TENTH EDITION

LANGE Q&A
™

RADIOGRAPHY
EXAMINATION

D. A. Saia, MA, RT(R) (M)

Radiography Educator and Consultant
Adjunct Professor, Concordia College
Bronxville, New York

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MCGH356-FM_pi-xxiv.indd 1 18/09/15 10:45 AM

 Lange Q&ATM: Radiography Examination, Tenth Edition

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ISBN 978-0-07-183310-3
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Notice

Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy
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Library of Congress Cataloging-in-Publication Data

Saia, D. A. (Dorothy A.), author.

Lange Q & A radiography examination / D.A. Saia. — Tenth edition.
p. ; cm.
Q & A radiography examination
  Radiography examination
Includes bibliographical references and index.
ISBN 978-0-07-183310-3 (pbk.: alk. paper) — ISBN 0-07-183310-2 (pbk. : alk. paper)
  I. Title.  II. Title: Q & A radiography examination.  III. Title:
Radiography examination.
  [DNLM: 1. Radiography—Examination Questions.  2. Technology,
Radiologic—Examination Questions.   WN 18.2]
  RC78.15
  616.07'572076—dc23
2015016034

The following figures were originally published in Saia DA, Radiography PREP: Program Review and Examination
Preparation, 5th ed. New York: McGraw-Hill, 2009 and are reproduced with permission from McGraw-Hill: Figures
2-47, 2-49, 2-50, 2-52, 2-55, 2-58, 3-5, 4-19, 4-21, 4-22, 4-24, 5-1, 5-3, 5-10, 5-12, 6-14, 6-15, 6-17, 6-22, and 7-24.

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 Contents

To the Student. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Master Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii
1. Patient Care and Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Answers and Explanations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Subspecialty List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
2. Imaging Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Answers and Explanations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Subspecialty List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
3. Radiation Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Answers and Explanations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Subspecialty List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
4. Image Acquisition and Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Answers and Explanations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Subspecialty List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
5. Equipment Operation and Quality Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Answers and Explanations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
Subspecialty List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
6. Practice Test 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Answers and Explanations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322
Subspecialty List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350
7. Practice Test 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Answers and Explanations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
Subspecialty List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411

To access your complimentary online practice exam, visit www.MHEAlliedHealth.com.

vii

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 CHAPTER 1

Patient Care and Education

Questions

DIRECTIONS (Questions 1 through 130): Each of the 4. For medicolegal reasons, radiographic images are
numbered items or incomplete statements in this sec- required to include all the following information
tion is followed by answers or by completions of the except
statement. Select the one lettered answer or completion
that is best in each case. (A) the patient’s name and/or identification number
(B) the patient’s birth date
1. Which blood vessels are best suited for determina- (C) a right- or left-side marker
tion of pulse rate? (D) the date of the examination
(A) Superficial arteries
5. A radiographer who discloses confidential patient
(B) Deep arteries information to unauthorized individuals can be
(C) Superficial veins found guilty of
(D) Deep veins
(A) libel
2. Diseases that require contact precautions include (B) invasion of privacy
(C) slander
1. MRSA
2. Clostridium difficile (C-diff) (D) defamation
3. TB
6. An iatrogenic infection is one caused by
(A) 1 only
(A) physician intervention
(B) 1 and 2 only
(B) blood-borne pathogens
(C) 2 and 3 only
(C) chemotherapy
(D) 1, 2, and 3
(D) infected droplets
3. Circumstances that could prevent a radiography
student from meeting ARRT certification require- 7. A vasomotor effect experienced after injection of a
ments include contrast agent is characterized by all of the follow-
ing symptoms except
1. failing one or more courses in the radiography
program (A) nausea
2. being suspended from a radiography program (B) syncope
3. being dismissed/expelled from a radiography (C) hypotension
program (D) anxiety
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3

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 2 1: Patient Care and Education

8. Which of the below is the first step to be taken in 13. Which of the following can be transmitted via
the performance of a radiographic examination? infected blood?

(A) Obtain clinical history 1. HBV

(B) Provide appropriate patient assistance 2. AIDS
3. TB
(C) Verify patient identity
(D) Use appropriate infection control (A) 1 only
(B) 1 and 2 only
9. Which of the following drugs is used to treat (C) 2 and 3 only
dysrhythmias?
(D) 1, 2, and 3
(A) Epinephrine
(B) Lidocaine 14. The mechanical device used to correct an ineffec-
tual cardiac rhythm is a
(C) Nitroglycerin
(D) Verapamil (A) defibrillator
(B) cardiac monitor
10. Examples of a portal of entry in the cycle of infec- (C) crash cart
tion include
(D) resuscitation bag
1. a break in the skin
2. nasal mucous membrane 15. A small container holding several doses of medica-
3. urinary tract tion is termed

(A) 1 only (A) an ampoule

(B) 1 and 2 only (B) a vial
(C) 2 and 3 only (C) a bolus
(D) 1, 2, and 3 (D) a carafe

11. Administration of contrast agents for radiographic 16. You have encountered a person who is apparently
demonstration of the spinal canal is performed by unconscious and unresponsive. There is no rise
which of the following parenteral routes? and fall of the chest, and you can hear no breath
sounds. You should first
(A) Subcutaneous
(B) Intravenous (A) begin mouth-to-mouth rescue breathing,
(C) Intramuscular giving two full breaths
(D) Intrathecal (B) proceed with the Heimlich maneuver
(C) begin with 30 external chest compressions at
12. The radiographer can help to alleviate patient anx- a rate of 100 compressions/min
iety in the following way(s) (D) begin with 5 external chest compressions at a
rate of 50 compressions/min
1. careful explanation of the procedure
2. avoiding use of complex medical terms
17. In classifying IV contrast agents, the total number
3. listening carefully to the patient
of dissolved particles in solution per kilogram of
(A) 1 only water defines
(B) 1 and 2 only (A) osmolality
(C) 2 and 3 only (B) toxicity
(D) 1, 2, and 3 (C) viscosity
(D) miscibility

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 Questions: 8–27 3

18. A patient who is warm, flushed, or feverish is said 23. A large volume of medication introduced intrave-
to be nously over a period of time is termed

(A) diaphoretic (A) an IV push

(B) febrile (B) an infusion
(C) cyanotic (C) a bolus
(D) anxious (D) a hypodermic

19. Misunderstandings between cultures can happen 24. The legal document or individual authorized to
as a result of make an individual’s healthcare decisions, should
the individual be unable to make them for himself
1. looking directly into someone’s eyes
or herself, is the
2. the use of certain gestures
3. standing too close while speaking to another 1. advance healthcare directive
2. living will
(A) 1 only 3. healthcare proxy
(B) 1 and 2 only
(C) 2 and 3 only (A) 1 only
(D) 1, 2, and 3 (B) 1 and 2 only
(C) 2 and 3 only
20. The legal doctrine res ipsa loquitur means which of (D) 1, 2, and 3
the following?
25. An inanimate object that has been in contact with
(A) A matter settled by precedent an infectious microorganism is termed a
(B) A thing or matter settled by justice
(C) The thing speaks for itself (A) vector
(D) Let the master answer (B) fomite
(C) host
21. Some proteins in latex can produce mild-to-severe (D) reservoir
allergic reactions. Medical equipment that could
contain latex includes 26. In which stage of infection do the infective
microbes begin to multiply?
1. airways
2. enema tips (A) Latent period
3. catheters (B) Incubation period
(A) 1 only (C) Disease phase
(B) 1 and 2 only (D) Convalescent phase
(C) 2 and 3 only
27. A partially obstructed airway is clinically mani-
(D) 1, 2, and 3
fested in the following way(s)
22. The request for imaging services for hospital patients 1. dysphasia
generally includes the following information 2. noisy, labored breathing
3. nailbed and lip cyanosis
1. patient name and/or identification number
2. mode of travel to Imaging department (A) 1 only
3. name of referring physician (B) 1 and 2 only
(A) 1 only (C) 2 and 3 only
(B) 1 and 2 only (D) 1, 2, and 3
(C) 2 and 3 only
(D) 1, 2, and 3

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 4 1: Patient Care and Education

28. All the following statements regarding hand 32. Possible side effects of an iodinated contrast
hygiene and skin care are correct, except medium that is administered intravenously include
all the following except
(A) hands should be cleansed before and after
each patient examination 1. a warm, flushed feeling
(B) faucets should be opened and closed with 2. altered taste
paper towels 3. rash and hives
(C) hands should be smooth and free from (A) 1 only
chapping (B) 3 only
(D) any cracks or abrasions should be left uncov- (C) 2 and 3 only
ered to facilitate healing
(D) 1, 2, and 3
29. All of the following are correct concepts of good
33. In the blood pressure reading 145/75 mm Hg, what
body mechanics during patient lifting/moving,
does 75 represent?
except
1. The phase of relaxation of the cardiac muscle
(A) the radiographer should stand with feet tissue
approximately 12 inches apart and with one 2. The phase of contraction of the cardiac muscle
foot slightly forward tissue
(B) the body’s center of gravity should be posi- 3. A higher-than-average diastolic pressure
tioned over its base of support
(C) the back should be kept straight; avoid (A) 1 only
twisting (B) 2 only
(D) when carrying a heavy object, hold it away (C) 1 and 3 only
from the body (D) 2 and 3 only

30. When a patient arrives in the radiology depart- 34. Facsimile transmission of health information is
ment with a urinary Foley catheter bag, it is impor-
1. not permitted
tant to
2. permitted for urgently needed patient care
(A) place the drainage bag above the level of the 3. permitted for third-party payer hospitalization
bladder certification
(B) place the drainage bag at the same level as (A) 1 only
the bladder
(B) 2 only
(C) place the drainage bag below the level of the
(C) 2 and 3 only
bladder
(D) 1, 2, and 3
(D) clamp the Foley catheter
35. Forms of intentional misconduct include
31. When a patient having one strong side and one
weak side is being assisted onto an x-ray table, the 1. slander
radiographer should 2. invasion of privacy
3. negligence
(A) start with the weaker side closer to the table
(B) start with the stronger side closer to the table (A) 1 only
(C) always use a two-person lift (B) 2 only
(D) lift the patient carefully onto the table (C) 1 and 2 only
(D) 1, 2, and 3

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 Questions: 28–45 5

36. Which of the following statements is correct with 41. What is the needle angle usually recommended for
regard to assisting a patient from a wheelchair to intravenous injections?
an x-ray table?
(A) 90 degrees
(A) The wheelchair should be parallel with the (B) 75 degrees
x-ray table (C) 45 degrees
(B) The wheelchair should be 45 degrees to the (D) 15 degrees
x-ray table
(C) The wheelchair should directly face the x-ray 42. The belief that one’s own cultural ways are superior
table to any other is termed
(D) The wheelchair footrests should be folded
down for foot support during transfer (A) ethnology
(B) ethnobiology
37. In her studies on death and dying, Dr. Elizabeth (C) ethnocentrism
Kubler-Ross described the first stage of the griev- (D) ethnography
ing process as
43. Potential violations of HIPAA standards include
(A) denial
the following
(B) anger
(C) bargaining 1. protected healthcare information is accessible
to hospital employees only
(D) depression
2. a copy of authorization for release of medical
information is kept on file
38. You and a fellow radiographer have received an
3. patient information computer files must be
unconscious patient from a motor vehicle accident.
encrypted
As you perform the examination, it is important
that you (A) 1 only
1. refer to the patient by name (B) 1 and 2 only
2. make only those statements that you would (C) 2 and 3 only
make with a conscious patient (D) 1, 2, and 3
3. reassure the patient about what you are doing
44. Which of the following may be used to effectively
(A) 1 only
reduce the viscosity of contrast media?
(B) 1 and 2 only
(C) 2 and 3 only (A) Warming
(D) 1, 2, and 3 (B) Refrigeration
(C) Storage at normal room temperature
39. A cathartic is used to (D) Storage in a cool, dry place
(A) inhibit coughing
45. The type of shock often associated with pulmonary
(B) promote elimination of urine embolism or myocardial infarction is classified as
(C) stimulate defecation
(D) induce vomiting (A) neurogenic
(B) cardiogenic
40. Another term used to describe nosocomial infec- (C) hypovolemic
tions is (D) septic
(A) iatrogenic
(B) healthcare-associated infections
(C) droplet
(D) airborne

MCGH356-Ch01_p001-036.indd 5 18/09/15 10:31 AM

 6 1: Patient Care and Education

46. Which of the following must be included in a 51. Which of the following legal phrases defines a cir-
patient’s medical record or chart? cumstance in which both the healthcare provider’s
and the patient’s actions contributed to an injuri-
1. Diagnostic and therapeutic orders
ous outcome?
2. Medical history
3. Informed consent (A) Intentional misconduct
(A) 1 and 2 only (B) Contributory negligence
(B) 1 and 3 only (C) Gross negligence
(C) 2 and 3 only (D) None of the above
(D) 1, 2, and 3
52. What is the first treatment for extravasation of con-
trast media during an IV injection?
47. What type of precautions prevent the spread of
infectious agents in droplet form? (A) Apply a hot compress
(A) Contact precautions (B) Apply a cold compress
(B) Airborne precautions (C) Apply pressure to the vein until bleeding
stops
(C) Protective isolation
(D) Remove the needle and locate a sturdier vein
(D) Strict isolation
immediately
48. Which of the following conditions must be met in
53. Which of the following diastolic pressure readings
order for patient consent to be valid?
might indicate hypertension?
1. The patient must sign the consent form before
receiving sedation (A) 40 mm Hg
2. The physician named on the consent form must (B) 60 mm Hg
perform the procedure (C) 80 mm Hg
3. Blank spaces on the form must be completed by (D) 100 mm Hg
the physician after patient signature
54. To reduce the back strain that can result from mov-
(A) 1 and 2 only
ing heavy objects, the radiographer should
(B) 1 and 3 only
(C) 2 and 3 only (A) hold the object away from his or her body
(D) 1, 2, and 3 when lifting
(B) bend at the waist and pull
49. Examples of nonverbal communication include (C) pull the object
1. Appearance (D) push the object
2. Eye contact
3. Touch 55. All the following statements regarding oxygen
delivery are true except
(A) 1 only
(A) oxygen is classified as a drug and must be
(B) 1 and 2 only
prescribed by a physician
(C) 2 and 3 only
(B) the rate of delivery and mode of delivery
(D) 1, 2, and 3 must be part of a physician order for oxygen
(C) oxygen may be ordered continuously or as
50. Each of the following is an example of a fomite except
needed by the patient
(A) a doorknob (D) none of the above; they are all true
(B) a tick
(C) a spoon
(D) an x-ray table

MCGH356-Ch01_p001-036.indd 6 18/09/15 10:31 AM

 Answers and Explanations

1. (A)  Superficial arteries are best suited for determi- from an educational program that you have
nation of pulse rate. The five most easily palpated attended?” In addition to reading and signing the
pulse points are the radial, carotid, temporal, femo- “Written Consent under FERPA,” allowing the
ral, and popliteal pulses. The radial pulse is used ARRT to obtain specific parts of their educational
most frequently. The apical pulse, at the apex of the records concerning violations to an honor code if
heart, is most accurate and can be determined with the student has ever been suspended, dismissed,
the use of a stethoscope. or expelled from an educational program
attended. If the applicant answers “yes” to that
2. (B) Any disease spread by direct or close contact, question he or she must include an explanation
such as MRSA and Clostridium difficile (C-diff), and documentation of the situation with the com-
and some wounds require contact precautions. Con- pleted application for certification. If the appli-
tact precaution procedures require a private patient cant has any doubts, he or she should contact the
room and the use of gloves and gowns for anyone ARRT Ethics Requirements Department at (651)
coming in direct contact with the infected individ- 687–0048, ext. 8580.
ual or the infected person’s environment. Some
facilities require healthcare workers to also wear a 4. (B) Every radiographic image must include (1) the
mask when caring for a patient with MRSA patient’s name or ID number, (2) the side marker,
infection. right or left; (3) the date of the examination; and
(4) the identity of the institution or office. Addi-
3. (C) The word honor implies regard for the stand- tional information may be included: the patient’s
ards of one’s profession, a refusal to lie/deceive, an birth date or age, name of the attending physician,
uprightness of character or action, a trustworthi- and the time of day. When multiple examinations
ness and incorruptibility. Other words used to (e.g., chest examinations or small bowel images) of
describe these qualities are honesty, integrity, and a patient are made on the same day, it becomes cru-
probity. cial that the time the radiographs were taken be
These are ethical qualities required of stu- included on the image. This allows the physician to
dents and healthcare professionals. This honor/ track the patient’s progress.
integrity can only be achieved in an environment
where intellectual honesty and personal integrity 5. (B) A radiographer who discloses confidential
are highly valued—and where the responsibility information to unauthorized individuals may be
for communicating and maintaining these stand- found guilty of invasion of privacy. If the disclo-
ards is widely shared. In order to meet ARRT cer- sure is in some way detrimental or otherwise
tification requirements, candidates for the ARRT harmful to the patient, the radiographer may also
examination must answer the question: “Have be accused of defamation. Spoken defamation is
you ever been suspended, dismissed, or expelled slander; written defamation is libel.

15

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 16 1: Patient Care and Education

6. (A) The prefix iatr- is from the Greek iatros, mean- (dysrhythmia). Epinephrine (Adrenalin) is a bron-
ing “physician.” An iatrogenic infection is one caused chodilator. Bronchodilators may be administered
by physician intervention or by medical or diagnos- in a spray mister, such as for asthma, or by injec-
tic treatment/procedures. Examples include infec- tion to relieve severe bronchospasm. Nitroglycerin
tion following surgery and nausea or other illness and verapamil are vasodilators. Vasodilators per-
following prescribed drug use. mit increased blood flow by relaxing the walls of
the blood vessels.
7. (C) Reactions to contrast agents are named and cat-
egorized according to the body system(s) affected, 10. (D) The pathway by which infectious organisms
the nature of the reaction (i.e., allergic vs. nonaller- gain entry to the body is termed the portal of entry.
gic), and its severity (i.e., mild, moderate, or severe). Potential portals of entry include breaks in the skin,
These reactions are categorized as mild (a nonaller- the gastrointestinal tract, mucous membranes of
gic reaction), anaphylactic (allergic reaction), and eyes, nose or mouth, the respiratory tract, and the
vasovagal (life-threatening). Mild effects are princi- urinary tract. Entry can be accomplished by inges-
pally emotional and anxiety-based. They are charac- tion, injection, inhalation, and across mucous mem-
terized by anxiety, syncope, nausea, lightheadedness, brane; the placenta serves as portal of entry between
and sometimes, a few hives. The patient usually mother and fetus.
requires reassurance and not medical attention. An
anaphylactic reaction is a true allergic reaction to, 11. (D) A parental route of drug administration is
for example, iodinated media and can lead to a one that bypasses the digestive system. The five
life-threatening situation. Immediate medical atten- parenteral routes require different needle place-
tion is required. Symptoms of anaphylactic reaction ments: under the skin (subcutaneous), through the
include laryngo/bronchospasm, hypotension, mod- skin and into the muscle (intramuscular), between
erate-to-severe urticaria, angioedema, and tachy- the layers of the skin (intradermal), into a vein
cardia. A vasovagal reaction is life-threatening and (intravenous), and into the subarachnoid space
requires a declared emergency (“code”). Symptoms (intrathecal).
of a vasovagal reaction include bradycardia, hypo-
tension, and no detectable pulse. The fourth type of 12. (D) It is essential that the radiographer take ade-
reaction, acute renal failure, may not manifest for up quate for explanation of the procedure to the
to 48 hours following injection of the contrast agent. patient. In addition, there are times when the radi-
Patients should notify their physician if they experi- ographer must inquire if proper diet and/or other
ence any changes in their urinary habits or any other preparation instructions have been followed prior
atypical symptoms. Treatment would include hydra- to the examination. The radiographer requires the
tion, dispensation of a diuretic (e.g., Lasix), and pos- cooperation of the patient throughout the course
sibly even renal dialysis. of the examination; therefore, providing a thor-
ough explanation will alleviate patient anxieties
8. (C) Although each of these steps is part of a com- and permit fuller cooperation. Patient anxiety can
plete radiologic examination, an all-important first also be reduced when the radiographer employs
step is careful and accurate patient identification. good listening skills, that is, looking at the patient
Patient identification, and correctly matching the (eye contact) and listening carefully without inter-
patient with the intended examination, is a routine ruption and answering questions in a simple, clear,
activity in the healthcare environment. The health- and direct manner, avoiding the use of elaborate
care worker has primary responsibility for checking/ medical terminology.
verifying patient identity. Most facilities require
checking at least two patient identifiers. Rigorous 13. (B) Epidemiologic studies indicate that HIV and
observance of “timeout” processes prior to proce- acquired immunodeficiency syndrome (AIDS) can
dures can avoid costly events, including those involv- be transmitted only by intimate contact with blood
ing patient identification. or body fluids of an infected individual. This can
occur through the sharing of contaminated needles,
9. (B) Lidocaine (Xylocaine) is an antiarrhythmic through sexual contact, from mother to baby at
used to prevent or treat cardiac arrhythmias childbirth, and from transfusion of contaminated

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 Answers: 6–18 17

blood. HIV and AIDS cannot be transmitted by inan- chin-lift movement. If the victim is not breathing
imate objects. Hepatitis B virus (HBV) is another normally, the professional rescuer should begin
blood-borne infection that affects the liver. It is mouth-to-mouth breathing. One cycle is consid-
thought that more than 1 million people in the ered to be 30 chest compressions followed by two
United States have chronic hepatitis B and, as such, rescue breaths.
can transmit the disease to others. Acid-fast bacillus
(AFB) isolation is employed with patients suspected 17. (A) In classifying contrast agents, the total num-
or known to be infected with tuberculosis (TB). AFB ber of dissolved particles in solution per kilogram
isolation requires that the patient wear a mask to of water defines the osmolality of the contrast agent.
avoid the spread of acid-fast bacilli (in bronchial The toxicity defines how noxious or harmful a con-
secretions) during coughing. trast agent is. Contrast agents with low osmolality
have been found to cause less tissue toxicity than
14. (A) The mechanical device used to correct an inef- the ionic IV contrast agents. The viscosity defines
fectual cardiac ventricular rhythm is a defibrillator. the thickness or concentration of the contrast
The two paddles attached to the unit are placed on a agent. The viscosity of a contrast agent can affect its
patient’s chest and used to introduce an electric injection rate. A thicker, or more viscous, contrast
current in an effort to correct the dysrhythmia. agent will be more difficult to inject (more pressure
Automatic implantable cardioverter defibrillators is needed to push the contrast agent through the
(AICDs) are devices that are implanted in the body syringe and needle or the angiocatheter). The mis-
and that deliver a small shock to the heart if a cibility of a contrast agent refers to its ability to mix
life-threatening dysrhythmia occurs. A cardiac with body fluids, such as blood. Miscibility is an
monitor is used to display, and sometimes record, important consideration in preventing thrombus
electrocardiographic (ECG) readings and some formation. It is generally preferable to use a con-
pressure readings. A crash cart is a supply cart with trast agent with low osmolality and low toxicity
various medications and equipment necessary for because such an agent is safer for the patient and
treating a patient who is suffering from a myocar- less likely to cause any untoward reactions. When
dial infarction or some other serious medical emer- ionic and nonionic contrast agents are compared, a
gency. It is checked and restocked periodically. A nonionic contrast agent has a lower osmolality. To
resuscitation bag is used for ventilation, such as further understand osmolality, remember that
during CPR. whenever IV contrast media are introduced, there
is a notable shift in fluid and ions. This shift is
15. (B) Injectable medications are available in two caused by an inflow of water from interstitial
different kinds of containers. An ampoule is a regions into the vascular compartment, which
small container that usually holds a single dose of increases the blood volume and cardiac output.
medication. A vial is a somewhat larger container Consequently, there will be an increase in systemic
that holds a number of doses of medication. The arterial pressure and peripheral vascular resistance
term bolus is used to describe an amount of fluid with peripheral vasodilation. In addition, the pul-
to be injected. A carafe is a narrow-mouthed con- monary pressure and heart rate increase. When the
tainer; it is not likely to be used for medical effects of osmolality on the patient are understood,
purposes. it becomes clear that an elderly patient or one with
cardiac disease or impaired circulation would
16. (C) The sudden cessation of productive ventilation greatly benefit from the use of an agent with lower
and circulation is called cardiopulmonary arrest. osmolality.
The radiographer should be trained in basic life
support (BLS) for healthcare providers. The Ameri- 18. (B) When the radiographer initially greets the
can Heart Association uses the acronym CAB, rep- patient, and as the diagnostic examination pro-
resenting circulation, airway, breathing to help gresses, the radiographer should be alert to the
individuals remember CPR step sequence. Com- patient’s appearance and condition, and any subse-
pressions should be about 100 per minute, begin- quent changes in them. These are referred to as
ning with 30 compressions. After 30 compressions, objective signs. It is important to notice the color,
airway should be established using the head-tilt, temperature, and moistness of the patient’s skin.

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 18 1: Patient Care and Education

Paleness frequently indicates weakness; the diapho- 22. (D) The imaging examination requisition is usu-
retic patient has pale, cool skin. The febrile patient ally printed with the patient’s personal information
is usually feverish and exhibits hot, dry skin. (name, address, age, referring/admitting physician’s
“Sweaty” palms may indicate anxiety. A patient name, and the patient’s hospital identification num-
who becomes cyanotic (bluish lips, mucous mem- ber). When examining patients who are admitted
branes, or nail beds) needs oxygen and requires to the hospital, the requisition should also include
immediate medical attention. the patient’s mode of travel to the radiology depart-
ment or other imaging facility (e.g., wheelchair vs.
19. (D) Misunderstandings between cultures can stretcher), the type of examination to be performed,
occur as a result of the use of gestures, which have pertinent diagnostic information, and any infection
different meanings in different countries. In the control or isolation information. The radiographer,
United States and Europe, the “thumbs up” gesture having access to confidential patient information,
has a positive implication. However, it is consid- must be mindful of compliance with HIPAA
ered rude in ­Australia and obscene in the Middle regulations.
East. Other examples of potentially misunderstood
gestures include: if you compliment a Mexican 23. (B) Quantities of medication can be dispensed
child, you must touch the head, while in Asia it is intravenously over a period of time via an IV
not acceptable to touch the head of a child; in the infusion. A special infusion pump may be used to
Philippines, it is rude to beckon with the index fin- precisely regulate the quantity received by the
ger; furthermore, in the United States, people are patient. An IV push refers to a rapid injection; the
comfortable speaking about 18 in apart, while in term bolus refers to the quantity of material being
the Middle East, p ­ eople stand much closer together injected. The term hypodermic refers to adminis-
when they talk; in England, people stand further tration of medication by any route other than
apart. oral.

20. (C) The legal doctrine res ipsa loquitur relates to a 24. (D) The patient’s rights can be exercised on the
thing or matter that speaks for itself. For instance, if patient’s behalf by a designated surrogate or proxy
a patient went into the hospital to have a kidney decision maker if the patient lacks decision-
stone removed and ended up with an appendec- making capacity, is legally incompetent, or is a
tomy, that speaks for itself, and negligence can be minor. Many people believe that potential legal
proven. Respondeat superior is a phrase meaning and ethical issues can be avoided by creating an
“let the master answer” or “the one ruling is respon- advance healthcare directive or living will. Since all
sible.” If a radiographer were negligent, there may be persons have the right to make decisions regarding
an attempt to prove that the radiologist was respon- their own health care, this legal document pre-
sible because the radiologist oversees the radiogra- serves that right in the event an individual is una-
pher. Res judicata means a thing or matter settled by ble to make those decisions. An advance healthcare
justice. Stare decisis refers to a matter settled by directive, or living will, names the healthcare proxy
precedent. authorized to make all healthcare decisions and
can include specifics regarding DNR (Do not
21. (D) Medical equipment that could contain latex resuscitate), DNI (Do not intubate), and/or other
includes disposable gloves, tourniquets, blood pres- end-of-life decisions.
sure cuffs, stethoscopes, IV tubing, oral and nasal
airways, enema tips, endotracheal tubes, syringes, 25. (B) A fomite is an inanimate object that has been
electrode pads, catheters, wound drains, and injec- in contact with an infectious microorganism. A
tion ports. It should be noted that when powdered reservoir is a site where an infectious organism can
latex gloves are changed, latex protein/powder par- remain alive and from which transmission can
ticles get into the air, where they can be inhaled and occur. Although an inanimate object can be a res-
come in contact with body membranes. Studies ervoir for infection, living objects (such as humans)
have indicated that when unpowdered gloves are also can be reservoirs. For infection to spread,
worn, there are extremely low levels of the allergy- there must be a host environment. Although an
producing proteins present. inanimate object may serve as a temporary host

MCGH356-Ch01_p001-036.indd 18 18/09/15 10:31 AM

 Answers: 19–32 19

where microbes can grow, microbes flourish on soap and water, except when there is visible soiling or
and in the human host, where there are plenty of after caring for a patient with ­Clostridium difficile
body fluids and tissues to nourish and feed the infection.
microbes. A vector is an animal host of an infec-
tious organism that transmits the infection via bite 29. (D) Rules of good body mechanics include: when
or sting. carrying a heavy object, hold it close to the body;
the back should be kept straight; avoid twisting
26. (B) There are four stages of infection. In the initial when lifting an object; bend the knees and use leg
phase, the latent period, the infection is introduced and abdominal muscles to lift (rather than the back
and lies dormant. As soon as the microbes begin muscles); whenever possible, push or roll heavy
to shed, the infection becomes communicable. objects (rather than lifting or pulling). To transfer
The microbes reproduce (during the incubation the patient with maximum safety, the radiographer
period), and during the actual disease period, must correctly use certain concepts of body
signs and symptoms of the infection may begin. mechanics. First, a broad base of support lends
The infection is most active and communicable at greater stability; therefore, the radiographer should
this point. As the patient fights off the infection and stand with his or her feet approximately 12 inches
the symptoms regress, the convalescent (recovery) apart and with one foot slightly forward. Second,
phase occurs. stability is achieved when the body’s center of grav-
ity (center of the pelvis) is positioned over its base
27. (C) Dyspnea (difficulty breathing) can precede a of support. For example, leaning away from the
respiratory arrest event. Dyspnea can be caused by central axis of the body makes the body more vul-
an aspirated foreign object, injury to the chest, nerable to losing balance; if the feet are close
tongue obstruction of airway in unresponsive per- together, balance is even more difficult to
son, drug overdose, etc. Dyspnea caused by a par- maintain.
tially obstructed airway can manifest itself in the
patient by wheezing, noisy/labored breathing, cya- 30. (C) When caring for a patient with an indwelling
nosis of the nailbeds and lips, distention of the neck Foley catheter, place the drainage bag and tubing
veins, and anxiety. The radiographer should not leave below the level of the bladder to maintain the grav-
the patient alone, should call for assistance, assist the ity flow of urine. Placement of the tubing or bag
patient to a seated or semi-Fowler position, and pre- above or level with the bladder will allow backflow
pare to assist with emergency treatment. of urine into the bladder. This reflux of urine can
increase the chance of developing a urinary tract
28. (D) Today we know that the most important precau- infection (UTI).
tion in the practice of aseptic technique is proper hand
hygiene. The radiographer’s hands should be thor- 31. (B) When transferring patients, always help the
oughly washed with soap and warm running water patient transfer toward the strong side. That is, begin
for at least 15 seconds before and after each patient with the stronger side closer to the x-ray table. Be
examination, or by using an alcohol sanitizer. If the certain that the wheels of stretchers and wheelchairs
faucet cannot be operated with the knee, it should be are locked during transfer. A two-person lift is not
opened and closed using paper towels (to avoid con- always necessary; most patients can transfer with
tamination of or by the faucet). The radiographer’s the careful assistance of the radiographer. When
uniform should not touch the sink. The hands and assisting a patient in changing, first remove clothing
forearms should always be kept lower than the from the unaffected side. If this is done, removing
elbows; care should be taken to wash all surfaces and clothing from the affected side will require less move-
between fingers. Hand lotions should be used to pre- ment and effort.
vent hands from chapping; broken skin permits the
entry of microorganisms. Disinfectants, antiseptics, 32. (B) Nonionic, low-osmolality iodinated contrast
and germicides are substances used to kill pathogenic agents are associated with far fewer side effects
bacteria; they are frequently used in hand hygiene and reactions than ionic, higher osmolality con-
substances. Alcohol-based hand sensitizers have been trast agents. A side effect is an effect that is unin-
recommended as an alternative to handwashing with tended but possibly expected and fundamentally

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 20 1: Patient Care and Education

not harmful. An adverse reaction is a harmful wheelchair, once the patient is seated, the footrests
unintended effect that can be immediate or should be lowered into place for the patient’s
delayed. Possible side effects of iodinated contrast comfort.
agents include a warm, flushed feeling, a metallic
taste in the mouth, nausea, headache, and pain at 37. (A) Dr. Elizabeth Kubler-Ross explains that loss
the injection site. Adverse reactions include itch- requires gradual adjustment and involves several
ing, anxiety, rash or hives, vomiting, sneezing, steps. The first is denial or isolation, where the
dyspnea, and hypotension. individual often refuses to accept the thought of
loss or death. The second step is anger, as the indi-
33. (C) The normal blood pressure range for adult vidual attempts to deal with feelings of helpless-
men and women is a 90 to 120 mm Hg systolic ness. The next is bargaining, in which the patient
reading (left number) and a 50 to 70 mm Hg dias- behaves as though “being good” like a “good
tolic reading (right number). Systolic pressure is patient” will be rewarded by a miraculous cure or
the contraction phase of the left ventricle, and dias- return of the loss. Once the individual acknowl-
tolic pressure is the relaxation phase in the heart edges that this is not likely to happen, depression is
cycle. Therefore, in the blood pressure reading the next step. This depression precedes acceptance,
145/75, the systolic pressure of 145 is higher than where the individual begins to deal with fate or
desirable, and the diastolic pressure of 75 is also loss.
higher than desirable. Systolic pressure consistently
above 140 and diastolic pressure consistently above 38. (D) An unconscious patient frequently is able to
90 is considered hypertension. hear and understand all that is going on, even
though he or she is unable to respond. Therefore,
34. (C) Facsimile transmission of health information while performing the examination, the radiogra-
is convenient but should be used only to address pher always should refer to the patient by name
immediate and urgent patient needs—and every and take care to continually explain what is being
precaution must be taken to ensure its confidenti- done and reassure the patient.
ality. It should be used only with prior patient
authorization, when urgently needed for patient 39. (C) Cathartics stimulate defecation and are used
care, or when required for third-party payer in preparation for radiologic examinations of the
­ongoing hospitalization certification. These recom- large bowel. Diuretics are used to promote urine
mendations are made by the American Health elimination in individuals whose tissues are retain-
Information Management Association (AHIMA). ing excessive fluid. Emetics induce vomiting, and
antitussives are used to inhibit coughing.
35. (C) Verbal defamation of another, or slander, is a
type of intentional misconduct. Invasion of pri- 40. (B) Healthcare-associated infections (HAIs) are
vacy (i.e., public discussion of privileged and infections acquired by patients while they are in
confidential information) is intentional miscon- the hospital; they are also termed nosocomial infec-
duct. However, if a radiographer leaves a weak tions. Many of these infections are acquired by
patient standing alone to check images or get patients whose resistance has been diminished by
supplies and that patient falls and sustains an their illness and are unrelated to the condition for
injury, that would be considered unintentional which the patients were hospitalized. Infection
misconduct, or negligence. resulting from physician intervention is termed
iatrogenic. The CDC estimates that from 5% to 15%
36. (B) When helping a patient out of a wheelchair, it of all hospital patients acquire some type of HAI.
must first be locked. Then, the footrests must be Hospital personnel can also become infected
moved up and aside to prevent the patient from (occupationally acquired infection).
tripping over them or tilting the wheelchair for- Individuals weakened by illness or disease are
ward. The wheelchair should be placed at a more susceptible to infection than are healthy indi-
45-degree angle with the x-ray table or bed, with viduals. The most common HAI is the urinary tract
the patient’s stronger side closest toward the x-ray infection (UTI), often related to the use of urinary
table or bed. When returning the patient to the catheters, which can allow passage of pathogens into

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 Answers: 33–47 21

the patient’s body. Other types of HAIs include sep- temperatures. This makes injection much more
sis, wound infection, and respiratory tract infection. difficult. Warming the contrast medium to body
These are often attributable to methicillin-resistant temperature serves to reduce viscosity. This may be
Staphylococcus aureus (MRSA) and vancomycin- achieved by placing the vial in warm water or put-
resistant enterococci (VRE). ting it into a special warming oven.
Droplet and airborne identify types of
t­ ransmission-based precautions. 45. (B) Cardiogenic shock is related to cardiac failure
and results from interference with heart function.
41. (D) Medications can be administered in a number It can occur in cases of cardiac tamponade,
of ways. Parenteral administration refers to drugs pulmonary embolus, or myocardial infarction.
­
administered via intramuscular, subcutaneous, IV, Hypovolemic shock is related to loss of large
or intrathecal routes—that is, any way other than amounts of blood, either from internal bleeding or
by mouth. Intramuscular drug injections usually from hemorrhage associated with trauma. Neuro-
require that the needle form a 90-degree angle of genic shock is associated with the pooling of blood
injection. For subcutaneous injections, the needle in the peripheral vessels. This occurs in cases of
should form a 45-degree angle. Intravenous injec- trauma to the central nervous system that results in
tions generally require that the needle form about a decreased arterial resistance and pooling of blood
15-degree angle with the arm. in peripheral vessels. Septic shock, along with ana-
phylactic shock, generally is classified as vasogenic
42. (C) Ethnocentrism is the belief that one’s personal shock.
experience and perception of the world is superior
to the experiences and perceptions of others, that 46. (D) The Joint Commission (formerly the Joint
is, the belief that one’s own cultural ways are supe- Commission on the Accreditation of Health-care
rior to any other. Ethnocentrism can be found in all Organizations [JCAHO]) is the organization that
cultures and is the most significant barrier to good accredits healthcare organizations in the United
communication. Ethnology is the comparative States. The Joint Commission sets forth certain
study of various cultures. Ethnobiology is the study standards for medical records, both written and
of biological characteristics of various races. Eth- electronic. In keeping with these standards, all
nography is the study of a single society’s culture. diagnostic and therapeutic orders must appear in
the patient’s medical record or chart. In addition,
43. (D) Most institutions now have computerized, patient identification information, medical his-
paperless systems for patient information trans- tory, consent forms, and any diagnostic and thera-
mittal; these systems must ensure confidentiality in peutic reports should be part of the patient’s
compliance with Health Insurance Portability and permanent record. The patient’s chart is a means
Accountability Act (HIPAA) of 1996 regulations. of communication between various healthcare
Only healthcare professionals having been trained in providers. ­
HIPAA compliance may have access to the comput-
erized system via personal password, thus helping 47. (B) Category-specific isolations have been replaced
ensure confidentiality of patient information. by transmission-based precautions: airborne, drop-
Computer files containing patient information let, and contact. Under these guidelines, some con-
must be encrypted. If authorization for release of ditions or diseases can fall into more than one
medical information is given, a copy of that author- category. Airborne precautions are employed with
ization must be kept on file. All medical records patients suspected or known to be infected with
and other individually identifiable health informa- tubercle bacillus (TB), chickenpox (varicella), or
tion, whether electronic, on paper, or oral, are cov- measles (rubeola). Airborne precautions require
ered by HIPAA legislation and by subsequent that the patient wear a string mask to avoid the
Department of Health and Human Services (HHS) spread of bronchial secretions or other pathogens
rules that took effect in April of 2001. during coughing. If the patient is unable or unwill-
ing to wear a mask, the radiographer must wear
44. (A) Iodinated contrast material can become some- one, and for a patient in airborne precautions that
what viscous (i.e., thick and sticky) at normal room would be an N95 particulate respirator mask. The

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 22 1: Patient Care and Education

radiographer should wear gloves, but a gown is unspoken/nonverbal communication. Facial expres-
required only if flagrant contamination is likely. sion can convey caring and reassurance or impa-
Patients under airborne precautions require a pri- tience and disapproval. Pursed lips, pointed fingers,
vate, ­specially ventilated (negative-pressure) room. A frowns, and hands on hips all indicate disapproval.
private room is also indicated for all patients on Similarly, a radiographer’s touch can convey his or
droplet precautions, that is, with diseases transmit- her commitment to considerate care, or it can convey
ted via large droplets expelled from the patient while a rough, uncaring, hurried attitude. Making eye con-
speaking, sneezing, or coughing. The pathogenic tact while speaking is generally considered polite and
droplets can infect others when they come in con- respectful in the United States, whereas it can be con-
tact with mouth or nasal mucosa or conjunctiva. sidered just the opposite in other cultures (e.g.,
Rubella (“German measles”), mumps, and influenza Asian, East Indian, Native American). Our appear-
are among the diseases spread by droplet contact; a ance gives an impression about how we feel about
­private room is required for the patient, and health- our work and our patients; it is very much a part of
care practitioners should wear a string mask and communication and we should strive for a profes-
may also wear gown and gloves as needed. Any dis- sional appearance/image.
eases spread by direct or close contact, such as
MRSA, conjunctivitis, and hepatitis A, require 50. (B) Many microorganisms can remain infectious
­contact precautions. Contact precautions require a while awaiting transmission to another host. A
private patient room and the use of gloves, gown, contaminated inanimate object such as a food uten-
and sometimes a mask for anyone coming in direct sil, doorknob, or IV pole is referred to as a fomite. A
contact with the infected individual or his or her vector is an insect or animal carrier of infectious
environment. organisms, such as a rabid animal, a mosquito that
carries malaria, or a mouse/deer tick that carries
48. (A) Informed consent is required for procedures Lyme disease. They can transmit disease through
that involve risk; many imaging procedures require either direct or indirect contact.
signed consent. Informed consent is also required
for procedures that are considered experimental, 51. (B) A circumstance in which both the healthcare
or for any research in which the patient is partici- provider’s and the patient’s actions contribute to an
pating. The consent form must be complete prior to injurious outcome is termed contributory negli-
being signed; there should be no blank spaces on gence. An example would be a patient who fails to
the consent form when the patient signs it. The follow the physician’s orders or fails to show up for
patient must sign the consent form before receiv- follow-up care and then sues when the condition
ing sedation. The physician named on the consent causes permanent damage. Another example would
form must perform the procedure; no other physi- be a patient who deliberately gives false informa-
cian should perform it. In the case of a minor, a tion about the ingestion of drugs, leading to adverse
parent or guardian is required to sign the form. If a effects from medications administered. Most states
patient is not competent, then the legally appointed do not completely dismiss injury if there has been
guardian must sign the consent form. Remember negligence on the part of the healthcare institution,
that obtaining consent is the physician’s responsi- even if the patient’s actions contributed substan-
bility, so the explanation of the procedural risks tially to the injury. Rather, comparative negligence is
should be performed by the physician, not by the applied, where the percentage of the injury owing
radiographer. The informed consent can be revoked to the patient’s actions is compared with the total
by the patient at any time. amount of injury. A jury may decide that a physi-
cian was negligent in his or her actions, but because
49. (D) The importance of effective and professional the patient lied about using an illegal street drug
patient communication skills cannot be overempha- that contributed to the injurious outcome, the
sized; the interaction between the patient and radi- patient is 80% responsible for his or her condition.
ographer generally leaves the patient with a lasting The party suing may be awarded $100,000 for inju-
impression of his or her healthcare experience. Of ries but actually would receive only $20,000. Gross
course, communication refers not only to the spoken negligence occurs when there is willful or deliberate
word (i.e., verbal communication) but also to neglect of the patient. Assault, battery, invasion of

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 Answers: 48–59 23

privacy, false imprisonment, and defamation of high-density barium. The patient then may be asked
character all fall under the category of intentional to roll in the recumbent position in order to coat the
misconduct. gastric mucosa while the carbon dioxide expands.
This procedure provides optimal visualization of
52. (C) Extravasation of contrast media into sur- the gastric walls. Although a double-­contrast BE
rounding tissue is potentially very painful. If it uses a negative contrast agent, it is not ingested but
does occur, the needle should be removed and the rather is delivered rectally. An oral cholecystogram
extravasation cared for immediately (before look- can be performed approximately 3  hours after
ing for another vein). First, pressure should be ingestion of special ipodate calcium granules. An
applied to the vein until bleeding stops. Applica- IVU requires an IV injection of iodinated contrast
tion of a cold pack to the affected area helps to medium.
relieve pain, and elevate the part. Application of a
warm towel at the injection site can hasten absorp- 58. (C) Category-specific isolations have been replaced
tion of any contrast medium. by transmission-based precautions: airborne, droplet,
and contact. Under these guidelines, some condi-
53. (D) The normal blood pressure range for adult men tions or diseases can fall into more than one category.
and women is a 90 to 120 mm Hg systolic reading Airborne precautions are employed with patients sus-
(left number) and a 50 to 70 mm Hg diastolic reading pected or known to be infected with tubercle bacillus
(right number). Systolic pressure is the contraction (TB), chickenpox (varicella), or measles (rubeola).
phase of the left ventricle, and diastolic pressure is Airborne precautions require that the patient wear a
the relaxation phase in the heart cycle. Systolic pres- string mask to avoid the spread of bronchial secre-
sure consistently above 140 and diastolic pressure tions or other pathogens during coughing. If the
consistently above 90 is considered hypertension. patient is unable or unwilling to wear a mask,
the radiographer must wear a string mask to avoid
54. (D) When moving heavy objects, there are several the spread of bronchial secretions or other patho-
rules that will reduce back strain. When carrying a gens during coughing. The radiographer should
heavy object, hold it close to your body. Your back wear gloves, but a gown is required only if flagrant
should be kept straight; avoid twisting. When lifting contamination is likely. Patients under airborne pre-
an object, bend at the knees and use leg and abdom- cautions require a private, specially ventilated (nega-
inal muscles to lift (rather than your back muscles). tive-pressure) room. A private room is also indicated
Whenever possible, push or roll heavy objects (i.e., for all patients on droplet precautions, that is, with
mobile unit), rather than pulling or lifting. diseases transmitted via large droplets expelled from
the patient while speaking, sneezing, or coughing.
55. (D) None of the statements in the question is false; The pathogenic droplets can infect others when they
all are true. Oxygen is classified as a drug and must be come in contact with mouth or nasal mucosa or con-
prescribed by a physician. The rate and mode of junctiva. Rubella (“German measles”), mumps, and
delivery of oxygen must be specified in the physician’s influenza are among the diseases spread by droplet
orders. It can be ordered to be delivered continuously contact; a private room is required for the patient, and
or as needed. healthcare practitioners should wear a string mask if
within 3 ft of patient. Any diseases spread by direct
56. (A) It is unlikely that the radiographer will be or close contact, such as methicillin-resistant Staphy-
faced with a wound hemorrhage because bleeding lococcus aureus (MRSA), conjunctivitis, and Rotavi-
from wounds is controlled before the patient is rus, require contact precautions. Contact precautions
seen for x-ray examination. However, if a patient require a private patient room and the use of gloves
does experience hemorrhaging from a wound, you and gowns for anyone coming in direct contact with
should apply pressure to the bleeding site and call the infected individual or his or her environment.
for assistance. Delay can lead to serious blood loss.
59. (D) Medications can be administered in a number
57. (B) A double-contrast GI examination requires that of ways: orally, sublingually, topically, and paren-
the patient ingest gas-producing powder, crystals, tally. Oral denotes delivery by mouth (e.g., analge-
pills, or beverage followed by a small amount of sics, etc.). Sublingual refers to medication placed

MCGH356-Ch01_p001-036.indd 23 18/09/15 10:31 AM