Deck 29: Interventional and Image-Guided Procedures

Question 1

Fluoroscopy time should be limited as much as possible.Which measures aid perioperative staff to limit the time of live fluoroscopy?

A) Sounding an audible warning alarm on fluoroscopy equipment after 5 minutes of fluoroscopy
B) Requiring nonessential team members to retreat to the control room during live imaging
C) Programming image-hold and loop-replay technique prior to imaging
D) Shutting off fluoroscopy equipment automatically after 5 minutes of continuous imaging

Answer 1

A
The U.S.Food and Drug Administration (FDA)requires that fluoroscopy equipment produce an audible warning sound after 5 minutes of fluoroscopy.Other radiation reduction techniques and applications include beam collimation,pulsed versus continuous fluoroscopy,digital fluoroscopy imaging techniques,and specific dose-reduction protocols for computed tomography (CT)and fluoroscopy.

Question 2

Postpartum hemorrhage remains a common health problem and is the main cause of pregnancy-related maternal death worldwide.Which therapeutic intervention may be used postpartum hemorrhage?

A) Transarterial placement of microspheres
B) Chemoembolization
C) Brachytherapy delivery
D) Uterine artery embolization

Answer 2

D
Potential life-threatening hemorrhagic conditions amenable to embolization include abdominal and cervical pregnancy,placenta previa,and placenta accreta.UAE (Uterine Artery Embolization)is a bilateral catheterization of the internal iliacs and uterine arteries.This treatment preserves the uterus and patient fertility.

Question 3

Angiography uses fluoroscopy and contrast to image anatomic and pathologic changes in vascular anatomy.What is an example of coronary angiography?

A) Ventriculography
B) Peripherally inserted central catheter insertion
C) Balloon-occluded retrograde obliteration
D) Peripheral vascular stent placement

Answer 3

A
Classification of angiography is either coronary or noncoronary.The left ventriculogram,an integral part of nearly every coronary angiographic study,provides information on the motion of the walls of the heart.Only interventional cardiologists perform percutaneous coronary intervention (PCI).Noncoronary angiography procedures include peripherally inserted central catheters (PICCs),vascular access procedures,organ-based therapies using fluoroscopic guidance for biopsies,tumor ablations,and various embolizations.

Question 4

Most IR procedures are initiated with the Seldinger technique.The first step of the technique is placement of the needle in the vessel.Select the step below that is performed after the needle is placed in the lumen of the vessel.

A) Catheter is threaded over a guidewire.
B) Guidewire is inserted.
C) Needle is removed.
D) Dilator is inserted.

Question 5

Acute adverse reactions to iodinated and gadolinium containing contrast media can be either allergic-like or physiologic.Sound clinical judgment should be used to determine when and how aggressively an acute reaction should be treated,however,many mild reactions resolve during a period of observation without treatment.Which statement by the patient would alert you to the possibility that the patient was having a mild reaction to the contrast agent?

A) "I am having trouble breathing, and my heart is racing!"
B) "I feel dizzy, hot, kind of nauseated, and my nose is stuffy."
C) "I am having pain and tightness in my chest and shoulders."
D) "I am itchy all over and there are shooting pains in my IV arm!"

Question 6

Distance is key to providing protection during fluoroscopy,because radiation exposure follows the inverse square law.(e.g.,the exposure at 2 m from the source will be only one-fourth as much as the exposure at 1 m distance.)When positioning the patient relative to the fluoroscopy image intensifier/C-arm,the patient should be placed as far away from the _______________ and as close to the __________as possible for optimal image quality and minimum radiation dose to the patient's body.

A) fluoroscope; lead shield
B) image intensifier; X-ray tube
C) X-ray tube; image intensifier
D) beam; radiologist

Question 7

The IR procedure that is used to correct a blocked or narrowed blood vessel and restore flow is called:

A) angioplasty.
B) venoplasty.
C) venogram.
D) Seldinger technique.

Question 8

Catheters are available in a variety of lengths and shapes,each with a specific advantage.Select the true statement about a pigtail catheter that describes its indications for use.

A) It is a microcatheter with one hole used in neuroendovascular procedures.
B) It can be used for balloon angioplasty in biliary procedures.
C) It has an in-line air trap for pulmonary artery procedures.
D) It can deliver a large amount of contrast medium through its side holes.

Question 9

Gastric variceal (GV)bleeding is a major complication of portal hypertension and is associated with high morbidity and mortality.Which interventional procedure is used for treating GV?

A) Peripheral angioplasty
B) Balloon-occluded retrograde transvenous obliteration
C) Transjugular portosystemic shunt
D) Image-guided ablation

Question 10

What are the indications for using a power injector during an IR vascular procedure?

A) To propel contrast agents and emergency drugs into the arterial system
B) To bolus contrast media at a rapid preset flow rate
C) To provide torque to guide the catheter through stenosed vessels
D) To decrease the procedure and radiation exposure time for the patient

Question 11

Needles,guidewires,sheaths,catheters,and vascular closure devices are several specialty items used for IR procedures.A sheath is commonly inserted at the arterial or venous puncture site.What is the function of the sheath?

A) To protect the puncture site and vessel from damage
B) To dilate the vessel and prevent backflow
C) To prevent thromboembolism development
D) To hold the guidewire and catheter in place

Question 12

Reactions to gadolinium-based contrast are less frequent than those observed with iodinated contrast media and are usually mild and well tolerated.What potential severe reaction must the nurse be prepared for?

A) Paresthesia
B) Vessel occlusion
C) Nephrogenic systemic fibrosis
D) Pseudoaneurysm formation

Question 13

Thrombus formation often depends on the size of a catheter's outer diameter,with respect to the vessel's inner diameter and indwelling time.Select the best practice to prevent thrombus formation.

A) Instill heparinized saline through a high-speed injector.
B) Use heparinized normal saline in pressure bags and a flush line.
C) Instill thrombolytic drugs at first signs of a fresh clot.
D) Flush the catheter frequently through a high-volume pump.

Question 14

Some of the new complex interventional procedures may require prolonged fluoroscopic guidance to perform and complete the procedure.Which patient safety strategy will reduce exposure risk to the patient?

A) Total body shielding of the patient above and below the body
B) Changing the beam's entry point to reduce repeated exposure to the same area
C) Placing a dosimeter on the patient, both under and outside the lead patient shield
D) Increasing the pause between pulses when using pulse-mode fluoroscopy

Question 15

Contrast media-induced nephrotoxicity (CIN)results from administering intravascular radiographic contrast material.After the administration of contrast,a transient increase in blood flow is then followed by a longer period of decreased blood flow to the kidneys.Which statement best describes a true risk factor for CIN?

A) Biphasic renal flow has been shown to induce CIN.
B) Underlying renal insufficiency is believed to be a predictor of CIN.
C) Occasional nephrotoxic drug use and dehydration among diabetic patients comprise most patients with CIN.
D) Vasodilatation, toxic stress, and tubular necrosis are known contributing factors as cited by a recent study.

Question 16

The new neuroangiography interventional room has a biplane configuration.What is the correct description of a biplane configuration?

A) It has an elevated platform for conversion to cardiac angiography.
B) It has two C-arms-one on the ceiling and one on the floor.
C) It has three-dimensional fluoroscopy imaging.
D) It can acquire images from more than three reference points at the same time.

Question 17

Select the statement that correctly describes the mechanism of action of contrast media.

A) Contrast media are used to enhance visualization of anatomic structures by influencing tissue radiopacity with different concentrations of iodine.
B) A contrast agent works by having either a higher or lower density than the body tissue being investigated.
C) Contrast media radiopacity is related to its iodine concentration.
D) A contrast agent works by the speed of delivery affecting blood flow and hemodilution.

Question 18

Extravasation occurs when contrast medium is injected into or leaks into soft tissue.It can cause tissue damage because of the toxicity of the agent or through pressure (e.g.,compartment syndrome).Select all the appropriate corrective treatment actions.

A) Apply warm or cold compresses.
B) Apply anesthetic ointment or cream to affected area.
C) Alert the pharmacy immediately for a reversal neutralizing agent.
D) Consult a surgeon for fasciotomy if pulses are lost.
E) Attempt to withdraw the contrast agent back through the catheter.
F) Elevate the affected limb.

Question 19

The principle of ALARA,as low as reasonably achievable,is a protective measure designed to protect both patients and staff.What are the three principles of ALARA?

A) Time, distance, and shielding
B) Dose, rad, and rem
C) Time, dose, and depth
D) Scatter, leakage, and tissue density

Question 20

Personnel radiation monitoring is an important part of radiation exposure safety.Select the statement that best describes the proper placement of the personal radiation dosimeter.

A) On the trunk under the apron and at the collar level outside the apron
B) Attached to the facility identification badge and always worn
C) On the waist under the apron and the collar over the apron
D) On the trunk outside the apron and the neckline of the scrub shirt under the apron

Question 21

In the IR suite,the concomitant use of various imaging modalities creates a different environment and new dimension of patient care.Because IR is procedure based,it requires a higher standard of patient care than general radiology.The scope of IR nursing practice is diverse and includes which roles?

A) Patient education
B) Preprocedure planning
C) Calculating radiation dosimetry
D) Administering conscious sedation
E) Circulating