A nurse is preparing a patient for a cerebral angiogram. Which of the following pre-procedure actions are essential? Select all that apply
Assessing for any known allergies to iodine-based contrast dye.
Ensuring the patient has been NPO for 6-8 hours.
Checking and documenting peripheral pulses in the limb to be used.
Obtaining a full medical history and current medication list.
Administering a sedative to all patients to ensure they remain still.
Correct Answer : A,B,C,D
Before a cerebral angiogram, the nurse must ensure the patient is safe for contrast dye use, appropriately prepared with NPO status, and has a baseline vascular assessment. Obtaining a detailed history helps identify any conditions or medications that may affect the procedure or recovery. Sedatives are not always required and are administered only if prescribed.
Rationale for correct answers:
A. Assessing for any known allergies to iodine-based contrast dye: Essential to prevent allergic or anaphylactic reactions to the contrast used during angiography.
B. Ensuring the patient has been NPO for 6–8 hours: Reduces the risk of aspiration during the procedure, especially if sedation is required.
C. Checking and documenting peripheral pulses in the limb to be used: Provides a baseline for comparison after the procedure to detect vascular complications.
D. Obtaining a full medical history and current medication list: Critical for identifying bleeding risks (e.g., anticoagulants) and other potential contraindications.
Rationale for incorrect answer:
E. Administering a sedative to all patients to ensure they remain still: Sedation is not universally required; some patients undergo the procedure under local anesthesia with minimal or no sedation. Administration depends on the patient’s condition and provider’s order.
Take home points:
- Always assess for contrast dye allergy before angiographic procedures.
- NPO status helps prevent aspiration if sedation is used.
- Peripheral pulse checks are vital for detecting post-procedure vascular compromise.
- Sedation is individualized, not routine for every patient.
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Related Questions
Correct Answer is C
Explanation
Cerebral angiography is considered the gold standard for confirming the presence, size, and location of a cerebral aneurysm. It provides detailed visualization of cerebral blood vessels, enabling precise diagnosis and surgical planning.
Rationale for correct answer:
C. Cerebral angiography: This test offers the highest resolution imaging of intracranial vasculature, allowing clinicians to detect aneurysms with accuracy. It also helps evaluate the aneurysm’s shape and risk of rupture, making it essential for definitive diagnosis.
Rationale for incorrect answers:
A. Non-contrast CT scan: While useful for detecting subarachnoid hemorrhage from a ruptured aneurysm, it does not provide detailed vessel imaging to confirm or characterize the aneurysm itself.
B. Electroencephalogram (EEG): EEG measures electrical brain activity and is used for seizure evaluation, not aneurysm diagnosis.
D. Magnetic resonance imaging (MRI) without contrast: MRI can detect vascular abnormalities, but without contrast or specialized techniques like MRA, it is less definitive than angiography.
Take home points:
- Cerebral angiography remains the gold standard for aneurysm diagnosis.
- CT is valuable for detecting bleeding but not for detailed vascular assessment.
- Timely and accurate imaging is critical to prevent catastrophic rupture.
Correct Answer is B
Explanation
On a non-contrast CT scan, acute blood appears as a bright (hyperdense) area. This is a hallmark finding of a hemorrhagic stroke, which occurs when a blood vessel ruptures and bleeds into brain tissue. The high density is due to the clot’s protein content and the absence of dilution by cerebrospinal fluid.
Rationale for correct answer:
B. A hemorrhagic stroke: Acute intracranial bleeding appears bright on a non-contrast CT because the hemoglobin in clotted blood has high attenuation. This imaging helps differentiate hemorrhagic stroke from ischemic stroke, guiding immediate treatment decisions.
Rationale for incorrect answers:
A. An ischemic stroke: In the early stages, ischemic strokes may appear normal or show subtle hypodense changes on CT. They do not typically present as bright, hyperdense areas.
C. Multiple sclerosis: MS lesions are best detected with MRI and appear as hypodense or isodense areas on CT, not bright hyperdensities.
D. A brain abscess: Abscesses may appear as ring-enhancing lesions with contrast but are not hyperdense on non-contrast CT unless calcified or hemorrhagic.
Take home points:
- Acute blood is hyperdense on non-contrast CT and strongly suggests hemorrhage.
- CT scans are the preferred first-line imaging for suspected stroke to distinguish between hemorrhagic and ischemic types.
- Early identification of hemorrhagic stroke is essential because treatment differs drastically from ischemic stroke.
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