TEST BANK for Introduction to Radiologic & Imaging Sciences & Patient Care 8th Edition by Adler

TEST BANK TEST BANK

TEST BANK TEST BANK

PART I: The Profession of Radiologic Technology Chapter

1. Introduction to Imaging and Radiologic Sciences

Chapter

2. Professional Organizations

Chapter

3. Educational Survival Skills

Chapter

4. Critical-Thinking and Problem-Solving Strategies

PART II: Introduction to the Clinical Environment Chapter

5. Introduction to Clinical Education

Chapter

6. Radiology Administration

Chapter

7. Radiographic Imaging

Chapter

8. Radiographic and Fluoroscopic Equipment

Chapter

9. Basic Radiation Protection and Radiobiology

Chapter

10. Human Diversity

PART III: Patient Care Chapter

11. Patient Interactions

Chapter

12. History Taking

Chapter

13. Safe Patient Movement and Handling Techniques

Chapter

14. Immobilization Techniques

Chapter

15. Vital Signs, Oxygen, Chest Tubes, and Lines

Chapter

16. Basic Cardiac Monitoring: The Electrocardiogram

Chapter

17. Infection Control

Chapter

18. Aseptic Techniques

Chapter

19. Nonaseptic Techniques

Chapter

20. Medical Emergencies

Chapter

21. Pharmacology

Chapter

22. Principles of Drug Administration

Chapter

23. Contrast Media and Introduction to Radiopharmaceuticals

PART IV: Ethical and Legal Issues Chapter

24. Professional Ethics

Chapter

25. Health Records and Health Information Management

Chapter

26. Medical Law

Chapter 01: Introduction to Imaging and Radiologic Sciences Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. The use of x-rays to create a medical image on patients is referred to as a. electrocardiography. b. radiography. c. sonography. d. magnetic resonance imaging.

ANS: B

Radiography is the making of records, known as radiographs, of internal structures of the body by passage of x-rays or gamma rays through the body to act on, historically, specially sensitized film or, most commonly, on a digital imaging plate or detector. In the diagnostic radiography department, images are created using X-rays that pass through the body.

REF: pp. 3-4 2. Particular care must be taken when using radiation for medical imaging. This is the result of

radiation’s ability to create __________ in human tissue and possible biochemical changes. a. ionizations b. radio waves c. sound waves d. thermal changes ANS: A

Some forms of electromagnetic energy, including X-rays, have the ability to ionize atoms in matter. These ionizations have the ability to disrupt the composition of matter and are capable of disrupting life processes. Special protection should be provided to prevent excessive exposure to ionizing radiation.

REF: p. 3 3. In the radiology field, a number of imaging technologies do not employ ionizing radiations.

As a result, the profession is starting to reference a new term that includes medical sonography and magnetic resonance imaging. This term is often referred to as: a. x-ray. b. diagnostic modalities. c. imaging sciences. d. therapeutic services.

ANS: C

The term imaging sciences has been preferred to the term radiation or radiologic sciences in areas that use a nonionizing form of radiation such as diagnostic medical sonography and MRI. REF: p. 4

4. The Greek physician Hippocrates is regarded as the father of Western medicine. All of the

following choices represent his medical beliefs except the a. use of high ethical standards of conduct. b. important medical value of medicinal potions and super natural powers. c. importance of closely monitoring a patient’s condition and recovery. d. value of diet and exercise and allowing nature to take its course in recovery.

ANS: B

The Hippocratic Corpus is writings that they emphasize rational and natural explanations for the treatment of disease and natural recovery and rejects sorcery and magic. The Hippocratic Oath still governs the ethical conduct of physicians today.

REF: p. 5 5. Throughout the history of medicine, remarkable achievements have been recorded. These

events have led to our current understanding of the human organism and disease. As this research continues, much of it will most likely focus on new pharmaceuticals based upon a. proper sanitation and public health. b. immunology and the development of vaccines. c. germ theory and infection. d. human genes and genetic engineering.

ANS: D

Although the Human Genome Project is finished, analyses of the data will continue for many years. The replacement of faulty genes through gene therapy offers promises of cures for a variety of hereditary diseases, and through genetic engineering, important pharmaceuticals continue to be developed. Medical research will continue to focus on the genetic code in all cells.

REF: p. 6 6. Wilhelm C. Roentgen’s discovery of “the X-ray” is regarded as one of medicine’s most

significant achievements. Although his discovery was accidental, his early research was so thorough that no significant findings have been added to his original theories. This in itself is a true tribute to the brilliance of Roentgen as a scientist. One of the most famous early images he created was an X-ray image of his a. colon. b. laboratory assistant’s foot. c. wife’s hand. d. hand-held fluoroscope.

ANS: C

November 8, 1895, is believed by historians to be the day that Roentgen created the famous image of the hand of his wife. Through his investigative methods, Roentgen identified the properties of X-rays. His methods were so thorough that no significant additions have been made to his work.

REF: p. 6 7. The application of x-rays or gamma rays for disease treatment purposes is referred to as a. chemotherapy.

b. positron scanning. c. dual energy absorptiometry. d. radiation therapy.

ANS: D

Radiologic technology also involves the use of x-rays or radioactive substances in the treatment of disease (radiation therapy).

REF: p. 7 8. All of the following are true of the diagnostic procedure of mammography except a. it is very valuable for the detection of early breast cancers. b. the procedures are be performed using a general radiographic machine. c. radiographers need to be specially trained in order to perform mammography. d. 3-D images of the breast can be produced using tomosynthesis.

ANS: B

Special breast imaging centers have been built to accommodate the demand for mammography procedures. Equipment and supplies, such as a specially designed X-ray tube and high-resolution digital imaging detectors, are used to create high-quality breast images.

Many facilities now routinely perform breast tomosynthesis also known as three-dimensional (3-D) mammography. Mammography cannot be performed using general X-ray equipment.

REF: p. 8 9. To study the blood vessels of the brain, kidneys, liver, and other organs, contrast material is

administered into these vessels by using a. catheters. b. stents. c. angioplastic balloons. d. ostomy ports ANS: A

Angiography is the term for radiologic examination of the blood vessels after injection of a contrast medium. Most often, the contrast material is injected through a catheter, which can be directed to a variety of major arteries or veins for visualization of these structures.

REF: p. 8 10. Radiologic science continues to be one of the most exciting professions in medicine. An

imaging modality that uses no ionizing radiation and the energy of radio waves and magnetic fields to produce images is a. nuclear imaging. b. thermography. c. MSK echo imaging. d. MRI. ANS: D

Magnetic resonance imaging (MRI) uses a strong magnetic field and radio waves along with a computer to generate sectional images of patient anatomy. MRI creates no ionizations at current energy levels and is regarded as a safe modality, particularly for pediatric and pregnant patients.

REF: p. 11 11. A technologist with the credentials R.T.(R), (QM), (BD) (ARRT) would be considered

qualified to perform a. PET scans. b. DXA scans. c. qualitative mammograms. d. radiation therapy.

ANS: B

In 2001 the ARRT began offering a post-primary examination in bone densitometry (BD). To qualify to take the examination, individuals must be ARRT certified in radiography, nuclear medicine technology (or NMTCB certified), or radiation therapy and meet clinical requirements. An ARRT-certified individual uses the initials R.T.(BD)(ARRT) after his or her name.

REF: p. 10 12. A class of health care workers who specialize in carrying out treatments designed to improve

the function of a particular body part or system and who likely possess a 2- or 4-year degree are known as a. osteopaths. b. therapists. c. technologists. d. practitioners.

ANS: B

Therapists specialize in carrying out treatments designed to correct or improve the function of a particular body part or system. Therapists possess varied levels of educational experiences ranging from 2- to 4-year to graduate college degrees.

REF: p. 12 13. Board-certified radiologists can be a medical doctor (MD) or a doctor of osteopathy (DO). To

become a board-certified radiologist following medical school, these physicians must complete a a. residency. b. fellowship. c. preceptorship. d. doctoral (Ph.D) degree program.

ANS: A

After medical school, most MDs and DOs complete additional clinical experience, known as a residency, in an area of specialization. Residencies are usually 3 or 4 years and may include a wide variety of branches in medicine.

REF: p. 12 14. The health occupation that deals with the management of patient medical records and medical

coding is a. radiologist assistant (RA).

b. biomedical engineering. c. health information services. d. compliance management.

ANS: C

Health information services involves the management of health information, such as that contained in the patient’s health record. These careers require 2-4 years of education beyond high school, do not involve direct patient contact and are essential to the efficient operation of any health care facility.

REF: p. 13 15. The distinction between a technologist and a technician can be confusing to the general

public, when related to medical personnel. A key difference between the two involves education. A technologist typically a. can order and prescribe radiopharmaceuticals. b. has a higher level of education and deal with higher-level problems. c. calibrates and repairs medical imaging equipment. d. works in a supportive role at the direction of a technician.

ANS: B

Technologist is a general term that applies to an individual skilled in a practical art. This health care provider applies knowledge to practical and theoretic problems in the field.

Technicians work under the direction of another health care provider. In general, technologists are involved in higher-level problem-solving situations and have more extensive educational preparation than do technicians. They typically do not repair equipment and cannot prescribe medications.

REF: p. 12 16. The medical imaging specialty of ___________ utilizes the administration of

radiopharmaceuticals in the production of medical images for patient diagnosis. a. radiation oncology b. MRI c. nuclear resonance d. nuclear medicine ANS: D

The field of nuclear medicine involves procedures that use radioactive materials for diagnostic or therapeutic purposes. Nuclear medicine procedures usually involve the imaging of a patient’s organs—such as the liver, heart, or brain—after the introduction of a radioactive material known as a radiopharmaceutical.

REF: p. 9 17. The current medical standard for measuring bone health, with a high degree of accuracy, is a. PET scans of the ribs and shoulder girdle. b. DEXA studies of the hip and lower spine. c. sonography of the heel. d. nuclear scans of the bones.

ANS: B

Bone densitometry (BD) is used to diagnose osteoporosis, a condition that is often recognized in menopausal women but can also occur in men. To detect osteoporosis accurately, dualenergy X-ray absorptiometry (DEXA or DXA) is used to assess bone density of the hip and lower spine. DEXA BD is the current standard for measuring bone mineral density (BMD).

REF: p. 10 18. Many medical professions have developed “practice standards” to ensure optimum

performance of their members. The radiography “practice standards” are developed and maintained by the a. American College of Radiology (ACR). b. American Society of Radiologic Technologists (ASRT). c. American Registry of Radiologic Technologists (ARRT). d. Food and Drug Administration (FDA).

ANS: B

Clinical practice standards for radiography have been developed by the ASRT. These practice standards help define the role of the radiographer and establish criteria used to judge performance.

REF: p. 7 19. The education of radiographers involves the commitment and dedication of many people. All

of the following may be directly involved with and responsible for your education as a radiographer except the a. program director. b. clinical instructor. c. equipment applications specialist. d. didactic faculty member.

ANS: C

A clinical instructor teaches students primarily on a one-on-one basis in the clinical setting and a didactic faculty member teaches students typically through classroom lectures and laboratory activities. A clinical coordinator has teaching responsibilities along with administrative duties in overseeing clinical education. A program director has teaching responsibilities, as well as overall administrative responsibility for the entire educational program. Manufacturer representatives such as applications personnel, have no direct responsibility a student’s education.

REF: p. 11 20. To become a qualified, registered radiologist assistant (RRA), you must

1. complete a recognized RRA educational course of study.

2. successfully pass the national examination for nursing (NCLEX).

3. be certified in radiography by the ARRT. 4. successfully complete the radiologist assistant examination offered by the ARRT. 5. become a member of a local professional group of radiologists. a. 2, 4, and 5 only b. 1, 3, 4, and 5 only c. 1, 3, and 4 only d. 1 and 4 only

ANS: C

In 2005, the ARRT began offering a post primary examination for RRAs. To qualify to take the examination, individuals must be ARRT certified in radiography, earn a bachelor’s degree, have at least 1 year of acceptable clinical experience in radiography, complete an ARRTapproved RRA education program, and meet the educational, ethics, and examination standards established by the ARRT. REF: pp. 8-9

Chapter 02: Professional Organizations Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. The process whereby an organization seeks recognition from its peer groups through

demonstrated compliance with developed standards is termed a. licensure. b. registration. c. accreditation. d. self-analysis.

ANS: C

Accreditation is a voluntary peer-review process. Accredited programs have satisfactorily demonstrated compliance with educational standards developed by and for the profession.

These standards are set by the organizations that sponsor the accrediting agency.

REF: p. 15 2. Professional certification of medical imaging practitioners, such as radiographers, is offered

by the a. American Society of Radiologic Technologists (ASRT). b. American College of Radiology (ACR). c. individual states. d. American Registry of Radiologic Technologists.

ANS: D

Professional certification is a process through which an agency grants recognition to an individual on demonstration, usually by examination, of specialized professional skills. For radiography, the American Registry of Radiologic Technologists (ARRT) is a nationally recognized certification agency.

REF: p. 16 3. Many organizations are involved with medical imaging making up this great profession. A

common goal of all of these organizations is to a. ensure the highest quality of care within the profession. b. improve the standard of care within medical imaging. c. foster positive public relations and communication with the general public and governmental agencies. d. All of the above ANS: D

Professional societies represent the interests of various groups to the public and to governmental bodies. Additionally, they foster educational opportunities in an effort to improve patient care standards and quality.

REF: p. 17

4. A radiographer looking to relocate to another state for similar employment is advised to check

into that state’s requirements to ensure qualified employability. a. professional membership b. licensure c. registry d. accreditation ANS: B

Most, but not all, states and territories require a license. The licensure laws in effect vary tremendously from one state to another and can vary from year to year within a state as a result of new legislation. Verifying current licensing requirements is important before practicing in a new state because penalties may be assessed for practicing without a license.

REF: p. 17 5. All of the following are true of the American Healthcare Radiology Administrators (AHRA)

organization except a. they have the authority to certify radiographers. b. they publish a periodical journal titled, Radiology Management. c. the AHRA offers a certification examination for radiology administrators. d. the AHRA plays a key role with the manpower needs of the medical imaging profession.

ANS: A

The AHRA provides a broad range of services for its members, including the journal Radiology Management. It offers the Certified Radiology Administrator (CRA) examination for radiology administrators. The AHRA has strong cooperative ties with other professional associations and has spearheaded the Summit. on Manpower, a consortium of radiology and health care organizations concerned with labor shortages in radiology.

REF: p. 17 6. The organization that sponsors an international meeting in Chicago each year in late

November is the a. International Society of Radiographers and Radiologic Technologists (ISRRT). b. Radiological Society of North America (RSNA). c. American College of Radiology (ACR). d. Joint Review Committee on Education in Radiologic Technology (JRCERT).

ANS: B

The RSNA conducts the world’s largest radiology meeting with more than 55,000 registrants in Chicago each November.

REF: p. 20 7. When you consider the many organizations that make up the medical imaging profession, it is

accurate to conclude that a. all of the agencies have a financial focus and interest in the political strength of the profession. b. all agencies are accountable to the American College of Radiology. c. the collective group of agencies are responsible for the accreditation, certification,

and representation of the medical imaging profession. d. the various groups operate independently with minimal cooperation and

communication.

ANS: C

A major part of the fabric of a profession is its organizations, especially the accrediting agencies for educational programs, the certification bodies for individuals, and the professional societies that represent the interests of the profession to the public and government.

REF: p. 20 8. The oldest radiologic society in the medical imaging profession is the a. American Medical Association. b. International Society of Radiographers and Radiologic Technologists. c. American Roentgen Ray Society. d. Radiological Society of the America.

ANS: C

The ARRS is the oldest U.S. radiologic society. Founded in 1900 in St Louis, the society had approximately 7000 members by the early 1990s.

REF: p. 19 9. Accredited programs in radiologic technology are recognized by the Joint Review Committee

on Education in Radiologic Technology (JRCERT). Programs seeking this programmatic recognition necessarily must comply with the JRCERT a. Essentials and Guidelines. b. Rules of Conduct. c. Content Specifications. d. Policies for Operation and Conduct.

ANS: A

The sponsoring organizations of the JRCs approve a document known as either the Essentials and Guidelines or the Standards, which details the minimum requirements for how an accredited program must operate.

REF: p. 15 10. The organization that is principally responsible for the general welfare of the profession of

radiologic technology, through its efforts in continuing education, practice standards, and socioeconomics is the a. Association of Educators in Imaging and Radiologic Sciences (AEIRS). b. American Healthcare Radiology Administrators (AHRA). c. Medical Dosimetry Certification Board (MDCB). d. American Society of Radiologic Technologists (ASRT).

ANS: D

The goals of the ASRT are to advance the professions of radiologic technology and imaging specialties, maintain high standards of education, enhance the quality of patient care, and further the welfare and socioeconomics of radiologic technologists.

REF: p. 17 | p. 18

Chapter 03: Educational Survival Skills Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. One of your classmates consistently gets A’s on tests and homework, with no apparent effort

or study. In talking with him, you discover he has a good strategy for studying that involves a. staying up late and pulling “all-nighters” before an examination. b. eating a heavy, “high-carb” meal the night before the examination. c. consistently allocating specific times of the day for studying and exercise. d. studying with friends using flashcards.

ANS: C

Waiting until the last minute to study increases anxiety to a point that it actually may interfere with the ability to learn and recall information. Studies have shown that short, regular periods of study and review result in greater recall than a long period of study followed by a long period of no exposure to the information.

REF: p. 28 2. An example of a stress buffer is a. taking antacids the day of a big examination. b. intensive studying with close friends the night before a test. c. agreeing to work more hours a few days before a big test to ease your money

problems.

d. exercising with friends f o r 45 m i nute s the day before a big test.

ANS: D

People who exercise regularly look forward to the relaxing benefits of the aerobic activity, which usually promotes improved sleep patterns, increased energy, and increased stress tolerance.

REF: p. 25 3. The fight-or-flight response is a natural process of the body. It is characterized by a. the release of hormones to increase metabolism. b. decreased metabolism of fats and sugars to conserve available energy for later use

by the body. c. a decreased heart rate with rapid respirations. d. increased circulation to the muscles of the digestive tract to hasten digestion in preparation for high energy expenditure.

ANS: A

The fight-or-flight response readies the body for action. Circulation increases in the long muscles, and the heart rate and respiration rate increase to supply more oxygen to the muscles.

Sugars and fats are dumped into the system to supply the needed energy for physical activity.

The physiologic responses include the release of hormones to increase metabolism, increases in fats and sugars for energy, and increases in heart rate and respiration. Blood flows at a greater-than-normal rate to the long muscles of the extremities, and the central nervous system is stimulated.

REF: p. 25 4. As you prepare for an important final examination on positioning, a casual friend stops by

unexpectedly to tell you she thinks she is about to lose her job. It’s clear she wants to talk to someone, and from your friend’s perspective, you appear to have some time to talk. How would you best handle this situation? a. Stop your studying and console your friend throughout the evening in an effort to become closer friends. b. Politely tell your friend that you would love to talk after you have finished studying, if time permits. c. Order a large pizza with beverages and ask her to study with you. d. Tell your friend you have no time for idle talk as you are in the process of studying for an examination. Give her the name of one of your classmates.

ANS: B

Plan a regular schedule of study. Help your friend to understand the responsibility you have to yourself for studying and that you will talk when you are more relaxed and in a better frame of mind to listen to her concerns. Waiting until the last minute to study increases anxiety to a point that it actually may interfere with the ability to learn and recall information.

REF: p. 28 5. As you are driving to your clinical site for the day’s activities, you encounter an unexpected

construction zone that will most likely make you late. You have taken this reliable and quickest route many times before and plan your driving time precisely. You have never been late before, and you feel that your clinical instructor will dismiss you from the program. In this particular case, an effective way t o d e a l with t h i s new stressor would be to a. call your clinical instructor and provide an estimate as to your delay. b. ask a construction worker for an alternative route to make up the time. c. call your clinical instructor and tell him that your GPS took you in the wrong direction. d. alter your travel route and take an unknown highway that you think will be shorter.

ANS: A

Most of the things about which we worry never happen or turn out better than we thought they would. We worry about possibilities that might be removed from our thoughts by taking some action. Calling your clinical instructor and being proactive about your situation is a responsible action and will be understood by all and will lower your stress levels.

REF: p. 24 6. Nutrition that will improve your stress level includes a. drinking a strong coffee or tea with a hearty breakfast of ham and eggs. b. making a “smoothie” with whole milk to increase calcium levels avoiding bananas

and nuts. c. eating a spinach salad topped with nuts and tomatoes. d. eating a high protein meal that includes a caffeine energy drink.

ANS: C

Good nutrition includes a diet that provides appropriate servings from all food groups (Fig. 3.1). The U.S. Department of Agriculture (USDA) has updated the historical food pyramid with MyPlate, which emphasizes the importance of healthy food choices and being active every day. The dietary guidelines begin by emphasizing the importance of building a healthy plate consisting of five food groups: fruits, vegetables, grains, protein foods, and dairy.

REF: p. 25 | p. 26 7. As you prepare to study for your final examinations, one of your classmates asks to study with

you because she has not been keeping up with the lectures, having missed a few classes over the past week. This person always seems unhappy and is never prepared for clinical experiences. She frequently complains about having to get up so early to get to class and that she is not sure she made the right choice in selecting radiologic technology. Studying with this classmate will a. provide a more positive experience for you and make you feel grateful for not being “in her shoes.” b. make for a positive experience by allowing you to review material you already understand. c. create a negative climate for both of you; you should politely excuse yourself. d. give you a positive experience and the opportunity to improve her attitude toward the profession.

ANS: C

Attitude helps remembering. Having a positive attitude about the reason for studying enhances your ability to learn and remember. You have set a goal for your professional future.

Approach it with enthusiasm and a can-do attitude. Become part of the self-fulfilling prophecy that says you are in control of y o u r s u c c e s s e s and failures. A feeling of control, in turn, reduces the stress response and enhances your chances for a healthy period of learning.

Studying with classmates can be good if classmates agree to maintain a positive attitude and stay focused on the study material. Allowing a stressed classmate to alter your study habits only adds to your stress.

REF: p. 28 8. You are about to take a 100-question test in a timed fashion. The test time allotment is 90

minutes. An effective test-taking strategy to use when taking this test is a. pace yourself and allow exactly the same amount of time for each question. b. scan the test and answer the questions you clearly know and then go back and spend the necessary time on those questions that need more time, even though you may not quite finish. c. answer only the questions to which you know the answers and then randomly answer the rest of the questions without reading them, making sure you finish. d. go immediately to the last page of the test and work back to make sure you get done.

ANS: B

Scan the test, and answer all the questions you are sure you know. Do not waste time initially on questions that are problematic for you. Go back and repeat the procedure, allowing yourself a little more time to answer. Leave questions whose answers are difficult to recall until the last. This way, if it is a time-limited examination, most questions will be answered even if you are caught short of time.

Introduction to Radiologic and Imaging Sciences and Patient Care 8th Edition Adler Test Bank

REF: p. 29 9. As you prepare to take a final examination for a course you have enjoyed, you discover that

your laptop computer battery is very low, causing concern. You wanted to review your notes one last time before going into the examination. This event would be classified as a(n) a. hassle. b. uplift. c. worry. d. intervention.

ANS: A

This event would be considered a hassle because it is a minor event and not life altering.

Minor changes can be countered by balancing unexpected change with planned positive activity.

REF: p. 21 (Key Terms) | p. 22 | p. 23 10. Time management is an important part of controlling stress levels. Effective methods to

control time include 1. avoiding deadlines because they only add stress to one’s life.

2. pushing yourself to unknown limits because you need to know your potential.

3. determining the most important activities that could contribute to your success.

4. focusing only on those activities that are important, allowing little time for close friends and family.

5. doubling your study time to improve your grade from a D to an A. a. 1 only b. 3 only c. 1, 2, and 5 only d. 3, 4, and 5 only ANS: B

An important part of managing stress is learning to manage time. Because the amount of time available cannot be controlled, practicing time management becomes necessary; time management is self-management related to how time is used. Set priorities according to goals and the length of time that will be needed to complete an activity.

REF: p. 24 | p. 25 | p. 26 | p. 27 11. Which of the following statements uses out-of-control language? a. “I can’t believe I have all these examinations in the same week. This is so unfair!” b. “Wow, three examinations this week. Oh well, I’ll take each as it comes.” c. “I’m looking for a study partner for examinations this week. Anyone available?” d. “Final examination week, wow! I’ve had bigger challenges in my life and have

come out on top.”

ANS: A

Many factors influence how we feel about events occurring around us every day. Statements used to express a feeling of not having any control imply you are losing control. Statements such as these are stressors. If out-of-control words can evoke negative feelings, then using in-control language will produce positive feelings.

REF: p. 23 12. Steps for successful test taking include

1. memorizing acronyms to remember important formulas.

2. going out for a spaghetti dinner with friends, the night before an examination.

3. wearing bright colors the day of the examination.

4. relaxing the day before the examination and avoiding cramming.

5. rechecking your answers, particularly if you had to record them on a scan sheet using blackened circles.

6. looking for a pattern of correct answers on the test and using that pattern to answer questions that are questionable. a. 1, 4, 5, and 6 b. 2, 3, 5, 6, and 7 c. 3, 4, and 5 d. 2, 4, 6, and 7 ANS: C

Bright colors promote positive and optimistic feelings. Get a good night’s sleep before the examination. Rest allows clear thinking and improved interpretation. Review your test when done and make corrections as needed. Make certain you have answered all the questions. If you are answering on an answer sheet that requires blackening circles or boxes, then be certain that the number of the question corresponds with the number on the answer sheet.

REF: p. 29

Chapter 04: Critical-Thinking and Problem-Solving Strategies Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. Critical thinking is an essential part of the radiologic sciences profession. This requires the

professional radiographer to use broad intellectual skills and experiences when making the correct choice for any given situation. This is true because a. many decisions are difficult and complex. b. working with each patient is a unique experience. c. no two procedures or treatments are the same. d. All of the above ANS: D

Critical thinking is required in most health care situations. In the radiologic sciences, critical thinking is a reflective decision-making process that is necessary because every patient presents a new situation or challenge. No two procedures or treatments are the same. Critical thinking involves sound professional judgment applied with high ethical standards and integrity.

REF: p. 31 2. All of the following choices would generally require critical analysis thinking except a. checking in for work and reviewing the day’s schedule. b. working in surgery with a portable C-arm that is malfunctioning. c. preparing to perform a radiographic examination on a hearing-impaired patient. d. working in the emergency depa rtm ent with a trauma patient.

ANS: A

Critical thinking involves sound professional judgment applied with high ethical standards and integrity. Arriving at work and looking at the day’s routine does not necessarily require critical thinking. Critical thinking is required in most health care situations. An uncomfortable or difficult decision that must be made about a patient’s care likely involves critical-thinking skills. Challenges with communication, modifying procedures or treatments from the normal routine with regard to patient condition, and solving equipment malfunctions or technical problems are just a few examples of situations that involve problem solving and critical thinking.

REF: p. 31 3. Critical thinking skills are necessary for the competent medical imaging professional. Various

organizations within the radiologic sciences provide guidance and documentation of these traits. As an example, the American Society of Radiologic Technologists (ASRT) publishes that help define specific professional expectations and responsibilities. a. Essentials and Standards b. Standards of Care c. Codes of Conduct d. practice standards ANS: D

Professional societies such as the American Society of Radiologic Technologists (ASRT) publish practice standards that define specific professional expectations and responsibilities.

Inherent in these professional standards are the elements of appropriate decision-making skills associated with problem solving and critical thinking.

REF: p. 31 4. As a student radiographer, you have been assigned to work with a classmate as part of a group

project. Your assignment is to produce an X-ray image of a nonroutine projection of the skull.

To do this, you would perform this a. on your classmate in a hospital radiographic room. b. on a family member volunteer, in a small clinic setting. c. using a skull phantom in a laboratory setting. d. on a patient when he or she visits the clinical setting for this type of study.

ANS: C

The classroom and the laboratory provide valuable experiences that allow the student to develop critical-thinking and analysis skills that involve cognitive and psychomotor learning.

In the classroom or laboratory, students are given the freedom to develop alternative ideas, test the classics, solve new problems, and increase their understanding of old problems without endangering the health of a patient.

REF: p. 32 5. Exposure factor selection for optimum image quality is one of the most challenging aspects of

radiography. In your attempt to produce an image of a patient’s hip in the AP projection, you become frustrated with the image you have created because it is sub-optimal in image quality.

When you show the image to t h e s u p e r v i s o r , he ab ruptly states that you need to repeat the image and this time “get it right.” As you begin to repeat the image, your first critical analysis thought should be to a. select the best solution to get a good image. b. clearly identify the problem that led to the suboptimal image. c. seek out the department manager to report the attitude of the supervisor. d. ask your clinical instructor to repeat the exam for you, so as not to upset the patient.

ANS: B

A key element of critical thought is problem solving. The first step in problem solving is to identify the problem. After this, solutions to solve the problem can be investigated.

REF: p. 32 6. The transfer of knowledge gained in the laboratory or classroom setting is best demonstrated a. on human phantoms in the practice laboratory. b. through essay questions on a major examination. c. on volunteer patients in a skills laboratory. d. in an actual clinical setting on patients.

ANS: D

The clinical setting is where students can transfer knowledge into action in a real-world environment. Students are exposed to unique real-life experiences that can be reinforced by the supervising radiologic sciences professional. Clinical experience provides a variety of critical-thinking situations and allows for complete, guided student learning.

REF: p. 33 7. When you write a lengthy essay on your feelings about radiation protection, you are analyzing

your a. values that are learned or instilled as a part of your affective education. b. knowledge of allowable dose limits. c. skills with patient restraint that were developed in the laboratory setting. d. comprehension of the cardinal rules of radiation protection.

ANS: A

Analyzing personal values and feelings and managing uncomfortable ethical situations are components of affective critical thinking. Students must value the professional knowledge that serves as the foundation for their chosen profession. Feelings can be expressed through journal writing, essay responses, or conferences with faculty and clinical instructors.

REF: p. 33 8. In your experiences as a student radiographer, you will encounter a variety of technologists,

each with his or her own methods for performing procedures. Most will be quite good, but unfortunately some will be poor. As a student, you have a responsibility to recognize these various behaviors and assess their professional correctness. A firm reference point for determining the appropriate behavior for technologist behavior would be a. asking other technologists if these behaviors a r e correct. b. calling the Joint Review Committee on Education in Radiologic Technology and getting their opinion. c. referencing the ASRT Practice Standards and ARRT Code of Ethics. d. consulting a radiologist to get his or her opinion.

ANS: C

Professional standards of the radiologic sciences support and define skills and behavior expected in the workplace. Professional societies such as the American Society of Radiologic Technologists (ASRT) publish practice standards that define specific professional expectations and responsibilities. Credentialing agencies such as the American Registry of Radiologic Technologists (ARRT) publish codes of ethics.

REF: p. 31 9. While working as a radiographer, you design a unique receptor holder to use during portable

procedures that clearly reduces the exposure of others, by lessening the need to hold patients or image receptors. The development of this imaging device shows that you are functioning at what level of learning? a. Psychomotor b. Synthesis c. Affective d. Cognitive

ANS: B

The goals and objectives of a student program in radiography may include elements of critical thinking, including analysis, synthesis, evaluation, and critique. Coming up with a new equipment design is an example of learning at the synthesis level and demonstrates higher level learning.

REF: p. 31 10. Which of the following situations would require critical analysis thinking skills?

1. A patient asking for directions to the restroom 2. A physician asking you to call his office to connect with his/her nurse 3. Improvising the angulation of the X-ray tube to compensate for a patient condition 4. Your supervisor asking you to develop a new quality control plan 5. Repositioning a patient after assessing the patient’s previous images 6. Providing a gown to a patient with instructions on putting it on correctly 7. Modifying exposure factors after reviewing the patient’s history a. 2, 3, 4, 5 and 6 only b. 1 and 2 only c. 3, 4, 5, and 7 only d. 1, 2, and 6 only ANS: C

Radiologic sciences professionals are presented with unique and challenging ethical, technical, and patient care situations every day. Critical thinking and problem solving skills are essential to provide high-quality patient care, diagnosis, and treatment in these situations.

Critical thinking and problem solving skills may also be used to manage personal concerns and issues.

REF: p. 36 | p. 37

Chapter 05: Introduction to Clinical Education Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. The professional organization that is responsible for the development and publication of

minimum educational guidelines, outlining entry-level knowledge and skill levels is the a. American Medical Association (AMA). b. American Registry of Radiologic Technologists (ARRT). c. Joint Review Committee on Education in Radiologic Technology (JRCERT). d. American Society of Radiologic Technologists (ASRT).

ANS: D

The American Society of Radiologic Technologists (ASRT) is the professional organization that provides a curriculum articulating educational guidelines to ensure that entry-level medical imaging and radiologic science professionals possess the necessary skills and knowledge for practice.

REF: p. 40 2. As students gain competency in medical imaging procedures, three phases in the clinical

setting are planned by clinical faculty. These three phases in the correct learning sequence are a. affective, psychomotor, and cognitive. b. discovery, analysis, and repetition. c. observation, assistance, and performance. d. classroom, laboratory, a n d cl ini c al.

ANS: C

Throughout the length of the program, clinical situations will arise that are new to the student.

The new student’s eyes are open to anything and everything that goes on as the clinical education segment of the program begins. The first phase is observation and is extensive during the early portion of the program, tapering off as the new student gains confidence.

When the student feels confident, he or she can then proceed to assistance and finally to performance of the entire procedure without assistance.

REF: p. 42 | p. 43 3. As a radiography student, you will be expected to demonstrate clinical competency in various

procedures as part of your clinical rotations. The required number of imaging procedure competencies is currently a. 37. b. 48. c. 72. d. 98.

ANS: A

To be eligible for participation in the American Registry of Radiologic Technologists (ARRT) radiographic examination, clinical competence must be demonstrated and completed.

Mandatory competencies are needed for 10 general patient care activities and 37 mandatory imaging procedures.

REF: p. 40 | ARRT website (http://www.arrt.org.)

4. Student learning that occurs in a classroom or on-line setting is referred to as a. psychomotor b. transfer of c. didactic d. competency-based

learning.

ANS: C

Didactic education occurs in formal settings such as the classroom, the laboratory, and online.

Didactic courses provide students with experiences designed to support conceptual learning as well as to provide an opportunity for students to gain hands-on skills in a simulated environment.

REF: p. 41 5. When a patient hand-off occurs, the principle of a. SBAR b. TeamSTEPPS c. HIPPA d. STAT

is recommended.

ANS: A

Patient handoff occurs when a patient is transferred from one health care worker to another for different types of care, procedures, or treatments. SBAR is a structured communication process that provides for accurate sharing of patient information between health care workers when patient handoff occurs.

REF: p. 45 6.

As a student radiographer, you have received a requisition to perform a procedure that requires indirect supervision. In completing the examination, you mistakenly mislabel the image with regard to the left and right sides of the patient. Department policy requires a repeat image. In doing so, you must be aware that a. you can repeat the image with a technologist in another part of the department. b. a qualified practitioner must review your repeat procedures and directly supervise your work. c. you can still perform under indirect supervision as long as a technologist is within “shouting” distance. d. you can repeat the examination with a classmate who has already demonstrated competency with this type of examination.

ANS: B

In order to assure the safety of patients, students, staff, and the general public present in the health care environment, students should be supervised at all times while in the clinical setting. Unsatisfactory radiographic images must be directly supervised by a qualified radiographer, regardless of the student’s level of competency.

REF: p. 43

7. Which of the following choices is false regarding the typical organizational structure of a

medical radiography program? a. Registered radiographers (ARRT) all perform as clinical instructors. b. The Program Director must be a full-time position. c. The Clinical Coordinator works closely with the Program Director to ensure quality clinical experiences for students. d. All clinical faculty are accountable to the Program Director.

ANS: A

Members of the clinical staff are employees of the health care institution and provide student supervision and guidance. The program director works full time in organizing, administering, and assessing the radiography program. The clinical coordinator works closely with the program director in ensuring program effectiveness through a regular schedule of coordination, instruction, and evaluation. The clinical instructor works directly with the student in the clinical setting.

REF: p. 41 8. A radiography program’s effectiveness is measured through a variety of benchmarks. One of

these deals specifically with a. student attendance and punctuality. b. clinical evaluations of student performance by clinical staff. c. learning outcomes. d. accomplishment of clinical competencies within the established timeline.

ANS: C

Learning outcomes, assessed at the program level, are measurable expectations for student learning. Learning outcomes are components . o f a p r o g r a m ’ s assessment plan, which are used to document the effectiveness of the program.

REF: p. 41 9. All of the following are true of the TeamSTEPPS approach to patient care except a. it is an evidence-based teamwork strategy. b. it encourages individuals to perform independently with little or no need for

support. c. situation monitoring is essential to the process of TeamSTEPPS. d. it consists of five (5) key principles.

ANS: B

TeamSTEPPS is an evidence-based teamwork system used to improve the quality, safety, and efficiency of health care. The purpose of utilizing the TeamSTEPPS approach is to create highly effective teams necessary to assure the best patient outcomes. The five key principles to TeamSTEPPS include team structure coupled with skills in communication, leadership, situation monitoring, and mutual support.

REF: p. 45 10. At a specific time in the student-patient interaction, the student may be permitted to position a

patient and provide for their general care in order to perform the procedure. At this specific point in the student’s clinical experience, they are considered to be

a. b. c. d.

at the observation phase of clinical competency. clinically competent in all phases of clinical performance. performing at the assistance level of clinical progression. testing out to complete a clinical competency.

ANS: C

When the student feels confident, he or she can then proceed to assistance, the next phase of clinical education. In this phase, the student begins aiding and supporting the medical imaging and radiologic science professional in the performance of diagnostic and therapeutic procedures. The student is now gaining hands-on experience—literally placing a hand on the patient to assist the patient as they move to the table or helping them to assume a specific position for the diagnostic or therapeutic procedure.

REF: p. 42

Chapter 06: Radiology Administration Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. The health care industry is a significant part of the U.S. economy. Hospitals, clinics, imaging

centers, rehabilitation centers, and other institutions all make up a sizeable network of this country’s health care delivery system. The complexities of a hospital and all of its departments, professions, infrastructure, and design can be likened to a. communities within a community. b. isolated enterprises that operate with complete independence. c. simple businesses with a single product or service to offer its customers. d. a family-run business with only a few employees.

ANS: A

Hospitals have a direct relationship with the community in which they are located, comparable to the relationship a city has with the county or state where it is located. This relationship should be mutually supportive and beneficial. Single hospitals have merged into multihospital groups, or systems, similar to the way nearby cities merge activities first and later combine governance. The medical staff and employees of a hospital show a parallel with the city’s skilled and trained persons who provide services to other citizens. The complexity of a hospital can be compared to that of a town or city in which people work together in mutually supportive functions.

REF: p. 49

N R I G B.C M

2. A document that guides a hospU ital S as tN o itsTpurposO e a n d role in the community it serves is

called a a. proclamation. b. set of bylaws. c. mission statement. d. master plan.

ANS: C

An organization’s mission statement is the defining and guiding force that outlines the reason for existence. “The mission statement summarizes the hospital’s intent to provide service in terms of the intended recipients of service, the type of care or services, and the level of quality and cost expected. Because every function of a hospital should be focused on what the organization wants to accomplish, all of its members should be familiar with the mission.”

REF: p. 49 3. A typical organizational structure of a hospital will have the hospital’s chief executive officer

(CEO) or president reporting to the a. chief financial officer (CFO). b. board of directors. c. city council. d. medical staff chief.

ANS: B

Governance of a hospital begins with the board of directors or governing board, which is authorized by law to operate a hospital. The board employs a chief executive officer (CEO) or president, and defines how the operation of the hospital is maintained and conducted.

REF: p. 49 4. A formal document that outlines the departmental structure of a hospital by showing lines of

authority, reporting structures, and the interrelationships of departments is a(n) a. organizational chart. b. PACS network diagram. c. flowchart. d. decision matrix.

ANS: A

The organizational chart of a hospital demonstrates how managers and employees carry out the functions within the institution in an organized and logical manner. In its basic definition, it demonstrates who reports to whom in the organization.

REF: p. 49 5. All of the physicians practicing medicine within a hospital comprise the hospital’s a. board of trustees. b. continuous quality-improvement (CQI) group. c. regulatory council. d. medical staff.

ANS: D

The medical staff is the formN al o R r g a nIi z e G d s t rBu . c t uCr e M of physicians within a hospital with S Nofficers, T committees, authorized privileges, bylaws, U elected and organized activities.

REF: p. 50 6. In large hospitals the person responsible for the operations of radiologic services is typically

the administrative director of radiology. This individual must have strong managerial and other skills, including 1. leadership skills.

2. finance and budgeting skills.

3. medical image interpretation skills.

4. strategic planning skills.

5. nursing skills, including pharmacology.

6. customer service skills.

7. communications and public relations skills. a. 2, 3, 4, 5, and 6 only b. 1, 2, 5, 6, and 7 only c. 1, 2, 4, 6, and 7 only d. 3, 5, and 6 only ANS: C

Organization of the radiology department begins with an administrative director, who reports to senior hospital administration and has direct responsibility and authority for operation and organization of the department. Key traditional responsibilities include staffing, planning, educating, supervising, organizing, coordinating, communicating, maintaining safety, and minimizing hazards in the workplace.

REF: p. 51 7. In a typical radiology department, the medical director is an essential position. The medical

director is principally responsible for a. developing staffing schedules. b. department quality-improvement activities. c. staffing decisions regarding insubordination. d. creating department social activities to encourage a teamwork attitude.

ANS: B

According to The Joint Commission (TJC), the medical director is responsible for all quality-improvement activities, although he or she may delegate responsibilities to the administrative director.

REF: p. 52 8. In addition to the traditional hospital setting for health care, it is quite common to offer

medical imaging services in a wide variety of medical settings. These sites could include 1. outpatient clinics.

2. freestanding imaging centers.

3. shoe stores in which pedal fluoroscopic imaging is available.

Nr t aRbSl eICNTGsTcanning B.C Ois available for security screening.

4. regional airports in which p oU 5. physician offices and clinics.

6. urgent care centers. a. 1, 2, 4, 5, and 6 only b. 1, 2, 5, and 6 only c. 2, 5, and 6 only d. 4, 5, and 6 only ANS: B

Radiology services have transitioned from being primarily hospital based to other health care settings. Among these settings are clinics, urgent care centers, physicians’ offices, freestanding imaging centers, manufacturing plants, research centers, outpatient surgical centers, mobile imaging centers, and so on. Placing radiology services in malls for fluoroscopic foot (pedal) imaging and for security screening is not a customary location for radiology services.

REF: p. 53 9. All of the following are related except a. performance improvement (PI). b. quality control inspections (QCI). c. continuous quality improvement (CQI). d. total quality management (TQM).

ANS: B

The functions of management are evolving from the traditional roles of directing and controlling employees to leading, coaching, and supporting employees. The influence for this change comes from the movement toward continuous quality improvement (CQI), total quality management (TQM), or performance improvement (PI).

REF: p. 54 10. At a recent radiology department meeting, the director discussed an incident that occurred a

few days earlier involving a patient within medical imaging. In his description, the director revealed that this patient had an incorrect ultrasound examination performed. Investigation into the situation showed that a receptionist told the patient to wait in the wrong holding area before the examination. The sonographer assumed that the patient was in the correct location and performed the wrong examination. To prevent this type of event from occurring in the future, what type of analysis needs to be undertaken by the department? a. Task Analysis Inventory b. PACS assessment c. CQI analysis d. Joint Commission Self-Study ANS: C

Radiology departments involved in patient safety goals or process improvement study the work functions within the department, such as patient waiting time, and report turnaround time or ways to prevent medication errors. Significant sentinel events such as examining the wrong patient necessarily warrant a CQI analysis to evaluate the processes and make improvements. Perhaps even more significant to the overall success of the hospital are the interdisciplinary CQI or patient safety process improvement activities conducted among NUR SI NG TB.C OM multiple departments.

REF: p. 54 11. The federal agency that regulates the use of ionizing radiation including medical and nuclear

applications is the a. Joint Commission (TJC). b. Nuclear Regulatory Commission (NRC). c. Occupational Health and Safety Administration (OSHA). d. Radiation Safety Committee.

ANS: B

Radiation-regulating agencies include the NRC and state licensing agencies for control of equipment, including nuclear, and technologists. Noncompliance with these agency regulations could force a health care facility to shut down any operations that involve ionizing radiation.

REF: p. 56 12. All of the following are true of the Mammography Quality Standards Act (MQSA) except a. its intent is to ensure high-quality mammography imaging nationwide. b. accreditation of mammography services through the ASRT is integral to MQSA

compliance. c. it was established by the federal government in 1992 and has been in place since

that time. d. MQSA noncompliance will prevent Medicare reimbursement for mammography

examinations.

ANS: B

The American College of Radiology (ACR) is the accrediting body for mammography services. All facilities providing mammography must be ACR accredited in order to receive reimbursement by Medicare. The Mammography Quality Standards Act (MQSA) was developed in 1992 to ensure that all women have access to high-quality mammography services.

REF: p. 57 13. Examples of internal committees within a hospital or health care enterprise include the

1. Radiation Safety Committee.

2. Joint Commission (TJC).

3. Food and Drug Administration (FDA).

4. Infection Control Committee.

5. P&T Committee. a. 1, 3, and 5 only b. 1, 3, and 4 only c. 2 and 4 only d. 1, 4, and 5 only ANS: D

In addition to external agencies, internal committees also regulate operations in a hospital or health care facility. These internal committees may consist of a Radiation Safety Committee, Infection Control CommitteeN , aUnR dS PhIaN rmGaT cyBa. nC dO T hMerapeutics (P&T) committee, to mention a few. The FDA and TJC are external agencies to the hospital.

REF: p. 57 14. Among its many virtues, digital medical imaging has permitted the networking and computer

storage of thousands of images. The transmission, display, and storage of these images are accomplished through what type of technology? a. HIPAA b. MQSA c. PACS d. NRC ANS: C

Picture archive and communication systems (PACSs) became widely accepted as a digital alternative to film-screen imaging devices in the late 1990s. A PACS is defined as a system for acquiring, archiving, interpreting, and distributing digital images throughout a health system enterprise. The most noted benefit of PACS is that it allows a health care provider to access digital imaging information anytime and anywhere care is being provided. The clinical benefits of PACSs are the availability of digital images where care is provided, faster turnaround of imaging diagnosis, simultaneous consultation ability with the radiologist, and the ability to always retrieve an examination file without fear of it being lost or misplaced.

REF: p. 58

Introduction to Radiologic and Imaging Sciences and Patient Care 8th Edition Adler Test Bank

15. Employers are looking for two principle traits in all radiologic science professionals. These

traits are a. an electronics background and critical thinking skills. b. initiative and drive. c. communication skills and the ability to speak a second language. d. technical competency and teamwork skills.

ANS: D

When radiology administrators and supervisors prepare to hire new employees, two specific criteria stand out for administrators. First, the prospective radiology employee should be knowledgeable and possess the necessary technical skills to perform the required job duties.

Second, they should have superior skills in interactive relationships.

REF: p. 58 16. Select the true statement from the choices below, regarding a Radiation Safety Officer (RSO). a. This person has to be board-certified medical physicist. b. An RSO is not needed if radioactive sources are in the department, as this area is

controlled by the Nuclear Regulatory Commission. c. An RSO may be a physicist or radiologist. d. The department RSO is an optional position depending upon the decision of the

hospital Board of Directors and their sense of need.

ANS: C

The radiation safety officer (RSO) is the person delegated within an organization that is responsible for the safe operation and use of radiation and radioactive materials, as well as ..CTOypMically organizations employ a physicist or implementing the radiation pN roU teR ctS ioI nN prG ogTrB am have a radiologist fulfill the role of the RSO. REF: p. 53 17. Medical imaging professionals must be aware that their actions, comments, and appearance

contribute to the image of their employer and of the profession. Positive interactions with patients and their family members establish goodwill on behalf of the organization. Which of the following is the best single choice that illustrates desirable goodwill efforts enhancing public image? a. Greeting patients and telling simple jokes to raise their spirits b. Proudly displaying your religious tattoos to express your spirituality c. Wearing attire that is consistent with the dress code and presenting an upbeat attitude d. Referencing your notes tableside during a medical procedure to avoid mistakes ANS: C

When patients observe cooperative interactions among employees, their perception of the quality of the facility and the value they receive in the service provided are enhanced.

Professional attire and behavior are paramount in creating a positive patient experience. Each employee can make a difference.

REF: p. 59

Introduction to Radiologic and Imaging Sciences and Patient Care 8th Edition Adler Test Bank 18. To a medical imaging department, the customer could be described as a. a referring physician or patient. b. more educated and informed about imaging procedures. c. having options for medical care and therefore they can be more selective. d. All of the above ANS: D

Customers to medical imaging can be considered at many levels, including referring physicians, patients and their families, vendor representatives, visitors, medical staff members, and nursing. Because of the Internet and social networking technologies, patients are more informed about imaging procedures and require special consideration in terms of communication and their medical imaging choices.

REF: p. 58 19. In providing radiology care to a patient, you observe a colleague accidentally exposing the

wrong body part. It appears that he is unaware of the mistake. This action would be considered a(n) a. insignificant patient care event since no visible harm was done. b. medical error. c. true diagnostic accident and not worthy of documentation. d. medical event that would be billed as a separate procedure.

ANS: B

Although the knowledge requirements for technologists continue to include solid technical skills, a higher demand is placed on superior interpersonal and patient care skills. Recognizing a medical error requires intervention to correct the mistake and an analysis using CQI techniques to improve the prN ocU esR sS anIdNprGeT veBnt.fC utO urM e errors. In the twenty-first century, high-quality service and communication skills are as important as technical skills in the preparation of students for future employment. High-quality service can be defined as doing things right the first time and meeting or exceeding the customer’s expectations.

REF: p. 58 20. A competent, professional radiographer will demonstrate many skills and talents in the

performance of their position. Many radiology directors will express particular interest in a single trait among many, when considering the employment of a new radiographer. This critically important trait centers around one’s a. teamwork skills. b. knowledge of radiation protection and safety. c. understanding of digital technology and how to fix image errors. d. practice of sterile technique in surgical procedures.

ANS: A

Many administrators believe they can assist the new employee who has a solid knowledge base to grow and acquire an increased range of technical skills, but people skills depend on long-term training, instincts, and personality development. An employee with strong interpersonal skills cooperatively enhances patient care and workflow, thereby increasing his or her value to the workplace.

REF: p. 58

Chapter 07: Radiographic Imaging Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. The component that intercepts the remnant radiation from a patient and creates the

radiographic image is the a. radiographic grid. b. collimator. c. image receptor. d. table top.

ANS: C

A device called an image receptor (IR) intercepts the X-ray photons that are able to exit the patient. Multiple different IR systems are used in radiography, including film-screen systems, computed radiography (CR) cassette-based systems, digital radiography (DR) cassette-less systems, and fluoroscopic imaging systems.

REF: p. 62 2. All of the following are related except a. source of electrons. b. means for setting electrons in high-speed motion. c. a target to stop or suddenly decelerate the electron travel. d. aluminum filtration material.

ANS: D

Basically, four requirements exist for the production of X-rays: a vacuum environment in the tube, a source of electrons, a method for accelerating them to very high speed, and a target material to stop the electrons suddenly to create x-radiation. Aluminum, as a filter material, is not essential for x-radiation production.

REF: p. 62 3. The production of x-radiation that occurs in an X-ray tube requires the movement of

negatively charged particles traveling from one side of the tube to the other. This movement of charges must occur in a. an aqueous medium. b. a vacuum. c. a tungsten gas environment. d. the subnuclear space.

ANS: B

The vacuum removes all of the air so gas molecules will not interfere with the production of X-rays. When the electrons strike the target, X-ray photons are produced; however, less than 1% of this production is actually X-rays; the remaining 99%+ is heat.

REF: p. 67

4. The X-ray tube component that stops the stream of electrons and produces the X-ray beam is

called the a. cathode. b. anode. c. tetrode. d. positode.

ANS: B

When the electrons strike the target, X-ray photons are produced. This target material is positively charged (anode) to attract the negatively charged electrons.

REF: p. 62 5. The x-radiation that is “left over” and exits the patient to strike the image receptor and create

the image is known as a. remnant b. primary c. scatter and secondary d. nuclear

radiation.

ANS: A

The resulting beam that is able to exit from the patient is called exit or remnant radiation.

This remnant radiation produces an image in the image receptor.

REF: p. 62 6. Of all of the energy traveling through the X-ray tube during a radiographic exposure, the

largest percentage of this elecNtricR al eI e r gGy i sBc.o C r t ed to U nS N T nv e M a. x-radiation. b. infrared energy. c. thermal energy (heat). d. mechanical energy.

ANS: C

During X-ray production, 99%+ of the electrical energy passing through the X-ray tube is converted to heat in the form of thermal energy. The remaining 1% actually is converted to X-ray energy. X-ray production is a very inefficient process.

REF: p. 62 7. As you process a radiographic image of the abdomen of a small child, you notice a small

ring-like object on the image. It appears this object is in the patient’s stomach, which is consistent with the examination history. The ring shows on the X-ray image because of its metallic density. This is the result of a. attenuation of the X-ray beam by the metallic density of the ring. b. transmission of the X-ray beam through the soft metal of the ring. c. electrons from the X-ray tube striking the patient. d. scatter radiation from the patient.

ANS: A

Attenuation is the process by which the nature of the primary radiation is changed as it travels through the patient. The X-ray beam is attenuated differently, depending on the type of body tissue irradiated. This difference in attenuation allows for the formation of radiographic images. Metallic objects such as rings attenuate X-ray energy to a large degree and can look opaque on the image.

REF: p. 63 8. Bowel gas in the abdomen is an example of a a. radiopaque b. radiolucent c. radiofrequent d. radioresistant

material, with regard to the X-ray beam.

ANS: B

Radiolucent materials allow X-ray photons to pass through comparatively easily similar to how translucent panes of glass allow the passage of light. On the final image, they are typically dark.

REF: p. 63 9. The total quantity of X-ray photons produced during an exposure is determined by the a. kVp. b. SID. c. milliamperage (mA). d. mAs. ANS: D

Milliampere-seconds (mAs) is the parameter that controls the amount of x-radiation produced by the X-ray tube; it is the product of milliamperage (mA) multiplied by seconds. It directly controls the quantity of X-ray photons produced.

REF: p. 63

When radiographic images of patients are created, many exposure variables come into play to

10. produce optimum image quality. Any change in the radiographic image appearance should be

the result of a. the experience and competency of the technologist. b. the radiation output of the X-ray machine. c. the patient’s medical condition as reflected in the image characteristics. d. computer processing to enhance image contrast.

ANS: C

Because radiography is actually the investigation of tissue characteristics, attempting to standardize exposure factors affecting image quality is an important part of image production.

Technique charts, automatic exposure control, accurate positioning, and standard imaging protocols are useful in this regard. Any variance in the image appearance should be due to the patient’s medical condition, not an exposure factor variable.

REF: p. 63 | p. 64 11.

X-ray film imaging has been replaced by

a. b. c. d.

computed radiography (CR). direct and indirect digital detector technology. digital radiography (DR) systems.

All of the above

ANS: D

Historically, film has been the primary recording medium for X-ray images. However, almost all film-based systems have now been replaced with CR and DR systems.

REF: p. 64 12. The invisible, unprocessed data on an image detector immediately after X-ray exposure forms

the a. b. c. d.

image. remnant manifest primary latent

ANS: D

This invisible image is called the latent image. After the latent image has been processed, a visual image appears. The latent image can be chemical alterations to a film emulsion, or stored electron traps in CR imaging, or atomic disturbances in a DR detector. All are considered latent images.

REF: p. 64 13. The resolution of an image using thin-film-transistor (TFT) technology is determined by the a. size of the energy traps. b. storage phosphor plate dimension. c. detector pixel size. d. the scanning frequency of the reader optics.

ANS: C

The TFT is an array of small (approximately 100 to 200 m) pixels. A pixel is a single picture element, and a matrix is a rectangular series of pixels. The resolution of digital images is determined by the individual size of each pixel. Each pixel contains a photodiode that absorbs the electrons and generates electrical charges. More than 1 million pixels can be read and converted to a composite digital image in less than 1 second.

REF: p. 65 14.

A direct capture digital radiography detector uses a. silver bromide b. amorphous silicon c. amorphous selenium d. barium fluorohalide

as the receptor material.

ANS: C

In direct capture, X-ray photons are absorbed by the coating material and immediately converted into an electrical signal. The DR detector has a radiation-conversion material or scintillator, typically made of amorphous selenium (a-Se). This material absorbs X-rays and converts them to electrons, which are stored in the thin-film transistor (TFT) detectors.

REF: p. 65 15. There are four primary image quality factors. They are a. SID, mAs, SOD, and kVp. b. primary radiation, scatter radiation, secondary radiation, and remnant radiation. c. contrast, IR exposure or density, distortion, and recorded detail. d. grids, collimation, filtration, and beam restriction.

ANS: C

There are four primary image quality factors. Two of these are photographic in nature: IR exposure and contrast. The two geometric quality factors are recorded detail and distortion. A proper balance between the photographic and geometric properties of an image results in good image quality.

REF: p. 66 16. All of the following are true of computed radiography (CR) except a. it uses cassettes. b. the image is recorded on an amorphous silicon imaging plate. c. the active material in CR plates is barium fluorohalide. d. the image plates are reusable.

ANS: B

Computed radiography employs the use of light-tight cassettes encasing a barium fluorohalide-coated imaging plate. This reusable technology is a storage phosphor process that does not use a thin-film transistor layer, as is the case with DR technology.

REF: p. 64 17. Sub-optimum mAs exposures in CR imaging technology will yield an image that is a. grainy and demonstrates quantum mottle. b. magnified and distorted. c. minified and distorted. d. overexposed and too dark to interpret.

ANS: A

The mAs is selected according to the number of photons needed for a particular part. If there are too few photons, regardless of the kVp chosen, the result will be a lack of IR exposure to create sufficient phosphor stimulation. When insufficient light is emitted from the phosphors, it produces an image that is grainy, a condition known as quantum mottle or quantum noise.

REF: p. 65 18. Optimum radiographic image quality is a function of proper exposure technique selection.

Given the three sets of mAs calculations that follow, all three should yield the same degree of radiographic exposure to a detector.

Exposure 1: 200 mA  0.05 ms Exposure 2: 100 mA  0.10 ms Exposure 3: 400 mA  0.025 ms This is known as

a. b. c. d.

the inverse square law. the kVp/mAs ratio. mA/mAs proportionality. mAs reciprocity.

ANS: D

Milliampere-seconds is the product of mA and time. Any combination of mA and time producing equivalent mAs values should produce equivalent IR exposures. This process is known as mAs reciprocity.

REF: p. 68 19. As you position patients for various radiographic procedures, you will occasionally angle the

X-ray tube assembly. This intentional use of tube angles is referred to as a. size distortion. b. size minification. c. shape distortion. d. magnification.

ANS: C

The misrepresentation of the shape of an object on an image is called shape distortion or true distortion. It is controlled by the alignment of the beam, part, and image receptor. Influencing factors include central ray angulation and body part rotation.

REF: p. 77 20. An effective method to overcome superimposition of patient anatomy on a radiograph is to

1. increase the SID. 2. angle the X-ray tube.

3. decrease the SOD. 4. rotate the patient into an oblique position.

5. angle the image receptor. a. 1 and 3 only b. 2 and 5 only c. 2 and 4 only d. 1 and 5 only ANS: C

If the object of interest is superimposed on another object, the resulting image is difficult to evaluate. By rotating or obliquing the body, the object of interest can be projected free from the interference of the overlying object. Frequently, a combination of part rotation and central ray angulation is used to best demonstrate the anatomic details free from superimposition by overlying structures.

REF: p. 77 21. As you perform a portable chest radiograph, the optimal SID of 40 inches is unattainable

because of orthopedic supports over the patient. It is necessary for you to shorten the SID to 34 inches. A professional radiographer should do which of the following? a. Indicate the shorter SID on the examination notes to the radiologist. b. Prop the patient up to increase the distance 6 inches from the image receptor.

c. Angle the tube cephalad to compensate for the shorter SID. d. Use a shorter exposure time to improve resolution.

ANS: A

In radiography, the greater the SID, the better the recorded detail will be. Because radiographic rooms and equipment are not currently built to accommodate extremely long distances, SIDs are standardized so that the degree of penumbra is at least a known factor. The most common SID is 40 inches, but some procedures such as chest radiography use a 72-inch SID. Exceptions to these standards exist, but the SID of an examination should always be indicated to allow for the calculation of image unsharpness.

REF: p. 76 22. The dynamic display of a patient’s anatomy using x-radiation is termed a. fluoroscopy. b. tomosynthesis. c. image intensification. d. real-time radiography.

ANS: A

The fluoroscopic image itself is a dynamic, or moving, image rather than a static radiographic image. Fluoroscopy permits X-ray evaluation of body dynamics and function, something that static radiographs are unable to provide.

REF: p. 78 23. The loss of radiographic image resolution is often referred to as unsharpness. All of the

following contribute to total N imaR ge uIn s hG Be.s sCe x cMe p t the U S aNr p nT a. size and shape of the patient’s anatomy. b. pixel size of the image receptor (IR) and monitor display. c. size and shape of the exposure field (collimation). d. image geometry factors such as SID, OID, and focal spot size.

ANS: C

Loss of image sharpness is primarily the result of the geometric factors contributing to optimum image quality. These include the SID, OID, focal spot size, patient size and shape, and the resolution characteristics of the detector technology used. In the case of DR detectors, the size of the detector element (pixel) is a key factor. The shape and size of the X-ray field does not contribute to the recorded detail of the image.

REF: p. 75 | p. 76 | p. 77 24. An effective measure of actual exposure compared to a target exposure value is the use of a(n) a. S number. b. deviation index (DI). c. exposure index (EI). d. half-value layer.

ANS: B

The deviation index (DI) would be used in conjunction to determine if the appropriate radiographic technique factors were used during an examination. The DI can be defined as a comparison of the target value with the actual exposure recorded by the IR.

REF: p. 73 25. Computers and their software programs are essential to the processing of digital image data

for digital X-ray images. This software can compensate for wide variances in radiation exposure to produce an image. Sub-optimum or excessive exposure is compensated for through a process referred to as a. automatic rescaling. b. automatic processing. c. the 15% rule. d. pixel value optimization.

ANS: A

Automatic rescaling is used when exposure is greater or less than what is needed to produce a diagnostic image. Automatic rescaling means that images are displayed with uniform brightness and contrast, regardless of the amount of exposure to the IR. REF: p. 73 26. A very effective method for reducing your exposure to radiation during an exposure is to take

advantage of distance. You can reduce your exposure by a factor of nine if you a. double your distance. b. triple your distance. c. increase your distance according to the 15% rule. d. increase your distance directly by a factor of nine.

ANS: B

The relationship between di sN t a n cRe a nId eG su. reCis dMescribed by the inverse square law: the B U Sin mR) N xTpo O proportional to the square of the intensity of radiation (as measured is inversely distance from the source. In other words, as an example, if the distance is doubled, the intensity decreases to one-fourth of the original.

REF: p. 71

Chapter 08: Radiographic and Fluoroscopic Equipment Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. A general radiographic imaging system consists of which components?

1. Control console and generator 2. X-ray tube and support assembly 3. Lead aprons and gloves 4. Left and right lead markers 5. X-ray table and upright cassette holder 6. Collimator assembly a. 3, 4, 5, and 7 only b. 1, 2, 5, and 6 only c. 1, 2, 3, and 4 only d. 1, 2, 4, and 6 only ANS: B

Regardless of the manufacturer, all X-ray systems have the same basic design features, which are an X-ray tube and support system, collimator assembly, X-ray table, X-ray generator, control console, and upright image receptor holder devices. All components combine to form an X-ray imaging system.

REF: p. 81 2. Radiographic exposure tec hnN i queRselIectiGon iB s . p eCr f o M r m e d with what component of an X-ray

U S system? a. Generator electronics cabinet b. X-ray tube assembly c. Operator’s console d. Radiographic table

N T

O

ANS: C

Generator console designs vary, but all have some key features. All systems allow the radiographer to turn the system on and off, select the X-ray exposure factors, initiate and terminate the exposure, and provide an audible and visual indication of X-ray exposure.

REF: p. 89 3. Physicians can choose from several medical imaging modalities to determine their patient’s

condition. Among these are radiography, MRI, CT, ultrasonography, and nuclear medicine, just to mention a few. Each specialty has its own of information. a. diagnostic yield b. interpretation cycle c. diagnostic efficacy d. diagnostic ratio ANS: A

All diagnostic procedures have an expected yield of medical information regarding the patient’s condition. When physicians choose one procedure over another, many factors are considered in making the selection based on diagnostic yield.

REF: p. 87 | p. 88 4. To improve the flexibility of a radiographic system, engineers have designed equipment so

that the X-ray tube support system and detector assembly a. are always connected and centered to each other. b. have only longitudinal motions. c. have only transverse motions. d. can move independently of each other.

ANS: D

X-ray tube support designs are intended to permit easy, flexible positioning of the X-ray tube toward the patient. They must provide longitudinal, vertical, transverse, and rotation capabilities. They may be either a floor-mounted tube stand design or a ceiling-mounted overhead suspension tube crane design.

REF: p. 86 | p. 87 5. Desirable features of a modern radiographic table consist of which of the following?

1. High-attenuation tabletop material 2. Variable height 3. Four-way floating tabletop 4. Radiolucent tabletop 5. Convenient and ergonomic-friendly controls Ral rINa yGTB.COM 6. Automatic centering to the cU eN n t rS a. 1, 2, 4, 5, and 6 only b. 2, 3, 4, and 6 only c. 2, 3, 4, and 5 only d. 1, 2, 3, 5, and 6 only ANS: C

Radiographic tables come in a variety of designs. All include essential features, including a radiolucent table top material, variable height, floating tabletop travel, and convenient controls. Automatic centering to the central ray would not improve table functionality.

REF: p. 82 | p. 83 6. You have just completed a chest radiograph on a young female patient. As you review the

image, you notice she was wearing a necklace during the exposure that is clearly seen over the chest anatomy. Submitting this image to the radiologist for interpretation would a. be of no consequence to the interpretation. b. be acceptable as long as an explanation is provided to the radiologist. c. detract from the diagnostic efficacy because it is not part of the patient’s anatomy. d. increase the diagnostic yield of information.

ANS: C

The accuracy with which a diagnostic study reveals the patient’s medical condition is its diagnostic efficacy. Image artifacts such as jewelry, clothing, tubes, lines, etc. do not truly represent the patient’s medical condition and lower diagnostic efficacy.

REF: p. 81 7. Which of the following occur during X-ray tube preparation or “boost?”

1. The collimator light goes out to save energy.

2. The anode comes up to rotational speed.

3. The preselected milliamperage increases in the cathode filament.

4. A high voltage is applied across both diodes of the X-ray tube, enabling electrons to travel across to the anode.

5. The grid in the table begins to oscillate. a. 1, 2, 4, and 5 only b. 2, 3, and 4 only c. 2 and 3 only d. 2, 4, and 5 only ANS: C

Before actual exposure, prepping the tube includes the milliamperage increasing to the preselected value and the anode disk rotating up to a minimum speed of rotation. At the precise moment of exposure, a large electrical potential is applied across the dipoles of the X-ray tube, causing the liberated electrons to accelerate at tremendous speed from cathode to anode.

REF: p. 81 | p. 82 8. Newer fluoroscopic system dN esU igRnS s uItiN liG zeTfB la. t-pCaO neM l digital detectors for both static and

dynamic imaging. Depending upon the design, the X-ray tube can be positioned above or below the patient. If the X-ray tube is above the patient during fluoroscopy, a key point to remember is that a. the scatter radiation exposure is no different than traditional designs. b. there is a loss of resolution due to the increased SID. c. the scatter radiation is more intense to the operator at the waist and trunk level. d. there is an increase in image resolution because of tighter collimation.

ANS: C

An alternative R/F system design positions the X-ray tube above the patient and fluoroscopic detector below. A principal advantage to this approach is that a single detector can perform both fluoroscopic and static imaging. The expandable SID permits improved image resolution and a lower patient skin dose during fluoroscopy. An important consideration, however, is that with this design, the scatter radiation coming from the patient during fluoroscopy is more intense at the waist level and above. Because of this, persons standing next to the patient during fluoroscopy should be aware of exposure to their necks and eyes particularly and use appropriate lead protection.

REF: p. 91 9. Chest radiographs and upright abdominal studies are conveniently performed using a(n) a. variable height table. b. upright cassette holder or Bucky.

c. tilting radiographic table. d. interventional C-arm system with a fixed SID. ANS: B

Many radiographic rooms have an upright holder a special unit that allows the technologist to obtain radiographs of standing patients. The two primary devices are a simple wall-mounted cassette holder or a wall-mounted Bucky system.

REF: p. 87 10. The term PSP technology commonly refers to a. photon saturation plate technology. b. indirect DR imaging. c. photon static production technology. d. computed radiography (CR).

ANS: D

Commonly referred to as CR, PSP imaging uses a reusable imaging plate that is flexible and coated with an alkali-earth halide material. The imaging plate is enclosed in a light-tight cassette. PSP detectors capture the energy of the remnant beam and store it for a period in electron traps. These electron traps represent the latent image.

REF: p. 89 11. The latent image in computed radiography is actually

within the barium fluorohalide

material. a. sensitivity specks b. silver halide specks c. electron traps d. detector elements ANS: C

PSP detectors (CR) capture the energy of the remnant beam and store it for a period of time in “electron traps.” These electron traps represent the latent image.

REF: p. 89 12. Another term for automatic collimation is a. electronic masking. b. positive beam limitation. c. electronic shuttering. d. coning.

ANS: B

Most X-ray machines are equipped with an automatic collimation system that performs positive beam limitation (PBL). This feature allows the X-ray unit to detect the size of the image receptor the radiographer is using and automatically collimates to a size not larger than the image receptor.

REF: p. 82

13. A popular feature on X-ray generators that reduces repeat exposures caused by inaccurate

exposure technique selection by technologists is a. high-speed anode rotation. b. automatic exposure control (AEC). c. integrated anode heat unit calculation. d. positive beam limitation (PBL).

ANS: B

For many procedures, exposures are terminated using automatic exposure control (AEC) circuitry. The technology of AEC has simplified exposure technique selection and improved the consistency of image quality.

REF: p. 85 14. Damage to X-ray tubes that can shorten their useful life can occur with a. prolonged anode preparation times. b. repeated “boosting” of the tube several times before exposures are performed. c. repeatedly removing and replacing the added filtration selection. d. prolonged anode preparation times and repeated “boosting” of the tube several

times before exposures are performed ANS: D

Repeatedly prepping the tube unnecessarily can damage the X-ray tube and shorten its useful life. The radiographer clearly needs to understand proper exposure control operations and use extended “anode prep” times only when clinically appropriate. Similar to a car having its own normal sounds of operation, X-ray units do as well. It is important to pay attention to unusual sounds and report them to appropriate personnel.

REF: p. 86 15. All of the following are true of CR technology except a. there is no difference in image resolution among the three image plate (cassette)

sizes. b. the latent image is time sensitive and should be processed in the reader in a

reasonable time period. c. CR image plates need to be erased or “washed clean” with an intense light source

in the reader assembly. d. CR technology offers an affordable electronic transition toward digital imaging.

ANS: A

The best spatial resolution with CR receptors is achieved with smaller receptors. The difference in resolution can be as much as two line pairs per millimeter (lp/mm) between cassette sizes.

REF: p. 89 16. In a radiographic/fluoroscopic (R/F) system, the primary barrier is considered to be the a. fluoroscopy lead apron in front of the spot film device. b. image intensifier or flat-panel detector. c. tabletop of the R/F table. d. patient.

ANS: B

During fluoroscopy, the fluoroscopic tower is locked into position with the fluoroscopic X-ray tube so that both are centered to each other. The image receptor is considered a primary barrier to the X-ray beam, and fluoroscopic exposures are allowed only when the fluoroscopic X-ray tube and image receptor are locked in place and centered to each other to permit exposure.

REF: p. 90 17. The correct combination of exposure factors necessary to yield a total of 24 mAs using the

shortest exposure time to minimize patient motion is a. 400; 0.06 sec b. 500; 48 ms c. 250; 9 ms d. 50; 0.48 sec

mA at

.

ANS: B

When the milliamperage (mA) is multiplied by the total exposure time(s), the total quantity of X-ray exposure or mAs is the result. This mAs value directly affects the amount of X-ray exposure of the patient and ultimately the image receptor.

REF: p. 85 18. Fluoroscopy done in the surgical theater is typically accomplished with a a. portable radiographic unit. b. mobile radiographic unit. c. portable C-arm system.

R I G B.C M N d. conventional R/F system. U S N T O ANS: C

As use of interventional radiologic procedures increases, increasingly more fluoroscopic procedures are being performed in surgical suites. Portable fluoroscopy is accomplished through the use of mobile C-arm design and consists of a fluoroscopic X-ray tube and image receptor that are centered to other. Most designs now use a flat-panel digital fluoroscopic detector, which has reduced the weight and size of the C-arm designs.

REF: p. 93 19. Portable digital DR detectors are very popular for portable radiographic imaging. It is

important to remember that a. they must have a small electrical charge applied to the TFT layer. b. wireless detectors use batteries for charging. c. a communication connection must exist between the detector and X-ray generator. d. All of the above ANS: D

Wireless DR panel systems have gained considerable popularity and use an on-board battery or capacitor to provide a small “trickle charge” to the TFT layer of these panels. The charge is placed on the TFT layer just prior to and during the X-ray exposure; therefore an electronic communication between the panel and generator is required.

REF: p. 94

20. Select the true statement from the choices given. a. Digital tomosynthesis is possible using CR technology. b. Digital photospot images have higher image quality due to the higher radiation

dose. c. Dual-energy subtraction radiography employs PSP technology. d. Last Image Hold (LIH) is only possible on indirect flat-panel TFT digital systems.

ANS: B

Digital spot images are taken at a higher dose, yielding better image quality. The development of DR detectors has opened the door for increased clinical utility. Of particular interest are the innovations of digital tomosynthesis and dual-energy subtraction radiography. All R/F systems provide a last image hold (LIH) function, which freezes the last video image on the monitor for detailed study by the viewer.

REF: p. 92

Chapter 09: Basic Radiation Protection and Radiobiology Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. The radiation a person receives from the sun (cosmic radiation) is categorized as a. natural background radiation. b. medical background radiation. c. atmospheric radiation. d. radioactivity.

ANS: A

The two basic sources of ionizing radiation exposure are natural (or background) radiation and human-made (artificial) radiation sources. Background sources occur spontaneously in nature and can be affected by human activity. These forms include cosmic radiation from the sun and other planetary bodies and naturally occurring radioactive substances present on earth (e.g., uranium and radium), which can be inhaled or ingested through food, water, or air (radon).

REF: p. 96 2. With regard to the ALARA principle, the responsibility of the radiographer is to a. obtain high-quality radiographs in an efficient manner. b. keep radiation exposures at the lowest levels possible. c. assess image quality as a function of dose. d. determine the risk-to-benefit relationship between ordered examinations and dose.

ANS: B

Risk versus benefit governs the exposure of individuals when physicians ordered radiographic procedures. The benefit to the patient from performing those procedures must outweigh the risk of possible biologic damage. Because current studies indicate that an individual’s dose should be kept as low as reasonably achievable (ALARA), and that no dose is considered permissible, the term maximum permissible dose is no longer acceptable.

REF: p. 100 | p. 101 3. The dose equivalent limits for radiation workers are based on the radiation received from what

source(s)? a. Background radiation b. Medical and dental radiography c. Occupational exposure d. Radiation fallout ANS: C

Because patients and workers exposed to radiation are at risk for biologic effects, limits must be set to ensure safe practice for both patients and radiation workers. Dose measurement for radiation workers is limited exclusively to occupational exposure. The annual whole-body effective dose limit for the occupational worker is 50 mSv (5 rem).

REF: p. 100 | p. 101

4. A given dose of radiation generally has the greatest potential for damage in tissues that have a. the most mature. b. the largest cells. c. more rapidly dividing cells. d. cells with the lowest cytoplasmic water content.

ANS: C

To study a cell’s response to radiation, a method of classification according to sensitivity was developed by Bergonie and Tribondeau in 1906. Cells are most sensitive to radiation during active division, when they are primitive in structure and function. Cells with a high rate of mitosis are more radiosensitive.

REF: p. 102 5. Nausea is principally associated with the a. prodromal period. b. latent period. c. central nervous system syndrome. d. manifest stage.

ANS: A

Three general stages of response exist for each acute radiation syndrome. The first is the prodromal stage, commonly referred to as the nausea, vomiting, and diarrhea stage.

REF: p. 102 6. The material commonly used for shielding against radiation exposure in protective aprons and

gloves is a. lead. b. barium impregnated vinyl. c. bismuth. d. titanium.

ANS: A

Shields are made of lead, which has an atomic number of 82. Lead absorbs X-rays through the process of photoelectric effect, thereby minimizing patient exposure.

REF: p. 103 7. The photon interaction that results in the highest patient exposure is a. bremsstrahlung b. Compton c. classical scattering d. photoelectric

interactions.

ANS: D

Because complete energy absorption takes place in photoelectric interactions, this constitutes the greatest hazard to patients in diagnostic radiography.

REF: p. 97 8. The law of Bergonie and Tribondeau states that cells are more radiosensitive if they are

1. highly mitotic.

2. primitive and undifferentiated.

3. mature cells.

4. larger in size.

5. nonnucleated. a. 1 only b. 1 and 2 only c. 2, 3, and 5 only d. 2, 4, and 5 only ANS: B

The law of Bergonie and Tribondeau states that the mitotic activity and specific characteristics of each cell affected how the cell exhibited radiation damage. Cells are most sensitive to radiation during active division, when they are primitive in structure and function (undifferentiated).

REF: p. 102 9. In which of the following X-ray interactions with matter is the energy of the incident photon

completely absorbed? a. Compton scattering b. Photoelectric absorption c. Bremsstrahlung interactions d. Characteristic interactions ANS: B

Because complete energy absorption takes place in photoelectric interactions, this constitutes the greatest hazard to patientN s iU nR diS agInN osGtiT c B ra. diC ogOraMphy. Compton scattering contributes most to radiation worker exposure, and bremsstrahlung and characteristic interactions are not X-ray photon interactions.

REF: p. 97 | p. 98 10. Which action of ionizing radiation is most prevalent and most harmful to the human body? a. Direct action b. Indirect action c. Hormesis d. Mitotic apoptosis ANS: B

Because cells are approximately 80% water, indirect action occurs when water molecules are ionized. This action produces chemical changes (free radicals) within the cell that alter the internal environment, injuring the cell, and can result in eventual cell death. With x-radiation and gamma radiation, the vast majority of cellular damage is the result of indirect hits.

REF: p. 102 11. Acute radiation syndrome manifests in four major stages. In what order do these stages occur? a. Latent period, prodromal period, manifest stage, and recovery or death b. Manifest stage, prodromal period, latent period, and recovery or death c. Prodromal period, latent period, manifest stage, and recovery or death

d. Manifest stage, latent period, prodromal period, and recovery or death ANS: C

The total-body response of any organism to radiation depends on the effect on all the systems of the body. This response, known as acute radiation syndrome, occurs only when the organism is exposed fully (total body) to an external source of radiation given in a few minutes. Three general stages of response exist for each acute radiation syndrome. The first is the prodromal stage. The second stage is the latent period, in which the organism feels well; however, during this time, the body is undergoing biologic changes that will lead to the final period, the manifest stage. Now the organism feels the full effects of the exposure, leading to either recovery or death.

REF: p. 102 12. The radiographic beam should be restricted so that it is a. slightly larger than b. no larger than c. twice as large as d. four times as large as

the image receptor.

ANS: B

The radiographer always must restrict the primary beam to the anatomic area of interest, never exceeding the size of the image receptor used to capture the information.

REF: p. 104 13. The function of an X-ray beam filter in diagnostic radiology is to a. decrease the average enerN gy R of thIe bG oC i m pM r ove image quality.

U S NeamTBt. b. permit only beta particles to interact with the atoms of the patient’s body. c. decrease the x-radiation dose to the patient’s skin and superficial tissue. d. remove gamma radiation from the useful X-ray beam.

ANS: C

Filtration material in the path of the X-ray beam absorbs the low-energy X-rays that only add to the patient’s entrance dose. Eliminating their presence in the primary beam reduces patient entrance skin exposure (ESE). Aluminum is the most common material used in filtration.

REF: p. 104 14. A woman who is 3 months’ pregnant has been in a motor vehicle accident. The emergency

department physician suspects there is injury to her cervical spine and thus feels justified in ordering an X-ray examination to aid in determining the extent of the patient’s injury. Because the patient is pregnant, the radiographer should 1. select the lowest exposure factors that will produce a diagnostically useful radiograph.

2. adequately and precisely collimate the radiographic beam to include only the anatomic area of interest.

3. shield the patient’s lower abdomen and pelvic region with a suitable protective contact shield.

4. only perform the lateral projection to minimize radiation dose. a. 1 and 4 only b. 2 only

c. 3 and 4 only d. 1, 2, and 3 ANS: D

Radiographing pregnant patients require special attention to protection. The principle of ALARA always prevails, and in doing so, the exposed anatomy should be as small as clinically possible. A good rule of protection is to shield by placing some material over the reproductive organs (gonads) of the patient whenever they are within 4 to 5 cm of the primary beam. Gonadal shielding is used only when it will not interfere with the anatomy of interest.

This precaution is particularly important when performing radiography on children and adults of reproductive age.

REF: p. 104 15. Which of the following is a principle of the ALARA concept? a. All diagnostic X-ray exposure is low energy and of little concern. b. The radiographer should hold a standard number of patients per year as long as it is

below the allowable limits. c. X-ray doses can increase progressively to allowable limits on older patients. d. The radiographer’s occupational exposure should be kept as low as reasonably

achievable and the concept of “permissible dose” is no longer recognized.

ANS: D

The concept of ALARA—as low as reasonably achievable—is used to guide radiation protection practices when performing examinations. Because current studies indicate that an individual’s dose should be kept as low as reasonably achievable (ALARA), no dose is considered permissible.

REF: p. 100 | p. 101

NURSINGTB.COM

16. For a pregnant radiographer who declares her pregnancy to the employer, a second personnel

monitoring device is provided. The purpose of this additional monitor is to ensure that the monthly equivalent dose to the embryo or fetus does not exceed mSv ( rem). a. 0.5; 0.05 b. 10; 1 c. 5; 0.5 d. 50; 5 ANS: A

The NRC regulations require that a personnel monitor be used if the declared pregnant student could potentially receive 10% of the embryo or fetal dose limit or 0.5 mSv per month. In addition to the collar monitor, a second dosimeter (fetal badge) must be worn at waist level.

During fluoroscopic procedures when a lead apron is worn, the fetal badge is worn at waist level under the lead apron.

REF: p. 101 | Table 9.2 | p. 106 17. If a technologist stands 2 m from an X-ray tube and receives an exposure rate of 4 mR/h, the

exposure rate would be a. 1 b. 2

mR/h if the person stands 4 m from the X-ray tube.

c. 3 d. 4 ANS: A

Distance is the best measure of protection for an occupational worker. The principle of the inverse square law states that the intensity of radiation varies inversely with the square of the distance. Doubling the distance between the radiographer and the source of radiation reduces the exposure by a factor of 4 (now the dose at the original distance).

REF: p. 104 18. When laser light stimulates the sensing material in an optically stimulated luminescence

dosimeter (OSL), the a. aluminum oxide material luminesces in proportion to the amount of radiation exposure received. b. aluminum oxide stores the laser energy for future reference. c. lithium fluoride chip emits light. d. film darkens proportionally to the amount of laser light.

ANS: A

The Luxel OSL dosimeter is the most common method used to monitor personnel exposure.

To determine the individual’s exposure, the aluminum oxide is exposed to a laser light, which stimulates the aluminum oxide after use, causing it to become luminescent in proportion to the amount of radiation exposure, which determines the occupational worker’s exposure.

REF: p. 106 19. Protective devices such as leaNdUaR prS onIsNaG reTinBte.nC deO dM to protect the user from

radiation.

1. Compton scatter and secondary 2. primary 3. remnant 4. bremsstrahlung a. 1 only b. 1, 2, and 4 only c. 1 and 3 only d. 1, 3, and 4 only ANS: A

The radiographer must use shielding whenever time and distance alone cannot satisfactorily protect the worker. Exposure to radiation workers is generally from secondary and scatter interactions and should never be from primary radiation. The Compton effect is extremely important because it is responsible for a majority of occupational worker exposure to radiation.

REF: p. 105 20. Which of the following personnel radiation monitors will provide a near-immediate reading of

radiation exposure, if necessary? a. TLD b. Film badge c. Lithium fluoride chips

d. Pocket dosimeter ANS: D

The pocket dosimeter is used when an immediate reading of occupational dose is desired; however, it is subject to false readings and does not provide a permanent record. Pocket dosimeters are not commonly used to monitor exposure to medical imaging personnel.

REF: p. 107 21. A device that is commonly used to locate and measure the intensity of a radioactive material

in an area is a(n) a. film badge. b. flat panel TFT detector. c. Geiger-Müller counter. d. OSL dosimeter.

ANS: C

A common instrument used to detect x-radiation, gamma radiation, and beta radiation is the Geiger-Müller counter, which is an ionization chamber constructed of an electrode housed within a chamber. They are commonly used to measure the presence of ionizing radiation in an area and also can indicate the type of emission and its intensity. For locating a missing dosage of radionuclide, the G-M counter is essential in most nuclear medicine departments.

REF: p. 107

Chapter 10: Human Diversity Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. Another term for human diversity is a. independence. b. social autonomy. c. cultural diversity. d. existentialism.

ANS: C

Human diversity, also called cultural diversity, addresses the variety of human societies and cultures and examines their similarities and differences. Human diversity simply means the differences inherent among people. Studies indicate that these differences are what make each person unique and valuable in his or her own right.

REF: p. 110 2. All of the following are considered cultures except a. Hmong. b. Native American. c. Slovakian. d. Floridian.

ANS: D

Bh.eC Humans are divided into d i f f N e rU e nRt S cuI ltN urG esT .T yO arM e not specific to geographic boundaries such as states. Cultures develop behaviors, norms, and values that are suited to a specific environment and over time take on the strength of tradition. Even when conditions or environments change, cultures often do not.

REF: p. 110 3. To perform effectively and compassionately as a radiologic sciences professional, it is

important to understand the areas of human cultural diversity. These may include 1. social organizations.

2. phobias.

3. symbolism.

4. space.

5. time.

6. communication. a. 1, 3, 4, and 6 only. b. 1, 2, 3, and 5 only. c. 1, 4, 5, and 6 only. d. 2, 3, and 6 only.

ANS: C

Introduction to Radiologic and Imaging Sciences and Patient Care 8th Edition Adler Test Bank To provide high-quality and effective care for all patients, health care providers need to understand six areas of human cultural diversity and how these areas influence the delivery of care. The areas of human cultural diversity include communication, space, time, environmental control, biologic variations, and social organizations.

REF: p. 117 | p. 118 4. A social organization that seeks to understand and accept peoples from diverse backgrounds

through policies and procedures, communication media, activities, and so on, in an effort to achieve a positive cross-cultural environment, is seeking to achieve a. consensus. b. cultural competency. c. social autonomy. d. segregation.

ANS: B

Cultural competency is defined as possessing a set of attitudes, behaviors, and policies that come together in a system, or among individuals, that enable effective interactions in a cross-cultural framework.

REF: p. 117 5. You are working as a radiographer in a small community hospital. As you get on the elevator

to ride up to the cafeteria for your morning break, you are joined by a group of people who are quite vocal about the skin tone and dialect of the doctor that is taking care of one of their family members. This group inherently demonstrates a group a. consortium. b. consensus. c. bias. d. assimilation.

ANS: C

Everyone has at least one personal bias. These biases, whether based on reason or simply perceptions of human characteristics, are real. The impact of some biases can be lessened through knowledge. The more that is known about a subject, the better the understanding of the subject will lessen bias behavior. Typical bias traits include age, ethnicity, national origin, race, gender, sexual orientation, mental and physical ability, and religious beliefs.

REF: p. 110 | p. 111 6. Which of the following would not reflect a human diversity characteristic? a. Disability b. Gender c. Occupation d. Race ANS: C

Introduction to Radiologic and Imaging Sciences and Patient Care 8th Edition Adler Test Bank Diversity includes many human characteristics that affect our perceptions of ourselves and others, individual values, opportunities, and acceptance. Some of the most prevalent characteristics are age, disability, economic status, education, ethnicity, family status, first language, gender, geographic location, lifestyle, organizational level, physical characteristics, political affiliation, religious preference, sexual orientation, work style or ethic, and many others.

REF: p. 110 7. As you are enjoying a light breakfast in a local coffee shop, a small group sits down at an

adjacent table. As they talk, you overhear them making derogatory statements about people who are obese. Comments such as, “I can’t believe people can eat so much!” and “How can they let themselves get that way?” are typical of the conversation. One group member openly states, “Why can’t they be like us, fit and trim? Don’t they understand what they are doing to their bodies?” This group is demonstrating a. ethnocentrism. b. assimilation. c. biculturalism. d. racism.

ANS: A

Ethnocentrism is regarded as the tendency of some individuals to view norms and values of their own culture as the only acceptable ones and to use them as the standard by which all other cultures are measured.

REF: p. 112

NeUnsRusS, ImNorGeTthBan.4C0O%Mof the population was 60 years old and 8. According to the 2010 U.S. C older. This age class of citizens represents a very large population that will have a significant impact on the country with regard to economics, politics, health care, employment, and so on.

This group is collectively referred to as , and the country will undoubtedly change in many ways to accommodate these valued members of society. a. Generation X b. Millennials c. Baby boomers d. Postwar citizens ANS: C

The most significant subset, because of the impact they will have on the population, is the baby boomer group. The baby boom generation is considered to be generally healthy and well educated. These individuals are expected to stay in the workforce longer because they are expected to live longer than previous generations. In general, the graying of America is expected to transform many areas, including banking, health care, labor, politics, retirement systems, social services, and the stock market.

REF: p. 111 9. It is safe to conclude that in the years ahead, the U.S. population will a. become less ethnically diverse. b. demonstrate a younger average age. c. require a more diverse health care labor force.

Introduction to Radiologic and Imaging Sciences and Patient Care 8th Edition Adler Test Bank d. become more of a single linguistic society.

ANS: C

In general, the graying of America is expected to transform many areas, including banking, health care, labor, politics, retirement systems, social services, and the stock market. Time is not on the side of American society to address these issues. In 2000, Americans over the age of 85 outnumbered those at the beginning of the previous century by 26 times. At the beginning of 2010, more than 53,000 Americans were over the age of 100. This expectation forces an overview and overhaul of social mores and prejudices regarding older adults in the job market through their end-of-life care. This necessarily will bring about a more diverse health care labor marketplace.

REF: p. 111 10. In the process of preparing a Hmong patient for an interventional procedure, you discover the

patient speaks no English. She has no family members with her and was escorted down by hospital transport. A necessary part of the examination is for the patient to complete an informed consent document. An effective strategy you could use to accomplish this would be a. speaking slowly and deliberately in English and showing the patient where to sign the document. b. trying to act out the intent of the document through demonstration and modeling. c. asking a coworker to witness your explanation of the document and the patient’s signature. d. delaying the procedure until a hospital translator can be present during the explanation.

ANS: D

One of the major concerns ofNliU nR guS isI ticNdGifTfeBre.nC ceO sM is informed consent. A patient cannot be truly informed if he or she does not understand what is attempted to be communicated to them. This failure places health care providers at great liability and serves as a barrier to medical treatment decisions. To provide improved medical care to individuals without or with limited English proficiency, many health care institutions are striving to overcome linguistic barriers to high-quality health care by providing translators and medical interpreters, bilingual documents, and employing more bilingual and multicultural staff.

REF: p. 113 11. The Americans with Disabilities Act of 1990 provides for all of the following conditions

except a. employers must give preference to those with disabilities. b. legal protection against discrimination because of physical or mental disability. c. institutions must make reasonable accommodations for all individuals. d. guarantees basic human rights to persons with a disability.

ANS: A

The Americans with Disabilities Act of 1990 was a profound and necessary step in preventing discrimination against persons with disabilities. This Act provides protection under the law for people with mental and physical disabilities. It also directs institutions, especially those receiving federal funds, to make reasonable accommodations for persons with disabilities.

REF: p. 115

Introduction to Radiologic and Imaging Sciences and Patient Care 8th Edition Adler Test Bank

12. The commitment to cultural diversity is an integral part of the medical imaging profession as

evidenced by official position statements from the American Society of Radiologic Technologists (ASRT). In a continuing effort to broaden the profession’s human diversity, a well-known student scholarship is available, known as the Scholarship. a. Ed Jerman Merit b. GE Minority Merit c. Royce Osborne Minority Student d. Clarence Dally Diversity ANS: C

The American Society of Radiologic Technologists (ASRT) has developed initiatives to increase cultural diversity among members of the profession. One of the more notable initiatives is the establishment of the Royce Osborne Minority Student Scholarship. The scholarship fund, endowed by the ARRT, provides scholarships to minority imaging and therapy students in educational programs throughout the country.

REF: p. 117 13. To protect the human rights of people with disabilities, four essential core values of human

rights were recognized by the 1993 Vienna Declaration for Human Rights. These core values are a. freedom of speech, assembly, vote, and travel. b. solidarity, dignity, autonomy, and equality. c. religion, expression, employment, and education. d. integrity, justice, due process, and appeal.

ANS: B

Four essential core values of human rights law are particularly important when thinking about people with disabilities: (1) autonomy, (2) dignity, (3) equality, and (4) solidarity.

REF: p. 115

For a medical imaging department manager, reasonable efforts to improve human diversity in

14. the department would include all of the following except a. multilingual signage throughout the department. b. requiring staff to attend diversity in-services. c. participating in an effective resource pool of interpreters. d. requiring all department employees to speak a second language.

ANS: D

For total cultural competency to be achieved, consideration must be given to all of the areas of human diversity, including language. Linguistic competency means providing readily available, culturally appropriate oral and written language services to individuals with limited English proficiency. This goal may be accomplished through the use of bicultural and bilingual individuals or interpreters. Requiring staff to be bilingual can be viewed as an unreasonable expectation of staff.

REF: p. 117

15. A native-born Latino individual who has moved to the United States and successfully blended

into local community activities, such as work, church, school, and volunteering, without losing his native culture demonstrates a. dual bias. b. biculturalism. c. assimilation. d. ethnocentrism.

ANS: B

Biculturalism is the ability of individuals to be able to negotiate competently two or more cultures, the mainstream culture and the individual’s own culture.

REF: p. 112 16. Valuable traits of the U.S. mainstream culture include which of the following?

1. Strong work ethic 2. Efficiency 3. Travel and mobility 4. Tolerance and patience 5. Individualism 6. Capitalism 7. Competition a. 1, 2, 4, and 6 only b. 1, 3, 4, 5, and 7 only c. 1, 2, 5, and 7 only d. 2, 4, 5, 6, and 7 only ANS: C

Members of the U.S. mainstream culture are said to value and identify with the following traits: activity and hard work, personal achievement and success, individualism, efficiency and practicality, affluence, consumerism, material comfort, competition, openness, directness, and being well informed.

REF: p. 112 17.

It is illegal to deny an individual the opportunity to advance professionally through employment because of a. gender. b. technical skills. c. daycare needs. d. personal hygiene.

ANS: A

Gender role stereotyping is the expectation of how people should behave based solely on whether they are male or female beings. These stereotypes have nothing to do with the individual’s capabilities, but they limit his or her alternatives. Only by recognizing, promoting, and valuing the capabilities and contributions of individuals, male or female, can society embrace gender diversity as one of the essential elements for embracing human diversity.

REF: p. 114

18. The #MeToo movement gained momentum socially in 2017 in the United States. A key

expectation of this changing attitude is that a. women will better understand their role as mothers and homemakers. b. male employees will have equal access to female restrooms. c. men are expected to intervene to prevent sexual harassment. d. None of the above ANS: C

A good example of the application of respect is the #MeToo movement that began in late 2017 to empower women through empathy, especially the experiences of young and vulnerable brown or black women. The #MeToo movement is helping society understand the magnitude of the problem. It requires men to take a stand against behavior that objectifies women.

REF: p. 116 19. An ethnic group that would place a cultural core value on the sacredness of the earth and its

waters, clean air, wildlife, and foliage would most likely be a. Native American. b. Latino. c. Mexican American. d. European American.

ANS: A

People of different ethnicities may have different core values, although people who reside in the United States also generally prescribe to core values of the mainstream. Native Americans, a proud ethnic group, bel ieveNi U nR a cSoI reNvG alT ueBt. haC tO i nM c l u d e s a unified whole universe. The earth is considered sacred according to this core value.

REF: p. 112 | p. 113 | Table 10.2 20. A person’s hair color and texture as well as his or her skin condition would be an example of

what area of human diversity? a. Social hierarchy b. Mental and physical ability c. Biologic variations d. Regional ethnicity ANS: C

To provide high-quality and effective care for all patients, health care providers need to understand six areas of human cultural diversity and how these areas influence the delivery of care. One of these areas includes biologic variations, which deals with ethnical or racially related differences in body structure, hair color, skin color, hair textures, and other biologic traits.

REF: p. 117 | Table 10.5

Chapter 11: Patient Interactions Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. All of the following are nonverbal communication characteristics except a. volume of voice. b. body language. c. amount of eye contact. d. professional appearance.

ANS: A

Patients quickly perceive nonverbal communication such as tone of voice, speed of speech, and the position of the speaker’s extremities and torso (body language). Additionally, eye contact and general appearance can send nonverbal messages to others that can be equally as powerful as the spoken word.

REF: p. 125 | p. 126 2. A patient who is near death will likely exhibit what signs of impending death?

1. Loss of bowel functions and control 2. State of unconsciousness 3. Unusual high level of alertness and response to conversation 4. A condition of “wasting away” (cachexia) a. 1 and 3 only b. 1, 2, and 4 only c. 3 only d. 2 only ANS: B

Terminally ill patients typically experience various stages in preparation for death. Dr. Elizabeth Kübler-Ross has outlined these stages, and there is general agreement as to these sequence of events. The final physiologic events leading to impending death include loss of bowel, unconsciousness, and no appetite with subsequent shutdown of the digestive tract. This leads to a cachexic state. A high state of energy and alertness is not an expected behavior with dying patients.

REF: p. 133 | Table 11.2 3. You have received a request to perform a radiographic study on a patient who is clearly

intoxicated but coherent. In preparing to perform this procedure, you should a. close all the examination room doors to prevent others from hearing the patient’s language. b. put on a patient gown and gloves in case the patient vomits or has bodily discharges. c. ensure your safety by checking to see that the hospital security officer will stay with the patient during the procedure. d. prepare patient restraint devices, including restraint jackets, and tape to hold down the patient during the procedure.

ANS: C

Some substance abusers respond well to firm directions about what to do, but others are best handled by requesting that they return for examination at a later time when the effects have diminished considerably. The technologist will encounter some patients who simply cannot be examined properly without assistance from other medical personnel.

REF: p. 129 4. A dying patient who wants to stay alive long enough to see his son graduate from college

would be in what stage of the dying process? a. Denial b. Depression c. Anger d. Bargaining ANS: D

Some patients experience a bargaining stage that focuses on hope and may be based in religion—for example, prayers for small extensions of life to perform good deeds and heal family wounds. Supporting the patient’s beliefs at this time is important because the hope itself can reduce stress.

REF: p. 132 5. Upon receiving an order or request to perform a radiographic examination on a patient, the

first step to consider in order to achieve exam success is to a. contact the ordering practitioner to obtain a better history. b. check with your coworkers to see if anyone examined this patient previously. c. perform a patient assessmNeU ntRbS yI reN feG reT ncBin.gCthOeMpatient’s chart or exam request. d. prepare the exam room in order to prevent the unexpected.

ANS: C

Whether the patient is an inpatient or an outpatient, one of the initial patient communication skills is patient assessment. Initial patient assessment by the technologist usually comes in the form of chart or procedure request review, or both. Much information can be learned from reviewing these two sources concerning patient history and indications for or contraindications to the requested procedure.

REF: p. 123 6. According to Maslow’s hierarchy of needs, our first and most basic need is a. ensuring enough money into and past retirement. b. succeeding at job or work. c. protection from outside enemies. d. shelter, nourishment, and water.

ANS: D

Maslow’s hierarchy of needs provides insight into the factors guiding human behavior.

Maslow suggests that people strive from a basic level of physiologic needs toward a level of self-actualization.

REF: p. 123 | Figure 11.1

7. Clearly understanding your emotions when handling patients and their families is referred to

as a. b. c. d.

personal bias. emotional intelligence. psychoanalysis. personal intellect.

ANS: B

Patients exhibit a wide range of emotions, and the way technologists handle those emotions relies on how well they understand not only the emotions exhibited by their patients but also how well they understand their own. That understanding is one of the concepts involved in emotional intelligence (EI).

REF: p. 122 8. When communicating with a young child as part of a radiographic examination, an effective

strategy to communicate would be to 1. kneel down to the child’s eye level and lower your voice.

2. speak loudly and quickly so the child knows you’re in charge.

3. allow one of the younger radiographers in the department to perform the study.

4. speak exclusively to the parent so the child cooperates. a. 1 and 3 only b. 1 only c. 3 only d. 2 and 4 only ANS: B

“To stand tall in pediatrics, yN ouUhRaS veItN oG geT tB do. wC nO oM n your knees,” according to Armand Brodeur, MD, chief radiologist at Cardinal Glennon Children’s Hospital in St. Louis. Simply getting down to the child’s level—physically, in language, and in spirit—establishes a positive relationship.

REF: p. 129 9. When working with an elderly patient, a. speak slowly and clearly and ask for understanding and feedback. b. write down your instructions first for the patient to read. c. give the patient breathing instructions while you’re positioning him or her in order

to hasten the procedure. d. assume the patient can see and hear you clearly and move quickly and deliberately

in order to get done.

ANS: A

Technologists should treat geriatric patients as mature adults, with all the normal interaction that would be used with healthier or younger patients. When communicating with geriatric patients, it is important to speak clearly and slowly and to ask for feedback from the patient to ensure complete understanding. The cardinal rules when dealing with geriatric patients are patience and respect.

REF: p. 131

10. When dealing with a terminally ill patient who demonstrates mutual pretense of their

condition, which of the following would seem most appropriate? a. Sharing similar death experience with the patient to comfort them b. Happily moving around the room trying to cheer him/her up c. Politely working in silence as necessary and attending to his/her physical needs d. Attempt to get the patient to transition into open awareness of their condition ANS: C

Attempting to cheer up the patient may meet the needs of the health care provider but not of the patient. Touch and silence are often construed as acceptance of the patient’s fate, and working in respective silence is regarded as appropriate patient care behavior for a patient in this stage of the dying process.

REF: p. 132 | p. 133 11. According to Maslow’s hierarchy of needs, few people completely satisfy the need for a. shelter, peace, and protection. b. self-fulfillment and self-actualization. c. food, water, and nutrition. d. acceptance and love by family and by peers.

ANS: B

Maslow suggests that people strive from a basic level of physiologic needs toward a level of self-actualization. This highest level is characterized by confidence in who the person is and what the person’s goals are in life. Only a small percentage of people truly achieve this highest level.

REF: p. 123 | Figure 11.1

When radiographing a toddler, work silently in order to avoid questions and alarming the child. ask the child if he or she has ever had this type of procedure before. use simple one-word instructions that are familiar to the child. speak loudly and take charge of the examination from the beginning.

12. a. b. c. d.

ANS: C

Toddlers’ concept of time is essentially now, and distance is whatever can be seen. Therefore speaking with simple words that are familiar to children is important, and expecting them to think about how they will feel in an hour should be avoided. Toddlers are often concerned only with what you are going to do to them at the moment.

REF: p. 130

A common emotion of most patients entering the hospital is hope for a cure for their condition. fear of the unknown and about their condition. concern for the cost of the hospital care and insurance coverage. insincerity.

13. a. b. c. d.

ANS: B

To interact effectively with patients, understanding that patients may be in an altered state of consciousness is important. They are in an unfamiliar environment in which they are no longer in complete control. In addition, they often fear not knowing the exact state of their health. Nearly all patients are apprehensive and anxious.

REF: p. 123 14. A dying patient who has asked to see his loved ones and is asking for medication to relieve

their pain would be in the a. anger b. bargaining c. grief d. preparatory depression

stage of dying.

ANS: D

Preparatory depression comes with the realization of the inevitability of death and is accompanied by a desire for death as a release from suffering. The most important thing at this time is to permit the behavior.

REF: p. 132 15. Which of the following is an example of a negative nonverbal communication technique? a. Giving a pleasant smile b. Maintaining eye contact while referencing the patient’s chart c. Leaning toward the patient when talking to him or her d. Talking to the patient with your back turned as you record in the chart ANS: D

Patients quickly perceive nonverbal communication such as tone of voice, speed of speech, and the position of the speaker’s extremities and torso (body language). Radiographers must be cautious to avoid giving confusing signals to patients by saying one thing and acting in a totally different manner. The technologist should look at patients and show interest in their statements.

REF: p. 125

Which of the following statements is false?

16. a. Non–English-speaking patients typically understand simple phrases and commands

such as “Yes,” “No,” and “Stop.” b. Pediatric patients always require special attention. c. To minimize feelings of alienation, it is safe to assume that a patient with a

nasogastric tube would prefer to wait in a general reception area. d. Dealing with mentally impaired patients often requires the technologist use a

strong yet reassuring tone of voice.

ANS: C

When patients arrive with a nasogastric tube in place, although they may normally be friendly and outgoing, they may prefer to wait in a location where they do not have to face the public.

REF: p. 124 | Figure 11.2

17. A(n)

is someone who has been admitted to the hospital for diagnostic studies or treatment. a. inpatient b. outpatient c. semi-private patient d. referral ANS: A

An inpatient is someone who has been admitted to the hospital for diagnostic studies or treatment. In general, these persons occupy a hospital bed for longer than 24 hours.

REF: p. 124 18. The cadence and rhythm of your speech, often referred to as the “music of speech,” is known

as a. b. c. d.

auditory communication. paralanguage. therapeutic communication. negative therapeutic communication.

ANS: B

Paralanguage is the music of language; it is often considered a form of nonverbal communication. Patients receive signals about your attitude toward them from the pitch, stress, tone, pauses, speech rate, volume, accent, and quality of your voice.

REF: p. 125 19. Touch can be an effective c o N m mR u n i cIa t i oGn stB ra. teC gy w Mh en dealing with patients for medical

U Sto turn N Ton his or O her side for an oblique projection, you examinations. As you ask a patient gently touch his or her hip or shoulder to guide them into the correct position. This is a type of touch for a. emotional support. b. emphasis. c. palpation. d. control.

ANS: B

The use of touch conveys to patients that the technologist is trying to understand, be empathetic, and care about them as people. Touching for emphasis involves using touch to highlight or to specify instructions or locations.

REF: p. 126 20. Aging is a natural part of living. As you work with older patients, it is important to empathize

with their conditions and understand the physiologic changes of the aging process. These changes may include 1. always feeling cold.

2. a heightened state of mental alertness and memory.

3. a greater awareness of their surroundings.

4. a loss of tactile sensation in the fingertips.

5. a greater likelihood of skin damage during movement and transport.

6. less flexibility and joint mobility. a. 1, 3, 4, and 6 only b. 1, 4, 5, and 6 only c. 2, 3, and 5 only d. 4, 5, and 6 only ANS: B

Geriatric patients are now being classified as young-old, old-old, and oldest-old in an attempt to differentiate between widely varying conditions that accompany the aging process. The aging process itself can vary from person to person, but generally there is a loss of tactile sensitivity, body fat, and skin elasticity. These changes can result in skin damage, feelings of being cold, dropping of objects, and limited mobility caused by arthritic changes.

REF: p. 133 | Table 11.2 21. According to Elisabeth Kübler-Ross, the customary stages of the dying or grieving process in

the typical sequence are a. acceptance, denial, depression, anger, and bargaining. b. denial and isolation, anger, bargaining, depression, and acceptance. c. anger, denial, bargaining, depression, and acceptance. d. denial and isolation, anger, depression, bargaining, and acceptance.

ANS: B

The stages delineated by Elisabeth Kübler-Ross have been generally regarded as an acceptable sequence of events. Denial and isolation may be the initial reactions. Anger may then occur as a result of the realization that life will be interrupted before everything the person planned has been accomplished and feelings that the person will soon be forgotten. Some patients experience a bargaining s t a g eNtUh aRt S foI cuNsG esToB n. hoCpO e.MThis stage may be followed by depression. Preparatory depression comes with the realization of the inevitability of death.

Acceptance, which is considered the final stage, can occur only if enough time is provided and if the patient is appropriately helped through the other stages.

REF: p. 132 22. As a patient begins to accept the inevitability of death, he or she may ask to discuss important

circumstances that will affect the last moments of life. These concerns may include the administration of CPR techniques, organ donation, internment plans, pain control, and sedation. To formalize these wishes, patients will complete a(n) a. will and testimonial. b. death directive. c. advanced directive. d. terminal care agreement.

ANS: C

An advance directive provides an individual a means to direct health care if a situation occurs in which he or she is unable to make decisions. Such directives allow the will of the patient to be known regarding certain health care options.

REF: p. 133

23. Professional medical imaging personnel must possess many desirable traits and skills. To

succeed in patient interactions as a part of performing examinations, it is important that the radiographer a. avoid touching patients for fear of offending them. b. work efficiently by minimizing small conversations with patients that slow down the procedure. c. reference procedure notes or textbooks often during examinations to reassure the patient they are double checking their work for safety reasons. d. do none of the above.

ANS: D

Attention to the various forms of interaction and communication techniques that have proved effective in improving relationships with patients can produce dramatic results in clinical situations. These skills include verbal skills, including humor, and nonverbal communications, such as paralanguage, body language, and touch. Touching can be used for emotional support, emphasis, and palpation. Professional appearance, personal hygiene, physical presence, and visual contact are also important.

REF: p. 133 24. The use of humor during radiographic procedures can be effective with patients if used

professionally and under the right circumstance. An example of correct use of humor is a. repeating a political joke you heard on the radio earlier in the day. b. making light of the bad weather and how it “brightened your day” to have a job inside helping people. c. telling the patient you need to repeat the examination because someone opened the door to the darkroom that doesn’t exist anymore.

Ns taRSttoo INand G TB.C d. commenting on the patient’U how fuOnny it looks with the skin stretched from the X-ray positions.

ANS: B

Using humor to relax and open up conversation is acceptable, but the technologist must be extremely careful to avoid cultural slurs and references to age, sex, diseases, and the abilities of other health professionals. The use of humor, when correctly done, can be an effective communication strategy. Humor should not be offensive, personal, or unprofessional.

REF: p. 125

Chapter 12: History Taking Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. When taking a patient history, it is important to a. remain very impersonal and show little emotion or empathy toward the patient. b. consistently call the patient by his or her first name to establish instant credibility. c. maintain a polite and professional demeanor when gathering information. d. consistently call the patient by his or her first name to establish instant credibility and maintain a polite and professional demeanor when gathering information ANS:

C

Because history taking is one of the most critical and valuable diagnostic tools, possessing good history-taking skills is an essential responsibility of the radiologic and imaging sciences professional and requires a polite and professional demeanor during the interview.

REF:

p. 136

2. In preparing to radiograph a patient who has come to the medical imaging department with a complaint of abdominal pain, you begin to question the patient as part of the history. A good initial question to ask the patient would be a. “Did you have any problem with parking here at the hospital?” b. “Can you tell me about the nature of your pain?” c. “Your request states that you have stomach pain, is that correct?” d. “Have you seen your doNcU toR r ab ”M SIouNtGthTeBpa.inC?O ANS:

B

All histories should begin with open-ended questions to encourage the patient’s spontaneous associations about the clinical problem. The use of leading questions should be avoided whenever possible because they introduce biases into the history.

REF:

p. 137

3. An important piece of information regarding a patient’s need for medical care is sought by physicians and medical professionals. Many times, patients are vague about their pain or reason for seeing the doctor. It is important to discover the patient’s for seeking medical care. a. chief complaint b. pain threshold c. tolerance d. primary reason ANS:

A

Physicians attempt to determine the patient’s chief complaint. This effort is valuable because it focuses the history toward the single most important issue. In many instances, the chief complaint is directly related to the first symptom that is discussed.

REF:

p. 137

4. In the process of questioning a patient about the reason for having the requested X-ray examination, the patient becomes irritated and complains that she “is getting pretty tired of saying the same things over and over to all these nurses.” An effective method to deal with this patient’s attitude would be to a. ask the patient to sign a statement declining to answer questions. b. tell her it is not your fault she is upset and you would be upset as well. c. not ask any additional questions so as not to upset her any more. d. explain that each person is asking questions specific to their patient care task.

ANS:

D

A useful tool is to repeat information obtained as a part of the history for two reasons: to verify that the radiologic technologist has perceived the information correctly and to ensure that the patient has not changed his or her mind. Asking for like information from different people can often reveal new information.

REF:

p. 137 | p. 138

5. Good history taking involves the collection of objective and subjective data. All of the following are examples of subjective data except the patient’s a. emotions. b. respiratory rate. c. speech pattern. d. ability to follow your instructions.

ANS:

B

Objective data are perceptible to the senses, such as signs that can be seen, heard, or felt and such things as laboratory reports. Subjective data pertain to or are perceived by the affected individual only. RespiratorN yU raR teS isIaNpG hyTsB io. loC giO cM measurement and considered objective data.

REF:

6.

p. 136

Objective data regarding a patient’s history a. are more important than subjective data. b. deal with a patient’s feelings. c. consist of a patient’s vital signs. d. are an effective way to explain the patient’s pain level.

ANS:

C

Objective data are perceptible to the senses, such as signs that can be seen, heard, or felt and such things as laboratory reports. Many objective signs are physiologic measurements such as temperature, pulse, respiration, and blood pressure.

REF:

p. 136

7. When asking about a patient’s pain, it is effective to a. ask the patient if the pain runs down his or her leg. b. assure the patient that questions about pain are required and standard questions. c. ask the patient if the pain is in his or her abdomen. d. ask the patient to point to or touch the area that hurts and record the information.

ANS:

D

Localization is defining as exact and precise an area as possible for the patient’s complaint.

Two types of touch that the technologist commonly uses in gathering a clinical history are (1) touching for emphasis and (2) touching for palpation. Touching for emphasis involves using touch to highlight or to specify instructions or specify locations. A history can be clarified by a light touch to specify the region.

REF:

p. 138

8. When questioning patients to obtain an accurate patient history, a. keep your questions general in nature so as not to offend the patient. b. start with open-ended questions and then follow up with more direct inquiries. c. do not let the patient talk too much in order to keep the examination moving. d. use medical terms to make your questions more precise.

ANS:

B

All histories should begin with open-ended questions to encourage the patient’s spontaneous associations about the clinical problem. Answers to these questions can often enable more direct, probing questions for clarification and precision.

REF:

p. 137

9. It would be inappropriate to a. repeat the patient’s comments regarding the symptoms to keep the examination time short. b. call the patient by his or her surname (preceded by Mr., Ms., or Mrs.) to establish a professional image. N R I G B.C M U S N T O c. ask the patient leading questions regarding his or her symptoms. d. describe the patient’s symptoms to the radiologist in precise medical terms.

ANS:

C

The use of leading questions should be avoided whenever possible because they introduce biases into the history.

REF:

p. 137

10. As a patient begins to explain his reasons for coming to the clinic for a radiographic examination, he begins to use medical terms to describe his conditions. His information appears to be accurate medically and helps clarify his symptoms. To deal with this patient, you should a. politely listen, record his comments, and repeat his statements to clarify. b. ask him if he is a doctor and tell the radiologist. c. determine if he knows what he is talking about by quizzing him on basic anatomy. d. disregard his information and record your impressions of his symptoms.

ANS:

A

The ability to assess the patient’s background can be a difficult skill to develop. Probably the most helpful technique is to begin with a question that provides an opportunity for the patient to respond in a manner that reflects his or her life experience and educational background.

REF:

p. 137

11. Which of the following is not one of the sacred seven of medical histories? a. Severity b. Family history c. Onset d. Chronology ANS:

B

The interviewer’s role is to collect a focused history specific to the procedure that is to be performed. Seven elements are recognized for a complete history. These elements are often referred to as the sacred seven. They are localization, chronology, quality, severity, onset, aggravating or alleviating factors, and associated manifestations.

REF:

p. 138

12. In determining a patient’s description of his or her pain, a good question to ask would be a. “How would you describe the pain?” b. “When did the pain first happen?” c. “If the pain comes and goes, how often does it occur, and what is the time span between occurrences?” d. All of the above ANS:

D

All histories should begin with open-ended questions to encourage the patient’s spontaneous associations about the clinical problem. All of the choices in this question are open-ended types of questions and deal with a Sacred Seven piece of information.

REF:

p. 137

13. When taking a patient history, a competent medical imaging professional a. relates his or her personal experiences to the patient’s, when taking a history. b. uses “pet names” such as “dear,” “cutie,” and “honey” to encourage the patient to provide more intimate information about his or her condition. c. relies exclusively on objective patient data so as not to bias the patient history. d. does none of the above.

ANS:

D

Taking a history must be a cooperative event between the patient and the radiologic technologist. The radiologic and imaging sciences professional should maintain a polite and professional demeanor during the interview. Using “pet names” for the patient is unprofessional and often offensive to the patient. History taking necessarily is a precise process that consists of both objective and subjective data.

REF:

p. 136

14. On a patient’s examination requisition for a KUB, you notice that the history recorded by the emergency department staff states “R/O appendicitis.” In an effort to gain more precise information about the patient’s condition, questions to ask that would be important to this examination (KUB) would be 1. “How would you describe the pain?”

2. “Have you had previous appendix surgery?”

3. “Do you know if the emergency department called in a sonographer?”

4. “Can you touch the area that specifically hurts?”

5. “Are you sure it’s not your kidneys?”

6. “Does the pain appear to be in your appendix?” a. 1, 3, 4, and 6 only b. 1 and 4 only c. 2, 3, 5, and 6 only d. 1 only ANS:

B

The use of leading questions should be avoided whenever possible because they introduce biases into the history. The correct choices in this question are examples of open-ended questions that do not lead the patient to describe his or her pain.

REF:

p. 137

15. Most radiologists have one key question they want answered when it relates to any medical imaging examination. That question most likely would be a. Why is the patient having this examination? b. What pain level is the patient tolerating? c. Can the patient tell you what day it is and what hospital he or she is visiting? d. Is there a reason for coming to the hospital rather than an outpatient clinic?

ANS:

A

Physicians attempt to determine the patient’s chief complaint. A key item to determine is why the exam was ordered by the referring physician. In many instances, the chief B. complaint is directly r el a t e dN tUo Rt hSe If i N r sG t sT ym ptC om that is discussed.

OM REF:

p. 137

16. In recording a patient history for the radiologist, you note that the patient has an open sore on her ankle. In your description, you indicate that the sore is draining and has a foul odor.

This information deals with the of a patient history. a. quality b. chronology c. logic d. onset ANS:

A

The quality describes the character of the symptoms. Examples include the color and consistency of body fluids, the presence of clots or sores, the size of lumps or lesions, the type of cough, and the character of pain.

REF:

p. 138

17. As you prepare to take a PA chest radiograph on a patient who is suspected of having a lung collapse, you note that the patient has an extremely difficult time taking in a deep inspiration. An imaging sciences professional would a. make no mention of the breathing pattern as it has no relationship to a lung collapse.

b. work very quickly and not bother with any additional patient history. c. record the depth of inspiration as a measure of the quality of the symptom. d. call inhalation therapy to measure the inspiration with a spirometer.

ANS:

C

The quality describes the character of the symptoms, in this case the respiratory effort.

REF:

p. 138

18. As you perform a STAT skull series on a conscious patient from the emergency department (ED), you notice that the patient has a large swelling over his left temporal region. The patient requisition states that the patient had trauma, and nothing else is provided. An imaging sciences professional would a. give the patient an ice pack to lessen the swelling before the exposure is taken. b. call the ED nurse to ask if he or she saw the swelling and recorded it in the patient’s electronic medical record (EMR). c. ask the ED nurse to come to the radiography room for a more accurate patient history. d. record the swelling on the requisition and ask the patient what kind of injury he experienced.

ANS:

D

The radiologic and imaging sciences professional typically does not need to compile a complete medical history on patients. The physician or the nursing staff who first saw the patient will have completed this job. The interviewer’s role is to collect a focused history specific to the procedure that is to be performed. Often this includes the sacred seven of a clinical history.

REF:

p. 138

19. It would be professionally appropriate for the imaging professional to a. gently touch the patient to clarify the location of his or her pain. b. touch the patient with varying degrees of pressure to measure the patient’s pain tolerance over the area of interest. c. ask the patient to give you a general idea of the area of concern before the examination is started. d. palpate the patient on the regions that do not hurt to isolate the area of interest.

ANS:

A

By consenting to a procedure, patients give implied consent for the technologist to professionally touch their bodies for both information and positioning. Remember that the patient can use verbal or nonverbal communication to withdraw this permission at any time.

A history can be clarified by a light touch to specify the region.

REF:

p. 138

20. The patient coming to you for an abdominal examination (KUB) states, “My belly hurts.” A logical question to ask next would be a. “Can you touch the area of your belly that specifically hurts?” b. “Can you point out on a diagram the area that hurts?” c. “Did you tell the nurse this when you were in the urgent care center?”

d. “Would you point to the area that hurts for the radiologist when he enters the examination room?”

ANS:

A

A response using the word “belly” may indicate lack of knowledge about abdominal organs and requires that the technologist customize his or her questioning to fit the educational background of the patient. In this case, using “touch” can be an effective method for assessing a more precise location of the patient’s pain.

REF:

p. 138

Chapter 13: Safe Patient Movement and Handling Techniques Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. The purpose of a patient transfer is to a. make arrangements for the patient to be moved to another nursing unit. b. safely move a patient from one area to another. c. provide for the patient’s hospital bill to be deducted from his or her banking

institution. d. make delivery arrangements for the patient’s personal belongings.

ANS: B

The purpose of a transfer is to safely get a patient from one place to another. The patient’s physical and cognitive abilities determine the amount of assistance required in each transfer.

REF: p. 141 2. When moving a patient from a cart to the radiographic table, it would be appropriate to a. ask the patient how much he or she can help with the transfer. b. permit the patient to sit up so you can determine their degree of alertness. c. allow the patient to safely help with the transfer as much as he or she is able. d. ask the patient how much he or she can help with the transfer and allow the patient

to safely help with the transfer as much as he or she is able.

ANS: D

The patient’s physical and coN gU niR tivSeI abNilG itT ieB s d.eC teO rmMine the amount of assistance required in each transfer. Some patients can perform the movement tasks independently or with verbal directions from the health professional. Other patients need manual assistance or the use of special equipment, such as lifts or transfer devices. To promote safety for patients and staff, health professionals involved with patient handling and movement must decide on the appropriate type of transfer.

REF: p. 141 3. According to the U.S. Department of Labor, one of the most common work-related injuries

resulting in lost work time and disability is a. strains, sprains, and musculoskeletal injuries. b. needle sticks with uncapped needles. c. electrical shocks from poorly insulated electronic devices. d. emotional exhaustion from working high stress patient care areas.

ANS: A

The US Department of Labor Statistics cites sprains, strains, and other musculoskeletal problems as the leading causes of disability for people in health care, estimating the involvement of over 600,000 employees each year and a cost estimated of about $50 billion.

REF: p. 141 4. Mobility muscles differ from stability muscles in that

a. b. c. d.

stability muscles are located in the knees and ankles. mobility muscles are located in the arms and legs. stability muscles are involved in digestion and body homeostasis. mobility muscles provide postural support.

ANS: B

Mobility muscles are found in the limbs. Typically, these muscles have long white tendons and cross two or more joints. Examples include the biceps muscles that flex the elbows and the hamstring muscles that flex the knees. Stability muscles are found in the torso. Typically, stability muscles are large expanses of red muscle belly and provide postural support.

REF: p. 142 5. A sudden drop in a patient’s blood pressure caused by standing or sitting upright is called a. hypertension. b. static hypotension. c. orthostatic hypotension. d. recumbent hypotension.

ANS: C

A slight drop in blood pressure occurs normally when any person rises quickly from a recumbent to an upright position. This condition, known as orthostatic hypotension, becomes increasingly serious when patients have been in bed for long periods and have a debilitated status. Symptoms of orthostatic hypotension include dizziness, fainting, blurred vision, and slurred speech.

REF: p. 143 6. When lifting patients, it is important to a. lift with your back and save your leg strength. b. twist at the waist to improve your center of gravity. c. use the strong muscles of your upper arms to improve lifting ergonomics. d. keep your back stationary and lift with your legs.

ANS: D

When lifting a patient, the technologist should stand with his or her feet apart to increase the base of support. When lifting patients, the technologist keep the back stationary and let the legs do all of the lifting and avoid any twisting.

REF: p. 142 | p. 143 7. All of the following are true of good lifting mechanics except a. do most of the lifting with your legs and keep your back stationary. b. extend your reach beyond the center of gravity to broaden your arm coverage. c. stand with your feet far apart to broaden your base of support. d. ensure your center of gravity is over your base of support.

ANS: B

When lifting a patient, the technologist should stand with feet apart to increase the base of support. The patient’s center of gravity should be held close to the clinician’s center of gravity. When lifting patients, keep the back stationary and let the legs do all of the lifting and avoid any twisting.

REF: p. 142 | p. 143 8. When transferring a patient from a wheelchair to a radiographic table, a. position the wheelchair at a 90-degree angle to the table. b. allow the patient to help with the transfer if it is safe based upon their capabilities. c. do not let the patient do any weight-bearing movements. d. break the transfer into a series of simultaneous movements and commands.

ANS: B

Some patients have the ability to transfer from a wheelchair to a table on their own. Position the wheelchair at a 45-degree angle to the table. Talk to the patient before he or she moves to determine how much, if any, assistance is required. Divide the transfer into single-step components and talk the patient through each step.

REF: p. 144 | p. 145 | Box 13.1 9. You have received a patient from the nursing floor who needs to be transferred by way of a

hydraulic lift. The patient arrives at the medical imaging department on a cart without a transfer sling. To proceed with a safe lift, you should a. set up the patient in a transfer sling and start the lift. b. roll the patient over onto a transfer sling. c. improvise using a sheet as a transfer sling. d. call the nursing floor and return the patient to be placed on a sling.

ANS: D

Prior arrangements should be made with the nursing staff to have patients needing hydraulic lift transfers arrive in the r a diNo l o R g y dIepaG rtmB en. tC s i t t iM n g on a transfer sling. If the patient arrives S and N discuss T without a sling, call the nursingUstaff the need for a sling. One option is to send the patient back to the floor and have the patient return sitting on the sling.

REF: p. 147 10. When positioning a patient in a rolling motion transfer, a. always move the patient toward you. b. ask the patient which way he or she wants to be rolled. c. roll the patient toward his or her weak side. d. never roll a patient because it creates postural hypotension.

ANS: A

To minimize trauma and discomfort for the patient, take an extra moment to make sure that the patient is ready to make the move. When moving a patient, always roll the patient toward you.

REF: p. 149 11. If a patient cannot assist with a cart-to-table transfer, a. a draw sheet or transfer assist device should be used. b. ask one other colleague to help you do the lifting. c. disregard the transfer and do a portable examination with the patient on the cart. d. None of the above are appropriate.

ANS: A

If the patient can assist with the transfer, then all that may be required is stabilization of the cart and support for the involved body part. If the patient cannot assist, then a moving device or draw sheet should be used. Three people usually perform a cart-to-table transfer.

REF: p. 147 | p. 148 12. All of the following are true of a two-person lift except a. the stronger person should lift the patient’s torso. b. it is used for cart-to-table transfers. c. ask the patient to cross their arms over their chest. d. the person lifting the torso is in charge of the commands and process.

ANS: B

Some patients cannot bear weight on their lower extremities and must be lifted onto the table.

If the patient is lightweight, a two-person lift can be executed. The stronger person should lift the patient’s torso while the second person lifts the patient’s feet. The person lifting the patient’s torso usually directs the other person’s actions.

REF: p. 145 13. All of the following are related except a. assisted standing pivot. b. standby assist. c. log roll assist. d. hydraulic lift.

ANS: C

Radiologic technologists use four types of wheelchair transfers: (1) standby assist, (2) assisted standing pivot, (3) two-person lift, and (4) hydraulic lift. Log roll assist is not a wheelchair transfer.

REF: p. 143

After successfully completing a safe hydraulic lift of a large patient, the imaging professional

14. should a. remove the transfer sling and send it to laundry for cleaning. b. keep the patient in the hydraulic lift and return him or her to the floor. c. return the patient in a wheelchair with the transfer sling under the patient. d. return the patient to the floor on a cart with the sling draped alongside the cart.

ANS: C

After the patient has achieved a safe, stable position, the lift can be removed. If possible, leave the sling under the patient in anticipation of the return transfer.

REF: p. 147

When moving a patient to or from a stretcher, have the patient hold the stretcher from moving. lock the stretcher securely against the examination table. raise the head-end of the stretcher to prevent orthostatic hypotension. protect the stretcher with positioning sponges.

15. a. b. c. d.

ANS: B

To move a patient from a cart onto a radiographic table, position the cart alongside the table on the patient’s strong or less affected side. The cart must be wheeled as close to the table as possible and then secured.

REF: p. 147 16. Which of the following statements is true? a. When lifting stand as close as possible to whatever you are lifting. b. Keep your feet very wide apart and your back arched when lifting. c. Urinary catheters should be clamped before moving patients, to prevent retrograde

flow of urine. d. When lifting patients, keep your back flexible and let your strong arm muscles carry the load.

ANS: A

Moving heavy objects is relatively easy and safe if the object is held close to the mover’s center of gravity. Stability can be achieved when a body’s center of gravity is over its base of support.

REF: p. 142 17. As you enter a patient’s room to perform a portable examination, you notice the patient

sleeping on her side with one leg over the other with the knees bent. This patient is in the position. a. Fowler b. recumbent c. Sims d. None of the above are correct.

ANS: C

The patient is in the Sims’ position when they are on their side with one leg over the other, and the knees bent. The proper terms for the most common positions are given in Figure 13.12.

REF: p. 151 | Figure 13.12 18. When performing a two-person lift of a patient from a wheelchair, it is important to a. ask the patient to put his or her arms up over his or her head. b. lift the patient over the arm rest of the wheelchair. c. bend over from the back and lift the patient’s legs with your partner. d. lift the patient as a unit, with his or her arms crossed and legs straight.

ANS: D

Begin with the wheelchair: lock the wheelchair wheels, remove the armrests, and swing away or remove the leg rests. Ask the patient to cross his or her arms over the chest and straighten his or her legs. On command, the patient is lifted to clear the wheelchair and is moved as a unit to the desired place.

REF: p. 145 | p. 146 | p. 147 | Figure 13.7

19. The human body’s center of gravity a. is in the region of the thoraco-lumbar area. b. should be over the base of support for safe lifting. c. is best positioned at an angle to your base of support for quicker lifting. d. is the same between genders.

ANS: B

Center of gravity is a hypothetical point at which all the mass appears to be concentrated (Fig. 13.2). Gravitational forces appear to act on the entire body from this specific point. In humans aligned in the anatomic position, the center of gravity is at approximately sacral level two, with slight variations between men and women. Moving heavy objects is relatively easy and safe if the object is held close to the mover’s center of gravity. Stability can be achieved when a body’s center of gravity is over its base of support. Instability results when the center of gravity moves beyond the boundaries of the base. For safe, stable lifting, the center of gravity must always be over the base of support.

REF: p. 142 20. For efficient and safe patient transfers and handling, the imaging professional should a. use mobility muscles for posture. b. use red postural muscles for support. c. narrow the stance and close your fists for extra strength. d. keep the knees straight and taut and lift from the shoulders.

ANS: B

For effective patient moving and handling, practitioners should use white mobility muscles for lifting and red postural muscles for support. Lifting should be done by bending and straightening the knees. The N baU ckRsShI ouNldGbTeB k. epC tO s t rMa i g h t or in a position of slightly increased lumbar lordosis.

REF: p. 142

Chapter 14: Immobilization Techniques Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. All of the following are examples of simple immobilization techniques except a. wrapping a child in a sheet (mummy wrap). b. using a positioning sponge. c. laying a sandbag across the patient’s anatomy. d. using a Velcro strap to stabilize the anatomy.

ANS: A

The simplest immobilization techniques involve the use of a positioning sponge to support the anatomic area of interest or gently laying a sandbag across a patient’s forearm to minimize shaking caused by patient anxiety. A “mummy wrap” is regarded as a more complex technique.

REF: p. 154 2. Patient immobilization is a critical part of achieving optimum image quality. Even the

smallest, undetectable involuntary motion can degrade the final image. Effective methods to reduce the amount of patient motion include a. giving clear, concise instructions to the patient before the exposure. b. assessing the amount of patient cooperation you can expect and making adjustments in immobilization. c. explaining how important it is to hol d st i l l d u r i n g the exposure so that a good N R I G B .C M U S N T O image can be obtained. d. All of the above ANS: D

One of the most effective means of reducing motion on images is good communication with the patient. Also required is an accurate assessment of the degree of cooperation the patient is able to provide.

REF: p. 154 3. Establishing a rapport with a patient contributes greatly to a successful immobilization

exercise. To establish patient rapport, the imaging professional should a. explain to the patient how important it is hold still and that you will use restraints to ensure this as part of the exam. b. pull out all your immobilization tools in front of the patient to show you know what you are doing. c. gently tell the patient what you need to accomplish and how you would like to move forward with the examination. d. ask for two or three other technologists to come into the room as you begin the positioning.

ANS: C

The patient is often capable of cooperation and would be more than willing to facilitate the examination if he or she were simply informed of what was going to happen and apprised of the importance of cooperation in producing an accurate diagnosis. A key component to effective communication with the patient is the establishment of rapport.

REF: p. 154 4. A patient arrives at the medical imaging department for a facial bones series after being hit in

the head by a softball. The patient comes to you with a cervical collar, but it is apparent that the collar may not be needed because the patient is turning his head to converse with you as the examination starts. A professional imaging technologist would a. remove the cervical collar because it appears to be unnecessary. b. complete the facial bone images with the collar in place using the positioning flexibility of your equipment. c. call the emergency department nurse and ask her to remove the cervical collar. d. immobilize the patient’s head and then remove the cervical collar so it’s not in the image.

ANS: B

In many instances, examining the skull of a patient wearing a cervical collar or similar immobilization device is necessary. Because of the presence of the cervical collar, a radiographer must become versatile in the production of skull images. Instead of being able to rotate and tilt the head or flex and extend the neck so as to position the patient correctly, the radiographer must be able to manipulate the radiographic equipment to compensate for the patient’s lack of mobility.

REF: p. 158 5. When using sandbags as an immobilization device, a. refill any sand that leaks out of the bag before the examination begins. b. make a note for the radiologist, as the sandbag is radiopaque and may leave an

artifact. c. place the sandbag over the area of interest, so the radiologist knows you used one. d. weigh the sandbag before using it, to ensure it is not too heavy on the patient.

ANS: B

Sandbags, unlike radiolucent positioning sponges, are radiopaque. As a result, they cannot be placed in such a way that diagnostic information is obscured within the anatomic area of interest. They must be placed gently on or against the areas adjacent to the anatomic area of interest so as not to injure or cause further damage.

REF: p. 156 6. To achieve extreme dorsiflexion of the ankle, the most effective immobilization method uses a. elastic wraps. b. tape. c. a draw sheet. d. Velcro straps.

ANS: D

An axial projection of the calcaneus requires extreme dorsiflexion of the ankle to produce an optimally diagnostic image. The use of the strap beneath the plantar surface of the foot allows the patient to maintain the extreme flexion required and at the same time reduces the possibility of motion that may result from maintaining an uncomfortable position.

REF: p. 156 7. When radiographing a patient with severe abdominal trauma and possible hemorrhagic shock,

it is important to a. remove the patient’s trousers to prevent artifacts. b. radiograph the patient through the antishock garment the patient is wearing. c. slowly remove the air in the antishock garment to decrease its radiolucency. d. add air to the antishock garment to improve image quality.

ANS: B

An antishock garment is a pair of inflatable trousers applied to a trauma patient. This garment is used in instances in which the patient has sustained trauma to the abdomen, pelvis, or lower extremities and internal hemorrhage is suggested. Because the trousers are radiolucent, they can be left in place while the examination is being performed.

REF: p. 159 8. When obtaining cervical spine images on a patient with a cervical collar, complete a. the AP and lateral projections with the cervical collar in place. b. the lateral projection and then remove the collar. c. the AP projection and then remove the collar. d. all spine projections with the col lar removed and replaced with a head clamp.

ANS: A

N R I G B.C M U S N T O

All projections should be taken with the cervical collar in place and removed only after the physician has reviewed the radiographic images and determined that it is safe to move the patient without the collar.

REF: p. 158 9. Effective techniques to use when radiographing children include a. showing the child a candy treat they will receive if they cooperate. b. communicating with the parents exclusively and letting them work with their child. c. getting down to eye level with the child and establishing rapport. d. asking a uniformed security officer to be in the room during the exam.

ANS: C

Kindness, patience, honesty, and understanding are best conveyed to children literally on their level by dropping to one knee to talk with the children face to face. Other approaches can be intimidating to pediatric patients.

REF: p. 159 10. The technique of wrapping an infant patient in a sheet a. is known as mummification. b. is effective for young adults and teenagers. c. requires the use of a commercially available Velcro-edged sheet design.

d. should be used only with parental approval.

ANS: A

One of the most effective, simple, inexpensive, and reliable methods of restraining or immobilizing a child is a mummy wrap. Although this method can be used on children 4 or 5 years of age, it is beneficial for children who are still too young to understand cooperation.

REF: p. 159 11. You have received an examination request for a pediatric wrist and hand radiograph. The

examination history states that the child caught her hand in a fan. The child’s hand shows soft tissue swelling but no cuts or abrasions. The patient is brought to you with her mother, who is quite distraught and upset over her child’s injury. As you proceed to image the daughter, how would you effectively handle the parent in this situation? a. Refer to departmental policy on parents in the examination room and use your best experience to deal with the mother, which may include having her leave the room. b. Ask the mother to hold the child if the child appears to be moving. c. Simulate the exam on the mother first to show the child how easy it will be and show the child sample images. d. Delay the examination until the mother has regained her composure.

ANS: A

A preliminary consideration for pediatric radiography is how to manage parents while the examination is being performed. Parents in the room during the examination may be helpful in comforting the child but also may get in the way of examination success. With the use of department protocol and experience, the radiographer must decide what option will yield the best results.

REF: p. 159

12. All of the following are true of the Pigg-O-Stat infant immobilizer except a. it is radiolucent and produces no image. b. its design provides for lead protection over the child’s gonads. c. it is made of contour-shaped, clear acrylic restraining forms. d. the patient can be rotated 360 degrees for various oblique projections.

ANS: A

The Pigg-O-Stat is useful for upright chest and abdominal radiographic examinations. It is not designed for recumbent positioning. One disadvantage of the Pigg-O-Stat is possible artifacts caused by the plastic sides, which can overlap the anatomic area of interest.

REF: p. 159 13. When performing a lumbar spine series on an elderly patient, a. move quickly and deliberately from one position to the next to demonstrate your

proficiency. b. increase the thickness of the radiolucent table pad to improve image quality. c. provide a wedge sponge, placed under the knees. d. provide a warm blanket for comfort and remove it for each exposure.

ANS: C

A sponge or radiolucent pad beneath the patient’s knees can greatly reduce strain on the patient’s back and increase the patient’s ability to cooperate during the examination.

REF: p. 163 14. An inflatable air splint is used under what circumstances? a. Severe head and cervical spine injuries b. Lower extremity trauma c. Spinal injury d. Shoulder injuries ANS: B

An inflation or air splint is simply an inflatable plastic cuff that is slipped over the affected limb and inflated to provide stability for transport by the emergency team. These splints are readily radiolucent, and routine radiography usually can be achieved with little discomfort or danger to the patient. An exception would be when a patient has multiple injuries that complicate the procedures.

REF: p. 159 15. The ideal patient immobilization device would be a. robotic and intuitive. b. elaborate in design and disposable. c. outlined in radiopaque material to show its presence on the image. d. radiolucent, durable, and easy to use for the radiographer.

ANS: D

Some of the commonly used N rouR ili. zaCtionMmethods are positioning sponges, Velcro Ut ineSIimm N Gand TobBhead straps, Velcro strap restraints, sandbags, clamps. Many ways exist to use these methods of immobilization, and their use is limited only by the creativity of the radiographer.

Essential features of immobilization devices include radiolucency, positioning flexibility, and ease of use as well as a sufficient degree of restraint.

REF: p. 163 16. An effective and simple immobilization tool for stabilizing a child’s arms, above and behind

the head is a: Patient immobilization methods contribute significantly to a patient’s X-ray exposure. The desirable features of an immobilization device, from a radiation protection standpoint, would be a. Velcro wrist bracelet. b. nylon tie wrap. c. stockinette. d. cloth drawstring.

ANS: C

A stockinette is effective as a restraint when pulled over the upper or lower extremities of a child and secured with tape. This technique is good for immobilizing the upper limbs above and behind the child’s head.

REF: p. 162 17. When using a sheet to “mummify” an infant, the sheet should first be formed into a

a. b. c. d.

triangle. square. rolled tube. rectangle the size of pillowcase.

ANS: A

One of the most effective, simple, inexpensive, and reliable methods of restraining or immobilizing a child is a mummy wrap. Basically, the child is wrapped in a triangular-shaped sheet, which effectively limits the movement of the extremities and also gives the technique its name (Figure 14.12).

REF: p. 160 | Figure 14.2 18. When tape is used as an immobilization tool with an infant, a. use liberal amounts of tape to hold the infant tightly. b. place the tape with the adhesive side in touch with the infant’s skin to hold better. c. wrap the tape around the patient several times to secure tightly. d. twist the tape so the nonadhesive side is against the infant’s skin.

ANS: D

When tape is used, it should be twisted where it comes in contact with the skin so that the nonadhesive side is in contact with the skin. Another technique to protect the skin is to place a gauze pad between the skin and the tape.

REF: p. 161 19. When immobilizing neonates and young infants, a. communication with the N patiR viG tallyBi. t ant.

Ue n tSiIs N T mCporM b. using a sheet for mummification can prove to be very effective. c. having a fellow radiographer hold the patient should be your first strategy. d. patient motion is generally not a concern because the infant is typically sleeping.

ANS: B

One of the most effective, simple, inexpensive, and reliable methods of restraining or immobilizing a child is a mummy wrap. Although this method can be used on children 4 or 5 years of age, it is beneficial for children who are still too young to understand cooperation.

REF: p. 159 20. The Octostop immobilization device is used a. on adolescents and adults. b. in conjunction with infant mummification. c. on infants and children younger than 1 year. d. for upright imaging studies only.

ANS: C

Only infants and small children up to 1 year of age should be immobilized with the Octostop.

It can be used for upright and recumbent positions and takes advantage of Velcro straps.

REF: p. 160

Chapter 15: Vital Signs, Oxygen, Chest Tubes, and Lines Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. The collection of vital signs data is quick and noninvasive. The usual vital signs measured

include a. electrolytes, blood gases, urinalysis values. b. temperature, pulse, respiration, and blood pressure. c. temperature, blood pressure, blood gases, and bowel sounds. d. respiration, pulse, cardiac output, and urinalysis values.

ANS: B

Collectively, the vital signs are body temperature, pulse rate, blood pressure, and respiratory rate. In addition, assessment of the patient’s mental alertness (sensorium) is often reported along with the vital signs.

REF: p. 166 2. Adequate breathing consists of a. good respiratory rate. b. good respiratory depth. c. 10 to 12 breaths/min. d. All of the above ANS: D

Adequate breathing (minute N veU ntR ilS atiI oN n)GisTpB re.dC icO atM ed on respiratory rate and depth of the breath. At rest, respiratory rates are at least 10 to 12 breaths/min.

REF: p. 166 3. Body homeostasis is often referred to as the body’s “steady state” and is maintained by

important body systems using physiologic feedback loops. Vital signs are an excellent indicator of the body’s response to conditions and therapies the patient is undergoing. A key strength of using vital signs as an indicator of homeostasis is that they a. are subjective and subject to interpretation. b. are measured using interventional catheters and therefore are very accurate. c. can be assessed quickly, and the data revealed are objective. d. can be confirmed by asking the patient how he or she feels.

ANS: C

Vital signs can be assessed quickly in the clinical setting and serve as objective, noninvasive evidence of the patient’s immediate condition. They are reliable indicators of physiologic body processes.

REF: p. 166 4. All of the following are related except a. oral. b. tympanic.

c. inguinal. d. rectal.

ANS: C

Five routes are commonly used to measure and extrapolate core body temperature: (1) oral, (2) axillary, (3) tympanic, (4) temporal, and (5) rectal. There is no body temperature measurement that is inguinal.

REF: p. 167 5. All of the following are true of body temperature measurement except a. all temperatures should be the same, regardless of where the temperature is

measured. b. an oral temperature reading higher than 99.5° F indicates a fever. c. temporal artery (TA) measurements can be measured in 3 seconds noninvasively. d. rectal and TA measurement are typically 1° higher than oral readings.

ANS: A

Body temperature readings may be measured in either degrees Fahrenheit (°F) or degrees Celsius (°C) and vary depending on where they are measured. Oral temperature readings in healthy adults and children are within the narrow range of 97.7° F to 99.5° F (36.5° C to 37.5° C). Tympanic measurements range from 95.9° F to 99.5° F (35.5° C to 37.5° C). Axillary temperatures register slightly lower, and rectal and TA temperatures register approximately 1° F higher than oral readings.

REF: p. 168 6. The peak blood pressure rea dNi ngR eaB su. riC ng bMlood pressures, is GT U, wh SIenNm O a. diastolic pressure. b. systolic pressure. c. blood pressure resulting from right ventricular contraction. d. insignificant, as it does not truly indicate resting blood pressure.

ANS: B

During a contraction of the heart, blood is ejected from the ventricles into the arterial blood vessels, creating an increase in pressure. The peak pressure present during contraction of the heart is known as the systolic pressure.

REF: p. 171 7. A reliable device to measure oxygen saturation levels of arterial blood is a a. sphygmomanometer. b. stethoscope. c. pulse oximeter. d. spirometer.

ANS: C

A pulse oximeter is a noninvasive device used to provide ongoing assessment of the hemoglobin oxygen saturation of arterial blood as well as the patient’s pulse rate. Normal pulse oximeter (SpO2) values for a healthy person are 95% to 100%.

REF: p. 170

8. A patient who has a temporal artery temperature of 100° F is a. febrile. b. hyperthermic. c. hypothermic. d. normal.

ANS: D

The TA lies superficial in the temporal region of the skull. A noninvasive swipe of the thermometer along the forehead and across the temporal region provides immediate, accurate measures closely correlating to core body temperature. Today, TA thermometry is popular. A TA reading of 100° F is considered normal (Table 15.1).

REF: p. 167 | p. 168 9. All of the following apply to respiratory measurements except a. a single respiration cycle consists of an inspiration and an expiration. b. the respiratory rate of newborns averages 12 to 20 breaths/min. c. adult respiration quality refers to rhythm, depth, and degree of effort. d. respiratory rates in children should be measured for at least one minute respiration

measurements may alter if the patient is supine.

ANS: B

Respiratory rates are measured as the number of breaths per minute; normal range at rest is 12 to 20 breaths/min. Newborns’ respiratory rates average 30 to 60 breaths/min.

10.0.1

REF: p. 169

The term bradypnea is used to describe a. a decrease in respiratory rate. b. the depth of respiration. c. difficulty in breathing. d. absence of breathing.

ANS: A

Bradypnea is the term used to describe a decrease in the respiratory rate. Bradypnea occurs much less frequently than tachypnea and results from depression of the respiratory center of the brain, which is common with drug overdoses, head trauma, and hypothermia.

REF: p. 170 11. The levels of blood pressures that are read on a sphygmomanometer are a. systolic over diastolic. b. diastolic over systolic. c. arterial over venous. d. None of the above ANS: A

Blood pressure measurements are expressed as the systolic pressure over the diastolic pressure. Normal blood pressure in a healthy adult includes a systolic pressure of less than 120 mm Hg and diastolic pressure of less than 80 mm Hg.

REF: p. 172 12. The objective of oxygen therapy is to a. produce a condition of hypoxemia. b. increase diaphragmatic movement to decrease tidal volume. c. increase the CO2 concentration going to the patient. d. increase the O2 concentration going to the patient.

ANS: D

The primary clinical indications for oxygen administration are to correct hypoxemia. This is achieved by increasing oxygen levels in the blood. The overall goal of oxygen therapy is to maintain adequate tissue oxygenation while minimizing cardiopulmonary work.

REF: p. 173 13. When “high-flow” oxygen therapy is given, the a. intracatheter b. nasal cannula c. nasogastric d. air-entrainment mask

method is used.

ANS: D

The facial mask, a high-flow device, is constructed to provide an accurate concentration of oxygen to the patient by propelling a high velocity of source oxygen through a narrowed opening near the mask. This method results in room air being drawn into the mask. The source oxygen, along with the entrained room air, provides a flow of gas that is capable of meeting the total need of the inspiratory capacity of the patient.

REF: p. 177

NURSINGTB.COM

14. The flow rate of oxygen therapy is given in a. liters per minute. b. cubic meters per minute. c. pounds per square inch. d. cubic centimeters.

ANS: A

In terms of dosage, and depending on equipment, oxygen is usually ordered either in liters per minute or as a concentration.

REF: p. 173 15. From the choices below, the most accurate way to determine body temperature is a. taking a blood sample and recording its temperature. b. with an oral thermometer. c. with a rectal thermometer. d. by using both an oral and a rectal thermometer and averaging the readings.

ANS: C

Even with all the newer measurement technologies, rectal thermometry is still believed to be the most accurate reflection of core body temperature. Temporal artery thermometry is gaining in popularity due to its convenience and accuracy, as well.

REF: p. 167 16. To measure blood pressures, you will need a a. thermometer and otoscope. b. stethoscope and pulse oximeter. c. sphygmomanometer and otoscope. d. stethoscope and sphygmomanometer.

ANS: D

Blood pressure readings are obtained with the use of a sphygmomanometer and stethoscope.

REF: p. 171 17. In a patient with hypoxia, a. heart rate decreases owing to high oxygen saturation values. b. respiratory rate remains unchanged. c. respiratory depth remains unchanged owing to increased cardiac output. d. blood pressure increases.

ANS: D

Tissue hypoxia is a term used to describe an inadequate amount of oxygen at the cellular (tissue) level. When hypoxia is present, the metabolic rate of the body is compromised, resulting in altered homeostasis. To compensate for hypoxia, respiratory rates, depth of breathing, blood pressure, and heart rates increase.

REF: p. 173

N R I G B.C M

18. All of the following are true ofUoxySgenNtheT rapy exO cept a. the universal color of flowmeters is green. b. oxygen is considered a drug and is regulated by the government. c. oxygen therapy can be prescribed by pharmacists and respiratory therapists. d. oxygen delivery devices either have a low flow rate or a high flow rate.

ANS: C

Oxygen is listed in the U.S. Pharmacopeia and is defined as a drug in the Federal Food, Drug, and Cosmetic Act of 1962. Similar to any drug, oxygen has both good and bad biologic effects; the minimum dose should always be given to obtain the desired result and no more.

Therefore, a physician must prescribe oxygen.

REF: p. 173 19. When taking a portable chest radiograph on a patient undergoing oxygen therapy, a. it is safe to remove the oxygen delivery during the setup and exposure. b. the oxygen should not be removed without the consent of a physician or

respiratory care practitioner. c. the oxygen should be turned off briefly during the exposure to prevent an electrical

spark. d. the oxygen delivery system should have a low flow rate only.

ANS: B

If the oxygen device must be repositioned, the responsibility of the technologist is to ascertain that any tubing leading to the device is not kinked or disconnected and that the device is properly repositioned on the patient at the conclusion of the radiologic procedure. Under no circumstances should an oxygen device be completely removed from the patient for the purpose of taking a radiograph without the consent or supervision of a physician, respiratory care practitioner, or attending nurse.

REF: p. 173 | p. 174 20. All of the following are related except a. nasal cannula. b. facial mask. c. thoracostomy tube. d. tent and oxy hood.

ANS: C

Thoracostomy (intrapleural) tubes, more commonly called chest tubes (Figure 15.30), are used to drain the intrapleural space and the mediastinum.

REF: p. 180 21. A Swan-Ganz catheter is a. intended to measure venous pressure in the superior vena cava. b. used to measure pulmonary wedge pressures. c. also referred to as a PICC line. d. None of the above ANS: B

Pulmonary arterial (PA) lines are commonly called Swan-Ganz catheters, so named for the developers of the catheter. PA catheters have a balloon located at the distal end. During pressure monitoring, this balloon is inflated, allowing the catheter tip to float and wedge in a small pulmonary artery. During this interval, the electrode, at the most distal end of the catheter, measures PA (wedged capillary) pressures. PA-wedged pressure is indicative of left atrial pressure, which in turn is indicative of left ventricular pressure.

REF: p. 182

The ideal location of the endotracheal tube tip is

22. a. just below the junction of the esophagus and trachea. b. in the left or right mainstem bronchus. c. in the back of the throat. d. in the trachea 1 to 2 inches above the carina.

ANS: D

After an endotracheal tube has been inserted, placement of the tube is confirmed by chest radiography and is assessed periodically thereafter. Properly positioned tubes will show the distal tip 1 to 2 inches (3 to 5 cm) superior to the tracheal bifurcation.

REF: p. 179

The preferred location of a central venous line tip is the

23. a. superior vena cava.

b. inferior vena cava. c. main pulmonary artery. d. jugular vein.

ANS: A

The preferred location is the superior vena cava, approximately 2 to 3 cm above the right atrial junction.

REF: p. 182 24. Which of the following is a common complication associated with CV line placement? a. Pneumothorax or hemothorax b. Tracheal erosion c. Laryngedema d. Atelectasis ANS: A

Regarding insertion problems, as many as one-third of CV catheters are placed incorrectly at insertion time. Malpositioning, pinching, and kinking also occur with significant frequency.

Pneumothorax and hemothorax are potential complications associated with catheter insertions.

REF: p. 183 25. Thoracostomy tubes are used to a. biopsy chest tumors. b. reestablish negative intrapleural pressure. c. administer oxygen at high concentrations. d. administer chemotherapeN ut icRd ruI gs . G B.C M

U S N T

O

ANS: B

Thoracostomy tubes are inserted through the chest wall to reestablish negative intrapleural pressure in cases of pneumothorax, hemothorax, pleural effusion, and empyema.

REF: p. 180 26. To relieve a large tension pneumothorax, what kind of tube(s) is (are) inserted into the

patient? a. Nasogastric b. Chest c. Thoracostomy d. Chest and Thoracostomy ANS: D

Thoracostomy (intrapleural) tubes, more commonly called chest tubes, are used to drain the intrapleural space and the mediastinum. Tension pneumothorax is a dramatic event that requires aggressive care. This condition requires a thoracostomy or chest tube insertion to relieve the pressure. Pressure increases on the ipsilateral side, causing a shift of the mediastinum toward the opposite side and producing a life-threatening event.

REF: p. 181 | p. 182

27. A patient is thought to have had a cardiac arrest. The patient’s pulse should be checked at the a. b. c. d.

artery. radial temporal carotid femoral

ANS: C

During cardiac arrest, the pulse is routinely assessed at the carotid artery. To monitor the effectiveness of CPR compressions, peripheral pulse points—the femoral, pedal, and radial arteries—may also be assessed to verify the effectiveness of chest compressions.

REF: p. 170 28. You have completed a portable chest radiograph on a patient in the ICU. The image is

positioned correctly and has acceptable image quality. When the correct placement of a central venous (CV) line using a right-sided approach is assessed, the catheter tip should a. not cross the midline of the patient and should be located in the superior vena cava. b. cross the patient’s midline and be positioned in the thoracic duct. c. be located in the main pulmonary artery in a “wedge” position. d. be located in the left ventricle for accurate pressure measurement.

ANS: A

Recognition of catheter malposition requires thorough knowledge of CV structures and their branches. Typically, CV lines inserted from a right-sided approach will follow the course of the subclavian vein in a latero-medial direction and then descend through the right brachiocephalic vein. From the right brachiocephalic vein, the catheter passes into the superior vena cava, where it should teN rm naS teIaN boGvT eB th. eC rigOhM t atrium. Because of the right-sided UiR position of the superior vena cava, as the catheter advances, its image should remain to the right of the vertebral column and should not cross midline.

REF: p. 184 29. A Swan-Ganz catheter differs from a central venous (CV) catheter in that Swan-Ganz a. lines measure arterial pressures in the wedge position and reflect pressure in the

left atrium. b. catheters may be single-lumen or multilumen design, with a pressure electrode and

cuff at the distal end. c. catheters are named after Jeremy Swan and William Ganz developers. d. All of the above are true.

ANS: D

Pulmonary arterial (PA) lines were commonly called Swan-Ganz catheters, so named for the developers of the catheter. PA lines are specialized single-lumen or multilumen CV lines that incorporate at the distal end a small electrode used to monitor pulmonary artery pressures. PA lines are used to estimate left ventricular end-diastolic pressure.

REF: p. 182

30. While performing a portable chest radiograph on an uncooperative patient with a CV line

inserted, you note that the catheter fixation material has loosened. Your responsibility as a professional radiographer is to a. quickly complete the exam as best you can, so as not cause any more harm. b. reattach the catheter line and complete the exam. c. take the chest image to assess the catheter tip position and its displacement. d. inform the patient’s nurse of the catheter issue before taking the radiograph.

ANS: D

One of the most critical concerns of radiographers is catheter dislodgment, which can be prevented only with increased awareness of the catheter’s presence. Care must be exercised when handling patients with CV lines. Assessing the patient before performing radiographic procedures is essential to avert the possibility of line displacement.

REF: p. 183

Chapter 16: Basic Cardiac Monitoring: The Electrocardiogram Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. Adequate perfusion of human tissue generally requires a. a diastolic pressure of 20 mm Hg. b. a systolic pressure of 90 mm Hg or greater. c. occasional arrhythmias to bring the heart into a rhythmic cardiac cycle. d. a diastolic pressure of at least 90 mm Hg. ANS: B

Through the pumping of blood through the vascular system, a pressure (systolic blood pressure) is created that can easily be assessed using a stethoscope and sphygmomanometer.

Systolic pressures greater than 90 mm Hg generally ensure adequate perfusion of tissues. This sequence of events is known as the cardiac cycle.

REF: p. 188 2. All of the following are related except a. AV node. b. Purkinje fibers. c. SA node. d. myocardium.

ANS: D

The heart is composed of myN ocUaR rdS iaI l tN isG suT esBt. haC tO p eMr f o r m several functions, including conduction. Specialized cells include the sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, and Purkinje fibers. These cells form a cardiac conduction system, and originate in and transmit electrical impulses across the myocardium and regulate the rhythm of a cardiac cycle.

REF: p. 188 3. For a cardiac cell to return to its resting membrane potential, a. repolarization of the cell membrane must occur. b. a nerve impulse must be initiated by the Purkinje fibers. c. depolarization of the cardiac cell membrane must occur. d. None of the above are correct.

ANS: A

All cardiac cell membranes are positively charged on their outer surfaces. When the cell is stimulated, movement of ions in and out of the membrane alters its charge, reversing the resting potential. This period is referred to as depolarization. Reversal of ion flow reestablishes a positive charge to the outside of the membrane, a process called repolarization, which returns the membrane to its resting membrane potential.

REF: p. 188

4. The polarity that exists across a cardiac cell membrane is maintained by an active transport

process known as a. automaticity. b. fibrillation. c. sodium-potassium ion pump. d. pinocytosis.

ANS: C

All cardiac cell membranes are positively charged on their outer surfaces owing to the relative distribution of cations. This resting membrane potential is maintained by an active transport mechanism called the sodium-potassium ion pump.

REF: p. 188 5. Referring to the choices below, the normal flow of electrical impulse through the cardiac

conduction system of the heart follows what sequence of events?

1. Purkinje fibers 2. AV node 3. SA node 4. Bundle of His 5. Interventricular node (IV node) a. 3, 1, 4, 5 b. 2, 3, 5, 1 c. 3, 2, 4, 1 d. 3, 5, 4, 1 ANS: C

The normal cardiac conductiN onUsR eqSuI enN ceGiT sB as.foClO loM ws. The sinoatrial (SA) node initiates depolarization of the atrial muscle, and the impulse is slightly delayed as it travels to the atrioventricular (AV) node. The AV node delays and finally relays the impulse along the common bundle of His. The impulse continues along the common bundle of His and its branches until it finally reaches the Purkinje fibers, stimulating the ventricular muscular sheet.

REF: p. 188 | p. 189 | Figure 16.1 6. The QRS complex on a typical ECG represents a. depolarization of atrial muscle. b. depolarization of ventricular muscle. c. repolarization of ventricular muscle. d. repolarization of atrial muscle.

ANS: B

The QRS complex represents depolarization of ventricular muscle cells. The Q portion is the initial downward deflection, the R portion is the initial upward deflection, and the S portion is the return to the baseline (isoelectric point).

REF: p. 189 7. If the PR interval is longer than normal on a typical ECG tracing, one can assume that a. the patient has tachycardia. b. the patient has tachycardia.

c. the patient has an AV node block. d. the patient has bradycardia.

ANS: C

If the PR interval is prolonged, it can be deduced that an AV block is present. The PR interval is normally 0.12 to 0.20 seconds (3 to 5 small squares). Longer intervals indicate that the impulse is being delayed from entering the ventricles, and the condition is designated AV block.

REF: p. 190 8. A widened QRS complex on an ECG tracing could represent a. ventricular hypertrophy. b. ventricular-paced rhythm. c. pacemaker tissue that is below the AV node. d. All of the above ANS: D

The duration of the QRS complex should not exceed 0.12 seconds (3 small squares). A widened complex indicates ventricular enlargement (hypertrophy) or that ventricular depolarization is being initiated by pacemaker tissue below the AV node, for example, ventricular-paced rhythm. In this example, one ventricle depolarizes first, and the current must spread into the second ventricle. This takes more time than when the current spreads down the bundle of His into both ventricles simultaneously.

REF: p. 190 9. Heart rates above 100 beats/m is.teC rmeMd Nin R In adNGultTB Uin aS O a. bradycardia. b. tachycardia. c. cardiac ectopia. d. fibrillation.

ANS: B

Adult cardiac rates below 60 beats/min indicate bradycardia, and those above 100 beats/min indicate tachycardia.

REF: p. 190 10. A possible complication of patients with a history of atrial fibrillation is a. right coronary artery stenosis. b. left coronary artery stenosis. c. atrial emboli formation. d. AV node bundle block.

ANS: C

One of the most common cardiac arrhythmias is atrial fibrillation. Additional ectopic pacemaker firings in the atria exceed those of the SA node, creating a quiver of the atria syncytium instead of a full contraction. Although this arrhythmia is not life threatening, the formation of atrial emboli is a potential complication.

REF: p. 190

11. A cardiac arrhythmia that is life threatening and provides no effective cardiac output is a. atrial fibrillation. b. V-tach. c. V-fib. d. PVC. ANS: C

Ventricular fibrillation (“V-fib”) is a serious arrhythmia that is life threatening. Instead of competent myocardial contraction, the muscle fibers twitch or quiver. As a result, little to no blood is pumped, and cardiac output is virtually zero. This is a case of cardiac arrest, and unless it is reversed, death will occur.

REF: p. 190 12. The cardiac arrhythmia of bradycardia generally involves abnormalities to the a. SA and AV nodes. b. Purkinje fibers of the left atrium. c. right coronary sinus. d. bundle of HIS. ANS: A

Cardiac arrhythmia is caused by abnormalities of the heart that negatively interfere with its neural conduction system and consequently impact cardiac output. Bradycardia typically involves either SA or AV node abnormalities.

REF: p. 190 13. 3 .1

An effective method for treating select cardiac arrhythmias is the use of high-frequency alternating current to destroy strategic cardiac tissue and reroute the cardiac impulses generated. These procedures are known as a. selective coronary angioplastic repairs. b. cardiac ablation treatments. c. cardiac thermoplastics. d. cardiac valvular replacements.

ANS: B

Ablation therapies involve either heating or freezing tissues within a chamber of the heart that is considered to be the etiology of the arrhythmia. Radiofrequency ablation involves the use of electrodes at the tip of catheter wires, which are heated with radiofrequency energy. Whether heating or freezing, the involved tissue is ablated, and the arrhythmia is resolved.

REF: p. 191 14. A dual-wire pacemaker places electrode tips in the a. right atrium and right ventricle. b. right and left ventricles. c. right and left atria. d. left atrium and left ventricle.

ANS: A

Arrhythmias may be treated with an implantable device such as a cardiac pacemaker or an implantable cardioverter-defibrillator (ICD). In a dual-wired unit, the electrodes are positioned in the right atrium and right ventricle. In a three-wired pacemaker, wires are positioned with electrodes in the right atrium and right and left ventricles. The battery and generator stimulate myocardial pacing of the heart.

REF: p. 191 15. Cardioversion therapy can be used to treat a. ventricular fibrillation. b. atrial-related arrhythmias. c. V-tach. d. All of the above ANS: D

Cardioversion therapy is useful for treating atrial-related causes of arrhythmias, including atrial fibrillation. It involves external shock therapy to the chest to restore normal cardiac rhythm. In severe cases of ventricular tachycardia or fibrillation, electric shock defibrillation therapy is administered.

REF: p. 191

Chapter 17: Infection Control Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. Lyme disease is a condition caused by bacteria carried by deer ticks. The tick bite may cause

fever, fatigue, and other associated symptoms. This is an example of transmission of an infection by a. droplet contact. b. a vehicle. c. the airborne route. d. a vector.

ANS: D

Some microorganisms require a vector to enter and exit the human host. A vector is usually an arthropod (mosquito, flea, tick, and so forth). A vector, the deer tick, transmits Lyme disease.

REF: p. 199 2. Streptococci and bacilli are classified as what type of microorganisms? a. Viruses b. Bacteria c. Fungi d. Molds ANS: B

Bacteria are identified and clN asU siR fieSdIaN ccG orT dB in. gC t o Ot hMe i r morphology, biochemistry, and genetic constitution. The medically important bacteria are classified into three general morphologies: cocci or spheres, bacilli or rods, and spirals.

REF: p. 196 3. The process of establishment and growth of a microorganism on or in a host is referred to as a. inflammation. b. infection. c. pathogen. d. prokaryotic nosocomial.

ANS: B

Infection refers to the establishment and growth of a microorganism on or in a host. Only when the infection results in injury to the host is the host said to have a disease. Pathogenic microorganisms cause infectious diseases.

REF: p. 196 4. Bacteria have all of the following characteristics except they a. are eukaryotic organisms. b. have the ability to produce endospores. c. are single-cell organisms. d. may live on a host in a colony form.

ANS: A

Bacteria are microscopic single-celled organisms with a simple internal organization. They are prokaryotic rather than eukaryotic organisms. Whereas prokaryotes lack a nucleus and membrane-bound organelles, eukaryotes have a true nucleus.

REF: p. 196 5. Any microorganism that causes disease is a. prokaryotic. b. idiopathic c. pathogenic. d. iatrogenic.

ANS: C

Pathogenic microorganisms cause infectious diseases. Most often, pathogens have the ability to do one of three functions extremely well: (1) multiply in large numbers and cause an obstruction, (2) cause tissue damage, and (3) secrete organic substances called exotoxins.

REF: p. 196 6. All of the following are related except a. fungi. b. protozoa. c. viruses. d. bacillus.

ANS: D

Pathogens are divided into foNur bRa s i cIi n fGe c t iB o u.sCa g eMn t s : bacteria, viruses, fungi, and protozoan S N aTbacillus parasites. Of the choices in thisUquestion, is a type of bacteria.

REF: p. 196 7. Pathogenic organisms have the ability to a. cause cellular and tissue damage. b. replicate and cause blockages to the flow of fluids and gases. c. secrete endotoxins. d. do all of the above.

ANS: D

Pathogens have the ability to do one of three functions extremely well: (1) multiply in large numbers and cause an obstruction, (2) cause tissue damage, and (3) secrete organic substances called exotoxins.

REF: p. 196 8. All of the following are viral infections except a. cold sores. b. tinea pedis. c. common cold. d. warts.

ANS: B

A cold sore caused by herpes simplex virus is an example of a viral infection. Common viral diseases in humans include the common cold, infectious mononucleosis, and warts. Tinea pedis, commonly known as athletes’ foot, is a fungal infection.

REF: p. 197 9. After an organism is infected and by the time symptoms of the infectious process manifest,

several steps have taken place. These steps consist of 1. multiplication and spread.

2. encounter and entry.

3. host.

4. damage.

5. reservoir.

6. phagocytosis.

7. outcome. a. 1, 2, 3, and 4 only b. 2, 4, 5, 6, and 7 only c. 3 and 6 only d. 1, 2, 4, and 7 only ANS: D

From the time the infectious agent comes in contact with the host until the devastation of a disease is apparent, several complicated processes must be completed. These processes can be categorized into six steps: (1) the encounter, (2) entry, (3) spread, (4) multiplication, (5) damage, and (6) outcome. Refer to Figure 17.5 in the text for a diagram.

REF: p. 198 10. A disease spread by kissing is being transmitted by which of the following methods? a. Direct contact b. Vector spread c. Droplet spread d. Aerosol ANS: A

Microorganisms can be transmitted either exogenously, from outside the body, or endogenously, from inside the body. Transmission can occur by either direct or indirect host-to-host contact. Kissing is a type of direct contact.

REF: p. 199 11. Which of the following is the most effective method for achieving medical asepsis? a. Frequent hand washing b. Having most medical employees in perfect health c. Changing linen after every patient d. Cleaning the radiographic table between patients ANS: A

Medical asepsis involves a reduction in numbers of infectious agents, which in turn decreases the probability of infection but does not necessarily reduce it to zero. Hand washing is a routine practice in all patient care settings. It is the single most important means of preventing the spread of infection.

REF: p. 203 12. When a disease is spread by an insect depositing the pathogen on or in a human, it is

transmitted by what method? a. Vector b. Vehicle c. Direct contact d. Fomite ANS: A

Some microorganisms require a vector to enter and exit the human host. A vector is usually an arthropod (mosquito, flea, tick, fly).

REF: p. 199 13. By what method are pathogens spread when a person coughs or sneezes? a. Vector b. Vehicle c. Direct contact d. Droplet ANS: D

When caring for patients wh oNa reRi n fIec t eGd wBit. hC suchMpathogenic organisms as rubella, mumps, U Sprecautions N T should influenza, and adenovirus, droplet be used. These pathogens disseminate through large particulate droplets expelled from the patient during coughing, sneezing, or even talking.

REF: p. 206 14. Which of the following is not a method of sterilization? a. Autoclaving b. Moist heat c. Steam under pressure d. Hand washing ANS: D

The absolute killing of all life forms is termed sterilization. If proper sterilization techniques are used, the probability of infection is theoretically zero. Hand washing is a form of medical asepsis, but it does not kill all microorganisms, which is a requirement for sterilization.

REF: p. 202 15. Chemical substances capable of killing pathologic microbes are termed a. disinfectants. b. antiseptics. c. bactericidal. d. bacteriostatic.

ANS: C

Disinfectants can be classified not only according to whether they can be used on a living body but also by whether they kill or do not kill microbes. A bacteriostatic agent stops bacterial growth, and a bactericidal agent kills cells.

REF: p. 203 16. The spread of infection via contaminated food referenced is spread by a. contact. b. fomite. c. air. d. vector.

ANS: B

A fomite is an inanimate object that has been in contact with an infectious organism. Food and water, radiographic equipment, and latex gloves can all serve as fomites.

REF: p. 199 17. At the conclusion of an interventional radiographic examination, the examination room is

cleaned, and major components are wiped down with chemical disinfectants. By performing this important task, the radiographer is practicing a. medical asepsis. b. sterilization. c. surgical asepsis. d. fomite asepsis.

ANS: A

Contamination through the health care environment is often through fomites, such as instruments, fluids, food, air, and medications. Radiologic technologists have the ability and the responsibility to prevent the spread of infectious organisms. Using chemical disinfectants when cleaning examination rooms is a type of medical asepsis.

REF: p. 202 18. A nosocomial infection is an a. infection acquired at a large gathering. b. upper respiratory infection. c. infection acquired in a hospital. d. infection obtained through a physician’s physical examination.

ANS: C

Hospital-acquired conditions are known as nosocomial infections (nosocomium is the Latin word for “hospital”). Approximately 5% of all inpatients acquire an additional condition while in the hospital. These hospital-acquired pathogens follow the chain of infection, but the links are limited to persons who are in contact with the microenvironment we know as the health care facility.

REF: p. 200 19. The chain of infection consists of

a. b. c. d.

fomite, vector, reservoir, and breachment. bacteria, virus, protozoa, and fungi. host, infectious microbe, mode of transmission, and reservoir. encounter, entry, spread, multiplication, and outcome.

ANS: C

For infections to be transmitted, the following must exist: (1) a host, (2) an infectious microorganism, (3) a mode of transportation, and (4) a reservoir.

REF: p. 199 | Figure 17.6 20.

All of the following are possible sources of nosocomial infection except a. transfer of pathogenic microbes from a urethral catheter to a patient. b. contamination of a surgical instrument in the surgical theater. c. transfer of microbes through hand contact with a waitress in the coffee shop adjacent to the hospital. d. placement of an image receptor against a patient wound during a portable examination.

ANS: C

Hospital-acquired conditions are known as nosocomial infections (nosocomium is the Latin word for “hospital”). These hospital-acquired infections follow the chain of infection, but the links are limited to persons who are in contact within the microenvironment of the health care setting, exclusively.

REF: p. 200 21. A few days after a stereotactiN c b rRe a s I t b i oGp s yBp.e rCf o r m Me d by a radiologist in a breast imaging

S N Twith an obvious infection at the incision site. This center, the patient returns to herUphysician is an example of a(n) a. unsourced infection. b. idiopathic infection. c. nosocomial infection. d. iatrogenic infection.

ANS: D

An infection that is the result of intervention with a physician is an iatrogenic infection. This type of infection is strictly limited to the physician, whether he or she is in the hospital or not.

REF: p. 200 22. Two bloodborne pathogens of particular importance to hospital personnel are a. pneumonia and tuberculosis. b. hepatitis B virus (HBV) and HIV. c. papillomavirus and rhinovirus. d. Clostridium and Bacillus.

ANS: B

Bloodborne pathogens are disease-causing microorganisms that may be present in human blood. They may be transmitted with any exposure to blood or other potentially infectious material. Two bloodborne pathogens are of concern within the hospital setting: hepatitis B virus (HBV) and human immunodeficiency virus (HIV).

REF: p. 201 23. In a hospital setting, constant awareness is given to the simple fact that patients come to the

hospital because they are sick and vulnerable to disease. With the current system of medical care, by the time patients come to the hospital setting for care, they are sicker than ever in the past. The most common nosocomial infection seen in hospital patients is a. common colds picked up on contaminated radiography equipment. b. urinary tract infections from Foley catheter insertions. c. shingles (Herpes Zoster) from contaminated needles. d. staphylococcal infection from labor and delivery.

ANS: B

The majority of hospital-acquired infections (HAIs) include urinary tract infections, surgical site infections, bloodstream infections, and pneumonia. The US Department of Health and Human Services estimates that tens of thousands of lives are lost to HAIs, and such infections are the eighth leading cause of death.

REF: p. 200 24. All of the following are true of radiology department biosafety except a. washing hands before and after an interventional procedure. b. wearing gloves while handling an emesis basin with vomitus. c. cleaning up a biospill area using a commercial soap solution. d. using a resuscitation mask or bag during CPR. ANS: C

Biosafety in the radiology d eN p a r tRm e nIt reG quiB re. s tCh e uMse of standard precautions. Standard U S ofNboth T body Ofluid precautions and body substance precautions incorporate the features isolation. The contaminated area can be cleaned with a bleach solution or a hospital-grade disinfectant.

REF: p. 205 25. When you and a colleague perform a portable chest radiograph on a patient with contact

precautions, it would be appropriate to 1. place the cassette in a protective bag before exposure and dispose of the bag properly after exposure.

2. wash your hands only after the examination has been completed.

3. remove jewelry and place it in a safe place.

4. put on a clean mask, clean gloves, and clean gown (your assistants need not do so as they are not going to touch the patient) and put on a lead apron outside of the clean gown.

5. greet the patient professionally and explain what you are going to do.

6. have your assistant position the receptor behind the patient.

7. after exposure, remove the gown, mask, and gloves and discard them when you return to radiology. a. 1, 2, 4, 5, and 6 only b. 1, 3, and 5 only c. 1, 3, 5, 6, and 7 only d. 4, 5, 6, and 7 only

ANS: B

Contact precautions must be used when caring for a patient infected with a virulent pathogen that spreads by direct contact with the patient or by indirect contact with a contaminated object, such as patient’s dressings or bed rails. The health care practitioner should properly don gloves before entering the room. The gloves are removed and hands washed before the practitioner leaves the room. A gown should be worn if the practitioner anticipates contact with the patient or his or her environment; the gown is removed before the practitioner leaves the room. All radiographic equipment should be decontaminated with an antiseptic after the radiographic procedure is completed.

REF: p. 206 26. The single greatest measure that can be done to prevent the spread of infection is a. proper discarding of all refuse in sharps containers. b. proper hand washing technique. c. proper disinfection of radiographic cassettes. d. discarding lead aprons that have been contaminated.

ANS: B

Hand washing is a routine practice in all patient care settings. It is the single most important means of preventing the spread of infection. Washing or scrubbing the hands involves the removal of contaminants (transients) as well as resident microorganisms. Hand washing is both a chemical and a physical process.

REF: p. 203 27. A pathogen that requires contact precautions is a. MRSA. b. tuberculosis. c. rubeola. d. rhinovirus.

ANS: A

Contact precautions must be used when caring for a patient infected with a virulent pathogen that spreads by direct contact with the patient or by indirect contact with a contaminated object, such as patient’s dressings or bed rails. Conditions that require using contact precautions include methicillin-resistant Staphylococcus aureus (MRSA), hepatitis A, impetigo, varicella, and varicella zoster. Rubeola is commonly called measles and requires droplet precautions.

REF: p. 206 28. A person who acts as a reservoir of pathogenic organisms is referred to as a carrier. An

example of a carrier is a a. friend who appears to be healthy and shows no signs of sickness. b. family member who recently had a tooth removed. c. coworker who has demonstrated a cold for 2 weeks. d. a patient who is being examined for an inguinal hernia repair.

ANS: C

A person who serves as a reservoir is called a carrier. A carrier is an infected person who does not display the disease symptoms.

REF: p. 200 29. All of the following are effective methods of sterilization except a. chemical agents. b. moist heat. c. ultraviolet radiation. d. isolation.

ANS: D

The absolute killing of all life forms is termed sterilization. If proper sterilization techniques are used, the probability of infection is theoretically zero. Hand washing is a form of medical asepsis but it does not kill all microorganisms, which is a requirement for sterilization.

Isolation is not a sterilization method.

REF: p. 203 30. Sterile gloves should be used for all of the following instances except a. an arteriogram with angioplastic catheter. b. emptying a patient’s emesis basin. c. positioning a patient for a suspected simple wrist fracture. d. palpating a patient’s skin for a venipuncture.

ANS: C

Gloves must be worn during procedures that may involve contact with any patient’s body fluids, blood, secretions, e x c rNet i oRn s , Im u cGou sBm.eCm b M r ane s , non-intact skin, or contaminated U during S N allTvascular access procedures. items. Gloves must also be worn REF: p. 205

Chapter 18: Aseptic Techniques Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. All of the following situations would require aseptic techniques except a. insertion of barium enema tip. b. insertion of central venous line. c. insertion of an indwelling Foley catheter. d. insertion of an angiographic catheter.

ANS: A

Among the numerous imaging procedures that require sterile technique are angiography, arthrography, hysterosalpingography, and biopsies in the surgical environment. Additionally, aseptic techniques are used for line placements and indwelling urinary catheters. Barium enema examinations are not considered sterile procedures.

REF: p. 211 | p. 212 2. The goal of aseptic technique is to a. protect the radiographer from infection. b. protect the patient from pathogenic microbes. c. prevent the spread of infection from the patient to any equipment in the

examination room. d. protect the surgical team from an infected patient.

ANS: B

The goals of aseptic technique are to protect the patient from infection and to prevent the spread of pathogenic microorganisms.

REF: p. 211 3. When creating a sterile field, it is important for the imaging professional to a. establish the sterile field as early in the day as possible to create an awareness of

the scheduled procedure. b. remember that anything above the ankles is considered sterile. c. keep sterile gloves in sight and above the waist level. d. remember that any moisture that develops on the sterile field can be dried using an

infrared lamp.

ANS: C

A sterile field is a specified area that is considered free of viable microorganisms. It is regarded to be everything above waist level.

REF: p. 212 4. When establishing a sterile field using a sterile drape, a. reach over the sterile field to minimize reach and air motion. b. all drape items must be clean and dry. c. inspect the expiration date to determine if you are using the sterile pack within 36

hours of the expiration date. d. open the sterile package with the top flap set to open toward the person opening

the pack.

ANS: B

In most instances, a sterile field is established using a sterile drape. The first step in using a sterile drape is confirming that the package is sterile. If a package is not clean and dry, it is considered unsterile. If it appears to have been previously opened or if the expiration date has passed, it is also considered unsterile. It is not acceptable to reach over any sterile field.

REF: p. 212 | Figure 18.1 5. When opening and pouring sterile solutions, a. remove the cap and place it on a corner of the sterile field with the lid down. b. wipe up any spills of solution using a sterile towel. c. hold the bottle approximately 6 inches above the basin when pouring to form a

steady stream of fluid. d. hold the bottle with the label facing up to prevent fluids from staining the label.

ANS: D

Sterile solutions are frequently poured into a metal or other container within the sterile field.

Begin with verifying the contents and expiration date on the solution. When possible, show the name to another health care person for verification. Remove the lid or cap from the bottle and place it on an unsterile surface. Hold the bottle with the label uppermost so that poured solution cannot stain and obscure the label. With as little of the bottle as possible over the field, hold it at a height of approximately 1 to 2 inches over the bowl so that no splashing occurs.

REF: p. 212 | p. 213

NURSINGTB.COM

6. The inflatable balloon portion of the Foley catheter is typically filled with a. radiopaque contrast material. b. carbon dioxide. c. sterile water. d. denatured alcohol.

ANS: C

On insertion of the Foley catheter, the balloon is filled with sterile water to hold the catheter in place.

REF: p. 221 7. Which of the following statements is false? a. A sterile person may touch only what is sterile. b. Create sterile fields early in the morning while equipment is clean and equipment

is clean. c. A sterile field must be watched continually to be considered sterile. d. If a solution soaks through a sterile field to a nonsterile field, the wet area must be redraped.

ANS: B

The goals of aseptic technique are to protect the patient from infection and to prevent the spread of pathogens and harmful microorganisms. Sterile fields should be created no sooner than the needed procedure time to prevent transient contamination as a function of time delays and they must be monitored continually once established.

REF: p. 221 | Box 18.1c | p. 226 | p. 227 | p. 228 | p. 229 8. When opening a sterile tray, your fingers a. may not touch any metal content. b. must be covered with sterile gloves. c. may not touch any cloth content. d. must never touch the inside of the tray.

ANS: D

A sterile field is a specified area (such as within a tray or on a sterile towel) that is considered free of viable microorganisms. Touching the inside of the tray creates an unsterile situation and must be reported.

REF: p. 221 9. When opening and pouring sterile solutions, a. both the inside and outside of the container are considered sterile. b. move the sterile basin to the edge of the sterile field. c. show the solution name and strength to another person before pouring. d. move the sterile basin to the edge of the sterile field and show the solution name

and strength to another person before pouring are appropriate.

ANS: D

Sterile solutions are frequently poured into a metal or other container within the sterile field.

Bottles containing sterile solutions usually are considered sterile on the inside but contaminated on the outside. Begin with verifying the contents and expiration date on the solution. When possible, show the name to another health care person for verification. When pouring into a sterile basin, move the basin to the edge of the sterile field to avoid splashing contents onto the sterile field area.

REF: p. 213 | p. 214

You are about to assist with a sterile procedure. In scrubbing for the procedure, it is important

10. to a. tightly wrap surgical tape around your rings and watch, before scrubbing. b. keep your arms down when scrubbing to prevent fluids running up your arm. c. scrub the fingers completely, as well as the front and back of your hands, for 3

minutes. d. use a surgical antimicrobial solution such as alcohol or antiseptic soap.

ANS: C

The sterile scrub consists of scrubbing with an antimicrobial agent. Remove all jewelry, including watches. Wash hands and arms with antiseptic soap. Clean subungual areas with nail file. Scrub the sides of each finger, between the fingers, and the back and front of the hand for 3 minutes. Scrub the arm with the hands higher than the elbows. Each side of the arm is washed to 3 inches above the elbow for 1 minute. The hands remain above the elbows at all times.

REF: p. 214 | p. 215 11. When gowning and gloving for a sterile procedure, it is important to remember that a. the techniques are the same as gowning for medical asepsis. b. sterile gloves must be put on outside of the sterile work area. c. after gowning, the front of the gown down to the waist, and the sleeves are

considered sterile. d. when passing a sterile team member, you must pass each other face to face in order

to see any contamination.

ANS: C

After the gown is on, only the sleeves and front of the gown down to the waist are considered sterile. To maintain sterile technique when wearing a sterile gown and gloves, persons must pass each other back to back.

REF: p. 215 | p. 216 | p. 217 12. When gowning another person, a. a nonsterile circulating person pulls up the gown and fastens the back and

waistband.

N R I G B.C M b. the nonsterile person picks U up tSh e oNp e nTe d go wOn from behind, and hands it to the sterile person. c. sterile masks are unnecessary. d. the sterile person grabs the gown by the waist and wraps it around their waist with the assistance from the unsterile person.

ANS: A

A nonsterile circulator pulls up the gown and fastens the back and waistband of the gown.

REF: p. 216 | p. 217 13. When putting on a pair of sterile gloves using the self-gloving, open technique, a. jewelry must be wrapped in skin tape and may remain on during gloving. b. the glove package is open and positioned so the wearer crosses his or her arm over

the left glove to reach for the right glove. c. the first glove is picked up by the inside cuff with one hand, being careful not the touch the outside of the glove. d. the remaining glove is grabbed by the outside and placed on the unsterile hand, making it sterile.

ANS: C

When using the open-glove technique, it is important that you pick up the glove by its inside cuff with one hand. Do not touch the outside surface of the glove or the glove wrapper. The glove is then pulled onto the hand without touching the inside surface of the glove, which is actually the outside surface of the folded cuff.

REF: p. 217 | Figure 18.8 14. When performing dressing changes, it is important to remember that a. working on the dressing change as a single person is highly recommended to

prevent contamination. b. dressing changes can be performed once there is a color change on the dressing

surface. c. if the wound is purulent, gowns are recommended. d. sterile gowns are only needed if the wound is openly draining.

ANS: C

Dressings are best changed in a team setting with another health care worker. The physician is responsible for ordering dressing changes. Literature recommends that gowns should be used if the wound is purulent. In a standard precautions environment, gowns are required at all times.

REF: p. 217 | p. 218 | p. 219 15. Which of the following represents good sterile technique? a. When using a sterile setup, avoid bending and reaching over it. b. Remove sterile forceps from their container and tap them on the edge so all the

solution drips off.

N R I G B.C M c. Any sterile supplies added U to aSs te rNi l e T t ray , s u cOh as cotton balls, can be returned to their containers if not used, as such waste is inefficient and costly. d. The solution in the forceps container should be checked regularly and added to when its level gets too low.

ANS: A

Necessary sterile supplies can be added to a sterile field using the proper package-opening techniques. Remember that it is unacceptable to reach across a sterile field.

REF: p. 221 | Box 18.1 16. Which of the following should be examined first when a sterile package is used? a. The tightness of the wrapping b. Type of material used to wrap the package c. Expiration date d. Way the package is folded ANS: C

The first step in using a sterile package is confirming that the package is sterile. If a package is not clean and dry, it is considered unsterile. If it appears to have been previously opened or if the expiration date has passed, it is also considered unsterile.

REF: p. 212 17. If the sterility of an object is unknown, which of the following should be done?

a. b. c. d.

Ask the physician if it is alright to use the object.

Use the object as long as the expiration date has not passed.

Consider the object unsterile and do not use it.

Clean the object with a disinfectant or antimicrobial before using it.

ANS: C

A sterile field is a specified area that is considered free of viable microorganisms and is known to be sterile by those involved in the procedure. If there is any doubt as to the sterility of a field or any item or fluid, it must be considered unsterile and replaced.

REF: p. 212 18. Two people in sterile attire should pass each other in which of the following ways? a. Front to back b. Back to front c. Back to back d. Front to front ANS: C

To maintain sterile technique when wearing a sterile gown and gloves, persons must pass each other back to back. The backs of sterile gowns are considered unsterile.

REF: p. 221 | Box 18.1 19. If you suspect the radiologist has unknowingly contaminated his or her glove, which of the

following should you do? a. Ignore the contamination as it is their responsibility to know their own contamination. b. Remain silent so as not to jeopardize the case and complete a sentinel event report afterward. c. Confirm the contamination with a second person, and if there is agreement, inform the radiologist. d. Make the radiologist aware of the possible contamination immediately.

ANS: D

A sterile field must be continually monitored for sterility. If it becomes contaminated for any reason, the physician must be notified immediately regardless of the circumstances. To do otherwise could jeopardize patient safety and be considered unethical.

REF: p. 221 | Box 18.1 20.

When performing radiologic examinations on patients with chest tubes, a. the chest drainage system has three compartments: collection chamber, water seal chamber, and suction control chamber. b. check for the color of the drainage and report any pale amber color indicating serous fluid. c. the exterior chamber of the assembly must remain higher than the patient’s chest level to prevent retrograde flow. d. All of the above are correct.

ANS: A

Radiographers often perform chest radiography before and after the insertion of chest tubes to ensure proper placement. Chest drainage systems have three compartments to which chest tubes are attached. The exterior assembly of the chest tubes must always remain lower than the patient’s chest. Additionally, any change in chest fluid color must be reported, particularly a dark red color.

REF: p. 220 | p. 221 21. The purpose of the inflatable balloon portion at the tip of the Foley catheter is to a. hold the catheter within the bladder. b. present the backflow of urine into the ureters. c. permit its visualization under fluoroscopy. d. induce the stimulus for voiding.

ANS: A

On insertion of the Foley catheter, the balloon is filled with sterile water to hold the catheter in place.

REF: p. 221 22. When handling a patient with a Foley catheter in place, a. the drainage bag should be placed at the same level or higher than the bladder. b. avoid kinks in the tubing and keep the drainage bag lower than the bladder. c. it is advisable to clamp the tubing to do a lengthy small bowel study. d. never let the volume of urine fill more than 30% of the collection bag capacity.

ANS: B

The urine collection bag and N tubiRng I s h o uGl d nBo. e kM inked and should be kept below the level N back T intot bC Othe of the bladder to prevent refluxUof S urine bladder. Failure to do so can lead to infection.

REF: p. 222 23. When a Foley catheter system is inserted into a patient for an expected period of 4 to 6 weeks, a. a polyvinyl chloride catheter is used. b. a suction pump is attached to the drainage bag to ensure bladder emptying. c. the patient is taught how to remove and replace the Foley using aseptic techniques. d. the catheter will most likely not have an inflatable balloon end.

ANS: A

Plastic catheters are suitable for short-term use only. Latex catheters can be used for 2 to 3 weeks and polyvinyl chloride catheters for 4 to 6 weeks, but the expensive pure silicone catheters are used only for long-term catheterization of 2 to 3 months.

REF: p. 222 24. You are working as a radiographer in a busy imaging department, late into the evening. You

receive a request for a portable chest radiograph on a cardiac patient in the ICU. Your coworker comments that he just did a portable chest procedure on the same patient approximately 15 minutes earlier and questions why they are ordering another one so soon.

The rationale for this next chest image would most likely be a. the floor had a change in nursing staff and they are re-ordering the examination to

make sure it was completed. b. a new resident cardiologist arrived for his shift and wants his own image. c. the patient has a central venous line, and the physician wants to check the

repositioning. d. the patient is now sleeping, and a better image can now be achieved.

ANS: C

Radiographers often perform chest radiography, especially portable procedures, before and after the insertion of chest tubes and vascular lines to check line placement or the presence of a pneumothorax.

REF: p. 220 25. The role of the imaging technologist during cardiac pacemaker studies is to a. assist the surgeon with sterile technique. b. position the patient into various oblique angles for static radiographic images. c. operate fluoroscopy for the physician as he or she guides the pacemaker into

position. d. provide nursing care to the patient and monitor the electrophysiology data.

ANS: C

The role of the radiographer is to operate the fluoroscopy unit, which will allow the physician to place the pacemaker wires (leads) correctly.

REF: p. 225 26. When using a portable fluoroscopy C-arm in surgery, a. the image receptor and CN -a r mR a r I apedBw U Se dr NG T .iCthOaMsnap cover for sterility. b. the surgery team members operate the fluoroscopy unit. c. the C-arm is disinfected and considered sterile. d. sterile technique is only needed when the C-arm is over the patient’s surgical

incision.

ANS: A

The most common approach for draping an image intensifier and C-arm is with a snap cover.

A tension band is snapped in place when the image intensifier and C-arm are covered with a sterile cloth or bags. This approach allows the physician to manipulate the C-arm while maintaining a sterile field.

REF: p. 226 27. When using a portable C-arm for a surgical hip pinning, a. sterility will be maintained using a “shower curtain” approach. b. snap covers are not recommended. c. the surgeon can reach through the curtain and move the C-arm manually. d. an additional sterile towel is positioned over the incision site and then removed

when the C-arm is brought into the field of view for imaging.

ANS: A

Hip pinning or femur rodding may use an approach known as the shower curtain approach.

On the patient’s affected side, a sterile clear plastic sheet is suspended from a long horizontal metal bar attached to two vertical suspending rods. An opening is located in the middle of the sheet, which is attached using a special adhesive to the patient, allowing access to the surgical site.

REF: p. 226 28. Hazardous drug-related waste materials a. include only pharmaceuticals, to prevent needle perforations through the collection

bag. b. deal with bodily discharges such as sputum and feces. c. are collected in clear bags for identification. d. require the labeling of needle containers and breakable items of hazardous waste.

ANS: D

The Occupational Safety and Health Administration (OSHA) Technical Manual Part IV (section c) requires the labeling of needle containers and breakable items of hazardous waste as hazardous drug waste only. Thick, leak-proof plastic bags, colored differently from other hospital trash bags, should be used for routine collection of discarded gloves, gowns, tubing, and other disposable materials.

REF: p. 226 | p. 227 29. When performing portable radiography on neonatal infants, a. gonadal protection is not important because the reproductive organs are

undeveloped.

N R I G B.C M b. aseptic techniques are espeU cial S l y im NpoTrtant beOcause of the infant’s weak immune system. c. the portable radiographic unit must be wiped down within 24 hours before the procedure. d. sterile technique procedures should be adhered to strictly.

ANS: B

Sepsis and nosocomial infections are recognized as major threats that result in significant morbidity and mortality each year in neonatal units. Thus, in neonatal radiography, maintaining asepsis as much as possible is important.

REF: p. 226 30. A common neonatal chest disorder requiring portable radiography in the neonatal unit is

transient tachypnea of the newborn (TTN). Radiographs are taken to visualize the chest for respiratory distress, and in doing so, the imaging professional must 1. use the highest degree of aseptic techniques.

2. use lead protection when possible, and sterilize after each use.

3. surgically scrub your hands to replace gloves in order to position the neonate with better precision.

4. wrap all items that may have the potential of coming in contact with the newborn.

5. use contact or shadow shielding for patient protection.

6. treat the procedure as a sterile procedure similar to surgery. a. 1, 3, 4, and 6 only

b. 1, 2, 4, and 5 only c. 3, 4, 5, and 6 only d. 1, 3, 5, and 6 only ANS: B

Neonatal infant patients require many therapeutic interventions to support them, which may lead to frequent invasive procedures and long exposure to the hospital environment. Frequent radiographs are taken, and special attention must be given to gonadal protection, medical asepsis, and protecting the neonate from unsterile materials by wrapping them with clean wraps.

REF: p. 226

Chapter 19: Nonaseptic Techniques Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. Nasogastric (NG) tubes are inserted with the patient in the a. Sims’ b. high Fowler c. Trendelenburg d. recumbent, prone

position.

ANS: B

Nasogastric (NG) tubes are plastic or rubber tubes inserted through the nasopharynx into the stomach. The patient is placed in a high Fowler position with pillows supporting the head and shoulders.

REF: p. 231 2. NG tubes are inserted through the patient’s a. b. c. d.

with the end of the tube placed in the

. mouth; duodenum nasopharynx; stomach mouth; ileum oropharynx; stomach

ANS: B

NG tubes are plastic or r u b b eNr U tuR beSs I inN seGrtT edBt. hrC oO ugM h the nasopharynx into the stomach. The primary use of an NG tube is for administration of medications and gastric decompression or removal of flatus and fluids from the stomach after intestinal obstruction or major trauma.

REF: p. 230 3. To facilitate removal of a nasogastric tube, the patient is a. sedated heavily. b. encouraged to take a deep breath. c. placed in the Trendelenburg position. d. told to drink water through a straw.

ANS: B

Identify the patient and explain the procedure. Verify that consent for the procedure has been obtained. Wash your hands and then turn off and disconnect the suction equipment if it is in place. Put on clean gloves and instruct the patient to take in a deep breath as the tube is gently withdrawn.

REF: p. 231 4. The most common type of nasogastric tube used for stomach decompression is the a. Swan-Ganz catheter. b. double-lumen valvular Clevis tube. c. peripherally inserted central catheter (PICC).

d. single-lumen Levin tube.

ANS: D

The most common NG tube used for gastric decompression is the Levin tube, which is a single-lumen tube with several holes near its tip.

REF: p. 230 5. To confirm the placement of an NG tube in its proper position, a physician may use a. a syringe to remove gastric contents as proof. b. fluoroscopy for visualization. c. a device to measure the length of tubing inserted. d. a syringe to remove gastric contents as proof and fluoroscopy for visualization ANS: D

Verification of tube placement can be obtained through a variety of methods, including fluoroscopy. Additionally, the physician may use a stethoscope to listen for gastric sounds and, with a syringe, aspirate back gastric contents into an emesis basin.

REF: p. 231 6. When transporting a patient with a NG tube to medical imaging, a. confirm the suction pressure before disconnecting the tube. b. make sure the NG tube is secured to the patient’s nose. c. confirm the allowable time for suction interruption. d. do all of the above.

ANS: D

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If a patient is to be transferred, then the radiologic technologist must first confirm that the physician has given an order allowing the transfer and interruption of suctioning. The length of time that suction can be interrupted safely also must be known as well as the level of suction pressure required.

REF: p. 231 | p. 232 7. As you arrive into a patient’s room for transport to radiology, you notice that the patient has

an NG tube in place with a syringe upright and pinned to the gown. You should know that this patient a. has a double-lumen NG tube in place. b. has a Levine line that is single lumen. c. must have the line clamped before transport. d. has a double-lumen NG tube in place and must have the line clamped before transport.

ANS: A

To prevent leakage from a double-lumen type NG tube, the barrel of a piston-like syringe may be inserted into the suction-drainage lumen, and it is then pinned to the patient’s gown with the barrel upward. A double-lumen tube must never be clamped closed because to do so might cause the lumina to adhere to each other and destroy the double-lumen effect.

REF: p. 232

8. When working with a nonambulatory male patient who needs to void, a. ask the patient how much assistance he feels he needs and allow him to use a

urinal. b. after the patient has voided, record the volume of urine in the patient’s chart if

documentation is required. c. dispose of the urine in the toilet and rinse the urinal with cold water. d. remove your disposable gloves, wash your hands, and place the soiled urinal in a

receptacle for resterilization. e. do all of the above.

ANS: E

If the patient is able to help himself, the imaging professional simply hands him an aseptic urinal and allows him to use it, providing privacy whenever possible. When he has finished, the radiologic technologist should put on clean disposable gloves, remove the urinal, empty it, and rinse it with cold water. If the patient’s urinary output needs to be documented, note the level of urine indicated by the measurement scale on the side of the urinal and record it in the patient’s chart. The urinal is then placed with the soiled supplies to be resterilized.

REF: p. 232 9. As you begin to perform a hip examination on an elderly female patient who has undergone

hip surgery, the patient states that she “needs to go to the bathroom.” Which of the following should be done?

1. Use a standard bedpan.

2. Provide for the patient’s privacy and locate a fracture bedpan.

3. Be sure to wear gloves and wash your hands.

4. If the bedpan is metallic, r u n it u n d e r warm water for patient comfort and discard in a N R I G B.C M U S N T O recycling bin.

5. You and an assistant should assist the patient with movement onto the bedpan.

6. Return the patient to the nursing floor for cleanup and patient hygiene. a. 2, 3, 4, 5, and 6 only b. 2, 3, and 5 only c. 1, 5, and 6 only d. 2, 3, 5, and 6 only ANS: B

If a patient has a fracture or another disability that makes using a standard bedpan unacceptable, then a fracture pan is used. This type of bedpan may be used for those who cannot raise their hips high enough or to roll over onto a regular size bedpan. Fracture pans are shallower and are contoured for patient comfort. Typical bedpan procedures regarding hygiene and cleanliness are used.

REF: p. 233 | p. 234 10. After bedpan use, hygiene of the female patient’s perineum is important. Proper cleansing of

this region requires using gloves and several folded tissues to wipe the region a. from the anus to the mons pubis. b. transversely between gluteal folds. c. from the mons pubis to the anus. d. in circular motions.

ANS: C

The patient may require assistance in cleaning the perineum. For female patients, be sure to wipe from the mons pubis toward the rectal area to avoid contaminating the genital area.

REF: p. 234 11. Which of the following is a true statement regarding cleansing enemas? a. Oil retention enemas are used to “harden” stool material for more complete

evacuation. b. Diabetic patients require special colon preparation procedures. c. Standardized colonic preparation protocols are used by all departments performing colon studies. d. Cleansing enemas are typically not recommended for inflammatory bowel disease.

ANS: B

Patients with diabetes require special preparation. Diabetic low-calorie drinks may be added to the standard regimen, and patients with insulin-dependent diabetes often forgo their normal morning insulin dose until after the examination has been completed.

REF: p. 234 12. All of the following are true of cleansing enemas except a. they are intended for the administration of enteric medications. b. they promote the defecation reflex and discharge. c. they are complete when bowel contents are clear and free of fecal matter. d. hydrating patients is a significant concern for patients undergoing a cleansing

enema.

ANS: A

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A cleansing enema is used to promote defecation and naturally is not done to administer medications. For any examination that evaluates the colon, the bowel should be clear and free of fecal material. A diet of clear liquids maintains vital body fluids, salts, and minerals.

Consumption of clear liquids also provides some energy for patients when normal food consumption must be interrupted. Several types of enemas may be used depending on the situation.

REF: p. 234 | p. 235 13. Performing fluoroscopic examinations of the colon are scheduled less often than before. The

reason for this change in the clinical study of the colon includes a. an increased cost of barium as a contrast agent. b. patient tolerance for barium enemas as diminished. c. the sensitivity of colonoscopy has surpassed the results of barium contrast colon studies. d. the shortage of radiologists has made fluoroscopy of the colon harder to schedule.

ANS: C

The sensitivity for colonoscopy in the detection of cancerous and precancerous lesions has been estimated to be greater than 95%. This is far better than traditional colon studies. A major advantage of colonoscopy is that polyps can be excised during the procedure.

Specimens that are removed are taken to the clinical laboratory to diagnose cell type.

REF: p. 235 | p. 236 14. All of the following are true of virtual colonoscopy except a. it is performed using MR technology. b. hundreds of images are obtained in seconds, permitting the processing of a 3D

study of the colon. c. it is considered a minimally invasive diagnostic study. d. they typically require no sedation or referral from the patient’s doctor.

ANS: A

Virtual colonoscopy involves no scopes, sedation, recovery time, or referral from your doctor or insurance plan. It is performed on a multislice CT scanner that takes up to 600 two-dimensional (2D) and three-dimensional (3D) images of the colon in just 30 seconds. The combination of 2D and 3D images increases the radiologist’s ability to detect and analyze areas of concern.

REF: p. 234 15. Currently, in most radiology departments, barium studies of the colon a. are single-contrast studies using Gastrografin. b. employ carbon dioxide and barium as a double-contrast exam. c. require no special colon preparation. d. do not use fluoroscopy and utilize the technology of CT. ANS: B

In almost all facilities, the double-contrast barium enema (the addition of air or carbon dioxide to provide for two contrasts— d th e . aiC r) h aMs become more of a routine as compared Nb aURr i uSmINa nG T B to a single-contrast enema. This type is highly recommended for patients experiencing diarrhea and in high-risk patients—for example, the patient who has polyps, a family history of colorectal cancer, or a personal history of cancer or rectal bleeding.

REF: p. 238 16. To diagnose the condition of colitis, a. single-contrast barium enema studies are considered the “gold-standard.” b. patients are heavily sedated to prevent motion and bowel motility. c. colonoscopy is the preferred diagnostic study. d. double-contrast colon studies are recommended without fluoroscopic assessment.

ANS: C

Today, colonoscopy, virtual colonoscopy, and magnetic resonance imaging are performed most often due to their overall effectiveness, especially in the identification of polyps, cancers, and detecting colitis.

REF: p. 235 17. When performing a single-contrast barium enema examination, a. show the patient the entire volume of enema solution to prepare him or her for the

study. b. suspend the enema bag above the table at a height no greater than 30 inches. c. continue emptying the barium solution as the patient cramps to encourage

peristalsis. d. encourage the patient to use short breaths or gasps and to tighten abdominal

movements, similar to a bowel movement.

ANS: B

Because greater pressure is required to secure an adequate flow rate, the bag is usually suspended at a distance, up to 30 inches above the table. Due to gravity, the higher the bag is positioned, the faster the suspension liquid enters the rectum and colon. Severe abdominal cramping may result from excessive height, and rupturing of diverticula in the colon may result from excessive fluid pressure.

REF: p. 237 18. The administration of glucagon shortly before a double-contrast barium enema is intended to a. increase liver function and the release of glycogen. b. cause the gallbladder to empty. c. relieve bowel spasm. d. increase peristalsis to improve bowel motility.

ANS: C

In almost all facilities, the double-contrast barium has become routine. This type of enema is highly recommended for patients experiencing diarrhea or with suspected colorectal cancer or rectal bleeding. The patient often receives an injection of a smooth muscle relaxant such as glucagon immediately before the examination to relieve bowel spasm.

REF: p. 238 19. For a single-contrast barium N enem UR aS, I NGTB.C OM a. approximately 500 mL of barium is used for an adult. b. air or carbon dioxide is used as a contrast agent. c. spot images of the cecum, hepatic flexure, splenic flexure, and sigmoid are taken. d. a post-evacuation image is taken 24 hours later to assess emptying.

ANS: C

In a typical single-contrast barium enema, the suspension is run in slowly with compression applied to the abdomen. Approximately 1500 mL of barium is required for the average adult barium enema, and spot views of the cecum, flexures, and sigmoid colon are taken.

REF: p. 237 | p. 238 20. The use of a water-soluble contrast agent such as Gastrografin for a colon examination is

warranted for patients with a. an intussusception. b. a possible bowel perforation. c. diverticulosis. d. pancreatitis.

ANS: B

When perforation of the bowel is suspected, water-soluble iodine compounds, such as Gastrografin, are the only acceptable contrast media. These compounds also are used in a variety of other cases in which administration of barium sulfate can prove hazardous.

REF: p. 235 21. Post-procedural care for patients who have had a colon examination should include a. instructions for maintaining hydration. b. an increase in fluid intake and dietary fiber for a few days after the examination. c. an awareness of the change in stool color to an ashen gray color and the

importance of eliminating the barium during defecation. d. All of the above ANS: D

Post-procedural instructions to the patient are extremely important after a barium enema because barium retention can cause fecal impaction or intestinal obstruction. Barium has hydroscopic qualities, which means that it will absorb fluid from the bowel. Extreme dehydration as a result of preparation for the examination is another possible post-procedural complication. Stools are typically white or light-colored until all of the barium is expelled.

The patient should increase fluid intake and dietary fiber for several days unless medically contraindicated and should be instructed to rest after the examination.

REF: p. 238 | p. 239 22. To allow tissue healing from a partial colon resection, a. the patient is encouraged to sleep in the recumbent, prone position. b. an external stoma is created to allow for defecation. c. the patient will be kept on a liquid diet for the entire recovery period. d. the patient’s colon will be clamped off distal to the resection site.

ANS: B

Because of trauma or a pathoN loU giR cS coInN diG tioTnBs. ucCh aM s cancer, diverticulitis, and ulcerative colitis, formation of a stoma (mouth) from the bowel to the outside of the body may be necessary. A permanent colostomy is performed when a portion of bowel is removed. A temporary colostomy is performed to heal or rest a diseased portion of bowel.

REF: p. 239 23. In preparation for a barium examination of a colostomy patient, it is important to a. tell the patient to not take their bismuth anti-odor tablets before the examination. b. understand the sensitivity of these patients to their condition and lifestyle change. c. irrigate the stoma the night before and morning of the examination. d. do all of the above.

ANS: D

A patient with a colostomy needs special instructions for adequate preparation. In most patients, the stoma is irrigated the night before and the morning of the examination. Dietary and laxative preparations also vary depending on the ostomy. The patient with a colostomy must be instructed, for example, not to take bismuth subgallate tablets—as he or she may normally do to control odor—because these are radiopaque.

REF: p. 239 24. When a barium examination of an ostomy patient is performed, a. the patient is imaged in the prone position.

b. allow the patient to insert the enema cone-tip into the stoma orifice. c. glucagon is never given to such patients. d. a larger volume of barium is used to allow for leakage around the stoma site.

ANS: B

The procedure for administering a barium enema to a patient with a colostomy differs somewhat from that for the regular examination because of the lack of a sphincter. The main problem with barium administration through a colostomy is trying to prevent leakage without damaging the colostomy. A cone-shaped tip with a long drainage bag that attaches to it is frequently preferred. The radiologic technologist typically lubricates the tip of the cone and hands it to the patient for insertion. If the patient is unable to perform the insertion, the radiologist, who also tapes the device in place, performs the task.

REF: p. 239 25. The radiographic evaluation of the small and large bowel that has been connected to the skin

surface, as a substitute for the urinary bladder with an ostomy, is typically called a(n) a. stomogram. b. fecagram. c. loopogram. d. vesiculogram ANS: C

The radiographic evaluation of the small and large bowel that has been connected to the surface of the skin, as a substitute for the urinary bladder, is typically called a loopogram.

REF: p. 239

Chapter 20: Medical Emergencies Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. Providing care in an emergency situation is intended to

1. prepare the injured patient for surgery.

2. prevent further harm to the patient.

3. preserve life.

4. place the patient into a sedated state for transport.

5. stabilize the patient until the appropriate medical assistance arrives. a. 2, 3, and 5 only b. 1, 3, 4, and 5 only c. 3, 4, and 5 only d. 1, 4, and 5 only ANS: A

An emergency is a situation in which the condition of a patient or a sudden change in medical status requires immediate action. Emergency actions on the part of the radiologic technologist generally have the objectives of preserving life, avoiding further harm to the patient, and obtaining appropriate medical assistance as quickly as possible.

REF: p. 242 2. The single most important action for the radiographer when administering emergency care is a. reacting to the emergent s i t u a t i o n an d pr ov i d i n g a n y and all care needed to save

N R I G B.C M

U S N T O the patient’s life. b. minimally getting involved for fear of medical and professional liability. c. providing a competent level of care, recognizing when advanced care is needed, and calling for assistance. d. waiting to provide care until any doctor or practitioner arrives.

ANS: C

The technologist must be able to recognize emergency situations, maintain a calm and confident presence, and take appropriate action. The recognition of need for assistance is a critical first step; the technologist must be able to recognize when such assistance might be warranted.

REF: p. 242 3. A common name for an emergency cart within medical imaging is the a. first aid b. crash c. first call d. code

cart.

ANS: B

Most radiology departments have at least one emergency cart, often referred to as a crash cart, which is typically a wheeled container of equipment and drugs typically required in emergency situations.

REF: p. 242 4. The medical term for a temporary suspension of consciousness is a. epistaxis. b. vertigo. c. syncope. d. aura.

ANS: C

Syncope is a self-correcting, temporary state of shock and loss of consciousness and the result of lack of blood flow to the brain. Treatment is aimed at increasing blood flow to the head.

REF: p. 250 5. What type of shock is caused by a failure of the heart to pump enough blood to the vital

organs including the brain? a. Cardiogenic b. Septic c. Anaphylactic d. Neurogenic ANS: A

Shock is a general term that indicates a failure of the circulatory system to support vital body functions. Cardiogenic shock, caused by a variety of cardiac disorders, including myocardial infarction, causes a major circulatory disruption to the body’s vital organs.

REF: p. 244

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6. A 16-year-old patient comes to the diagnostic imaging department for a CT examination. He

is lying on the table in a supine position and suddenly seems to lose consciousness and begins to move violently, with jerking motions. You realize that he is having a generalized seizure.

The action that you must take is a. go to the patient immediately, prevent him from harm and call for help. b. insert your protected thumbs to prevent damage to teeth. c. place the patient on the floor and begin cardiopulmonary resuscitation (CPR). d. restrain the patient’s extremities to prevent orthopedic injuries.

ANS: D

Severe seizures are characterized by involuntary contraction of muscles on either one or both sides of the body. The goal is, to the extent possible, to prevent the patient from being injured.

The technologist should certainly call for help and remain by the patient.

REF: p. 251 7. The type of shock that is a result of severe loss of blood is a. hypovolemic. b. septic. c. vasogenic. d. anaphylactic.

ANS: A

Shock is a general term that indicates a failure of the circulatory system to support vital body functions. Hypovolemic shock is caused by a severe loss of blood or tissue fluid.

REF: p. 244 8. Symptoms of a head injury include a. respiratory distress. b. change in state of consciousness. c. patient is lethargic. d. All of the above ANS: D

The technologist should quickly assess a patient with a head injury to note if his or her level of consciousness deteriorates. Findings in an alert or drowsy patient that can signify a deteriorating head injury include irritability, lethargy, slowing pulse rate, and slowing respiratory rate.

REF: p. 243 9. What type of shock can result from a severe reaction to the contrast media used in

radiographic examinations? a. Hypovolemic b. Septic c. Anaphylactic d. Cardiogenic ANS: C

Anaphylactic shock is a typeNof vRa s oIg e n G shBo. ckCanM d is most commonly encountered in the U Swith N the Ti c administration radiology department in connection of iodinated contrast media.

REF: p. 244 10. Which of the following is most appropriate for a patient to counteract hypoglycemia? a. Orange juice b. Diet soda c. Protein bar d. Buttered toast ANS: A

Hypoglycemia is a condition in which excessive insulin is present. Most patients, especially those who have lived with the condition for a time, recognize the condition before it becomes serious. The patient needs a quick form of carbohydrate, which can include orange juice sweetened with sugar, a sugared soft drink, a candy bar, or any form of carbohydrate.

REF: p. 244 | p. 245 11. After the administration of an iodine-based contrast into a patient, it is important for the

technologist to observe the patient for a. signs of a reaction such as a metallic taste in the mouth, cold extremities, and bladder swelling. b. urticaria, nausea, shortness of breath, tightening in the throat, and cardiac arrest. c. blurred vision, syncope, and epistaxis.

d. excessive salivation, dry eyes, and nasal dryness.

ANS: B

Patients develop localized itching and urticaria (hives) and may experience nausea and vomiting. The most serious reactions might include laryngeal edema, shock, and cardiac arrest. All of these conditions are potentially life threatening and should be handled accordingly.

REF: p. 244 12. In preparation for any emergent situation, the professional technologist should become

familiar with a. the location of and access to the crash cart. b. automatic external defibrillator (AED) operation. c. institutional numbers for emergency code announcements. d. All of the above ANS: D

Radiologic technologists should never underestimate their ability to contribute to a patient’s survival and well-being through quick thinking and appropriate action. The technologist should keep in mind the location of a crash cart, AED and its operation and emergency paging procedures, as well as remaining vigilant.

REF: p. 242 | p. 243 13. What type of shock is caused by loss of blood from a knife or gunshot wound? a. Cardiogenic b. Septic c. Anaphylactic d. Hypovolemic ANS: D

Shock is a general term that indicates a failure of the circulatory system to support vital body functions. Hypovolemic shock is caused by a severe loss of blood or tissue fluid which drops the body’s blood volumes.

REF: p. 244 14. When comparing a semi-automatic AED device with an automatic device, a. both devices determine the patient’s cardiac rhythm. b. the automatic device robotically places the AED paddles on the patient. c. the semi-automatic AED automatically shocks the patient by placing the unit next

to their torso. d. None of the above are correct.

ANS: A

Increasingly, radiology departments and other public places have AED available. Fully automatic defibrillators, which analyze the patient’s cardiac rhythm, determine whether defibrillation is necessary and, if necessary, deliver a shock. Similarly, semi-automatic defibrillators analyze the patient’s cardiac rhythm to determine whether defibrillation is necessary and, if necessary, advise the operator to deliver a shock by pushing a button.

REF: p. 242 15. When comparing hyperglycemia with hypoglycemia, hyperglycemia a. indicates a low blood glucose level. b. is typically of rapid onset. c. portrays clinical symptoms of excessive thirst and urination as well as dry mouth. d. requires the patient receive a quick form of glucose.

ANS: C

Hyperglycemia is a condition of excessive sugar in the blood and is the characteristic typically associated with diabetes. This condition develops gradually, and patients exhibit excessive thirst and urination, dry mucosa, rapid and deep breathing, and drowsiness and confusion.

These patients need insulin.

REF: p. 245 16. What is the first thing you should do if a patient who is standing turns pale and says he feels

dizzy? a. Quickly take the exposure and get an emesis basin. b. Have the patient inhale ammonia. c. Have the patient lean against the radiographic table. d. Have the patient lie down.

ANS: D

A patient who experiences vertigo should be assisted to a seated or recumbent position, which prevents injury from falling as a result of problems with equilibrium.

REF: p. 250

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17. When caring for a patient with epistaxis, the patient a. should lean forward and pinch their nostrils against the midline septum for several

minutes. b. should lie down quickly and tilt his or her head back. c. should be given an emesis basin and gauze pads. d. should sit back with his or her head tilted, and heparin gel should be applied inside

the nose.

ANS: A

Epistaxis, or nosebleed, can be a common occurrence and requires the patient to lean forward and pinch the affected nostril against the midline nasal cartilage with the fingers.

REF: p. 250 18. An effective method to handle a patient with an asthmatic attack during a radiographic

procedure would be to a. tell the patient to breathe faster and with less depth to avoid losing consciousness. b. tell the patient to hold his or her breath for 30 seconds to recover. c. have the patient sit down and allow the patient to use his or her aerosol inhaler. d. recognize the patient's situation and work faster to get the examination done so they can use their inhaler sooner.

ANS: C

Asthma attacks are often triggered in patients with asthma when they are exposed to stressful situations, such as might be experienced in a radiology department. The radiologic technologist should stop the procedure; assist the patient to a sitting position to support easier respiration; and if the patient has medications available, allow the patient to use them.

REF: p. 245 19. As you are radiographing a patient from the emergency department who has a knife wound to

the upper extremity, you notice that his wound dressing is becoming saturated with blood quickly, and he is getting lightheaded. You should a. remove the dressing to assess the degree of bleeding. b. tell the patient to lean over to get his arm lower than his heart. c. call for help, apply pressure to the wound site, and elevate his arm. d. lay the patient down and begin CPR. ANS: C

Some patients come to the radiology department with wounds sustained previously or during surgery. Pressure should be applied directly over the saturated dressing, preferably with an additional sterile bandage pressed against it. When a bleeding wound is on an extremity, the affected extremity may be placed above the level of the heart unless other problems that would contraindicate such a procedure exist.

REF: p. 251 20.

When working with burn patients, it is critically important to not encase the detector in plastic to prevent skin peeling. position the patient with Teflon-coated positioning aids.

RocaINineGTtoB.C spray the burn dressing witU hNlidS relieO ve the pain. use an extraordinary level of aseptic technique.

a. b. c. d.

ANS: D

Because a burn injury disrupts the normal protective function of the skin, maintaining sterile precautions is imperative. Burns are typically extremely painful injuries; therefore, extra gentle care in handling is also indicated.

REF: p. 251 21. You have come upon a motor vehicle accident as the first person to arrive. As you assess the

victim’s level of consciousness, you begin to ask questions and encourage the victim to respond. During your efforts to do so, the victim has no verbal response to any stimuli, but his leg moves with your touch and pinch. This person demonstrates what level of consciousness? a. Alert and responsive b. Drowsy but can be aroused c. Unconscious but reflexive d. Comatose and unresponsive ANS: C

The patient with the least severe injury is classified as alert and conscious. In most instances, this patient can respond fully to questions and other stimuli. A more seriously injured patient is drowsy but can be roused to response with loud speaking or gentle physical contact. Even more serious injury produces a patient who is unconscious and reacts only to painful stimuli.

These patients typically do not respond to verbal stimuli but react to stimuli such as pinches and pinpricks. The most serious condition is that of a patient who is comatose and unresponsive to virtually all stimuli.

REF: p. 243 22. All of the following are related except a. airway. b. breathing. c. circulation. d. chest compression.

ANS: C

In October 2010, new guidelines for CPR were released by the American Heart Association (AHA). CPR provides external support for circulation and respiration and consists of three primary aspects—historically known as the ABCs: airway, breathing, and chest compressions.

New guidelines have replaced the ABC order with CAB emphasizing the need, particularly for the non-health care provider, to start chest compressions first.

REF: p. 247 23. When performing CPR as a single rescuer, a. the compression rate is performed at 60 compressions per minute.

N SRporI B.C b. assess circulation using theUtem Nal G aT rtery ofOthe forehead. c. after each group of 30 compressions, give 2 quick ventilations. d. sternal compressions should have a maximum depth of 1 inch.

ANS: C

CPR provides external support for circulation and respiration and consists of three primary aspects—historically known as the ABCs: airway, breathing, and chest compressions. A single rescuer should use 30 compressions alternated with 2 ventilations; the compressions are given at a rate of approximately 100 per minute.

REF: p. 247 24. CPR can be stopped when a. the rescuer is physically exhausted. b. a physician says it’s time to stop CPR. c. the patient responds and shows signs of recovery. d. All of the above are correct.

ANS: D

After it is begun, basic life support should (and for legal reasons, must) be continued until the victim resumes spontaneous respiration and circulation, a physician or other responsible health care professional calls a halt or the rescuer is too exhausted to continue.

REF: p. 247

25. When performing two-person CPR, a. compressions are at a rate of 60 per minute. b. compressions are paused briefly to give two ventilations. c. the rescuers remain at their positions to ensure continuity of compressions. d. All of the above are correct.

ANS: C

The protocol for CPR with two rescuers is similar to single-person CPR, but each rescuer independently performs compressions or ventilations with periodic switches of position.

REF: p. 247 | p. 248 26. CPR performed on an infant a. is the same as on an adult but adjusted based on patient size. b. requires chest compressions of 1 to 2 inches. c. uses a ventilation depth comparable to an adult. d. is done at a higher rate with more ventilations because of a higher respiratory and

cardiac rate for infants.

ANS: A

The CPR procedure for infants and children is basically the same as that for adults, with adjustments made in the volume of air delivered during artificial breathing, the placement of the hands, and the depth of depression of the sternum during external chest compressions.

REF: p. 248 27. The Heimlich maneuver is a. used to relieve a suspecteN d sm o b.stC ructMion.

RUallS Ibow NGelTB b. never used on a pregnant patient. c. modified for infants to include back slaps and chest thrusts. d. None of the above are correct.

ANS: C

In infants younger than 1 year old, Heimlich techniques require a combination of back blows and chest thrusts using the back of the hand and fingers.

REF: p. 245 | p. 246 28. When using an AED, a. it is used simultaneously with CPR compressions. b. two AED chest pads are used, one on the upper right side of the chest and the other

on the lower left ribs. c. it is important to plug the unit into the correct power source. d. CPR can be terminated since it is of little value after the AED is attached.

ANS: B

Death from cardiac arrest has been reduced significantly since the advent of CPR and the more recent availability of AEDs. Attach the defibrillator cables to the pads if not already connected and place the pads on the patient with one pad placed on the upper right area of the chest and the second pad on the lower left ribs. AEDs have an on-board power system.

REF: p. 249 | p. 250

29. When performing CPR on a patient, who is lying supine in a patient bed with a soft mattress,

you would first look for what item from the emergency crash cart? a. Backboard b. Benadryl c. Firm sponge pillow Hemostat d. Suction bottle ANS: A

Position the patient on his or her back on a hard surface to facilitate CPR. A radiographic table is suitable. If the patient is lying on a stretcher, then the backboard from the emergency cart should be used.

REF: p. 247 30. A disorganized cardiac rhythm in which the ventricle “flutters” and loses cardiac output is

called a. syncope. b. fibrillation. c. pallor. d. lethargy.

ANS: B

Ventricular fibrillation is a fluttering or ineffective cardiac rhythm that results in the heart’s inability to pump blood. Effective ventricular rhythm must be restored within a few minutes to preserve life.

REF: p. 249

It is acceptable to discontinue CPR on a person when a qualified medical practitioner calls a halt. the rescuers decide it is not working. law enforcement arrives and pronounces the victim deceased.

All of the above

31. a. b. c. d.

ANS: A

Once begun, basic life support should (and for legal reasons, must) be continued until the victim resumes spontaneous respiration and circulation, a physician or other responsible health care professional calls a halt, or the rescuer is too exhausted to continue.

REF: p. 249

Chapter 21: Pharmacology Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. The science dealing with the nature, effects, uses, and origin of drugs is called a. pharmacokinetics. b. pharmacology. c. pharmacotherapy. d. pharmacodynamics.

ANS: B

The science concerned with the origin, nature, effects, and uses of drugs is pharmacology. A drug is a substance used as medicine to aid in the diagnosis, treatment, or prevention of disease.

REF: p. 254 2. A drug agent that promotes bowel evacuation is a(n) a. enteric. b. exlax. c. parenteral. d. laxative.

ANS: D

Laxatives are drugs that act to promote the passage and elimination of feces from the large intestines. Laxatives are freqN ueU ntR lySuI seNdGinTrB ad.ioCloOgM y to prepare patients for both gastrointestinal procedures and urinary tract procedures.

REF: p. 262 3. When you ask the pharmacist for the drug Benadryl, you are asking for the drug using the

drug’s name. a. brand b. generic c. kinematic d. chemical ANS: A

A brand name is the name given to a drug manufactured by a specific company. It is usually short and easy to remember. It may or may not reflect any characteristic of the chemical structure of the drug.

REF: p. 255 4. Any characteristic that makes a drug undesirable or improper is its a. risk-to-benefit factor. b. tolerance. c. solubility. d. contraindication.

ANS: D

Contraindications to a drug are conditions that render the administration of some drug or some particular line of treatment improper or undesirable.

REF: p. 255 5. Nonprescription drugs are also known as a. illegal drugs. b. over-the-counter drugs. c. barbiturates. d. generics.

ANS: B

Nonprescription drugs, better known as over-the-counter drugs, can be obtained legally without a prescription.

REF: p. 255 6. Common dosage forms of drugs include

1. suspension.

2. capsule.

3. oral.

4. transdermal.

5. inhalant.

6. parenteral.

7. solution. a. 1, 2, 4, 5, and 7 only b. 1, 2, 3, and 7 only c. 3, 4, and 7 only d. 3, 6, and 7 only ANS: A

A single drug may be available in many different forms to facilitate the administration and action of the drug under a variety of conditions. Some of the common dose forms include tablets, capsules, inhalants, suppositories, solutions, suspensions, and transdermal patches.

REF: p. 255 7. Vitamins, herbals, and dietary supplements are classified as a. opioids. b. generics. c. over-the-counter drugs. d. analgesics.

ANS: C

Nonprescription drugs, better known as over-the-counter drugs, can be obtained legally without a prescription. Vitamins, supplements, and herbal remedies are classified as dietary supplements and by law are not classified as drugs and are therefore not controlled by the US Food and Drug Administration (FDA). Medical personnel should be aware that many over-the-counter products and herbal remedies are capable of producing toxic effects if they are misused or used in combination with other drugs.

Introduction to Radiologic and Imaging Sciences and Patient Care 8th Edition Adler Test Bank

REF: p. 255 8. All of the following describe pharmacokinetics except a. excretion. b. metabolism. c. absorption. d. filtration.

ANS: D

Pharmacokinetics is the study of the metabolism and action of drugs with particular emphasis on the time required for absorption, metabolic action, and distribution in the body and method of excretion.

REF: p. 263 9. All of the following are related except a. 2-diphenylmethoxy-N,N-dimethylethylamine. b. Echinacea. c. Benadryl. d. diphenhydramine.

ANS: B

Echinacea is not related to Benadryl.

REF: p. 255 10. Reaction to a drug that resultN s i n Rre spIi r atGor yBo. r cCircuMlatory collapse is referred to as a. b. c. d.

tachypnea. anaphylaxis. epistaxis. dyspnea.

U S N T

O

ANS: B

An allergic reaction may take one of two forms: immediate or delayed. Immediate reactions may range from a mild response such as hives to a severe life-threatening response such as anaphylaxis, which may include respiratory or circulatory collapse.

REF: p. 263 11. Some drugs are intended to have slow, uniform absorption over several hours and are said to

be extended-release drugs These drugs are designed to permit absorption in the a. liver. b. stomach. c. small bowel. d. distal colon.

ANS: C

Some tablets are coated with a substance that delays the dissolution of the tablet until it is in the small intestines rather than in the stomach, where it is normally dissolved. Some tablets are coated with polymers that are designed to produce slow, uniform absorption of the drug for several hours (8 hours or longer).

Introduction to Radiologic and Imaging Sciences and Patient Care 8th Edition Adler Test Bank

REF: p. 255 12. Transdermal patches are intended to release a drug over an extended period of time. Particular

care must be used with this type of drug administration owing to its design and thin metal backing. The modality of concern in medical imaging would be a. CT scanning. b. sonography. c. MRI scanning. d. PET scanning.

ANS: C

The patchlike device containing the drug is applied to the skin with a water-resistant covering.

Some of these patches contain aluminum or other metals in the backing of the patches. The metals in the patches can overheat during a magnetic resonance imaging scan and cause skin burns.

REF: p. 256 13. Metformin (Glucophage) is commonly used to treat a. herpes simplex. b. type 2 diabetes. c. bacterial infections. d. type 1 diabetes.

ANS: B

Diabetes mellitus is classified as type 1, in which insulin is absent, and type 2, in which insulin deficiency and insulinNresRistaI nce GexisBt..InCsulM in is the only treatment used to treat type 1 S N for T type 2 diabetes. Metformin (Glucophage) is diabetes but is also used in the U treatment commonly used for type 2 diabetes. It is recommended that metformin be temporarily discontinued before the use of radiographic contrast agents.

REF: p. 260 14. Drugs that relieve pain without causing a loss of consciousness are called a. analgesics. b. anesthetics. c. antibiotics. d. antiemetics.

ANS: A

Analgesics are drugs that relieve pain without causing a loss of consciousness. Analgesics can be divided into two groups, the nonopioids (nonnarcotic) and the opioids (narcotic).

REF: p. 259 15. All of the following are true of the drug nitroglycerine except it a. causes blood vessels to constrict. b. is commonly used to treat angina. c. may be administered to a patient under the tongue. d. may be injected into a patient using a hypodermic needle.

ANS: A

Vasodilators are drugs that cause blood vessels to dilate. They are useful in treating vascular disease, particularly angina. Nitroglycerin is an effective coronary vasodilator administered sublingually, orally, topically, or parenterally.

REF: p. 263 16. An annual publication commonly used to answer questions about drugs and their actions is the a. pharmacists’ newsletter. b. Physicians’ Desk Reference (PDR). c. FDA Register. d. Compendium of Drugs and Meds (CDM).

ANS: B

Confusion occurs when some physicians use generic names and others use trade names when requesting drugs. The PDR is an annual publication that contains current product information.

The pages are color coded for easy reference, and the PDR lists drugs by both their generic and their brand names. The PDR provides a drug summary listing the class, drug enforcement agency class, drug description, common brand names, how the drug is supplied, dosage and indications, maximum dosage, dosing considerations, administration storage, contraindications/precautions, adverse reactions, drug interactions, pregnancy and lactation, and mechanism of action.

REF: p. 255 17. A patient who is scheduled to have surgery of the esophagus for a diverticulum will likely be

given a(an) a. analgesic b. diuretic c. anticholinergic d. antiemetic

to decrease mucosal secretions and esophageal muscular activity.

ANS: C

Anticholinergics, or antispasmodics, are drugs that reduce smooth muscle tone, motility of the gastrointestinal tract, and secretions from respiratory tract and secretory glands.

REF: p. 260 18. Drugs that are commonly used for the treatment of high cholesterol are referred to as a. statins. b. antiplatelets. c. cholinesterase inhibitors. d. antianemic agents.

ANS: A

Drugs called statins are usually the drugs of choice in the management of hyperlipidemia.

Two common statins, atorvastatin (Lipitor) and simvastatin (Zocor), are used to treat hyperlipidemia.

REF: p. 261 19. A major complication for patients undergoing (antiplatelet) blood clotting drug therapy is

a. b. c. d.

vomiting. deep vein thrombosis (DVT). anxiety. bleeding.

ANS: D

Antiplatelet drugs inhibit platelet aggregation. Antiplatelet drugs are indicated in the prevention of myocardial infarction, stroke, and transient ischemic attacks. The major complication for these drugs is bleeding.

REF: p. 261 20. A common drug used to manage hypothyroidism is a. lorazepam. b. levothyroxine. c. Levaquin. d. simvastatin.

ANS: B

Hormones are drugs that affect the endocrine system. The most important clinical application of these drugs is their use in replacement therapy, such as hypothyroidism. Levothyroxine (Synthroid) is used in the management of hypothyroidism. It can be administered orally or parenterally.

REF: p. 262 21. A drug name that is unique to the drug, as given by the drug’s manufacturer, is called the

drug’s name. a. generic b. market c. brand d. chemical ANS: C

A brand name is the name given to a drug manufactured by a specific company. It is usually short and easy to remember. It may or may not reflect any characteristic of the chemical structure of the drug. Because the same drug is manufactured by more than one company, each company selects its own brand name or trademark for the drug.

REF: p. 254 | p. 255 22. Select the true statement from the choices below. a. Drugs are classified legally as either prescription or nonprescription. b. Prescription drugs are also known as over-the-counter drugs. c. Vitamins, supplements, and herbal remedies are classified as prescription drugs

and dietary supplements. d. Prescription drugs can only be dispensed by pharmacists.

ANS: A

According to federal laws, drugs are classified legally as either prescription or nonprescription. Prescription drugs are usually dispensed by a licensed pharmacist, although some physicians supply prescription drugs to their patients. Nonprescription drugs, better known as over-the-counter drugs, can be obtained legally without a prescription. Vitamins, supplements, and herbal remedies are classified as dietary supplements and by law are not classified as drugs.

REF: p. 255 23. Heparin is best administered to patients a. orally by way of a tablet. b. as a laxative. c. through an intramuscular injection. d. as an intravenous injection.

ANS: D

Heparin is a commonly used parenteral anticoagulant. Heparin is not effective when administered orally because it is not absorbed through the gastrointestinal tract and should not be administered intramuscularly as it may cause a hematoma.

REF: p. 260 24. Patients with congestive heart failure and lymphedema are typically prescribed a. a diuretic. b. furosemide. c. Lasix. d. All of the above ANS: D

Diuretics are drugs that increase the amount of urine excreted by the kidneys, thus removing sodium and water from the body. Furosemide (Lasix) is a nephron loop of Henle diuretic, often used to treat the tissue edema associated with congestive heart failure.

REF: p. 262 25. A contraindication to NSAIDs is a. depression. b. compromised renal function. c. mild to moderate pain. d. fever.

ANS: B

Nonsteroidal anti-inflammatory drugs (NSAIDs) have analgesic, antipyretic (fever reducing), and anti-inflammatory actions. Ibuprofen (Motrin) is an example of an NSAID commonly used to treat inflammatory conditions, mild to moderate pain, and fever. All NSAIDs can cause gastrointestinal (GI) irritation, peptic ulcers, GI bleeding, and acute renal failure.

REF: p. 262 26. A patient who has a history of bloody stools caused by a suspected malignant neoplasm

(cancer) in the colon should not be given a. a laxative.

b. thrombolytics. c. polyethylene glycol electrolyte solution. d. GoLytely.

ANS: B

Thrombolytics are drugs that dissolve thrombi (clots) that have already formed. The major adverse effect is bleeding complications. Patients with bloody stools must be suspected for a bleeding tumor in the digestive tract. Prescribing a patient a thrombolytic under these circumstances can complicate the bleeding process and loss of blood.

REF: p. 263 27. Examples of antihistamines include

1. Benadryl.

2. Fosamax.

3. metformin.

4. Dilantin.

5. Claritin.

6. Allegra. a. 2, 4, and 5 only b. 1, 3, and 6 only c. 1, 5, and 6 only d. 1 and 5 only ANS: C

Antihistamines are drugs used primarily to treat allergic disorders, both acute and chronic.

Diphenhydramine (Benadryl) is a sedating antihistamine and is available in oral and parenteral forms. Lo rat a dine N (CUl aRriSt iI n)NaG ndTfB ex.oC feO naMdi ne (Allegra) are examples of nonsedating antihistamines.

REF: p. 261 28. Parenteral administration of a drug involves a. taking a pill. b. insertion of a suppository. c. drinking a suspension. d. needle injections.

ANS: D

Parenteral administration includes any injection of the drug with a needle and syringe beneath the surface of the skin.

REF: p. 256 29. A substance that nullifies the intended action of an administered drug is call a(n) a. stabilizer. b. antagonist. c. protagonist. d. catalyst.

ANS: B

An antagonist is a drug intended to nullify the action of another drug.

REF: p. 253 (Key Terms) 30. As you approach a patient for a portable chest radiograph, you notice a localized swelling

around the insertion site of the patient’s IV. There is no associated skin erythema. This patient likely demonstrates of the injection site. a. infiltration b. inflammation c. extravasation d. infiltration and extravasation ANS: D

Infiltration is the localized diffusion of fluid into a tissue. Often used interchangeably with extravasation, this is a complication of a dislodged needle tip at an intravenous insertion site.

REF: p. 254

Chapter 22: Principles of Drug Administration Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. All patients should expect correct procedures with regard to drug administration. These

correct procedures or “rights” include the 1. the right route of administration.

2. the correct time for giving the drug.

3. the correct person giving the drug.

4. their own physician ordering the drug.

5. their own physician administering the drug.

6. the correct drug and drug amount administered. a. 1, 2, 4, and 5 only b. 1, 2, and 6 only c. 3, 4, and 6 only d. 4, 5, and 6 only ANS: B

In preparing to administer drugs, the radiologic technologist should always follow the golden rules of drug administration, or what are commonly referred to as the five rights of drug administration. The five rights are right drug, right amount, right patient, right time, and right route.

REF: p. 267 | Box 22.1

N R I G B. C M

2. Heart attack patients often takeUa sS malN l tabT let of nO i t r og l yce ri ne and put it in their mouth, under

their tongue, for quick action. This route of administration is a. parenteral. b. topical. c. sublingual. d. oral.

ANS: C

Administration by the sublingual route means that the drug is placed under the tongue and allowed to dissolve. Drugs intended to be administered sublingually should not be swallowed.

One drug commonly given by the sublingual route is nitroglycerin. This allows for rapid absorption for immediate onset of action.

REF: p. 269 3. All of the following are related except a. intramuscular. b. intragluteal. c. subcutaneous. d. intravenous.

ANS: B

Parenteral drugs can be administered in four different routes: intradermal (ID), intramuscular (IM), with a rapid onset of action; subcutaneous (subcut), with a slow and constant absorption; and intravenous (IV), with an immediate onset of action.

REF: p. 269 4. An injection that is given to a patient relies on a(n) a. enteral b. parenteral c. topical d. portal

route of administration.

ANS: B

The term parenteral means that the drug is administered by a route other than the GI tract, typically by injection using a syringe and needle. Parenteral administration is used when drug administration by other means would be ineffective or impractical.

REF: p. 269 5. When performing a subcutaneous injection, the needle tip is positioned a. in the deltoid muscle of the upper arm. b. at a 45-degree angle for average-sized patients. c. perpendicular to the skin line. d. at a 55- to 60-degree angle for thin patients.

ANS: B

When a subcutaneous injection is administered, the drug is placed under the skin into the subcutaneous tissue that lies N undR er thIe eG pideB rm .aCl l aMye rs. The needle length and angle of U of S theN subcutaneous T insertion depend on the thickness tissue. For average-size patients, a 25-gauge, 5/8-inch needle at a 45-degree angle of insertion is generally used. For above-average-size patients, a 25-gauge, 1/2-inch needle at a 90-degree angle of insertion is generally used.

REF: p. 275 6. When venipuncture is performed on an adult, for contrast medium administration, a. the veins of the arms are preferred injection sites. b. a 25-gauge needle is preferred to lessen extravasation. c. delayed reaction to the intravenous injection is routine. d. All of the above ANS: A

When an intravenous injection is administered, the drug is placed directly into a vein, and a rapid action occurs in minutes. Needle gauge is usually 18 to 20 g to increase the volume of contrast bolus injected.

REF: p. 276 7. Sites commonly used for venipuncture include the

1. basilic 2. iliac 3. cephalic

vein(s).

4. carotid 5. brachiocephalic a. 1 and 3 only b. 2, 4, and 5 only c. 3 and 5 only d. 5 only ANS: A

The most commonly used intravenous injection sites include the major veins of the antecubital fossa of the elbow. The cephalic vein on the lateral side and the basilic vein on the medial side of the anterior surface of the elbow are favorite choices for injection.

REF: p. 276 8. The abbreviation IM means a. in the morning. b. in mouth. c. intramuscular. d. intramedullary.

ANS: C

Health care professionals who order, dispense, or administer drugs often use abbreviations.

Becoming thoroughly familiar with the common abbreviations that are used is important to ensure the safe and accurate administration of drugs. Table 22.1 provides a concise listing of commonly used abbreviations.

REF: p. 268 | Table 22.1 9. During an intravenous drug administration, a small area around the needle site is growing and

swelling. The patient states that the area is starting to burn slightly. In this situation, a. extravasation has occurred. b. the injection site has become infected. c. a cold, ice pack needs to be placed on the insertion site. d. a high level medical alert is issued.

ANS: A

Patients receiving intravenous infusion should be monitored closely. If the flow stops, the site of injection should be checked for signs of infiltration. If evidence such as swelling and pain around the injection site exists, the infusion must be stopped immediately, the needle removed, and a warm pack applied to the area.

REF: p. 277 10. The medical abbreviation stat means a. statistic. b. immediately. c. statutory. d. static ANS: B

Becoming thoroughly familiar with the common abbreviations that are used is important to ensure the safe and accurate administration of drugs. Table 22.1 provides a concise listing of commonly used abbreviations. The abbreviation leaves no room for interpretation and means that the command must be immediately completed.

REF: p. 268 | Table 22.1 11. All of the following are true of the milliliter unit of measurement except it a. is a metric unit of volume measurement. b. is equivalent to 1 cc. c. represents 1/10 of a liter (L). d. is equivalent to 1/1000 of a cubic centimeter.

ANS: C

Correct patient dosages of pharmaceuticals require a thorough understanding between the English and metric systems of weights, volumes, and measures. The metric system is based on units of 10, and units are easily divisible by this convenient standard. One millimeter is equal to 1/1000 of a liter.

REF: p. 268 | Table 22.3 12. Technologists working in CT are often required to administer pharmaceuticals to patients to

complete an examination. When such is the case, it is important to remember that a. any charting of medication administered must be entered by a registered nurse. b. qualified technologists are permitted to enter medication data into patient charts. c. all medication errors must be corrected by a radiologist. d. medical errors dealing wi th m edi cati on a d m inis tration are uncommon.

ANS: B

N R I G B.C M U S N T O

Increasingly, radiologic technologists are expected to chart drugs they administered or helped to administer. If an error occurs in the administration of a drug or if the patient experiences any adverse effects from the drug, make certain to document the details of the incident thoroughly. Errors associated with drug administration are among the most common legal problems in which radiologic technologists are involved. If an error is made, immediately report the incident to a supervisor or physician. Follow facility protocols for drug charting and reporting drug administration errors and adverse drug events.

REF: p. 267 | p. 268 13. Sterile needles used for patient injections a. typically have four components: cannula, shaft, hub, and bevel. b. range in gauge from 0.25 to 5 inches. c. are made of high-grade surgical titanium. d. often require the use of an angiocath for improved safety.

ANS: D

Needles used for injection are made of stainless steel and may or may not be disposable. The needle has three parts: (1) the hub, which is the part that attaches to the syringe; (2) the cannula or shaft, which is the length of the metal part; and (3) the bevel, which is the slanted part at the tip of the needle. The gauge refers to the thickness or diameter of the needle. The length refers to the measurement in inches of the shaft portion. The length will vary from 0.25 to 5 inches and the gauge from 14 to 28 inches. An angiocath is a safer device compared with other systems to use when performing venipuncture. An angiocath is used the same as any other needle to puncture the vein.

REF: p. 270 | p. 271 14. Drugs intended for single use by parenteral administration are typically contained in a(n) a. ampule. b. vial. c. angiocath. d. foil packet.

ANS: A

Drugs intended for use by parenteral administration are packaged in two different kinds of containers: ampules and vials. An ampule is a sealed glass container designed to hold a single dose of a drug and is intended for use only once.

REF: p. 271 15. If you accidentally “prick” yourself with a needle as you perform a venipuncture procedure a. wipe the puncture site with an alcohol swab immediately and continue. b. flood the area with water, clean with soap and water, and report the incident.

N RSaI“NSGh aTB.C Mtainer” and get a new one to c. immediately place the needU le in r p s conO

continue. d. inspect the puncture site for blood and, if none, continue with the venipuncture.

ANS: B

If you are injured or pricked by a needle or other sharp object or get blood or other potentially infectious materials in the eyes, nose, mouth, or on broken skin, flood the area with water, clean with soap and water, report the incident immediately, and follow facility protocols for a needle stick.

REF: p. 276

Chapter 23: Contrast Media and Introduction to Radiopharmaceuticals Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. The use of contrast material as a means for visualizing human anatomy has a long history.

Regardless of the type of contrast media, the purpose for using contrast media is to a. take advantage of Compton interactions and increase the amount of remnant radiation. b. enhance the low subject contrast of anatomic structures. c. improve gastric motility and digestion. d. improve the contrast between high contrast structures such as bone.

ANS: B

Contrast media are diagnostic agents that are instilled into body orifices or injected into the vascular system, joints, and ducts to enhance subject contrast in anatomic areas where low subject contrast exists.

REF: p. 283 2. Contrast agents can be generally classified as a. ionic and nonionic. b. metallic and nonmetallic. c. positive and negative. d. low osmolality and high osmolality.

ANS: C

Contrast media are generally classified as negative or positive contrast agents. Whereas negative contrast agents decrease attenuation of the X-ray beam and produce areas of increased density on the radiograph, positive contrast agents increase the attenuation of the X-ray beam and produce areas of decreased density on the radiograph.

REF: p. 283 3. Generally speaking, radiographic images are the result of X-ray photons being absorbed to

varying degrees based on tissue density and thickness. There are five radiographic densities seen on radiographs: air or gas, water, fat, mineral, and metal. The lowest subject contrast between these five densities is between a. bone and air. b. water and mineral. c. water and fat. d. metal and air.

ANS: C

The ability of the contrast media used in radiographic procedures to enhance subject contrast depends greatly on the atomic number of the element used in a particular medium and the concentration of atoms of the element per volume of the medium. The average atomic number difference between fat and water as a tissue density is very small and therefore yields the lowest subject contrast.

REF: p. 283 4. Negative contrast agents a. are opaque to the transmission of X-rays. b. have low atomic numbers. c. provide high X-ray beam attenuation and absorption. d. are materials such as bone and metal.

ANS: B

X-ray photons are easily transmitted or scattered through radiolucent contrast media. As the name implies, these media are relatively lucent to X-rays. Because the anatomic areas filled by these agents appear dark (increased density) on radiographs, they are also called negative contrast agents. These media are composed of elements with low atomic numbers.

REF: p. 283 5. Positive contrast agents a. have high atomic numbers. b. appear opaque on radiographs because of the degree of attenuation. c. have a tendency to absorb X-ray photon energy to a great extent. d. All of the above are correct.

ANS: D

X-ray photons are absorbed by radiopaque contrast media because these media are opaque to X-rays. Because the anatomic areas filled by these agents appear light (decreased density) on radiographs, they are also called positive contrast agents. These media are composed of elements with high atomic numbers.

REF: p. 283

NURSINGTB.COM

6. A double-contrast study of the colon is an example of a. a low-contrast examination. b. the use of both a negative and a positive contrast agent on the same image. c. an exam utilizing twice the volume of contrast media. d. All of the above ANS: B

In some instances, negative and positive agents are used together so that the lumen of organs, such as the colon, can be visualized or so that anatomic structures within a space, such as the menisci of the knee, can be visualized.

REF: p. 283 7. A common contrast agent used for MRI examinations is a. protease. b. barium sulfate. c. gadolinium-DTPA. d. triiodinated thorium.

ANS: C

Contrast agents of varying types are also being used in other modalities, such as magnetic resonance imaging (MRI) and diagnostic medical sonography. A common intravenous contrast agent used in MRI studies is gadolinium. This contrast agent is a metallic and magnetic agent that affects the signal intensity used to image the anatomic area of interest using MRI technology.

REF: p. 283 | p. 284 8. For select examinations, air (negative contrast) and radiopaque contrast are used as a pair to

outline mucosal linings, joint interspaces, and passageways. These examinations are considered a. double-contrast studies. b. extremely dangerous and rarely done. c. single-contrast examinations. d. low-contrast studies.

ANS: A

In some instances, negative and positive agents are used together so that the lumen of organs, such as the colon, can be visualized or so that anatomic structures within a space, such as the menisci of the knee, can be visualized.

REF: p. 283 9. All of the following are true of barium sulfate as a contrast agent except a. when mixed with water, it dissolves completely. b. its atomic number (Z) is 56. c. it is chemically inert.

N R I G B.C M d. barium sulfate is often mixU e d wSi t h Nw a tTe r and sOodium citrate, to prevent

flocculation.

ANS: A

The element barium has an atomic number of 56 and is radiopaque. Because barium sulfate is not soluble in water, it must be mixed or shaken into a suspension in water. In an acid environment, barium has a tendency to clump and come out of suspension, a process called flocculation. Stabilizing agents such as sodium carbonate or sodium citrate are usually used to prevent flocculation.

REF: p. 284 10. Barium sulfate would be contraindicated for a patient with a. colonic polyps. b. a suspected duodenal bulb perforation. c. diverticulosis. d. All of the above ANS: B

If a patient is thought to have a perforation in the digestive tract, then barium sulfate is contraindicated because the body does not absorb barium sulfate naturally. If it enters the peritoneal or pelvic cavity, barium sulfate can cause peritonitis and must be surgically removed.

REF: p. 285 11. Stomach examinations using barium sulfate have some degree of risk for patients who are a. sedated. b. mentally disabled. c. potentially hypovolemic. d. All of the above ANS: D

Sedated patients should not undergo upper GI examinations because the swallowing reflex is diminished, which greatly increases the risk for aspiration (inhalation) of the barium sulfate suspension with resultant barium pneumonia. Aspiration is also a risk for mentally handicapped patients and persons with altered mental status because of age or disease.

Patients who are dehydrated are also at risk because barium tends to draw fluids from the colon wall and further deplete a patient’s blood volume.

REF: p. 286 12. Most adverse reactions to ionic, iodinated contrast agents are caused by a. their pH. b. their hydrogen concentration. c. their osmolality. d. the presence of iodine.

ANS: C

Most adverse reactions to contrast media have been related to the osmolality of the media because the osmolality of a solution determines osmotic pressure, which controls the movement of water in the boN dyU. RSINGTB.COM REF: p. 287 13. An undesirable characteristic of ionic contrast agents is their a. chemical stability and inertness. b. neutral osmolality. c. neutral pH. d. dissociation into a cation and an anion when dissolved in plasma.

ANS: D

Efforts to decrease the many side effects of ionic iodine contrast media resulted in the development of molecules that do not dissociate into anions and cations. The chemical breakdown into an anion and cation can be an irritant to cells.

REF: p. 287 14. Nonionic iodine contrast agents differ from ionic agents in that nonionics a. do not break down into a cation and an anion. b. have a low pH. c. have a small chemical structure and high osmolality. d. are not triiodinated.

ANS: A

Efforts to decrease the many side effects of ionic iodine contrast media resulted in the development of nonionic molecules that do not dissociate into anions.

REF: p. 287 15. The ideal iodinated contrast agent would have what characteristic(s)?

1. High osmolality 2. Low osmolality 3. Nonionic chemical structure 4. Water solubility (hydrophilic) 5. Three or more iodine atoms per molecule a. 1, 4, and 5 only b. 1, 3, and 5 only c. 2, 3, 4, and 5 only d. 2 only ANS: C

Efforts to decrease the many side effects of ionic iodine contrast media resulted in the development of molecules that do not dissociate into anions and cations. These are considered nonionics and are less toxic to cells. Additionally, the contrast agent should possess low osmolality so as not to disrupt the fluid environment in which cells exist and to maximize the photoelectric effect. Atomically, a three-iodinated benzene ring maximizes the radiopacity of the molecule, thereby increasing image contrast.

REF: p. 287 16. The osmotic effects of ionic contrast agents are a result of the movement of a. water from the body’s cellsN UintRS o tIh N eGblT oB.C odstreaOm, causing increased blood volume

and higher blood pressure. b. water from the blood plasma into cells, causing them to swell and possibly burst. c. iodine into cells, thereby increasing the cell membrane permeability. d. glucose molecules into cells, increasing metabolism.

ANS: A

The osmolality of contrast media is of great biologic significance. Most adverse reactions to contrast media have been related to the osmolality of the media because the osmolality of a solution determines osmotic pressure, which controls the movement of water in the body.

High-osmolality contrast media have an increased number of particles in solution, such as blood plasma, which pull water toward them.

REF: p. 287 17. After the injection of an ionic iodinated contrast agent into a patient for a renal study, the

patient complains of a warm feeling and is starting to itch. You notice the patient is developing urticaria. As you monitor the patient, you should a. calmly talk to the patient to lessen their stress level, which is the likely cause of the symptoms casually watch the patient and note any more symptoms because these are not unusual. b. closely monitor the patient and look for worsening signs such as vomiting and bronchospasm. c. inform the radiologist or physician of the patient’s anaphylaxis.

d. closely monitor the patient and look for worsening signs such as vomiting and

bronchospasm and inform the radiologist or physician of the patient’s anaphylaxis.

ANS: D

Allergic reactions to water-soluble iodinated contrast media resemble allergic reactions to foreign substances, such as pollen grains. Reactions of typical allergic patients may be minor, such as urticaria (hives). Some patients, however, experience wheezing and edema in the throat and lungs, with accompanying bronchospasm. Other anaphylactoid effects of water-soluble iodinated contrast media are nausea and vomiting. These patient reactions can be typical but require close monitoring and communication with the radiologist.

REF: p. 289 18. Laboratory tests to assess a patient’s BUN and creatinine are used to determine the patient’s a. liver function. b. renal function. c. pancreas. d. thymus.

ANS: B

Increased blood urea nitrogen (BUN) and creatinine (waste product of metabolism) levels indicate that the patient may have renal disease and are good indicators for possible contrast medium–induced renal effects.

REF: p. 289 19. Contrast media that are high in osmolality can be harmful to patients with compromised renal

function. Patients who c o m mNo n l R CiseMd kidney function include U ySh aNIv eTcGomBpr.om a. patients with diabetes. b. elderly patients. c. renal dialysis patients. d. All of the above ANS: D

Patients with renal disease or diabetes and older patients are at increased risk for these complications. Theophylline, a substance found in tea, is currently being investigated as a preventive of toxic renal effects by increasing the filtering action of the kidneys.

REF: p. 289 20. Nonionic low-osmolality contrast agents have gained tremendous popularity with physicians

as a safer choice for iodine contrast examinations. It is important to remember that nonionics a. are much less expensive than ionics. b. still pose a risk to renal function. c. are more difficult to inject owing to their higher viscosity. d. cannot be used on patients who have had several CT examinations.

ANS: B

Most adverse reactions associated with water-soluble ionic iodine contrast media are significantly decreased with the use of the nonionic media. This decrease is attributed to the decreased osmolality of the nonionic media. Although much improvement has been made, renal toxicity is still a concern and must be considered when selecting the use of any iodine-based contrast agent. Patient who have undergone several CT examinations within a short period of time, benefit from the use of nonionic media.

REF: p. 290 21. When using any type of contrast agent for a radiographic examination, a. the patient should have the final choice on the type of contrast used. b. a thorough medical history must be taken by the imaging professional. c. the cost of the contrast agent and options should be explained to the patient agent. d. a radiopharmaceutical may be substituted for contrast material, in patients with a

moderated risk factor.

ANS: B

The most important patient care aspect before administration of water-soluble iodine contrast media is the patient history. The possibility of patient reaction is closely related to the patient’s disease state or age. The prevention of contrast media reactions depends on obtaining a thorough patient history that can indicate contrast media contraindications or an increased likelihood of adverse reactions.

REF: p. 290 22. A radiopharmaceutical is a. a contrast agent.

N R I G B.C M b. any medication given to paU t i e nS t s inNradTiology.O c. any medication given by a radiologist. d. a radioactive material used for nuclear imaging.

ANS: D

A radiopharmaceutical is a radionuclide that is chemically bound to a pharmaceutical injected into the human body. The radionuclide typically emits gamma radiation, which is detected by a sophisticated nuclear gamma camera using a sodium iodide crystal and computers.

REF: p. 290 23. Select the true statement from the choices below. a. Nuclear studies using radiopharmaceuticals are generally more functional in

nature. b. Nephrogenic Systemic Fibrosis (NSF) is a significant concern in the use of

radioisotopes in nuclear medicine. Radiographic examinations are generally more structural in nature. c. When a patient scheduled for both a PET scan and CT scan, it is important to do the CT scan first due to the length of the PET scan procedure and its radioisotope half-life. d. The principle ingredient in MR contrast material is hydrogen.

ANS: A

By design, radionuclide studies are considered perfusion (functional) studies because they assess the body’s biodistribution of an injected radioactive material. When performing a PET and CT scan on the same patient on the same day, it is important to perform the PET scan first as there is a small possibility that the contrast media could attenuate or interfere with the PET scan, if the area of interest is a place in the body that concentrates the contrast media. A common intravenous contrast agent used in MRI studies is gadolinium diethylenetriaminepentaacetic acid (gadolinium-DTPA). This contrast agent is a metallic and magnetic agent that will affect the signal intensity used to image the anatomic area of interest.

NSF is a concern in MR scanning due to presence of gadolinium persisting in some tissues after the MR is completed.

REF: p. 284 | p. 290 | p. 296 | p. 297 24. When working with a radiopharmaceutical, the nuclear medicine professional must be

particularly aware of a. the half-life of the isotope. b. any isotope spills or leaks. c. contamination of isotope that yields image artifacts. d. All of the above ANS: D

The primary concern when working with short-lived (small half-lives of hours, minutes, or seconds) unsealed radiation sources is contamination, which can occur on patients, personnel, floors, tables, or imaging equipment, that might be misconstrued as part of the image produced for physicians to read. These artifacts may not be easily ascertained and might be misinterpreted by a physician as a pathologic abnormality in a patient when reading a study.

REF: p. 296 | p. 297 25. A responsible medical imaging professional will always maintain his or her focus on patients,

particularly when any contrast agent is administered. A mandatory prerequisite to these studies is always a. laboratory tests to determine renal function. b. a completed registration form. c. a thorough medical history including allergies and diseases. d. making sure a qualified nurse is available to handle any reactions.

ANS: C

The prevention of contrast media reactions depends on obtaining a thorough patient history that can indicate contrast media contraindications or an increased likelihood of adverse reactions. When renal function is in question, laboratory test to assess BUN, creatinine, and glomerular filtration rates (GFR) may be needed, but is not considered as mandatory unless renal function is suspect.

REF: p. 298 26. When a nonionic contrast agent is injected into an artery such as the carotid, visualization of

the artery and its branches occurs because a. blood in the artery chemically changes into iodine. b. iodine in the contrast agent mixes with blood and makes the artery radiopaque. c. the contrast medium makes the artery easier to penetrate at the optimum kVp.

d. the contrast agent changes into a radiopharmaceutical.

ANS: B

The use of iodinated contrast agents is essential for vascular angiography, such as a carotid arteriogram. Because the carotid is filled with blood and is considered a water density radiographically, its visualization is not possible as the surrounding tissues are water density as well. There is no contrast between the vessel and surrounding structures. By injecting iodine into the vessel and mixing with blood, the carotid now has a much higher average atomic number and becomes radiopaque. Because the anatomic areas filled by these agents appear light (decreased density) on radiographs, they are also called positive contrast agents.

These media are composed of elements with high atomic numbers.

REF: p. 283

Chapter 24: Professional Ethics Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. Which of the following would make up the professional ethics of the profession of radiologic

sciences?

1. State licensing board for X-ray machine operators 2. Radiography department social events 3. ARRT Code of Ethics 4. State Medical Society 5. Collective bargaining rules of behavior a. 1 and 3 only b. 3 and 5 only c. 1, 2, 4, and 5 only d. 1 and 5 only ANS: A

State licensing laws reflect the public’s demand that it be served by qualified health care practitioners. The professional licensing boards that enforce these and other professional practice laws provide one element of self-regulation. This standard of conduct, this common concern for collective self-discipline, and this control of the profession from within are known as ethics. Additionally, society expects a profession, through its collective members, to generate its own statement of acceptable and unacceptable behavior, usually in the form of a code of ethics.

REF: p. 302 | p. 303

NURSINGTB.COM

2. The American Registry of Radiologic Technologists (ARRT) reserves the right to revoke any

certification from an individual whom it has registered. Reasons for revocation can vary from ethical violations to failure to maintain continuing education credits, just to mention two. This process of sanctioning demonstrates professional _ to society. a. morals b. self-regulation c. ethics d. collective bargaining ANS: B

All ARRT-registered radiologic technologists subscribe to the ethical principles contained in the organization’s Code of Ethics and apply them to problems in their professional practice.

The public expects all professionals to exhibit self-discipline within a system of self-regulation. This sense of self-discipline is particularly important within the health care professions, in which errors in judgment can have serious, even life-threatening, consequences.

REF: p. 302 | p. 303 3. Failure to pay one’s federal income taxes would be an example of a(n) a. misdemeanor violation. b. moral violation.

c. professional conduct violation. d. violation of federal law.

ANS: D

Laws are regulations established by a government that are applicable to people within a certain political subdivision. All persons in a society are required to comply with laws, including federal income taxes.

REF: p. 303 4. You are enjoying an evening with a friend at the theater. The person seated behind you

routinely texts messages to his girlfriend about the movie and what is happening. This behavior would be a a. violation of local laws and ordinances. b. ethical violation. c. violation of socially accepted values. d. moral violation.

ANS: C

Social contract theory attempts to describe the relationship that exists between two mutually dependent persons or groups of persons in a society. Under this theory, these persons or groups have certain expectations of each other and act accordingly.

REF: p. 304 5. When you were a student radiographer, the importance of radiation protection was constantly

stressed, and you have incorporated the principle of ALARA as a professional value. As an employee working within a bNu s yRi m aIg i nGg deBp. arC tmeM nt, you work with some technologists who U S N T O do not practice radiation protection as you have been taught. One technologist in particular routinely overexposes patients to get a “perfect image for the radiologist.” This poor technologist practice would be an example of a. an ethical violation. b. a hospital rule violation. c. poor morals. d. a violation of personal values.

ANS: A

Society expects a profession, through its collective members, to generate its own statement of acceptable and unacceptable behavior, usually in the form of a code of ethics. Performance that is not in compliance with these established standards of practice is viewed as an ethical violation and routine overexposure to patients is a clear ALARA ethical violation.

REF: p. 303 6. Which of the following would be considered an unethical practice for a radiologic

technologist? a. Repeating a radiograph because of incorrect technique selection b. Watching an interesting case c. Criticizing a doctor or team member in a private or public forum d. Reporting unethical practices of a coworker ANS: C

Professional ethics consists of rules of conduct or standards beyond conformance to either law or etiquette, the internal controls of a profession based on human values or moral principles. It would be unethical to publicly criticize a fellow health care worker or professional in either a public or private forum. The key factor is the characteristic of conduct beyond conformance to either law or etiquette. Questions concerning the competency or professional judgment of the physicians working with you often raise serious ethical issues and should be handled with professional discretion.

REF: p. 303 | p. 307 7. You are the director of a busy medical imaging department. One of your technologists has

been accused of looking up the personal medical records and radiography reports of his brother’s girlfriend. The girlfriend visited the hospital as a patient for an ultrasound examination of the pelvis to rule out pregnancy. Disciplinary action for this technologist would be appropriate because of a violation of a. local statutes and ordinances. b. state laws. c. federal constitutional laws. d. professional ethics.

ANS: D

Of the values associated with radiologic practice, patient confidentiality is the most easily identified and the most prevalent. Information obtained directly from the patient, observed, or obtained from other sources should be kept strictly confidential. The radiographer should be alert to situations that may compromise patient confidences.

REF: p. 306 8. Being rude and impolite to a patient’s family members because they are asking how long an

examination will take, is an example of a(n) a. ethics violation. b. violation of the institution’s standards of care. c. professional etiquette violation. d. ethical dilemma.

ANS: C

Professional etiquette, the manners and attitudes toward patients generally accepted by practitioners, should not be confused with professional ethics. Rudeness to patients or insensitivity to their need to preserve modesty may violate our sense of professional propriety, but are not considered breaches in professional ethics.

REF: p. 303 9. A technologist who has completed a procedure on a patient leaves the area grumbling, “I hate

to do HIV patients because I am afraid of catching the disease.” A member of the housekeeping staff hears the technologist and asks who the HIV patient is so he can pass the information along to his coworkers for safety reasons. The technologist responds by giving the patient’s name and room number. This act constitutes a(n) a. ethical dilemma. b. ethics violation. c. moral violation.

d. social error.

ANS: B

Of the values associated with radiologic practice, patient confidentiality is the most easily identified and the most prevalent. Information obtained directly from the patient, observed, or obtained from other sources should be kept strictly confidential. Any compromise to patient confidentiality is viewed as an ethical violation.

REF: p. 306 10. All professional decisions in medical imaging and other health care practices involve a

consideration of a. human values. b. local laws. c. union contract restrictions. d. religious doctrine.

ANS: A

The principles that make up an ethical code take into consideration the role of human values and virtues in deciding professional practice behavior. Basic human values are ever present when making decisions about ethical behavior.

REF: p. 302 | p. 303 11. Using moral rules as your complete guide to determine appropriate professional behavior a. is a reliable strategy to avoid ethical dilemmas. b. assumes everyone has the same moral values as you do, which is generally true. c. is too restrictive and of nN o v aR Ul u eSIi nNdGecis T Bio.nCmakMing. d. has its weaknesses because others may not have the same moral value system as

you.

ANS: D

The principles that make up an ethical code take into consideration the role of human values and virtues. Recognizing that not all people have identical values, further guidance is provided through standards of professional conduct. Although some values can vary from person to person, basic human values remain constant.

REF: p. 304 12. Which of the following choices could be classified as an ethical outrage? a. Repeating a radiograph because the patient moved during the exposure b. A technologist refusing to complete a procedure because his shift is over c. Not repeating an image that demonstrates marginal image noise d. A technologist consistently forgetting to wear his or her personnel monitoring

device ANS: B

Ethical theories tell us what actions are right or wrong. Two common theories are consequentialism and nonconsequentialism. In this case, consequentialism is the guiding ethical theory because it forces one to consider the consequences, good or bad, of a decision.

The concept of “do no harm” prevails, and leaving the procedure jeopardizes the patient’s right to continuity of care and therefore would be viewed as harmful and unethical.

REF: p. 304 13. When undertaking an ethical analysis, a. identification of human values pertinent to the analysis must be considered. b. group personal values should be discussed as used as a guide. c. your ARRT certification needs to be included in the analysis. d. seniority with your employer should be considered.

ANS: A

When an ethical dilemma has been identified, it needs to be analyzed for a correct solution.

The process of ethical analysis generally contains the following four components: identifying the problem, developing alternative solutions, selecting the best solution, and defending the selection. Because human values are central to an ethical decision, they must be analyzed as an essential part of the process. One’s personal values should not be an overriding consideration. Every ethical decision also involves human values, values that often conflict and compete for recognition and acceptance among our professional colleagues.

REF: p. 304 14. The best way to characterize an ethical dilemma is to describe it as the a. correct choice is absolutely identified with clear outcomes. b. incorrect choice is absolutely identified with clear consequences. c. correct choice is not entirely clear and has both positive and negative

consequences. d. moral thing to do based on your religious values.

ANS: C

We must develop some skill in both recognizing and analyzing ethical dilemmas. An ethical dilemma presents both positive and negative aspects. Consequently, it is a dilemma as the correct choice may not be that clear. The true ethical dilemma invites a wide range of personal opinion among colleagues in a profession, each of which is based on a highly individualistic, strongly held value system.

REF: p. 303

All of the following are related except selecting the best solution and defending it. looking for a similar situation as a precedent. defining the real problem. working out alternative solutions.

15. a. b. c. d.

ANS: B

The process of ethical analysis generally contains the following four components: identifying the problem, developing alternative solutions, selecting the best solution, and defending the selection. Looking for a precedent setting example to help make your decision is not a safe ethical decision-making strategy.

REF: p. 304

16. A patient arrives for her annual mammogram and registers with reception. Then she goes to

the dressing room as instructed and puts on the gown that was given to her. As you bring her into the mammography room, she answers a few routine questions and listens intently as you explain the procedure to her. It is safe to assume as the mammographer that a. a social contract has been established between the patient and the mammographer. b. the patient is expecting a normal mammogram. c. the patient’s previous annual mammogram was uneventful. d. the patient is coming in as a self-referral.

ANS: A

Social contract theory attempts to describe the relationship that exists between two mutually dependent persons or groups of persons in a society. Under this theory, these persons or groups recognize certain expectations of each other and act accordingly. Social contracts are unwritten, leaving the specific duties and actions expected of health care practitioners and their patients to be resolved through a process of reasoning and discernment. Social contracts imply agreement by both parties to deliver an expected service.

REF: p. 304 17. You are placed in an unfortunate situation with a patient that requires you to tell a small

“white lie” regarding the late arrival of the radiologist. The patient is noticeably upset about the procedure having to be done at all and is quite anxious. You are aware that the radiologist and the patient’s surgeon are meeting in his office to discuss the best approach to deal with this patient’s cancer. You feel certain that telling the patient the truth as to why the radiologist is late would increase her anxiety. This technologist is practicing a. unethical and immoral radiography. b. consequentialism. c. nonconsequentialism. d. in a negligent manner.

ANS: B

Consequentialism evaluates the rightness or wrongness of ethical decisions by assessing the consequences of these decisions on the patient—that is, producing a good effect for the patient or at least avoiding some potential harm.

REF: p. 304 18. Which of the following best defines fidelity? a. Producing an image that faithfully represents the patient’s medical status b. Being totally honest and truthful about the fluoroscopic exposure they received c. Saying a short prayer with the patient as they await an interventional procedure to

begin d. Filling in for a colleague who became sick at the start of the procedure ANS: A

Fidelity implies faithfulness. Performing acts that observe covenants or promises is right.

Doing the right thing under all circumstances. Honesty and truthfulness are characteristics of veracity.

REF: p. 305 | Table 24.2

19. The term veracity refers to a. preventing evil and harm. b. doing no harm but also doing good. c. telling the truth. d. being persistent and tenacious.

ANS: C

Veracity involves being truthful and acting in a truthful manner. Telling the truth is expected of medical professionals.

REF: p. 305 | Table 24.2 20. After a stressful CT scan on a patient, you are confronted by the patient’s family regarding the

results of the examination. The patient was in a motor vehicle accident and has a severe head injury. The images you took are being sent to a “Nighthawk” reading service and will not be available for several minutes. The family insists they have a “right” to know the results immediately so they can make a decision about organ donation. How would you rationalize this situation to yourself as an imaging professional? a. Your duty as a professional is to complete a quality CT examination quickly, not to interpret the images, and to do no harm to the patient. b. You tell the family what you saw on the images as an act of veracity. c. You tell the emergency department nurse about the images as an act of nonmaleficence. d. You call the organ donor program director to tell him of the patient’s condition as an act of fidelity.

ANS: A

Radiologic technologists see,NhU eaRr,SaI ndNeGxT peB ri. enCcO e aMwide variety of personal and sensitive patient care activities. Radiologic technologists must both respect the confidences of their patients and safeguard the knowledge they obtain through their everyday practice activities.

The ASRT Code of Ethics provides an excellent framework for guiding technologists in perplexing situations such as this one. Although your intent is to do good and do no harm, it would be unethical to share examination results with the family.

REF: p. 307

Chapter 25: Health Records and Health Information Management Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. All of the following would be characteristics of a patient health record except it a. is a single record on a single patient only. b. may be maintained in paper or electronic media (or both). c. is required for hospitals and emergency department visits only. d. promotes communication among providers and continuity of care.

ANS: C

Hospitals, ambulatory care facilities, physician practices, emergency and trauma centers, rehabilitation centers, long-term care facilities, home care programs, and all other health care settings all maintain health records on all persons receiving health care services. Although these settings vary with regard to the type and range of medical and health-related services they provide, they all have a common need to concentrate, within a single record, all patient care information that applies to an individual patient.

REF: p. 311 2. A typical health information management department a. charges patients and doctors for its services and is a major revenue center for a

hospital. b. is responsible for the maintenance, retrieval, and storage of health information. c. is considered an essential dep artm en t a n d staffed by physicians only.

N R I G B .C M d. provides health records to pUh ysSi c i aNn s oTnly. O ANS: B

The functions of the health information management department are service oriented and support the optimal standards set forth for quality of care and services in the health care institution. It is responsible for the maintenance of health information systems in one or more forms to provide for the availability, accuracy, and protection of the clinical information that is needed to deliver health care services and to make appropriate health care–related decisions.

REF: p. 311 3. The health information department performs which of the following supportive functions?

1. Health research 2. Administrative activities of the organization 3. Publication of marketing literature for advertising 4. Support for medical education activities 5. Maintenance of a medical library for physicians and the general public 6. Patient billing and accounting processes 7. Quality management programs a. 1, 2, 3, 6, and 7 only b. 2, 3, 5, 6, and 7 only c. 2, 4, 5, and 6 only d. 1, 2, 4, 6, and 7 only

ANS: D

The health information department’s functions support the current and continuing care of patients; the institution’s administrative processes; patient billing and accounting processes; medical education programs; health services research; utilization management, risk management, and quality management or performance improvement programs; privacy and security issues related to the Health Insurance Portability and Accountability Act of 1996 (HIPAA); legal requirements; and extraneous patient services.

REF: p. 311 | p. 312 4. The shift to a prospective payment system (PPS) and diagnostic related groups (DRGs) has

made the health information process of critically important to the complete and timely reimbursement of medical costs provided by the government (Medicare/Medicaid) and third-party payers. a. digitization b. archiving c. transcription d. coding ANS: D

The coding of inpatient and outpatient diagnoses and procedures is of highest priority. Coding involves converting diagnoses and procedures into a numeric classification system. The numbers are reported to Medicare and other third-party payers, such as insurance companies.

Coding must be complete and accurate so that claims can be processed within prescribed time frames.

REF: p. 312 5. Standards have been established for the maintenance of complete medical records by a. The Joint Commission (formerly the Joint Commission on the Accreditation of

Healthcare Organizations). b. the American Registry of Medical Records (ARMR). c. the American Medical Association (AMA). d. the World Trade Organization (WTO).

ANS: A

Standards for the maintenance and the adequacy of health records have been established by accrediting agencies such as The Joint Commission and the American Osteopathic Association via its Healthcare Facilities Accreditation Program.

REF: p. 312 6. Entering health information into a patient’s medical record (charting) is completed by a. any department personnel who provide care to a patient. b. physicians and practitioners only. c. physicians and charge nurses only. d. health information managers only.

ANS: A

All departments that take part in the care of a patient must document that care in the health record. Documenting in the patient’s record, or charting, should be done by radiologists and radiographers when a patient receives either diagnostic or therapeutic radiologic services.

REF: p. 312 7. Health records for inpatients should contain what information?

1. Patient identification data 2. Number of patient visitors during the stay 3. Reports of any diagnostic or therapeutic studies 4. Physical examination data 5. Number of times the nurse call light is activated for nursing care 6. All informed consent documents 7. Medical history, including the chief complaint a. 1, 2, 4, 6, and 7 only b. 1, 3, 4, 6, and 7 only c. 2, 3, 4, 5, and 7 only d. 1, 4, and 6 only ANS: B

Regardless of the method used to record health information, the content of each health record depends on which health care facility department is treating the patient and recording the information. Standards for inpatient records require that the records include the following information: • Patient identification data • Medical history of the patient provided by the patient, including chief complaint, history of present illnN ess R or i nIj u r G y , reBle. vC ant M family and social histories, and inventory U S N T O by body system • Report of relevant physical examination findings • Diagnostic and therapeutic orders • Clinical observations, including results of therapy • Reports of diagnostic and therapeutic procedures and tests, as well as their results • Evidence of appropriate informed consent (when consent is not obtainable, the reason should be entered in the record) • Conclusions at termination of hospitalization or evaluation of treatment, including any pertinent instructions for follow-up care REF: p. 312 8. As you and a colleague transport a patient back to the emergency department, the patient’s

fingers get caught in the wheels of the wheelchair, but there is no apparent injury to the patient. This event does require that an incident report be completed. The incident report must be part of the a. patient’s health record. b. patient’s medical history on discharge. c. hospital’s risk management documentation. d. nurses’ notes in the patient’s chart.

ANS: C

Incident reports contain information relative to patient incidences or event occurrences.

Incident reports must be completed after an event; however, the reports themselves should not be a part of the patient record. Rather, they are administrative documents and are typically maintained by hospital legal counsel or perhaps the risk management team.

REF: p. 313 9. As a radiographer working in a busy department, you have received an examination request

for an interventional venous line placement for an inpatient. The referring physician is very upset about any delay with his patient. In reviewing the request, you notice that there is no indication as to why this examination is being done. How would you proceed with this situation? a. Complete the examination and get the missing information later. b. Ask the patient if he knows why the examination is being done. c. Because this patient is an inpatient, the missing information is unnecessary. d. Delay the examination until the needed information is provided by the referring physician.

ANS: D

For documentation of medical necessity, a diagnosis or sign or symptom for which the test is being performed must be included on the order. Failure of the attending physician to report such a diagnosis, or sign or symptom, will result in a delay in performing the procedure.

Hospital and billing requirements under medical necessity require that the medical necessity be justified before a procedure is performed. This requirement applies to inpatient and outpatient procedures.

REF: p. 313 10. Before a diagnostic study can be initiated, a. a formal, documented examination request is entered into the institution’s

information system. b. the requesting physician must be identified on the request. c. reasons for the examination must be on the request. d. all of the above should be done.

ANS: D

Before a radiologic procedure is performed, a radiology order or request for service is completed. This order includes the patient demographic information (name, health record number, other identifying information) along with the specific procedure being requested. The physician ordering the procedure should also be identified as well as documentation of the medical necessity for the procedure.

REF: p. 313 11. A key function performed by a patient’s health information record is to a. ensure the patient is discharged in a timely fashion. b. communicate to the patient’s physician all care rendered by all persons. c. document the patient’s chief complaint to see if it was treated and explain the

outcome. d. ensure all patient’s requests were met during the stay as a measure of quality assurance.

ANS: B

Because clinical decision making and financial reimbursement depend on the information contained in the health record, maintaining a complete and accurate record is essential. An error in recording the medications administered to a patient, for example, might lead to a life-threatening situation. An error in data reporting might mean a sizable financial loss for the health care institution. Such a concentration promotes effective communication among all the health care professionals, including physicians, and provides for continuity of patient care.

REF: p. 312 12. When entering information into a patient health record, it is important to remember that a. entries can be made in ink or with an indelible pencil. b. abbreviations that are common with cell phone texting are acceptable. c. any data entered must be legible and in ink when the entry is written. d. information can be entered electronically by anyone with a hospital-provided

computer.

ANS: C

Medical records must incorporate all significant clinical information regarding a patient.

Entries to the medical record must be clear and legible, and all entries should be in ink when the information is written. Pencil documentation is not legal in any state. Additionally, recognized and approved abbreviations are permitted, and only authorized individuals can legally enter patient data into a patient health record.

REF: p. 314 13. You are asked to testify in a N courR t c aIs e iG nvoB lv. inC g aM m ammographic biopsy with which you

U SDuring N Ttestimony, a question is raised regarding whether were involved as a mammographer. the biopsy was done successfully. You remember clearly that it was, and state so. In the patient’s health record, there is no written documentation of the biopsy being done. As far as the court is concerned, a. the biopsy did not occur. b. your testimony is all that is needed to straighten out the mistake. c. the examination was completed if the patient paid her bill. d. the radiologist who performed the procedure must be subpoenaed.

ANS: A

A longstanding basic principle of health record documentation is the adage “not documented, not done.” This tenet applies to all health care practitioners who make entries in patient health records. If records are submitted in court in any type of legal case, then the statement holds true. In the absence of the requisite documentation in the health record of what was done to the patient, the assumption is that the event did not take place.

REF: p. 315 14. A major distinction between DRGs and APCs is that a. APCs are used for the reimbursement of outpatient and ancillary procedures. b. DRGs are used exclusively for outpatient studies. c. DRGs reference the ICD-10 revision and APCs reference the ICD-9 version. d. APCs are generally at a lower reimbursement amount and are used only by the

federal government because of this lower cost.

ANS: A

Health record data serve as the basis for hospital reimbursement in the Prospective Payment System (PPS) using the DRG system in the inpatient setting and ambulatory patient classifications (APCs) in the outpatient setting.

REF: p. 315 15. In 2007, the government upgraded the DRG system of reimbursement and introduced the

MS-DRG system. This upgrade is designed to take into account a. the patient’s severity of illness and the amount of medical resources utilized. b. the amount of medical resources used to care for the patient. c. whether or not the patient had a positive outcome. d. patients who are ultimately placed into extended care facilities such as rehabilitation centers or nursing homes.

ANS: A

A criticism of DRGs has been that the system does not take into account the severity of a patient’s disease. As of October 1, 2007, the Centers for Medicare and Medicaid Services implemented the Medicare Severity DRG system (MS-DRG), which takes into account the level of severity of a patient’s condition and the amount of resources used to care for him or her.

REF: p. 315 16. To maximize the full reimbursement for a diagnostic study performed in medical imaging, a. the correct DRG must beN attaR cheI tudies performed.

U dStoG NinpTBat.ieCnt sM b. any changes to radiology’s examinations must be communicated with the hospital

chargemaster so that the correct CPT-4 code is assigned. c. the correct CPT code must be assigned using the ICD-10-CM nomenclature. d. All of the above are correct.

ANS: D

The management personnel in a radiology department must understand communication through the diagnostic codes of ICD-10-CM and procedural codes of CPT-4. The correct billing process in a major revenue-producing department of a hospital, such as radiology, is critical to a hospital’s financial solvency. Payers carefully review radiology services for medical necessity. The diagnosis code provided by the ordering physician is critical to the payment and is the reason to either justify or deny reimbursement.

REF: p. 315 | p. 316 17. The ICD-10-CM codes for radiologic procedures using CPT coding nomenclature range from a. 10000 to 59999. b. 70010 to 79999. c. 80000 to 89999. d. 90010 to 99999.

ANS: B

The ICD-10-CM classification system is used for inpatient reporting. The code numbers range from 70010 to 79999.

REF: p. 316 18. You have been asked to participate in the radiology department’s quality assurance

committee. The purpose of this committee would most likely be to a. determine the qualifications of radiographers used in the department. b. review personnel monitoring data to determine staff exposures. c. evaluate various radiology services to seek improvement. d. calculate the cost of X-ray equipment service contracts between companies.

ANS: C

Performance improvement is a process by which the quality of the care and services provided to patients within a health care facility are monitored and evaluated. The terms quality assurance, quality assessment, and performance improvement are all used to encompass activities related to performance improvement.

REF: p. 316 | p. 317 19. An effective hospital quality improvement program a. includes the operations and effectiveness of the hospital’s medical staff. b. includes only departments that are historically problematic. c. deals exclusively with the financial strength of the hospital. d. publishes all of its findings to local media outlets.

ANS: A

Performance improvement activities include work performed by various committees and the medical staff, as well as other professional staff from various ancillary departments.

REF: p. 316

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20. As part of a medical imaging quality assurance program, items to be considered would include

1. medication errors.

2. the amount and duration of breaks taken by staff daily.

3. thermal injuries occurring in MR. 4. the time span available to schedule mammograms.

5. the radiology department’s rate of repeat images.

6. personnel monitoring (film badge) data of staff.

7. patient satisfaction survey results. a. 1, 3, 4, 5, and 7 only b. 2, 3, 5, and 6 only c. 1, 2, 5, and 6 only d. 3, 4, 5, and 7 only ANS: A

The Joint Commission has defined various dimensions of performance that need to be addressed in performance improvement activities in health care organizations. Many of these dimensions center around patient care, efficiency, safety, and efficacy. Factors such as staff break times and frequency as well as radiation monitoring data are typically not considered.

REF: p. 316 21. In the event a correction is needed in a paper document in a patient health record,

a. the correction can be made by erasing the original entry, writing over it, and

initialing the correction. b. the incorrect entry can be covered using whiteout and the record can be recopied with the correction along with the person’s initials. c. the original entry needs to be crossed out by the author with a line and highlighted as an ERROR followed by authentication and dating. d. the person discovering the error can make the correction by writing ERROR and recording their name, date, and time.

ANS: C

The proper method for correcting an error that an author makes, is for the author to draw a single line through the error, write “ERROR,” and then record the correct information. The individual then should date and authenticate the entry.

REF: p. 317 22. It is important for the professional imaging technologist to thoroughly understand his or her

responsibilities with regard to health information confidentiality. Particularly important considerations include a. a testimonial statement must be signed, indicating your awareness and responsibility in maintaining the privacy of patient records. b. all examination results are released to patients by physicians only. c. all health care personnel have the same responsibilities for maintaining confidentiality, including students. d. All of the above ANS: D

Medical imaging pro fessi onaN l sU , iR ncSluIdN inG gT stB ud.eC ntO s, M bear the same responsibility as all other hospital personnel to safeguard the confidentiality of health record information. Computerized information systems are a significant part of these records. Employers require that all employees or students who have access to the medical record sign a confidentiality statement.

Informing patients of examination results is the physician’s responsibility, and the technologist should refer the patient to his or her physician.

REF: p. 317 | p. 318 23. With regard to HIPAA regulations, a. patients cannot access their medical information without their physician’s consent

and attendance. b. patients have a legal write to their medical information and to have copies made at

no cost to the patient. c. copying and faxing medical information is strictly forbidden. d. None of the above is true.

ANS: D

HIPAA regulations prevent unauthorized individuals from accessing, creating, or modifying information while at the same time allowing authorized users to have access. With proper documentation, patients have the right to their health information and no other information. In a world of electronic transmission of data, faxing is common, and faxing medical information must conform to established policies according to HIPAA regulations.

REF: p. 318 24. According to the Mammography Quality Standards Act, a. a patient can request that her images be sent to another mammography service. b. original mammographic images must be converted to a paper media and stored in

medical records. c. mammographic images must be kept for 24 months or until her next

mammographic examination date, whichever is sooner. d. All of the above are correct.

ANS: A

The Mammography Quality Standards Act requires a facility keep a mammogram in the permanent medical record of the patient for no less than 5 years or no less than 10 years if a patient has had no other mammograms at that facility or longer if mandated by state law. A facility must also, on request, transfer the mammogram to another medical institution, to a physician, or to the patient directly.

REF: p. 312 25. With regard to patient medical information a. patient health records are considered legal documents. b. original patient health records must be submitted to courts upon subpoena. c. a spouse has a legal right to the medical information of their partner. d. when a patient’s attorney requests medical records, the patient must be present to

sign off on the release.

ANS: A

The health record is a legal dN ocUuR mS enIt N thG atT isBa. dm CissMible as evidence in court. A health information manager may be required to honor a subpoena for the record and take the record to court. The original record is never left in court; rather, a photocopy is used. The original record is then retained in the hospital health information management department. The patient, or legal representative, must sign a release of information form for consenting to release information.

REF: p. 318

Chapter 26: Medical Law Adler: Introduction to Radiologic and Imaging Sciences and Patient Care, 8th Edition MULTIPLE CHOICE 1. It has been estimated that about 10% of all medical claims of negligence involve a. orthopedic surgeons. b. family practitioners. c. pharmacy. d. medical imaging.

ANS: D

An estimated 10% of all medical negligence claims are somehow related to diagnostic imaging, either by improper diagnosis or by injuries to patients sustained during diagnostic procedures. Therefore any radiographer may be called to testify at some time, either as a defendant or as a witness to the practice of another.

REF: p. 322 2. Which of the following is false regarding informed consent? a. The patient must be competent to sign. b. For accuracy, medical terms specific to the procedure should be used. c. The physician named on the consent form is the only physician who can perform

the procedure. d. Any condition stated on the consent form must be met.

ANS: B

Informed consent information must be relayed to patients in language they can understand. A patient cannot understand the explanation of a procedure if the health care practitioner uses medical terminology that is foreign to the patient.

REF: p. 326 3. When negligence occurs to a patient, who is responsible for proving injury? a. An expert witness b. Plaintiff c. A reasonable and prudent practitioner d. Defendant ANS: A

For a patient (plaintiff) to recover damages for injuries sustained because of alleged negligence, four elements must be proved by the plaintiff: (1) a duty to the patient by the health care practitioner, (2) breach of this duty by an act or by failing to perform some act, (3) a compensable injury, and (4) a causal relationship between the injury and the breach of duty.

REF: p. 324 4. If the threat of bodily harm were to occur to a patient as a result of reckless conduct by the

health care provider, this would be deemed a. battery.

b. assault. c. defamation. d. slander.

ANS: B

An assault claim may arise when a patient believes he or she has been threatened in such a way that reason to fear or to expect immediate bodily harm exists. This fear may arise from comments made by a technologist to the patient before or during the examination and does not necessarily involve physical contact between the parties.

REF: p. 322 5. What type of complaint can be filed by patients if they feel they have been touched without

permission? a. Battery b. Assault c. Defamation d. Slander ANS: A

A technologist who performs an examination or touches a patient without that patient’s permission may be accused of battery even if no injury arises from such contact. Any unlawful touching may constitute battery if the patient thinks that the technologist has touched him or her in an offensive way.

REF: p. 322 6. Placing a child in a Pigg-O-SN tat w R iUt hIoSu t GNt h eTBp .a r Ce n t ’Ms permission may warrant a. assault. b. battery. c. false imprisonment. d. libel.

ANS: C

The common claim of false imprisonment arises when a person is restrained or believes that he or she is being restrained against his or her will. In the case of pediatric patients, obtaining consent to restrain or immobilize from someone authorized to give consent is important. This person may be a parent or guardian who has the legal right to make decisions about the treatment and care of the patient. This person must be informed as to the reasons for the restraint and the possible risks that may occur if restraints are not used before any such devices may be applied. In either of these cases, the radiographer or other provider should document the use of restraint or immobilization device as well as the rationale for use and evidence of consent, if available.

REF: p. 322 7. Which of the following is an example of negligence? a. Delaying a procedure until an interpreter arrives b. Radiographing the wrong body part c. Making a patient wait in the reception area until a radiologist is available d. Recording in the patient chart the family’s reaction to examination results

ANS: B

Negligence is a failure to use such care as a reasonably prudent person would use under like or similar circumstances. A reasonable and prudent radiographer would not radiograph the wrong body part; therefore, an act of negligence has occurred.

REF: p. 323 8. Which of the following is not a legal right of a patient in the radiology department? a. To know of alternative diagnostic studies b. To refuse the ordered radiographic examination c. To be informed of the possible risks d. To ask for and receive extra studies ANS: D

When patients enter a health care facility for examination or treatment, they place their trust in health care professionals. This trust includes an assumption that the correct procedures are being performed and that the professional is meeting the appropriate standard of care. Patients always have the right to refuse examinations but do not have the right to request additional studies.

REF: p. 325 9. A claim that someone has been wronged or sustained injury is called a. a tort. b. negligence. c. defamation. d. libel.

ANS: A

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A patient’s claim that he or she has been wronged or has sustained some injury other than a breach of contract and for which cause may exist for an action to receive compensation for damages is known as a tort. This type of claim arises from a violation of a duty imposed by general law on all persons involved in a transaction or situation.

REF: p. 322 10. Fastening a patient into a confining, immobilization device that they question, for a simple

wrist radiograph can be viewed as a. reasonable and prudent. b. false imprisonment. c. a Standard of Care approach. d. tortuous.

ANS: B

The common claim of false imprisonment arises when a person is restrained or believes that he or she is being restrained against his or her will. The individual must be aware of the confinement and have no reasonable means of escape.

REF: p. 322 11. A process by which patients can agree to be treated or refuse to be treated based on

information provided by the radiographer about the examination is called _

consent.

a. b. c. d.

implied informed simple inadequate

ANS: B

Only when patients have all the information they need to make decisions about their health care will they be able to give an informed consent for examination and treatment.

REF: p. 325 12. Touching a patient on the symphysis pubis for a frontal thoracic spine projection a. could be viewed as battery. b. would be viewed by courts as reasonable and prudent. c. is standard and does not warrant patient permission. d. None of the above ANS: A

If a technologist performs an examination or touches a patient without that patient’s permission, battery may occur even if no injury arises from such contact. Any unlawful touching may constitute battery if the patient thinks that the technologist has touched him or her in an offensive way. Additionally, a reasonable and prudent radiographer under similar circumstance would not need to palpate this anatomy for this projection.

REF: p. 322 13. The term res ipsa loquitur means the a. thing speaks for itself. b. employee is responsible for his or her actions. c. accused must prove innocence. d. employer is responsible for an employee’s actions.

ANS: A

The legal doctrine of res ipsa loquitur sometimes arises in cases of medical negligence and is used to switch the burden of proof from the plaintiff to the defendant. Res ipsa loquitur translates to the “thing speaks for itself” and describes how a patient is injured through no fault of his or her own while in the complete control of another.

REF: p. 325 14.

The doctrine of respondeat superior states that the a. thing speaks for itself. b. accused must prove innocence. c. buyer should beware of a medical purchase. d. employer is responsible for employees’ actions.

ANS: D

The legal theory of respondeat superior, or “the master speaks for the servant,” implies that employees, contracted agents, physicians with medical privileges, volunteers, and so on function under the authority of their employers. Consequently, the employer is generally liable for the actions and behaviors of its agents and parties.

REF: p. 325 15. At a recent professional meeting of radiographers, an attendee stands up at a business meeting

and states that the chairperson uses excessive radiation and violates ALARA daily. The person making these statements would be committing an act of a. civil disobedience. b. militant disobedience. c. defamation. d. fraud.

ANS: C

Two types of defamation are generally recognized: (1) slander, which involves the spoken word, and (2) libel, which involves written or published comments or pictures. In the case of slander, it may involve releasing information about a patient in a way that causes harm to the individual or gossiping about a coworker or other professional colleague in a way that causes some injury to the person in his or her professional or personal life.

REF: p. 323 16. Getting a speeding ticket from a state police officer on an interstate highway would be a

violation of a. case law. b. constitutional law. c. Common Law of England. d. legislative law.

ANS: D

Legislative law is a system oN f sU taR tuS teI sN anGdT reBg. ulC atioM ns written at local, state, and federal levels and runs the gamut from who will drive cars to how citizens will be taxed. Many areas of health care are defined and regulated by these statutes and regulations.

REF: p. 321 17. In a legal proceeding, the actions of a radiographer will be judged with regard to his or her

compliance with the a. actions of other radiographers working in the same department. b. orders of a physician. c. practice standards for medical imaging and radiation therapy. d. standards of care of medicine.

ANS: C

Practice Standards for Medical Imaging and Radiation Therapy were developed by members of the American Society of Radiologic Technology (ASRT) in order to help define the expectations of the profession for those who practice in the professions. A review of actual practice as compared to the guidance in the standards will be used to determine whether an individual is compliant with acceptable professional practice.

REF: p. 324

18. As you perform a mammogram on an anxious patient, she asks you to stop the breast

compression and examination because it is getting painful. Your responsibility as a professional is to a. explain to her the importance of compression and continue uninterrupted. b. release the compression slightly and make the exposure. c. allow the patient to do her own compression. d. stop the examination at her request and submit the images you have completed.

ANS: D

The patient’s autonomy should always be considered when performing diagnostic or therapeutic procedures. If the patient consents to a procedure and then revokes the consent, the health care practitioner must then recognize the patient’s right to revoke and must stop the procedure at a point at which the patient will not be injured in any way.

REF: p. 326 19. It is the duty of any health care practitioner, including medical imaging personnel, to a. safeguard all patient rights and autonomy. b. refrain from giving patients uncomfortable information about an impending exam,

in order to protect their fears. c. provide all patients dosage values for all X-ray studies before the exam has started. d. All of the above ANS: A

The patient’s autonomy should always be considered when performing diagnostic or therapeutic procedures. Patients have well-outlined rights when in the care of a medical provider, and they expect health professionals to respect these rights, including self-determination of care.

REF: p. 326

Written defamation of a person is termed invasion of privacy. criminal law. slander. libel.

20. a. b. c. d.

ANS: D

Two types of defamation are generally recognized: (1) slander, which involves the spoken word, and (2) libel, which involves written or published comments or pictures.

REF: p. 322 | p. 323 21.

Defamation of a character by speaking poorly of an individual is a. libel. b. slander. c. civil assault. d. false imprisonment.

ANS: B

Two types of defamation are generally recognized: (1) slander, which involves the spoken word, and (2) libel, which involves written or published comments or pictures.

REF: p. 322 | p. 323 22. All of the following are necessary for a legitimate case of malpractice except a. a clear definition of duty. b. proof of damages. c. a clear illustration of one’s breach of duty. d. third-party testimonial as to the inappropriate acts of the defendant.

ANS: D

For a plaintiff to recover damages for injuries sustained because of alleged negligence, four elements must be proved: (1) a duty to the patient by the health care practitioner (in medical-related cases, this is defined as the standard of care), (2) breach of this duty by an act or by failing to perform some act (deviation from the standard of care), (3) a compensable injury, and (4) a causal relationship between the injury and the breach of duty. An expert witness as a third party is not required.

REF: p. 324 23. As a radiographer positions an elderly patient for an upright abdominal view, the patient is

asked to stand up from his wheelchair. As he does so, the wheelchair moves out from under him, and he falls to the floor. As the technologist attempts to break his fall, a coworker notes that the wheel locks on the chair were left unlocked. In this situation, a. a breach of duty has occurred. b. it would be acceptable to apologize to the patient and perform the examination free of charge to establish goodwill. c. the technologist will not be held negligent because the wheel locks were most NUR SI NG TB.C OM likely defective. d. the patient’s condition contributed significantly to the accident and will most likely prove the technologist was not negligent.

ANS: A

Four elements must be proved for negligence to have happened. Central to this is the responsibility to perform a duty. Failure to fulfill this duty obligation is viewed as a breach and cause for negligence. The standards of care of the profession of radiologic technology along with department procedures assists in defining the duty and leaving the wheelchair locks unlocked is inconsistent with the standards of care of the profession and likely department procedures as well.

REF: p. 324 24. In a legal case of negligence,

1. rationale and excuses are balanced against implied damages.

2. a breach of duty has to be identified.

3. the definition of duty has to be identified.

4. standards of practice are not considered.

5. injury has to clearly be identified.

6. injury has to be clearly connected to the negligent act. a. 1, 2, 3, 5, and 6 only b. 2, 3, 5, and 6 only c. 1, 2, 3, 5, and 6 only

Introduction to Radiologic and Imaging Sciences and Patient Care 8th Edition Adler Test Bank d. 3, 4, 5, and 6 only ANS: B

For a plaintiff to recover damages for injuries sustained because of alleged negligence, four elements must be proved: (1) a duty to the patient by the health care practitioner (in medical-related cases, this is defined as the standard of care), (2) breach of this duty by an act or by failing to perform some act (deviation from the standard of care), (3) a compensable injury, and (4) a causal relationship between the injury and the breach of duty.

REF: p. 323 | p. 324 25. As you position an adult patient for a skull examination, you begin to position a shadow shield

attached to the X-ray tube assembly to protect the patient’s thyroid from exposure. While you are doing so, the lead shield falls and hits the patient in the throat. You apologize, and nursing care is administered to the patient. Eventually, the patient’s voice changes, and he contends that the accident led to his throat damage. In the court proceedings, his attorney claims negligence and uses the principle of a. respondeat superior. b. caveat emptor. c. res ipsa loquitur. d. tort reform.

ANS: C

The legal doctrine of res ipsa loquitur sometimes arises in cases of medical negligence and is used to switch the burden of proof from the plaintiff to the defendant. Res ipsa loquitur translates to “the thing speaks for itself” and describes how a patient is injured through no fault of his or her own while in the complete control of another.

REF: p. 325 26. Your department has received a new piece of digital radiographic equipment. A radiation

physicist has inspected the unit and determined that the automatic exposure control function is not operating properly. His report indicates this clearly and is submitted to the department director. This new equipment has been expected for weeks and is the only device in the department capable of performing certain examinations. The director insists that the device is completely safe, and the technologists need to use it while applications’ training is on site. In this situation, who is responsible for taking corrective action? a. Radiation physicist b. Radiation Safety Officer c. Manufacturer of the equipment d. Hospital and director ANS: D

The theory of corporate liability requires the hospital or health care entity to be responsible for the quality of care delivered to patients in their facilities. Liability may arise if an organization uses equipment that exposes a patient to excessive amounts of radiation through some type of automatic exposure control or preprogrammed delivery.

REF: p. 325 27. Acceptable informed consent for a simple breast biopsy

Introduction to Radiologic and Imaging Sciences and Patient Care 8th Edition Adler Test Bank a. b. c. d.

does not need a tissue-disposal clause. is the same as implied consent. must be witnessed by someone not involved in the procedure. should state that the procedure is similar to an abscess drainage.

ANS: C

After the patient has been given all of the information necessary to make an informed decision by the physician, a consent form should be signed that documents the information that has been given. A signature clause, which calls for the signature of the patient, as well as that of a witness is required. The witness should be a disinterested third party who will not be involved in the actual performance of the procedure.

REF: p. 326 28. As you begin a barium study of the colon, the patient states clearly that she wants the

examination to stop. A professional imaging technologist should a. turn off the barium, clean up the patient, and help her exit the room quickly. b. record the amount of barium given to the patient and charge her accordingly. c. insist that she can handle the barium enema and that after you have started, it needs to be completed because you cannot get the barium out. d. stop the barium, drain as much of it as possible from the patient’s colon, and conclude the examination.

ANS: D

The patient’s autonomy should always be considered when performing diagnostic or therapeutic procedures. If the patient consents to a procedure and then revokes the consent, the health care practitioner must then recognize the patient’s right to revoke and must stop the procedure at a point at whichNthUeRpS atiIeN ntGwTilB l n.oC t bOeMi n j u r e d in any way. In the case of a barium enema, the already-administered barium must be allowed to empty the colon.

REF: p. 326 29. A technologist who has completed a procedure on a patient leaves the area grumbling, “I hate

to do AIDS patients because I am afraid of catching the disease.” A member of the housekeeping staff hears the technologist and asks who the AIDS patient is so he can pass the information along to his coworkers for safety reasons. The technologist responds by giving the patient’s name and room number. After the incident, housekeeping personnel refuse to clean the room. One person from housekeeping tells the story to members of the housekeeper’s church, where the patient is also a church member. After learning of the patient’s condition, the church asks the patient not to return to church. What type of complaint might be brought against the technologist? a. Negligence b. Defamation c. Assault d. False imprisonment ANS: B

Introduction to Radiologic and Imaging Sciences and Patient Care 8th Edition Adler Test Bank Health care professionals have an obligation to maintain patient confidentiality and are required to keep all protected health information concerning the patient including diagnosis and prognosis in strictest confidence. This information should be shared only with persons who need to know and who have an authorized health care relationship with the patient or whom the patient has authorized to receive information. A breach of this confidentiality is cause for defamation.

REF: p. 322 | p. 323 30. The legal doctrine of res ipsa loquitur intends to shift the burden of proof from the plaintiff to

the defendant (technologist). It implies that the patient was injured through no fault of his or her own while in the complete control of another. An example of this is a a. patient marking the wrong body part for an arthrogram. b. patient “ripping” her bandages off after surgery because they are painful. c. patient’s skin being torn as he is transferred from a cart to his bed. d. patient saying something very crude during surgery in a state of anesthesia.

ANS: C

The legal doctrine of res ipsa loquitur sometimes arises in cases of medical negligence and is used to switch the burden of proof from the plaintiff to the defendant. Res ipsa loquitur translates to “the thing speaks for itself” and describes how a patient is injured through no fault of his or her own while in the complete control of another. The damaged skin is clearly apparent through no action taken by the patient, during the transfer process. Res ipsa loquitur would prevail in this litigation.

REF: p. 325