to shed, the infection becomes communicable. The microbes reproduce (during the incubation period), and during the actual disease period signs and symptoms of the infection may begin. The infection is most active and communicable at this point. As the patient fights off the infection, and the symptoms regress, the convalescent (recovery) phase occurs.

B 2 only

-The normal blood pressure range for men and women is a 110 to 140 mmHg systolic reading (left number) and a 60 to 80 mmHg diastolic reading (right number). Systolic pressure is the contraction phase of the left ventricle, and diastolic pressure is the relaxation phase in the heart cycle.

C Objective signs

-Interviewing skills and the collection of valuable, objective, and subjective patient data (clinical history) are an important function of the health care professional. Objective data are those that are discernible to the senses of the interviewer—objective signs that can be heard, seen, or felt. Subjective data are those that can be discerned only by the patient—pain, emotions, and so on. Chief complaint is the principal medical problem as stated by the patient.

C 2 and 3 only

-The word honor implies regard for the standards of one's profession, a refusal to lie/deceive, an uprightness of character or action, a trustworthiness and incorruptibility. Other words used to describe these qualities are honesty, integrity, and probity.

These are qualities required of students and health care professionals. This honor/integrity can only be achieved in an environment where intellectual honesty and personal integrity are highly valued—and where the responsibility for communicating and maintaining these standards is widely shared. The ARRT publishes an important document regarding Honor Code violations. In order to meet ARRT certification requirements, candidates for the ARRT exam must answer the question: “Have you ever been suspended, dismissed, or expelled from an educational program that you have attended?” … in addition to reading and signing the “Written Consent under FERPA,” allowing the ARRT to obtain specific parts of their educational records concerning violations to an honor code if the student has ever been suspended, dismissed, or expelled from an educational program attended. If the applicant answers “yes” to that question he or she must include an explanation and documentation of the situation with the completed application for certification. If the applicant has any doubts, he or she should contact the ARRT Ethics Requirements Department at (651) 687-0048, ext. 8580.

B Heparin lock

-Another name for an intermittent injection port is a heparin lock. Heparin locks are used for patients who will require frequent or regular injections. An intravenous catheter is placed in the vein, and an external adapter with a diaphragm allows for repeated injections. This helps to prevent the formation of scarred, sclerotic veins as a result of frequent injections at the same site. Heparin locks provide more freedom than an IV infusion, which also allows for repeated access. Hypodermic needles usually are used for drawing blood or drawing up fluids, whereas a butterfly needle usually is used for venipuncture.

A assault.

-Assault is the threat of touching or laying hands on someone. If a patient feels threatened by a practitioner, either because of the tone or pitch of the practitioner's voice or because the practitioner uses words that are threatening, the practitioner can be accused of assault. A radiographer who performs the wrong examination on a patient may be charged with battery. Battery refers to the unlawful laying of hands on a patient. The radiographer also could be charged with battery if a patient were moved about roughly or touched in a manner that is inappropriate or without the patient's consent. False imprisonment may be considered if a patient is ignored after stating that he or she no longer wishes to continue with the procedure or if restraining devices are used improperly or used without a physician's order. The accusation of defamation can be upheld when patient confidentiality is not respected, and as a result, the patient suffers embarrassment or mockery.

D 1, 2, and 3

-The cycle of infection includes four components—a susceptible host, a reservoir of infection, a pathogenic organism, and a means of transmission. Pathogenic organisms are microscopic and include bacteria, fungi, and viruses. The reservoir of infection is the environment in which the microorganism thrives; this can be the human body. A susceptible host may have reduced resistance to infection. The means of transmission is either direct (touch) or indirect (vector, fomite, airborne).

C 1 and 3 only

-The tracheostomy patient will have difficulty speaking as a result of 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

C the right to order an x-ray procedure.

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

1. The right to considerate and respectful care

2. The right to be informed completely and understandably

3. The right to refuse treatment

4. The right to have an advance directive (e.g., a living will or health care proxy)

5. The right to privacy

6. The right to confidentiality

7. The right to review one's records

8. The right to request appropriate and medically indicated care and services

9. The right to know about institutional business relationships that could influence treatment and care

10. The right to be informed of, consent to, or decline participation in proposed research studies

11. The right to continuity of care

12. The right to be informed of hospital policies and procedures relating to patient care, treatment, and responsibilities

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

A 90°

-Medications can be administered in a number of ways. Parenteral administration refers to drugs administered via intramuscular, subcutaneously, intravenously, or intrathecally—that is, any way other than by mouth. Intramuscular drug injections usually require that the needle form a 90° angle of injection. For subcutaneous injections the needle should form a 45° angle. Intravenous injections generally require that the needle form about a 15° angle with the arm.

D 1, 2, and 3

-The Centers for Disease Control and Prevention (CDC) has established rules that serve to protect health care workers. The CDC states that human blood and certain body fluids must be treated as though they contain pathogenic microorganisms. Therefore health care workers wear gloves whenever they might come in contact with blood, synovial fluid, mucous membrane, CSF, seminal or vaginal fluid, wounds, and any surface or body fluid containing blood. If there is any concern of spray or splash of these body fluids, a gown and eye shields should also be worn.

B 1 and 3 only

-Both ultrasound and magnetic resonance imaging do not require the use of ionizing radiation to produce an image. Computed axial tomography does require ionizing radiation to produce an image. Ultrasound requires the use of high-frequency sound waves to produce images of soft tissue structures and certain blood vessels within the body. Magnetic resonance imaging relies on the use of a very powerful magnet and specially designed coils that are sensitive to radio-wave signals to produce the image.

C Veracity

-Veracity (i.e., sincerity) is not only telling the truth but also not practicing deception. Autonomy is the ethical principle that is related to the theory that patients have the right to decide what will or will not be done to them. Beneficence is related to the idea of doing good and being kind. Fidelity is faithfulness and loyalty.

A hypertensive.

-Systolic blood pressure describes the pressure during contraction of the heart. It is expressed as the top (left) number when recording blood pressure. Diastolic blood pressure is the reading during relaxation of the heart and is placed on the bottom (right) when recording blood pressure. A patient is considered hypertensive when the systolic pressure is consistently above 140 mm Hg and hypotensive when the systolic pressure is lower than 90 mm Hg.

B nasal cannula.

-The most commonly used method of low-flow oxygen delivery is the nasal cannula. It can be used to deliver oxygen at rates from 1 to 4 L/min at concentrations of 24% to 36%. The nasal cannula also provides increased patient freedom to eat and talk, which a mask does not. Masks are used for higher-flow concentrations of oxygen, over 5 L/min; depending on the type of mask, they can deliver anywhere from 35% to 60% oxygen. Respirators and ventilators are high-flow delivery mechanisms that are used for patients who are in severe respiratory distress or are unable to breathe on their own. Oxyhoods or tents generally are used for pediatric patients who may not tolerate a mask or cannula. The amount of oxygen delivered is somewhat unpredictable, especially if the opening is accessed frequently. Oxygen delivery may be between 20% and 100%.

B a vial.

-Injectable medications are available in two different kinds of containers. An ampule is a small container that usually holds a single dose of medication. A vial is a somewhat larger container that holds a number of doses of 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.

D 100 mm Hg

-The diastolic number is the bottom (right) number in a blood pressure reading. The normal range for diastolic pressure is considered to be 60 to 80 mm Hg. A diastolic pressure reading of 110 mmHg might indicate hypertension. A diastolic pressure of 50 mm Hg might indicate shock. The systolic number is the top (left) number in a blood pressure reading. The normal systolic pressure range is 110 to 140 mm Hg.

C report this directly to the ARRT.

-The ARRT Rules of Ethics are mandatory minimum professional standards for all RTs and candidate RTs. Violators, and individuals who permit violation, of these Rules are subject to sanctions. Rules of Ethics numbers 15 and 21 specifically refer to those who knowingly assist another without proper certification to engage in the practice of radiologic technology, and/or those who fail to promptly report such activity to the ARRT—as being subject to sanction.

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. In keeping with these standards, all diagnostic and therapeutic orders must appear on the patient's medical record or chart. Additionally, patient identification information, medical history, consent forms, and any diagnostic and therapeutic reports should also be part of the patient's permanent record. The patient's chart is a means of communication between various health-care providers.

B Battery

-A radiographer who performs the wrong examination on a patient may be charged with battery. Battery refers to the unlawful laying of hands on a patient. The radiographer also could be charged with battery if a patient is moved about roughly or touched in a manner that is inappropriate or without the patient's consent. Assault is the threat of touching or laying hands on someone. If a patient feels threatened by a practitioner, either because of the tone or pitch of the practitioner's voice or because the practitioner uses words that are threatening, the practitioner can be accused of assault. False imprisonment may be considered if a patient is ignored after stating that she no longer wishes to continue with the procedure or if restraining devices are used improperly or used without a physician's order. The accusation of defamation can be upheld when patient confidentiality is not respected and, as a result, the patient suffers embarrassment or mockery.

B anaphylaxis.

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

C magnetic resonance imaging (MRI)

-Patients are instructed to remove all jewelry, hair clips, metal prostheses, coins, and credit cards before entering the room for MRI. MRI does not use radiation to produce images but instead uses a very strong magnetic field. All patients must be screened prior to entering the magnetic field to be sure that they do not have any metal on or within them. Proper screening includes questioning the patient about any eye injury involving metal, cardiac pacemakers, aneurysm clips, insulin pumps, heart valves, shrapnel, or any metal in the body. This is extremely important, and if there is any doubt, the patient should be rescheduled for a time after it has been determined that it is safe for him or her to enter the room. Patients who have done metalwork or welding are frequently sent to diagnostic radiology for screening images of the orbits to ensure that there are no metal fragments near the optic nerve. Any external metallic objects, such as bobby pins, hair clips, or coins in the pocket, must be removed, or they will be pulled by the magnet and can cause harm to the patient. Credit cards and any other plastic cards with a magnetic strip will be wiped clean if they come in contact with the magnetic field.

A keep hands and forearms higher than elbows.

-Frequent and correct hand hygiene is an essential part of medical asepsis; it is the best method for avoiding the spread of microorganisms. If the faucet cannot be operated with the knee or a foot pedal, it should be opened and (especially) closed using paper towels. Care should be taken to wash all surfaces of the hand and between the fingers thoroughly. The hands and forearms always should be lower than the elbows. Hand lotions should be used frequently to keep hands from chapping. Unbroken skin prevents the entry of microorganisms; dry, cracked skin breaks down that defense and permits the entry of microorganisms.

D left vertebral artery

The figure illustrates the aortic arch (number 1) and its three main branches—the brachiocephalic artery (number 6), the left common carotid artery (number 4), and the left subclavian artery (number 2). The right common carotid artery (number 5) and the right subclavian artery (number 7) are branches of the brachiocephalic. The vertebral arteries are the first main branch of the subclavian arteries. The left vertebral artery is labeled number 3.

C 2 and 3 only

-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, especially on hard surfaces. A ntiseptics (like alcohol) are used to stop the growth/spread of pathogenic microorganisms, especially on living tissue.Sterilization is another associated term; it refers to the killing of all microorganisms and their spores.

A denial.

-Dr. Elizabeth Kubler-Ross explains that loss requires gradual adjustment and involves several steps. The first is denial or isolation, where the individual often refuses to accept the thought of loss or death. The second step is anger, as the individual attempts to deal with feelings of helplessness. The next is bargaining, in which the patient behaves as though “being good” like a “good patient” will be rewarded by a miraculous cure or return of the loss. Once the individual acknowledges that this is not likely to happen, depression is the next step. This depression precedes acceptance, where the individual begins to deal with fate or loss.

C HIPAA

-Hospital information systems must ensure confidentiality in compliance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations. Most institutions now have computerized, paperless systems that accomplish the same information transmittal; these systems must ensure confidentiality in compliance with HIPAA regulations. The health care professional generally has access to the computerized system only via personal password, thus helping to ensure confidentiality of patient information. All medical records and other individually identifiable health information, whether electronic, on paper, or oral, are covered by HIPAA legislation and by subsequent Department of Health and Human Services (HHS) rules that took effect in April of 2001

C stimulate defecation.

-Cathartics stimulate defecation and are used in preparation for radiologic examinations of the large bowel. Diuretics are used to promote urine elimination in individuals whose tissues are retaining excessive fluid. Emetics induce vomiting, and antitussives are used to inhibit coughing.

A Ewing sarcoma

-Ewing sarcoma is a (primary) malignant bone tumor that arises from bone marrow and occurs in children and young adults. The disease is characterized by new bone formation in a layering effect—giving the bone the characteristic “onion peel” appearance radiographically. Multiple myeloma is also a cancerous bone tumor usually affecting adults between the ages of 40 and 70 years. Bone undergoes osteolytic changes, and radiographic demonstration appears as circular areas of bone loss. As their name implies (chondr), enchondroma and osteochondroma involve cartilage—they are both benign conditions.

B The brachial artery is temporarily collapsed.

-A stethoscope and a sphygmomanometer are used together to measure blood pressure. The sphygmomanometer's cuff is placed around the midportion of the upper arm. The cuff is inflated to a value higher than the patient's systolic pressure to temporarily collapse the brachial artery. As the inflation is gradually released, the first sound heard is the systolic pressure; the normal range is 110 to 140 mmHg. When no more sound is heard, the diastolic pressure is recorded. The normal diastolic range is 60 to 90 mm Hg. Elevated blood pressure is called hypertension. Hypotension, low blood pressure, is not of concern unless it is caused by injury or disease; in that case, it can result in shock.

B cardiogenic.

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

A induce vomiting

-Emetics, such as ipecac, function to induce vomiting. Cathartics are used to stimulate defecation (bowel movements). Diuretics are used to promote urine elimination in individuals whose tissues are retaining excessive fluid. And antitussives are used to inhibit coughing.

D orthostatic hypotension

-A patient who has been recumbent for some period of time and gets up quickly may suffer from light-headedness or feel faint. This is referred to as orthostatic hypotension. It is best to have patients sit up and dangle their feet from the table for a moment while being supported and then assist them off the table. Patients also will feel better emotionally if they are not rushed or treated like they are on an assembly line. Always assist patients on and off of the radiographic table. Even healthy, young outpatients can injure themselves. Patients with dyspnea or orthopnea are unable to lie supine.Dyspnea and orthopnea refer to difficulty breathing; this may be due to a heart condition, asthma, strenuous exercise, or excessive anxiety. Hypertension refers to the condition of elevated blood pressure.

D Combats bacterial growth

-An analgesic is any drug, such as aspirin, which functions to relieve pain. An anticoagulant (e.g., heparin) is used to prevent clotting of blood. A diuretic is used to increase urine output. And an antibiotic (e.g., penicillin) fights the growth of bacterial microorganisms.

B 1 and 2 only

-The American Hospital Association identifies 12 important areas in its "Patients' Bill of Rights." These include the right to refuse treatment (to the extent allowed by law), the right to confidentiality of records and communication, and the right to continuing care. Other patient rights identified are the right to informed consent, privacy, respectful care, access to records, refuse to participate in research projects, and an explanation of the hospital bill.

B Contributory negligence

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

D Immediately stop the procedure and inform the radiologist and the referring physician of the patient's request.

-According to the patient's bill of rights, the patient's verbal request supersedes any prior written consent. It is not appropriate to dismiss the patient without notifying the referring physician and the radiologist. The patient may very well need a particular radiographic examination to make a proper diagnosis or for preoperative planning, and the radiographer must inform the physician of the patient's decision immediately

D 1, 2, and 3

-For negligent tort liability, four elements must be present—duty (what should have been done), breach (deviation from duty), injury sustained, and cause (as a result of breach). The assessment of duty is determined by the professional standard of care. Examples of negligent torts include patient injury as a result of a fall while unattended on an x-ray table, in a radiographic room, or on a stretcher without side rails or safety belt. Radiographing the wrong patient and radiographing the opposite limb are other examples of negligence. If patient injury results from misperformance of a duty in the routine scope of practice of the radiographer, most courts will apply res ipsa loquitur; that is, “the thing speaks for itself.” If the patient is obviously injured as a result of the radiographer's actions, it becomes the radiographer's burden to disprove negligence. In many instances, the hospital and/or radiologist also will be held responsible according to respondeat superior, or “the master speaks for the servant.”

C 1 and 2 only

-Invasion of privacy—that is, public discussion of privileged and confidential information—is intentional misconduct. False imprisonment, such as unnecessarily restraining a patient, is also intentional misconduct. However, if a radiographer left a weak patient standing while leaving the room to check images or get supplies and the patient fell and sustained an injury, that would be considered unintentional misconduct or negligence.

A right main stem bronchus

-Because the right main stem bronchus is wider and more vertical, aspirated foreign bodies are more likely to enter it than the left main stem bronchus, which is narrower and angles more sharply from the trachea. An aspirated foreign body does not enter the esophagus or the stomach because they are not respiratory structures. The esophagus and stomach are digestive structures; a foreign body would most likely be swallowed to enter these structures.

D Hypovolemic

-Shock caused by an abnormally low volume of blood in the body is termed hypovolemic shock. Neurogenic shock can be caused by some kind of trauma to the nervous system, that is, spinal cord injury or extreme psychological stress. Cardiogenic shock is related to the heart and caused by failure of the heart to pump adequate blood to the body's vital organs. Septic shock can result when the body is invaded by bacteria; there are signs of acute septicemia and hypotension.

A osmolality.

-In classifying contrast agents, the total number of dissolved particles in solution per kilogram of water defines the osmolality of the contrast agent. The toxicity defines how noxious or harmful a contrast agent is. Contrast agents with low osmolality have been found to cause less tissue toxicity than the ionic IV contrast agents. The viscosity defines the thickness or concentration of the contrast agent. The viscosity of a contrast agent can affect its injection rate. A thicker, or more viscous, contrast agent will be more difficult to inject (more pressure is needed to push the contrast agent through the syringe and needle or the angiocatheter). The miscibility of a contrast agent refers to its ability to mix with body fluids, such as blood. Miscibility is an important consideration in preventing thrombus formation. It is generally preferable to use a contrast agent with low osmolality and low toxicity because such an agent is safer for the patient and less likely to cause any untoward reactions. When ionic and nonionic contrast agents are compared, a nonionic contrast agent has a lower osmolality. To further understand osmolality, remember that whenever IV contrast media are introduced, there is a notable shift in fluid and ions. This shift is caused by an inflow of water from interstitial regions into the vascular compartment, which increases the blood volume and cardiac output. Consequently, there will be an increase in systemic arterial pressure and peripheral vascular resistance with peripheral vasodilation. In addition, the pulmonary pressure and heart rate increase. When the effects of osmolality on the patient are understood, it becomes clear that an elderly patient or one with cardiac disease or impaired circulation would greatly benefit from the use of an agent with lower osmolality.

A hemoptysis

-The expectoration of blood from the larynx, trachea, bronchi, or lungs is termed hemoptysis.Hemoptysis can occur in several diseases, including pneumonia, bronchitis, pulmonary tuberculosis, and others. Hematemesis is vomiting of blood—this can occur with gastric ulcers, gastritis, esophageal varices, and other conditions.

A millimeters of mercury (mm Hg).

-Blood pressure is measured in millimeters of mercury (mm Hg). Heart rate, or pulse, is measured in units of beats per minute. Temperature is measured in degrees Fahrenheit (°F). Oxygen delivery is measured in units of liters per minute (L/min). Table 1–1 outlines the normal ranges for vital signs in healthy adults.(Torres et al., 6th ed., p. 147)

Table 1–1 NORMAL RANGES FOR VITAL SIGNS IN ADULTS

Blood pressure110–140 mm Hg/60–80 mm Hg

Pulse rate 60–100 beats/min

Temperature 97.7°F–99.5°F

Respiration rate 12–20 breaths/min

A vector

-A vector is an animal host of an infectious organism that transmits the infection via a bite or sting, such as the mosquito (malaria) and the deer tick (Lyme disease). 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 for microbes to grow, microbes flourish on and in the human host, where plenty of body fluids and tissue nourish and feed the microbes.

A defibrillator.

-The mechanical device used to correct an ineffectual cardiac ventricular rhythm is a defibrillator. The two paddles attached to the unit are placed on a patient's chest and used to introduce an electric current in an effort to correct the dysrhythmia. Automatic implantable cardioverter defibrillators (AICDs) are devices that are implanted in the body and that deliver a small shock to the heart if a life-threatening dysrhythmia occurs. A cardiac monitor is used to display, and sometimes record, electrocardiographic (ECG) readings and some pressure readings. A crash cart is a supply cart with various medications and equipment necessary for treating a patient who is suffering from a myocardial infarction or some other serious medical emergency. It is checked and restocked periodically. Aresuscitation bag is used for ventilation, such as during CPR.

A 1 only

-The shortest possible exposure should be used as a matter of routine. Parkinson disease is characterized by uncontrollable tremors, and the resulting unsharpness can destroy image resolution. High ratio grid will absorb a higher percentage of scattered radiation but increase patient dose. Compensating filtration is unrelated to the problem and is not indicated here.

A respiratory isolation

-The type of isolation practiced to prevent the spread of infectious agents in aerosol form is respiratory isolation. A mask is sufficient protection from aerosol transmission of pathogens. Protective isolation,also referred to as reverse isolation, is used to protect patients whose immune systems are compromised. Patients receiving chemotherapy, burn patients, or patients who are human immunodeficiency virus (HIV)–positive all may have compromised immune systems. Contact isolation is used when there is a chance that infection may be spread by contact with body fluids. Gloves and a gown are used, and goggles and masks may be necessary if there is a chance of fluids spraying, such as in biopsy or drainage. Strict isolation is practiced with highly contagious diseases or viruses that may be spread by air and/or contact.

A tid.

-Three times a day is indicated by the abbreviation tid. The abbreviation qid means four times a day. Every hour is represented by qh, and pc means after meals.

A 1 only

-When performing bedside radiography in a contact isolation room, the radiographer should wear a gown and gloves. 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,” whereas the other handles the patient. The mobile unit should be cleaned with a disinfectant on exiting the patient's room, not prior to entering.

D 1, 2, and 3

-Normal blood pressure is 110 to 140 mmHg systolic and 60 to 80 mmHg diastolic. High blood pressure (hypertension) is indicated by systolic pressure higher than 140 mmHg and diastolic pressure higher than 90 mmHg. Hypertension can be identified as extreme or moderate. Extreme hypertension can result in brain damage within just a few minutes. Moderate hypertension can cause damage to organs: the lungs, kidneys, brain, heart, and so on. Various disease processes can produce hypertension as well as contributing factors such as medications, obesity, smoking, and stress.

A in contact with the floor or other horizontal surface.

-Proper body mechanics includes a wide base of support. The base of support is the portion of the body that is in contact with the floor or some other horizontal plane. The center of gravity is the midpoint of the pelvis or lower abdomen, depending on body build. The line of gravity is the abstract line passing vertically through the center of gravity. Proper body mechanics can help to prevent painful back injuries by making proficient use of the muscles in the arms and legs.

A Genetically significant dose

-The genetically significant dose (GSD) illustrates that large exposures to a few people are cause for little concern when diluted by the total population. On the other hand, we all share the burden of the radiation that is received by the total population, and especially as the use of medical radiation increases, each individual's share of the total exposure increases

C infection acquired in a hospital.

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

D 1, 2, and 3

-DXA imaging is used to evaluate bone mineral density (BMD). It is the most widely used method of bone densitometry—it is low-dose, precise, and uncomplicated to use/perform. DXA uses two photon energies—one for soft tissue and one for bone. Since bone is denser and attenuates x-ray photons more readily, their attenuation is calculated to represent the degree of bone density. Bone densitometry/DXA can be used to evaluate bone mineral content of the body or part of it, to diagnosis osteoporosis, or to evaluate the effectiveness of treatments for osteoporosis.

B Epinephrine

-Epinephrine (Adrenalin) is the vasopressor used to treat an anaphylactic reaction or cardiac arrest.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.

C upper GI series.

-A signed consent form (informed consent) is not necessary prior to performing an upper GI series. Informed consent is necessary before performing any procedure that is considered invasive or that carries considerable risk. A myelogram, a cardiac catheterization, and an interventional vascular procedure are all invasive procedures, and all carry some degree of risk. A physician should explain to the patient what those risks are as well as the risk of not having the procedure. In addition, the patient should be made aware of alternative procedures and the risks associated with the alternatives. Only after the patient has been made aware and all questions have been answered appropriately should the informed consent be signed. A radiographer is not responsible for obtaining informed consent. However, in some institutions, it may be departmental procedure for the radiographer to check the chart and see whether there is a signed consent form in place.

A extravasation.

-Extravasation occurs when medication or contrast medium is injected into the tissues surrounding a vein rather than into the vein itself. It can happen when the patient's veins are particularly deep and/or small. If this happens, the needle should be removed, pressure applied to prevent formation of a hematoma, and then moist heat applied to the affected area to help relieve pain. The antecubital vein is the most commonly used venipuncture site for contrast medium administration

C 1 and 3 only

-The diabetic patient who has taken their insulin, but not eaten food, can develop hypoglycemia/low blood sugar. Hypoglycemic reactions can be very severe and should be treated with an immediate dose of sugar in the form of juice or candy. Symptoms of hypoglycemia include fatigue, restlessness, irritability, and weakness. Diabetic patients who have taken their insulin prior to a fasting examination should be given priority, and their examinations should be expedited as quickly as possible.

C each lung is enclosed in peritoneum

-The trachea (windpipe) bifurcates into left and right main stem bronchi, each of which enters its respective lung hilum. The left bronchus divides into two portions—one for each lobe of the left lung. The right bronchus divides into three portions—one for each lobe of the right lung. The lungs are conical in shape, consisting of upper pointed portions, termed the apices (plural of apex), and broad lower portions (or bases). The lungs are enclosed in a double-walled serous membrane called the pleura

A Let the master answer.

-The legal doctrine res ipsa locquitur relates to “a matter that speaks for itself.” For instance, if a patient were admitted to the hospital to have a kidney stone removed and incorrectly was given an appendectomy, “that speaks for itself,” and negligence could be proven. Respondeat superior is the phrase meaning “let the master answer” or “the one ruling is responsible.” If a radiographer is 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.”

D Do not recap needle, dispose of entire syringe.

-Most needle sticks occur while attempting to recap a needle. Several diseases, including hepatitis and human immune-deficiency virus (HIV) infection, can be transmitted via a needle stick. Therefore, do not attempt to recap a needle, but rather dispose of the entire syringe with needle attached in the special container that is available.

B 1 and 2 only

-The overall chance that a person will become infected with HIV is high with entry sites such as the anus, broken skin, shared needles, infected blood products, and perinatal exposure. Low-risk entry methods include oral and nasal, conjunctiva, and accidental needle stick.

A 18 to 20 inches above the level of the vein.

-It is generally recommended that the IV bottle/bag be kept 18 to 20 inches above the level of the vein. If the container is too high, the pressure of the IV fluid can cause it to pass through the vein into surrounding tissues, causing a painful and potentially harmful condition. If the IV container is too low, blood may return through the needle into the tubing, form a clot, and obstruct the flow of IV fluid.

A 1 only

-Heparin is produced by the body (especially in the liver) and functions to prevent intravascular clotting. Heparin is also produced artificially and used to treat thromboembolic disorders. Lidocaine and Benadryl are drugs that are usually available on crash carts for emergency use. Lidocaine is used to treat ventricular arrhythmias, and Benadryl is used to treat allergic reactions and acute anaphylaxis.

B tissue drainage of wounds or postoperative drainage

-Hemovac or Penrose drains are used for tissue drainage of wounds or in postoperative drainage. Drainage tubes help prevent the formation of infection or fistulas in wounds and postoperative sites with large amounts of drainage. Bile duct drainage, when necessary, is performed with a T-tube, and radiographers often perform radiographic examinations of the T-tube to verify patency. Nasogastric and nasoenteric tubes may be used either for decompression of the gastrointestinal tract or to feed patients who are unable to swallow food normally. In addition, radiographic examination of the gastrointestinal tract may be performed by introducing a contrast agent into a nasogastric or nasoenteric tube.

A 1 only

- American College of Radiology (ACR) recommendations state that “there have been no reports of lactic acidosis following intravenous iodinated contrast medium administration in patients properly selected for metformin use”. The ACR recommends that metformin (Glucophage) patients be classified in two ways. Category 1 patients taking metformin are those with no evidence of AKI and with eGFR ≥30 mL/l.73² ; these patients need not discontinue metformin before or after receiving contrast, and it is not required that renal function be reassessed following the exam. Category 2 patients taking metformin are those having AKI or severe chronic kidney disease as indicated by eGFR, or that will be undergoing an arterial catheter study; these patients should temporarily discontinue metformin at time of (or prior to) the procedure, and withhold metformin for 48 hours after the procedure. Metformin should be reinstituted only after renal function studies have been reevaluated and found to be acceptable.

D Hysterosalpingography

-The lithotomy position is generally employed for hysterosalpingography. The lithotomy position requires that the patient lie on the back with buttocks at the edge of the table. The hips are flexed, the knees are flexed and resting on leg supports, and the feet rest in stirrups.

B 1 and 2 only

-Fluids and medications are administered to patients intravenously to achieve a more rapid response to the medication than if it were delivered orally or intramuscularly. The IV route is also often used to deliver parenteral nutrition to patients who cannot take their meals by mouth. Medications that are administered topically, such as calamine lotion, achieve a local effect.

A 1 1/2 in. superior to the xiphoid tip

-Location of the heels of the hands is of great importance during CPR. They should be placed about 1 1 /₂ in. superior to the xiphoid tip. In this way, the heart will receive the compressions it requires without causing internal injuries. Rib fractures can depress and cause injury to the lung tissues within the rib cage

A hub

-The diameter of a needle is the needle's gauge. The higher the gauge number, the thinner is the diameter. For example, a very tiny-gauge needle such as 25-gauge needle may be used on a pediatric patient for IV injection, whereas a large-gauge needle such as 16-gauge needle may be used for donating blood. The hub of the needle is the portion of the needle that attaches to a syringe. The length of the needle varies depending on its use. A longer needle is needed for intramuscular injections; a shorter needle, for a subcutaneous injection. The bevel of the needle is the slanted tip of the needle. For IV injections, the bevel should always face up.

B 1 and 2 only

-The heel effect is characterized by a variation in beam intensity that increases gradually from anode to cathode. This can be effectively put to use when performing radiographic examinations of large body parts with uneven tissue density. For example, the AP thoracic spine is thicker caudally than cranially, so the thicker portion is best placed under the cathode. However, in the lateral projection of the thoracic spine, the upper portion is thicker because of superimposed shoulders, and therefore, that portion is best placed under the cathode end of the beam. The femur is also uneven in tissue density, particularly in the AP position, and can benefit from use of the heel effect. However, the sternum and its surrounding anatomy are fairly uniform in thickness and would not benefit from use of the anode heel effect. The anode heel effect is most pronounced when using large IRs at short SIDs and with an anode having a steep (small) target angle.

D 1, 2, and 3

-Medical equipment that could contain latex includes disposable gloves, tourniquets, blood pressure cuffs, stethoscopes, IV tubing, oral and nasal airways, enema tips, endotracheal tubes, syringes, electrode pads, catheters, wound drains, and injection ports. It should be noted that when powdered latex gloves are changed, latex protein/powder particles get into the air, where they can be inhaled and come in contact with body membranes. Studies have indicated that when unpowdered gloves are worn, there are extremely low levels of the allergy-producing proteins present.

B 1 and 2 only

-DXA imaging is used to evaluate bone mineral density (BMD). Bone densitometry (i.e., DXA) can be used to evaluate bone mineral content of the body, or part of it, to diagnose osteoporosis or to evaluate the effectiveness of treatments for osteoporosis. It is the most widely used method of bone densitometry—it is low-dose, precise, and uncomplicated to use/perform. DXA uses two photon energies—one for soft tissue and one for bone. Since bone is denser and attenuates x-ray photons more readily, their attenuation is calculated to represent the degree of bone density. Soft tissue attenuation information is not used to measure bone density.

C a pulsed x-ray beam

-Although the CT x-ray tube is similar to direct-projection x-ray tubes, it has several special requirements. The CT x-ray tube must have a very high short-exposure rating and must be capable of tolerating several million heat units while still having a small focal spot for optimal resolution. To help tolerate the very high production of heat units, the anode must be capable of high-speed rotation. The x-ray tube produces a pulsed x-ray beam (1–5 ms) using up to about 1,000 mA. The collimator assembly has two parts: The prepatient, or predetector, collimator is at the x-ray tube and consists of multiple beam restrictions so that the x-ray beam diverges little. This reduces patient dose and reduces the production of scattered radiation, thereby improving the CT image. The post patient collimator, or predetector collimator, confines the exit photons before they reach the detector array and determines slice thickness.

C "I have several other patients, so please change quickly."

-The radiographer should never rush the patient. A patient is usually anxious from the start, and the anxiety of being instructed to "hurry up" is likely to make matters worse. The anxious patient will have difficulty following directions, and a good examination might be difficult to achieve. The anxious patient appreciates a radiographer who is compassionate enough to take the extra few minutes necessary for comfort.

A 1 and 2 only

-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"—that is, he or 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 IP and retrieve the IP. As the IP's protective plastic cover is folded down, 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. In addition, after the examination is completed, the mobile unit should be cleaned with a disinfectant. Conditions requiring the use of contact precautions also include hepatitis A and varicella infection.

D 1, 2, and 3

-Each time an x-ray exposure is made, less than 1% of the total energy is converted to x-rays, and the remainder (more than 99%) of the energy is converted to heat. Thus, it is important to use target material with a high atomic number and high melting point. The larger the actual focal-spot size, the larger is the area over which the generated heat is spread, and the more tolerant the x-ray tube is. Heat is particularly damaging to the target if it is concentrated or limited to a small area. A target that rotates during the exposure is spreading the heat over a large area, the entire surface of the focal track. If the diameter of the anode is greater, the focal track will be longer, and heat will be spread over an even larger area.

C 1 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, and diastolic pressure is the relaxation phase in the heart cycle

B slander

-A radiographer who discloses confidential information to unauthorized individuals may be found guilty of invasion of privacy. If the disclosure is in some way detrimental or otherwise harmful to the patient, the radiographer may be accused of defamation. Spoken defamation is slander; written defamation is libel. Assault is to threaten harm; battery is to carry out the threat.

B Patient's father

-If mechanical restraint is impossible, a friend or relative accompanying the patient should be requested to hold the patient. If a parent is to perform this task, it is preferable to elect the father so as to avoid the possibility of subjecting a newly fertilized ovum to even scattered radiation. If a friend or relative is not available, a nurse or transporter may be asked for help. Protective apparel, such as lead apron and gloves, must be provided to the person(s) holding the patient. Radiology personnel must never assist in holding patients, and the individual assisting must never be in the path of the primary beam.

C Persons in sterile dress should pass each other face to face.

-Persons in sterile dress should not pass each other face to face. Rather, they should pass each other back to back to avoid contaminating each other. Gowns are considered sterile in the front down to the waist, including the arms. Sterile gloves must be kept above the waist level. If the hands are accidentally lowered or placed behind the back, they are no longer sterile. A sterile field should not be left unattended. Sterile fields should be set up immediately prior to a procedure and should be covered with a sterile drape if a few moments are to elapse before the procedure can begin. A sterile field should be monitored constantly to be certain that it has not been contaminated.

C Emphysema

-Emphysema is abnormal distension of the pulmonary alveoli (or tissue spaces) with air. The presence of abnormal amounts of air makes a decrease from normal exposure factors necessary to avoid excessive receptor exposure. Congestive heart failure, pneumonia, and pleural effusion all involve abnormal amounts of fluid in the chest and, therefore, would require an increase in exposure factors.

D review any institutional records.

-The AHA publishes a Patient's Bill of Rights, which details 12 specific areas of patients' rights and the health care professional's ethical (and often legal) responsibility to adhere to these rights. The Patient's Bill of Rights is summarized as follows:

1. The right to considerate and respectful care

2. The right to be informed completely and understandably

3. The right to refuse treatment

4. The right to have an advance directive (e.g., a living will or health care proxy)

5. The right to privacy

6. The right to confidentiality

7. The right to review one's records

8. The right to request appropriate and medically indicated care and services

9. The right to know about institutional business relationships that could influence treatment and care

10. The right to be informed of, consent to, or decline participation in proposed research studies

11. The right to continuity of care

12. The right to be informed of hospital policies and procedures relating to patient care, treatment, and responsibilities

Although it is the patient's right to appropriate and medically indicated care and services, only a physician may order an x-ray procedure—just as it is only the physician who may order prescription drugs. Although it is the patient's right to review his or her records and the patient's right to know about institutional business relationships that could influence treatment and care, the patient does not have the right to review just any hospital/institutional records. The AHA recently replaced the Patient's Bill of Rights with The Patient Care Partnership—Understanding Expectations, Rights and Responsibilities. This plain-language brochure includes the essentials of the Patient's Bill of Rights and reviews what patients can and should expect during a hospital stay.

B aspiration

-Inhalation of a foreign substance such as water or food particles into the airway and/or bronchial tree is called aspiration. Asphyxia is caused by deprivation of oxygen as a result of interference with ventilation from trauma, electric shock, and so on. Atelectasis is incomplete expansion of a lung or portion of a lung. Asystole is cardiac standstill—failure of the heart muscle to contract and pump blood to vital organs.

D 1, 2, and 3

-When a diabetic patient misses an insulin injection, the body loses its ability to metabolize glucose, and ketoacidosis can occur. If this is not corrected quickly, the patient may become comatose. Symptoms of impending coma include increased urination, sweet (fruity) breath, and extreme thirst. Other symptoms are weakness and nausea.

D DNA molecules

-The principal interactions that occur between x-ray photons and body tissues in the diagnostic x-ray range, the photoelectric effect and Compton scatter, are ionization processes producing photoelectrons and recoil electrons that traverse tissue and subsequently ionize molecules. These interactions occur randomly but can lead to molecular damage in the form of impaired function or cell death. The target theory specifies that DNA molecules are the targets of greatest importance and sensitivity; that is, DNA is the key sensitive molecule. However, since the body is 65% to 80% water, most interactions between ionizing radiation and body cells will involve radiolysis of water rather than direct interaction with DNA. The two major types of effects that occur are the direct effect and the indirect effect. The direct effect usually occurs with high-LET radiations and when ionization occurs at the DNA molecule itself. The indirect effect, which occurs most frequently, happens when ionization takes place away from the DNA molecule in cellular water. However, the energy from the interaction can be transferred to the molecule via a free radical (formed by radiolysis of cellular water).

D Explain the clinical history to the technologist and stress that he is uncomfortable sending a suboptimal study.

-Wrong action, also vindictiveness or malice.

Ethically, sending the image would not be beneficial to the patient, and the ethical principle of beneficence suggests that our actions always should benefit the patient. In a worse-case scenario, the patient could have TB, but because of the missing apices, the radiologist could read the image as negative. The radiologist might request that the patient return for a repeat image—further inconveniencing the patient and adding to his or her stress. Adding a negative comment to the study without first consulting with the technologist implies malice or vindictiveness. Repeating the image against the technologist's advise would be a definite violation of department and program policy. Joseph should not discredit his own judgment or intuitions. He should first attempt to resolve the matter by discussing it with the technologist.

C 1 and 2 only

-Verbal defamation of another, or slander, is a type of intentional misconduct. Invasion of privacy (i.e., public discussion of privileged and confidential information) is intentional misconduct. However, if a radiographer leaves a weak patient standing alone to check images or get supplies and that patient falls and sustains an injury, that would be considered unintentional misconduct, or negligence.

A 1 only

-DXA imaging is used to evaluate BMD. It is the most widely used method of bone densitometry—it is low-dose, precise, and uncomplicated to use/perform. DXA uses two photon energies—one for soft tissue and one for bone. Since bone is denser and attenuates x-ray photons more readily, their attenuation is calculated to represent the degree of bone density. Soft tissue attenuation information is not used to measure bone density. Any images obtained in DXA/bone densitometry are strictly to evaluate the accuracy of the region of interest (ROI); they are not used for further diagnostic purposes—additional diagnostic examinations are done for any required further evaluation. Bone densitometry/DXA can be used to evaluate bone mineral content of the body or part of it, to diagnose osteoporosis, or to evaluate the effectiveness of treatments for osteoporosis.

B 1 and 2 only

-Use of high osmolality (ionic) water-soluble contrast media can result in adverse physiological effects. These effects are usually classified as mild, moderate, or severe. Mild effects include warmth, itching, flushing, nausea, pallor, hives, anxiety, chills. Mild reactions are usually temporary and transient. The radiographer should reassure the patient and should observe and communicate with the patient to be certain that the mild reaction is resolved. Treatment is usually not necessary for mild reactions. Moderate adverse effects include hypertension, dyspnea, hypotension, bronchospasm. Patients must be closely observed for possible worsening of reaction; treatment might be required depending on progression of the reaction. Severe reactions include arrhythmia, cardiopulmonary arrest, laryngeal edema. Clearly, severe reactions require immediate recognition and treatment.

C 12 to 20 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. 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/min in an adult would be considered tachypnea.

B invasion of privacy.

-A radiographer who discloses confidential information to unauthorized individuals may be found guilty of invasion of privacy. If the disclosure is in some way detrimental or otherwise harmful to the patient, the radiographer may also be accused of defamation. Spoken defamation is slander; written defamation is libel

A angina.

-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.

A A postpubertal adolescent

-Breast tissue is most dense, glandular, and radiographically homogeneous in appearance in the postpubertal adolescent. Following pregnancy and lactation, changes occur within the breast that reduce the glandular tissue and replace it with fatty tissue (a process called fatty infiltration). Menopause causes further atrophy of glandular tissue.

A physician intervention.

-The prefix iatr- is from the Greek iatros, meaning “physician.” An iatrogenic infection is one caused by physician intervention or by medical or diagnostic treatment/procedures. Examples include infection following surgery and nausea or other illness following prescribed drug use.

D The patient's stronger side should be closer to the x-ray table.

-When helping a patient in or out of a wheelchair, it must first be locked. Then the footrests must be moved up and aside to prevent the patient from tripping over them or tilting the wheelchair forward. The wheelchair should be placed at a 45-degree angle with the x-ray table or bed, with the patient's stronger side closest toward the x-ray table or bed. Once the patient is seated, the footrests should be lowered into place for the patient's comfort.

D steam sterilization.

-Sterilization is the complete elimination of all living microorganisms, and it can be accomplished by several methods. Pressurized steam, in an autoclave, is probably the most familiar means of sterilization; the pressure allows higher temperatures to be achieved. Gas or chemical sterilization is used for items that are unable to withstand moisture and/or high temperatures. Other methods of sterilization include dry heat, ionizing radiation, and microwaves (nonionizing radiation).

D 1, 2, and 3

-A CT imaging system has three component parts—a gantry, a computer, and an operating console. The gantry component includes an x-ray tube, a detector array, a high-voltage generator, a collimator assembly, and a patient couch with its motorized mechanism. While the CT x-ray tube is similar to direct-projection x-ray tubes, it has several special requirements. The CT x-ray tube must have a very high short-exposure rating and must be capable of tolerating several million heat units while still having a small focal spot for optimal resolution. To help tolerate the very high production of heat units, the anode must be capable of high-speed rotation. The x-ray tube produces a pulsed x-ray beam (1–5 ms)using up to about 1,000 mA.

C 2 and 3 only

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

B anaphylaxis

-Anaphylaxis is an acute reaction characterized by sudden onset of urticaria, respiratory distress, vascular collapse, or systemic shock; it sometimes leads to death. It is caused by ingestion or injection of a sensitizing agent such as a drug, vaccine, contrast agent, or food or by an insect bite. Asthma and rhinitis are examples of allergic reactions. Myocardial infarction results from a blocked coronary artery.

D a Salem-sump.

-A catheter placed in a large vein is called a central venous line. It can be used to deliver frequent medications or nutrition or to monitor cardiac pressures. Catheters can vary in size and number of lumens depending on intended use. The Port-a-Cath is a totally implanted access port, and the peripherally inserted central catheter (PICC) is a peripherally inserted central catheter—they both permit long-term intravenous treatment. The Swan–Ganz catheter is advanced to the pulmonary artery and is used to measure the pumping ability of the heart, to obtain pressure readings, and to introduce medications and IV fluids. The Levin and Salem-sump tubes are NG tubes used for gastric decompression. The Salem-sump tube is radiopaque and has a double lumen. One lumen is for gastric air compression, and the other is for removal of fluids.

A invasion of privacy

-A radiographer who discloses confidential information to unauthorized individuals may be found guilty of invasion of privacy. If the disclosure is in some way detrimental or otherwise harmful to the patient, the radiographer may be accused of defamation. Spoken defamation is slander; written defamation is libel. Assault is to threaten harm; battery is to carry out the threat.

B 1 and 2 only

-Radiologic interventional procedures function to treat pathologic conditions as well as provide diagnostic information. Percutaneous transluminal angioplasty (PTA) uses an inflatable balloon catheter under fluoroscopic guidance to increase the diameter of a plaquestenosed vessel. A stent is a cage-like metal device that can be placed in the vessel to provide support to the vessel wall. A peripherally inserted central catheter (PICC) is also placed under fluoroscopic control. It is simply a venous access catheter that can be left in place for several months. It provides convenient venous access for patients requiring frequent blood tests, chemotherapy, or large amounts of antibiotics.

D 1, 2, and 3

-A CT imaging system has three component parts—a gantry, a computer, and an operating console. The gantry component includes an x-ray tube, a detector array, a high-voltage generator, a collimator assembly, and a patient couch with its motorized mechanism. Although the CT x-ray tube is similar to direct-projection x-ray tubes, it has several special requirements. The CT x-ray tube must have a very high short-exposure rating and must be capable of tolerating several million heat units while still having a small focal spot for optimal resolution. To help tolerate the very high production of heat units, the anode must be capable of high-speed rotation. The x-ray tube produces a pulsed x-ray beam (1–5 ms) using up to about 1,000 mA. The scintillation detector array is made of thousands of solid-state photodiodes. These scintillation crystal photodiode assemblies (cadmium tungstate or rare earth oxide ceramic crystals) convert the transmitted x-ray energy into light. The light then is converted into electrical energy and finally into an electronic/digital signal. If the scintillation crystals are packed tightly together so that there is virtually no distance between them, efficiency of x-ray absorption is increased, and patient dose is decreased. Detection efficiency is extremely high—approximately 90%. The high-voltage generator provides high-frequency power to the CT x-ray tube, enabling the high-speed anode rotation and the production of high-energy pulsed x-ray photons. Similar to the high-frequency x-ray tubes used in projection radiography, conventional 60-Hz full-wave-rectified power is converted to a higher frequency of 500 to 25,000 Hz. The high-frequency generator is small in size, in addition to producing an almost constant potential waveform. The CT high-frequency generator is often mounted in the gantry's rotating wheel. The collimator assembly has two parts: The prepatient, or predetector, collimator is at the x-ray tube and consists of multiple beam restrictions so that the x-ray beam diverges little. This reduces patient dose and reduces the production of scattered radiation, thereby improving the CT image. The postpatient collimator, or predetector collimator, confines the exit photons before they reach the detector array and determines slice thickness. The patient table, or couch, provides positioning support for the patient. Its motorized movement should be smooth and accurate. Inaccurate indexing can result in missed anatomy and/or double-exposed anatomy.

B Incubation period

-There are four stages of infection. In the initial phase, the latent period, the infection is introduced and lies dormant. As soon as the microbes begin to shed, the infection becomes communicable. The microbes reproduce (during the incubation period), and during the actual disease period, signs and symptoms of the infection may begin. The infection is most active and communicable at this point. As the patient fights off the infection and the symptoms regress, the convalescent (recovery) phase occurs.

A urinary tract

-Hospital-acquired infections (HAIs) are also referred to as nosocomial. Despite the efforts of infectious disease departments, HAIs continue to be a problem in hospitals today. This is at least partly due to there being a greater number of older, more vulnerable patients and an increase in the number of invasive procedures performed today (i.e., needles and catheters). The most frequent site of HAI is the urinary tract, followed by wounds, the respiratory tract, and blood.

C 8 to 25 mg/100 m

-The BUN level indicates the quantity of nitrogen in the blood in the form of urea. The normal concentration is 8 to 25 mg/100 mL. BUN and creatinine blood chemistry levels should be checked prior to beginning an IVU. 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. The normal creatinine range is 0.6 to 1.5 mg/100 mL.

B 1 and 2 only

-A patient who has been NPO since midnight or who is anxious, frightened, or in pain may suffer an episode of syncope (fainting) on exertion. The patient should be helped to a recumbent position with feet elevated to increase blood flow to the head. A patient who feels like fainting should never be left alone.

D 1, 2, and 3

-The cycle of infection includes four components: a susceptible host, a reservoir of infection, a pathogenic organism, and a means of transmission. Pathogenic organisms are microscopic and include bacteria, fungi, and viruses. The reservoir of infection is the environment in which the microorganism thrives; this can be the human body. A susceptible host may have reduced resistance to infection. The means of transmission is either direct (i.e., touch) or indirect (i.e., vector, fomite, or airborne).

A 0.6 to 1.5 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 IVU. Increased levels may forecast an increased possibility of contrast media–induced renal effects and poor visualization of the renal collecting systems. The normal creatinine range is 0.6 to 1.5 mg/100 mL. The normal BUN range is 8 to 25 mg/100 mL.

D Check with the referring physician.

-Although it is never the responsibility of the radiographer to diagnose a patient, it is the responsibility of every radiographer to be alert. The patient should not be subjected to unnecessary radiation from an unwanted examination. Rather, it is the radiographer's responsibility to check with the referring physician and report the patient's complaint.

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 measure a patient's temperature. A watch with a second hand is required to measure a 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 because it is the one most likely to be needed in an emergency situation.

D 1, 2, and 3

-Adverse reactions to the intravascular administration of iodinated contrast medium are not uncommon, but although the risk of a life-threatening reaction is relatively rare, the radiographer must be alert to recognize and deal effectively with a serious reaction should it occur. Flushed appearance and nausea, occasionally vomiting, and a few hives characterize a minor reaction. Early symptoms of a possible anaphylactic reaction include constriction of the throat, possibly owing to laryngeal edema, dysphagia (difficulty in swallowing), and itching of the palms and soles. The radiographer must maintain the patient's airway, summon the radiologist, and call a “code.”

B 1 and 3 only

-Children are often fearful of leaving familiar surroundings, and being able to take along a familiar toy is helpful. A calm and cheerful radiographer can be reassuring to the anxious child. Honesty is essential, and false reassurances, such as telling the child it will not hurt, not only do more harm than good, but also focus the child's attention on pain.

A 1 only

-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.

D Intrathecal

-A parental route of drug administration is one that bypasses the digestive system. The five parenteral routes require different needle placements: under the skin (subcutaneous), through the skin and into the muscle (intramuscular), between the layers of the skin (intradermal), into a vein (intravenous), and into the subarachnoid space (intrathecal).

D emetic.

-Ipecac is a medication used to induce vomiting and is classified as an emetic. This is easy to remember if you think of what an emesis basin is for. A diuretic is a medication that stimulates the production of urine. Lasix (furosemide) is an example of a diuretic. An antipyretic is used to reduce fever. Tylenol (acetaminophen) is an example of an antipyretic. An antihistamine is used to relieve allergic effects. Benadryl (diphenhydramine hydrochloride) is an example of an antihistamine that is often on hand in radiology departments in the event of a minor reaction to contrast media.

B 1 and 2 only

-A computed tomographic (CT) imaging system has three component parts—a gantry, a computer, and an operator console. The gantry component includes an x-ray tube, a detector array, a high-voltage generator, a collimator assembly, and a patient couch with its motorized mechanism. The computer is exceedingly sophisticated, performing thousands of calculations simultaneously per second. It is responsible for image reconstruction and post processing functions. At the operator console, somewhat similar to a control panel used in projection radiography, has the controls for equipment operation and image manipulation. Technical factors are selected and monitored here, adjustments can be made, and the patient couch is operated.

B standard precautions.

-Standard blood and body fluid precautions serve to protect health care workers and patients from the spread of diseases such as AIDS and AIDS-related complex. Although the precautions are indicated for all patients, special care must be emphasized when working with patients whose infectious status is unknown (e.g., the emergency trauma patient). Gloves must be worn if the radiographer may come in contact with blood or body fluids. A gown should be worn if the clothing may become contaminated. Blood spills should be cleaned with a solution of 1 part bleach to 10 parts water.

D 1, 2, and 3

-Although the CT x-ray tube is similar to direct-projection x-ray tubes, it has several special requirements. The CT x-ray tube must have a very high short-exposure rating and must be capable of tolerating several million heat units while still having a small focal spot for optimal resolution. To help tolerate the very high production of heat units, the anode must be capable of high-speed rotation. The x-ray tube produces a pulsed x-ray beam (1–5 ms) using up to about 1,000 mA.

D none of the above; they are all true

-None of the statements in the question is false; all are true. Oxygen is classified as a drug and must be prescribed by a physician. The rate and mode of delivery of oxygen must be specified in the physician's orders. It can be ordered to be delivered continuously or as needed.

D bacterium.

-Streptococcal pharyngitis (“strep throat”) is caused by bacteria. To know this, you have to remember that bacteria are classified according to their morphology (i.e., size and shape). The three classifications are spirals, rods (bacilli), and spheres (cocci). Viruses, unlike bacteria, cannot live outside a human cell. Viruses attach themselves to a host cell and invade the cell with their genetic information. Various fungal infections may grow on the skin (cutaneously), or they may enter the skin. Fungal infections that enter the circulatory or lymphatic system can be deadly. Protozoa are one-celled organisms classified by their motility. Ameboids move by locomotion, flagella use their protein tail, cilia possess numerous short protein tails, and sporozoans actually are not mobile.

A protected from 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.

C 2 and 3 only

-Venous blood is returned to the right atrium via the superior (from the upper body) and inferior (from the lower body) venae cavae (see Figure 2–47). During atrial systole, blood passes from the right atrium through the tricuspid valve into the right ventricle and from the left atrium through the bicuspid/mitral valve into the left ventricle. During ventricular systole, the pulmonary artery (the only artery to carry deoxygenated blood) carries blood from the right ventricle to the lungs for oxygenation, whereas the left ventricle moves oxygenated blood through the aortic semilunar valve into the aorta and to all body tissues.

D push the object.

-When moving heavy objects, there are several rules that will reduce back strain. When carrying a heavy object, hold it close to your body. Your back should be kept straight; avoid twisting. When lifting an object, bend at the knees an use leg and abdominal muscles to lift (rather than your back muscles). Whenever possible, push or roll heavy objects (i.e., mobile unit), rather than pulling or lifting.

A profuse sweating.

-Observation is an important part of the evaluation of acutely ill patients. The patient who is diaphoreticis experiencing profuse sweating. Diaphoresis can be associated with elevated body temperature, exposure to heat, physical exertion, or emotional stress. Hot, dry skin accompanies fever. Warm, moist skin may be a result of anxiety or simply of being in a warm room. The pupils dilate in dimly illuminated places in order to allow more light into the eyes.

D 1, 2, and 3

-All 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 on 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 (i.e., oxygen should be administered prior to suctioning). It is also important that patients be permitted to rest during suctioning. Never suction for longer than 15 seconds; check breath sounds with a stethoscope to ensure that the airway is clear. It is the radiographer's responsibility to check the work area and ensure that the suction is working and that ample ancillary supplies (i.e., suction kit, catheters, and tubing) are available.

B a tick.

-Many microorganisms can remain infectious while awaiting transmission to another host. A contaminated inanimate object such as a food utensil, doorknob, or IV pole is referred to as a fomite. A vector is an insect, rodent, or other animal carrier of infectious organisms, such as a rabid animal, a mosquito that carries malaria, or a tick that carries Lyme disease. They can transmit disease through either direct or indirect contact.

C increase urine output

-Diuretics are used to promote urine elimination in individuals whose tissues are retaining excessive fluid. They are used in treating hypertension, congestive heart failure, and edema. Cathartics are used to stimulate defecation (bowel movements); they are used as preparation for some x-ray examinations such as barium enemas. Emetics function to induce vomiting, and antitussives are used to inhibit coughing.

B The thing speaks for itself.

-The legal doctrine res ipsa locquitur relates to a thing or matter that speaks for itself. 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 phrase meaning "let the master answer" or "the one ruling is responsible." If a radiographer were 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.

D a vector.

-Lyme disease is a condition that results from the transmission of an infection by a vector (in this case, a deer tick). Vectors are insects and animals carrying disease. Droplet contact involves contact with secretions (from the nose, mouth, or eye) that travel via a sneeze or cough. The airborne route involves evaporated droplets in the air that transfer disease. A vehicle can transmit infection via contaminated water, food, blood, or drugs.

D 1, 2, and 3

-Late somatic effects are those that can occur years after initial exposure and are caused by low, chronic exposures. Occupationally exposed personnel are concerned with the late effects of radiation exposure. Bone malignancies, thyroid cancers, leukemia, and skin cancers are examples of carcinogenicsomatic effects of radiation. Another example of somatic effects of radiation is cataract formation to the lenses of eyes of individuals accidentally exposed to sufficient quantities of radiation. The lives of many of the early radiation workers were several years shorter than the lives of the general population. Statistics revealed that radiologists, for example, had a shorter life span than physicians of other specialties. Life-span shortening, then, was another somatic effect of radiation. Certainly, these effects should never be experienced today. The human reproductive organs are particularly radiosensitive.Fertility and heredity can be greatly affected by the germ cells produced within the testes (spermatogonia) and ovaries (oogonia). Excessive radiation exposure to the gonads can cause temporary or permanent sterility and/or genetic mutations.

D 1, 2, and 3

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

C 2 and 3 only

-Federal regulations regarding infection control in the workplace, as amended by OSHA, require development of policies conforming to OSHA guidelines and instruction in their application/use. These regulations also require provision of hepatitis B immunization (free of charge) for all staff who might be exposed to blood/body substances, follow-up care for any staff accidentally exposed to blood/body fluids and/or needle stick injuries, and readily accessible personal protective equipment (PPE) and impermeable puncture-proof containers for used needles/syringes. It also requires that all health care workers and their employers follow/enforce standard precautions, transmission-based precautions, and these OSHA guidelines under penalty of law.

B nonmaleficence.

-There are many medicolegal terms with which the radiographer should be familiar. Beneficence refers to decisions and actions made to bring about good, ie, to benefit the patient. Nonmaleficence refers to the prevention of harm to the patient. Autonomy refers to the right of every individual to act with personal self-reliance. Veracity refers to telling the truth.

B an infusion.

-Quantities of medication can be dispensed intravenously over a period of time via an IV infusion. A special infusion pump may be used to precisely regulate the quantity received by the patient. An IV push refers to a rapid injection; the term bolus refers to the quantity of material being injected. The term hypodermic refers to administration of medication by any route other than oral.

D by a route other than orally

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

D 1, 2, and 3

-A computed tomographic (CT) imaging system has three component parts: a gantry, a computer, and an operator console. The gantry component includes an x-ray tube, a detector array, a high-voltage generator, a collimator assembly, and a patient couch with its motorized mechanism. The computer is exceedingly sophisticated, performing thousands of calculations simultaneously per second. It is responsible for image reconstruction and post processing functions. At the operator console, somewhat similar to a control panel used in projection radiography, are the controls for equipment operation and image manipulation. Technical factors are selected and monitored here, adjustments can be made, and the patient couch is operated from here.

A 1 only

-Extravasation of contrast media into surrounding tissue is potentially very painful. If it does occur, the needle should be removed and the extravasation cared for immediately (before looking for another vein). The arm should be elevated and pressure should be applied to the vein until bleeding stops. There is conflicting information regarding application of warm vs cold compress. Cold seems to alleviate pain better, while warm seems to encourage absorption and improve blood flow. It is therefor the prerogative of the radiologist or departmental routine.

B the patient's birth date.

-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, name of the attending physician, and the time of day. When multiple examinations (e.g., chest examinations or small bowel images) of a patient are made on the same day, it becomes crucial that the time the radiographs were taken be included on the image. This allows the physician to track the patient's progress.

B 1 and 2 only

-Anemia is a blood condition characterized by a decreased number of circulating red blood cells and decreased hemoglobin; it has many causes. Adequate hemoglobin is required to provide oxygen to the body. Anemia is treated according to its cause. Hematuria is the term used to describe blood in the urine and is unrelated to anemia.

D 1, 2, and 3

-Body substance precaution procedures identify various body fluids as infectious or potentially infectious. These body substances include pleural, pericardial, peritoneal, and amniotic fluids; synovial fluid; CSF; breast milk; and vaginal secretions, as well as semen, nasal secretions, tears, saliva, sputum, feces, urine, and wound drainage.

C 2 and 3 only

-Somatic effects are those induced in the irradiated body. Genetic effects of ionizing radiation are those that may not appear for many years (generations) following exposure. Formation of cataracts or cancer (such as leukemia) and embryologic damage are all possible long-term somatic effects of radiation exposure. A fourth is life-span shortening. Blood changes are generally early effects of exposure to large quantities of ionizing radiation.

D 1, 2, and 3

-The U.S. Food and Drug Administration mandates that certain information be included in every drug package. Some of the information that drug companies are required to provide is trade and generic names, indications and contraindications, usual dose, chemical composition and strength, and any reported side effects.

B intrathecally.

-Sterile technique is required for administration of contrast media by the intravenous and intrathecal (intraspinal) methods. Aseptic technique is used for administration of contrast media by the oral and rectal routes as well as through the nasogastric tube.

D begin external chest compressions at a rate of at least 100 compressions/min.

-The long tradition of ABC'c (airway, breathing, chest compressions) has been changed to CAB (chest compressions, airway, breathing). If the victim is unable to be roused, the rescuer should start with 30 compressions, at a rate of 100 compressions per minute. The victim's airway should then be opened and rescue breathing begun. 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 to 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.

B 1 and 3 only

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

B 1 and 2 only

-Infectious microorganisms can be transmitted from patients to other patients or to health care workers and from health care workers to patients. They are transmitted by means of either direct or indirect contact. Direct contact involves touch. Diseases transmitted by direct contact include skin infections such as boils and sexually transmitted diseases such as syphilis and AIDS. Direct contact with droplets of nasal or oral secretions from a sneeze or cough is referred to as droplet contact. Indirect contact involves transmission of microorganisms via airborne contamination, fomites, and vectors. Pathogenic microorganisms expelled from the respiratory tract through the mouth or nose can be carried as evaporated droplets through the air or dust and settle on clothing, utensils, or food. Patients with respiratory tract infections or disease transported to the radiology department therefore should wear a mask to prevent such transmission during a cough or sneeze; it is not necessary for the health care worker to wear a mask (as long as the patient does). Many microorganisms can remain infectious while awaiting transmission to another host. A contaminated inanimate object such as a food utensil, doorknob, or IV pole is referred to as a fomite. A vector is an insect or animal carrier of infectious organisms, such as a rabid animal, a mosquito that carries malaria, or a tick that carries Lyme disease. They can transmit disease through either direct or indirect contact.

D contrast medium is injected into surrounding tissue

-Extravasation occurs when medication or contrast medium is injected into the tissues surrounding a vein rather than into the vein itself. It can happen when the patient's veins are particularly deep and/or small. If this happens, the needle should be removed, pressure applied to prevent formation of a hematoma, and then hot packs applied to relieve pain.

C the patient states that she experiences extreme pain in the upright position.

-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. 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 the patient and document the information on the requisition for the radiologist.

A asthma.

-Asthma is characterized by difficulty in breathing, causing bronchospasm. It is often precipitated by stress, and although dyspnea is a symptom, oxygen is not administered. Asthmatics carry a nebulizer that contains a medication to relieve the bronchospasm, thereby relieving their breathing distress. Anaphylaxis is an acute reaction characterized by sudden onset of urticaria, respiratory distress, vascular collapse, or systemic shock; it sometimes leads to death. It is caused by ingestion or injection of a sensitizing agent such as a drug, vaccine, contrast agent, or food, or by an insect bite. Asthma and rhinitis are examples of allergic reactions.

B Antihistamine

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

A Beneficence

-There are many medicolegal terms with which the radiographer should be familiar. Beneficence refers to decisions and actions made to bring about good, ie, to benefit the patient. Nonmaleficence refers to the prevention of harm to the patient. Autonomy refers to the right of every individual to act with personal self-reliance. Veracity refers to telling the truth.

D Do not recap the needle and dispose of the entire syringe.

-Most needle sticks occur during attempts to recap a needle. Proper disposal of contaminated needles and syringes is becoming more vital as HIV infection, AIDS, and HBV infection reach epidemic proportions. To prevent the spread of any possible infection, handle contaminated materials as little as possible. Therefore, do not attempt to recap a needle; instead, dispose of the entire syringe with the needle attached in the special container that is available.

B 1 and 2 only

-Because minerals in rocks and the earth can emanate radioactivity, high levels of radon gas inside homes have been of recent concern. Another source of radon gas is from burning cigarettes, whether as a smoker or as passive exposure. Uranium miners have been identified with a much higher incidence of lung cancer; many of these individuals also were smokers. Radiology departments are not known as a source of radon gas exposure.

C Myelogram

-An intrathecal injection is one made within the spinal meninges. A myelogram requires an intrathecal injection to introduce contrast medium into the subarachnoid space. An IVU requires an intravenous injection; a retrograde pyelogram requires that contrast medium be introduced into the ureters by way of cystoscopy. A cystogram requires that contrast medium be introduced via catheter into the urinary bladder.

C retrograde studies do not demonstrate function.

-Retrograde urography requires ureteral catheterization so that a contrast medium can be introduced directly into the pelvicalyceal system. This procedure provides excellent opacification and structural information but does not demonstrate the function of these structures. Intravenous studies such as the IVU demonstrate function.

D 1, 2, and 3

-A private room is indicated for all patients on droplet precaution; that is, diseases transmitted via large droplets expelled from the patient while speaking, sneezing, or coughing. The pathogenic droplets can infect others when they come in contact with mouth or nasal mucosa or conjunctiva. Rubella (“German measles”), mumps, and influenza are among the diseases spread by droplet contact; a private room is required for the patient, and health care practitioners must wear a regular (string) mask to enter a droplet precautions isolation room.

B 1 and 2 only

-The term parenteral denotes any medication route other than the alimentary canal (by mouth). Examples of parenteral routes are subcutaneous, intravenous, intramuscular, and intracardiac. The speed of absorption varies with the route used.

B 1 and 2 only

-The patient naturally will feel more comfortable and confident if brought into a clean, orderly, x-ray room that has been prepared appropriately for the examination to be performed. A disorderly, untidy room and a disorganized radiographer hardly inspire confidence; more likely, they will increase anxiety and apprehensiveness. The x-ray tube's anode only needs to be warmed when it is cold, at the beginning of the day, not before every patient.

C idiopathic.

-Idiopathic refers to a disease of unknown or unclear cause. The term systemic refers to or concerns a (body) system. An epidemic describes a disease that swiftly affects a large number of people in a particular geographic region. Anything that is or can be disease-producing is termed pathogenic.

A hematemesis

-Hematemesis refers to vomiting blood. If the blood is dark in color, it is probably gastric in origin; if it is bright red, it is most likely pharyngeal in origin. Expectoration (coughing or spitting up) of blood is called hemoptysis. Blood is originating from the mouth, larynx, or respiratory structure. Hematuria is the condition of blood in the urine. Epistaxis is the medical term for nosebleed.

C nonmalficence.

-Fidelity, veracity, nonmalficence, and beneficence are all ethical principles. Nonmalficence is the principle that refers to the prevention of harm. Beneficence is the ethical principle that refers to bringing about good or benefiting others. Fidelity refers to faithfulness, and veracity refers to truthfulness.

B Airborne precautions

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

C 3 only

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

A Gestation

-The length of time from conception to birth, that is, pregnancy, is referred to as gestation. The term congenital refers to a condition existing at birth. Neonatal relates to the time immediately after birth and the first month of life. In vitro refers to something living outside a living body (as in a test tube), as opposed to in vivo (within a living system).

D 2, 3, 1

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

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 forairborne precautions require a private, specially ventilated (negative-pressure) room. A private room is also indicated for all patients on droplet precautions, that is, with diseases 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 gowns and gloves.

C 2 and 3 only

-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. This includes both angiography and biopsy/aspiration procedures. This would not be expected during a routine upper GI examination.

B battery

-Battery refers to the unlawful laying of hands on a patient. Battery could be charged if a patient were moved about roughly or touched in a manner that is inappropriate or without the patient's consent.Assault is the threat of touching or laying hands on. If a patient feels threatened by a health care provider either because of the provider's tone or pitch of voice or because of words that are threatening, an assault charge may be made. False imprisonment may be considered if a patient states that he or she no longer wishes to continue with a procedure and is ignored or if restraining devices are used improperly or used without a physician's order. Invasion-of-privacy issues arise when there has been a disclosure of confidential information.

B epistaxis.

-The medical term for nosebleed is epistaxis. Vertigo refers to a feeling of "whirling" or a sensation that the room is spinning. 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 sensory response (such as flashing lights, tasting metal, smelling coffee) that precedes an episode such as a seizure or a migraine headache.

D Let the master answer.

-Respondeat superior is a phase meaning “let the master answer” or “the one ruling is responsible.” If a radiographer were negligent, there may be an attempt to prove that the radiologist was responsible because the radiologist oversees the radiographer. The legal doctrine res ipsa locquitur relates to a thing or matter that speaks for itself. 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. Res judicata means a thing or matter settled by justice. Stare decisis refers to a matter settled by precedent.

A 1 and 2 only

-It is unlikely that the radiographer will be faced with a wound hemorrhage because bleeding from wounds is controlled before the patient is seen for x-ray examination. However, if a patient does experience hemorrhaging from a wound, you should apply pressure to the bleeding site and call for assistance. Delay can lead to serious blood loss.

B Norepinephrine

-All four medications are found routinely on the typical emergency cart. Heparin is used to decrease coagulation and often used in the cardiovascular imaging suite to inhibit coagulation on catheters.Norepinephrine functions to raise the blood pressure, whereas nitroglycerin functions as a vasodilator, relaxing the walls of blood vessels and increasing circulation. Lidocaine is used as a local anesthetic or antidysrhythmic.

D keep a narrow base of support

-Proper body mechanics can help to prevent painful back injuries by making proficient use of the muscles in the arms and legs. Proper body mechanics includes a wide base of support. The base of support is the part of the body in touch with the floor or other horizontal plane. The back always should be kept straight; twisting increases the chance of injury. When lifting a load, keep it as close to the body as possible to avoid back strain. Always push a load (such as a mobile x-ray machine) rather than pull it.

D allergic shock.

-A severe allergic reaction affecting several tissue functions is referred to as anaphylaxis or anaphylactic shock. It is characterized by dyspnea (difficulty breathing) caused by rapid swelling of the respiratory tract and a sharp drop in blood pressure. Individuals who are sensitive to bee stings and certain medications, including iodinated contrast agents, are candidates for this reaction.

The Correct Answer is: A
Shock is indicated by extremely low blood pressure, that is, a systolic blood pressure reading lower than 60 mmHg (below 90 mmHg is considered low blood pressure). Normal blood pressure is 110 to 140 mmHg systolic and 60 to 80 mmHg diastolic. High blood pressure is indicated by systolic pressure higher than 140 mmHg and diastolic pressure higher than 90 mmHg.

C Between the draped patient and the instrument table

-When radiographs in the surgical suite are required, the radiographer is responsible for ensuring that surgical asepsis is maintained. This requires proper dress, cleanliness of equipment, and restricted access to certain areas. An example of a restricted area is the "sterile corridor," which is located between the draped patient and the instrument table and is occupied only by the surgeon and the instrument nurse.

B 1 and 2 only

-Psychologist Abraham Maslow described a hierarchy, or pyramid, of needs with primary (physiologic) needs at the base and secondary (nonphysiologic) needs at higher levels. Maslow postulated that as the most basic survival needs are met, new needs emerge. At the bottom of the hierarchy are physiologic needs such as food, water, air, rest, and so on. One step up in the hierarchy is safety and security. Next is love and belongingness, followed by self-esteem and the esteem of others. Last is self-actualization, which is a kind of spiritual growth, satisfaction from life achievement, the feeling of leaving one's mark.

B caliper.

-Radiographic technique charts are highly recommended for use with every x-ray unit. A technique chart identifies the standardized factors that should be used with that particular x-ray unit, for various examinations/positions, of anatomic parts of different sizes. To be used effectively, these technique charts require that the anatomic part in question be measured correctly with a caliper.

A gantry is a component of a computed tomography imaging system, a collimator is used to determine the size of the x-ray field.

A 1 only

-The chest drainage system unit always should be kept below the level of the patient's chest. Chest tubes are used to remove air, blood, or fluid from the pleural cavity. By draining fluid from the pleural cavity, a collapsed lung, or atelectasis, may be relieved. By relieving the pressure from air in the pleural cavity, a pneumothorax may be reduced. Radiographers must take care that the tubes of the chest drainage unit do not kink and do not get caught on IV poles or radiographic equipment. It is imperative that the unit remain below the level of the chest. The chest drainage system has several components. One component is a chamber that collects the draining fluid. Another component is the suction control chamber. A third component is the water-seal chamber, which prevents air from the atmosphere from entering the system. The last component is the water-seal venting chamber, which allows air to leave the system, thus preventing pressure buildup. In order for the unit to work properly, it must remain below the level of the chest.

A an atrial septal defect

-Atrial septal defect is a small hole (the remnant of the fetal foramen ovale) in the interatrial septum. It usually closes spontaneously in the first months of life; if it persists or is unusually large, surgical repair is necessary. The ductus arteriosus is a short fetal blood vessel connecting the aorta and pulmonary artery that usually closes within 10 to 15 hours after birth. A patent ductus arteriosus is one that persists and requires surgical closure. Ventricular septal defect is a congenital heart condition characterized by a hole in the interventricular septum that allows oxygenated and unoxygenated blood to mix. Some interventricular septal defects are small and close spontaneously; others require surgery. Coarctation of the aorta is a narrowing or constriction of the aorta.

B systolic pressure.

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

C 2 and 3 only

-The ARRT Standards of Ethics is a three-part document. Following the Preamble, it consists of the Code of Ethics, the Rules of Ethics, and Administrative Procedures. The Code of Ethics serves as a guide that imaging professionals use to direct their conduct and growth—it addresses humanistic behavior, delivery of care without bias, good judgment, minimizing exposure to ionizing radiation, assuming responsibility, not attempting to diagnose or interpret, etc. The Code of Ethics is aspirational. The Rules of Ethics are minimally acceptable mandatory and enforceable standards required of all imaging professionals to ensure quality patient care. Violation of the Code of Ethics renders the individual subject to sanction. The Rules of Ethics cover issues such as fraud/deceit regarding individual ARRT certification; subversion/attempt to the subvert the certification examination process; conviction of a crime; failure to report charges concerning the individual's permit, license, or certification; engaging in unethical conduct; etc. There are 20 Rules of Ethics with which the imaging professional should be familiar.

B thyroid overactivity

-Graves disease is the most frequently occurring form of hyperthyroidism. Graves disease is an autoimmune disorder whose symptoms include enlargement of the thyroid gland and exophthalmos (protrusion of the eyes resulting from fluid buildup behind them). Hypothyroidism can result in cretinism in the child and myxedema in the adult. Adrenal overactivity produces Cushing syndrome; underactivity causes Addison disease.

C 2 and 3 only

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

B 1 and 2 only

-Cyanosis is a condition resulting from a deficiency of oxygen circulating in the blood. It is characterized by bluish discoloration of the gums, nail beds, earlobes, and the area around the mouth. Cyanosis may be accompanied by labored breathing or other types of respiratory distress.

B 1 and 2 only

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

A respiratory pathway obstruction above the larynx

-The respiratory passageways include the nose, pharynx, larynx (upper respiratory structures), trachea, bronchi, and lungs (lower structures). If obstruction of the breathing passageways occurs in the upper respiratory tract, above the larynx (i.e., in the nose or pharynx), tracheotomy may be performed to restore breathing. Intubation can be done into the lower structures, larynx, and trachea, moving aside any soft obstruction and restoring the breathing passageway.

D 1, 2, and 3

-The Joint Commission [formerly the Joint Commission on the Accreditation of Health-care Organizations (JCAHO)] is the organization that accredits health care organizations in the United States. The Joint Commission sets forth certain standards for medical records. In keeping with these standards, all diagnostic and therapeutic orders must appear in the patient's medical record or chart. In addition, patient identification information, medical history, consent forms, and any diagnostic and therapeutic reports should be part of the patient's permanent record. The patient's chart is a means of communication between various health care providers.

B anaphylaxis

-Anaphylaxis is an acute reaction characterized by sudden onset of urticaria, respiratory distress, vascular collapse, or systemic shock; it sometimes leads to death. It is caused by ingestion or injection of a sensitizing agent such as a drug, vaccine, contrast agent, or food or by an insect bite. Asthma is characterized by difficulty in breathing, causing bronchospasm. It is often precipitated by stress, and although dyspnea is a symptom, oxygen is not administered. Asthmatics carry a nebulizer that contains a medication to relieve the bronchospasm, thereby relieving their breathing distress. Asthma and rhinitis are examples of allergic reactions.

B breaking the ARRT Rules of Ethics

-The ARRT Standards of Ethics apply to those Registered Technologists holding ARRT certification and Candidates for ARRT certification. The Standards consist of two parts: the Code of Ethics (aspirational) and the Rules of Ethics (mandatory). The ARRT Rules of Ethics are mandatory minimum professional standards for all RTs and candidate RTs. Violators, and individuals who permit violation, of these Rules are subject to sanctions. Rules of Ethics numbers 15 and 21 specifically refer to those who knowingly assist another without proper certification to engage in the practice of radiologic technology, and/or those who fail to promptly report such activity to the ARRT—as being subject to sanction.

A generic name.

-A drug's generic name identifies its chemical family. A particular generic drug can be manufactured by several different companies and given different trade names (brand or proprietary names). For example, the drug with the chemical/generic name acetaminophen is known by the trade or brand name Tylenol. Drugs can be classified by either their generic name or their trade name.

A Neonate

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

D Check with the referring physician.

-Although it is never the responsibility of the radiographer to diagnose a patient, it is the responsibility of every radiographer to be alert. The patient should not be subjected to unnecessary radiation from an unwanted examination. Rather, it is the radiographer's responsibility to check with the referring physician and report the patient's complaint.

C 2 and 3 only

-Facsimile transmission of health information is convenient but should be used only to address immediate and urgent patient needs—and every precaution must be taken to ensure its confidentiality. It should be used only with prior patient authorization, when urgently needed for patient care, or when required for third-party payer ongoing hospitalization certification. These recommendations are made by the American Health Information Management Association (AHIMA).

B 1 and 2 only

-The radiographer must check blood chemistry levels that are associated with renal function prior to beginning excretory urography. These levels are blood urea nitrogen (BUN) and creatinine. Normal BUN range is 8–25 mg/100 mL. Normal creatinine range is 0.6–1.5 mg/100 mL. Elevated levels can indicate poor renal function.

B Dorsal recumbent with feet elevated

-Syncope, or fainting, is the result of a drop in blood pressure caused by insufficient blood (oxygen) flow to the brain. The patient should be helped into a dorsal recumbent position with feet elevated to facilitate blood flow to the brain.

C Heparin lock

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

D radiography of pediatric patients with a myelomeningocele defect should be performed in the supine position.

-Radiography of pediatric patients with a myelomeningocele defect should be performed in the prone position rather than in the routine supine position. The supine position would put unnecessary pressure on the protrusion of the meninges and spinal cord. All the other statements in the question are true. The anatomic dimensions of children are different from those of adults, and this must be kept in mind when performing pediatric radiography. The liver occupies a larger area of the abdominal cavity in a child than in an adult. This causes the kidneys to be in a lower position. Generally, the kidneys will be midway between the diaphragm and the symphysis pubis. Chest radiography for the pediatric patient varies depending on the age of the child. Neonates are routinely radiographed in the supine position. Although infants also may be examined in the supine position, it is preferable to examine them by placing the infant securely in a support device to obtain a good PA erect radiograph. Exceptions to this rule are made if the infant is in respiratory distress. To avoid aggravating the respiratory distress, an erect AP radiograph usually is obtained.

C pulse

-Since the heart contracts and relaxes while functioning to pump blood from the heart, arteries that are large and those that are in closest proximity to the heart will feel the effect of the heart's forceful contractions in their walls. The arterial walls pulsate in unison with the heart's contractions. This movement may be detected with the fingers in various parts of the body and is referred to as the pulse.

C intrathecally.

-Sterile technique is required for the administration of contrast media by the IV and intrathecal (intraspinal) methods. 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.

A antisepsis.

-Antisepsis is the practice that retards the growth of pathogenic bacteria. Medical asepsis refers to the destruction of pathogenic microorganisms through the process of disinfection. Examples of disinfectants include hydrogen peroxide, chlorine, and boric acid. Surgical asepsis (i.e., sterilization) refers to the removal of all microorganisms and their spores (reproductive cells) and is practiced in the surgical suite. Health care practitioners must practice medical asepsis at all times.

B aneurysm clips.

-The presence of aneurysm clips is contraindication for magnetic resonance imaging (MRI); even a slight shift can cause damage. MRI can be performed for a herniated disk and subdural bleeding. Dental fillings do not contraindicate MRI.

D 1, 2, and 3

-Epidemiologic studies indicate that human immunodeficiency virus (HIV) can be transmitted only by intimate contact with body fluids of an infected individual. This can occur through the sharing of contaminated needles, through sexual contact, and from mother to baby at childbirth (perinatal). HIV can also be transmitted by transfusion of contaminated blood.

D 1, 2, and 3

-Improper support of a patient's fractured lower leg (tibia/fibula) while performing radiography could result in movement of the fracture fragments, which can cause tearing of the soft tissue, nerves, and blood vessels. In addition, lack of support may cause muscle spasm, which can make closed reduction of some fractures difficult.

C libel.

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

A 1 and 2 only

-Either the antecubital vein or the basilic vein, both found in the elbow region, may be used for an IV injection. Other veins in the area include the cephalic and accessory veins. The popliteal vein, found in the area of the knee, is not commonly used for an IV injection.

B 1 and 2 only

-Epidemiologic studies indicate that HIV and acquired immunodeficiency syndrome (AIDS) can be transmitted only by intimate contact with blood or body fluids of an infected individual. This can occur through the sharing of contaminated needles, through sexual contact, from mother to baby at childbirth, and from transfusion of contaminated blood. HIV and AIDS cannot be transmitted by inanimate objects. hepatitis B virus (HBV) is another blood-borne infection that affects the liver. It is thought that more than 1 million people in the United States have chronic hepatitis B and, as such, can transmit the disease to others. Acid-fast bacillus (AFB) isolation is employed with patients suspected or known to be infected with tuberculosis (TB). AFB isolation requires that the patient wear a mask to avoid the spread of acid-fast bacilli (in bronchial secretions) during coughing.

C patients under MRSA precautions require a negative-pressure room.

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

C urticaria.

-Urticaria is a vascular reaction resulting in dilated capillaries and edema and causing the patient to break out in hives. The medical term for nosebleed is epistaxis. Vertigo refers to a feeling of “whirling” or a sensation that the room is spinning. Some possible causes of vertigo include inner ear infection and acoustic neuroma. An aura may be classified as either a feeling or a sensory response (such as flashing lights, tasting metal, or smelling coffee) that precedes an episode such as a seizure or a migraine headache.

B 1 and 2 only

-The overall chance that a person will become infected with HIV is high with entry sites such as the anus, broken skin, shared needles, infected blood products, and perinatal exposure. Low-risk entry methods include oral and nasal, conjunctiva, and accidental needle stick.

C the smaller is its diameter.

-The diameter of a needle is the needle's gauge. The higher the gauge number, the smaller is the diameter and the thinner is the needle. For example, a very tiny-gauge needle (25 gauge) may be used on a pediatric patient for an IV injection, whereas a large-gauge needle (16 gauge) may be used for donating blood. The hub of a needle is the portion of the needle that attaches to a syringe. The length of the needle varies depending on its use. A longer needle is needed for intramuscular injections, whereas a shorter needle is used for subcutaneous injections. The bevel of the needle is the slanted tip of the needle. For IV injections, the bevel always should face up.

D 1, 2, and 3

-Adverse reactions to the intravascular administration of iodinated contrast media 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. A minor reaction is characterized by flushed appearance and nausea and, occasionally, by vomiting and a few hives. 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.”

C Orthopnea

-A patient with orthopnea is unable to breathe while lying down. When the body is recumbent, the diaphragm and abdominal viscera move to a more superior position. It is therefore more difficult to breathe deeply. Patients with orthopnea must be examined in an erect or semierect position. Dyspnea refers to difficulty breathing in any body position. Apnea describes cessation of breathing for short intervals. Oligopnea is infrequent breathing—as slow as 6 to 10 respirations per minute.

B 1 and 2 only

-A patient who is going into shock may exhibit pallor and weakness, a significant drop in blood pressure,and an increased pulse. The patient may also experience apprehension and restlessness and may have cool, clammy skin. A radiographer recognizing these symptoms should call them to the physician's attention immediately. Fever is not associated with shock.

B Diarthrodial

-Diarthrodial joints are freely movable joints that distinctively contain a joint capsule. Contrast medium is injected into this joint capsule to demonstrate the menisci, articular cartilage, bursae, and ligaments of the joint under investigation. Synarthrodial joints are immovable joints composed of either cartilage or fibrous connective tissue. Amphiarthrodial joints allow only slight movement.

B abnormal development of tissue.

-Dysplasia refers to abnormal development of tissue—often demonstrated radiographically in skeletal imaging. Difficulty in speaking is termed dysphasia. Malposition refers to an anatomic structure located in a place other than the norm, for example, situs inversus. Difficult or painful breathing is termed dyspnea.

C 1 and 3 only

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

B spinal injury.

-Patients arriving at the emergency department (ED) with suspected spinal injury should not be moved. Anteroposterior (AP) and horizontal lateral projections of the suspected area should be evaluated and a decision made about the advisability of further images. 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.

B 3 only

-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 a warm, flushed feeling, a metallic taste in the mouth, nausea, headache, and pain at the injection site. Adverse reactions include itching, anxiety, rash or hives, vomiting, sneezing, dyspnea, and hypotension.

D disinfectants.

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

C sterilization

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

D 1, 2, and 3

-All the choices listed in the question should be part of a preliminary patient history before deciding to inject ionic or nonionic contrast media. As patients age, their general health decreases, and they are, therefore, more likely to suffer from adverse reactions. Patients with a history of respiratory disease, such as asthma or emphysema and COPD, are more likely to have a reaction and to suffer greater distress in the event of a reaction. Patients with cardiac disease run an increased risk of changes in heart rate and myocardial infarction. Patients also should be screened for decreased renal or hepatic function, sickle-cell disease, diabetes, and pregnancy.

B 2 only

-The patient's right to privacy refers to his or her modesty and dignity being respected. It also refers to the professional health-care worker's obligation to respect the confidentiality of privileged information. Communication of privileged information to anyone but health-care workers involved with the patient's care is inexcusable.

B hypotension.

-Hypotension occurs if the blood pressure drops below the normal ranges (95/60 mm Hg). It can occur in shock, hemorrhage, infection, and anemia. The condition in which a patient's heart rate slows below 60 beats per minute is bradycardia. Hyperthermia is the condition in which the patient's temperature is well above the normal average range (97.7 to 99.5°F). Hypoxia is a condition in which there is a decrease in the oxygen supplied to the tissues in the body.

D 1, 2, and 3

-Oxygen is taken into the body and supplied to the blood to be delivered to all body tissues. Any tissue(s) lacking in or devoid of an adequate blood supply can suffer permanent damage or die. Oxygen may be required in cases of severe anemia, pneumonia, pulmonary edema, and shock. Symptoms of inadequate oxygen supply include dyspnea, cyanosis, diaphoresis, retraction of intercostal spaces, dilated nostrils, and distension of the veins of the neck. The patient who experiences any of these symptoms will be very anxious and must not be left unattended. The radiographer must call for help, assist the patient to a sitting or semi-Fowler position (the recumbent position makes breathing more difficult), and have oxygen and emergency drugs available.

C Pulmonary embolism

-Blood pressure in the pulmonary circulation is relatively low, and therefore, pulmonary vessels can easily become blocked by blood clots, air bubbles, or fatty masses, resulting in a pulmonary embolism. If the blockage stays in place, it results in an extra strain on the right ventricle, which is now unable to pump blood. This can result in congestive heart failure. Pneumothorax is air in the pleural cavity.Atelectasis is a collapsed lung or part of a lung. Hypoxia is a condition of low tissue oxygen.

A Fluoroscopy

-The dynamics, or motion, of a part must be studied during a "real-time" examination such as fluoroscopy affords. Stereoscopy is a technique used to produce a radiographic third dimension.Tomography produces sectional images of body parts by blurring superimposed structures above and below the section, or level, of interest. A phototimer is one type of AEC device.

C qh

-The abbreviation for every hour is qh. The abbreviation tid means three times a day, and qid means four times a day. After meals is abbreviated pc.

A Superficial arteries

-Superficial arteries are best suited for determination of pulse rate. The five most easily palpated pulse points are the radial, carotid, temporal, femoral, and popliteal pulses. The radial pulse is used most frequently. The apical pulse, at the apex of the heart, is most accurate and can be determined with the use of a stethoscope.

C 2 and 3 only

-The Levin and Salem-sump tubes are NG tubes used for gastric decompression. The Salem-sump tube is radiopaque and has a double lumen. One lumen is for gastric air compression, and the other is for removal of fluids. The Levin tube is a single-lumen tube that is used to prevent accumulation of intestinal liquids and gas during and following intestinal surgery. The Swan–Ganz IV catheter is advanced to the pulmonary artery and used to measure various heart pressures.

C Apply pressure to the vein until bleeding stops.

-Extravasation of contrast media into surrounding tissue is potentially very painful. If it does occur, the needle should be removed and the extravasation cared for immediately (before looking for another vein). First, pressure should be applied to the vein until bleeding stops. Application of moist heat to the affected area helps to relieve pain.

B 1 and 2 only

-Gerontology, or geriatrics, is the study of the elderly. Although 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.