A female client admitted to the hospital with a neurological problem asks the nurse whether magnetic resonance imaging may be done. The nurse interprets that the client may be ineligible for this diagnostic procedure based on the client’s history of:
A. Hypertension
B. Heart failure
C. Prosthetic valve replacement
D. Chronic obstructive pulmonary disorder
Correct Answer: C. Prosthetic valve replacement
The client having a magnetic resonance imaging scan has all metallic objects removed because of the magnetic field generated by the device. A careful history is obtained to determine whether any metal objects are inside the client, such as orthopedic hardware, pacemakers, artificial heart valves, aneurysm clips, or intrauterine devices. These may heat up, become dislodged, or malfunction during this procedure. The client may be ineligible if a significant risk exists.
Option A: MRI contrast agents are gadolinium chelates with different stability, viscosity, and osmolality. Gadolinium is a relatively very safe contrast; however, it rarely might cause allergic reactions in patients. Evaluate carefully patients with diabetes mellitus or hypertension who are receiving treatment with medications; calculate these patients’ estimated glomerular filtration rate, and if less than 35 mL/min/1.73 m2, there is a need to consult a radiologist for further instructions.
Option B: Patients with impaired renal function are at risk of NSF associated with gadolinium chelate. Patients with known or at risk of renal impairment need to require evaluation regarding their renal function before an MRI scan.
Option D: Patients who are unable to be still or obey breathing instructions in the scanner need special attention. Some patients in pain might move during the procedure, which degrades the quality of the images, restrict the interpretation, and decrease the accuracy of the report. Some MRI sequences need to be obtained while patients hold their breath and lie motionless.
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