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

Accepted Answer

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

Accepted Answer

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

Accepted Answer

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.

Accepted Answer

The Seldinger technique uses a hollow needle and guidewire to obtain vessel access for percutaneous procedures.The steps include inserting a needle; placing the needle in the lumen of the vessel (the inner cannula is removed); inserting the guidewire; removing the needle (the guidewire remains in place); threading the catheter over the guidewire; and removing the guidewire.

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!"

Accepted Answer

Most contrast reactions are mild and include,nasal congestion,sneezing,scratchy throat,nausea with or without vomiting,headache,dizziness,and mild hypertension that resolves spontaneously.

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

Accepted Answer

The team ensures the patient is positioned as far from the X-ray tube and as close to the image intensifier as possible for optimal image quality and minimal radiation dose.

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.

Accepted Answer

Angioplasty is a nonsurgical means to open atherosclerotic vessels using fluoroscopy guidance to inflate a balloon-tipped catheter compressing atherosclerotic plaque.Peripheral angioplasty refers to vessels outside the coronary and cerebral vasculature,most notably the aortoiliac,infrapopliteal,superior femoral artery (SFA),and other lower extremity vessels.Indications for peripheral angioplasty include lifestyle-limiting claudication,chronic leg ischemia,restenosis of a previous graft anastomoses,treatment pre- or post-bypass surgery,tissue ulceration,and necrosis.After establishing vessel access,the patient receives heparin to achieve the desired anticoagulation status.The surgeon advances the appropriate guidewire across the stenosis or occlusion and positions the balloon catheter in the affected area using radiopaque markers and fluoroscopy.The balloon is inflated with a mixture of sterile saline and contrast medium to a specific atmosphere of pressure.

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.

Accepted Answer

A pigtail catheter delivers a larger amount of contrast medium because of additional side holes,compared to a catheter with one end hole.

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

Accepted Answer

Balloon-occluded retrograde transvenous obliteration (BRTO)is a safe and effective interventional procedure for treating GV and reducing the risk of rebleeding by obliterating the gastric varix using direct sclerotherapy.The clinical indications for BRTO are impending,prior,or active gastric variceal bleeding and GV with hepatic encephalopathy refractory to medical management.

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

Accepted Answer

Radiographic contrast is administered by a handheld syringe or a power injector.A power injector allows the operator to bolus contrast media at a rapid preset flow rate,triggered by a hand or foot switch.The physician selects the quantity,type of contrast media,dilution,and injection rate.Location of the power injectors is either free standing or table mounted.

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

Accepted Answer

Sheaths protect the puncture site and vessel from damage and increase patient comfort during multiple sheath and dilator exchanges.Sheaths have a valved end to prevent backflow of arterial blood and a side arm to infuse heparinized saline solution.

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

Accepted Answer

GBCM administered to patients with acute kidney injury or severe chronic kidney disease can result in a syndrome of nephrogenic systemic fibrosis (NSF).NSF is a fibrosing disease primarily of the skin and subcutaneous tissues but also involves the lung,esophagus,heart,and skeletal muscles.Initial symptoms develop rapidly and include skin thickening and or pruritus.

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.

Accepted Answer

The physician flushes the catheters frequently,usually after removing the wire and every few minutes when in the vessel and again on removal,to reduce the incidence of thrombus.Interventional procedures require pressure bags with heparinized normal saline,high-pressure tubing,connectors,and three-way stopcocks and manifolds within the flush line for the drawing up and discard of flush,contrast medium,or blood.

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

Accepted Answer

Strategies that will reduce exposure risk to the patient include changing the beam's entry point to reduce repeated exposure to the same area,ensuring proper dosing protocols are in place,keeping extremities out of the beam,maximizing the distance between the X-ray tube and patient,minimizing the distance between the patient and image receptor,minimizing fluoroscopy time,using last-image-hold and stored fluoroscopic image settings to review findings,using collimation to the fullest extent,and considering the use of other diagnostic technologies.

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.

Accepted Answer

The incidence of CIN is negligible with normal renal function but increases 4% to 11% with mild-to-moderate insufficiency alone,defined as a plasma creatinine 1.5 to 4 mg/L.The incidence rises to 9% to 38% with diabetes,and more than 40% in patients with advanced renal dysfunction,marked volume depletion,advanced heart failure,or multiple contrast studies within a 72-hour period; and more than 50% if baseline plasma creatinine exceeds 4 mg/dL,particularly in patients with diabetic neuropathy.

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.

Accepted Answer

A biplane configuration has two C-arms-one on the ceiling and one on the floor.Biplane,as the name suggests,acquires images from two reference points at the same time.Clinical settings for biplane imaging include neuroangiography,congenital and/or structural cardiac abnormalities,and complex electrophysiology (EP)mapping procedures.

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.

Accepted Answer

Contrast media are substances used to enhance the visibility of blood vessels,fluid,and other structures.Contrast agent classification is by effect,either positive or negative.A negative contrast agent is a substance with a lower density than the body tissues being investigated (e.g.,carbon dioxide,air).A positive contrast agent has a higher density than the body tissue being investigated (e.g.,iodine-based contrast media,barium sulfate,and gadolinium).

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.

Accepted Answer

Before the procedure,the patient should be instructed to report any burning,stinging,swelling,or tight feeling that occurs with the injection of the contrast agent.There should be a close follow-up for any extravasation,because the initial evaluation may not reveal the extent of the problem.Treatment includes limb elevation and warm or cold compresses as per the physician.It may take up to 2 weeks for tissue damage,discoloration,blistering,and sloughing to occur following extravasation.Compartment syndrome is often identifiable within 24 hours.Symptoms include coolness in the extremity and continuing swelling after the initial extravasation.Loss of pulses is a medical emergency,requiring a fasciotomy.

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

Accepted Answer

The three major principles inherent to ALARA are:
1.Time: Minimizing the time of exposure directly reduces radiation dose.Minimizing the time of exposure (also known as "on beam" time)directly reduces radiation dose to the patient as well as the staff exposure to scatter radiation.
2.Distance: The intensity and dose of radiation decreases dramatically as one increases the distance from the source.
3.Shielding: Barriers of lead,or absorber materials such as Plexiglas,concrete,or water provide protection from penetrating radiation.Therefore,inserting the proper shield between the person and a radiation source will greatly reduce or eliminate the dose of radiation.The procedure team ensures the patient is positioned as far from the X-ray tube and as close to the image intensifier as possible.

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

Accepted Answer

Personnel radiation monitoring is an important part of radiation safety.Personal radiation dosimeters are worn on the trunk (under the apron)and at the collar level (outside the apron)to measure exposure.These dosimeters should not be left on aprons,because this would cause inaccurate readings when an apron is worn by another user.

Quiz 29: Interventional and Image-Guided Procedures

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

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?

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

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.

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

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.

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?

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

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?

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?

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.

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?

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

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

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.

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?

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.