Week 4 RADR 1309

Streptococci and bacilli are classified as what type of microorganisms?

Bacteria

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.

Pathogens are divided into four basic infectious agents: bacteria, viruses, fungi, and protozoan parasites. Of the choices in this question, a bacillus is

a type of bacteria.

Know the most effective methods for achieving medical asepsis.

This includes proper handwashing, using disinfectants, and sterilizing equipment to prevent infection.

When a disease is spread by an insect depositing the pathogen on or in a human, it is transmitted by what method?

vector

Know sterilization methods.

Sterilization methods include autoclaving, chemical sterilization, and dry heat sterilization to eliminate all microorganisms.

Chemical substances capable of killing pathologic microbes are termed:

bactericidal

The spread of infection via contaminated food referenced is spread by:

fomite

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:

medical asepsis

A nosocomial infection is an:

infection acquired in a hospital

All of the following are possible sources of nosocomial infection EXCEPT

A. Transfer of pathogenic microbes from a Foley catheter to a patient
B. Contamination of surgical instrument
C. Transfer of microbes through hand contact with a waitress in the coffee shop adjacent to the hospital
D. Placements of an unclean receptor against a patients wound during portable examination

C. Transfer of microbes through hand contact with a waitress in the coffee shop adjacent to the hospital

A few days after a stereotactic breast biopsy performed by a radiologist in a breast imaging center, the patient returns to her physician with an obvious infection at the incision site. This is an example of a(n):

iatrogenic infection.

Two bloodborne pathogens of particular importance to hospital personnel are:

hepatitis B virus (HBV) and HIV

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:

urinary tract infections from Foley catheter insertions.

___________ 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.

Contact precautions

A person who acts as a reservoir of pathogenic organisms is referred to as a carrier. An example of a carrier is a:

Coworker who has demonstrated a cold for 2 weeks.

Know the instances when it’s appropriate to wear sterile gloves.

procedures that demand an aseptic technique to prevent introducing microorganisms into a sterile field or vulnerable body sites

Know situations that require aseptic technique.

invading sterile body sites, handling surgical equipment, or managing invasive devices

Know the steps to create a sterile field.

set up a clean, dry work surface above your waist, wash your hands, and open the sterile package by pulling the outer flap away from your body first

Know the steps of opening a sterile tray.

first checking the package integrity and expiration date, placing it on a clean surface, and unfolding the flaps outward while touching only the outer one-inch border

Know the steps of pouring a sterile solution.

holding the bottle with the label against your palm to prevent fluids from staining the label

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.

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

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.

What should be examined first when a sterile package is used?

Expiration date

If the sterility of an object is unknown, which of the following should be done?

Consider the object unsterile and do not use it

Two people in sterile attire should pass each other in which of the following ways?

back to back

If you suspect the radiologist has unknowingly contaminated his or her glove, which of the following should you do?

Make the radiologist aware of the possible contamination immediately

The urine collection bag and tubing should not be kinked and should be kept below the level of the bladder to ____________. Failure to do so can lead to infection.

prevent reflux of urine back into the bladder

Hip pinning or femur rodding may use an approach known as the__________. 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.

shower curtain approach

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____________. 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.

hazardous drug waste only

To facilitate removal of a nasogastric tube, the patient is:

encouraged to take a deep breath

The most common type of nasogastric tube used for stomach decompression is the:

single-lumen Levin tube

To confirm the placement of an NG tube in its proper position, a physician may use:

a syringe to remove gastric contents as proof and fluoroscopy for visualization

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. What should be known?

The length of time that suction can be interrupted safely also must be known as well as the level of suction pressure required.

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:

has a double-lumen NG tube in place.

When working with a non-ambulatory 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

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.

___________ 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.

A cleansing enema

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:

the sensitivity of colonoscopy has surpassed the results of barium contrast colon studies.

_________ involves no scopes, sedation, recovery time, or referral from your doctor or insurance plan. It is performed on a multi-slice 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.

Virtual colonoscopy

In almost all facilities, the___________ (the addition of air or carbon dioxide to provide for two contrasts—barium and the air) has become more of a routine as compared 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.

double-contrast barium enema

What is the preferred method to diagnose the condition of colitis?

colonoscopy

Because greater pressure is required to secure an adequate flow rate, the bag is usually suspended at a distance, up to _____ 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.

30 inches

In a typical single-contrast barium enema, the suspension is run in slowly with compression applied to the abdomen. Approximately _______ is required for the average adult barium enema, and spot views of the cecum, flexures, and sigmoid colon are taken.

1500 mL of barium

In preparation for a barium examination of a colostomy patient, it is important to:

do all of the above.

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.

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.

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):

loopogram

the single most important action for the radiographer when administering emergency care is:

providing a competent level of care, recognizing when advanced care is needed, and calling for assistance.

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:

restrain the patient’s extremities to prevent orthopedic injuries.

The type of shock that is a result of severe loss of blood is:

hypovolemic

What type of shock can result from a severe reaction to the contrast media used in radiographic examinations?

Anaphylactic

What type of shock is caused by loss of blood from a knife or gunshot wound?

Hypovolemic

What is the first thing you should do if a patient who is standing turns pale and says he feels dizzy?

have the patient lie down or sit down immediately

_________, 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.

Epistaxis

An effective method to handle a patient with an asthmatic attack during a radiographic procedure would be to:

have the patient sit down, and allow the patient to use his or her aerosol inhaler.

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?

Unconscious but reflexive

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.

The protocol for CPR with to rescuers is similar to single-person CPR, but each rescuer

independently perform compressions or ventilations with periodic switches of position.

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?

Backboard

A disorganized cardiac rhythm in which the ventricle “flutters” and loses cardiac output is called:

fibrillation

It is acceptable to discontinue CPR on a person when:

Signs of life, exhaustion, professionals take over, and DNR order

The science dealing with the nature, effects, uses, and origin of drugs is called:

Pharmacology

A drug agent that promotes bowel evacuation is a(n):

Laxative

When you ask the pharmacist for the drug Benadryl, you are asking for the drug using the drug’s _____ name.

Brand name

Nonprescription drugs are also known as:

Over the counter

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.

Reaction to a drug that results in respiratory or circulatory collapse is referred to as:

anaphylaxis

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:

Magnetic Resonance Imaging (MRI)

Metformin (Glucophage) is commonly used to treat:

Type 2 diabetes

Drugs that relieve pain without causing a loss of consciousness are called:

Analgesics

A patient who is scheduled to have surgery of the esophagus for a diverticulum will likely be given a(an) _______ to decrease mucosal secretions and esophageal muscular activity.

Anticholinergic

Drugs that are commonly used for the treatment of high cholesterol are referred to as:

statins

A major complication for patients undergoing (antiplatelet) blood clotting drug therapy is:

bleeding

A drug name that is unique to the drug, as given by the drug’s manufacturer, is called the drug’s _____ name.

Brand

Patients with congestive heart failure and lymphedema are typically prescribed:

a diuretic, furosemide, and lasix

A contraindication to NSAIDs is:

compromised renal function.

A patient who has a history of bloody stools caused by a suspected malignant neoplasm (cancer) in the colon should not be given:

thrombolytics

Parenteral administration of a drug involves:

needle injections

A substance that nullifies the intended action of an administered drug is call a(n):

antagonist

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.

infiltration and extravasation

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:

enhance the low subject contrast of anatomic structures.

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:

water and fat.

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.

positive contrast agents containing high-atomic-number elements.

A common contrast agent used for MRI examinations is:

gadolinium-DTPA

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:

double-contrast studies

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 ______. Stabilizing agents such as sodium carbonate or sodium citrate are usually used to prevent ________.

flocculation

Barium sulfate would be contraindicated for a patient with:

a suspected duodenal bulb perforation.

Stomach examinations using barium sulfate have some degree of risk for patients who are:

sedated, mentally handicapped, and potentially hypovolemic.

Most adverse reactions to ionic, iodinated contrast agents are caused by:

their osmolality

An undesirable characteristic of ionic contrast agents is their:

dissociation into a cation and an anion when dissolved in plasma

The ideal iodinated contrast agent would have what characteristic(s)?

low osmolality, nonionic chemical structure, water solubility (hydrophilic), three or more iodine atoms per molecule.

The osmotic effects of ionic contrast agents are a result of the movement of:

low osmolality, nonionic chemical structure, water solubility (hydrophilic), three or more iodine atoms per molecule.

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:

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

Laboratory tests to assess a patient’s BUN and creatinine are used to determine the patient’s:

renal function

Contrast media that are high in osmolality can be harmful to patients with compromised renal function. Patients who commonly have compromised kidney function include:

diabetics, elderly patients, and renal dialysis patients.

The most important patient care aspect before administration of water-soluble iodine contrast media is the ___________. 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.

patient history

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.

When working with a radiopharmaceutical, the nuclear medicine professional must be particularly aware of:

the half-life of the isotope, any isotope spills or leaks, and contamination of isotope that yields image artifacts.

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 thorough medical history including allergies and diseases.