Deck 28: Interventional Radiology

Question 1

Shielding is the third method of protection.Lead aprons with a minimum of 0.5 mm of lead and a thyroid shield are used to reduce radiation exposure and should be worn by staff for protection.The patient should be shielded as well,if appropriate,when the lead shield will not interfere with the area being imaged.Select the statement regarding patient shielding that is true.

A) All patient body parts should be covered with lead.
B) Lead shields should be placed under and above the patient in case the C-arm is turned.
C) All body parts not being imaged should be out of the field of view during fluoroscopy.
D) The patient should wear leaded glasses to prevent the eyes from cataract development.

Answer 1

C
Patient shielding should be considered.All patient body parts not being imaged (e.g.,hands)should be out of the field of view during fluoroscopy.

Question 2

An interventional radiology procedure for the correction of a blocked or narrowed blood vessel is a(n):

A) angiogram.
B) arterial embolization.
C) biliary stenting.
D) balloon angioplasty.

Answer 2

D
Balloon angioplasty:Opens blocked or narrowed blood vessels by inserting a very small balloon into the vessel and inflating it.Used by IRs to unblock arteries in the legs or arms,kidneys,brain,or elsewhere in the body.Angiography:An x-ray exam of the arteries and veins to diagnose blockages and other blood vessel problems.Biliary drainage and stenting:Uses a stent (small mesh tube)to open blocked ducts and allow bile to drain from the liver.

Question 3

A diagnostic or therapeutic radiology procedure may necessitate the administration of heparin or other anticoagulant or antiplatelet medications (e.g.,aspirin,dipyridamole,ticlopidine)because vascular injury can lead to thrombus development.Heparin is often used to prevent acute thrombosis and ischemic episodes.What condition is a contraindication for the use of heparin?

A) A patient who is taking protamine sulfate
B) Hypersensitivity to heparin or excessive bleeding
C) Thrombolysis or angioplasty procedures
D) Sensitivity to the thrombin inhibitor bivalirudin

Answer 3

B
Heparin is contraindicated in the patient with heparin hypersensitivity or the patient with bleeding.Thrombocytopenia and heparin-induced thrombocytopenia (HIT)can develop.Aspirin or other antiplatelet drugs can be given to prevent embolic or ischemic events caused by coagulation problems.

Question 4

Select the diagnostic and interventional radiology procedure that is not classified as a vascular procedure.

A) Percutaneous nephrolithotomy
B) Carotid interventions
C) Portal hypertension management (TIPS)
D) Uterine artery embolization

Question 5

Contrast media-induced nephrotoxicity (CIN)can occur as a result of a physiologic change when a transient increase in blood flow is then followed by a longer period of decreased blood flow to the kidneys,after the administration of contrast media.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) Diabetic patients with concurrent use of nephrotoxic drugs and dehydration comprise the majority of patients with CIN.
D) Vasodilatation,toxic stress,and tubular necrosis are known contributing factors as cited by a recent study.

Question 6

What type(s)of devices,supplies,or agents are needed for procedures that are designed to occlude a vessel or aneurysm?

A) Coils
B) Embolic agents
C) Sclerosants
D) All of the options are correct.

Question 7

Distance is key to providing protection during fluoroscopy because radiation exposure follows the inverse square law.(For example,the exposure at 2 meters from the source will be only one fourth as much as the exposure at 1 meter's 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 8

A variety of specialty items are used for IR procedures.A Seldinger needle (18 gauge,2 3/4 inches)is commonly used for groin access.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 9

Reactions to contrast media can occur and the risk varies according to several patient and contrast-related factors.What is the single best predictor of a contrast-related reaction?

A) Allergy to shellfish
B) Allergy to iodine
C) Prior reaction to contrast media
D) A history of anaphylactoid reactions

Question 10

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 11

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 attenuating (absorbing) the x-ray beam either more than or less than the surrounding tissue.
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 12

The majority of serious reactions to contrast media occur immediately or within 20 minutes after the injection.Increased capillary permeability and constriction of bronchial smooth muscle cells are present.What 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 13

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 worn at all times
C) On the waist under the apron and the collar under the apron
D) On the trunk outside the apron and the neckline of the scrub shirt under the apron

Question 14

Some of the new complex interventional procedures may require prolonged fluoroscopic guidance in order to perform and complete the procedure.Select the procedure that requires prolonged fluoroscopic guidance.

A) Image-guided pin fixation of Colles' fracture
B) Vertebroplasty
C) Greenfield filter placement
D) Chemoembolization of a liver tumor

Question 15

Embolic materials induce mechanical obstruction within a vessel and formation of thrombus via platelet activation and activation of the patient's clotting mechanism.Select an appropriate clinical indication for an embolic procedure.

A) Inflammation of a vessel wall
B) Carotid artery obstruction
C) Renal stricture
D) Severe hemoptysis

Question 16

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

A) Staff should realize that some equipment sounds a warning alarm after 5 minutes.
B) Some equipment shows the fluoroscopy time elapsed on a digital screen so that it can be monitored.
C) Last-image-hold and loop-replay techniques may be used by the radiologist/technologist.
D) All of the options are correct.

Question 17

All staff members are responsible for patient and staff safety.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 18

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

A) To propel contrast agents and also emergency drugs into the arterial system
B) To ensure precise timing and rate of injection of contrast media
C) To provide torque to guide the catheter through stenosed vessels
D) To decrease the procedure and radiation exposure time for the patient

Question 19

Diagnostic and therapeutic procedures performed in a comprehensive cancer center interventional radiology department might include the injection of targeted antimetabolic drugs into the blood supply that feeds a tumor to block further blood flow and kill cancer cells.Select the appropriate procedure.

A) Transarterial placement of yttrium-90 microspheres (90Y)
B) Chemoembolization of the liver
C) Brachytherapy delivery
D) Tumor ablation with radiofrequency (RFA)/thermal,cryotherapy energy

Question 20

Small amounts of a thrombolytic drug can be instilled into portacaths and aspirated to ensure patency of the device.An example of a true statement regarding thrombolytics is:

A) thrombolytic drugs break down the fiber matrix of active plasmin.
B) there are no reported complications to thrombolytic drugs.
C) thrombolytic drugs work best on a fresh clot.
D) thrombolytic drugs convert plasminogen to fibrin.

Question 21

Extravasation occurs when contrast medium is injected into or leaks into soft tissue.It can cause tissue damage as a result 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 radiologist immediately when discovered.
D) Consult a surgeon if injury is significant.
E) Attempt to withdraw the contrast agent back through the catheter._ f.Elevate the affected limb.

Question 22

Karen Trainor is a perioperative nurse working in the interventional radiology suite as a sedation nurse.She is preparing to provide moderate procedural sedation to Aron Whitten,an ASA class III 52-year-old man,for an endoscopic retrograde cholangiopancreatography (ERCP).The radiologist will probably order midazolam and fentanyl for the patient.Karen has assessed the patient's health history,allergies,baseline vital signs,and lab results and has performed an airway assessment.Because Aron will be positioned on his anterolateral left side,he may inadvertently tilt more to the left,which can impede his airway.Karen is preparing for any airway emergency.What measures will she employ as a risk reduction strategy to prepare for extreme airway management?

A) Have available the bag-valve-mask ventilation equipment with oxygen.
B) Have reversal agents for benzodiazepines and narcotics available,drawn up and labeled.
C) Predocument default segments in the electronic record before the procedure.
D) Prelabel all specimen containers to save time and prevent inattention to the patient.
E) Check the airway cart for a laryngeal mask airway sized to fit Aron.f.Have the phone number available for the rapid response team and anesthesia support.

Question 23

Celeste Barney and Amanda Vail,two experienced perioperative nurses,are orienting two new surgical technology students to the orthopedic service for their 6-week clinical rotation.Today they are focusing on how to properly wear,care,and handle lead aprons and protective radiologic apparel.Of the list of orientation content topics,which are considered risk reduction strategies for protection from inadvertent radiation exposure?

A) Obtain assistive transfer devices and encourage staff to use them.
B) Wear lightest apron available that meets shielding requirements.
C) Place shielding around and under the patient to increase scatter radiation.
D) Use mobile x-ray barriers whenever possible to sequester the anesthesia provider.

Question 24

Most interventional radiology procedures are initiated with the Seldinger technique,which employs a guidewire fed through the lumen of a puncture needle inserted into a vessel.This is the essence of the catheter-based intervention used in such fields as interventional radiology and cardiology;it provides a less invasive and safer means of access to vessels.Number the steps of the Seldinger technique in the appropriate order.
a.Threading of catheter over guidewire
b.Placement of needle in lumen of vessel (inner cannula removed)
c.Removal of needle (guidewire remains in place)
d.Removal of guidewire
e.Insertion of needle
f.Insertion of guidewire