RADR 1309 Introduction to Radiography and Patient Care

Correct Answer:

B. Normal saline

Explanation of the Correct Answer:

When performing a barium enema (BE) on a patient with Hirschsprung disease, it is important to dilute the barium with normal saline. This is done to reduce the risk of complications, such as intestinal perforation or excessive irritation. In patients with Hirschsprung disease, the colon has areas of aganglionosis, meaning there are missing nerve cells, which affects normal bowel function. These patients often have a more sensitive and fragile colon, making them more susceptible to perforation or other complications during procedures. Mixing barium with normal saline helps make the contrast media less dense and easier to manage in the colon, reducing the risk of injury.

Why the Other Options Are Incorrect:

A. Flavor and coloring

Adding flavor and coloring to the barium solution is generally unnecessary for medical procedures, especially in serious conditions like Hirschsprung disease. The primary concern is the safety and effectiveness of the contrast media, not the taste or appearance.

C. Iodine contrast

Iodine contrast is typically used in imaging of the blood vessels (angiography) or in other areas like CT scans. It is not generally mixed with barium for a barium enema. The goal in Hirschsprung disease is to use the correct consistency of barium, and iodine contrast is not necessary for this purpose.

D. A gas-producing powder

While gas-producing powders (such as barium with carbon dioxide or air in some cases) are sometimes used in double-contrast barium enemas to provide better imaging of the colon’s mucosal lining, it is not typically mixed with the barium in patients with Hirschsprung disease. This could increase the risk of perforation or excessive distention in a colon that may already be compromised due to the disease.

Summary:

In patients with Hirschsprung disease, mixing barium with normal saline during a barium enema is a safer approach to minimize risks, such as perforation, due to the more fragile nature of the colon in these patients. The use of iodine contrast, flavor/coloring, or gas-producing powders is not indicated for this specific procedure.

Correct Answer:

B. High BUN and creatinine levels are associated with a low glomerular filtration rate (GFR).

Explanation of the Correct Answer:

When kidney function is impaired, the glomerular filtration rate (GFR) decreases, leading to the accumulation of waste products like creatinine and blood urea nitrogen (BUN) in the bloodstream. These elevated levels are indicative of reduced kidney function and often suggest that the kidneys are not filtering waste efficiently. A low GFR means the kidneys are not removing waste as effectively, and therefore, elevated levels of BUN and creatinine are typically seen in patients with impaired kidney function.

Why the Other Options Are Incorrect:

A. A high creatinine level is associated with a high glomerular filtration rate (GFR).

This statement is incorrect. A high creatinine level is usually associated with impaired kidney function, which leads to a low GFR. When kidney function is normal or high, creatinine levels are typically lower.

C. High blood urea nitrogen (BUN) and creatinine levels are indicators that iodine contrast media is acceptable for a patient.

This statement is incorrect. High levels of BUN and creatinine are often signs of kidney dysfunction, and this would actually raise concern when considering the use of iodine contrast media, as the kidneys are responsible for clearing the contrast media. For patients with elevated BUN and creatinine levels, caution is needed to avoid further kidney damage.

D. Lower-than-normal creatinine and blood urea nitrogen (BUN) levels indicate that the kidneys are filtering insufficient amounts of waste.

This statement is incorrect. Low levels of creatinine and BUN generally suggest good kidney function, as these waste products are being efficiently filtered out of the bloodstream. It would typically indicate that the kidneys are functioning well, not poorly.

Summary:

Elevated levels of creatinine and BUN are indicative of impaired kidney function, leading to a low GFR. This is an important consideration in evaluating a patient's ability to safely undergo procedures involving iodine contrast media, as the kidneys are responsible for eliminating the contrast from the body. Therefore, high BUN and creatinine levels suggest reduced kidney function, which can complicate the use of contrast media.

Correct Answer:

3. Avoid chewing gum

4. NPO for about 8-12 hours before the exam

5. Avoid smoking

Explanation of the Correct Answer:

3. Avoid chewing gum:

Chewing gum is often discouraged prior to an Upper GI exam because it can stimulate the production of gastric juices (stomach acid), which could interfere with the clarity of the images. It can also cause swallowed air, which might lead to unnecessary distension of the stomach and potentially obscure diagnostic results.

4. NPO for about 8-12 hours before the exam:

The patient is typically instructed to be NPO (nothing by mouth) for 8-12 hours before an Upper GI exam. This is important because it ensures that the stomach is empty, allowing for clear visualization of the upper gastrointestinal tract during the procedure. Food or liquid in the stomach can obstruct the view of the stomach lining and surrounding structures, compromising the quality of the imaging.

5. Avoid smoking:

Smoking should be avoided before an Upper GI exam because it stimulates the production of gastric acid, which can also interfere with the clarity of the exam and affect the stomach lining. Smoking might increase the risk of gastric reflux, which can lead to diagnostic confusion during the procedure.

Why the Other Options Are Incorrect:

1. Cleansing enema:

A cleansing enema is not typically part of the preparation for an Upper GI exam, as it is more commonly used for procedures like lower GI exams (e.g., barium enema or colonoscopies) that focus on the large intestine. For an Upper GI exam, the focus is on clearing the stomach and duodenum, not the entire colon.

2. NPO for 24 hours prior to the exam:

While the NPO period is important, 24 hours of fasting is generally excessive for an Upper GI exam. Most protocols recommend 8-12 hours of fasting, not 24 hours, as this is sufficient to ensure the stomach is empty and that the imaging is clear. 24 hours of fasting is more commonly required for procedures that involve more extensive bowel preparation or longer periods of digestion.

Summary:

For an Upper GI exam, the patient typically needs to avoid chewing gum, be NPO for 8-12 hours, and avoid smoking to ensure a clear and accurate study. Other factors, such as cleansing enemas and 24-hour fasting, are not usually required for this particular exam.

Correct Answer:

A. Non-ionic solutions contain molecules that do not break apart upon injection

Explanation of the Correct Answer:

The primary difference between ionic and non-ionic iodine contrast media is that non-ionic contrast media do not break apart into ions when injected into the body. Non-ionic solutions have a stable molecular structure that does not dissociate into charged particles (ions). This makes them less likely to cause adverse reactions compared to ionic contrast media, which dissociate into ions when injected, potentially leading to higher osmolarity and increased risk of toxicity.

Why the Other Options Are Incorrect:

B. Non-ionic solutions do not contain iodine: This is incorrect. Both ionic and non-ionic contrast media contain iodine. Iodine is the element responsible for the contrast properties of these media because of its high atomic number, which helps absorb x-rays.

C. Non-ionic solutions are considered more toxic to the body: This is incorrect. Non-ionic contrast media are actually considered less toxic than ionic contrast media. Non-ionic contrast media are associated with fewer side effects and a lower incidence of adverse reactions due to their lower osmolarity and their ability to stay stable in the body.

D. Non-ionic solutions are not water-soluble: This is incorrect. Non-ionic contrast media are water-soluble, just like ionic solutions. Water solubility is essential for the contrast media to be effective in the body and to be excreted through the kidneys after the procedure.

Summary:

The main difference between ionic and non-ionic iodine contrast media is that non-ionic solutions contain molecules that do not dissociate into ions upon injection, making them less likely to cause adverse reactions. Non-ionic contrast media are preferred for their reduced toxicity and better patient tolerance.

Correct Answer:

A) Teaching students primarily on a one-on-one basis in the clinical setting

Explanation of the Correct Answer:

A clinical instructor in radiologic technology plays a pivotal role in supervising students during their clinical training. This responsibility often involves direct, one-on-one instruction, where the instructor closely monitors the student's performance, provides feedback, and ensures that students are applying the skills and knowledge they learned in the classroom to real-world clinical scenarios. The clinical instructor’s primary role is to guide the student in a clinical environment, helping them develop hands-on proficiency.

Why the Other Options Are Incorrect:

B) Teaching students typically through classroom lectures and laboratory activities

This option describes the role of an academic or didactic instructor, not a clinical instructor. Didactic instructors are responsible for teaching in the classroom and laboratory, whereas clinical instructors focus on the practical application in a clinical setting.

C) Teaching responsibilities along with administrative duties in overseeing clinic education

While clinical instructors may have some administrative duties, their primary focus is teaching and mentoring students in clinical practice. Administrative responsibilities are generally handled by the clinical coordinator or program director.

D) Teaching responsibilities as well as overall administrative responsibility for the entire educational program

This is the role of the program director or clinical coordinator, who oversees the entire educational program. While the clinical instructor contributes to the education process, they are not typically responsible for the overall administration of the entire program.

Summary:

The clinical instructor in radiologic technology primarily teaches students in the clinical setting, providing one-on-one instruction, supervising their clinical tasks, and ensuring they gain hands-on experience essential for their professional development.

Correct Answer: A. Drink plenty of liquids to avoid a bowel obstruction from the residual barium.

Explanation of the Correct Answer:

A. Drink plenty of liquids to avoid a bowel obstruction from the residual barium:

After a barium sulfate contrast study, it is crucial for patients to drink plenty of fluids. This helps to flush out the residual barium from the gastrointestinal (GI) system and prevent any potential constipation or bowel obstruction that could result from the barium left in the intestines. Barium is not easily absorbed by the body, so it is important for patients to stay hydrated to encourage its excretion.

Why the Other Options Are Incorrect:

B. Patients should have Solu-Medrol (methylprednisolone) prescribed to them in case they have an allergic reaction to the contrast 8 hours after the exam:

Solu-Medrol (methylprednisolone) is a steroid that is not typically prescribed to prevent allergic reactions to barium sulfate. Although an allergic reaction to iodinated contrast media is possible, barium sulfate usually does not cause delayed reactions like this. Instead, patients who are at higher risk for contrast reactions would receive antihistamines or steroids if needed, but it would be specifically related to iodinated contrast media, not barium sulfate.

C. Patients should take nitroglycerin to dilate the structures of the gastrointestinal system:

Nitroglycerin is not used to dilate the gastrointestinal system in the context of a barium study. While nitroglycerin may be used in cardiac settings to dilate blood vessels, it is not typically indicated for GI motility or contrast studies. Dilating the GI tract is generally not necessary for barium exams.

D. Be sure to eat a fatty meal to increase motility of the digestive system:

After a barium study, a fatty meal is not specifically recommended for increasing motility of the GI tract. While fatty foods can increase gallbladder contraction and some gastrointestinal motility, eating a fatty meal is not necessary for barium excretion or for completing the study. Hydration and movement (such as walking) are more useful for encouraging the passage of the contrast.

Summary:

After a barium sulfate contrast study, the patient should drink plenty of liquids to help flush out the barium from the body and prevent complications like bowel obstruction. The other options are not typically indicated for managing barium sulfate studies or their side effects.

Correct Answer: B. Tracheotomy

Explanation of the Correct Answer:

B. Tracheotomy:

A tracheotomy is a surgical procedure in which an opening (stoma) is created in the trachea (windpipe) to allow for direct access to the airway. This procedure is often performed to bypass an obstruction, provide airway management, or support long-term ventilation for patients who are unable to breathe normally through their upper airways.

Why the Other Options Are Incorrect:

A. Cholecystectomy:

This procedure involves the removal of the gallbladder. It is unrelated to the trachea or any procedures involving the airway.

C. Gastrectomy:

A gastrectomy is a surgical procedure in which part or all of the stomach is removed. It is unrelated to the trachea and doesn't involve the creation of an opening in the windpipe.

D. Esophagealostomy:

This is not a commonly used term. However, it would suggest a surgical opening to the esophagus, not the trachea. The procedure would involve an opening into the esophagus, not the airway (trachea).

Summary:

A tracheotomy is the procedure that creates an opening into the trachea to facilitate breathing or airway management.

Correct Answer: C. A cathartic such as citrate of magnesia

Explanation of the Correct Answer:

After an upper GI series or other barium studies, a cathartic, such as citrate of magnesia, is often used to help eliminate the barium from the digestive system. Barium can be constipating, so it is essential to help the patient evacuate the barium to prevent it from hardening in the intestines. Citrate of magnesia is a common over-the-counter laxative that helps promote bowel movements and expel the barium from the gastrointestinal tract.

Why the Other Options Are Incorrect:

A. A clear liquid diet

While a clear liquid diet might be suggested before a procedure to ensure the stomach and intestines are empty, it is not typically part of the follow-up care after a barium study. After the study, the primary concern is eliminating the barium from the system rather than continuing a liquid-only diet.

B. Cleansing enemas

Cleansing enemas are generally used to evacuate the lower gastrointestinal tract before procedures like a colonoscopy or barium enema. They are not routinely used after an upper GI series to clear barium from the system. The primary concern after an upper GI study is facilitating the passage of barium from the stomach and small intestine, not the colon.

D. Glucagon

Glucagon is sometimes used to relax the muscles of the gastrointestinal tract during certain procedures (e.g., in cases of spasm or to reduce motility during imaging). However, it is not used in follow-up care after a barium study. The goal after the study is to expel the barium, which is better achieved through the use of a cathartic, not glucagon.

Summary:

After an upper GI series or other barium study, a cathartic such as citrate of magnesia is commonly used to help expel the barium from the digestive system, preventing constipation and discomfort. Other methods like a clear liquid diet, cleansing enemas, or glucagon are not typically required in follow-up care.

Correct Answer:

A. 0.8-1.2

Explanation of the Correct Answer:

The normal range for the international normalized ratio (INR) for reporting prothrombin time (PT) is typically 0.8-1.2. The INR is a standardized number that helps to measure the time it takes for blood to clot. It is commonly used to monitor patients on anticoagulant therapy, ensuring that the blood's clotting ability remains within a therapeutic range.

Why the Other Options Are Incorrect:

B. 1.5-2.0:

This range is commonly seen for patients who are on anticoagulant therapy, such as warfarin, but it is not considered the normal range. It is a therapeutic range used for patients being treated to reduce the risk of clotting.

C. 2.0-2.5:

This range is also a therapeutic range for patients undergoing anticoagulant therapy, particularly those at risk for thromboembolic events. It is above the normal range of 0.8-1.2.

D. 2.5-5.0:

This is a higher therapeutic range for patients on anticoagulation therapy, especially in cases where a more aggressive anticoagulant effect is desired (e.g., for patients with mechanical heart valves or certain clotting disorders).

Summary:

The normal range for INR is 0.8-1.2. Higher values are seen in patients on anticoagulant therapy, and the therapeutic range depends on the medical condition being treated.