Report signs of anaphylaxis such as wheezing, throat tightness, hives, hypotension, or facial swelling during or after contrast.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A 3-year-old with pertussis (whooping cough) is admitted. Which finding is most characteristic of the paroxysmal stage of this illness?
Answer: A. The paroxysmal stage of pertussis is marked by severe paroxysms of coughing followed by a high-pitched inspiratory whoop, often with post-tussive vomiting. The cough can cause cyanosis in young children.
Question 2 of 5
A nurse reviews the onset, peak, and duration of insulins. Which insulin has the most rapid onset and is given with meals?
Answer: A. Insulin lispro is a rapid-acting insulin with an onset of about 15 minutes; it should be given within 15 minutes before a meal so the client eats as it begins to act. Regular insulin is short-acting, NPH is intermediate-acting, and detemir is long-acting basal insulin.
Question 3 of 5
A nurse compares a caput succedaneum to a cephalohematoma. Which feature distinguishes a caput succedaneum?
Answer: A. Caput succedaneum is edema of the scalp that crosses suture lines and is present at birth, resolving within a few days. In contrast, a cephalohematoma is a blood collection that does not cross suture lines and appears after birth, resolving over weeks.
Question 4 of 5
On a rhythm strip the nurse notes a consistently prolonged PR interval of 0.26 seconds with a P wave before every QRS and a regular rhythm. How should the nurse document this finding?
Answer: A. First-degree AV block is defined by a PR interval greater than 0.20 seconds that remains constant, with every P wave conducted to a QRS. Second-degree type I shows progressive PR lengthening with a dropped beat, type II has intermittent nonconducted P waves with a stable PR, and third-degree block shows AV dissociation.
Question 5 of 5
A nurse documents that a client with a brain injury demonstrates decorticate posturing. Which description matches this finding?
Answer: A. Decorticate (flexor) posturing is adduction of the arms with flexion of the elbows, wrists, and fingers held toward the core, with legs extended and feet plantar-flexed. Decerebrate posturing is rigid extension with arms pronated. Decerebrate is generally a more ominous sign than decorticate.
Keep the streak going with more questions like these, each with a full rationale.
What is ct with contrast?
The dye is nephrotoxic and can cause allergic reactions, so allergy screening, hydration, and renal protection are key nursing concerns. Memory aid: ask about iodine and shellfish allergy, hydrate, and hold metformin.
Key points to remember
- Iodinated contrast can trigger allergic reactions, so a history of iodine, shellfish, or prior contrast reaction must be assessed.
- Contrast is nephrotoxic and can cause contrast-induced nephropathy, especially in patients with preexisting kidney disease.
- Metformin is typically held before and 48 hours after contrast to reduce the risk of lactic acidosis.
- A warm, flushing sensation and a metallic taste during dye injection are expected and harmless.
- Adequate hydration before and after helps flush the contrast and protect the kidneys.
- The patient is usually NPO for a period before scans with oral or IV contrast per facility protocol.
Nursing priorities
- Screen for iodine, shellfish, and contrast allergies and verify baseline renal function before the scan.
- Confirm metformin is held as ordered and assess for pregnancy.
- Encourage fluids before and after the scan unless contraindicated to protect the kidneys.
- Monitor for allergic reaction during and after contrast administration.
- Document IV access, contrast given, and the patient's response.
Labs & values
Patient teaching
- Tell the staff if you are allergic to iodine, shellfish, or contrast dye.
- You may feel a warm flush and a metallic taste when the dye goes in, which is normal.
- Drink plenty of fluids afterward to help clear the dye from your body.
- Report itching, hives, swelling, or trouble breathing right away.
- Do not take metformin until cleared by your provider if you take it.
Red flags: report now
- Report signs of anaphylaxis such as wheezing, throat tightness, hives, hypotension, or facial swelling during or after contrast.
- Report decreasing urine output or rising creatinine indicating contrast-induced nephropathy.
- Report extravasation of contrast at the IV site causing swelling and pain.
- Never give iodinated contrast to a patient with a documented severe contrast allergy without provider clearance and premedication.
References
Clinical references for this topic
