HESI Radiology Exit Exam Prep Version 3 2026/2027 – Elsevier
Evolve – Comprehensive Radiologic Sciences Competency
Assessment — 290 Questions
Section 1: Patient Care and Management (Questions 1-38)
1 A patient undergoing a CT scan with intravenous iodinated contrast develops sudden onset of urticaria, facial
edema, and stridor. The radiographer's initial action should be to:
A) Administer 0.3 mg epinephrine intramuscularly and call the emergency team.
B) Administer diphenhydramine 50 mg intravenously and monitor vital signs.
C) Stop the injection, maintain the IV line, and assess airway and breathing.
D) Apply oxygen at 15 L/min via non-rebreather mask and elevate the head of the bed.
Answer: C
Rationale: The first priority in any contrast reaction is to stop the contrast agent and assess the patient's airway,
breathing, and circulation. Epinephrine is indicated for severe anaphylaxis but only after initial assessment and
support. Diphenhydramine is for mild reactions, and oxygen is supportive but not the first step.
2 When transferring a patient from a stretcher to the X-ray table, the radiographer notices the patient has a femoral
central venous catheter in the right groin. Which positioning consideration is most critical?
A) Elevate the head of the stretcher to 45 degrees to reduce catheter migration.
B) Place the patient in a left lateral position to avoid pressure on the catheter hub.
C) Maintain the right hip in neutral alignment and avoid acute flexion beyond 90 degrees.
D) Secure the catheter tubing with tape directly over the insertion site to prevent dislodgment.
Answer: C
Rationale: Femoral catheters can kink or become dislodged with excessive hip flexion. Maintaining neutral
alignment prevents mechanical complications. Elevating the head does not directly protect the catheter, and taping
over the site is not recommended as it can obscure signs of infection. Left lateral positioning may be unnecessary
and could cause discomfort.
3 A radiographer is preparing to perform a portable chest radiograph on a patient in the intensive care unit who is
on mechanical ventilation with positive end-expiratory pressure (PEEP) of 10 cm H2O. Which action is most
appropriate to ensure patient safety during the procedure?
A) Disconnect the ventilator briefly to obtain a clear image without motion artifact.
B) Adjust the PEEP to 5 cm H2O to reduce the risk of barotrauma during positioning.
C) Coordinate with the respiratory therapist to maintain ventilator settings and use a breath-hold technique if
possible.
D) Place the patient in a Trendelenburg position to improve lung expansion for the radiograph.
Answer: C
Rationale: Disconnecting the ventilator or altering PEEP without orders can cause desaturation or lung injury.
Coordination with respiratory therapy allows for safe breath-holding (e.g., at end-inspiration) without
compromising ventilation. Trendelenburg position is not indicated and could increase intracranial pressure or
worsen ventilation.
4 During a routine fluoroscopic examination, the radiographer notices the patient's skin appears erythematous in
the beam entrance field after 15 minutes of cumulative exposure. Which action is most appropriate?
,A) Continue the procedure but reduce the pulse rate to minimize further exposure.
B) Document the observation, note cumulative dose, and inform the radiologist of potential radiation-induced
skin injury.
C) Apply a topical corticosteroid cream to the area and proceed with the examination.
D) Terminate the procedure immediately and schedule a follow-up dermatology consult.
Answer: B
Rationale: Erythema indicates possible radiation-induced skin injury, which requires documentation and
communication with the radiologist to assess risk-benefit. Reducing pulse rate may help but does not address the
existing injury. Topical treatment is not standard without diagnosis. Termination may be premature if the
diagnostic benefit outweighs risk; the radiologist decides.
5 A radiographer is assigned to perform an upper GI series on a patient with a known allergy to latex. Which of
the following actions is most critical to prevent an allergic reaction?
A) Use a latex-free barium enema kit and verify all equipment (e.g., gloves, tubing) are latex-free.
B) Pre-medicate the patient with diphenhydramine 50 mg orally one hour before the procedure.
C) Apply a barrier cream to the patient's skin where contact with equipment may occur.
D) Use only non-ionic contrast media to reduce the risk of cross-reactivity.
Answer: A
Rationale: Direct contact with latex-containing materials (e.g., gloves, enema tips) can trigger anaphylaxis in
sensitized patients. Using a latex-free kit is the primary prevention. Pre-medication is not a substitute for
avoidance. Barrier cream is not reliable. Non-ionic contrast does not contain latex.
6 A patient with a history of claustrophobia is scheduled for an MRI of the brain without sedation. The
radiographer explains the procedure and offers a panic button. The patient agrees but during the scan becomes
distressed and presses the button repeatedly. What is the radiographer's priority action?
A) Increase the intercom reassurance and encourage the patient to complete the remaining sequences.
B) Immediately stop the scan, remove the patient from the magnet, and assess their condition.
C) Reduce the gradient noise by using a quieter pulse sequence and continue.
D) Administer a sedative via the IV line if available and monitor the patient.
Answer: B
Rationale: Patient safety and autonomy are paramount. The panic button indicates a desire to stop; continuing could
escalate distress or cause injury. Immediate removal and reassessment are required. Reassurance may help but must
respect the patient's request. Sedation without prior order is not appropriate.
7 A radiographer is positioning a patient for a lateral lumbar spine radiograph. The patient has a history of severe
osteoporosis and reports acute back pain. Which modification to standard positioning is most appropriate to
minimize risk of fracture?
A) Use a 30-degree foam wedge to support the patient's back and reduce the need for rotation.
B) Place the patient in a supine position and use a horizontal beam lateral technique.
C) Ask the patient to flex the hips and knees to reduce lordosis and improve visualization.
D) Immobilize the patient with a sandbag over the iliac crest to prevent movement.
Answer: B
Rationale: A horizontal beam lateral technique avoids the need for the patient to roll onto their side, which can cause
vertebral fracture in severe osteoporosis. The supine position is safer. Using a wedge still requires rolling. Flexion
may exacerbate pain. Sandbags do not prevent fracture from positioning.
,8 A radiographer is to perform a cystogram on a patient with a suspected bladder rupture. The patient has an
indwelling Foley catheter. Which of the following steps is essential to ensure accurate diagnosis and patient
safety?
A) Inflate the catheter balloon with 30 mL of sterile water to ensure secure placement.
B) Obtain a scout image before contrast instillation to identify any pre-existing abnormalities.
C) Instill contrast media under gravity at a rate of 100 mL/min until the patient feels fullness.
D) Use a sterile technique and clamp the catheter after instillation to prevent leakage.
Answer: B
Rationale: A scout image is necessary to evaluate baseline anatomy and detect any radiopaque calculi or catheter
position. Balloon inflation volume should follow manufacturer guidelines (usually 5-10 mL). Rapid instillation can
cause pain or extravasation. Clamping is not routinely done; post-drainage images are often obtained.
9 A radiographer receives a verbal order from a physician to perform a CT scan of the abdomen with intravenous
contrast on a patient who has not been pre-medicated despite a documented mild contrast allergy. The
radiographer should:
A) Proceed with the scan using a non-ionic contrast agent and monitor the patient closely.
B) Ask the physician to provide a written order and document the allergy history.
C) Administer the standard pre-medication regimen (prednisone and diphenhydramine) immediately.
D) Refuse to perform the scan until pre-medication is given per protocol and document the incident.
Answer: D
Rationale: Patient safety protocols require pre-medication for known contrast allergies. The radiographer must
advocate for the patient and follow established guidelines. Proceeding without pre-medication, even with non-ionic
contrast, increases risk. Verbal orders are acceptable but do not override safety. Self-administering medications
without a prescription is outside scope.
10 A radiographer is performing a mobile chest radiograph on a patient in isolation for methicillin-resistant
Staphylococcus aureus (MRSA). Which sequence of actions is correct for donning and doffing personal
protective equipment (PPE) to prevent self-contamination?
A) Don: gown, mask, gloves, eye protection. Doff: gloves, eye protection, gown, mask.
B) Don: mask, gown, gloves, eye protection. Doff: gloves, gown, mask, eye protection.
C) Don: gown, mask, eye protection, gloves. Doff: gloves, gown, mask, eye protection.
D) Don: gloves, gown, mask, eye protection. Doff: mask, eye protection, gown, gloves.
Answer: C
Rationale: Correct donning sequence: gown first, then mask, eye protection, and gloves last to prevent
contamination of gloves. Doffing: gloves first (most contaminated), then gown (by pulling away from body), mask,
and eye protection last. Option A has incorrect doffing order (gloves before eye protection is correct, but mask
before gown is wrong). Option B has mask before gown (correct) but doffing order is wrong (gloves, gown, mask,
eye protection – eye protection should be last). Option D has gloves first (incorrect donning).
11 A patient undergoing a fluoroscopic-guided lumbar puncture develops sudden severe hypotension, tachycardia,
and urticaria 10 minutes after injection of iodinated contrast. The patient is conscious but anxious. Which
sequence of interventions is most appropriate for the radiologic technologist to initiate while awaiting the
emergency team?
A) Administer epinephrine 0.3 mg IM, place patient in Trendelenburg position, and start high-flow oxygen via
non-rebreather mask.
B) Place patient supine with legs elevated, administer diphenhydramine 50 mg IV, and monitor blood pressure
every 2 minutes.
, C) Administer epinephrine 0.3 mg IM, place patient in supine position with legs elevated, and administer oxygen
via nasal cannula at 4 L/min.
D) Start IV normal saline wide open, administer methylprednisolone 125 mg IV, and prepare for intubation.
Answer: A
Rationale: In anaphylactic shock with hypotension and tachycardia, immediate IM epinephrine is first-line for
vasoconstriction and bronchodilation. Trendelenburg positioning improves venous return, and high-flow oxygen
addresses hypoxemia. Option B lacks epinephrine; Option C uses inadequate oxygen delivery; Option D delays
epinephrine and uses steroids (not first-line).
12 A patient with a known allergy to iodinated contrast media requires an urgent CT angiogram of the chest. The
referring physician prescribes premedication with prednisone and diphenhydramine. Which of the following
premedication regimens is most consistent with current guidelines for emergency prophylaxis (less than 12
hours before contrast administration)?
A) Methylprednisolone 32 mg orally 12 hours and 2 hours before contrast, plus diphenhydramine 50 mg IV 1
hour before.
B) Prednisone 50 mg orally 13 hours, 7 hours, and 1 hour before contrast, plus diphenhydramine 50 mg IM 30
minutes before.
C) Hydrocortisone 200 mg IV immediately before contrast, plus diphenhydramine 50 mg IV 30 minutes before.
D) Dexamethasone 20 mg IV 4 hours before contrast, plus diphenhydramine 25 mg IV 1 hour before.
Answer: A
Rationale: For emergency prophylaxis (<12 hours), ACR guidelines recommend methylprednisolone 32 mg orally
12 hours and 2 hours before contrast, plus diphenhydramine 50 mg IV/IM 1 hour prior. Option B uses prednisone
but with incorrect timing; Option C uses hydrocortisone which is less effective; Option D uses dexamethasone with
insufficient evidence.
13 During a portable chest radiograph in the ICU, the patient becomes unresponsive, pulseless, and apneic. The
radiographer has just completed the exposure and is still holding the image receptor. What is the radiographer's
immediate priority action according to standard resuscitation protocols?
A) Complete the radiograph and then call for help, ensuring the image is diagnostic before leaving.
B) Place the image receptor aside, call for help, and begin chest compressions at a rate of 100-120 per minute.
C) Move the patient to a safe position, retrieve the crash cart, and attach the defibrillator pads.
D) Check the patient's pulse for 10 seconds, then begin rescue breathing if no pulse is detected.
Answer: B
Rationale: In a witnessed cardiac arrest, the radiographer must immediately activate the emergency response system
and begin high-quality chest compressions. Delaying to complete the radiograph (A) or leaving to retrieve
equipment (C) wastes critical time. Checking pulse (D) is part of assessment but should be brief; starting
compressions is the priority.
14 A patient with a history of severe claustrophobia is scheduled for an MRI of the lumbar spine without sedation.
Which of the following communication strategies is most effective in reducing patient anxiety and likelihood of
scan abandonment?
A) Explain that the scan is painless and only takes 15 minutes; encourage the patient to close their eyes and think
of a pleasant scene.
B) Provide the patient with a panic button, allow a family member in the scan room, and use a mirror system so
the patient can see the technologist.
C) Offer the patient a blindfold and earplugs, and instruct them to signal by tapping if they need to stop.
Evolve – Comprehensive Radiologic Sciences Competency
Assessment — 290 Questions
Section 1: Patient Care and Management (Questions 1-38)
1 A patient undergoing a CT scan with intravenous iodinated contrast develops sudden onset of urticaria, facial
edema, and stridor. The radiographer's initial action should be to:
A) Administer 0.3 mg epinephrine intramuscularly and call the emergency team.
B) Administer diphenhydramine 50 mg intravenously and monitor vital signs.
C) Stop the injection, maintain the IV line, and assess airway and breathing.
D) Apply oxygen at 15 L/min via non-rebreather mask and elevate the head of the bed.
Answer: C
Rationale: The first priority in any contrast reaction is to stop the contrast agent and assess the patient's airway,
breathing, and circulation. Epinephrine is indicated for severe anaphylaxis but only after initial assessment and
support. Diphenhydramine is for mild reactions, and oxygen is supportive but not the first step.
2 When transferring a patient from a stretcher to the X-ray table, the radiographer notices the patient has a femoral
central venous catheter in the right groin. Which positioning consideration is most critical?
A) Elevate the head of the stretcher to 45 degrees to reduce catheter migration.
B) Place the patient in a left lateral position to avoid pressure on the catheter hub.
C) Maintain the right hip in neutral alignment and avoid acute flexion beyond 90 degrees.
D) Secure the catheter tubing with tape directly over the insertion site to prevent dislodgment.
Answer: C
Rationale: Femoral catheters can kink or become dislodged with excessive hip flexion. Maintaining neutral
alignment prevents mechanical complications. Elevating the head does not directly protect the catheter, and taping
over the site is not recommended as it can obscure signs of infection. Left lateral positioning may be unnecessary
and could cause discomfort.
3 A radiographer is preparing to perform a portable chest radiograph on a patient in the intensive care unit who is
on mechanical ventilation with positive end-expiratory pressure (PEEP) of 10 cm H2O. Which action is most
appropriate to ensure patient safety during the procedure?
A) Disconnect the ventilator briefly to obtain a clear image without motion artifact.
B) Adjust the PEEP to 5 cm H2O to reduce the risk of barotrauma during positioning.
C) Coordinate with the respiratory therapist to maintain ventilator settings and use a breath-hold technique if
possible.
D) Place the patient in a Trendelenburg position to improve lung expansion for the radiograph.
Answer: C
Rationale: Disconnecting the ventilator or altering PEEP without orders can cause desaturation or lung injury.
Coordination with respiratory therapy allows for safe breath-holding (e.g., at end-inspiration) without
compromising ventilation. Trendelenburg position is not indicated and could increase intracranial pressure or
worsen ventilation.
4 During a routine fluoroscopic examination, the radiographer notices the patient's skin appears erythematous in
the beam entrance field after 15 minutes of cumulative exposure. Which action is most appropriate?
,A) Continue the procedure but reduce the pulse rate to minimize further exposure.
B) Document the observation, note cumulative dose, and inform the radiologist of potential radiation-induced
skin injury.
C) Apply a topical corticosteroid cream to the area and proceed with the examination.
D) Terminate the procedure immediately and schedule a follow-up dermatology consult.
Answer: B
Rationale: Erythema indicates possible radiation-induced skin injury, which requires documentation and
communication with the radiologist to assess risk-benefit. Reducing pulse rate may help but does not address the
existing injury. Topical treatment is not standard without diagnosis. Termination may be premature if the
diagnostic benefit outweighs risk; the radiologist decides.
5 A radiographer is assigned to perform an upper GI series on a patient with a known allergy to latex. Which of
the following actions is most critical to prevent an allergic reaction?
A) Use a latex-free barium enema kit and verify all equipment (e.g., gloves, tubing) are latex-free.
B) Pre-medicate the patient with diphenhydramine 50 mg orally one hour before the procedure.
C) Apply a barrier cream to the patient's skin where contact with equipment may occur.
D) Use only non-ionic contrast media to reduce the risk of cross-reactivity.
Answer: A
Rationale: Direct contact with latex-containing materials (e.g., gloves, enema tips) can trigger anaphylaxis in
sensitized patients. Using a latex-free kit is the primary prevention. Pre-medication is not a substitute for
avoidance. Barrier cream is not reliable. Non-ionic contrast does not contain latex.
6 A patient with a history of claustrophobia is scheduled for an MRI of the brain without sedation. The
radiographer explains the procedure and offers a panic button. The patient agrees but during the scan becomes
distressed and presses the button repeatedly. What is the radiographer's priority action?
A) Increase the intercom reassurance and encourage the patient to complete the remaining sequences.
B) Immediately stop the scan, remove the patient from the magnet, and assess their condition.
C) Reduce the gradient noise by using a quieter pulse sequence and continue.
D) Administer a sedative via the IV line if available and monitor the patient.
Answer: B
Rationale: Patient safety and autonomy are paramount. The panic button indicates a desire to stop; continuing could
escalate distress or cause injury. Immediate removal and reassessment are required. Reassurance may help but must
respect the patient's request. Sedation without prior order is not appropriate.
7 A radiographer is positioning a patient for a lateral lumbar spine radiograph. The patient has a history of severe
osteoporosis and reports acute back pain. Which modification to standard positioning is most appropriate to
minimize risk of fracture?
A) Use a 30-degree foam wedge to support the patient's back and reduce the need for rotation.
B) Place the patient in a supine position and use a horizontal beam lateral technique.
C) Ask the patient to flex the hips and knees to reduce lordosis and improve visualization.
D) Immobilize the patient with a sandbag over the iliac crest to prevent movement.
Answer: B
Rationale: A horizontal beam lateral technique avoids the need for the patient to roll onto their side, which can cause
vertebral fracture in severe osteoporosis. The supine position is safer. Using a wedge still requires rolling. Flexion
may exacerbate pain. Sandbags do not prevent fracture from positioning.
,8 A radiographer is to perform a cystogram on a patient with a suspected bladder rupture. The patient has an
indwelling Foley catheter. Which of the following steps is essential to ensure accurate diagnosis and patient
safety?
A) Inflate the catheter balloon with 30 mL of sterile water to ensure secure placement.
B) Obtain a scout image before contrast instillation to identify any pre-existing abnormalities.
C) Instill contrast media under gravity at a rate of 100 mL/min until the patient feels fullness.
D) Use a sterile technique and clamp the catheter after instillation to prevent leakage.
Answer: B
Rationale: A scout image is necessary to evaluate baseline anatomy and detect any radiopaque calculi or catheter
position. Balloon inflation volume should follow manufacturer guidelines (usually 5-10 mL). Rapid instillation can
cause pain or extravasation. Clamping is not routinely done; post-drainage images are often obtained.
9 A radiographer receives a verbal order from a physician to perform a CT scan of the abdomen with intravenous
contrast on a patient who has not been pre-medicated despite a documented mild contrast allergy. The
radiographer should:
A) Proceed with the scan using a non-ionic contrast agent and monitor the patient closely.
B) Ask the physician to provide a written order and document the allergy history.
C) Administer the standard pre-medication regimen (prednisone and diphenhydramine) immediately.
D) Refuse to perform the scan until pre-medication is given per protocol and document the incident.
Answer: D
Rationale: Patient safety protocols require pre-medication for known contrast allergies. The radiographer must
advocate for the patient and follow established guidelines. Proceeding without pre-medication, even with non-ionic
contrast, increases risk. Verbal orders are acceptable but do not override safety. Self-administering medications
without a prescription is outside scope.
10 A radiographer is performing a mobile chest radiograph on a patient in isolation for methicillin-resistant
Staphylococcus aureus (MRSA). Which sequence of actions is correct for donning and doffing personal
protective equipment (PPE) to prevent self-contamination?
A) Don: gown, mask, gloves, eye protection. Doff: gloves, eye protection, gown, mask.
B) Don: mask, gown, gloves, eye protection. Doff: gloves, gown, mask, eye protection.
C) Don: gown, mask, eye protection, gloves. Doff: gloves, gown, mask, eye protection.
D) Don: gloves, gown, mask, eye protection. Doff: mask, eye protection, gown, gloves.
Answer: C
Rationale: Correct donning sequence: gown first, then mask, eye protection, and gloves last to prevent
contamination of gloves. Doffing: gloves first (most contaminated), then gown (by pulling away from body), mask,
and eye protection last. Option A has incorrect doffing order (gloves before eye protection is correct, but mask
before gown is wrong). Option B has mask before gown (correct) but doffing order is wrong (gloves, gown, mask,
eye protection – eye protection should be last). Option D has gloves first (incorrect donning).
11 A patient undergoing a fluoroscopic-guided lumbar puncture develops sudden severe hypotension, tachycardia,
and urticaria 10 minutes after injection of iodinated contrast. The patient is conscious but anxious. Which
sequence of interventions is most appropriate for the radiologic technologist to initiate while awaiting the
emergency team?
A) Administer epinephrine 0.3 mg IM, place patient in Trendelenburg position, and start high-flow oxygen via
non-rebreather mask.
B) Place patient supine with legs elevated, administer diphenhydramine 50 mg IV, and monitor blood pressure
every 2 minutes.
, C) Administer epinephrine 0.3 mg IM, place patient in supine position with legs elevated, and administer oxygen
via nasal cannula at 4 L/min.
D) Start IV normal saline wide open, administer methylprednisolone 125 mg IV, and prepare for intubation.
Answer: A
Rationale: In anaphylactic shock with hypotension and tachycardia, immediate IM epinephrine is first-line for
vasoconstriction and bronchodilation. Trendelenburg positioning improves venous return, and high-flow oxygen
addresses hypoxemia. Option B lacks epinephrine; Option C uses inadequate oxygen delivery; Option D delays
epinephrine and uses steroids (not first-line).
12 A patient with a known allergy to iodinated contrast media requires an urgent CT angiogram of the chest. The
referring physician prescribes premedication with prednisone and diphenhydramine. Which of the following
premedication regimens is most consistent with current guidelines for emergency prophylaxis (less than 12
hours before contrast administration)?
A) Methylprednisolone 32 mg orally 12 hours and 2 hours before contrast, plus diphenhydramine 50 mg IV 1
hour before.
B) Prednisone 50 mg orally 13 hours, 7 hours, and 1 hour before contrast, plus diphenhydramine 50 mg IM 30
minutes before.
C) Hydrocortisone 200 mg IV immediately before contrast, plus diphenhydramine 50 mg IV 30 minutes before.
D) Dexamethasone 20 mg IV 4 hours before contrast, plus diphenhydramine 25 mg IV 1 hour before.
Answer: A
Rationale: For emergency prophylaxis (<12 hours), ACR guidelines recommend methylprednisolone 32 mg orally
12 hours and 2 hours before contrast, plus diphenhydramine 50 mg IV/IM 1 hour prior. Option B uses prednisone
but with incorrect timing; Option C uses hydrocortisone which is less effective; Option D uses dexamethasone with
insufficient evidence.
13 During a portable chest radiograph in the ICU, the patient becomes unresponsive, pulseless, and apneic. The
radiographer has just completed the exposure and is still holding the image receptor. What is the radiographer's
immediate priority action according to standard resuscitation protocols?
A) Complete the radiograph and then call for help, ensuring the image is diagnostic before leaving.
B) Place the image receptor aside, call for help, and begin chest compressions at a rate of 100-120 per minute.
C) Move the patient to a safe position, retrieve the crash cart, and attach the defibrillator pads.
D) Check the patient's pulse for 10 seconds, then begin rescue breathing if no pulse is detected.
Answer: B
Rationale: In a witnessed cardiac arrest, the radiographer must immediately activate the emergency response system
and begin high-quality chest compressions. Delaying to complete the radiograph (A) or leaving to retrieve
equipment (C) wastes critical time. Checking pulse (D) is part of assessment but should be brief; starting
compressions is the priority.
14 A patient with a history of severe claustrophobia is scheduled for an MRI of the lumbar spine without sedation.
Which of the following communication strategies is most effective in reducing patient anxiety and likelihood of
scan abandonment?
A) Explain that the scan is painless and only takes 15 minutes; encourage the patient to close their eyes and think
of a pleasant scene.
B) Provide the patient with a panic button, allow a family member in the scan room, and use a mirror system so
the patient can see the technologist.
C) Offer the patient a blindfold and earplugs, and instruct them to signal by tapping if they need to stop.
