Patient Care: Patient Interactions and Management (13%)

ARRT-N · 39 questions

• At shift start, three patients arrive on a medical unit: one with fever and cough being evaluated for pulmonary tuberculosis, one with a draining wound colonized with vancomycin-resistant enterococcus, and one who recently received an allogeneic hematopoietic stem-cell transplant. Which set of transmission-based and protective-environment precautions matches each patient?
• A patient checks in for a scheduled Tc-99m sestamibi parathyroid study, but the signed order lists the clinical indication as restaging of metastatic melanoma after therapy while the visit note documents workup of a suspected parathyroid adenoma. Department policy requires a confirmed patient identity and an order that matches the documented reason for care before dosing. Which verification sequence must be completed before any activity is drawn?
• A patient nods through the pre-scan explanation but then asks whether the injection will make them radioactive and what a tracer does. The technologist used terms like radiopharmaceutical, scintigraphy, and uptake throughout. Which communication technique would best confirm that the patient understands the explanation?
• Midway through a renal dynamic study, a competent inpatient says she wants the scan stopped. Her daughter at the bedside asks what the imaging has shown so far, and the patient says she is still waiting for the hospital's Patient Care Partnership brochure. Which response best protects her consent and confidentiality rights right now?
• A patient in the injection room begins to cry after learning the scan will run late and asks what happens next. Other patients are within earshot, the patient is upset, and the plan has to be clear enough to repeat back. Which combination of verbal and nonverbal communication meets all three needs?
• During a pharmacologic stress infusion the pump stops with an occlusion alarm while the patient feels well and the vitals hold steady. Policy here holds the infusion until the device is cleared, calls for your supervisor to be told right away, and requires the alarm code to be entered in the equipment log. Which response handles this infusion-pump malfunction while meeting all three rules?
• A patient scheduled for an outpatient scan asks two things at once: whether the radiation could harm family members at home and why the scan is worth that risk. Preparation and appointment instructions have already been covered in plain language. Which content completes this patient's education on radiation risk and scan benefit before the injection?
• After drawing a Tc-99m dose, the prep bench holds a used needle with a drop of blood, a gauze pad soiled with blood and radiopharmaceutical, and an absorbent pad that soaked up a spilled dose. Facility policy requires radioactive items to be held for decay-in-storage before disposal, with blood-contaminated items then disposed of as regulated medical waste. Which route for the needle, gauze, and absorbent pad follows policy?
• A 78-year-old with limited English and marked hearing loss, who reads lips only in her first language, arrives for a hepatobiliary scan with her daughter, who answers every question before the patient can reply. You need the history straight from the patient and must confirm that she understands the procedure. Which communication approach handles her language and hearing barriers while giving you an accurate history?
• An alert adult on the oncology unit is offered enrollment in a trial of an investigational radiopharmaceutical. The patient has an advance directive on file, holds a DNR order signed today, and asks whether declining will change the imaging already ordered. Which point should anchor the informed consent discussion?
• An elderly outpatient who uses a cane and has fallen twice in the past month stands up in the waiting room and reports light-headedness before a bone scan. The study needs the patient to walk to the camera and empty the bladder first. Which steps should the technologist take before any further standing or walking?
• During a scheduled study, a competent patient clearly tells the technologist to stop before the tracer is injected, but the team continues because the physician's order is already written. The patient finishes the study, is physically unharmed, and then complains to the department. Which legal concept best describes the violation that occurred?
• At the dose-calibration bench, a tech knocks over a bottle of solvent used to clean well-counter parts; the label is soaked through and the vapor is strong. The safety officer asks that cleanup follow the product's safety data sheet. Which SDS section should the responder consult to choose the spill cleanup method?
• An outpatient arrives for whole-body bone scintigraphy with an intravenously injected phosphonate agent. Before the tracer is injected and again at discharge, the technologist reviews what the patient should do at home. Which instruction set correctly covers hydration and voiding before the injection and after the study ends?
• A patient scheduled for a myocardial perfusion study nods along as you describe the tracer and the stress phase, but when you ask what happens during the study they say they will just take the picture medicine and walk a bit. Which communication approach will improve this patient's understanding before the study?
• After a mild anxiolytic before a myocardial perfusion study, a patient dozes on the imaging table and begins to slide toward the foot of it. The technologist tucks a foam wedge under the knees that the patient could push aside, and fastens a padded strap across the thighs that the patient would be unable to remove even when awake. Which classification applies to each device under patient-rights restraint rules?
• A 47-year-old outpatient becomes flushed and itchy two minutes after an IV Tc-99m injection, then develops stridor, audible wheeze, and a blood pressure of 78/40. Epinephrine, diphenhydramine, oxygen, and IV fluids are stocked in the injection room, and the waiting area is busy. Which first-line treatment should you give for this suspected anaphylaxis?
• You are covering the injection room on a busy afternoon. Two identifiers on the armband match the order, and the appointment time matches the schedule, but the order gives the reason as restaging of colon cancer while the chart shows the patient is being worked up for a hip infection. The tray is still empty at this point. Which first step resolves the mismatch between the order's indication and the clinical picture?
• During check-in for a bone scintigraphy appointment, a patient with asthma and a previous iodinated contrast reaction asks how nuclear medicine differs from the CT she had last month. Department policy requires allergies and prior reactions, pregnancy status, and current medications to be reviewed before the radiopharmaceutical order. Which history review and patient explanation best meets those check-in requirements?
• A 57-year-old who had a thyroidectomy for papillary carcinoma arrives for a diagnostic I-131 whole-body scan to check for leftover or spread disease. She has been off her thyroid hormone for several weeks as instructed, feels well, and this morning's labs are already in the chart. Which lab value must be verified before the I-131 dose is given?
• A 33-year-old scheduled for a myocardial perfusion scan arrives anxious after reading about radiation online and asks what the tracer does, what the benefit is, and how much dose the scan adds. The department requires the tracer, benefit, radiation risk and alternatives to be covered in everyday words, with understanding confirmed before the tracer is given. Which patient-education approach best meets those requirements for this patient?
• A 77-year-old outpatient finishes a whole-body bone scan, and while checking the delayed images the technologist spots an unexpected focal finding in a weight-bearing bone that the team would want acted on today. The patient is dressed and ready to leave, the ordering physician is in clinic, and department policy requires closed-loop communication for urgent findings. Which communication approach meets that requirement before the patient is discharged?
• A patient having a blood-pool study says the signed consent form is fine but still has questions about what the injected tracer will do, and their spouse is waiting just outside the room. Which response best applies the ARRT Standards of Ethics at this moment?
• A signed consent form for a hepatobiliary study is on file when the patient is called from the waiting room. The patient says the exam was fully explained but has changed their mind and turns away from the chair. Because the paperwork is complete, a colleague starts prepping the arm anyway. Which legal claim best describes proceeding after that withdrawal of consent?
• Within minutes of an intravenous radiopharmaceutical injection, a patient develops generalized hives, a raspy voice and audible wheeze, and the blood pressure drops. The injection site itself is comfortable with normal skin color. Which emergency medication should be given first to treat this systemic reaction?
• A patient with diabetes calls two days before their first nuclear medicine study, which starts after an overnight fast. They ask what to change at home beforehand and what to do afterward. Which approach gives the best pre- and post-exam instructions?
• A patient who is unable to bear weight through the legs, unable to stand from the bed, and lacking the arm strength to push up must be moved from bed to a wheelchair this morning. Two staff members are available, the patient follows directions, and the room has space to work. Which patient transfer method fits this mobility and staffing situation?
• During a busy morning in an outpatient nuclear medicine department, a patient waiting for a hepatobiliary study is hard of hearing, depends on lip reading, and the waiting area is loud. You must explain the delayed imaging steps and confirm the patient understands before the tracer is injected. Which communication approach best combines verbal and nonverbal modes for this patient?
• During a slow therapy infusion the pump sounds a downstream occlusion alarm and stops. The tubing is visibly kinked where it passes under the patient's arm, the IV site shows no swelling or redness, and vital signs and oxygen saturation are normal. Which action should you take first to address the alarm and, if appropriate, resume the infusion?
• A man at the outpatient desk says he is the patient's spouse and asks for a copy of yesterday's myocardial perfusion report. The patient is still in the scan room, the file lists only the patient as authorized to receive results, and the department expects staff to help legitimate requesters begin the release process. Which HIPAA confidentiality step should the technologist take first?
• An inpatient with suspected Clostridioides difficile diarrhea used the nuclear medicine anteroom restroom before an injection appointment. Housekeeping removed the visible contamination, but staff must reuse the room within the hour. Which control measure best breaks the chain of infection in this restroom?
• During a whole-body bone scan, an adult with Parkinson's disease struggles to hold position because of resting tremor. A colleague proposes a padded strap fastened across the chest and thighs, while you prefer sandbags supporting the arms and a pillow beneath the knees. The patient is alert, follows directions, and can lift away any support that simply rests on the body. Which device choice correctly applies the ethical and legal distinction between restraints and positioning aids?
• A patient treated for breast cancer asks why her physician ordered a nuclear medicine bone scan instead of another CT scan. Her history notes possible spread to several bones, and the order calls for a survey of the whole skeleton's activity. Which explanation correctly compares the whole-skeleton activity shown by the bone scan with the anatomy shown by CT?
• A patient who is profoundly deaf and speaks limited English arrives for a bone scan with her adult son, who has been interpreting casually throughout the visit. The upcoming injection requires explaining allergies, radiation precautions, and how to respond to discomfort. Which interpreter arrangement should the technologist use for this injection discussion?
• In the hot lab, a technologist draws three patient doses from a single eluted vial for a busy afternoon list, and each syringe is headed to a different patient. Lab policy requires sterile doses with no cross-contamination. Which preparation sequence follows correct aseptic technique for this task?
• A research coordinator is enrolling hospitalized adults into a nuclear medicine study that adds an extra imaging session and a research-only radiopharmaceutical. One candidate has a DNR documented and another has an advance directive limiting certain interventions. Which consent requirement must be satisfied before either patient is enrolled?
• A patient recovering from a stroke is non-weight-bearing and has limited use of both arms, so two staff members must move the patient from the bed onto the nuclear medicine table for a bone scan. The bed and the table sit at fixed, unequal heights, and the department has a draw sheet and a slide board while its mechanical lift is in use on another unit. Which action best protects the patient and the staff?
• A nuclear medicine technologist finds that a colleague entered 'QC passed' in the dose calibrator log for a linearity check that had been skipped, and that page is headed for a regulatory inspection next week. The colleague is a friend who has covered extra shifts. Facility policy requires any record discrepancy to be reported to the supervisor. Which action best meets the ARRT Standards of Ethics here?
• A 72-year-old is booked for a myocardial perfusion study using a pharmacologic stress agent. Department protocol requires baseline vital signs before any stress medication, continuous ECG with blood pressure checks during the stress phase, and escort-level assistance afterward because the patient has dizzied when standing before. Two cameras are running with staff split between them. Which monitoring plan covers every requirement for this stress study?