TEST BANK for Local Anesthesia for the Dental Hygienist 2nd Edition by Daskalo Logothetis

Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Chapter 01: Local Anesthesia in Dental Hygiene Practice: An Introduction Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition MATCHING

Match the following word or phrase with the correct drug category. a. ester (E) b. amide (A) c. inhalation drug (I) 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Ether Lidocaine Prilocaine Procaine Nitrous oxide Halothane Mepivacaine Novocaine Causes more allergic reactions Patients experience fewer allergic reactions

1. ANS: C DIF: Recall REF: 2 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology F: 2 OBJ: 1 2. ANS: B DIF: Recall I GREB .C M N R TOP: NBDHE, 3.0 Planning andUMaS nagN ing D ental H ygiene Care| NBDHE, 3.4 Anxiety and Pain T O Control| NBDHE, 6.0 Pharmacology 3. ANS: B DIF: Recall REF: 2|3 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 4. ANS: A DIF: Recall REF: 2|3 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 5. ANS: C DIF: Recall REF: 2|4|5|6 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 6. ANS: C DIF: Recall REF: 2|3 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 7. ANS: B DIF: Recall REF: 2|3 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 8. ANS: A DIF: Recall REF: 2|3 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 9. ANS: A DIF: Recall REF: 2|3 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 10. ANS: B DIF: Recall REF: 2|3 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain

Control| NBDHE, 6.0 Pharmacology MULTIPLE CHOICE 1. The first objections to the use of inhalation sedation included which of the following? a. It was viewed as a religious offense b. It was viewed as an unethical practice c. It was viewed as a retardant to the health process d. All options listed ANS: D

All options listed. Objections to operating on an unconscious patient included all options listed. Some viewed it as offensive to their religious beliefs; some viewed it as an ethical matter; and some objected because they believed that the relief from pain might actually retard the health process.

DIF: Recall REF: 2 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 2. Who was the first dentist to use “laughing gas” for dental procedures? a. William Clarke b. Horace Wells c. Henry Beecher d. Nils Lofgren ANS: B

Horace Wells was the first deNnU tisR tS toIuN seG“T laB ug.hC inO gM gas” for dental procedures. William Clark is known for his work with ether, Henry Beecher for his observations regarding clinical trials, and Nils Lofgren for the synthesis of lidocaine.

DIF: Recall REF: 2| 3 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 3. A highly effective analgesic and antipyretic compound, introduced in 1899 and still used

today, is commonly referred to as what? a. Aspirin b. Alcohol c. Novocaine d. Opium ANS: A

A new compound, introduced as aspirin in 1899, proved to be remarkably safe and well tolerated by patients. It is a highly effective analgesic and antipyretic. Alcohol and opium were universally popular narcotics used for pain control as was Novocaine (procaine), a local anesthetic.

DIF: Recall REF: 2 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology

4. Early methods of pain control included which of the following? a. Use of opium b. Scaring off of demons c. Roots, berries, and seeds d. All options listed ANS: D

All options listed. Early methods of pain control included all options listed: the use of opium, religious techniques of scaring off demons; and the use of plants and herbs for treating pain.

DIF: Recall REF: 2 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 5. Pain threshold is best described as which of the following? a. The physical and emotional response to a particular situation. b. The relationship between human need fulfillment and human behavior. c. A neurologic experience of pain. d. The point at which a sensation starts to be painful and discomfort results.

ANS: D

Pain threshold is best described as the point at which a sensation starts to be painful and discomfort results. The physical and emotional response to a particular situation describes stress; the relationship between human need fulfillment and human behavior is known as the Human Needs Paradigm; and a neurologic experience of pain describes pain perception.

DIF: Recall REF: 6 OBJ: 4 TOP: NBDHE, 3.0 Planning aN nd M anaging Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain URSING TB.C OM Control 6. The neurologic experience of pain is referred to as what? a. Pain control b. Pain threshold c. Pain perception d. Pain reaction ANS: C

Pain perception is the neurologic experience of pain. It differs little between individuals. Pain control refers to the mechanism to alleviate pain; pain threshold is the point at which a sensation starts to be painful and discomfort results; and pain reaction is the personal interpretation of and response to the pain message and is highly variable between individuals.

DIF: Recall REF: 6 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. An unpleasant sensory and emotional experience is called what? a. Pain b. Pain control c. Pain threshold d. Pain reaction

ANS: A

Pain is an unpleasant sensory and emotional experience. Pain control refers to the mechanism to alleviate pain; pain threshold is the point at which a sensation starts to be painful and discomfort results; and pain reaction is the personal interpretation of and response to the pain message.

DIF: Recall REF: 2 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. The personal interpretation and response to the pain message is called what? a. Pain b. Pain control c. Pain threshold d. Pain reaction ANS: D

The personal interpretation and response to the pain message is called one’s pain reaction. It is highly variable among individuals. Pain is an unpleasant sensory and emotional experience; pain control refers to the mechanism to alleviate pain; and pain threshold is the point at which a sensation starts to be painful and discomfort results.

DIF: Recall REF: 6 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. The creation of the loss of sensation in a circumscribed area, without loss of consciousness,

best defines which of the follN owi URng? SINGTB.COM a. Inhalation anesthesia b. Local anesthesia c. General anesthesia d. All options listed ANS: B

Local anesthesia creates a numbing feeling or the loss of sensation in a circumscribed area, without loss of consciousness. Inhalation and general anesthesia involve loss of consciousness.

DIF: Recall REF: 2|3 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 10. The newest amide to arrive on the dental market in the United States is which one of the

following? a. Articaine b. Mepivacaine c. Lidocaine d. Bupivacaine ANS: A

The newest amide local anesthetic, introduced to the dental field in 2000, is articaine.

Mepivacaine and bupivacaine were introduced in 1957, and lidocaine was introduced in 1943.

DIF: Recall REF: 2| 3 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 11. Lidocaine is said to have revolutionized pain control in dentistry. Why? a. It is more potent than prilocaine. b. It is less potent than procaine. c. Patients experience fewer allergic reactions with lidocaine. d. Some combination of the above ANS: C

Lidocaine is said to have revolutionized pain control in dentistry because it is less allergenic and more potent than procaine. Lidocaine is less potent than prilocaine.

DIF: Recall REF: 2|3 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 12. Procaine was used extensively in dentistry for a number of years; however, it was not the ideal

local anesthetic. Why not? a. It took a long time to produce the desired anesthetic result. b. It wore off quickly. c. It had a high potential for triggering allergic reactions. d. All options listed ANS: D

All options listed. Procaine took a long time to produce the desired anesthetic results and it NingRS Irgic GTreactio B.CO M had a high potential for triggerU alleN ns. Procaine wore off quickly.

DIF: Recall REF: 2|3 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 13. The first local anesthetic used in dentistry was which of the following? a. Novocaine b. Cocaine c. Procaine d. Lidocaine ANS: B

Cocaine was the first anesthetic used in dentistry (in 1884); followed by Novocaine (procaine) in 1905; and later, lidocaine in 1943.

DIF: Recall REF: 2|3 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 14. The benefit of local anesthesia is not limited to pain control but could also include which of

the following? a. Hemostasis b. Time management

c. Patient-centered stress reduction d. All options listed ANS: D

All options listed. The benefit of local anesthesia is not limited to pain control but could also include hemostasis, achieved via the vasoconstrictor in the anesthetic; time management, because the dental hygienist can administer the anesthesia and obviate the need for the dentist and the patient to wait for anesthesia to take effect; and patient-centered stress reduction, which addresses the relationship between human need fulfillment and human behavior.

DIF: Comprehension REF: 3| 7 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 15. Jon presents to your dental office in pain with an abscessed tooth. Utilizing the Visual Analog

Scale (VAS), Jon indicates that his pain level measures about 95 mm in length from the left hand end of the horizontal line. What is an appropriate translation of this action? a. Jon is experiencing a significant amount of pain. b. Jon is experiencing a moderate amount of pain. c. Jon is uncomfortable but able to tolerate the pain. d. None of the above because the pain scale is subjective.

ANS: A

Operationally, a VAS is usually a horizontal line, 100 mm in length. The VAS score is determined by measuring in millimeters from the left end of the line to the point that the patient indicates. Since Jon indicated that his pain threshold was close to the definitive end of 100 mm, one can assume that Jon is experiencing a significant amount of pain. The VAS scores would be lower for moNder mC fort able levels of pain. Although the scale is RateSIand Gunc Bo. M U N T O subjective, it is nonetheless useful.

DIF: Comprehension REF: 6|7 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 16. Considering the human needs paradigm, freedom from fear and stress includes which of the

following? a. The need to receive appreciation, attention, and respect from others b. The need to be free from emotional discomfort c. The need to feel safe d. All options listed ANS: D

All options listed. Considering the human needs paradigm, freedom from fear and stress includes the need to receive appreciation, attention, and respect from others. It also includes the need to be free from emotional discomfort and the need to feel safe.

DIF: Recall REF: 7 OBJ: 5 TOP: NBDHE, 1.0 Assessing Patient Characteristics| NBDHE, 1.6 General| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 17. An astute practitioner looks for signs of patient anxiousness. These signs may include which

of the following?

a. b. c. d.

Overwillingness to cooperate with clinician History of emergency dental care only Elevated blood pressure and heart rate All options listed

ANS: D

All options listed. An astute practitioner looks for signs of patient anxiousness. These signs may include an overwillingness to cooperate with clinician, which could be portrayed through nervous conversations and/or quick answers; a history of emergency dental care only or a history of canceled appointments; and physical symptoms including elevated blood pressure and fast heart rate.

DIF: Recall REF: 8 OBJ: 4 TOP: NBDHE, 1.0 Assessing Patient Characteristics| NBDHE, 1.6 General| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 18. The best method to manage an anxious patient is by: a. Prevention b. General sedation c. Referral to an anxiety specialist d. All options listed ANS: A

The best method to manage an anxious patient is by prevention. General sedation and referral to an anxiety specialist may be avoided through the use of stress reduction principles.

DIF: Comprehension REF: 8 OBJ: 2 TOP: NBDHE, 3.0 Planning aN nd M anaging Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain URSING TB.C OM Control 19. Performing a complete health history review at every appointment helps practitioners

recognize stressors and health conditions that may complicate dental procedures. Taking a patient’s vital signs does not play an important role in assessing a patient’s level of apprehension. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: C

The first statement is true; the second statement is false. Performing a complete health history review at every appointment helps practitioners recognize stressors and health conditions that may complicate dental procedures. Taking vital signs also plays an important role in helping to understand a patient’s total health history and in assessing a patient’s level of apprehension.

DIF: Comprehension REF: 8 OBJ: 2 TOP: NBDHE, 1.0 Assessing Patient Characteristics| NBDHE, 1.6 General| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 20. The use of anesthesia as needed is an important key to what? a. Understanding why patients are fearful of dental appointments b. Preventing fear associated with pain

c. Understanding the cause of pain d. All options listed ANS: B

The use of anesthesia as needed is an important key to preventing the fear associated with pain. Understanding why patients are fearful of dental appointments and the cause of pain assists in implementing a patient-centered approach to stress reduction.

DIF: Comprehension REF: 8 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 21. Considerations that have the potential of influencing a dental patient’s pain reaction threshold

include which of the following? a. Age b. Culture c. Fatigue d. All options listed ANS: D

All options listed. Pain reaction threshold may be influenced by the patient’s emotional state, fatigue, age, culture, and fear and apprehension.

DIF: Recall REF: 6|7 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 22. Patients who frequently miss dental appointments because of apprehension often demonstrate

N R I G B.C M

O what kind of pain reaction threU sholS d? N T a. A lower pain reaction threshold, which means that they have a high tolerance for pain b. A lower pain reaction threshold, which means that they have a low tolerance for pain c. A higher pain reaction threshold, which means that they have a high tolerance for pain d. None of the above ANS: B

Patients who frequently miss dental appointments because of apprehension will generally demonstrate a lower pain reaction threshold, which means that they have a low tolerance for pain and they will likely experience pain more quickly and/or intensely than if they were calm. Patients who demonstrate a higher pain reaction threshold generally have a higher tolerance to pain.

DIF: Comprehension REF: 7 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 23. Patients who are overly tired or stressed at the time of their dental appointment will generally

demonstrate what kind of pain reaction threshold? a. A lower pain reaction threshold, which means that they have a high tolerance for pain

b. A lower pain reaction threshold, which means that they have a low tolerance for

pain c. A higher pain reaction threshold, which means that they have a high tolerance for

pain d. None of the above ANS: B

Patients who are overly tired or stressed at the time of their dental appointment will generally demonstrate a lower pain reaction threshold, which means that they have a low tolerance for pain and they will likely experience pain more quickly and/or intensely than if they were well rested and calm. Patients who are not overly tired or stressed can demonstrate a higher pain reaction threshold, which means that they will have a higher tolerance for pain.

DIF: Comprehension REF: 7 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 24. The difference between the legal wording that states that the dental hygienist may monitor

nitrous oxide and that the dental hygienist may administer nitrous oxide is best explained by which of the following statements? a. When it is said that the dental hygienist may administer nitrous oxide, this indicates that the hygienist may change the nitrous oxide and/or oxygen settings during the appointment as needed. b. When it is said that the dental hygienist may monitor nitrous oxide, this means that the hygienist may turn on the nitrous oxide and/or oxygen settings during the appointment as needed. c. In legal terms, someone with the authority to monitor nitrous oxide may change Nyge RS I tting GTs;B.C M the nitrous oxide and/or oxU n seN somO eone with the authority to administer nitrous oxide may turn on the apparatus. d. In state law the terms monitor and administer can be used interchangeably.

ANS: C

In legal terms someone with the authority to monitor nitrous oxide may change the nitrous oxide and/or oxygen settings during the appointment as needed; someone with the authority to administer nitrous oxide may turn on the nitrous-oxide/oxygen apparatus.

DIF: Recall REF: 6 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 25. The most popular dental local anesthetic used in the United States today is which of the

following? a. Procaine b. Mepivicaine c. Prilocaine d. Lidocaine ANS: D

Lidocaine remains the most popular dental local anesthetic used in the United States today.

Procaine is no longer available, but mepivacaine and prilocaine are available in the United States.

DIF: Recall REF: 2|3 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 26. Which drug, added to dental local anesthetics, is helpful for achieving hemostasis? a. Halothane b. Epinephrine c. Cocaine d. None of the above ANS: B

Epinephrine, a vasoconstrictor, may be added to dental local anesthetics and is helpful in achieving hemostasis. Halothane, an inhalation drug, and cocaine, an ester local anesthetic no longer used in dentistry, are not added to dental local anesthetics.

DIF: Recall REF: 3 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 27. Dental anxiety may be attributed to which of the following? a. Unpleasant dental experiences in the past b. Learned dental fear from a parent c. All options listed d. None of the above ANS: C

All options listed. Patients who are anxious may have had unpleasant experiences in the past N enta RSl I GThe B.C M or may have a learned fear of dU caNre. T maO jority of studies confirm a relationship between parental and child dental fear.

DIF: Recall REF: 7|8 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 28. The physical and emotional response to a specific situation is referred to as which of the

following? a. Pain reaction b. Stress c. Pain perception d. Pain control ANS: B

Stress is a physical and emotional response to a particular situation. Pain reaction refers to the personal interpretation and response to a pain message that differs greatly between individuals; pain perception is a neurologic experience of pain that differs little between individuals; and pain control is the mechanism to alleviate pain.

DIF: Recall REF: 7|8 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

29. In 1842, who was known for assisting a dentist by administering ether to a patient? a. William Clarke b. Horace Wells c. Henry Beecher d. Francesco Di Stafano ANS: A

In 1842, it was reported that William Clarke administered ether via a towel to a woman as one of her teeth was extracted by a dentist. Horace Wells is best known for his work with nitrous oxide; Henry Beecher for his observations regarding clinical trials; and Francesco Di Stafano for his work isolating cocaine from coca leaves.

DIF: Recall REF: 2 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology 30. Opium was used as an early method for pain reduction. Later, when converted to morphine, it

became even more effective when injected into the bloodstream. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. Opium was most useful for pain control. In fact, opium proved even more effective when converted into a more potent form, morphine, and injected into the bloodstream.

NURSINGTB.COM

OBJ: 1 DIF: Recall REF: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 6.0 Pharmacology

Chapter 02: Neurophysiology Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition MATCHING

Match each description with the term that correctly identifies the generation and conduction of the nerve impulse stage. Terms may be used more than once. a. Polarization b. Slow depolarization c. Rapid depolarization d. Repolarization e. Relative refractory period f. Absolute refractory period 1. During this stage, the second action potential is inhibited but not impossible should a larger

stimulus be applied.

2. The nerve is stimulated by the minimal threshold level.

3. The electrical potential of the neuron is approximately −70 mV. 4. During this stage, the electrical charge on the outside of the membrane is positive, while the

electrical charge on the inside of the membrane is negative.

5. Occurs once the peak of the action potential is reached and the membrane potential begins to 6.

7.

8.

9.

10.

move back toward the resting potential.

The resting potential of the cell changes to become more negative, but not enough to trigger the firing threshold.

The interval during which a second action potential cannot be initiated, no matter how large a N R I G B.C M U S N T O stimulus is applied.

The outside of the cell contains excess sodium ions at a ratio of 14:1; the inside of the cell contains excess potassium ions.

The gated Na+ channels on the resting neuron’s membrane release and open suddenly in order to allow the Na+ in the extracellular fluid to influx into the cell.

The impulse moves between the uninsulated nodes of Ranvier that exist between each Schwann cell.

1. ANS: E DIF: Recall REF: 21| 23 TOP: NBDHE, 2.0 Physiology 2. ANS: C DIF: Recall REF: 21 TOP: NBDHE, 2.0 Physiology 3. ANS: A DIF: Recall REF: 20 TOP: NBDHE, 2.0 Physiology 4. ANS: A DIF: Recall REF: 20 TOP: NBDHE, 2.0 Physiology 5. ANS: D DIF: Recall REF: 21 TOP: NBDHE, 2.0 Physiology 6. ANS: B DIF: Comprehension TOP: NBDHE, 2.0 Physiology OBJ: 8 7. ANS: F DIF: Recall REF: 21| 23 TOP: NBDHE, 2.0 Physiology 8. ANS: A DIF: Recall REF: 20 TOP: NBDHE, 2.0 Physiology

OBJ: 8 OBJ: 8 OBJ: 5| 6 OBJ: 8 OBJ: 8 REF: 21 OBJ: 7 OBJ: 8

9. ANS: C DIF: Recall TOP: NBDHE, 2.0 Physiology DIF: Recall 10. ANS: C TOP: NBDHE, 2.0 Physiology

REF: 21

OBJ: 8

REF: 21

OBJ: 8

MULTIPLE CHOICE 1. What are the nerves that conduct signals from sensory neurons to the spinal cord or brain

called? a. Neurotransmitters b. Electrical synapses c. Afferent nerves d. Efferent nerves ANS: C

The nerves that conduct signals from sensory neurons to the spinal cord or brain are called afferent nerves. Neurotransmitters are the endogenous chemicals that transmit signals from a neuron to a target cell across a synapse. Electrical synapses involve gap junctions that allow action potentials to move from cell to cell directly by allowing electrical current to flow between cells. Efferent nerves conduct signals away from the brain or spinal cord.

DIF: Recall

REF: 14

OBJ: 3

TOP: NBDHE, 2.0 Physiology

2. What are the endogenous chemicals that transmit signals from a neuron to a target cell across

a synapse called? a. Neurotransmitters b. Electrical synapses c. Afferent nerves d. Efferent nerves

NURSINGTB.COM

ANS: A

The endogenous chemicals that transmit signals from a neuron to a target cell across a synapse are called neurotransmitters. Electrical synapses involve gap junctions that allow action potentials to move from cell to cell directly by allowing electrical current to flow between cells. Afferent nerves conduct signals from sensory neurons to the spinal cord or brain.

Efferent nerves conduct signals away from the brain or spinal cord.

DIF: Recall

REF: 21

OBJ: 7

TOP: NBDHE, 2.0 Physiology

3. What are the nerves that conduct signals away from the brain or spinal cord called? a. Neurotransmitters b. Electrical synapses c. Afferent nerves d. Efferent nerves ANS: D

The nerves that conduct signals away from the brain or spinal cord are called efferent nerves.

The endogenous chemicals that transmit signals from a neuron to a target cell across a synapse are called neurotransmitters. Electrical synapses involve gap junctions that allow action potentials to move from cell to cell directly by allowing electrical current to flow between cells. Afferent nerves conduct signals from sensory neurons to the spinal cord or brain.

DIF: Recall

REF: 14

OBJ: 3

TOP: NBDHE, 2.0 Physiology

4. Local anesthetic agents used in dentistry: a. Cause loss of nociception b. Prevent generation of a nerve impulse c. Prevent conduction of a nerve impulse d. All options listed ANS: D

All options listed. A local anesthetic is a drug that causes reversible local anesthesia and a loss of nociception as a result of the depression of excitation in nerve endings or the inhibition of the conduction process in peripheral nerves. Local anesthetic agents used in dentistry prevent both generation and conduction of a nerve impulse.

DIF: Recall REF: 11 OBJ: 9 TOP: NBDHE, 2.0 Physiology| NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. Tasks for neurons include receiving, processing, and sending information. They communicate

with other neurons through axons and synapses. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. TasN ks fR or nI eurG ons in. clC udeMreceiving, processing, and sending U with S other N TB O through axons and synapses. information. They communicate neurons DIF: Recall

REF: 12|13

OBJ: 5

TOP: NBDHE, 2.0 Physiology

6. What is another name for axons? a. Core bundles b. Mantle bundles c. Nerve fibers d. All options listed ANS: D

All options listed. Axons are often referred to as nerve fibers. The nerve fibers that are bundled together and located near the outside of the nerve are called mantle bundles. The bundled nerve fibers located near the inside of the nerve are called core bundles.

DIF: Comprehension TOP: NBDHE, 2.0 Physiology

REF: 13

OBJ: 4

7. What is the most distal arborization of the nerve endings called? a. Dendritic zone b. Soma c. Axon hillock d. Output zone

ANS: A

The dendritic zone is the most distal section of the neuron and is an arborization (formation of a treelike shape) of nerve endings. The soma refers to the cell body (located at the input zone); the axon hillock, located at the summation zone, is the part of the axon where it emerges from the soma; and the output zone is located at the distal end of the axon, where nerve impulse triggers the release of neurotransmitters.

DIF: Recall

REF: 14

OBJ: 4

TOP: NBDHE, 2.0 Physiology

8. What is the name of the portion of the sensory neuron that is easily excited and has the most

negative action potential threshold? a. Dendritic zone b. Soma c. Axon hillock d. Output zone ANS: C

The axon hillock is the part of the neuron that has the greatest density of voltage-dependent sodium channels (Na+); it easily excited and is the portion of the sensory neuron with the most negative action potential threshold. The dendritic zone is the most distal section of the neuron and is an arborization (formation of a treelike shape) of nerve endings. The soma refers to the cell body (located at the input zone); and the output zone is located at the distal end of the axon, where nerve impulse triggers the release of neurotransmitters.

DIF: Recall

REF: 15

OBJ: 4

TOP: NBDHE, 2.0 Physiology

9. The lipoprotein sheath that surrounds many neurons is called the myelin sheath. The myelin

sheath is composed of SchwaNnU nR ceS llI s. NGTB.COM a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. The lipoprotein sheath that surrounds many neurons is called myelin sheath and is composed of Schwann cells.

DIF: Recall

REF: 16-17

OBJ: 3

TOP: NBDHE, 2.0 Physiology

10. What is the propagation of action potentials along myelinated axons from one node of Ranvier

to another called? a. Nonmyelinated b. Saltatory conduction c. Polarization d. Refractory period ANS: B

Saltatory conduction is the propagation of action potentials along myelinated axons from one node of Ranvier to another. Nonmyelinated refers to nerve fibers that have no myelin sheath and therefore rely on diffusion of electrolytes along the nerve cell membrane for impulse travel. Polarization refers to the resting state, when the electrical charge on the outside of the membrane is positive while the inside of the membrane is negative. The refractory period refers to the time when the neuron is busy returning sodium and potassium ions to their original sides of the nerve membrane.

DIF: Recall

REF: 16-17| 17

OBJ: 5

TOP: NBDHE, 2.0 Physiology

11. The A alpha nerve fiber type is the smallest and the most numerous nerve fiber. The A delta

nerve fiber type is primarily responsible for dull, aching pain. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: B

Both statements are false. Nerve fiber type C, the smallest and the most numerous nerve fiber, is responsible for dull, aching pain. The A alpha nerve fiber type is the largest and fastest and is responsible for muscle movement and light touch. The A delta nerve fiber type is large, fast, and primarily responsible for sharp pain.

DIF: Recall

REF: 18-19

OBJ: 6

TOP: NBDHE, 2.0 Physiology

12. Which nerve fiber type is responsible for pain related to temperature? a. A alpha NURSINGTB.COM b. A delta c. B d. C ANS: B

Nerve fiber type A delta is responsible for sharp pain. The A alpha nerve fiber type is the largest and fastest and is responsible for muscle movement and light touch. B fibers are lightly myelinated motor fibers; and nerve fiber type C, the smallest and the most numerous nerve fiber, is responsible for dull, aching pain.

DIF: Recall

REF: 18-19

OBJ: 6

TOP: NBDHE, 2.0 Physiology

13. As the action potential moves down the line, its strength decreases as it moves from one

neuron to the next. The action potential in myelinated axons does not propagate as waves as in unmyelinated axons. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: D

The first statement is false; the second statement is true. Once a nerve is excited, the intensity of stimulation does not produce a stronger signal or become diminished as it propagates down the line. The action potential in myelinated axons does not propagate as waves as in unmyelinated axons.

DIF: Comprehension TOP: NBDHE, 2.0 Physiology

REF: 19

OBJ: 7

14. Which description best describes the mechanism by which local anesthetic drugs work? a. Anesthetic drugs bind to the sodium channels, the influx of sodium is interrupted,

the action potential cannot rise, and the signal conduction is inhibited. b. Anesthetic drugs bind to the potassium channels, the influx of sodium is

interrupted, the action potential cannot rise, and the signal conduction is inhibited. c. Anesthetic drugs bind to the sodium channels, the influx of potassium is interrupted, the action potential cannot rise, and the signal conduction is inhibited. d. Anesthetic drugs bind to the sodium channels, the influx of sodium and potassium is interrupted, the action potential cannot rise, and the signal conduction is inhibited.

ANS: A

Anesthetic drugs bind to the sodium channels, the influx of sodium is interrupted, the action potential cannot rise, and the signal conduction is inhibited. The mechanism does not include local anesthetic drugs binding to potassium channels or the influx of potassium.

DIF: Comprehension REF: 23 OBJ: 9 TOP: NBDHE, 2.0 Physiology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

NURSINGTB.COM

15. What is the layer of connective tissue that surrounds each axon within a nerve called? a. Epineurium b. Endoneurium c. Perineurium d. Fascicle ANS: B

Within a nerve, each axon is surrounded by a layer of connective tissue called the endoneurium. The epineurium wraps the entire nerve; the perineurium wraps each fascicle (group of nerve fibers).

DIF: Recall

REF: 13

OBJ: 3

TOP: NBDHE, 2.0 Physiology

16. What is the layer of connective tissue that surrounds the entire nerve called? a. Epineurium b. Endoneurium c. Perineurium d. Fascicle ANS: A

The entire nerve is wrapped in a layer of connective tissue called the epineurium. Within a nerve, each axon is surrounded by a layer of connective tissue called the endoneurium; the perineurium wraps each fascicle (group of nerve fibers).

DIF: Recall

REF: 13

OBJ: 3

TOP: NBDHE, 2.0 Physiology

17. The main difference between motor neurons and sensory neurons is the location of which

body part? a. Axon b. Dendritic zone c. Cell body d. Terminal arborization ANS: C

The main difference between motor neurons and sensory neurons is the location of the cell body. The cell body of the motor (efferent) neuron participates in impulse conduction, and therefore is located at the terminal arborization at the dendritic zone. The cell bodies of sensory (afferent) neurons do not participate in nerve conduction and therefore are located off the axon.

DIF: Recall

REF: 14

OBJ: 4

TOP: NBDHE, 2.0 Physiology

18. The cell body of which neuron participates in impulse conduction and therefore is located at

the terminal arborization? a. Sensory neurons b. Motor neurons c. Somatic neurons d. All options listed ANS: B

The cell body of the motor neuron participates in impulse conduction and therefore is located at the terminal arborization. T f sC ens ory (afferent) neurons do not participate in Nhe URcell SIbod NGies TBo. OM nerve conduction and therefore are located off the axon. Somatic neurons are associated with the somatic nervous system, a subdivision of the peripheral nervous system.

DIF: Recall

REF: 14

OBJ: 4

TOP: NBDHE, 2.0 Physiology

19. The difference between the electrical charge on the outside of the cell and that on the inside of

the cell is called what? a. Firing threshold b. Membrane potential c. Polarization d. Action potential ANS: B

The difference between the electrical charge on the outside of the cell and that on the inside of the cell is called the membrane potential. The nerve’s firing threshold is reached when axoplasm has depolarized approximately 15-20mV from −70mV, attaining the threshold for impulse generation; polarization refers to the resting state, when the electrical charge on the outside of the membrane is positive while the inside of the membrane is negative; the action potential is the membrane potential of an active nerve conducting an impulse.

DIF: Recall

REF: 19

OBJ: 8

TOP: NBDHE, 2.0 Physiology

20. At the synaptic knobs of neuron cells, what type of action is required to have the electrical

impulse cross the synapse of one cell to another cell? a. The action of electrical synapses b. The action of chemical synapses c. The action of either electrical or chemical synapses d. Repolarization ANS: C

To have the electrical impulse cross the synapse of one cell to another cell requires the action of either electrical synapses or chemical synapses. Repolarization occurs once the peak of the action potential is reached and membrane potential begins to move back toward the resting potential.

DIF: Recall

REF: 15-16

OBJ: 7

TOP: NBDHE, 2.0 Physiology

21. The nerve cell stage in which potassium returns to the inside of the cell and sodium returns to

the outside of the cell is called what? a. All-or-none principle b. Polarization c. Depolarization d. Refractory period ANS: D

The refractory period puts everything back to normal: Potassium returns inside, and sodium returns outside the cell membrane. The return to the resting state (polarization) is realized when the electrical charge on the outside of the membrane is positive while the inside of the membrane is negative. Depolarization occurs when action potential causes sodium channels to open, allowing an influx of sN odUiuRmSiI onNsG thTatBc. haCnO geMs the electrochemical gradient, which in turn produces a further rise in the membrane potential. The conduction of nerve impulses is an example of an all-or-none response: that is, once a neuron responds to the minimum threshold level, it must respond completely and will no longer be dependent of the stimulus to continue.

DIF: Recall

REF: 21

OBJ: 8

TOP: NBDHE, 2.0 Physiology

22. What do local anesthetic drugs inhibit in order to prevent nerve cell stimulation? a. Sodium influx b. Potassium influx c. Chloride excretion d. All options listed ANS: A

Local anesthetic drugs act mainly by inhibiting sodium influx through sodium-specific ion channels in the neuronal cell membrane. Local anesthetic drugs do not act by inhibiting potassium influx or chloride excretion.

DIF: Comprehension REF: 23 OBJ: 9 TOP: NBDHE, 2.0 Physiology| NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

23. The smaller-diameter nerve fibers associated with supraperiosteal injections are more

sensitive to local anesthetics. The larger-diameter nerve fibers of the IA and PSA require a larger volume of local anesthetic for successful nerve blockage. a. Both statements are true. b. Both statements are false c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. The smaller-diameter nerve fibers associated with supraperiosteal injections are more sensitive to local anesthetics. The larger-diameter nerve fibers of the IA and PSA require a larger volume of local anesthetic for successful nerve blockage.

DIF: Comprehension REF: 23 OBJ: 9 TOP: NBDHE, 2.0 Physiology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 24. The function of the cell body is to transmit impulses. The cell body is responsible for protein

synthesis and provides metabolic support for the neuron. a. Both statements are true. b. Both statements are false c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: D

The first statement is false; the second statement is true. The cell body is not involved in impulse transmission. The cell body is responsible for protein synthesis and provides metabolic support for the neuNroUnR . SINGTB.COM DIF: Recall

REF: 15

OBJ: 4

TOP: NBDHE, 2.0 Physiology

25. The axon is: a. Made up of cytoplasm b. Surrounded by a multiple lipid membrane c. All options listed d. None of the options listed ANS: C

All options listed. The axon is made up of cytoplasm, or axoplasm, and is surrounded by a multilayer lipid membrane.

DIF: Recall

REF: 15

OBJ: 4

TOP: NBDHE, 2.0 Physiology

26. Which of the following is true regarding the nodes of Ranvier? a. Found along myelinated nerve fibers between adjacent Schwann cells b. Occur at unevenly spaced intervals c. All options listed d. None of the options listed ANS: A

The nodes of Ranvier are found along myelinated nerve fibers, gaps in the sheath, and between adjacent Schwann cells, and they occur at evenly spaced intervals.

DIF: Recall

REF: 16-17

OBJ: 5

TOP: NBDHE, 2.0 Physiology

27. The relationship between relative amounts of ions inside and outside the nerve membrane is

known as which of the following? a. Relative refractory period b. Concentration gradient c. Action potential d. Axolemma ANS: B

The concentration gradient is the relationship between the relative amounts of ions inside and outside the nerve membrane. Relative refractory period is the interval immediately following the absolute refractory period and before complete reestablishment to the resting state. Action potential is a nerve impulse. Axolemma is the plasma membrane of the axon.

DIF: Recall

REF: 19

OBJ: 8

NURSINGTB.COM

TOP: NBDHE, 2.0 Physiology

Chapter 03: Pharmacology of Local Anesthetic Agents Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition TRUE/FALSE 1. Prilocaine is biotransformed in the liver only.

ANS: F

Correct: Prilocaine is biotransformed in the lungs and the liver.

DIF: Recall REF: 36| 38 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. The most potent local anesthetic is bupivacaine, which has the greatest degree of lipid

solubility.

ANS: T DIF: Comprehension REF: 28| 38 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. Intravascular injections significantly increase the possibility of an overdose.

ANS: T DIF: Comprehension REF: 36| 38 OBJ: 11 TOP: NBDHE, 6.0 PharmacolN ogy|RNBI 3.B 0.

PlC anniM U SDHE NG, T O ng and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. The higher the pKa of an anesthetic, the faster the onset of action.

ANS: F

Correct: The higher the pKa of the anesthetic, the slower the onset of action.

DIF: Recall REF: 29-30| 38 OBJ: 7 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. The speed of recovery from local anesthetic is determined by the degree of binding to the

receptor site of each anesthetic.

ANS: T DIF: Recall REF: 35| 38 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. Local anesthetics are vasoconstrictors and decrease the absorption of the drug by the blood.

ANS: F

Correct: Local anesthetics are vasodilators and increase the absorption of the drug by the blood.

DIF: Comprehension REF: 35-36| 38 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. If more anesthetic is needed for a procedure, it is important to reinject the anesthetic after the

mantel fibers have fully recovered.

ANS: F

Correct: If more anesthetic is needed for a procedure, it is important to reinject the anesthetic before the mantel fibers have fully recovered.

DIF: Recall REF: 35| 38 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. Local anesthetics affect the CNS and CVS after biotransformation.

ANS: F

Correct: Local anesthetics affect the CNS and CVS before biotransformation.

DIF: Recall REF: 37| 38 OBJ: 10| 11 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. The rate of systemic absorption of local anesthetics depends on the total dose, concentration,

route of administration, vascularity of tissues, and presence or absence of a vasoconstrictor.

ANS: T DIF: ReNcallR I GREB F:.C 35| 3M 8 OBJ: 10 U NBDHE, S N 3.0 T Planning O and Managing Dental Hygiene Care| TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.4 Anxiety and Pain Control 10. Local anesthetics easily cross the blood–brain barrier.

ANS: T DIF: Recall REF: 36| 38 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control MULTIPLE CHOICE 1. What is the significant clinical difference between esters and amides? a. Potential for allergic reactions b. Cross-hypersensitivity c. Lipid solubility d. Drug potency ANS: A

The significant clinical difference between esters and amides is the potential for allergic reactions. Cross-hypersensitivity between esters and amides is unlikely. Lipid solubility is improved by the lipophilic aromatic ring associated with the local anesthesia molecule. Drug potency is related to lipid solubility in that greater lipid solubility enhances diffusion through the nerve, allowing a lower effective dose.

DIF: Comprehension REF: 28 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. Which component of the local anesthetic molecule improves the lipid solubility, facilitating

the penetration of the anesthetic through the lipid-rich membrane where the receptor sites are located? a. Hydrophilic amino group b. Intermediate hydrocarbon ester or amide chain c. Lipophilic aromatic ring d. All options listed ANS: C

The lipophilic aromatic ring improves the lipid solubility of the molecule, which facilitates the penetration of the anesthetic through the lipid rich-membrane where the receptor sites are located. The hydrophilic amino group acts as the “on-off’ switch allowing the local anesthetic to exist in either lipid-soluble or water-soluble configurations. The intermediate hydrocarbon ester or amide chain determines if the molecule is an ester or an amide.

DIF: Recall REF: 28 OBJ: 3 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. Which component of the local anesthetic molecule renders the molecule water soluble? a. Hydrophilic amino group b. Intermediate hydrocarbon ester or amide chain c. Lipophilic aromatic ring d. All options listed

NURSINGTB.COM

ANS: A

The hydrophilic amino group renders the molecule water soluble. The intermediate hydrocarbon ester or amide chain determines if the molecule is an ester or amide. The lipophilic aromatic ring improves the lipid solubility of the molecule.

DIF: Recall REF: 28 OBJ: 3 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. Dissociation constant refers to which of the following descriptions? a. Determines the portion of administered anesthetic dose in the lipid-soluble state

(RN) b. Determines the onset of anesthetic action as the increase of molecules crossing the

nerve membrane decreases the time of the anesthetic’s onset c. The pH at which 50% of the molecules exist in the lipid-soluble form and 50% in

the water-soluble form d. All options listed ANS: D

All options listed. The dissociation constant determines the portion of administered anesthetic dose in the lipid-soluble state (RN); determines the onset of anesthetic action as the increase of molecules crossing the nerve membrane decreases the time of the anesthetic’s onset; and it is the pH at which 50% of the molecules exist in the lipid-soluble form and 50% in the water-soluble form.

DIF: Comprehension REF: 29| 30 OBJ: 7 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. Why is lipid solubility an important characteristic of local anesthetic drugs? a. A greater lipid solubility enhances the diffusion of the anesthetic drug through the

nerve. b. A greater lipid solubility indicates a higher potency of the anesthetic drug. c. A greater lipid solubility allows for a lower effective dose of the local anesthetic

drug. d. All options listed.

ANS: D

All options listed. Lipid solubility is an important characteristic of local anesthetic drugs because a greater lipid solubility enhances the diffusion of the anesthetic through the nerve, indicates a higher potency of the drug, and allows for a lower effective dose.

DIF: Comprehension REF: 28| 31 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. Why is protein binding an imN pU orR taS ntIcN haG raT ctB er. isC ticOoMf local anesthetic drugs? a. Increased protein binding allows more cations (RNH+) to bind to the receptor sites

within the sodium channels, prolonging the presence of anesthetic at the site of action. b. Increased protein binding allows more RN molecules to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action. c. Decreased protein binding allows more cations (RNH+) to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action. d. Decreased protein binding allows more RN molecules to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action.

ANS: A

Increased protein binding allows more cations (RNH+) to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action. An increase of RN molecules is not associated with increased protein binding or prolonging the presence of anesthetic at the site of action.

DIF: Recall REF: 31| 35 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

7. What characteristic of local anesthetic drugs determines the speed of nerve recovery? a. The concentration of the local anesthetic b. The degree of lipid solubility c. The degree of protein binding d. The nonnervous tissue diffusibility ANS: C

The degree of protein binding at the receptor site for each anesthetic determines the speed of nerve recovery. The concentration of local anesthetic is associated with diffusion and onset; degree of lipid solubility with potency; and nonnvervous tissue diffusibility with onset.

DIF: Recall REF: 35 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. What does the membrane expansion theory of the action of local anesthetics suggest? a. Anesthetics that are highly hydrophilic cause the matrix of the nerve membrane to

expand, narrowing the sodium channels, thus preventing depolarization. b. Anesthetics that are highly lipid soluble cause the lipoprotein matrix of the nerve

membrane to expand, narrowing the sodium channels, thus preventing depolarization. c. Anesthetics cause the sodium channels to expand, thus allowing the increase in protein binding within the channels. d. All options listed ANS: B

The membrane expansion theory suggests that anesthetics that are highly lipid soluble cause the lipoprotein matrix of the N nerv bran UReSmIem NG TBe.toCexp OMand, narrowing the sodium channels, thus preventing depolarization. The theory does not discuss hydrophilic local anesthetics or the consequences of expansion of sodium channels.

DIF: Comprehension REF: 33 OBJ: 9 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. What does the specific protein receptor theory of the action of local anesthetics suggest? a. The specific protein receptor theory suggests that anesthetics that are highly lipid

soluble cause the lipoprotein matrix of the nerve membrane to expand, narrowing the sodium channels, thus preventing depolarization. b. The method by which the impulses travel down the length of the nerve affects whether nodes of Ranvier are stimulated or not. c. Displaced Ca++ and local anesthetic drugs compete to bind to receptor sites within the ion channels of cell membranes. d. All options listed.

ANS: C

The specific protein receptor theory suggests that, during depolarization, Ca++ ions are displaced and are thought to be the most significant factor responsible for the influx of sodium into the nerve. During slow depolarization, local anesthetics work by competing with Ca++ ions to bind to these ion channels. It is the membrane expansion theory that suggests that anesthetics that are highly lipid soluble cause the lipoprotein matrix of the nerve membrane to expand, narrowing the sodium channels, thus preventing depolarization. The specific protein receptor theory does not discuss the stimulation of the nodes of Ranvier.

DIF: Comprehension REF: 32| 33 OBJ: 9 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 10. Tachyphylaxis is a term used to describe what phenomenon? a. An increased tolerance to a drug that is administered repeatedly. b. If the dental procedure lasts longer than the duration of the anesthetic and the

mantel and core fibers have fully recovered, the reinjection of local anesthetic will be ineffective. c. Once the mantel fibers return to function, the patient experiences pain, yet administration of anesthetic does not alleviate the pain. d. All options listed ANS: D

All options listed. Tachyphylaxis is an increased tolerance to a drug that is administered repeatedly. If the dental procedure lasts longer than the duration of the anesthetic and the mantel and core fibers have fully recovered, the reinjection of local anesthetic will be ineffective. Once the mantel fibers return to function, the patient experiences pain, yet the administration of local anesthetic does not alleviate the pain.

N R I G B.C M U S N T O

DIF: Recall REF: 35| 38 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 11. What factor/factors influence(s) the duration of the effects of local anesthetics? a. Degree of protein binding b. Vascularity of injection site c. Addition or absence of a vasoconstrictor d. All options listed ANS: D

All options listed. The duration of local anesthetics is influenced by the degree to which the local anesthetic is bound to the receptor sites or the protein binding; the vascularity of the injection site; and the addition or absence of an added vasoconstrictor to the local anesthetic.

DIF: Recall REF: 35 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 12. Adding vasoconstrictor to local anesthetics can result in reduced systemic toxicity and

increased duration of anesthetic because the vasoconstrictor reduces the rate of absorption. a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but NOT related.

c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: A

Both the statement and reason are correct and related. To reduce the rate of absorption, vasoconstrictors are added to local anesthetics. The vasoconstrictor will reduce rapid systemic absorption, which reduces systemic toxicity and increases the duration of anesthetic.

DIF: Recall REF: 35-36 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 13. After absorption of the local anesthetics into the bloodstream, they are distributed throughout

the body to all tissues. Highly vascular organs such as the brain, heart, liver, kidneys, and lungs have higher concentrations of anesthetics a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. After absorption of the local anesthetics into the bloodstream, they are distributed throughout the body to all tissues. Highly vascular organs such as the brain, heart, liver, kidneys, and lungs have higher concentrations of anesthetics.

DIF: Recall REF: 36 OBJ: 10 TOP: NBDHE, 6.0 PharmacolN ogy|RNBI DHE, 3.0 Planning and Managing Dental Hygiene Care| U S NG TB.C OM NBDHE, 3.4 Anxiety and Pain Control 14. What is another name for the elimination of the local anesthetic from the blood and tissues? a. Tachyphylaxis b. Dissociation constant c. Half-life d. Distribution barriers ANS: C

Another name for the elimination of the local anesthetic from the blood and tissues is the half-life of the anesthetic. Tachyphlylaxis is the increased tolerance to a drug that is administered repeatedly. Dissociation constant (pKa) represents the pH at which 50% of the molecules exist in the lipid-soluble tertiary form and 50% in the quaternary, water-soluble form. Distribution barriers are related to vascularity.

DIF: Recall REF: 36 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 15. Which part of the chemical structure of a local anesthetic determines the pattern of

biotransformation of the anesthetic? a. Lipophilic part b. Hydrophilic part c. Intermediate chain

d. All options listed ANS: C

The intermediate chain determines the pattern of biotransformation of the anesthetic. The lipophilic part facilitates diffusion of local anesthetic through lipid rich membrane, and the hydrophilic part determines either lipid-soluble or water-soluble configurations of the local anesthetic.

DIF: Recall REF: 36 OBJ: 3 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 16. What is the inability to hydrolyze ester local anesthetics and other chemically related drugs

called? a. Atypical pseudocholinesterase b. Low hepatic dysfunction c. Para-aminobenzoic acid intolerance d. None of the above ANS: A

The inability to hydrolyze ester local anesthetics and other chemically related drugs is called atypical pseudocholinesterase. Low hepatic dysfunction effects biotransformation of the anesthetic. Para-aminobenzoic acid intolerance is responsible for allergic reaction associated with procaine.

DIF: Recall REF: 36 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain N ConR trol I G B.C M

U S N T

O

17. Esters, benzocaine, tetracaine, and procaine are hydrolyzed in the plasma by the enzyme

pseudocholinesterase and by liver esterases. Procaine is metabolized to PABA and is the major metabolic by-product responsible for allergic reactions. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. Esters, benzocaine, tetracaine, and procaine are hydrolyzed in the plasma by the enzyme pseudocholinesterase and by liver esterases. Procaine is metabolized to PABA and is the major metabolic by-product responsible for allergic reactions.

DIF: Recall REF: 36 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 18. What factor/factors determine the severity of an overdose reaction to local anesthetic? a. Degree of drop in blood pressure b. Time lapse between the administering of the local anesthetic to the overdose c. Number of symptoms patient experiences d. All options listed

ANS: B

The time lapse between the administering of the local anesthetic to the overdose reaction determines its severity. Because blood pressure may initially rise and then drop, the degree of drop in blood pressure is not a reliable determinant, nor is the number of symptoms that a patient experiences. Symptoms that occur rapidly (within 5 minutes) are more likely to evolve into a more serious reaction. Delayed symptoms that occur after 5 minutes are usually easily resolved and do not develop into a serious reaction.

DIF: Recall REF: 37 OBJ: 11 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 19. Which anesthetic drug has a short half-life of 45 minutes and is the least toxic of the

anesthetics? a. Articaine b. Lidocaine c. Mepivacaine d. Prilocaine ANS: A

Articaine has a short half-life of 45 minutes and is the least toxic of the anesthetics. Lidocaine, mepivacaine, and prilocaine have significantly longer half-lives and are more toxic than articaine.

DIF: Recall REF: 36 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

NURSINGTB.COM

20. Anesthetic recovery is a slower process than induction because the anesthetic binds to the

receptor site in the sodium channel, releasing the anesthetic slowly into the systemic circulation. a. Both the statement and the reason are correct and related. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: A

Both the statement and the reason are correct and related. Anesthetic recovery is a slower process than induction because the anesthetic binds to the receptor site in the sodium channel, releasing the anesthetic slowly into the systemic circulation.

DIF: Recall REF: 35 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 21. The time interval between the initial deposition of the anesthetic solution at the nerve site and

complete conduction blockade is referred to as the: a. Absolute refractory period b. Relative refractory period c. Induction time

d. Half-life e. None of the above ANS: C

Induction time is the time interval between the initial deposition of the anesthetic solution at the nerve site and complete conduction blockade. The absolute refractory period is the interval during which a second action potential absolutely cannot be initiated to restimulate the nerve membrane, no matter how large a stimulus is applied. The relative refractory period refers to the interval immediately following the absolute refractory period. Half-life is the amount of time required to eliminate the drug in the body by one-half of its strength.

DIF: Recall REF: 35 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 22. Ester local anesthetics have a high probability of producing an allergic reaction compared to

amide local anesthetics. A patient who has an allergic reaction to one ester agent is likely to experience hypersensitivity to all ester anesthetics. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. Ester local anesthetics have a high probability of producing an allergic reaction compared to amide local anesthetics. A patient who has an allergic reaction to one ester agent is likely to experience hypersensitivity to all ester anesthetics.

NURSING TB.COM

DIF: Recall REF: 28 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 23. Which of the following is a major route of delivery of local anesthetic drugs? a. Topical b. Intravenous c. Inhalation d. All options listed ANS: A

Topical anesthetic is a major route of delivery of local anesthetic drugs. There are two major routes of delivery of local anesthetic drugs, topical and submucosal injection. Inhalation and intravenous methods are used primarily for general anesthesia and analgesia.

DIF: Recall REF: 29 OBJ: 1 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 24. Which is the primary factor that determines the onset of action? a. pH of the tissues b. pKa of the anesthetic agent c. Administrative site d. Anesthetic agent

e. None of the above ANS: B

The pKa of the local anesthetic is the primary factor that determines the onset of action. The pH of the tissues, the administrative site, and the anesthetic agent are also factors in determining the onset of action.

DIF: Recall REF: 33| 34 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 25. The liver is the organ responsible for the entire metabolic process of most amides. The rate of

biotransformation is faster in patients with significant liver dysfunction. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: C

The first statement is true; the second statement is false. The liver is the organ responsible for the entire metabolic process of most amides. The rate of biotransformation is SLOWER in patients with significant liver dysfunction.

DIF: Recall REF: 36 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

Answer the following questions based upon the following case study.

NlsRexSten INsive GTly,B.C M Sam, a businessman who traveU has O been in your dental chair for 2 hours for extensive nonsurgical perio procedures. He insisted on having a long appointment in order “to get everything done at one time.” A review of Sam’s health history reveals that he is taking medications for high blood pressure; has no known allergies; recently quit smoking; and is a recovering alcoholic. He mentions that he is going through a divorce and that he is leaving for China within the week. You explain to Sam that, because of the long appointment and the amount of work that you need to accomplish, you will use a long-lasting local anesthetic to ensure his comfort. You apply topical benzocaine to all injection sites on the right side. You choose to administer the local anesthetic bupivacaine because of its long-lasting effect.

Although Sam is a good-natured patient, you experience difficulty in achieving the desired level of anesthesia in order to keep Sam comfortable. Within 5 minutes of the administration of yet another cartridge of anesthetic, Sam begins to complain of a headache and you notice that he is slurring his words. You quickly retake his blood pressure only to discover that it has actually gone down since the beginning of the appointment. What thoughts should be going through your mind at this time?

26. Based on Sam’s physical symptoms, what should you consider? a. Sam is extremely relaxed, and his blood pressure medication is working. b. Sam is extremely stressed. c. Sam may be experiencing a mild overdose to the anesthetic. d. Sam may be experiencing a cardiovascular crisis.

ANS: D

Sam may be experiencing a cardiac crisis. Symptoms of an overdose on the cardiovascular system include headache and increased slurring of speech. Headache and slurring of speech would not be associated with the other considerations. In addition, during mild overdose as with increased stress, blood pressure would usually be elevated.

DIF: Application REF: 37| 38 OBJ: 11 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 27. Why do you think Sam’s blood pressure decreased from the beginning of the appointment? a. Sam became more comfortable during the appointment. b. Symptoms of a CNS and CVS overdose are biphasic. c. Symptoms of a possible overdose change from a stimulation phase to a depression

phase. d. All options listed ANS: D

All options listed. When patients become more comfortable and less apprehensive with dental procedures, a drop in blood pressure may be noted. However, in Sam’s case, the fact that he began experiencing a headache immediately after another injection combined with the noticeable drop in blood pressure should lead one to think about the possibility of an anesthetic drug overdose. Symptoms of a CNS and CVS overdose are biphasic, meaning that they progress from a stimulation phase to a depression phase.

DIF: Application REF: 37 OBJ: 11 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

NURSINGTB.COM

28. Considering Sam’s health history, what anesthetic drug may have been a better choice? a. Procaine b. Articaine with epinephrine c. Lidocaine d. Mepivacaine ANS: B

Consider that Sam is a recovering alcoholic who may or may not have liver damage. Because only about 10% of articaine is biotransformed in the liver, it may, at first, appear to be a better choice for Sam; however, due to its half-life, more anesthetic would be required in the long run to keep Sam comfortable, thus making articaine an unacceptable choice. BUT the addition of a vasoconstrictor such as epinephrine to the articaine changes this situation. The vasoconstrictor will delay the absorption of the local anesthetic into the tissue, thus prolonging tissue anesthesia and allowing the dental hygienist to work longer. This illustrates the range of considerations that affect local anesthetic selection.

DIF: Application REF: 37 OBJ: 11 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 29. Reflecting on your experience with Sam, what other factors may contribute to an incident

similar to Sam’s? a. The use of topical anesthetics plus intravascular injections

b. An injection that is administered too rapidly c. The perio infection and inflammation d. All options listed ANS: D

All options listed. Reflecting on one’s technique of administering anesthetic drugs and working to improve that technique can prevent further incidents such as Sam’s. Intravascular injections rapidly produce high blood levels, and topical anesthetics are administered in high concentrations that are absorbed quickly from the site of administration: both techniques increase the possibility of toxicity. The rate of injection can increase the chance of toxicity because tissues cannot accept the large, rapid volume of anesthetic. Vascular areas due to infection, inflammation, or vasodilation from the local anesthetic agent will increase systemic toxicity.

DIF: Application REF: 36| 37 OBJ: 8| 10| 11 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

NURSINGTB.COM

Chapter 04: Pharmacology of Vasoconstrictors Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition ESSAY 1. The number of 1:50,000 epinephrine-anesthesia cartridges that a healthy patient may have per

dental appointment is

.

ANS:

5.5 cartridges.

DIF: Recall REF: 46| 48 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. The number of 1:50,000 epinephrine-anesthesia cartridges that a patient with cardiovascular

disease may have per dental appointment is

.

ANS:

1.1 cartridges.

DIF: Recall REF: 46| 48 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. The number of 1:200,000 epinephrine-anesthesia cartridges that a healthy patient may have

per dental appointment is

NUR. SINGTB.COM

ANS:

22.2 cartridges. The actual number of cartridges is limited by the maximum recommended dose of the anesthetic agent.

DIF: Recall REF: 46| 48 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. The number of 1:200,000 epinephrine-anesthesia cartridges that a patient with cardiovascular

disease may have per dental appointment is

.

ANS:

4.4 cartridges, The actual number of cartridges is limited by the maximum recommended dose of the anesthetic agent.

DIF: Recall REF: 46| 48 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. Why is there such a difference in the number of epinephrine-anesthesia cartridges that a

healthy patient may have per dental appointment and that a patient with cardiovascular disease may have per dental appointment?

ANS:

Epinephrine mimics effects bought about by stimulation of the adrenergic nerves, including an increased heart rate, contraction of blood vessels, dilation of air passages, and instigation of the “fight-or-flight” response of the sympathetic nervous system. Patients with a healthy cardiovascular system are better able to absorb the side effects associated with epinephrine and thus are better able to tolerate larger amounts of epinephrine in the system than patients with a compromised cardiovascular system.

DIF: Comprehension REF: 41 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control TRUE/FALSE 1. A comparison of levonordefrin and epinephrine reveals that hemostasis is less effective with

the vasoconstrictor epinephrine.

ANS: F

Correct: A comparison of levonordefrin and epinephrine reveals that hemostasis is more effective with the vasoconstrictor epinephrine.

DIF: Recall REF: 46| 47| 48 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. A comparison of levonordefrin and epinephrine reveals that levonordefrin offers better pain

control than epinephrine.

NURSINGTB.COM

ANS: F

Correct: A comparison of levonordefrin and epinephrine reveals that levonordefrin offers similar pain control to that offered by epinephrine.

DIF: Recall REF: 46 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. Levarterenol is no longer available in the United States.

ANS: T DIF: Comprehension REF: 47 OBJ: 7 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. Adrenalin comes in concentrations of 1:50,000, 1:100,000, and 1:200,000.

ANS: T DIF: Recall REF: 44-45 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

5. The heart rate is increased when the beta 1 and beta 2 receptors are affected by the systemic

effects of adrenergic amines.

ANS: T DIF: Recall REF: 44 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control MULTIPLE CHOICE 1. Vasodilation of the blood vessels at the site of the administration of a local anesthetic will

cause what? a. An increased rate of anesthetic absorption b. A decrease in the duration of the anesthetic c. Increased risk of toxicity d. All options listed ANS: D

All options listed. Vasodilation of the blood vessels at the site of the administration of a local anesthetic will cause an increase in blood flow at the site, which results in an increased rate of anesthetic absorption, a decrease in the duration of the anesthetic, and an increased risk of toxicity.

DIF: Recall REF: 41 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. Why are vasoconstrictors important additives to the local anesthetic solution?

RSinj IN GTnB.C a. They provide hemostasisN atUthe ectio site. OM b. They reduce the possibility of systemic toxicity. c. They prolong the duration of the anesthetic’s effect. d. All options listed ANS: D

All options listed. Vasoconstrictors are important additives to the local anesthetic solution because they provide hemostasis at the injection site, reduce the possibility of systemic toxicity, and prolong the duration of the anesthetic’s effects.

DIF: Recall REF: 41 OBJ: 2 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. Which receptors are the most sensitive to epinephrine? a. Alpha receptors b. Beta receptors c. Alpha and beta receptors are equal d. Adrenergic receptors ANS: B

Beta receptors are the most sensitive to epinephrine. Alpha receptors are less sensitive to epinephrine. Adrenergic receptors are divided into two major groups: the alpha and beta receptors.

DIF: Recall REF: 45-46 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. Which receptors have inhibitory actions from adrenergic drugs on smooth muscle? a. Alpha receptors b. Beta receptors c. Alpha and beta receptors are equal d. Adrenergic receptors ANS: B

Beta receptors have inhibitory actions from adrenergic drugs on smooth muscle, whereas alpha receptors have excitatory actions. Adrenergic receptors are divided into two major groups: the alpha and beta receptors.

DIF: Recall REF: 43-44 OBJ: 8 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. Which receptors relax bronchial smooth muscles, causing the bronchi of the lungs to dilate? a. Alpha receptors b. Beta receptors c. Alpha and beta receptors are equal d. Adrenergic receptors ANS: B

Beta receptors relax bronchial smooth muscles, causing the bronchi of the lungs to dilate.

Ntion RSofItNheGsTmooth B.CO M Alpha receptors cause constricU muscle in the blood vessels. Adrenergic receptors are divided into two major groups: the alpha and beta receptors.

DIF: Recall REF: 43-44 OBJ: 8 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. Undesirable side effects of incorporating sympathomimetic agents such as epinephrine into

local anesthetic solutions include: a. Increased force of air exchange b. Increased bronchi dilation c. Increased rate and force of heart contractions d. All options listed ANS: C

Undesirable side effects of incorporating sympathomimetic agents such as epinephrine into local anesthetic solutions include increases in the rate and force of heart contractions.

Increased force of air exchange is not a side effect of incorporating sympathomimetic agents.

Instead, the bronchi dilation is increased, resulting in bronchial smooth muscle relaxation, which is not an undesirable effect.

DIF: Recall REF: 43-44 OBJ: 8 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

7. Neleen indicates on her health history that she is allergic to novocaine and sulfa drugs. What

patient education might you provide to Neleen? a. Explain that novocaine is in the ester family of drugs and you will be using a local anesthetic from the amide family. b. Explain that, because she is allergic to novocaine and to sulfa drugs, you will be using a local anesthetic without a preservative. c. Explain that, because she is allergic to sulfa drugs, you will be using a local anesthetic with a vasoconstrictor. d. Explain why you are choosing not to administer any local anesthesia.

ANS: A

Novocaine is in the ester family of drugs, and you will be using a local anesthetic from the amide family. Avoiding a vasoconstrictor is not necessary because true bisulfite allergy is specific and not directly related to sulfa drug allergy or local anesthetic agent allergy. There is no indication to avoid use of local anesthesia with or without vasoconstrictor for this patient based upon her medical history.

DIF: Application REF: 41| 45| 48 OBJ: 3 | 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. You have administered 2% lidocaine, 1:50,000 mg/mL epinephrine to a healthy patient. The

patient experiences restlessness, nausea, and begins to hyperventilate. What should you suspect? a. Central nervous system stimulation b. Overdose of epinephrine R I G B.C M N c. Metabolic rise in blood sugU ar S N T O d. All options listed ANS: B

Epinephrine does not stimulate the CNS. An overdose of epinephrine produces the signs and symptoms of CNS stimulation, which may include anxiety, nausea, restlessness, weakness, tremor, headache, and hyperventilation. A healthy patient should not experience a significant metabolic rise in blood sugar after administration of local anesthesia.

DIF: Recall REF: 45-46 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. Which of the following statement(s) is/are true regarding the vasculature effects of

epinephrine? a. The effects of epinephrine on the blood vessels of the skeletal muscles are dose dependent due to the predominance of beta 2 receptors. b. Smaller doses of epinephrine affect the beta 2 receptors of the blood vessels of the skeletal muscles and produce vasodilation. c. Larger doses of epinephrine affect the alpha receptors of the blood vessels of the skeletal muscles and produce vasoconstriction. d. All options listed ANS: D

All options listed. The effects of epinephrine on the blood vessels of the skeletal muscles are dose dependent due to the predominance of beta 2 receptors. Smaller doses of epinephrine affect the beta 2 receptors of the blood vessels of the skeletal muscles and produce vasodilation. Larger doses of epinephrine affect the alpha receptors of the blood vessels of the skeletal muscles and produce vasoconstriction.

DIF: Recall REF: 45-46 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 10. Which of the following is true regarding norepinephrine? a. Its use in dentistry is not recommended b. Has the same action as levonordefrin on alpha receptors c. Exhibits intense vasoconstriction d. All options listed e. None of the options listed ANS: D

All options listed. Regarding norepinephrine: Its use in dentistry is not recommended; it has the same action as levonordefrin on alpha receptors and it exhibits intense vasoconstriction.

DIF: Recall REF: 47 OBJ: 7 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 11. What is the name of the vasoconstrictor, commonly combined with 3% prilocaine, that may

be safely administered to patients with uncontrolled hyperthyroidism? a. Phenylephrine NURSINGTB.COM b. Felypressin c. All options listed d. None of the options listed ANS: B

Felypressin, a vasoconstrictor usually combined with 3% prilocaine, is available in Great Britain and other countries and may be safely administered to patients with uncontrolled hyperthyroidism and patients taking tricyclic antidepressants or MAO inhibitors because it has very little effect on the myocardium or adrenergic nerve transmission. Phenylephrine is no longer used in dentistry but is combined with local anesthetics for the management of hypotension, for nasal decongestants, and ophthalmic solutions.

DIF: Recall REF: 47 OBJ: 7 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 12. Which of the following vasoconstrictors are NOT added to dental local anesthetic drugs in the

United States? a. Phenylephrine b. Felypressin c. Norepinephrine d. All options listed e. None of the above

ANS: D

All options listed. Phenylephrine, felypressin, and norepinephrine are NOT added to dental local anesthetic drugs in the United States.

DIF: Comprehension REF: 47 OBJ: 7 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 13. The absorption of epinephrine is retarded because of the drug’s vasoconstricting properties. It

may take several hours for absorption to be completed. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. The absorption of epinephrine is retarded because of the drug’s vasoconstricting properties. It may take several hours for absorption to be completed.

DIF: Recall REF: 47 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 14. Which of the following anesthetics are combined with levonordefrin? a. 2% lidocaine b. 2% mepivacaine c. 3% mepivacaine d. 4% prilocaine N R I G B.C M

U S N T

O

ANS: B

Levonordefrin is available only with 2% mepivacaine in a 1:20,000 dilution.

DIF: Recall REF: 46 OBJ: 6 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 15. For all of the following conditions the risks of using a local anesthetic with a vasoconstrictor

might outweigh the benefits EXCEPT one. Which one is the EXCEPTION? a. Unstable angina b. Recent knee replacement c. Uncontrolled diabetes d. Uncontrolled hypertension ANS: B

EXCEPTION: Recent knee replacement Vasoconstrictors are not contraindicated for patients with recent knee replacement. The risks of using a vasoconstrictor may outweigh the benefits for a patient with unstable angina, uncontrolled hypertension, or uncontrolled diabetes.

DIF: Recall REF: 47 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

16. How long do adverse effects of vasoconstrictors last in the body? a. 1 to 3 minutes b. 5 to 10 minutes c. 5 to 10 hours d. Up to 48 hours ANS: B

The body is very efficient at removing vasoconstrictors. Adverse effects only last about 5 to 10 minutes.

DIF: Recall REF: 47 OBJ: 8 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 17. What factors might contribute to an accidental overdose of vasoconstrictors? a. Poor technique b. Selection of an inappropriate type of vasoconstrictor c. Too much vasoconstrictor administered d. All options listed ANS: D

All options listed. Poor technique, selection of an inappropriate type of vasoconstrictor, or administration of too much local anesthetic plus vasoconstrictor may all contribute to an accidental overdose.

DIF: Recall REF: 47 OBJ: 8 TOP: NBDHE, 3.0 Planning aN nd M RanaIgingGDeBnt.alCHygMiene Care| NBDHE, 3.4 Anxiety and Pain Control

U S N T

O

18. More concentrated formulations of epinephrine are safer for patients who are cardiovascularly

compromised. More diluted formulations of epinephrine provide the greatest bleeding control. a. Both statements are true. b. Both statements are false. c. The first statement is true, the second statement is false. d. The first statement is false, the second statement is true.

ANS: B

Both statements are false. More diluted formulations of epinephrine are safer for patients who are cardiovascularly compromised. More concentrated formulations of epinephrine provide the greatest bleeding control.

DIF: Recall REF: 44-45| 48 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 3.5 Recognition and Management of Compromised Patients 19. What inactivates epinephrine once it is in the bloodstream? a. Adrenergic nerves b. Liver enzymes c. Its excretion into the urine d. All options listed

ANS: A

Once in the bloodstream, epinephrine is rapidly inactivated by adrenergic nerves. Any epinephrine that escapes the reuptake action is inactivated by enzymes COMT and MAO in the blood. Liver enzymes are responsible for metabolism of most amide local anesthetics.

Only 1% of epinephrine is excreted unchanged in the urine.

DIF: Recall REF: 46| 48 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 20. Which local anesthetic would be appropriate for a patient with a history of true bisulfite

allergy? a. 2% mepivacaine, 1:20,000 levonordefrin b. 4% prilocaine c. 4% articaine, 1:200,000 epinephrine d. All options listed ANS: D

Prilocaine 4% plain has lower vasodilating properties and is a good choice for patients who are unable to receive a vasoconstrictor. 2% mepivacaine, 1:20,000 levonordefrin and 4% articaine, 1:200,000 epinephrine would not be good choices because the vasoconstrictors epinephrine and levonordefrin contain bisulfite.

DIF: Comprehension REF: 45| 46 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

N R I G B.C M

21. Which of the following may caU useSan N endoTgenousOrelease of epinephrine? a. An injection of epinephrine b. Anxiety related to a divorce c. Apprehension about a dental appointment d. All options listed ANS: D

All options listed. Patients who are experiencing anxiety, apprehension, or stress for any reason may internalize these feelings, causing an endogenous release of epinephrine. An injection of epinephrine may trigger the patient’s endogenous release of epinephrine, thus creating a situation in which the patient experiences an increase in adverse effects.

DIF: Recall REF: 42| 48 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 22. What effect does the endogenous release of epinephrine have on exogenous administration of

epinephrine? a. It may compound the effects. b. It may counteract the effects. c. It should have no effect. d. Its effects are unknown.

ANS: A

The endogenous release of epinephrine may compound the effects of the exogenous administration of epinephrine.

DIF: Recall REF: 42| 48 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 23. Why are vasoconstrictors added to local anesthetics? a. To increase the potency of the local anesthetic b. To inhibit the oxidation of the local anesthetic c. To counteract the vasodilating properties of the local anesthetic d. All options listed ANS: C

Vasoconstrictors are added to local anesthetics to counteract the vasodilating properties of the local anesthetic.

DIF: Recall REF: 41| 48 OBJ: 2 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 24. Patients with a relative contraindication for vasoconstrictors can receive epinephrine

containing local anesthetic agents in the lowest possible dose, not to exceed the MRD of 0.04 mg per appointment, using the best technique. In general, there are only a few absolute contraindications to the use of vasoconstrictor, and in most situations limiting the amount of vasoconstrictor a patient can receive produces the benefits of vasoconstrictor use in local anesthesia without compromising the patient. a. Both statements are true.NURSINGTB.COM b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. Patients with a relative contraindication for vasoconstrictors can receive epinephrine containing local anesthetic agents in the lowest possible dose, not to exceed the MRD of 0.04 mg per appointment, using the best technique. In general, there are only a few absolute contraindications to the use of vasoconstrictor, and in most situations limiting the amount of vasoconstrictor a patient can receive produces the benefits of vasoconstrictor use in in local anesthesia without compromising the patient.

DIF: Recall REF: 42 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 25. The undesirable effects of epinephrine are short lived because of the rapid inactivation of

epinephrine by the reuptake of adrenergic nerves. a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: A

Both the statement and the reason are correct and related. The undesirable effects of epinephrine are short lived because of the rapid inactivation of epinephrine by the reuptake of adrenergic nerves.

DIF: Recall REF: 42 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 26. The addition of sodium bisulfite preservative can reduce the efficiency of the quaternary

amine to dissociate into the uncharged tertiary amine base necessary to penetrate the lipid rich membrane of nerve because the preservative can increase the pH of the anesthetic solution. a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: C

The statement is correct, but the reason is NOT. The addition of sodium bisulfite can reduce the efficiency of the quaternary amine to dissociate into the uncharged tertiary amine base necessary to penetrate the lipid rich membrane of nerve because the preservative can decrease the pH of the anesthetic solution.

DIF: Recall REF: 45 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

NURSINGTB.COM

27. A 1:100,000 dilution of epinephrine for obtaining pulpal anesthesia may be used in

combination with a relatively small infiltrated dose of 1:50,000 to decrease bleeding. This is a particularly important strategy for dental hygienists to use during provision of nonsurgical periodontal therapy. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. A 1:100,000 dilution of epinephrine for obtaining pulpal anesthesia may be used in combination with a relatively small infiltrated dose of 1:50,000 to decrease bleeding. This is a particularly important strategy for dental hygienists to use during provision of nonsurgical periodontal therapy.

DIF: Recall REF: 44-45 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 28. Which vasoconstrictor is the most widely used in dentistry and the most potent? a. Epinephrine b. Levonordefrin c. Felypressin

d. All options listed ANS: A

Epinephrine is the most widely used vasoconstrictor in dentistry, and it is the most potent.

Epinephrine is the standard by which all other vasoconstrictors are measured.

DIF: Recall REF: 42 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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Chapter 05: Local Anesthetic Agents Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition ESSAY 1. Which two local anesthetic agents have the least vasodilating properties?

ANS:

Mepivacaine and prilocaine DIF: Recall REF: 52| 74 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. What local anesthetic agents would be a good choice to use when a vasoconstrictor is

contraindicated?

ANS:

Mepivacaine and prilocaine. They have the least vasodilating effects, allowing the anesthetic to remain in the deposition area longer.

DIF: Recall REF: 52| 74 OBJ: 10 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. Name the only long-lasting local anesthetic available for use in dentistry.

ANS:

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Bupivacaine DIF: Recall REF: 52| 67-69| 74 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. Name the local anesthetic that produces an intermediate duration when administered as a

block injection.

ANS:

Prilocaine DIF: Recall REF: 52| 58-62| 74 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. Name the local anesthetic that has the shortest half-life and the lowest risk for systemic

toxicity.

ANS:

Articaine DIF: Recall

REF: 62-67

OBJ: 10

TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. Name the local amide anesthetic agent that has the highest dissociation constant, and explain

what this high dissociation constant means.

ANS:

Bupivacaine has the highest pKa, which means that it has the slowest onset of action but has a duration that almost doubles the duration of lidocaine.

DIF: Recall REF: 52-53| 67-68 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. What is the difference between generic names and proprietary names of local anesthetics?

ANS:

Proprietary names are brand names or trademark names under which a product is marketed. A generic name is a nonproprietary name.

DIF: Recall REF: 51-52 OBJ: 3 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control TRUE/FALSE 1. An anesthetic solution of 1:100,000 epinephrine is twice as effective in controlling pain as a

NUe.RS IN GT B.COM solution of 1:50,000 epinephrin ANS: F

Correct: There is no difference in pain control between a 1:50,000 and 1:100,000 formulation of epinephrine.

DIF: Recall REF: 56-57| 74 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. Epinephrine is the most commonly used anesthetic in the United States.

ANS: F

Correct: Lidocaine is the most commonly used anesthetic in dentistry. Epinephrine is a vasoconstrictor.

DIF: Recall REF: 56-57 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. Intermediate-action anesthetics are most commonly used for regular restorative dentistry and

nonsurgical periodontal therapy.

ANS: T DIF: Recall REF: 74 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. Currently, no anesthetic cartridges contain methylparaben.

ANS: T DIF: Recall REF: 51| 74 OBJ: 1 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. Among local anesthetics procaine has the highest percentage of protein binding and is the

most lipid soluble.

ANS: F

Correct: Bupivacaine has the highest percentage of protein binding and is the most lipid soluble.

DIF: Recall REF: 52-53 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. Inflamed tissue experiences an increase in vascularity, slowing the onset of anesthetic action

and decreasing the duration of anesthetic action; however, in healthy tissues the onset of action and the duration of action are more predictable.

ANS: T DIF: Recall REF: 52-53 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain N ConR trol I G B.C M

U S N T

O

7. Articaine local anesthetic cartridges are labeled that they contain 1.7 mL of solution.

ANS: T DIF: Recall REF: 51| 52 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. Sodium chloride is a buffer creating an injectable solution that is isotonic.

ANS: T DIF: Recall REF: 51 OBJ: 1 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control MULTIPLE CHOICE 1. What is the solution that is added to the cartridge of local anesthetic to prevent oxidation of

the vasoconstrictor called? a. Vasoconstrictor preservative b. Sodium hydroxide c. Sodium chloride d. Methylparaben ANS: A

The vasoconstrictor preservative is the solution that is added to the cartridge of local anesthetic to prevent oxidation of the vasoconstrictor. Sodium hydroxide acts as a buffer to adjust the pH; sodium chloride acts as a buffer to create an isotonic solution; methylparaben is a bacteriostatic, no longer added to dental cartridges.

DIF: Comprehension REF: 51 OBJ: 1 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. What is the solution that was added to the cartridge of local anesthetic to prevent bacterial

growth? a. Vasoconstrictor preservative b. Sodium hydroxide c. Sodium chloride d. Methylparaben ANS: D

Methylparaben is the solution that was added to the cartridge of local anesthetic to prevent bacterial growth. It is no longer added to dental cartridges. The vasoconstrictor preservative is the solution that is added to the cartridge of local anesthetic to prevent oxidation of the vasoconstrictor. Sodium hydroxide acts as a buffer to adjust the pH; sodium chloride acts as a buffer to create an isotonic solution.

DIF: Recall REF: 51| 74 OBJ: 1 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. What is the solution that is adNdU edRtS oI thN eG caT rtB rid.gC eO ofMlocal anesthetic that can trigger

bronchospasms? a. Vasoconstrictor preservative b. Sodium hydroxide c. Sodium chloride d. Methylparaben ANS: A

The vasoconstrictor preservative is the solution that is added to the cartridge of local anesthetic that can trigger bronchospasms. Sodium hydroxide acts as a buffer to adjust the pH; sodium chloride acts as a buffer to create an isotonic solution; methylparaben is a bacteriostatic, no longer added to dental cartridges.

DIF: Recall REF: 51| 55 OBJ: 1 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. Which of the following local anesthetics, without vasoconstrictors, is/are useful in dentistry? a. Prilocaine b. Mepivacaine c. All options listed d. None of the options listed ANS: C

All options listed. Both prilocaine and mepivacaine have usefulness in dentistry even without the addition of vasoconstrictors.

DIF: Recall REF: 52-54 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. Which of the following should the dental hygienist consider prior to administering local

anesthetic to a patient? a. Need for posttreatment pain control b. Length of the procedure c. Patient’s current health assessment d. Need for hemostasis e. All options listed ANS: D

All options listed. The need for posttreatment pain control, the length of the procedure, the patient’s current health assessment, and the need for hemostasis are all important for the dental hygienist to consider prior to the administering of local anesthetic to a patient.

DIF: Recall REF: 51-52 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. Septocaine, Zorcaine, and Articadent are the proprietary names for which of the following? a. Lidocaine b. Prilocaine c. Articaine NURSINGTB.COM d. Bupivacaine ANS: C

Septocaine, Zorcaine, and Articadent are the proprietary names for articaine. Lidocaine, prilocaine, and bupivacaine are generic names for other amide local anesthetics commonly used in dentistry.

DIF: Recall REF: 52 OBJ: 3 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. Prilocaine is the generic name for which of the following? a. Citanest b. Marcaine c. Carbocaine d. Xylocaine, Alphacaine, Octocaine ANS: A

Prilocaine is the generic name for Citanest. Marcaine is the proprietary name for bupivacaine; Carbocaine is the proprietary name for mepivacaine, and Xylocaine, Alphacaine, Octocaine are proprietary names for lidocaine.

DIF: Recall REF: 52 OBJ: 3 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care|

NBDHE, 3.4 Anxiety and Pain Control 8. Marcaine is the proprietary name for which of the following? a. Mepivacaine b. Bupivacaine c. Carbocaine d. Xylocaine, alphacaine, octocaine ANS: B

Marcaine is the proprietary name for bupivacaine. Mepivacaine is the generic name for Carbocaine. Xylocaine, Alphacaine, Octocaine are proprietary names for lidocaine.

DIF: Recall REF: 52 OBJ: 3 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. What is the lipid solubility and the protein-binding ability of the local anesthetic related to? a. Anesthetic dissociation constant b. Anesthetic duration of action c. Distribution of cations and anions d. All options listed ANS: B

Anesthetic duration of action is related to the lipid solubility and the protein-binding ability of the local anesthetic. Anesthetic dissociation constant (pKa) determines the portion of administered dose in the lipid soluble state (RN). Lower pKa results in more rapid onset; distribution of cations and anions refers to the distribution of the acid and base forms of the local anesthetic. The pKa detN ermR inesItheGdisB tri. buCtioM n of the cations and anions.

U S N T

O

DIF: Recall REF: 52-54 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 10. What is the name of the only topical amide anesthetic currently on the dental market in the

United States? a. Levonordefrin b. Lidocaine c. Benzocaine d. Butacaine ANS: B

Lidocaine is an effective topical anesthetic and currently is the only topical amide anesthetic on the market. Levonordefrin is a vasoconstrictor added to mepivacaine; benzocaine and butacaine are esters.

DIF: Recall REF: 56-57 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 11. Which of the following statements is (are) true regarding local anesthetics and allergic

reactions? a. Sulfite sensitivities have been well documented and may rule out anesthetic

formulations that contain vasoconstrictors. b. Only 1% of reactions associated with administration of local anesthetics are true

allergies. c. A documented drug allergy would indicate the need for an alternative drug

selection and may represent an absolute contraindication to the offending drug. d. All options listed ANS: D

All options listed. Sulfite sensitivities have been well documented and may rule out anesthetic formulations that contain vasoconstrictors. Only 1% of reactions associated with administration of local anesthetics are true allergies. A documented drug allergy would indicate the need for an alternative drug selection and may represent an absolute contraindication to the offending drug.

DIF: Recall REF: 55 OBJ: 8 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 12. All of the following local anesthetic agents would be considered safer for cardiovascular

patients EXCEPT one. Which one is the EXCEPTION? a. 4% prilocaine 1:200,000 epinephrine b. 4% articaine 1:200,000 epinephrine c. 2% lidocaine 1:100,000 epinephrine d. 4% prilocaine, plain ANS: C

EXCEPTION: 2% lidocaine, 1:100,000 epinephrine.

Lidocaine 1:100,000 epinephN rine iceTB th. e cConc URhas SItw NG OMentration of vasoconstrictor, and therefore less can be provided to cardiovascular patients safely. 4% prilocaine 1:200,000 epinephrine, 2% articaine 1:200,000 epinephrine, and 4% prilocaine plain would be considered safer for cardiovascular patients.

DIF: Recall REF: 56-57| 58-62| 62-67 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 13. What is the advantage of the thiophene ring found in articaine? a. It stimulates bone penetration properties. b. It allows a slower metabolism, thus decreasing the risk of systemic toxicity. c. It gives the molecule better diffusion properties compared with lidocaine. d. All options listed.

ANS: C

The thiophene ring found in articaine gives the molecule better diffusion properties compared with lidocaine. Bone penetration properties and reducing metabolism are not associated with the thiophene ring. Articaine is metabolized more rapidly than other amide local anesthetics.

DIF: Recall REF: 70-71 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 14. Which of the following statements best describes levonordefrin?

a. b. c. d.

Levonordefrin is a vasoconstrictor added to mepivacaine.

Levonordefrin is a vasodilator added to mepivacaine.

Levonordefrin is an amide local anesthetic.

Levonordefrin is an ester local anesthetic that is not used in dentistry today.

ANS: A

Levonordefrin is a vasoconstrictor added to mepivacaine. It is not a vasodilator, amide, or ester local anesthetic.

DIF: Recall REF: 57-58 OBJ: 1 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 15. Which amide anesthetic agent is metabolized in both the plasma and the liver? a. Lidocaine b. Mepivacaine c. Prilocaine d. Articaine ANS: D

Articaine is the amide anesthetic agent that is metabolized in both the plasma and the liver.

Lidocaine, mepivacaine, and prilocaine are amides primarily metabolized in the liver.

DIF: Recall REF: 62-67 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 16. Which amide anesthetic agent is metabolized by the lungs before it reaches the liver?

N R I G B.C M U S N T O a. Lidocaine b. Mepivacaine c. Prilocaine d. Articaine ANS: C

Prilocaine is the amide anesthetic agent metabolized by the lungs before it reaches the liver.

DIF: Recall REF: 58-62 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 17. What is the term used to describe the persistent anesthesia or the altered sensation of tingling

or itching beyond the expected duration of local anesthetic? a. Paresthesia b. Paralysis c. All options listed d. None of the options listed ANS: A

Paresthesia is the term used to describe the persistent anesthesia or the altered sensation of tingling or itching beyond the expected duration of local anesthetic. Paralysis refers to loss of motor function.

DIF: Recall REF: 62-67 OBJ: 10 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 18. Which anesthetic solution, no longer used in dentistry, is still available in multidose vials and

is used in medicine as an antiarrhythmic agent? a. Mepivacaine b. Bupivacaine c. Carbocaine d. Procaine ANS: D

Procaine is still available in multidose vials and is used in medicine as an antiarrhythmic agent. Mepivacaine, bupivacaine, and Carbocaine are currently useful dental local anesthetics.

DIF: Recall REF: 73 OBJ: 11 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 19. Which ingredient added to the dental cartridge alkalinizes, or adjusts the pH, of the solution

between 6 and 7? a. Vasoconstrictor preservative b. Sodium chloride c. Sodium hydroxide d. Methylparaben ANS: C

Sodium hydroxide acts as a buffer the pH M of the solution between 6 and 7; sodium NURStoIadjust GTB.C N O chloride acts as a buffer to create an isotonic solution; the vasoconstrictor preservative is the solution that is added to the cartridge of local anesthetic to prevent oxidation of the vasoconstrictor; methylparaben is a bacteriostatic, no longer added to dental cartridges.

DIF: Recall REF: 51 OBJ: 1 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 20. There are two main classifications of local anesthetic agents: esters and amides. Esters are

metabolized in the liver, and most amides are metabolized in the plasma. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: B

Both statements are false. Esters are metabolized in the plasma, and most amides are metabolized in the liver.

DIF: Recall REF: 51-52 OBJ: 2 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 21. What duration category best describes mepivacaine 3%?

a. b. c. d.

Short-acting Intermediate-acting Long-acting None of the above

ANS: A

Mepivacaine 3% is a plain formulation (no vasoconstrictor) local anesthetic and has a short duration of approximately 30 minutes.

DIF: Recall REF: 52-53 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 22. Which of the following factors influence(s) duration of anesthesia? a. Individual response b. Accuracy of administration c. Vascularity of tissue d. All options listed ANS: D

Individual response to anesthetic, accuracy of anesthetic administration, and vascularity of tissue all effect duration of anesthesia DIF: Recall REF: 52-53 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 23. A relative contraindication means that the offending drug may be administered judiciously.

N R I G B.C M

An absolute contraindication mUeanS s thN at thTe offenO ding drug should not be administered to the individual under any circumstances. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. A relative contraindication means that the offending drug may be administered judiciously. An absolute contraindication means that the offending drug should not be administered to the individual under any circumstances.

DIF: Recall REF: 54-55 OBJ: 7 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 24. Local anesthetic agents with vasoconstrictors are generally more acidic than plain formations

because of the presence of sodium bisulfite. a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: A

Both the statement and the reason are correct and related. Local anesthetic agents with vasoconstrictors are generally more acidic than plain formations because of the presence of sodium bisulfite.

DIF: Recall REF: 51 OBJ: 1 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 25. Increasing the pH of local anesthetic agents toward physiologic prior to injection is referred to

as which of the following? a. Propagation b. Onset c. Biotransformation d. Anesthetic buffering ANS: D

Anesthetic buffering is the process of increasing the pH of local anesthetic agents toward physiologic prior to injection. Propagation is related to impulse generation; onset refers to the period from local anesthetic deposition near the nerve trunk to profound conduction block; biotransformation (metabolism) is the process by which local anesthetic is altered within the body by the action of enzymes to produce a less toxic metabolite.

DIF: Comprehension REF: 74 OBJ: 12 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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Chapter 06: Topical Anesthetic Agents Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition ESSAY 1. List common forms of topical anesthetics used in dentistry.

ANS:

Gel, spray, liquid, ointment, and one patch form DIF: Recall REF: 78-82 OBJ: 3 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. List the methods for delivery of topical anesthetic drugs.

ANS:

Cotton tip applicators, sprays, brushes, patches, blunted cannulas and/or syringes, and single-dose applicator swabs DIF: Recall REF: 78-82 OBJ: 3 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control TRUE/FALSE

N R I G B.C M

UnbS 1. The over-the-counter product A esolNwitT h benzoOcaine can be safely used by all family members.

ANS: F

Correct: Anbesol comes in a variety of strengths. One concentration cannot be used safely by all family members.

DIF: Comprehension REF: 79 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. Although topical anesthetics are generally regarded as safe, if used improperly they can

produce adverse reactions that are fatal.

ANS: T DIF: Recall REF: 85 OBJ: 6 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. A patient presents to your dental office the day after her dental appointment complaining of

swelling and itching on the right side of her face. You should reassure the patient that it is not possible that her symptoms are related to dental anesthesia.

ANS: F

Correct: Some allergic reactions occur up to 2 days after the anesthetic is given.

DIF: Recall REF: 85-87 OBJ: 6 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. Benzocaine topical anesthetic exists almost entirely in its base form, making absorption into

circulation high.

ANS: F

Correct: Benzocaine topical anesthetic exists almost entirely in its base form, making absorption into circulation low.

DIF: Recall REF: 82-83 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. The published maximum dosage recommendation for the topical anesthetic benzocaine is 200

mg.

ANS: F

Correct: The published maximum dosage recommendations for benzocaine have not been established and do not exist.

DIF: Recall REF: 82-83 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| Nontro RSl INGTB.C OM NBDHE, 3.4 Anxiety and Pain CU 6. Lidocaine is metabolized in the liver and excreted via the kidneys with less than 10%

remaining unchanged.

ANS: T DIF: Recall REF: 83 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. The most commonly found form of lidocaine is in base form because it is water soluble and

can easily penetrate and be absorbed into the tissues.

ANS: F

Correct: The base form is poorly soluble in water and has poor penetration and absorption abilities.

DIF: Recall REF: 83 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. Tetracaine hydrochloride has a rather slow onset of action; however, it can last approximately

45 minutes.

ANS: T

DIF: Recall

REF: 84

OBJ: 4

TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control MULTIPLE CHOICE 1. What is the name of a common ester topical anesthetic? a. Lidocaine b. Dyclonine hydrochloride c. Prilocaine 2.5% d. Benzocaine ANS: D

Benzocaine is the name of a common ester topical anesthetic. Lidocaine and prilocaine are amides, and dyclonine hydrochloride is a ketone.

DIF: Recall REF: 82-83 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. What is the name of a common ketone topical anesthetic? a. Lidocaine b. Dyclonine hydrochloride c. Tetracaine hydrochloride d. Benzocaine ANS: B

Dyclonine hydrochloride is the name of a common ketone topical anesthetic. Lidocaine is an amide, and tetracaine hydrocN hlU orR idS eI anNdGbT enBzo.cC aiO neMare esters.

DIF: Recall REF: 83-84 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. What is the name of the most potent ester topical anesthetic? a. 2.5% Lidocaine and 2.5% prilocaine cream b. Dyclonine hydrochloride c. Tetracaine hydrochloride d. Benzocaine ANS: C

Tetracaine hydrochloride is the name of the most potent ester topical anesthetic. 2.5% lidocaine and 2.5% prilocaine are amides. Benzocaine is an ester but not as potent as tetracaine hydrochloride.

DIF: Recall REF: 84 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. All of the following EXCEPT one are considered advantages for the use of topical anesthetic

agents. Which one is the EXCEPTION? a. Minimize pain associated with needle insertion b. Can be purchased over the counter

c. Useful in treatment of minor oral injuries d. Reduce gag reflex during radiographic procedures ANS: B

EXCEPTION: Can be purchased over the counter The fact that topical anesthetic agents can be purchased over the counter is not necessarily an advantage when one considers the risk of toxicity. Minimizing the pain associated with needle insertion, use in treatment of minor oral injuries, and reduction of gag reflex during radiographic procedures are three advantages for the use of topical anesthetic agents.

DIF: Recall REF: 78 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. Which of the following characteristics could contribute to the properties of an ideal intraoral

topical anesthetic? a. Allergenic b. Allow pain-free application c. Dissolves readily at the site of application d. Produces some systemic toxicity ANS: B

Ideal properties of an intraoral topical anesthetic would include the pain-free application of the agent. Being allergenic, dissolving readily at the site of application, and producing some systemic toxicity would not be beneficial properties.

DIF: Recall REF: 78| 80 OBJ: 2 TOP: NBDHE, 6.0 PharmacolN ogy|RNBI DHE, 3.0 Planning and Managing Dental Hygiene Care| U S NG TB.C OM NBDHE, 3.4 Anxiety and Pain Control 6. What is the main difference in the mechanism of action between topical anesthetics and

injectable anesthetics? a. Location of the blocking of nerve conduction b. Increase of depolarization c. Decrease of excitability threshold d. All options listed ANS: A

Topical anesthetics work by blocking nerve conduction at the surface of the skin or mucous membrane. Depolarization is decreased, and there is an increase of excitability threshold.

DIF: Recall REF: 78 OBJ: 1 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. To obtain the most benefit from the use of topical anesthetics, a fairly substantial amount of

topical should be placed on the cotton tip applicator. This amount mixes with the saliva and may numb the tongue, soft palate, or pharynx. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: D

The first statement is false, the second statement is true. Only a small amount of the gel or ointment on the applicator tip is necessary to achieve the desired results. An excess amount mixes with the saliva and may numb the tongue, soft palate, or pharynx, which usually leads to patient dissatisfaction with the whole process.

DIF: Recall REF: 78-82 OBJ: 3 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. Which of the following properties are advantages of topical anesthetics being in a liquid

form? a. Provides anesthesia to a widespread area b. Useful to decrease a patient’s gag reflex c. Can be applied to site-specific areas with an applicator d. All options listed ANS: D

All options listed. Liquids are great for providing anesthesia to a widespread area. They are especially useful when trying to decrease a patient’s gag reflex, and the use of a liquid for a more site-specific procedure requires an applicator.

DIF: Recall REF: 78-82 OBJ: 2 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. All of the following are advantages of purchasing a single-dose unit of a topical anesthetic

N R I G B.COM

SCENPTT EXCEPT one. Which one is thU e EX ION? a. Dose manageable b. Cost-effective c. Less cross-contamination d. Less messy ANS: B

EXCEPTION: Cost-effective. Individual packaging of topical anesthetic is usually more expensive. Individual packaging of topical anesthetic is not only less messy, it also helps to prevent possible cross-contamination and allows monitoring of the dosage being used.

DIF: Recall REF: 78-82 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 10. Unmetered sprays are not recommended because they do not allow control of the amount of

anesthetic dispensed, nor are they easily contained at a specific site. a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: A

Unmetered sprays are not recommended because they do not allow control of the amount of anesthetic dispensed, nor are they easily contained at a specific site. However, the use of a metered spray with a disposable nozzle enables control over the amount of agent being dispensed, thus decreasing the risk for systemic toxicity.

DIF: Recall REF: 78-82 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 11. Methemoglobinemia has been reported following topical anesthesia use of benzocaine,

particularly with higher concentrations of 14%-20% spray applications applied to the mouth and mucous membrane. An advisory statement informing the public of the association between benzocaine and methemoglobinemia has been released by the Institute of Safe Medication Practices and the U.S. Food and Drug Administration. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false, the second statement is true.

ANS: A

Both statements are true. Methemoglobinemia has been reported following topical anesthesia use of benzocaine, particularly with higher concentrations of 14%-20% spray applications applied to the mouth and mucous membrane. An advisory statement informing the public of the association between benzocaine and methemoglobinemia has been released by the Institute of Safe Medication Practices and the U.S. Food and Drug Administration.

DIF: Recall REF: 78-82| 82-83 OBJ: 6 G,T3.B0 .

TOP: NBDHE, 6.0 PharmacolN ogU y|RNS BI DN HE PlC anO niM ng and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 12. Which of the following are considered advantages of the application of dental topical

anesthetics in a patch form? a. Site-specific b. Multiple choices c. Cost-effective d. All options listed ANS: A

Site-specific. The advantage of patches over other methods of administration is that they can be placed directly to desired sites. Patches available for intraoral topical anesthesia are limited. Dental topical anesthetic patches cost more than other forms of topical anesthetics.

DIF: Recall REF: 78-82 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 13. Which of the following is/are true regarding topical anesthetics? a. Allergic reactions can occur up to 2 days after the anesthetic is given. b. Benzocaine and tetracaine are both amides, which increases their potential for

causing an allergic reaction. c. If there were an allergic reaction, it is likely to present immediately at the time of

anesthesia. d. All options listed ANS: A

Allergic reactions can occur up to 2 days after the anesthetic is given. Benzocaine and tetracaine are both esters. Any reaction would likely be delayed until after leaving the dental office.

DIF: Recall REF: 85-87 OBJ: 6 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 14. Possible localized adverse effects of topical anesthetics could include which of the following? a. Stinging at the site of application b. Tissue discoloration c. Sloughing d. All options listed ANS: D

All options listed. Possible localized adverse effects of topical anesthetics could include stinging at the site of application, tissue discoloration, and sloughing.

DIF: Recall REF: 85-87 OBJ: 6 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 15. What is the reason that concentrations of topical anesthetic agents are higher than those of

their injectable counterparts?

NURvasoconstrictors M SINGTB.C like O injectable anesthetic agents. a. Topical agents are not natural b. They facilitate high plasma concentrations of topical anesthetic agents. c. They facilitate diffusion of the topical anesthetic agent through the mucous membranes. d. With topical anesthetic agents, systemic absorption decreases.

ANS: C

The reason that concentrations of topical anesthetic agents are higher than that of their injectable counterparts is to facilitate diffusion of the topical anesthetic agent through the mucous membranes. Neither topical nor injectable anesthetics used in dentistry are natural vasoconstrictors. With these higher concentrations and lack of vasoconstriction abilities, the risk of local and systemic absorption increases, thus increasing the risk of toxicity.

DIF: Recall REF: 85-87 OBJ: 2 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 16. Which patients may be more susceptible to adverse effects to topical anesthetic agents? a. Children b. Elderly c. Medically compromised d. All options listed ANS: D

All options listed. Children, elderly, and medically compromised individuals are more susceptible to adverse reactions to topical anesthetics.

DIF: Recall REF: 85-87 OBJ: 6 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 3.5 Recognition and Management of Compromised Patients 17. Why does the local and systemic absorption of topical anesthetics increase the risk of

toxicity? a. Topical anesthetics do not contain vasoconstrictors. b. Topical anesthetics are formulated in high concentrations. c. Topical anesthetics are absorbed quickly into the tissue and blood stream due to vasodilation of the area. d. All options listed ANS: D

All options listed. With the higher concentrations of the topical anesthesia and in the absence of vasoconstricting abilities, the risk of local and systemic absorption increases with the use of topical anesthetics.

DIF: Recall REF: 85-87 OBJ: 6 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 18. What is the available concentration of Oraqix? a. 5% lidocaine and 5% prilocaine b. 2.5% lidocaine and 2.5%N pril ine URoca SI NGTB.COM c. 14% benzocaine, 2% butamben, and 2% tetracaine hydrochloride d. 20% benzocaine and 5% lidocaine ANS: B

Oraqix is available for dental use in a 2.5% lidocaine and 2.5% prilocaine concentration.

DIF: Recall REF: 79| 85 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 19. What is the maximum recommended dose of Oraqix at one dental treatment session? a. Two cartridges b. Four cartridges c. Five cartridges d. Eleven cartridges ANS: C

The maximum recommended dose of Oraqix at one dental treatment session is five cartridges.

DIF: Recall REF: 85 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 20. What FDA Category does Oraqix fall into?

a. b. c. d.

Category A Category B Category C Categories B or C, depending on the concentration used.

ANS: B

Oraqix falls into FDA Category B. Caution should be taken if administered to nursing mothers.

DIF: Recall REF: 85 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 21. While at room temperature, Oraqix is in gel form in the cartridge. It will liquidate as it reaches

body temperature in the periodontal pocket. a. Both statements are true. b. Both statements are false. c. The first statement is true, the second statement is false. d. The first statement is false, the second statement is true.

ANS: B

Both statements are false. While at room temperature, Oraqix is in liquid form in the cartridge. It will gel as it reaches body temperature in the periodontal pocket.

DIF: Recall REF: 85 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

N R I G B.C M

O been approved and effectively used for?

22. What has the combined lidocaiU ne/pSriloN cainTe cream a. Medical procedures b. Dental procedures c. Topical anesthetic for skin abrasions d. All options listed ANS: A

The combined lidocaine/prilocaine has cream been approved and effectively used for medical procedures. FDA approval is for nonmucosal skin, and the recommendation is that it be only applied to intact skin.

DIF: Recall REF: 85-86 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 23. Which of the following are best practices to follow when administering local anesthesia of

any kind in the dental office? a. Review the patient’s health and dental history at all appointments. b. Use the lowest concentration of anesthesia to satisfy clinical requirements. c. Limit the area of application. d. Know the concentration of the drug being used. e. All options listed ANS: E

All options listed. Best practices to follow when administering local anesthesia of any kind in the dental office include: review the patient’s health and dental history at all appointments; use the lowest concentration of anesthesia to satisfy clinical requirements; limit the area of application; and know the concentration of the drug being used.

DIF: Recall REF: 78-82| 87 OBJ: 6 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 24. Prior to providing an injection, the topical agent should remain at the site of penetration for

about 4 minutes. Anesthesia should be achieved to a depth of approximately 5-6 mm into the tissue. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: B

Both statements are false. The topical agent should remain at the site of penetration for 1-2 minutes. Anesthesia should be achieved to a depth of approximately 2-3 mm into the tissue.

DIF: Recall REF: 78-82 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 25. The onset of action for benzocaine is rapid. The duration of action for benzocaine is 5-15

minutes. a. Both statements are true.NURSINGTB.COM b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. The onset for benzocaine can occur as early as 30 seconds, with peak effect at 2 minutes. The duration of action is 5-15 minutes.

DIF: Recall REF: 82-83 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 26. What is the most common topical preparation for lidocaine? a. Patch b. Spray c. Ointment d. Solution ANS: C

The most common topical preparation for lidocaine is an ointment, but it is also available as a patch, spray, and in a solution.

DIF: Recall REF: 83 OBJ: 3 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care|

NBDHE, 3.4 Anxiety and Pain Control 27. Which of the following is true regarding Oraqix? a. It is a microemulsion b. Does not provide pulpal anesthesia c. Applicator assembly is easy d. All options listed ANS: D

All options listed are true. Oraqix is a microemulsion that is administered by an easy-to-assemble applicator. It does not provide pulpal anesthesia but can be useful for assessment and nonsurgical periodontal procedures.

DIF: Recall REF: 85 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 28. Topical anesthetics are available in concentrations ranging from 0.2% to 20%. Products

available over the counter can have concentrations just as high as those used professional in the dental office. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. Topical anesthetics are available as a prescription or over the counter, with concentrations N rangRingIfroG m 0B .2. %Cto M 20%

U S N T

O

DIF: Recall REF: 78-82| 87 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

Chapter 07: Preanesthetic Assessment Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition MATCHING

Match the drug or medical condition in the left-hand column with the description of the significant concern in the right-hand column. Each description is used only once.

1. Patients taking tricyclic antidepressants 2. Patients taking sulfonamides 3. Patients with liver disease 4. Patients taking beta blockers 5. Cocaine abusers

6. Patients taking cholinesterase inhibitors

a. Life-threatening syndrome caused by general anesthetics b. Avoid use of vasopressors; may lead to myocardial infarction c. Competitively inhibits PABA in microorganisms d. Will inhibit the reuptake of vasoconstrictor e. Frequently prescribed for the treatment of myasthenia gravis and glaucoma f. Increases effects of epinephrine; avoid levonordefrin

7. Patients with glaucoma

g. Use amides judiciously because they may increase risk of toxicity 8. Patients taking cimetidineNonRa reIgulG ar h. Adm inister prilocaine or articaine U S N TB.Cbecause OM these drugs reduce liver basis capacity to metabolize amides 9. Patients taking MAOI i. Administer prilocaine or articaine because these drugs decrease hepatic blood flow 10. Patients with malignant hyperthermia j. Limit amount of vasopressor because it can increase ocular pressure 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Patients taking tricyclic antidepressants Patients taking sulfonamides Patients with liver disease Patients taking beta blockers Cocaine abusers Patients taking cholinesterase inhibitors Patients with glaucoma Patients taking cimetidine on a regular basis Patients taking MAOI Patients with malignant hyperthermia

1. ANS: F DIF: Recall REF: 100 OBJ: 6 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. ANS: C DIF: Recall REF: 102 OBJ: 9

3.

4.

5.

6.

7.

8.

9.

10.

TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control ANS: G DIF: Recall REF: 103 OBJ: 11 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control ANS: I DIF: Recall REF: 102-103 OBJ: 11 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control ANS: B DIF: Recall REF: 100-101 OBJ: 6 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control ANS: E DIF: Recall REF: 94 OBJ: 9 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control ANS: J DIF: Recall REF: 101 OBJ: 7 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control ANS: H DIF: Comprehension REF: 102 OBJ: 10 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control ANS: D DIF: Comprehension REF: 102-103 OBJ: 6 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control ANS: A DIF: Recall REF: 102| 103 OBJ: 11 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain N ConR trol I G B.C M

U S N T

O

TRUE/FALSE 1. A patient who had heart bypass surgery 1 year ago should not have local anesthetics with

vasoconstrictors.

ANS: F

Correct: A patient who has had heart bypass surgery within the last 6 months should not have local anesthetics with vasoconstrictors.

DIF: Recall REF: 100-101| 101 OBJ: 7 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. Vasoconstrictors are an absolute contraindication for a patient with uncontrolled diabetes.

ANS: T DIF: Recall REF: 99 OBJ: 7 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. Vasoconstrictors can increase a patient’s blood pressure.

ANS: T

DIF: Recall

REF: 95

OBJ: 2

TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. Patients who report an allergy to sulfites should be given the vasoconstrictor levonordefrin.

ANS: F

Correct: Patients who report an allergy to sulfites should not be given vasoconstrictors due to the antioxidant sodium bisulfite or metabisulfite contained in them.

DIF: Recall REF: 92| 101| 101 OBJ: 8 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. Usual doses of amide local anesthetic do not pose any additional risk for patients with renal

dysfunction.

ANS: T DIF: Recall REF: 103 OBJ: 11 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. Local anesthetics containing a vasoconstrictor are relative contraindications for a patient who

reports experiencing an allergic reaction to local anesthetics in the past.

ANS: F

Correct: Local anesthetics containing a vasoconstrictor are absolute contraindications for a patient who reports experiencing an allergic reaction to local anesthetics in the past.

NURSINGTB.COM DIF: Recall REF: 92| 101| 102 OBJ: 8 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. Local anesthetics containing a vasoconstrictor are an absolute contraindication for a patient

who reports being allergic to wine and dried fruits.

ANS: T DIF: Comprehension REF: 92| 101| 102 OBJ: 8 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. The use of amide local anesthetic agents, not prilocaine or topical benzocaine, is

recommended for a patient with methemoglobinemia.

ANS: T DIF: Recall REF: 103 OBJ: 4 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control MULTIPLE CHOICE 1. What is the term that describes a situation in which a drug should not be administered to an

individual under any circumstances?

a. b. c. d.

Absolute contraindication Relative contraindication Drug to drug interaction None of the above

ANS: A

Absolute contraindication is the term that describes a situation in which a drug should not be administered to an individual under any circumstances. A relative contraindication describes a situation when the offending drug may be administered judiciously. A drug-to-drug interaction describes a situation in which one drug affects the activity of another drug when they are administered together.

DIF: Recall REF: 98-99| 104 OBJ: 5 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. What does the collection of preanesthetic data guide the dental hygienist in determining? a. Need for medical consultation b. Appropriateness of administering a local anesthetic or vasoconstrictor c. Modification of dental care plan d. All options listed ANS: D

All options listed. The collection of preanesthetic data guides the dental hygienist in determining the need for medical consultation, the appropriateness of administering a local anesthetic or vasoconstrictor, and the need for medication of the dental care plan.

DIF: Recall REF: 91N R I GOBB 1 M U SCharacteristics| N T J:.C ONBDHE, 1.1 Medical and Dental History| TOP: NBDHE, 1.0 Assessing Patient NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control |NBDHE, 1.0 Assessing Patient Characteristics| NBDHE, 1.1 Medical and Dental History 3. Which of the following conditions are absolute contraindications for vasoconstrictors? a. Myocardial infarction within 6 months b. Coronary bypass surgery within 6 months c. Uncontrolled high blood pressure d. All options listed ANS: D

All options listed. Use of vasoconstrictors is an absolute contraindication for patients who present with myocardial infarction within 6 months, coronary bypass surgery within 6 months, or uncontrolled high blood pressure.

DIF: Recall REF: 101 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. Best practices include which of the following? a. Take preanesthetic vital signs to provide a standard of comparison in the event of

an emergency. b. Take preanesthetic blood pressure readings to provide baseline information. c. Take preanesthetic blood pressure readings to determine whether to use a local

anesthetic with a vasoconstrictor. d. Take preanesthetic vital signs to identify diagnosed or undiagnosed conditions. e. All options listed ANS: E

All options listed. Best practices include the taking of preanesthetic vital signs and blood pressure readings. They are important to provide a standard of comparison in the event of an emergency, to identify diagnosed or undiagnosed conditions, to provide baseline information, and to determine whether to use a local anesthetic with a vasoconstrictor.

DIF: Recall REF: 95 OBJ: 1 TOP: NBDHE, 1.0 Assessing Patient Characteristics| NBDHE, 1.6 General| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. Which of the following are best practices to use to reduce a dental patient’s level of anxiety

about dental treatment? a. Consider appointment length and time of day. b. Administer adequate pain control during treatment and after the operation. c. Telephone the patient after treatment d. All options listed ANS: D

All options listed are best practices to use to reduce a dental patient’s level of anxiety about dental treatment. Consideration should be given for the length of the appointment and for the time of day it is scheduled. Adequate pain control, during treatment and after the operation, should be considered as well as premedication the evening before or immediately before the dental appointment. Telephoning the patient after treatment to relay a message of caring and concern is also a best practicN e. URSINGTB.COM DIF: Recall REF: 96 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. A patient presents to your dental office with a toothache. His blood pressure is 200/116. What

should you do? a. Refuse treatment and refer the patient immediately to the hospital emergency. b. Implement anxiety control measures, including the use of nitrous oxide/oxygen analgesia. c. Take no unusual precautions related to patient management based on blood pressure readings after medical approval is obtained. d. Have the dentist retake the patient’s blood pressure and have him initial the patient’s chart, granting you permission to treat this patient.

ANS: B

When a patient presents to the dental office with high blood pressure readings, wait 5 minutes then retake the BP. Immediate medical consultation if still elevated. Implement anxiety control measures, including the use of nitrous oxide/oxygen analgesia. Dental or dental hygiene therapy, routine, or emergency treatment may be performed if nitrous oxide-oxygen analgesia lowers the blood pressure below > 180 systolic or >110 diastolic. If blood pressure is not reduced using nitrous oxide–oxygen analgesia, only (noninvasive) emergency therapy with drugs (analgesics, antibiotics) is allowable to treat pain and infection. Refer to hospital if immediate dental therapy is indicated.

DIF: Recall REF: 95 OBJ: 2 TOP: NBDHE, 1.0 Assessing Patient Characteristics| NBDHE, 1.6 General| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. What is the standard prophylaxis for an adult not allergic to amoxicillin? a. 500 mg orally 1 hour prior to dental procedures b. 600 mg orally 1 hour prior to dental procedures c. 600 mg within 30 minutes prior to dental procedures d. 2 g orally 1 hour prior to dental procedures ANS: D

Standard prophylaxis for an adult not allergic to amoxicillin is 2 g orally 1 hour prior to dental procedures. 500 mg orally 1 hour prior to dental procedures is the dose of azithromycin (oral) for adults allergic to penicillin. 600 mg orally 1 hour prior to dental procedures is the dose of clindamycin (oral) for adults allergic to penicillin. 600 mg within 30 minutes prior to dental procedures is the dose of clindamycin (IV) for adults allergic to penicillin and unable to take oral medications.

DIF: Recall REF: 92NURSINGOT BB J:.C 1 OM TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. Your patient reports taking nonselective beta blockers. If vasoconstrictor is necessary, you

should: a. Limit epinephrine to 0.04 mg per appointment b. Limit levonordefrin to 0.2 mg per appointment c. Not use 1:50,000 epinephrine d. All options listed ANS: D

All options listed. If your patient is taking nonselective beta blockers and if a vasoconstrictor is necessary, you should reduce the amount of vasoconstrictors to the cardiac dose; 0.04 mg per appointment for epinephrine; 0.2 mg per appointment for levonordefrin; and do not use 1:50,000 epinephrine.

DIF: Recall REF: 99 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. The body’s response to fear provokes symptoms that could include: a. Irritability b. Muscular tension

c. Increased blood pressure d. All options listed ANS: D

All options listed. The body’s response to fear provokes symptoms that could include irritability, muscular tension, and an increase in blood pressure.

DIF: Recall REF: 96-98 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 10. The potentially adverse action of the released catecholamines on cardiovascular function in

the patient with clinically significant heart or blood vessel disease warrants the inclusion of vasoconstrictors in the local anesthetic solution. Without adequate control of pain, sedation and stress reduction are impossible to achieve; however, use of local anesthetic plus a vasoconstrictor will help to ensure adequate pain control. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. The potentially adverse action of the released catecholamines on cardiovascular function in the patient with clinically significant heart or blood vessel disease warrants the inclusion of vasoconstrictors in the local anesthetic solution. Without adequate control of pain, sedation and stress reduction are impossible to achieve; however, use of local anesthetic plus a vasoconstrictor will help to ensure adequate pain control.

NURSING TB.COM

DIF: Recall REF: 98 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 11. What is the name of the inherited syndrome that is triggered by the exposure to certain drugs

used for general anesthesia and the neuromuscular blocking agent succinylcholine? a. Methemoglobinemia b. Cirrhosis c. Malignant hyperthermia d. Cancer ANS: C

Malignant hyperthermia is the name of the inherited syndrome that is triggered by the exposure to certain drugs used for general anesthesia and the neuromuscular blocking agent succinylcholine. Methemoglobinemia is a rare hereditary condition characterized by the inability of the blood to bind to oxygen. Cirrhosis is a chronic degenerative disease of the liver, commonly the result of chronic alcohol abuse, in which blood flow is restricted and metabolic and detoxification functions are impaired or destroyed. Cancer refers to a malignant neoplasm.

DIF: Recall REF: 103 OBJ: 11 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

12. Which of the listed local anesthetics could produce an emergency situation characterized by

the inability of the blood to bind to oxygen? a. Prilocaine b. Mepivacaine c. Lidocaine d. Epinephrine ANS: A

Prilocaine administered in high doses may produce an emergency situation characterized by the inability of the blood to bind to oxygen. Mepivacaine and lidocaine do not interfere with the oxygen-carrying capabilities of the blood. Epinephrine is not a local anesthetic, it is a vasoconstrictor.

DIF: Recall REF: 103 OBJ: 8 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 13. What is the best reason for the relative contraindication to amide local anesthetics for patients

with liver disease? a. Amides are metabolized to ortho-toluidine. b. Biotransformation of the amides occurs primarily in the liver. c. Ester derivative drugs that are metabolized primarily in the lungs are available. d. Cyanosis of the lips and mucous membranes may be observed.

ANS: B

Liver disease could interrupt the biotransformation of the amides that are primarily metabolized in the liver. Only the amide prilocaine is metabolized to ortho-toluidine. Ester derivative drugs are not availN ableRas I ocalManesthetics in dentistry. Cyanosis is U S inje NGctab TBle.lC O related to oxygen deficiencies in the blood.

DIF: Recall REF: 103 OBJ: 11 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 14. Local anesthetics administered during pregnancy are not teratogenic and pose little danger to

the fetus. Pregnant women can receive dental hygiene care with anesthesia in any trimester, in consultation with the patient’s physician. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. Local anesthetics administered during pregnancy are not teratogenic and pose little danger to the fetus. Pregnant women can receive dental hygiene care with anesthesia in any trimester, in consultation with the patient’s physician.

DIF: Recall REF: 103 OBJ: 11 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

15. Which of the following statements is the correct consideration regarding the use of amide

local anesthetic plus vasoconstrictor in treating a patient with a known bleeding disorder? a. The amide local anesthetic should not be used because it has a vasodilatory effect. b. A high concentration of vasoconstrictor should be utilized. c. The risk of a positive aspiration is the greatest concern. d. All options listed ANS: C

All options listed. Patients who have bleeding clotting disorders should be assessed for the potential to develop excessive bleeding as a result of puncturing a blood vessel. Injection techniques that pose a risk of positive aspirations should be avoided. All amide injectable local anesthetics are mild vasodilators. Vasoconstrictors do not effect clotting.

DIF: Recall REF: 103 OBJ: 11 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 16. Which of the following influences the amount of local anesthetic agent in the systemic

circulation? a. Administration technique b. Ability of the body to metabolize the drug c. Ability of kidneys to excrete any unmetabolized drug. d. All options listed ANS: D

All options listed. The administration technique, ability of the body to metabolize the drug, and the ability of kidneys to excrete any unmetabolized drug influence the amount of local anesthetic in systemic circulaN tiU onR. SINGTB.COM DIF: Recall REF: 91 OBJ: 11 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 17. The most common procedure for assessing the pulse rate is to palpate the brachial artery.

Bradycardia is an abnormally elevated heart rate and may be a sign of cardiovascular disease or anxiety. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: B

Both statements are false. The most common procedure for assessing the pulse rate is to palpate the radial artery. Tachycardia is an abnormally elevated heart rate and may be a sign of cardiovascular disease or anxiety.

DIF: Recall REF: 95 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 18. Which of the following are signs of anxiety and fear? a. Increased vital signs

b. Paleness of skin c. Cold sweats d. All options listed ANS: D

All options listed. Anxiety and fear can be recognized by increases in vital signs, paleness of skin color, and cold sweats.

DIF: Recall REF: 96-98 OBJ: 3 TOP: NBDHE, 1.0 Assessing Patient Characteristics| NBDHE, 1.6 General| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 19. Adequate pain control is essential to provide thorough nonsurgical periodontal therapy.

Thorough pain control is best accomplished by the administration of local anesthetics. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second is false. d. The first statement is false; the second is true.

ANS: A

Both statements are true. Adequate pain control is essential to provide thorough nonsurgical periodontal therapy. Thorough pain control is best accomplished by the administration of local anesthetics.

DIF: Recall REF: 98 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

N R I G B.C M

20. Which of the following describU es dSigitN alisTglycosiO des? a. Used for the treatment of congestive heart failure b. When combined with epinephrine, the potential for cardiac arrhythmias increases. c. All options listed d. None of the options listed ANS: C

All options listed. Digitalis glycosides are used for the treatment of congestive heart failure.

The combination of digitalis glycosides and epinephrine increases the potential for cardiac arrhythmias.

DIF: Recall REF: 100 OBJ: 7 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 21. All of the following are true regarding phenothiazines EXCEPT one. Which one is the

EXCEPTION? a. Alpha blocker that antagonizes the beta effects of epinephrine b. May reverse the pressor effect of vasoconstrictors c. May increase the risk of hypertension d. When epinephrine is needed, the minimum effective dose should be administered ANS: C

EXCEPTION: May increase the risk of hypertension.

Phenothiazines may increase the risk of hypotension. Phenothiazines are alpha blockers that antagonize the beta effects of epinephrine and may reverse the pressor effect of vasoconstrictors. When epinephrine is needed, the minimum effective dose should be administered.

DIF: Recall REF: 100 OBJ: 6 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 22. Few health conditions absolutely contraindicate the administration of vasoconstrictors.

Patients with uncontrolled systemic disease are not normally seen for nonsurgical periodontal therapy. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. Few health conditions absolutely contraindicate the administration of vasoconstrictors. Patients with uncontrolled systemic disease are not normally seen for nonsurgical periodontal therapy.

DIF: Recall REF: 100-101 OBJ: 7 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 23. Which of the following should you consider regarding the use of vasoconstrictors for patients

R?SINGTB.COM who present with hypothyroiN diU sm a. Uncontrolled hyperthyroidism is an absolute contraindication to vasoconstrictors b. Patients may be at risk of developing thyrotoxicosis c. When controlled, cardiac dose of vasoconstrictors is permitted. d. All options listed ANS: D

All options listed. Uncontrolled hyperthyroidism is an absolute contraindication to vasoconstrictors. Patients may be at risk of developing thyrotoxicosis. When controlled, cardiac dose of vasoconstrictors is permitted.

DIF: Recall REF: 101 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

Chapter 08: Determining Drug Doses Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition ESSAY 1. What is the formula for calculating the milligrams of anesthetic drug in 1 mL of the selected

anesthetic?

ANS:

Multiply the percent concentration of local anesthetic by 10 mg.

DIF: Recall REF: 111-112 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. What is the formula for calculating the milligrams of solution in one cartridge of the selected

anesthetic?

ANS:

Multiply the number of mg in one mL by either 1.8 or 1.7.

DIF: Recall REF: 111-112 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. What is the formula for calculating the healthy patient’s MRD in mg?

ANS:

NURSINGTB.COM

Multiply the patient’s weight in pounds or kilograms by the absolute MRD per appointment for healthy patients.

DIF: Recall REF: 112 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. What is the formula for converting the MRD to number of cartridges?

ANS:

Divide the MRD in milligrams by the number of milligrams per cartridge of anesthetic.

DIF: Recall REF: 112-113 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. What is the formula for converting the maximum number of cartridges to milliliters?

ANS:

Multiply the number of cartridges by 1.8 (or 1.7 for articaine) DIF: Recall REF: 113 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain

Control MULTIPLE CHOICE 1. What does the MRD depend on? a. The patient’s weight b. The patient’s health c. Whether the anesthetic contains a vasoconstrictor or not d. All options listed ANS: B

The maximum recommended dose for a patient depends on that patient’s physical health. The patient’s weight and presence of vasoconstrictor are used in the calculation of MRD, and the MRD is then adjusted to reflect individual health considerations.

DIF: Recall REF: 110-111 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. The manufacturer determines the MRD based on results from animal and human studies. The

maximum doses determined by the manufacturer are approved by the U.S. Food and Drug Administration. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

NURSINGTB.COM

Both statements are true. The manufacturer determines the MRD based on results from animal and human studies. The maximum doses determined by the manufacturer are approved by the U.S. Food and Drug Administration.

DIF: Recall REF: 110 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. Which of the following is the first step in calculating the additional dose of a different drug? a. Calculate how many milligrams of drug #1 have already been administered. b. Calculate MRD of drug #2. c. Review patient’s history to determine appropriateness of new drug. d. Consult with dentist and/or physician.

ANS: C

The first step in calculating the additional dose of a different drug is to review patient’s history to determine appropriateness of the new drug. The second step is to calculate how many milligrams of drug #1 have already been administered. Step three is to calculate the MRD of drug #2.

DIF: Recall REF: 113-115 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

4. How much solution does the standard local anesthetic cartridge contain? a. 1.6 mL b. 1.7 mL c. 1.8 mL d. 2 mL ANS: C

The standard local anesthetic cartridge contains 1.8 mL of solution. Some manufacturers label their cartridges as containing a minimum of 1.7 mL. The other values do not represent the volume of a standard local anesthetic cartridge.

DIF: Recall REF: 111-112 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. What is the name of the local anesthetic that is marketed as a different quantity of solution per

individual cartridge? a. Lidocaine b. Articaine c. Mepivacaine d. Butacaine ANS: B

Articaine. Manufacturers of articaine guarantee a minimum of 1.7 mL per cartridge.

DIF: Recall REF: 111-112 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control N R I G B.C M

U S N T

O

6. What is the number of milligrams per cartridge of 4% prilocaine? a. 3.24 mg b. 2.89 mg c. 40 mg d. 30 mg ANS: C

Prilocaine 4% contains 40 mg of anesthetic solution per ml of solution.

Calculation: 10 mg/mL  4 = 40 mg/mL DIF: Application REF: 111| 113-115 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. What is the MRD of mepivacaine 3% for a 130-lb female patient? a. 390 mg of mepivacaine b. 275 mg of mepivacaine c. 300 mg of mepivacaine d. 572 mg of mepivacaine ANS: A

A 130-lb female can receive a MRD of 390 mg of mepivacaine per appointment.

Calculation: 130 lbs  3.0 mg/lb = 390 mg

DIF: Application REF: 113 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. Using the MRD from the previous question, how many cartridges of mepivacaine 3% can this

130-lb female receive? a. 7.2 cartridges b. 7.6 cartridges c. 8.3 cartridges d. 15.8 cartridges ANS: A

Using the MRD from the previous question, this 130-lb healthy female patient could receive 7.2 cartridges of mepivacaine per appointment.

Calculation: 390 mg MRD ÷ 54 mg/cartridge = 7.2 cartridges DIF: Application REF: 113 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. What is the formula for calculating how many milligrams of anesthetic solution were

administered? a. Subtract the MRD from the absolute MRD. b. Multiply the percent concentration of local anesthetic agent by 10 mg. c. Multiply the number of cartridges administered by the milligrams of anesthetic in each cartridge. d. Multiply the milligrams oNf U anReS sthIeN ticGiT nB ea.cC hO caM rtridge by the patient’s weight.

ANS: C

To calculate the milligrams of anesthetic administered, multiply the number of cartridges administered by the milligrams of anesthetic in each cartridge. When the MRD is subtracted from the absolute MRD, the result is the difference between the absolute MRD and the patient MRD. The percent concentration of local anesthetic agent multiplied by 10 mg results in the mg of anesthetic in 1 mL of solution. To multiply the milligrams of anesthetic in each cartridge by the patient’s weight is not a useful formula.

DIF: Recall REF: 113 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 10. Which of the following is the correct chart documentation for local anesthetic? a. The number of cartridges of local anesthetic administered b. The number of milligrams of local anesthetic administered c. The percentage of a cartridge of local anesthetic administered d. Any of the above ANS: B

The number of milligrams of local anesthetic administered is the correct chart documentation for local anesthetic. Neither the number of cartridges nor the percentage of cartridge administered is a recommended method for documenting local anesthetic.

DIF: Recall REF: 113 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 11. If one has to estimate the amount of local anesthetic solution that was administered from one

cartridge, the width of the rubber stopper would represent how much? a. 2 mL of solution b. 0.2 mL of solution c. 0.02 mL of solution d. Never estimate ANS: B

The width of the rubber stopper represents 0.2 mL of solution.

DIF: Recall REF: 113| 114 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 12. If a patient’s MRD is 240 mg and 108 mg of 3% mepivacaine has already been administered,

how much more mepivacaine can the patient receive? a. 0 mg of 3% mepivacaine; a different local anesthetic should be selected b. 30 mg of 3% mepivacaine c. 348 mg of 3% mepivacaine d. 132 mg of 3% mepivacaine ANS: D

If a patient’s MRD is 240 mg, and 108 mg of 3% mepivacaine has already been administered, the patient can receive 132 mN g mRoreIof 3G% m epC ivacMaine.

B.

Ng T Calculation: 240 mg – 108 mgU = 1S 32 m

O

DIF: Application REF: 113 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 13. Using the information from the previous question, how many additional cartridges of 3%

mepivacaine can the patient receive? a. 0 cartridges of 3% mepivacaine; a different local anesthetic should be selected b. 1.8 additional cartridges of 3% mepivacaine c. 6.4 additional cartridges of 3% mepivacaine d. 2.4 additional cartridges of 3% mepivacaine ANS: D

Using the information from the previous question, the patient can receive 2.4 additional cartridges of 3% mepivacaine.

Calculation: 132 mg ÷ 54 mg/cartridge = 2.4 cartridges DIF: Application REF: 113 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 14. If an anesthetic contains a vasoconstrictor, how is the maximum recommended dose

determined?

a. b. c. d.

The vasoconstrictor is always the limiting factor.

The anesthetic is always the limiting factor.

Whichever of the drugs reaches its MRD first is the limiting factor.

It is determined by the weight of the patient.

ANS: C

The MRD of an anesthetic containing a vasoconstrictor depends on which of the two drugs reaches its MRD first, and that is dependent upon the patient’s medical status, not weight.

DIF: Recall REF: 116 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 15. Which anesthetic/vasoconstrictor combination is most likely to limit the anesthetic drug? a. Lidocaine 2% 1:50,000 epinephrine b. Lidocaine 2% 1:100,000 epinephrine c. Mepivacaine 3% 1:20,000 levonordefrin d. All options listed ANS: A

The anesthetic/vasoconstrictor combination of lidocaine 2% 1:50,000 epinephrine is most likely to be the limiting factor of this combo. The absolute MRD for 2% lidocaine is 500 mg per appointment (13.8 cartridges). With the 1:50,000 epinephrine, the number of cartridges needed to reach MRD for a healthy adult is 5.5 cartridges and the cardiac dose maximum is 1.1 cartridges. For 1:100,000 epinephrine, the number of cartridges needed to reach MRD for a healthy adult is 11.1 and the cardiac doses maximum is 2.2. Healthy patients weighing 1ess than 150 lbs would reach their MRD of the anesthetic before reaching the MRD of the vasoconstrictor. MepivacaineN3% a pl ainTfBo. rmCula URisSI NG OMtion and does not include 1:20,000 levonordefrin.

DIF: Comprehension REF: 111| 119 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 16. What is the limiting factor for anesthetic in a compromised patient? a. Concentration of anesthetic b. Vasoconstrictor c. Patient’s weight d. Length of appointment ANS: B

The vasoconstrictor is always the limiting factor in a compromised patient. Concentration of anesthetic, patient’s weight, and length of appointment are not limiting factors. There is no formula for calculating anesthetic for a compromised patient; therefore, the lowest effective dose of local anesthetic should be administered to compromised patients.

DIF: Recall REF: 115-116 OBJ: 10 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 3.5 Recognition and Management of Compromised Patients 17. What is the MRD for epinephrine for a compromised patient? a. 0.04 mg per appointment

b. 0.04 mg per quadrant of scaling c. 0.2 mg per appointment d. 0.2 mg per tooth to be restored ANS: A

The MRD for epinephrine for a compromised patient is 0.04 mg per appointment. Milligrams per appointment, per quadrant, and per tooth are not used.

DIF: Recall REF: 113-115| 116-117 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 3.5 Recognition and Management of Compromised Patients 18. For what kind of patient should the MRD of local anesthetic agents be decreased? a. Children b. Elderly c. Medically compromised d. All options listed ANS: D

All options listed. The MRD of local anesthetic agents should be decreased for children, elderly, and/or medically compromised patients.

DIF: Recall REF: 115-116| 119 OBJ: 2|5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 3.5 Recognition and Management of Compromised Patients 19. Local anesthetic drug amounts are expressed in ratios. Vasoconstrictor drug amounts are

expressed in percentages.

N R I G B.COM a. Both statements are true. U S N T b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: B

Both statements are false. Local anesthetic drug amounts are expressed in percentages.

Vasoconstrictor drug amounts are expressed in ratios.

DIF: Recall REF: 116-118 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 20. MRD of the local anesthetic agent should be decreased for patients with medically

compromised situations, the elderly patient, and children. The lowest effective dose should be administered to any of these patients. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. MRD of the local anesthetic agent should be decreased for patients with medically compromised situations, the elderly patient, and children. The lowest effective dose should be administered to any of these patients.

DIF: Recall REF: 115-116 OBJ: 2|5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 3.5 Recognition and Management of Compromised Patients 21. The dental hygienist has already administered two cartridges of 2% lidocaine to a patient. The

patient is reporting that he is not getting numb. What should the hygienist do at this time? a. Ask the dentist to administer more anesthetic solution. b. Change to a different anesthetic solution. c. Attempt to readminister the anesthetic, adjusting the technique. d. Call the manufacturer to report a bad batch of anesthetic cartridges.

ANS: C

The dental hygienist should attempt to readminister the anesthetic, adjusting the technique used. Inadequate anesthesia is usually due to improper technique, anatomic variation or an inadequate volume of administered anesthetic, not a “bad batch.”

DIF: Recall REF: 113-115 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 22. What is the MRD for articaine for a 115-pound patient? a. 368 mg b. 297 mg c. 230 mg NURSINGTB.COM d. 69 mg ANS: A

The MRD for articaine for a 115-pound patient is 368 mg.

Calculation: 115 lbs  3.2 mg/lb = 368 mg DIF: Application REF: 113 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 23. If the dental hygienist were to administer two different local anesthetics, which MRD would

she use? a. Use the higher MRD b. Use the lower MRD c. Use the MRD for the local anesthetic administered in the greatest amount d. Subtract the lower MRD from the higher MRD and use the resulting MRD ANS: B

If the dental hygienist were to administer two different local anesthetics, he or she would calculate the MRD for both local anesthetics and use the lower MRD. Using the higher MRD or the MRD difference between the higher and lower MRDs is not reliable and could result in exceeding the MRD of the most toxic drug.

DIF: Recall

REF: 113-115

OBJ: 3

TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 24. What is the maximum dose of levonordefrin in a healthy patient? a. 0.2 mg b. 1.0 mg c. 0.04 mg d. Epinephrine should be used instead of levonordefrin.

ANS: B

The maximum dose of levonordefrin in a healthy patient is 1.0 mg. 0.2 mg represents the MRD for epinephrine for healthy patients and the MRD cardiac dose for levonordefrin. 0.04 mg is the MRD cardiac dose for epinephrine. For a healthy patient, either levonordefrin or epinephrine may be used.

DIF: Recall REF: 117| 119 OBJ: 7 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 25. For medically compromised patients, an appointment for nonsurgical periodontal therapy for

two quadrants that would normally be completed in one appointment could be completed in two shorter appointments rather than one longer appointment. This would increase the amount of local anesthetic needed per appointment, providing safer treatment to the medically compromised or elderly patient. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false.

CeOnMt is true. d. The first statement is falsN e;UthReSseIcN onGdTsB tat. em ANS: C

The first statement is true, the second statement is false. For medically compromised patients, an appointment for nonsurgical periodontal therapy for two quadrants that would normally be completed in one appointment could be completed in two shorter appointments rather than one longer appointment. This would decrease the amount of local anesthetic needed per appointment, providing safer treatment to the medically compromised or elderly patient.

DIF: Recall REF: 115 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 3.5 Recognition and Management of Compromised Patients 26. How much vasoconstrictor is in one cartridge of 1:50,000? a. 0.036 mg per cartridge b. 0.09 mg per cartridge c. 0.018 mg per cartridge d. 0.017 mg per cartridge ANS: A

In one cartridge of 1:50,000, there is 0.036 mg of vasoconstrictor.

Calculation: 0.02 mg/mL  1.8 mL = 0.036 DIF: Application REF: 117| 118 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain

Control 27. What is the MRD of 1:100,000 epinephrine per appointment for a healthy patient? a. 1.0 mg b. 0.2 mg c. 0.04 mg d. 0.4 mg ANS: B

The MRD of 1:100,000 epinephrine per appointment for a healthy patient is 0.2 mg. 1.0 mg represents the MRD of levonordefrin for a healthy patient. 0.04 mg represents the MRD cardiac dose of epinephrine. 0.4 mg does not represent a maximum dosage of vasoconstrictors.

DIF: Recall REF: 116-117| 119 OBJ: 7 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 28. What is the maximum number of cartridges of 1:50,000 epinephrine that can be administered

to a medically compromised patient? a. 5.5 cartridges b. 11.1 cartridges c. 2.2 cartridges d. 1.1 cartridges ANS: D

The maximum number of cartridges of 1:50,000 epinephrine that can be administered to a medically compromised patieNnt iR s 1.1 cartridges.

U SINGTB.COM Calculation: 0.04 MRD ÷ 0.036 mg/cartridge = 1.1 DIF: Application REF: 118 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 3.5 Recognition and Management of Compromised Patients 29. How many milligrams of lidocaine 2% 1:100,000 epinephrine may a healthy, 200-lb patient

receive? a. 800 mg b. 620 mg c. 600 mg d. 500 mg ANS: D

500 mg. Although 3.2 mg/lb  200 = 620 mg, a 200-lb patient can receive only 500 mg (the absolute MRD) of lidocaine 2% 1:100,000 epinephrine even though the calculated number based upon his weight is higher.

DIF: Application REF: 111| 112| 113 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 30. How many milligrams of lidocaine 2% 1:100,000 epinephrine may a patient with ischemic

heart disease receive?

a. 620 mg b. 500 mg c. 399.6 mg d. 79.2 mg ANS: D

31. A patient with ischemic heart disease may only receive 0.04 mg of epinephrine or 2.2 cartridges of 2% lidocaine 1:100,000 epinephrine. 2.2  36 mg/cart = 79.2 mg DIF: Application REF: 116-117 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

NURSINGTB.COM

Chapter 09: Armamentarium/Syringe Preparation Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition MATCHING

Match the parts of the anesthetic armamentarium with their function or main purpose. a. Syringe barrel b. Harpoon c. Finger grip d. Thumb ring e. Breech-loading syringe f. Bevel g. Shaft h. Syringe adaptor i. Gauge j. Diaphragm 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

The point or tip of the needle Used to advance or retract the piston The metal or plastic hub that attaches the needle to the syringe The size of the lumen of the needle Allows for insertion of the cartridge through the side of the barrel The length of the needle composed of long tubular metal extending from the tip of the needle to the cartridge penetrating end Has a large window and a small window for visibility of cartridge N cate RSdIatNthe GTtop B.C M The semipermeable material loU of O the anesthetic cartridge The sharp tip of an aspirating syringe that allows for aspiration Utilized to give clinician added support of the syringe

1. ANS: F DIF: Recall REF: 138-139 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. ANS: D DIF: Recall REF: 131 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. ANS: H DIF: Recall REF: 140 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. ANS: I DIF: Recall REF: 139-140| 141-142 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. ANS: E DIF: Recall REF: 129-130 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. ANS: G DIF: Recall REF: 139-140 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. ANS: A DIF: Recall REF: 129-130 OBJ: 3

TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. ANS: J DIF: Recall REF: 146 OBJ: 9 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. ANS: B DIF: Recall REF: 130 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 10. ANS: C DIF: Recall REF: 130-131 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control MULTIPLE CHOICE 1. Since the syringe was introduced in 1921, what has been the single most important

improvement in dental local anesthetic? a. The addition of the breech-loading window for visibility b. The addition of the aspirating harpoon c. The elimination of the needle d. The computer-controlled anesthetic devices ANS: B

Since the syringe was introduced in 1921, the single most important improvement in dental local anesthetic has been the addition of the aspirating harpoon, which allows engagement to the rubber stopper of the anesthetic cartridge. This addition introduced the important concept of aspirating. The breach loading allows the glass anesthetic cartridge to be inserted into the syringe through the side of the barrel; the needle has not been eliminated; computer-controlled N mo RS I and GTrate B.C M anesthetic devices control the aU unt N of O administration of anesthesia.

DIF: Recall REF: 129-131 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. Established local anesthetic syringe criteria include which of the following? a. Disposable and packaged in sterile containers b. Lightweight and simple to use c. Able to withstand repeated use and sterilization d. All options listed ANS: D

All options listed. Established local anesthetic syringe criteria include: disposable and packaged in sterile containers, lightweight and simple to use, and able to withstand repeated use and sterilization.

DIF: Recall REF: 129-131 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. Which of the following is an important feature of the syringe barrel? a. It provides the clinician with syringe stability and control. b. It is capable of being loaded from the side.

c. The large window provides direct vision of the cartridge during anesthetic

administration. d. All options listed ANS: C

An important feature of the syringe barrel is that the large window provides direct vision of the cartridge during anesthetic administration. Stability and control is provided by the finger grip; the breach-loading syringe is capable of being loaded from the side.

DIF: Recall REF: 129-130 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. Which part of the syringe must be pulled back when inserting the anesthetic cartridge? a. The internal end of the piston with the harpoon b. The external end of the piston c. The harpoon only d. The rubber stopper ANS: A

The part of the syringe that must be pulled back when inserting the anesthetic cartridge is the internal end of the piston with the harpoon attached to it. The external end of the piston attaches to the thumb ring; the rubber stopper is part of the cartridge.

DIF: Recall REF: 130 OBJ: 13 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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5. What is produced when the thuU mbS ringNofT a syringOe is pulled back by the clinician, causing

retraction of the rubber stopper? a. Positive aspiration b. Negative aspiration c. Negative pressure d. None of the above ANS: C

Negative pressure is produced when the thumb ring of a syringe is pulled back by the clinician, causing retraction of the rubber stopper. Positive aspiration describes blood entering the cartridge following an aspiration test indicating the needle tip is within a blood vessel.

Negative aspiration indicates that no blood is within the needle tip.

DIF: Recall REF: 130| 131 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. What is one disadvantage of using a smaller syringe? a. It is not comfortable or versatile enough to fit everyone in the dental office. b. A small portion of the anesthetic remains in the cartridge and is not usable. c. The cost of having multiple size syringes is prohibitive. d. The patients notice a difference in comfort levels.

ANS: B

The disadvantage of the smaller syringe is the inability of the clinician to deposit the entire cartridge of anesthetic. A small portion is unusable. There are differences in hand sizes, and the smaller syringes assist smaller-handed clinicians in performing sufficient aspiration. The cost of having multiple size syringes available is not prohibitive. The patient is unable to discern a difference in comfort levels.

DIF: Recall REF: 132 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. Why might the harpoon of the syringe become disengaged during aspiration? a. Clinician technique b. Dullness c. Improper syringe set-up d. All options listed ANS: D

All options listed. The harpoon of the syringe can become disengaged during aspiration when the harpoon is dull, if the harpoon has not been properly engaged during the syringe set-up, or if there is excessive pull on the thumb ring.

DIF: Recall REF: 132 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. What should the clinician do if the harpoon becomes disengaged during aspiration? a. Seek help from the dentist. b. Do not let the patient knoN .iC wUaR ndScIoN ntG inT ueBw thOthMe procedure, but document the

incident in the chart notes.

c. Remove the syringe, remove the needle, reengage the harpoon, reattach the needle,

and then continue with the procedure. d. Gently reengage the harpoon while maintaining correct injection site position.

ANS: C

If the harpoon becomes disengaged during aspiration, the clinician should remove the syringe from the patient’s mouth, remove the needle, reengage the harpoon, reattach the needle, and then continue with the procedure. It is not necessary to seek help from the dentist. Because positive aspiration cannot be ensured once the harpoon is disengaged, the clinician must not continue with the procedure. To ensure safety to the patient as well as proper harpoon engagement, the clinician must not reengage the harpoon while maintaining correct injection site position.

DIF: Recall REF: 132 OBJ: 13 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. The importance of aspirating prior to anesthetic deposition and the potential hazards

associated with intravascular injections are widely known and accepted. The self-aspirating syringe achieves the positive pressure for an aspiration without a harpoon. a. Both statements are true. b. Both statements are false.

c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: C

The first statement is true, the second statement is false. The importance of aspirating prior to anesthetic deposition and the potential hazards associated with intravascular injections are widely known and accepted. The self-aspirating syringe achieves the negative pressure for an aspiration without a harpoon.

DIF: Recall REF: 132 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 10. What is a possible disadvantage of using the self-aspirating syringe? a. Insecurity of the clinician accustomed to the harpoon-type syringe. b. Harpoon disengagement may occur more easily during aspiration. c. Discoloration of the plastic from autoclaving frequently. d. It is rust resistant.

ANS: A

A possible disadvantage of using the self-aspirating syringe is the insecurity of the clinician accustomed to the harpoon-type syringe. The self-aspirating syringe is not plastic and does not utilize a harpoon. Rust resistance is not a disadvantage.

DIF: Recall REF: 133 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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Sge Nis uT 11. In dentistry, the pressure-type sUyrin sed for O providing anesthetic for periodontal ligament injections. It provides reliable anesthesia for one tooth in the mandible. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. The pressure-type syringe is used for anesthetic for periodontal ligament injections in dentistry. It provides reliable anesthesia for one tooth in the mandible.

DIF: Recall REF: 133-134 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 12. What is an advantage of using the pressure-type syringe over the conventional type of

syringe? a. It achieves negative pressure for an aspiration without a harpoon. b. It utilizes a lightweight wand designed for ergonomic control. c. It administers a 0.2-mL dosage of anesthetic. d. It is more successful than block anesthetic.

ANS: C

An advantage of using the pressure-type syringe over the conventional type of syringe is that it administers a 0.2-mL dosage of anesthetic. There is no aspiration with a pressure-type syringe because it is used for periodontal ligament or intraligamentary injections and it is not used for block anesthesia. Lightweight wand–designed ergonomic control is provided by computer-controlled delivery devices.

DIF: Recall REF: 133-134 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 13. Because of the cost of the “needleless” injection, what is an alternative cost-effective

anesthetic that will produce results similar to those of the needleless injection? a. Computer-controlled anesthetic b. Topical anesthetic c. Articaine d. All options listed ANS: B

Topical anesthetics, when properly applied, can accomplish the same purpose as the needleless injection at a fraction of the cost. Computer-controlled anesthetic devices are not “needleless.” Articaine dental local anesthetic is available only as an injectable agent.

DIF: Recall REF: 134 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 14. What is a possible advantage of using the computer-controlled syringe? a. It offers precise control oN f aUnR esS thI etN icGfT loB w.aC ndOpM ressure. b. It has automatic aspiration. c. The rotational needle insertion minimizes needle deflection. d. All options listed ANS: D

All options listed. Advantages of using the computer-controlled syringe include more precise control of anesthetic flow and pressure, automatic aspiration, and the rotational needle insertion (which minimizes needle deflection).

DIF: Recall REF: 139 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 15. Manufacturer recommendations for the routine maintenance of reusable syringes include: a. Thorough cleaning and sterilization after use on each patient b. Never dismantling the syringe c. Disposing of syringes with bent harpoons d. Lubrication of the piston after every autoclave run ANS: A

Manufacturer recommendations for the routine maintenance of reusable syringes include thorough cleaning and sterilization after use on each patient. In lieu of disposing of the syringes, bent harpoons should be replaced. Following repeated autoclaving, reusable syringes should be dismantled and lubricated.

DIF: Recall REF: 136-138 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 16. Patient comfort can be increased by the sharpness of the bevel. The bevel of the needle should

be turned toward the bone. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. Patient comfort can be increased by the sharpness of the bevel. The bevel of the needle should be turned toward the bone to increase patient comfort.

DIF: Recall REF: 138-139 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 17. When comparing large-gauge numbers to smaller-gauge numbers, what does the larger-gauge

number of the needle mean? a. It refers to a short needle. b. It refers to a longer needle. c. It refers to the smaller diameter of the needle. d. It refers to the larger diameter of the needle.

ANS: C

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When comparing large numbers to smaller numbers, the larger number means the smaller diameter of the needle. The smaller number means the larger diameter of the needle. Gauge indicates diameter of the lumen, not the length of the needle.

DIF: Recall REF: 141-143 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 18. Which gauge needle is recommended for use for areas where there is a high risk for a positive

aspiration? a. 25-gauge b. 27-gauge c. 30-gauge d. All options listed ANS: A

The 25-gauge needle is recommended for use for areas where there is a high risk for a positive aspiration. The 27-gauge needle is acceptable. The 30-gauge needle is not recommended.

DIF: Recall REF: 141-143 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 19. On what factor should the clinician base the choice of the needle length?

a. b. c. d.

Type of anesthetic to be used Amount of tissue that needs to be penetrated Patient tolerance and comfort level Angle of the bevel

ANS: B

The needle length selection is based on the amount of tissue that needs to be penetrated to reach the target location and to deposit the anesthetic successfully. The type of anesthetic used is not a factor in needle length choice. Needle length does not affect patient tolerance and comfort when used appropriately.

DIF: Recall REF: 143 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 20. When does the needle become dull? a. It does not become dull because it is disposable. b. After three to four needle penetrations. c. After five to six needle penetrations. d. After it is sterilized.

ANS: B

The needle becomes dull after three to four needle penetrations. Disposable needles are presterilized and should never be used on more than one patient.

DIF: Recall REF: 144 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control N R I G B.C M

U S N T

O

21. It is recommended that the clinician know the location of the uncovered needle tip at all times.

Why? a. To prevent needle injury to the patient b. To prevent needle injury to the clinician c. To prevent accidental needle contamination d. All options listed ANS: D

All options listed. It is recommended that the clinician know the location of the uncovered needle tip at all times in order to prevent needle injury to the patient and to the clinician and to prevent accidental needle contamination.

DIF: Recall REF: 144 OBJ: 7 | 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 22. Your patient complained that the injection that you just administered was very painful as you

withdrew the needle. What do you think happened to cause this pain? a. You used a dull needle. b. You withdrew the needle too quickly. c. The needle had a barb from manufacturing. d. All options listed.

ANS: C

When the patient complains of pain when the needle is withdrawn from the tissue, it may be due to barbs on the needle tip that occurred during manufacturing. A dull needle may cause pain during needle insertion. Rapid withdrawal, not recommended due to safety concerns, does not usually cause pain.

DIF: Recall REF: 144 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 23. To prevent accidental needle stick exposures to the clinician, the clinician should wear thick

utility gloves to protect herself. Needle stick injuries typically occur from inattention by the clinician or unexpected patient movement. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: D

The first statement is false, the second statement is true. To prevent accidental needle stick exposures to the clinician, the needle should be capped (utilizing the scoop method) in the protective shield immediately following the injection. Needle stick injuries typically occur from inattention by the clinician or unexpected patient movement.

DIF: Recall REF: 144 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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24. Which of the following is likely to increase the incident of needle breakage? a. Bending the needle b. Changing the direction of the insertion of the needle c. Forcing the needle against resistance d. All options listed ANS: D

All options listed. All of the following will increase the incident of needle breakage: bending the needle, changing the direction of the insertion of the needle (especially when it is deeply embedded in tissue), and forcing the needle against resistance.

DIF: Recall REF: 144-145 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 25. What is the weakest part of the needle? a. The shaft b. The hub c. The bevel d. The smaller gauge ANS: B

The weakest portion of the needle is the hub, not the shaft or the bevel. The gauge is not a part of the needle, it is the size of the lumen.

DIF: Recall REF: 144-145 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 26. According to Malamed, what kinds of needles are most likely to break? a. 30-gauge short or ultrashort needles b. 25-gauge long needles c. Short needles, no matter the gauge d. Long needles, no matter the gauge ANS: A

According to Malamed, the majority of needle breakage incidences have occurred with 30-gauge short or ultrashort needles. 25- and 27-gauge needles, regardless of length, are less likely to break. The 30-gauge needle is not available in dentistry as a long needle.

DIF: Recall REF: 144-145 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 27. Which of the following guidelines should be followed in order to correctly store local

anesthetic cartridges in the dental office? a. Keep in a commercially available cartridge warmer b. Keep in a refrigerator at a constant cool temperature but without freezing c. Store at room temperature in a dark place d. Store in disinfectant solution so they are readily available for use as needed ANS: C

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Local anesthetic cartridges should be stored in their original container at room temperature in a dark place. Cartridge warmers are not necessary, nor are they recommended because overwarming may cause discomfort and destroy the heat-sensitive vasoconstrictor. Cartridges should never be placed in disinfectant solution because the rubber diaphragm is permeable and the solution can become contaminated and the aluminum cap can become corroded.

DIF: Recall REF: 146-147 OBJ: 10 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 28. What is indicated by the presence of bubbles larger than 2 mm in diameter and located within

the anesthetic cartridge? a. The anesthetic has expired. b. The anesthetic has gotten too warm. c. The anesthetic has been frozen. d. The anesthetic cartridge has been placed in disinfecting solution.

ANS: C

Bubbles in the cartridge that are larger than 2 mm in diameter are a warning that the anesthetic cartridge has been frozen. The reliability of expired anesthetic cannot be guaranteed, and patient discomfort may result from its use. Overwarming can result in discomfort to the patient during injection and destruction of the heat-sensitive vasoconstrictor. Anesthetic cartridges placed in disinfecting solution may result in contamination of the local anesthetic and The reliability of expired

Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank

DIF: Recall REF: 147 OBJ: 11 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 29. What does the presence of an extruded anesthetic cartridge stopper without a large bubble

mean? a. The anesthetic has expired. b. The anesthetic has gotten too warm. c. The anesthetic has been frozen. d. The anesthetic cartridge has been placed in disinfecting solution.

ANS: D

The presence of an extruded anesthetic cartridge stopper without a large bubble means that the anesthetic cartridge has been placed in disinfecting solution. The reliability of expired anesthetic cannot be guaranteed and patient discomfort may result from its use. Overwarming can result in discomfort to the patient during injection and destruction of the heat-sensitive vasoconstrictor. Bubbles in the cartridge that are larger than 2 mm in diameter are a warning that the anesthetic cartridge has been frozen.

DIF: Recall REF: 147 OBJ: 11 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 30. When the anesthetic solution has expired, the pH of the anesthetic solution will decrease when

the preservative sodium bisulfate is oxidized to sodium bisulfate. This can be avoided by checking the expiration date printed on the Mylar label. a. Both statements are true.NURSINGTB.COM b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. When the anesthetic solution has expired, the pH of the anesthetic solution will decrease when the preservative sodium bisulfate is oxidized to sodium bisulfate.

This can be avoided by checking the expiration date printed on the Mylar label.

DIF: Recall REF: 147-148 OBJ: 11 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 31. A patient presents to your office asking for a needleless injection. What anesthetic method is

the patient referring to? a. Computer-controlled anesthetic b. Self-aspirating syringes c. Jet injector syringes d. Breach-loading syringes ANS: C

The jet injector syringe delivers the anesthetic without the use of a needle.

Computer-controlled anesthesia, self-aspirating syringes, and breach-loading syringes all include the use of needles.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank

DIF: Recall REF: 134 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 32. What is the name of the component of the syringe that can easily be unscrewed and

inadvertently disposed of during needle removal? a. Finger grip b. Needle adaptor c. Harpoon d. Piston ANS: B

The needle adaptor can be easily unscrewed when the needle is removed and can be inadvertently disposed of with the contaminated needle. The finger grip, harpoon, and piston are not attached to the needle.

DIF: Recall REF: 129 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 33. Which of the following is an advantage of the plastic breech-loading aspirating syringe? a. Lighter weight b. Lower cost c. Less threatening appearance d. All options listed.

ANS: D

NURSINGTB.COM

All options listed. Advantages of the plastic breech-loading aspirating syringe include: lighter weight, lower cost, and a less threatening appearance.

DIF: Recall REF: 134 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 34. What is the name of a plastic, single-use or partially disposable syringe that utilizes a

retractable plastic sheath that locks over the needle upon removal from tissue? a. Plastic breech-loading syringe b. Safety syringe c. Jet injector syringe d. Pressure syringe ANS: B

The safety syringe is a plastic, single-use syringe that utilizes a retractable plastic sheath that locks over the needle upon removal from tissue. The plastic breech-loading, jet injector, and pressure syringes are all completely autoclavable and lack a retractable plastic sheath that locks over the needle.

DIF: Recall REF: 135-136 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank 35. The hub of the needle is the point where the shaft of the needle joins and secures the needle to

the syringe adaptor. The needle shank should never be inserted into tissue up to the hub of the needle. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. The hub of the needle is the point where the shaft of the needle joins and secures the needle to the syringe adaptor. The needle shank should never be inserted into tissue up to the hub of the needle.

DIF: Recall REF: 140 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 36. Various colors are used by manufacturers to indicate the gauge and length of needles. There

are no uniform guidelines for the color of needle shields. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: C

The first statement is true; the second statement is false. Various colors are used by manufacturers to indicate the gauge and length of needles. The shield that covers the cartridge penetrating end is clear.

NURSINGTB.COM DIF: Recall REF: 141 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 37. The 25-gauge needle is safer for the patient because the smaller lumen provides ease of

aspiration. a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: C

The statement is correct, but the reason is NOT. The 25-gauge needle is safer for the patient because the larger lumen provides ease of aspiration.

DIF: Recall REF: 141-143 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 38. Larger-gauge needles provide less tissue deflection during significant needle penetration

because of the greater rigidity of larger gauge needles. a. Both the statement and reason are correct and related.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank b. c. d. e.

Both the statement and reason are correct but NOT related.

The statement is correct, but the reason is NOT. The statement is NOT correct, but the reason is correct.

NEITHER the statement NOR the reason is correct.

ANS: A

Both the statement and reason are correct and related. Larger-gauge needles provide less tissue deflection during significant needle penetration because of the greater rigidity of larger-gauge needles.

DIF: Recall REF: 141-143 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 39. Long needles are required for which of the following? a. Inferior alveolar block injection b. Gow-Gates mandibular block injection c. Infraorbital block injection d. All options listed ANS: D

All options listed. Long needles are required for injections such as inferior alveolar block, Gow Gates mandibular block, and infraorbital block.

DIF: Recall REF: 143 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

N R I G B.C M

40. The cartridge silicone rubber sU toppS er iN s sliT ghtly inO dented from the rim of the glass barrel.

Cartridges that have rubber stoppers that are not indented slightly should be discarded. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. The cartridge silicone rubber stopper is slightly indented from the rim of the glass barrel. Cartridges that have rubber stoppers that are not indented slightly should be discarded because sterility of the solution cannot be guaranteed.

DIF: Recall REF: 145 OBJ: 11 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 41. Small bubbles (1-2 millimeters) trapped in the anesthetic cartridge are harmless because they

are produced by nitrogen gas bubbled into the solution during the manufacturing process. a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank ANS: A

Both the statement and reason are correct and related. Small bubbles (1-2 millimeters) trapped in the anesthetic cartridge are harmless because they are produced by nitrogen gas bubbled into the solution during the manufacturing process.

DIF: Recall REF: 147 OBJ: 11 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 42. Which of the following describe topical antiseptic placement? a. Optional procedure b. Screen patient for allergy to iodine c. May be useful for immunosuppressed patients d. All options listed ANS: D

All options listed. All of the following are true regarding topical antiseptic application: it is an optional procedure; patients should be screened for allergy to iodine; and it should be considered for patients who are immunosuppressed.

DIF: Recall REF: 148 OBJ: 12 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank

Chapter 10: Anatomic Considerations for the Administration of Local Anesthesia Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition MATCHING

Match the name of the nerve to the predominant structures that it innervates. a. Anterior superior alveolar nerve b. Middle superior alveolar nerve c. Posterior superior alveolar nerve d. Greater palatine nerve e. Nasopalatine nerve f. Lingual nerve g. Mental nerve h. Incisive nerve 1.

2.

3.

4.

5.

6.

7.

8.

Posterior hard palate and posterior lingual gingival tissue of the posterior teeth Afferent nerve for mandibular anterior teeth and premolars Maxillary central incisors, lateral incisors, and canines Afferent nerve for the chin, lower lip, and labial mucosa of anterior teeth and premolars The tongue Buccal gingival tissue of the maxillary molars Mucosa of the anterior hard palate In some cases, the mesiobuccal root of the maxillary first molar

1. ANS: D DIF: Recall REF: 178 OBJ: 4 NUienc RSes|INNBD GTHE, B.1.1OC M NBDHE, 1.1.1. Head and Neck TOP: NBDHE, 1.0 Anatomic Sc Anatomy| Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. ANS: H DIF: Recall REF: 183 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. ANS: A DIF: Recall REF: 177-178 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. ANS: G DIF: Recall REF: 182-183 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. ANS: F DIF: Recall REF: 180-181 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. ANS: C DIF: Recall REF: 178 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. ANS: E DIF: Recall REF: 179 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. ANS: B DIF: Comprehension REF: 178 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control MULTIPLE CHOICE 1. Which of the following is a prominent landmark for the administration of the anterior superior

alveolar block? a. Canine fossa b. Canine eminence c. Infraorbital foramen d. Posterosuperior to the roots of the maxillary canine teeth ANS: B

The facial ridge over the maxillary canine, the canine eminence, is especially prominent, making it a landmark for the administration of the anterior superior alveolar block. The canine fossa is located posterosuperior to the roots of the maxillary canine teeth and inferior to the infraorbital foramen, a landmark for the intraorbital injection.

DIF: Recall REF: 168-169| 177-178| 188 OBJ: 2 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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2. Which part of the maxilla articulates with the zygomatic bone laterally, thus completing the

infraorbital rim? a. Zygomatic process b. Frontal process c. Palatine process d. Alveolar processes ANS: A

The zygomatic process of the maxilla articulates with the zygomatic bone laterally, thus completing the infraorbital rim. Each frontal process articulates with the frontal bone; each palatine process articulates with the other to form the hard palate; the alveolar processes usually contain the roots of maxillary teeth.

DIF: Recall REF: 167-169 OBJ: 1 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. Which area of the maxilla articulates with the other to form the anterior or major part of the

hard palate? a. Zygomatic process b. Frontal process c. Palatine process

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank d. Alveolar processes ANS: C

Each palatine process of the maxilla articulates with the other to form the anterior or major part of the hard palate. The zygomatic process of the maxilla articulates with the zygomatic bone laterally, thus completing the infraorbital rim. Each frontal process articulates with the frontal bone; the alveolar processes usually contain the roots of maxillary teeth.

DIF: Recall REF: 167-169 OBJ: 1 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. What is the median palatine raphe? a. A fibrous band of tissue b. A landmark for the administration of the anterior middle superior alveolar block c. The tissue that covers the suture between the two palatine processes of the

maxillae d. All options listed ANS: D

All options listed. The median palatine raphe is a fibrous band of tissue that covers the suture between the two palatine processes of the maxillae. It is a landmark for the administration of the anterior middle superior alveolar block.

DIF: Recall REF: 167-169 OBJ: 2 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 PlanninN g anR d MI anaging Hygiene Care| NBDHE, 3.4 Anxiety and Pain G BD.enCtal M U S N T O Control 5. What is the name of the foramen located palatal to the maxillary central incisors? a. Mental foramen b. Infraorbital foramen c. Incisive foramen d. Lingual foramen ANS: C

The incisive foramen is located palatal to the maxillary central incisors. The mental and lingual foramina are located on the mandible. The infraorbital foramen is located below the infraorbital margin of the orbit.

DIF: Recall REF: 167-169 OBJ: 2 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. The maxillary tuberosity is a landmark for the administration of which injection? a. Anterior superior alveolar block b. Middle superior alveolar block c. Posterior superior alveolar block d. Inferior alveolar block ANS: C

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank The maxillary tuberosity is a landmark for the administration of the posterior superior alveolar block. It is neither a landmark for the anterior or middle superior alveolar blocks, nor the inferior alveolar block.

DIF: Recall REF: 178 OBJ: 2 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. The lesser palatine foramen transmits the lesser palatine nerve and blood vessels to the soft

palate and tonsils. Due to close proximity to the greater palatine foramen and its nerve, the patient’s soft palate can become inadvertently anesthetized with the greater palatine block. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. The lesser palatine foramen transmits the lesser palatine nerve and blood vessels to the soft palate and tonsils. Due to close proximity to the greater palatine foramen and its nerve, the patient’s soft palate can become inadvertently anesthetized with the greater palatine block.

DIF: Recall REF: 169-170| 178 OBJ: 2 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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8. Which bones does the mandible have a movable articulation with? a. Maxillae b. Temporal bones c. Sphenoid bone d. Palatal bones ANS: B

The mandible has a movable articulation with the temporal bones. The mandible does not have a movable articulation with the maxillae, sphenoid bone, or palatal bones.

DIF: Recall REF: 170-173 OBJ: 1 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. What is the name of the opening that is located between the apices of the mandibular first and

second premolars? a. Mandibular foramen b. Lingual foramen c. Mandibular symphysis d. Mental foramen ANS: D

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank The mental foramen is the name of the opening that is located between the apices of the mandibular first and second premolars. The mandibular foramen is located on the medial surface of the ramus, approximately three-fourths the distance from the coronoid notch to the posterior border of the mandibular ramus. The lingual foramen is located on the lingual surface above the genial tubercles. The mandibular symphysis is located in the midline on the anterior surface of the mandible.

DIF: Recall REF: 170-173 OBJ: 2 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 10. With which teeth will the clinician have a higher degree of success in achieving profound

anesthesia with infiltration of local anesthetic? a. Maxillary teeth b. Mandibular anterior teeth c. Mandibular posterior teeth d. Equal success no matter the arch ANS: A

The clinician will have a higher degree of success in achieving profound anesthesia with infiltration of local anesthetic in the maxillary teeth because the maxillary bone is less dense and more porous than the mandible.

DIF: Recall REF: 168-169| 188 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control N R I G B.C M

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11. The coronoid notch is a landmark for the administration of which injection? a. Anterior superior alveolar nerve block b. Posterior superior alveolar nerve block c. Inferior alveolar nerve block d. Lingual nerve block ANS: C

The coronoid notch is a landmark for the administration of the inferior alveolar nerve block.

The coronoid notch is not a landmark for the maxillary injections: Anterior superior alveolar nerve block and posterior superior nerve block. The lingual nerve is usually anesthetized during the process of providing the inferior alveolar nerve block through localized diffusion due to its close proximity to the inferior alveolar nerve.

DIF: Recall REF: 170-171| 181| 188 OBJ: 2 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 12. What is the name of the radiopaque line that denotes where the ramus joins the body of the

mandible? a. Mylohyoid line b. Internal oblique line c. External oblique line

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank d. Coronoid notch ANS: C

The external oblique line or ridge of bone is a crest where the ramus joins the body of the mandible. The mylohyoid line (internal oblique line) extends posteriorly and superiorly along each medial surface of the body of the mandible. The main part of the anterior border of the ramus forms a concave forward curve, the coronoid notch.

DIF: Recall REF: 170-173 OBJ: 2 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 13. What is the specific name of the part of the mandible that forms the temporomandibular joint? a. Condyle b. Coronoid process c. Coronoid notch d. Mandibular notch ANS: A

The articulating surface of the condyle is the name of the part of the mandible that forms the temporomandibular joint. The main part of the anterior border of the ramus forms a concave forward curve, the coronoid notch. The anterior border of the mandibular ramus is a thin, sharp margin that terminates in the coronoid process. Between the coronoid process and the condyle is the mandibular notch.

DIF: Recall REF: 170-173 OBJ: 2 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck NandRSMan INagin GTgB.C M Anatomy| NBDHE, 3.0 Planning U DentaO l Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 14. What is the name of the point of attachment of the muscle that forms the floor of the mouth? a. Mylohyoid line b. Internal oblique ridge c. All options listed d. None of the options listed ANS: C

All options listed. The name of the point of attachment of the muscle that forms the floor of the mouth is the mylohyoid line or the internal oblique ridge. The external oblique line or ridge of bone is a crest where the ramus joins the body of the mandible.

DIF: Recall REF: 170-173 OBJ: 2 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 15. Which nerve travels through the mandibular canal, exits the mandibular foramen, and

innervates the mandibular teeth? a. Lingual nerve b. Mandibular nerve c. Inferior alveolar nerve

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank d. Anterior superior alveolar nerve ANS: C

The inferior alveolar nerve travels through the mandibular canal, exits the mandibular foramen, and innervates the mandibular teeth. The mandibular nerve, lingual nerve, and anterior superior alveolar nerve do not travel through the mandibular canal or innervate the mandibular teeth.

DIF: Recall REF: 181 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 16. Which nerve provides sensory information for the teeth and associated tissue? a. V nerve b. Fifth cranial nerve c. Trigeminal nerve d. All options listed ANS: D

All options listed. The fifth cranial (V), or trigeminal, nerve provides sensory information for the teeth and associated tissue.

DIF: Recall REF: 173 OBJ: 3 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 17. Identify the divisions of the sN enUsR orS yI roN otGtT haB t. caC rrO yM only afferent nerves to the teeth and

associated tissue. a. Ophthalmic and mandibular nerves b. Ophthalmic and maxillary nerves c. Mandibular and maxillary nerves d. All options listed ANS: B

The ophthalmic and maxillary divisions of the sensory root carry only afferent nerves. In contrast, the mandibular nerve off the sensory root runs together with the motor root and thus carries both afferent and efferent nerves.

DIF: Recall REF: 174-175 OBJ: 3 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 18. What is the name of the first division of the sensory root of the trigeminal nerve? a. Mixed b. Ophthalmic c. Mandibular d. Maxillary ANS: B

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank The first division of the sensory root of the trigeminal nerve is the ophthalmic nerve. Mixed usually refers to motor and sensory roots; mandibular is the third division, and maxillary is the second division of the trigeminal nerve.

DIF: Recall REF: 174 OBJ: 3 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 19. Which nerve carries sensory information for the maxillary sinuses, nasal cavity, and palate? a. First division of the trigeminal nerve b. Second division of the trigeminal nerve c. Third division of the trigeminal nerve d. Ophthalmic nerve ANS: B

The second division (maxillary) of the trigeminal nerve carries sensory information for the maxillary sinuses, nasal cavity, and palate. The first division (ophthalmic) of the trigeminal nerve serves as an afferent nerve for the conjunctiva, cornea, eyeball, orbit, forehead, ethmoidal and frontal sinuses, part of the dura mater, and parts of the nasal cavity and nose.

The third division (mandibular) serves the structures innervated by the buccal, auriculotemporal, lingual, inferior alveolar, mylohyoid, mental, incisive, and muscular branches.

DIF: Recall REF: 174-175 OBJ: 3 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control N R I G B.C M

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20. What is the name of the largest contributor to the maxillary nerve trunk? a. Infraorbital nerve b. Ophthalmic nerve c. Second division of the trigeminal nerve d. Third division of the trigeminal nerve ANS: A

The infraorbital nerve is the largest contributor to the maxillary nerve trunk. The ophthalmic nerve arises from three major nerves: the frontal, lacrimal, and nasociliary nerves. The second division of the trigeminal nerve refers to the maxillary nerve. The third division of the trigeminal nerve refers to the mandibular nerve.

DIF: Recall REF: 174-175 OBJ: 3 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 21. Which nerve serves as an afferent nerve for the skin of the cheek? a. Infraorbital nerve b. Ophthalmic nerve c. Zygomaticofacial nerve d. Zygomaticotemporal nerve

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank ANS: C

The zygomaticofacial nerve serves as an afferent nerve for the skin of the cheek. The infraorbital nerve is an afferent nerve formed from the merger of cutaneous branches from the upper lip, medial part of the cheek, side of nose, and lower eyelid. The ophthalmic nerve serves as an afferent nerve for the conjunctiva, cornea, eyeball, orbit, forehead, ethmoidal and frontal sinuses, a part of the dura mater, and parts of the nasal cavity and nose. The zygomaticotemporal nerve serves as an afferent nerve for the skin of the temporal region.

DIF: Recall REF: 175 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 22.

When the clinician administers an IO injection, which nerves are anesthetized?

Posterior superior alveolar, middle superior alveolar, and ophthalmic nerves Posterior superior alveolar, middle superior alveolar, and infraorbital nerves Anterior superior alveolar, middle superior alveolar, and infraorbital nerves Some other combination of nerves

a. b. c. d.

ANS: C

When the clinician administers an IO injection, the anterior superior alveolar, middle superior alveolar, and infraorbital nerves are anesthetized. The posterior superior alveolar and ophthalmic nerves are not anesthetized during an IO injection.

DIF: Recall REF: 175-177 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control N R I G B.C M

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23. If the MSA nerve is not present, the area is innervated by the PSA, but mostly by the ASA. If

the MSA nerve is present, there is communication between the PSA and the ASA. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. If the MSA nerve is not present, the area is innervated by the PSA, but mostly by the ASA. If the MSA nerve is present, there is communication between the PSA and the ASA. DIF: Recall REF: 178 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 24. Which nerve supplies innervation to the second and third maxillary molars? a. ASA b. MSA c. PSA d. Infraorbital

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank ANS: C

The PSA supplies innervation to the second and third maxillary molars. The ASA, MSA, and infraorbital nerves do not supply innervation to the second and third maxillary molars.

DIF: Recall REF: 178 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 25. Which nerve is considered to be the most involved when a patient experiences paresthesia

complications? a. Lingual nerve b. Posterior superior alveolar nerve c. Anterior superior alveolar nerve d. Inferior alveolar nerve ANS: A

Current thought has implicated the lingual nerve in most paresthesia complications.

DIF: Recall REF: 180-181 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 26. Which structures of the body are most likely to experience the loss of sensation after the

administration of an anesthetic agent to the lingual nerve? a. Floor of the mouth b. Body of the tongue NURSINGTB.COM c. Lingual gingival tissue of the mandibular teeth d. All options listed ANS: D

All options listed. The lingual nerve serves as an afferent nerve for general sensation for the body of the tongue, floor of the mouth, and lingual gingival tissue of the mandibular teeth.

DIF: Recall REF: 180-181 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 27. Which nerve is anesthetized through localized diffusion of the local anesthetic agent through

the tissue when administering an inferior alveolar block? a. Posterior superior alveolar nerve b. Anterior superior alveolar nerve c. Lingual nerve d. Mandibular nerve ANS: C

NURSINGTB.COM

Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank The lingual nerve is anesthetized when administering an inferior alveolar block through localized diffusion of the local anesthetic agent through the tissue due to its close proximity to the inferior alveolar nerve. The maxillary nerves—posterior superior alveolar and anterior alveolar—are not usually anesthetized during the inferior alveolar block. The inferior alveolar and lingual nerves are branches of the mandibular nerve.

DIF: Recall REF: 180-181 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 28. Which of the following could occur as a complication of the posterior superior alveolar local

anesthetic block? a. Hematoma b. Infection of the cavernous venous sinus c. Piercing the pterygoid plexus d. All options listed ANS: D

All options listed. There is a possibility of piercing the pterygoid plexus when a posterior superior alveolar local anesthetic block is performed. This could result in a small amount of blood causing the discoloration of a hematoma. A spread of infection along the needle tract, deep into the tissue, could cause a serious spread of infection to the cavernous venous sinus.

DIF: Recall REF: 187 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control N R I G B.C M

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29. The mental foramen is an important landmark to note intraorally and on a radiograph before

administration of mental and incisive nerve blocks. The mental foramen can be as far posterior as the apex of the mandibular first molar or as far anterior as the apex of the mandibular canine. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. The mental foramen is an important landmark to note intraorally and on a radiograph before administration of mental and incisive nerve blocks. The mental foramen can be as far posterior as the apex of the mandibular first molar or as far anterior as the apex of the mandibular canine.

DIF: Recall REF: 170-173 OBJ: 2 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 30. Each of the following describes the buccal nerve associated with the buccal block EXCEPT

one. Which one is the EXCEPTION? a. Afferent nerve

NURSINGTB.COM

Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank b. Efferent nerve c. Serves skin of the cheek and molar region periodontal tissues d. Anterior border of the mandibular ramus is a landmark for the buccal block ANS: B

Efferent nerve is the EXCEPTION. Another buccal nerve, the buccal branch of the facial nerve, is an efferent nerve that innervates the buccinators muscle. The buccal nerve associated with the buccal block is an afferent nerve for the skin of the cheek, buccal mucosa, and associated buccal periodontium and gingiva of the mandibular molars in one quadrant. Anterior border of the mandibular ramus is a landmark for the buccal block.

DIF: Recall REF: 178-179 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 31. The medial surface of the mandibular ramus is a landmark for the administration for which of

the following? a. Incisive and inferior alveolar blocks b. Inferior alveolar block and Vazirani-Akinosi blocks c. Vazirani-Akinosi and the incisive blocks d. None of the above ANS: B

The inferior alveolar and Vazirani-Akinosi mandibular blocks both share the medial surface of the mandibular ramus as a landmark. The landmark for the incisive block is the mental foramen.

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DIF: Recall REF: 170-173| 188 OBJ: 2 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 32. Which of the following is a landmark for the inferior alveolar block? a. Lingula b. Pterygomandibular raphe c. Coronoid notch d. All options listed ANS: D

All options listed. The lingual, pterygomandibular raphe, and the coronoid notch are all landmarks for the inferior alveolar block.

DIF: Recall REF: 170-173 OBJ: 2 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 33. A patient may present with a bifid inferior alveolar nerve, in which case a second mandibular

foramen is more superiorly placed. The second foramen may be detected by noting a doubled mandibular canal on a radiograph.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank a. b. c. d.

Both statements are true.

Both statements are false.

The first statement is true; the second statement is false.

The first statement is false; the second statement is true.

ANS: D

The first statement is false, the second statement is true. A patient may present with a bifid inferior alveolar nerve, in which case a second mandibular foramen is more inferiorly placed.

The second foramen may be detected by noting a doubled mandibular canal on a radiograph.

DIF: Recall REF: 170-173 OBJ: 2 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 34. Which nerve may also serve as an afferent nerve for the mandibular first molar? a. Anterior middle superior alveolar b. Mylohyoid c. Mental d. Lingual ANS: B

The mylohyoid nerve may serve as an afferent nerve for the mandibular first molar. The anterior middle superior alveolar, mental, and lingual nerves do not innervate the mandibular first molar.

DIF: Recall REF: 183 OBJ: 4 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck N R I G B.C M U S N T O Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 35. Avoiding anesthesia of the facial nerve at the parotid salivary gland is important when

administering an inferior alveolar block because it may result in transient facial paralysis if given incorrectly. a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: A

Both the statement and reason are correct and related. Avoiding anesthesia of the facial nerve at the parotid salivary gland is important when administering an inferior alveolar block because it may result in transient facial paralysis if given incorrectly.

DIF: Recall REF: 183 OBJ: 5 TOP: NBDHE, 1.0 Anatomic Sciences| NBDHE, 1.1 Anatomy| NBDHE, 1.1.1. Head and Neck Anatomy| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank

Chapter 11: Basic Injection Techniques Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition ESSAY 1. Name the four anesthetic administration techniques.

ANS:

Topical, infiltration injection, field block, and nerve block DIF: Recall REF: 190 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. List the specific local anesthetic information that should be included in the chart

documentation.

ANS:

Drug used and concentration, vasoconstrictor used (if any), amount administered in milligrams, the gauge and type of needle, the injections given, the time of administration, and any patient reactions.

DIF: Recall REF: 204 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control TRUE/FALSE

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1. The dental hygienist should practice the local anesthetic technique until it becomes routine.

ANS: F

Correct: Dental hygienists should never let the administration of local anesthetics become routine.

DIF: Recall REF: 191-204| 206 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. If two quadrants are to be completed in a single visit, anesthesia should be administered to the

upper right and left quadrants or to the lower right and left quadrants.

ANS: F

Correct: If two quadrants are to be completed in a single visit, anesthesia should be administered to the upper and lower quadrants on the same side of the patient’s face.

DIF: Recall REF: 192| 206 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank 3. Nerve block anesthesia provides profound anesthesia over a larger area with fewer injections

needed.

ANS: T DIF: Recall REF: 190| 206 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. If the blood of a positive aspiration does not completely fill the cartridge, the clinician can

slightly reposition the needle and attempt a second aspiration.

ANS: T DIF: Recall REF: 191-204| 206 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. If the harpoon disengages during an aspiration, the clinician must remove the needle from the

tissue and re-embed the harpoon into the rubber stopper.

ANS: T DIF: Recall REF: 191-204| 206 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. To provide safe and comfortable injections, the clinician should administer the anesthetic

solution quickly.

ANS: F

Correct: To provide safe andN comRforI inB je. ctC ionsM U S tabl NGe T O , the clinician should administer the anesthetic solution slowly.

DIF: Recall REF: 203| 206 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. Informed consent is when the patient gives the clinician permission to perform the dental

procedure.

ANS: T DIF: Recall REF: 192-193 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. Field blocks are injections in which the local anesthetic is deposited near large terminal nerve

branches.

ANS: T DIF: Recall REF: 190 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. The incidence of occupational exposures is reduced for the experienced clinician.

ANS: F

Correct: The incidence of occupational exposures is not reduced for the experienced clinician.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank

DIF: Recall REF: 209 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 10. The self-sheathing anesthetic needle is an engineering design that reduces the clinician’s

exposures to blood and other potentially infectious material.

ANS: T DIF: Recall REF: 209 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 11. Suggested safety controls for needles and other sharps include placing used disposable

syringes and needles, scalpel blades, and other sharp items in appropriate puncture-resistant containers.

ANS: F

Correct: Safety controls for needles and other sharps are mandatory. These include placing used disposable syringes and needles, scalpel blades, and other sharp items in appropriate puncture-resistant containers.

DIF: Recall REF: 209 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 12. Needles should be carefully bent before disposing of them in the sharps container.

ANS: F

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Correct: Needles should never be bent or broken before disposal because the practice requires unnecessary manipulation and therefore involves greater chance for needle sticks to occur.

DIF: Recall REF: 209 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control MULTIPLE CHOICE 1. What is the correct dental term for the presence of a clear air bubble, or no return after definite

movement backward of the rubber stopper? a. Positive aspiration b. Negative aspiration c. Aspiration d. All options listed ANS: B

A negative aspiration is the correct term for the presence of a clear air bubble, or no return after definite movement backward of the rubber stopper. Positive aspiration is when blood enters the cartridge after negative pressure is applied to the cartridge. Aspiration occurs by pulling back on the thumb ring to change the pressure in the cartridge from positive to negative.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank DIF: Recall REF: 201-203 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. Successful delivery of local anesthetic agents depends on which of the following? a. Effective patient management b. Safe administration of the drug c. Patient assessment d. All options listed ANS: D

All options listed. Successful delivery of local anesthetic agents depends on effective patient management and patient assessment and the safe administration of the drug.

DIF: Recall REF: 191 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. Which of the following are considerations the clinician must respect when choosing the

appropriate administration technique? a. Area to be treated b. Duration of anesthesia needed c. Comfort needs of the patient d. All options listed ANS: D

All options listed. When choosing the appropriate administration technique, the clinician must consider the area to be treated, ion B of.thCe aM nesthesia needed, and the comfort needs of N thRe duIratG the patient.

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DIF: Recall REF: 190 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. What is the main advantage of the nerve block over other types of anesthesia? a. It can be administered at a distance from the area of treatment. b. It is administered in the vicinity of a nerve trunk. c. Provides profound pulpal and soft tissue anesthesia over a larger area. d. It has less potential for piercing the artery or vein that accompanies the nerve.

ANS: C

An advantage of the nerve block over the other techniques is that it provides profound pulpal and soft tissue anesthesia over a larger area. Nerve block anesthesia refers to the injection of local anesthetic in the vicinity of a major nerve trunk to anesthetize the nerve’s area of innervations, usually at a greater distance from the area of treatment. Arteries and veins accompany major nerve trunks, and the potential for piercing the artery or vein with this technique is greatly enhanced.

DIF: Recall REF: 190 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank 5. What can the clinician do to prevent an emergency situation from occurring while

administering local anesthesia? a. Provide effective communication b. Offer psychological support c. Do a thorough patient assessment d. All options listed ANS: D

All options listed. Providing effective communication and psychologic support is essential to building patient confidence and to reducing the risk of an emergency procedure. Another step in preventing emergencies is the preanesthetic patient assessment.

DIF: Recall REF: 191 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. What can the clinician safely do if a patient is experiencing excessive bleeding while

undergoing root planing? a. Administer more anesthesia plus vasoconstrictor b. Infiltrate epinephrine 1:50,000 in small amounts directly into the area of bleeding c. Use a larger volume of anesthetic d. Reschedule the patient for another appointment after some tissue healing ANS: B

For excessive bleeding, it is recommended to infiltrate epinephrine 1:50,000 in small amounts directly into the area of bleeding for greatest visibility and bleeding control. To administer more anesthetic (i.e., to use a larger volume of anesthetic with vasoconstrictor) may result in an unnecessarily larger total N dose eede it would not improve hemostasis as URtha SInNnG TBd., aCndOM effectively as infiltrating the 1:50,000 epinephrine directly into the area of bleeding. The patient should not need to be rescheduled unless profuse bleeding persists after provision of 1:50,000 epinephrine.

DIF: Recall REF: 192 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. Local anesthesia is best administered by quadrants or sextants. It is an effective patient

management strategy. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. Local anesthesia is best administered by quadrants or sextants. It is an effective patient management strategy.

DIF: Recall REF: 192 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank 8. When administering local anesthesia to the maxillary arch for extensive root planing

procedures, what is the correct order of the injections? a. PSA, MSA, then ASA. b. ASA, MSA, then PSA. c. Infraorbital, then PSA. d. Order does not matter and the patient can dictate what makes him or her most comfortable.

ANS: A

When administering local anesthesia to the maxillary arch for extensive root planing procedures, the correct order of the injections is PSA, MSA, then the ASA. The PSA block is given before any of the other maxillary facial injections as well as any maxillary palatal injections to allow the necessary time for the larger molars to become completely anesthetized, with instrumenting proceeding in the same manner.

DIF: Recall REF: 192 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. Why should the clinician avoid administering local anesthetics to both the mandibular right

and left quadrants during a single treatment? a. To prevent patients from self-mutilating their mouths b. To prevent toxicity due to the administration of too much local anesthetic c. To prevent the inability of the patient to control his/her mandible d. All options listed ANS: C

The clinician should avoid adNmin l aCnes URiste SIring NGloc TBa. OMthetics to both the mandibular right and left quadrants during a single treatment to ensure that patient remains able to control his/her mandible. The possibility of patients causing self-mutilation of their soft tissues is increased.

Providing the appropriate dose of local anesthesia to achieve bilateral anesthesia should not result in increased toxicity.

DIF: Recall REF: 192 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 10. A child can grant informed consent for dental work. The written agreement of the care plan

becomes a legal contract between the patient and the dental hygienist. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: D

The first statement is false, the second statement is true. In the case of a minor, the informed consent must be provided by the parent or guardian. The written agreement of the care plan becomes a legal contract between the patient and the dental hygienist.

DIF: Recall REF: 192-193 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank

11. What term describes the injection site where the bevel of the needle is covered with tissue? a. Depth of needle penetration b. Needle insertion point c. Deposit location d. None of the above ANS: B

The needle insertion point is the injection site where the bevel of the needle is covered with tissue. Depth of penetration refers to distance from insertion to target (deposit location).

DIF: Recall REF: 199-200 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 12. What is a common mistake that beginners tend to make when first learning to give local

anesthesia, especially if they do not have a firm fulcrum? a. Allowing the thumb ring to slip down to the bottom of the thumb, making it difficult to achieve full range of backward motion b. Not performing the aspiration step at the appropriate intervals c. Overexaggerating the pulling back motion of the thumb ring, pulling the needle away from the proper depth of penetration. d. Allowing the patient to dictate the placement of the site of the injection ANS: C

Beginners, especially those who do not have a firm fulcrum, tend to overexaggerate the pulling back motion of the thumb ring, pulling the needle away from the proper depth of penetration. Care should be tN akenRnoI t toG alloB w.thCe thMumb ring to slip down to the bottom of U S N T O the thumb, making it difficult to achieve the full range of backward motion needed for aspiration, but it is not a common mistake related to fulcrum technique. Performing the aspiration step at appropriate intervals and allowing the patient to dictate the site of injection are not common mistakes made by beginners.

DIF: Recall REF: 201-203 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 13. All of the following describe why aspiration is a necessary part of administering local

anesthesia EXCEPT one. Which one is the EXCEPTION? a. To ensure that the needle has not entered a blood vessel b. To dramatically decrease the incidence of an intravascular injection c. Patient comfort d. None of the above are exceptions.

ANS: C

EXCEPTION: Patient comfort.

Aspiration is not required to ensure patient comfort. Aspiration is a necessary part of administering local anesthesia to ensure that the needle has not entered a blood vessel and to dramatically decrease the incidence of an intravascular injection.

DIF: Recall REF: 201-203 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Control 14. Following the initial negative aspiration, the dental hygienist should rotate the barrel of the

syringe about 45 degrees and aspirate a second time. This ensures that the needle is not located within a blood vessel and possibly abutting the blood vessel wall, providing a false-negative aspiration. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. Following the initial negative aspiration, the dental hygienist should rotate the barrel of the syringe about 45 degrees and aspirate a second time. This ensures that the needle is not located within a blood vessel and possibly abutting the blood vessel wall, providing a false-negative aspiration.

DIF: Recall REF: 201-203 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 15. Why is the pterygoid venous plexus an area of concern when administering the PSA? a. It is located so far distally b. It is a highly vascular area c. It has major nerve innervations d. All options listed ANS: B

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When injecting near highly vascular areas (such as near the pterygoid venous plexus) with the PSA injection, the clinician should aspirate several times during the injection just in case movement of the needle has occurred, accidently placing the needle within blood vessels. The concern does not focus on the location of the pterygoid venous plexus or the nerve innervations, but rather the potential for side effects associated with intravascular injection.

DIF: Recall REF: 201-203 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 16. Why is the slow depositing of the anesthetic solution important? a. It is a safety factor b. It prevents tearing of tissue c. It improves patient comfort d. All options listed ANS: D

All options listed. Slowly depositing the anesthetic solution is a very important safety factor because it prevents the tearing of tissue and it improves patient comfort.

DIF: Recall REF: 203| 206 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank 17. Cartridges of local anesthetics contain 1.8 mL of solution—except articaine, which contains

1.7 mL of solution. How fast should articaine be injected? a. At a rate of 1.7 mL per minute b. At a rate of 1.8 mL per minute c. At a rate of 1.8 mL per 2 minutes d. At the rate that is comfortable for the patient ANS: C

The entire local anesthetic cartridge should be deposited in approximately 2 minutes.

Generally, dental local anesthetic solutions should be deposited at a rate of 1 mL per minute.

The patient may feel comfortable with a more rapid rate, but tearing of tissue or overdose could still occur.

DIF: Recall REF: 203 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 18. What should the clinician do while waiting for local anesthetic to take effect for her patient? a. Clean the other operatory b. Bag instruments in the sterilization area c. Take a much-needed break d. Observe the patient for possible signs of an adverse reaction ANS: D

The clinician should remain in the room while the anesthetic blood levels increase, observing the patient for possible signs of an adverse reaction. The clinician should not leave the patient to bag instruments, take a break, or to clean another operatory.

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DIF: Recall REF: 204| 206 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 19. Best practices to alleviate a patient’s anxiety about local anesthetic include: a. Show, tell, and explain the workings of the syringe and needle b. Communication c. Silence while administering the anesthetic d. Music playing in the background ANS: B

Good patient communication before, during, and after the injection will help alleviate the patient’s fears. Showing, telling, and explaining the workings of the syringe and needle may provoke anxiety; music in the background and silence while administering the anesthetic may also increase the patient’s anxiety.

DIF: Recall REF: 197| 206 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 20. The care plan should be developed by the dental hygienist and presented to the patient. Local

anesthesia should be administered in the areas that can be completed in one appointment. a. Both statements are true. b. Both statements are false.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: D

The first statement is false; the second statement is true. The care plan should be developed by the dental hygienist in collaboration with the patient. Local anesthesia should be administered only in the areas that can be completed in one appointment.

DIF: Recall REF: 192 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 21. When half-mouth treatment is planned, the inferior alveolar and buccal blocks are given first,

then the maxillary facial, and then palatal injections follow with instrumenting proceeding first on the maxillary arch. This allows time for the entire mandibular arch to become completely anesthetized. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. When half-mouth treatment is planned, the inferior alveolar and buccal blocks are given first, then the maxillary facial, and then palatal injections follow with instrumenting proceeding first on the maxillary arch. This allows time for the entire mandibular arch to become completely anesthetized.

DIF: Recall REF: 19N 2 R I GOBB 2 M S N Dental T J:.C O Care| NBDHE, 3.4 Anxiety and Pain TOP: NBDHE, 3.0 Planning andU Managing Hygiene Control 22. When infection is present, it is recommended to administer nerve blocks away from the area

of infection because the acidic nature of the anesthetic deposited into acidic tissue from an infection decreases the ability of the anesthetic to readily dissociate for nerve penetration. a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: A

Both the statement and reason are correct and related. When infection is present, it is recommended to administer nerve blocks away from the area of infection because the acidic nature of the anesthetic deposited into acidic tissue from an infection decreases the ability of the anesthetic to readily dissociate for nerve penetration.

DIF: Recall REF: 193-196 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 23. Each of the following is true regarding establishing a fulcrum while administering local

anesthesia EXCEPT one. Which one is the EXCEPTION?

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank a. b. c. d.

A fulcrum must always be used Use of the patient’s arm to rest the syringe-holding arm is acceptable If finger placement is not possible, arm-to-body support is acceptable Extraoral fulcrums are acceptable

ANS: B

EXCEPTION: Use of the patient’s arm to rest the syringe-holding arm is acceptable.

Any sudden movement of the patient’s arm may cause injury to the patient or dental hygienist.

True statements include: a fulcrum must always be used; if finger placement is not possible, arm-to-body support is acceptable; extraoral fulcrums are acceptable.

DIF: Recall REF: 197-199 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 24. Which of the following are benefits of taut tissue retraction at the penetration site? a. Increased visibility b. Easier needle insertion c. Less traumatic needle insertion d. All options listed ANS: D

All options listed. Retracting the tissue taut at the penetration site will assist the dental hygienist with visibility of the injection site and allow easier, less traumatic needle insertion.

DIF: Recall REF: 199 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control N R I G B.C M

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25. If repeated positive aspirations are observed at the same injection site, it may be necessary for

the dental hygienist to consider postponing treatment because repeated penetrations in the same area can cause bleeding at the target location and increase risk of hematoma, trismus, postoperative pain, and infection. a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: A

Both the statement and reason are correct and related. If repeated positive aspirations are observed at the same injection site, it may be necessary for the dental hygienist to consider postponing treatment because repeated penetrations in the same area can cause bleeding at the target location and increase risk of hematoma, trismus, postoperative pain, and infection.

DIF: Recall REF: 201-203 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank

Chapter 12: Maxillary Anesthesia Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition MATCHING

Match the name of the maxillary injection to the landmarks of the injection site and/or the area that receives the anesthesia. Names of injections may be used more than once. a. Anterior superior alveolar injection b. Middle superior alveolar injection c. Posterior superior alveolar injection d. Infraorbital e. Nasopalatine f. Greater palatine 1. Slightly mesial to the canine eminence and at the height of the mucobuccal fold 2. Hard palate and overlying soft tissue of the maxillary anterior teeth.

3. Foramen located at the junction of the maxillary alveolar process and palatine bone distal to 4.

5.

6.

7.

8.

9.

10.

11.

12.

the maxillary second molar Pulpal anesthesia of first and second maxillary premolars in a small percentage of the population Lateral to the incisive papilla Pulpal anesthesia of the distobuccal root of the maxillary first molar Height of mucobuccal fold above the first premolar Pulpal anesthesia of the mesiobuccal root of the maxillary first molar in 28% of the population Hard palate and overlying tissue of maxillary third molar to the first premolar Ne, RprSem IN G s,B.C M Bone overlying incisors, caninU olarT and sO ometimes mesiobuccal root of the first molar, as well as upper lip, lower eyelid, and lateral aspect of the nose Upward 45 degrees to occlusal plane, inward and backward 45 degrees to the midsagittal plane Pulpal anesthesia of maxillary central incisors

1. ANS: A DIF: Recall REF: 234-235 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. ANS: E DIF: Recall REF: 244-247 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. ANS: F DIF: Recall REF: 243-244 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. ANS: B DIF: Recall REF: 227-228 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. ANS: E DIF: Recall REF: 247 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. ANS: C DIF: Recall REF: 221-222 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank 7. ANS: D DIF: Recall REF: 235-238 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. ANS: B DIF: Recall REF: 227-228 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. ANS: F DIF: Recall REF: 243-244 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 10. ANS: D DIF: Recall REF: 235 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 11. ANS: C DIF: Recall REF: 222-226 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 12. ANS: A DIF: Recall REF: 230-231 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control MULTIPLE CHOICE 1. What is the name of the type of injection that anesthetizes a small area of one or two teeth and

the associated structures when the local anesthetic agent is deposited near the terminal nerve endings? a. Nerve block b. Supraperiosteal c. Topical NURSINGTB.COM d. Palatine injections ANS: B

Supraperiosteal is the name of the type of injection that anesthetizes a small area of one or two teeth and the associated structures when the local anesthetic agent is deposited near the terminal nerve endings. A nerve block anesthetizes a larger area than the local infiltration because the local anesthetic agent is deposited near large nerve trunks. Topical anesthetic is applied to the surface of the oral mucosa. Palatine injections do not provide pulpal anesthesia to one or two teeth.

DIF: Recall REF: 213-214 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. What is the name of the type of injection that anesthetizes a larger area than the local

infiltration because the local anesthetic agent is deposited near large nerve trunks? a. Nerve block b. Supraperiosteal c. Topical d. Palatine injections ANS: A

NURSINGTB.COM

Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Nerve block is the name of the type of injection that anesthetizes a larger area than the local infiltration because the local anesthetic agent is deposited near large nerve trunks.

Supraperiosteal is the name of the type of injection that anesthetizes a small area of one or two teeth and the associated structures when the local anesthetic agent is deposited near the terminal nerve endings. Topical anesthetic is applied to the surface of the oral mucosa.

Palatine injections do not provide pulpal anesthesia to one or two teeth.

DIF: Recall REF: 190| 219-221 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. There is less variation in the anatomy of the mandibular anesthetic landmarks than there is in

similar maxillary structures, thus making the mandibular injections more routine. Anesthesia in the maxillary arch usually does not require any troubleshooting of failure cases. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: D

The first statement is false; the second statement is true. There is less variation in the anatomy of the maxillary anesthetic landmarks than there is in similar mandibular structures, thus making the maxillary injections more routine. Anesthesia in the maxillary arch usually does not require any troubleshooting of failure cases.

DIF: Recall REF: 213| 254 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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4. Best practices for increasing patient comfort during the administration of maxillary injections

include which of the following? a. The needle should not be moved within the tissue. b. The patient’s upper lip should not be slightly jiggled for distraction. c. There is no bony contact of the overlying sensitive periosteum with the needle. d. All options listed ANS: D

All options listed. Best practices for increasing patient comfort during the administration of maxillary injections include: the needle should not be moved within the tissue; the patient’s upper lip should not be slightly jiggled for distraction; and there is no bony contact of the overlying sensitive periosteum with the needle.

DIF: Recall REF: 219-221 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. What is a good reason not to use distracters when administering maxillary facial anesthesia? a. The clinician needs her fingers for retraction of the upper lip. b. Pulpal anesthesia may be blocked. c. Movement may cause the anesthetic not to be placed at the target area. d. All options listed.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank ANS: C

In the past, shaking the patient’s upper lip with the clinician’s retraction fingers was used to distract the patient during the injection, but this movement may actually increase discomfort because the needle bevel is moved and the anesthetic may not be placed at the target area.

Using distractors should not affect ability to retract with fingers or attainment of pulpal anesthesia.

DIF: Recall REF: 214-216| 219-221 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. In which order would you administer the maxillary injections? a. Greater palatine, PSA b. Infraorbital, PSA c. PSA, MSA, ASA d. Order of anesthetic is at the discretion of the clinician ANS: C

The maxillary injections, in the correct order, are PSA, MSA, and ASA. The PSA block is administered before any of the other maxillary facial injections as well as any palatal injections to allow the necessary time for the larger maxillary molars to undergo pulpal anesthesia. After the PSA block, the MSA and then ASA blocks (or IO block instead) are then administered and in that order for the maxillary quadrant. Palatal injections are provided after facial injections.

DIF: Recall REF: 219-221 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain NURSINGTB.COM Control 7. Practices to avoid when administering local anesthetic include which of the following? a. Not using enough for patient comfort and hemostatic control b. Overadministering of anesthesia c. Administering anesthesia to a larger treatment area than can be completed in one

visit d. All options listed ANS: D

All options listed. Local anesthesia should be administered only in the areas of treatment that can be completed in one visit. Overestimating the treatment and administering more anesthesia than necessary should be avoided, as should not using enough anesthetic for patient comfort and hemostatic control.

DIF: Recall REF: 219-221 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. All of the following are strategies for when the clinician encounters bulky maxillary facial

alveolar ridges EXCEPT one. Which one is the EXCEPTION? a. Increase retraction b. Move the needle injection site more superior c. Utilize the palatal injections

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank d. All options listed ANS: C

EXCEPTION: Utilize the palatal injections.

Palatal injections do not provide the pulpal anesthesia achieved with facial injections.

Increasing retraction and moving the needle injection site more superior will usually help adaptation to a bulky facial alveolar ridge.

DIF: Recall REF: 219-221 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. Which of the following are best practices for the maxillary supraperiosteal injection

technique? a. The bevel orientation of the needle should be away from the bone. b. The needle should be inserted parallel with the long axis of the tooth. c. The needle tip is placed inferior to the apex of the selected tooth. d. All options listed.

ANS: B

The needle should be inserted parallel with the long axis of the tooth. The bevel orientation of the needle should be toward the bone, and the needle tip is placed superior to the apex of the selected tooth.

DIF: Recall REF: 212-216 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

N R I G B.C M

10. What should the clinician do ifUsheSaccN ideT ntly posO itions the anesthetic needle against the

periosteum and bony contact is made? a. Withdraw the needle and reinsert it farther away from the periosteum. b. Withdraw the needle and change it because it may be dull. c. Withdraw the needle, apply more topical anesthetic, and select a different injection to perform first. d. Without withdrawing the needle, move the needle slightly, aspirate, and attempt anesthesia again.

ANS: A

The patient may experience pain if bony contact is mistakenly made. The needle needs to be withdrawn and reinserted farther away from the periosteum. A dull needle is usually a result of repeated penetrations. Reinserting the needle should be attempted before considering changing injection type. Needle movement may cause tissue trauma and discomfort to the patient.

DIF: Recall REF: 216 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 11.

Which of the following are reasons for inadequate anesthesia? a. Deposition of the solution superior to the apex of the tooth. b. Dense bone covers the apices of the teeth as seen in children. c. The apex of the tooth lies beneath the maxillary sinus.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank d. All options listed.

ANS: B

Inadequate anesthesia can be a result of depositing solution inferior to the apex of the tooth, or if dense bone covers the apices (as usually seen in children), or when the apex of the tooth lies beneath the nasal cavity (as is the case around the maxillary central incisors).

DIF: Recall REF: 216 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 12. How can the clinician correct the problem of hitting bone while administering the PSA

injection? a. The needle needs to be bent slightly in order to accomplish the necessary needle angulation. b. The syringe needs to be farther away from the occlusal plane, thereby increasing the angle to more than 45 degrees. c. The syringe needs to be closer to the occlusal plane, thereby reducing the angle to less than 45 degrees. d. The patient most likely has a larger size skull, so a long needle should be utilized for patient comfort.

ANS: C

If bone is contacted or resistance is felt, the angle of the needle toward the midline is too great (more than 45 degrees) and the syringe needs to be closer to the occlusal plane, thereby reducing the angle to less than 45 degrees. The needle can break when bent, and there is little control over the needle direction, needle angulation, and needle bevel. Moving the syringe farther away from the occlusN al U pR lane uld SIwo NG TBin.crCease OMthe chance of contacting bone.

Contacting bone does not indicate a larger skull.

DIF: Recall REF: 216-217 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 13. When administering the PSA injection, what other nerve may inadvertently be anesthetized? a. Infraorbital nerve b. Greater palatine nerve c. MSA nerve d. Mandibular nerve ANS: D

Inadvertent and harmless anesthesia of branches of the mandibular nerve may also occur with a PSA block because they may be located lateral to the PSA nerve. The infraorbital, greater palatine, and MSA nerves are not affected by the PSA injection.

DIF: Recall REF: 216-217 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 14. Where should the site for the MSA injection be if the patient is missing one of his premolars

due to orthodontic treatment? a. Halfway in the dental arch

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank b. Mesial to the existing premolar c. Distal to the existing premolar d. Use the infraorbital injection ANS: A

If one of the premolars has been removed for orthodontic therapy, thereby moving the existing premolars from their original place in the dental arch, the injection site should be halfway in the dental arch to provide the best anesthetic coverage to the maxillary premolars. The infraorbital injection anesthetizes a wider area (ASA and MSA nerves) and requires a greater volume of anesthetic than the MSA alone.

DIF: Recall REF: 228-230 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 15. What is an important post−infraorbital injection procedure? a. The clinician should check for a hematoma across the lower eyelid. b. Maintain pressure and massage the solution into the infraorbital foramen for

approximately 2 minutes to enhance anesthetic diffusion. c. Maintain finger pressure on the infraorbital foramen during the injection to help keep the syringe toward the foramen. d. All options listed.

ANS: B

An important post−infraorbital injection procedure is to maintain pressure and massage the solution into the infraorbital foramen for approximately 2 minutes to enhance anesthetic diffusion. Although rarely, a hematoma may occur. However, checking for hematoma is not .iC an important postinjection prN ocUeR duS reI .N NG onT dB om naO nM t hand finger placement, not finger pressure, is used during the injection to help in keeping the syringe toward the foreman.

DIF: Recall REF: 235-238 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 16. Both the right nasopalatine nerve and the left nasopalatine nerve are anesthetized by the

nasopalatine block. Only one injection is needed for both sides of the palate. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. Both the right nasopalatine nerve and the left nasopalatine nerve are anesthetized by this block. Only one injection is needed for both sides of the palate.

DIF: Recall REF: 244-247 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 17. Which injection is commonly used when performing cosmetic dentistry on the maxillary

anterior teeth? a. ASA block

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank b. MSA block c. AMSA block d. Greater palatine block ANS: C

The anterior middle superior alveolar (AMSA) block is commonly used when performing cosmetic dentistry on the maxillary anterior teeth because the clinician can immediately and accurately assess the patient’s smile line. The ASA and MSA injections provide anesthesia to the upper lip and face, which can interfere with assessment of the patient’s smile line. The greater palatine block provides anesthesia to the posterior palate and is not commonly used during cosmetic dental procedures.

DIF: Recall REF: 247-250 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 18. What technique is best when administering the AMSA block? a. Disposable syringe b. Nonaspirating syringe c. Computer-controlled delivery device d. Topical anesthetic and aspirating syringe ANS: C

Studies show that the AMSA block is best accomplished with a computer-controlled delivery device because it regulates the pressure and volume ratio of solution delivered, which is not readily attained with a standard syringe, including disposable, nonaspirating, or aspirating syringes.

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DIF: Recall REF: 247-250 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 19. What should the clinician do if she notices excessive blanching of the palatal tissue during the

AMSA block administration? a. Slow down the deposition of anesthetic solution b. Stop the deposition of anesthetic solution for a few seconds c. All options listed d. None of the options listed ANS: C

All options listed. If excessive blanching is noted, slowing or stopping the device for a few seconds to let the solution dissipate will diminish the chance of tissue ischemia and sloughing.

DIF: Recall REF: 250 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 20. What is the most common technique error associated with supraperiosteal, ASA, and MSA

injections? a. Incorrect fulcrum b. Incorrect angulation of the syringe barrel and the needle c. Incorrect target site and solution deposition

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank d. Incorrect aspiration ANS: B

The most common technique error associated with supraperiosteal, ASA, and MSA injections is the incorrect angulation of the syringe barrel and the needle. Incorrect fulcrum, incorrect target site and solution deposition, and incorrect aspiration are not technique errors commonly associated with supraperiosteal, ASA, and MSA injections.

DIF: Recall REF: 250-251 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 21. What is the most common technique error associated with the infraorbital injection? a. Incorrect fulcrum b. Incorrect angulation of the syringe barrel and the needle c. Incorrect target site and solution deposition d. Incorrect aspiration ANS: B

The most common technique error associated with the infraorbital injection is the incorrect angulation of the syringe barrel and the needle. Incorrect fulcrum, incorrect target site and solution deposition, and incorrect aspiration are not technique errors commonly associated with the infraorbital injection.

DIF: Recall REF: 251 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

N R I G B.C M

UOTSrecNomTmendedOwhen there is (are): 22. Supraperiosteal injections are N a. close proximity to infection. b. close proximity to inflammation. c. several teeth to be anesthetized. d. All options listed.

ANS: D

All options listed. Supraperiosteal injections are NOT recommended when there is close proximity to infection or inflammation and when several teeth need to be anesthetized.

DIF: Recall REF: 214 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 23. Supraperiosteal injections are not recommended when several teeth in the quadrant need to be

anesthetized because larger volumes of anesthetic would be provided and there is increased patient discomfort due to multiple penetrations. a. Both the statement and reason are correct and related b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: A

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Both the statement and the reason are correct and related. Supraperiosteal injections are not recommended when several teeth in the quadrant need to be anesthetized because larger volumes of anesthetic would be provided and there is increased patient discomfort due to multiple penetrations.

DIF: Recall REF: 214 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 24. Which of the following describes the maxillary intraceptal injection? a. Useful for hemostasis b. Intraosseous injection c. Can use higher concentration of vasoconstrictor d. Usually administered after nerve block e. All options listed ANS: E

All options listed. The intraceptal injection is an intraosseous injection often administered after a nerve block. It is useful for achieving hemostasis and the clinician may use a higher level of vasoconstrictor.

DIF: Recall REF: 216-217 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 25. The PSA injection can be useful during maintenance or recare appointments. Many times the

maxillary molars are the first teeth involved in periodontal disease. a. Both statements are true.NURSINGTB.COM b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. The PSA injection can be useful during maintenance or recare appointments. Many times the maxillary molars are the first teeth involved in periodontal disease.

DIF: Recall REF: 221-222 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 26. Administering the PSA block first is a good way to introduce the patient to less discomfort

with local anesthesia because the injection does not contact bone and there is a relatively small area of soft tissue into which the local anesthetic is deposited. a. Both the statement and reason are correct and related b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: C

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank The statement is correct, but the reason is NOT. Administering the PSA block first is a good way to introduce the patient to less discomfort with local anesthesia because the injection does not contact bone and the there is a relatively large area of soft tissue into which the local anesthetic is deposited.

DIF: Recall REF: 222-226 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 27. The use of pressure anesthesia before, during, and after palatal injections to blanch the tissue

is recommended to reduce patient discomfort. The overlying palatal tissue is dense and adheres firmly to the underlying bones of the palate. a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct.

ANS: A

Both statements are true. The use of pressure anesthesia before, during, and after palatal injections to blanch the tissue is recommended to reduce patient discomfort. The overlying palatal tissue is dense and adheres firmly to the underlying bones of the palate.

DIF: Recall REF: 239-240 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 28. Each of the following is a descriptionof the AMSA injection EXCEPT one. Which one is the

NURSINGTB.COM EXCEPTION? a. Palatal nerve block b. Provides pulpal anesthesia c. Provides soft tissue anesthesia d. Provides anesthesia to the anterior teeth of one sextant ANS: D

EXCEPTION: Provides anesthesia to the anterior teeth of one sextant. The AMSA is a palatal nerve block that provides both pulpal and soft tissue anesthesia to a maxillary quadrant except for the structures innervated by the PSA. DIF: Recall REF: 239-240 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 29. In patients who have a vaulted palate, the GP foramen appears closer to the midline.

Conversely, in patients with a more shallow palate, the foramen appears closer to the dentition. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: B

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Both statements are false. In patients who have a vaulted palate, the GP foramen appears closer to the dentition. Conversely, in patients with a more shallow palate, the foramen appears closer to the midline.

DIF: Recall REF: 243-244 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 30. Which statement describes the P-ASA block? a. No anesthesia of upper lip and face b. Anesthesia for the maxillary anterior teeth of one sextant c. 3- to 4-minute deposition period d. All options listed ANS: D

All options listed. The P-ASA block provides anesthesia for the maxillary anterior teeth of one sextant with no collateral anesthesia of upper lip and face. The deposition period is 3-4 minutes.

DIF: Recall REF: 247 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank

Chapter 13: Mandibular Anesthesia Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition MATCHING

Match the name of the mandibular injection to the landmarks of the injection site and/or the area that receives the anesthesia. Names of injections may be used more than once. a. IA block b. Buccal block c. Mental block d. Incisive block e. Gow-Gates 1.

2.

3.

4.

5.

6.

7.

8.

Middle of pterygomandibular triangle at the height of the coronoid notch Massage anesthetic solution into foramen A true mandibular block because it anesthetizes almost the entire mandibular nerve Needle penetration depth is approximately 20 to 25 mm, or two thirds to three fourths of long needle Injection site is the alveolar mucosal tissue, distal and buccal to the most distal molar tooth in the arch Anesthesia of the anterior teeth, premolar teeth, and associated periodontium as well as facial soft tissue anterior to the mental foramen Does not massage anesthetic solution into foramen Useful for extensive procedures during quadrant dentistry or with failure of IA block

1. ANS: A DIF: ReNcU allRSINGRT EB F:.C 26O 5-M 268 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. ANS: D DIF: Recall REF: 282-283 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. ANS: E DIF: Recall REF: 261-265| 283 OBJ: 7 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. ANS: A DIF: Recall REF: 268-270 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. ANS: B DIF: Recall REF: 272-275 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. ANS: D DIF: Recall REF: 280-282| 282-283 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. ANS: C DIF: Recall REF: 276-279 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. ANS: E DIF: Recall REF: 261 OBJ: 7 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Control TRUE/FALSE 1. Anesthesia of the lingual nerve requires a separate technique and/or injection.

ANS: F

Correct: The lingual nerve will be anesthetized as the local anesthetic agent diffuses while injecting the IA block, so there is no need for a separate injection for this nerve.

DIF: Recall REF: 265-268 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. With the PDL injection, multirooted teeth require an injection for each root.

ANS: T DIF: Recall REF: 296 OBJ: 9 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. When administering the buccal block and the tissue balloons up, the clinician should correct

this by deeper penetration of the bevel of the needle.

ANS: F

Correct: A complication with the buccal block, the ballooning of the tissue, is caused by rapid deposit of solution; correct by slowing down the injection.

DIF: Recall REF: 27N 5-U 27R6SINGOT BB J:.C 10OM TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. Lingual shock may occur as the needle passes by the inferior alveolar nerve during the IA

block.

ANS: F

Correct: Lingual shock may occur as the needle passes by the lingual nerve during the IA block.

DIF: Recall REF: 270-272 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. Periodontal ligament injections are utilized when pulpal anesthesia is indicated on a single

tooth in the mandibular arch.

ANS: T DIF: Recall REF: 291-293 OBJ: 9 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. The periodontal ligament injection is administered directly into the periodontium of the tooth,

providing pulpal anesthesia along with the lingual and buccal mucosa.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank

ANS: T DIF: Recall REF: 292-296 OBJ: 9 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. Because the bone is denser on the mandibular anterior teeth than on the mandibular posterior

teeth, a supraperiosteal injection may be less successful than a supraperiosteal injection on the posterior teeth.

ANS: F

Correct: Because the bone is less dense on the mandibular anterior teeth compared to the mandibular posterior teeth, a supraperiosteal injection may be more successful than a supraperiosteal injection on the posterior teeth.

DIF: Recall REF: 292 OBJ: 10 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. In most cases, paresthesia occurs due to problematic surgical extraction of impacted molars.

ANS: T DIF: Recall REF: 270-272 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control MULTIPLE CHOICE 1. There is more variation in the anatomy of the mandibular anesthetic landmarks than in similar

RSsten INt G B.CwOithMthe IA block injection is due in part to maxillary structures. Lack ofNcU onsi suT ccess anatomic variations. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. There is more variation in the anatomy of the mandibular anesthetic landmarks than in similar maxillary structures. Lack of consistent success with the IA block injection is due in part to anatomic variations.

DIF: Recall REF: 260-261| 268-270 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. Which is the correct order for the administering of injections? a. PSA, Gow-Gates, B b. PSA, MSA, ASA, IA, B c. IA, B, PSA, MSA, ASA d. Mental, IA, ASA, PSA ANS: C

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank IA, B, PSA, MSA, ASA. The inferior alveolar and buccal blocks are given first, to allow time for the mandible to become fully anesthetized, then the maxillary facial injections and palatal injections, in that order. The PSA block is administered before any of the other maxillary facial injections, as well as any palatal injections, to allow the necessary time for the larger maxillary molars to undergo pulpal anesthesia. After the PSA block, the MSA and then ASA block (or IO block instead) is then administered, and in that order, for the maxillary quadrant.

DIF: Recall REF: 261-265| 272-275 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. What usually causes the discomfort associated with the IA injection? a. Lingual shock b. Needle close to the lingual nerve c. All options listed d. None of the options listed ANS: C

All options listed. The discomfort is mainly due to the reaction to the needle near the lingual nerve or lingual shock.

DIF: Recall REF: 270-272 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. What injection, in addition to the IA block, should be considered if the clinician will be

performing nonsurgical periodontal therapy on the mandibular molars? a. Gow-Gates NURSINGTB.COM b. Mental block c. Buccal block d. Incisive block ANS: C

Use of the buccal block may be considered if anesthesia of the buccal soft tissue of the mandibular molars is necessary, which is usually the case with nonsurgical periodontal therapy. The Gow-Gates may be considered if the IA injections fail. The mental and incisive blocks would not be provided, on the same side, as those nerves are anesthetized during the IA block.

DIF: Recall REF: 272-275 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. After administering the IA block, which injection should the clinician consider administering

if one of the lateral incisors fails to achieve pulpal anesthesia? a. Gow-Gates b. Incisive block c. Mental block d. Buccal block ANS: B

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank After administering the IA block, the clinician should consider administering a contralateral incisive block if one of the lateral incisors fails to achieve pulpal anesthesia, as opposed to the Gow-Gates, which anesthetizes the entire mandible. The mental and buccal blocks do not provide pulpal anesthesia to the anterior mandibular teeth.

DIF: Recall REF: 263-265 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. Where is the pterygomandibular fold located? a. It extends in front of the most distal mandibular molar and retromolar pad. b. It runs vertically to the posterior border of the mandible. c. It turns superior to the junction of hard and soft palates. d. It separates the buccal mucosa from the pharynx.

ANS: C

The pterygomandibular fold extends behind the most distal mandibular molar and retromolar pad, runs horizontally to the posterior border of the mandible, and then turns superior to the junction of hard and soft palates, separating the buccal mucosa from the pharynx.

DIF: Recall REF: 265-268 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. What is the most commonly cited error contributing to missed IA blocks? a. Injection being too low b. Injection being too high c. Inadequate aspiration NURSINGTB.COM d. Incorrect fulcrum ANS: A

The most commonly cited error contributing to missed IA blocks is the injection being too low. Missed IA blocks are not associated with the injection being too high, inadequate aspiration, or incorrect fulcrum.

DIF: Recall REF: 265-268 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. Best practices for administering the IA block injection include which of the following? a. After gently making contact with the bone, withdraw slightly and then begin the

deposition of solution. b. Deposition of solution at the target area will provide the most anesthetic power. c. Deposit a small amount of the local anesthetic agent as the needle enters the tissue

after each aspiration. d. All options listed ANS: B

Deposition of the solution at the target area will provide the most anesthetic power. The needle will naturally withdraw from the periosteum when contact is made with the mandible, so there is no need to withdraw the needle farther and possibly miss the target area. Small amounts injected early will not reduce any tissue discomfort for the patient.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank

DIF: Recall REF: 265-268 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. There is no need for the clinician to shake or vibrate the tissue of the cheek to distract the

patient. This action would move the needle and its bevel out of the correct pathway to the target area, causing less effective administration, possible trauma, and then pain to the patient. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. As with maxillary facial injections, there is no need for the clinician to shake or vibrate the tissues of the cheek to distract the patient because this will move the needle and its bevel out of the correct pathway to the target area.

DIF: Recall REF: 265-268 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 10. When administering the IA block injection, what other nerve may inadvertently be

anesthetized? a. PSA b. Facial nerve c. Lingual nerve d. Mandibular nerve

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ANS: B

During an IA block injection, the facial nerve can be inadvertently anesthetized, possibly causing transient facial paralysis. The PSA and mandibular nerve are superior to the IA and are not affected by the IA block injection. The lingual nerve is expected to be anesthetized during the IA block.

DIF: Recall REF: 268-270 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 11. Where is the injection site for the local anesthesia of the mylohyoid nerve? a. Halfway in the dental arch b. Mesial to the existing premolar c. Distal to the existing premolar d. At the apex of the mesial root of the mandibular first molar ANS: D

The injection site for the local anesthesia of the mylohyoid nerve should be at the apex of the mesial root of the mandibular first molar. Halfway in the dental arch or mesial or distal to the existing premolar are not strategies for anesthetizing the mylohyoid nerve.

DIF: Recall REF: 268-270 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Control 12. Where should the injection site for an IA block injection be located if the clinician notices a

double mandibular canal on dental images? a. Superior to the usual anatomic landmarks for the IA block b. Inferior to the usual anatomic landmarks for the IA block c. Slightly distal to the apex of the mandibular second premolar d. Slightly mesial to the apex of the mandibular first molar ANS: B

The local anesthetic agent is deposited more inferior to the usual anatomic landmarks for the IA block because in many cases the second foramen is more inferiorly placed. Deposition superior to the usual anatomic landmarks or slightly mesial or distal to the apex of the mandibular second premolar during provision of the IA are not recommended strategies when a double mandibular canal is noticed.

DIF: Recall REF: 268-270 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 13. Numbness or tingling of the lower lip is a good indication that profound anesthesia has

occurred. It is also an indicator that the inferior alveolar nerve has been initially anesthetized. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: D

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The first statement is false; the second statement is true. Numbness or tingling of the lower lip is a good indication that anesthesia has occurred; however, it is not a reliable indicator of the depth of anesthesia. It is also an indicator that the inferior alveolar nerve has been initially anesthetized.

DIF: Recall REF: 270-272 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 14. The IA has the highest positive aspiration rate of all block injections of either dental arch. If

hematoma occurs in the area of the pterygomandibular space, it is important to let the patient see the bruising when the treatment is finished and discuss that it is a basic risk of anesthesia and is temporary. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. The IA has the highest positive aspiration rate of all block injections of either dental arch. If hematoma occurs in the area of the pterygomandibular space, it is important to let the patient see the bruising when the treatment is finished and discuss that it is a basic risk of anesthesia and is temporary.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank DIF: Recall REF: 270-272 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 15. Which mandibular injection has the highest VAS number or is rated as the most

uncomfortable for the dental patient? a. Buccal block b. Incisive block c. Mental block d. Gow-Gates ANS: B

The long buccal nerve block is very successful because the nerve is readily located on the surface of the tissue and not within bone. However, the VAS is 2 to 4 if the clinician uses the correct technique, which is somewhat higher overall than the IA block. The incisive, mental, and Gow-Gates blocks have lower VAS than the buccal block.

DIF: Recall REF: 272-275 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 16. What area should the clinician palpate in order to determine the location of the mental

foramen? a. Directly below the mandibular notch on the ramus of the mandible b. Between the mandibular first and second premolars c. From the mandibular first molar to the distal surface of the canine d. On the lingual and at the apex of the mandibular incisors ANS: C

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From the mandibular first molar to the distal surface of the canine. The mandibular notch and lingual and apex of mandibular incisors are not in the vicinity of the mental foramen. Because the mental foramen may be located at a point between the first molar and the canine, palpating between the premolars may prove to be inadequate.

DIF: Recall REF: 276| 282-283 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 17. Which mandibular injection has the second highest rate of developing the complication of a

hematoma? a. IA nerve block b. Buccal block c. Mental block d. Gow-Gates ANS: C

The mental block has the second highest rate of developing the complication of a hematoma with a 5.7% aspiration rate. The aspiration rate for the IA is 10% to 15%; the buccal block, 0.7%; and the Gow-Gates, 2%.

DIF: Recall REF: 279 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Control 18. What is a noticeable difference between the mental block and the incisive block? a. There is pulpal anesthesia of the involved teeth with an incisive block b. There is pulpal anesthesia of the involved teeth with a mental block c. The syringe angulation is different between the two blocks d. The needle target site is different between the two blocks ANS: A

The symptoms of an incisive block are the same as the symptoms of a mental block, except that there is pulpal anesthesia of the involved teeth. The syringe angulation and target is the same. However, when providing the incisive block, more anesthetic is needed and gentle pressure applied over the mental foramen to anesthetize the incisive nerve after the mental nerve.

DIF: Recall REF: 283 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 19. When administering the Gow-Gates block, initially the vertical location for the injection is

just inferior to the mesiolingual cusp of the maxillary second molar; the needle is then placed distal to the maxillary second molar. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

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Both statements are true. When administering the Gow-Gates block, initially the vertical location for the injection is just inferior to the mesiolingual cusp of the maxillary second molar; the needle is then placed distal to the maxillary second molar.

DIF: Recall REF: 283-285 OBJ: 7 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 20. The needle is advanced and gentle bone contact is made for which injection? a. Buccal b. IA c. Gow-Gates d. IA and Gow-Gates e. All options listed ANS: E

All options listed. Gentle bone contact is made with all of the following injections: Buccal, IA and Gow-Gates.

DIF: Recall REF: 265-268| 275-276| 283-285 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 21. Which of the following are the MAIN disadvantages of the Gow-Gates block?

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank a. b. c. d.

Longer onset time and numbness to lower lip and temporal region Longer onset and long duration Numbness to lower lip and longer duration 2% aspiration rate and longer duration

ANS: A

Longer onset time and numbness to lower lip and temporal region are the two main disadvantages. Longer duration can be a disadvantage, but also it can be useful for more advanced cases of periodontal disease. The 2% aspiration rate is low and not a disadvantage.

DIF: Recall REF: 286-287 OBJ: 7 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 22. The Vazirani-Akinosi block is useful when soft tissue structures such as the tongue or buccal

fat pad persistently obstruct the view of the intraoral landmarks used in the IA block. The mylohyoid nerve is anesthetized during the Vazirani-Akinosi block. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. The Vazirani-Akinosi block is useful when soft tissue structures such as the tongue or buccal fat pad persistently obstruct the view of the intraoral landmarks used in the IA block. The mylohyoid nerve is anesthetized during the Vazirani-Akinosi block.

DIF: Recall REF: 28N 7-29R0 I GOBB 8 M S N Dental T J:.C O Care| NBDHE, 3.4 Anxiety and Pain TOP: NBDHE, 3.0 Planning andU Managing Hygiene Control 23. Which of the following mandibular supplemental injections enters the alveolar bone? a. Supraperiosteal b. Intraseptal c. Periodontal ligament d. All options listed ANS: C

The periodontal ligament injection enters the cancellous bone of the alveolar bone. The supraperiosteal and intraseptal injections do not enter the alveolar bone.

DIF: Recall REF: 293-296 OBJ: 11 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank

Chapter 14: Local Anesthesia for the Child and Adolescent Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition MULTIPLE CHOICE 1. Which of the following does successful treatment of all patients depend upon? a. Relief of pain b. Relief of anxiety c. Profound anesthesia d. All options listed ANS: D

All options listed. Successful treatment of all patients is dependent upon relieving their pain, discomfort, and anxiety for all dental procedures. This is facilitated by profound anesthesia.

DIF: Recall REF: 304 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 2. All of the following describe situations when dental hygienists most often provide local

anesthesia for pediatric patients EXCEPT one. Which one is the EXCEPTION? a. When requested by the dentist who is providing restorative work b. When the dental hygienist is licensed to provide restorative work c. During nonsurgical periodontal therapy d. When the patient has an appointment first with the hygienist and then with the dentist for restorative care. R I G B.C M ANS: C

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O

EXCEPTION: During nonsurgical periodontal therapy.

Pediatric patients typically do not require nonsurgical periodontal therapy. Most often dental hygienists provide local anesthesia for pediatric patients in situations where the dentist or dental hygienist is providing restorative treatment or when the patient has an appointment first with the hygienist and then with the dentist for restorative treatment.

DIF: Recall REF: 304 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 3. One of the most common adverse reactions to local anesthesia is systemic toxicity. This is

typically the result of administering the anesthetic agent over the patient’s maximum recommended dose (MRD) or from inadvertent intravascular injections. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. One of the most common adverse reactions to local anesthesia is systemic toxicity. This is typically the result of administering the anesthetic agent over the patient’s maximum recommended dose (MRD) or from inadvertent intravascular injections.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank DIF: Recall REF: 304 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. Most adverse drug reactions occur within 5-10 minutes of injection. Local anesthesia system

toxicity initially manifests as excitation followed by depression of the cardiovascular system and to a lesser extent of the central nervous system. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: C

The first statement is true, the second statement is false. Most adverse drug reactions occur within 5-10 minutes of injection. Local anesthesia system toxicity initially manifests as excitation followed by depression of the central nervous system and to a lesser extent of the cardiovascular system.

DIF: Recall REF: 304 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 5. For pediatric patients, each of the following contributes to increased risk of complications

from local anesthesia except ONE. Which one is the EXCEPTION? a. Concomitant use with opioid/sedatives during treatment b. Immature organ function c. Lowering MRD d. Use of long duration locaN l aUnR esS thI etN icG s TB.COM ANS: C

EXCEPTION: Lowering MRD. Lowering the MRD for children is recommended to reduce risk of complications.

Concomitant use with opioid/sedatives during treatment, immature organ function, or use of long-duration local anesthetics contribute to increase risk of complications.

DIF: Recall REF: 304-305 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 6. For the overweight child all of the following are important considerations when providing

local anesthesia EXCEPT one. Which one is the EXCEPTION? a. Use lowest effective dose b. Use Ideal Body Weight index c. Consider lowering AAPD MRD d. Calculate MRD based upon standard tables and Clark’s Rule ANS: D

EXCEPTION: Calculate MRD based upon standard tables and Clark’s Rule.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Calculating the MRD based upon standard tables and utilizing the Clark’s Rule does not apply for overweight children because the MRD calculated may exceed the ability for immature organs to biotransform the administered anesthetic. Using the lowest effective dose, IBW index, and lowering the AAPD MRD should be considered in determining a safe dose for the overweight child.

DIF: Recall REF: 304-305 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 7. Which of the following decreases the possibility of LAST? a. A standard scale to determine accurate body weight b. Adhering to MRDs set by the AAPD c. Anesthetizing only the quadrants currently being treated d. All options listed ANS: D

All options listed. Using a standard scale to determine accurate body weight, adhering to MRDs set by the AAPD, and anesthetizing only the quadrants currently being treated will decrease the possibility of LAST. DIF: Recall REF: 304 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 8. The amount of topical anesthetic applied prior to local anesthetic injection should be factored

into the total administered dose because it can infiltrate into the vascular system. a. Both the statement and reN asUoR nS arI eN coG rrT ecBt . anC dO reMlated. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: A

Both the statement and reason are correct and related. The amount of topical anesthetic applied prior to local anesthetic injection should be factored into the total administered dose because it can infiltrate into the vascular system.

DIF: Recall REF: 305 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 9. Which of the following is true regarding the use of mepivacaine 3% plain? a. Provides short-acting pulpal anesthesia b. Provides similar duration of soft tissue anesthesia as lidocaine 2% 1:100,000

epinephrine c. Makes it easier to reach or exceed MRD than 2% lidocaine 1:100,000 epinephrine d. Contains 50% more local anesthetic in a cartridge than 2% lidocaine 1:100,000

epinephrine e. All options listed ANS: E

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank All options listed. Mepivacaine 3% plain provides short-acting pulpal anesthesia, but almost identical duration of soft tissue anesthesia as lidocaine 2% 1:100,000 epinephrine, and makes it easier to reach or exceed MRD than lidocaine 2% 1:100,000 epinephrine because it contains 50% more local anesthetic in a cartridge than lidocaine 2% 10:100,000 epinephrine.

DIF: Recall REF: 305 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 10. Bupivacaine is not recommended for children because it will increase the risk of soft tissue

injury. a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: A

Both the statement and reason are correct and related. Bupivacaine is not recommended for children because it will increase the risk of soft tissue injury.

DIF: Recall REF: 305 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 11. Self-inflicted soft tissue injury resulting from regional local anesthesia in the dental office is a

significant and common local complication for children. The most common area of injury is the upper lip.

NURSINGTB.COM a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: C

The first statement is true, the second statement is false. Self-inflicted soft tissue injury resulting from regional local anesthesia in the dental office is a significant and common local complication for children. The most common area of injury is the lower lip.

DIF: Recall REF: 305 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 12. Which of the following are preventive measures to decrease the occurrences of soft tissue

injury? a. Selection of agent with appropriate duration of action b. Advise parent/caregiver about possible injury due to biting the lip, tongue, or cheek c. Place cotton rolls in vestibule and warning stickers on the patient’s head d. Advise parent/caregiver to delay meals and hot drinks e. All options listed ANS: E

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank All options listed. Preventive measures to decrease the occurrences of soft tissue injury include: selecting an agent with appropriate duration of action; advising parent/caregiver about possible injury due to biting the lip, tongue, or cheek and to delay meals and hot drinks; and placing cotton rolls in vestibule and warning stickers on the patient’s head.

DIF: Recall REF: 305-306 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 13. Which of the following agents is indicated for the reversal of soft tissue anesthesia? a. Epinephrine 1:100,000 b. Phentolamine mesylate c. Oraqix d. Mepivacaine 3% plain ANS: B

Phentolamine mesylate is indicated for the reversal of soft tissue anesthesia when agents with vasoconstrictor have been used. Epinephrine 1:100,000 (a vasoconstrictor), Oraqix (a topical anesthetic), and mepivacaine 3% plain (a local anesthetic) are not useful agents for reversal of soft tissue anesthesia.

DIF: Recall REF: 306 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 14. Treatment of soft tissue injury includes applying heat on the day of the injury. The following

day ice may be applied. a. Both statements are true.NURSINGTB.COM b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: B

Both statements are false. The day of the injury an icepack should be applied to the area to reduce swelling. The following day a warm pack should be applied to the lesion to encourage circulation in order to promote healing.

DIF: Recall REF: 306 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 15. The PSA may be needed in some children because the thick zygomatic process may overlie

the buccal roots of the second primary and first permanent molars. a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: A

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Both the statement and reason are correct and related. The PSA may be needed in some children because the thick zygomatic process may overlie the buccal roots of the second primary and first permanent molars.

DIF: Recall REF: 307 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 16. All of the following are considerations regarding the use of palatal injections for children with

only primary dentition EXCEPT one. Which one is the EXCEPTION? a. The use of the C-CLAD will increase comfort b. The NP block technique is identical to that described for adults c. The GP block technique is identical to that described for adults d. Prepuncture techniques increase comfort e. Slow administration increases comfort ANS: C

EXCEPTION: The GP block technique is identical to that described for adults.

For the GP block, the clinician should bisect an imaginary line drawn from the gingival border of the most posterior molar that has erupted to the midline and insert the needle from the contralateral side distal to the last molar approximately 10 mm posterior to the distal surface of the second primary molar. Utilizing the prepuncture and C-CLAD techniques increases comfort. The NP block is administered in the same manner as described for adults. The key to a successful, comfortable injection is administering the solution slowly.

DIF: Recall REF: 307-308 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

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17. Supraperiosteal injection techniques are less clinically effective in mandibular primary molars

compared to mandibular permanent molars due to the shorter roots of primary molars. a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. The statement is NOT correct, but the reason is correct. e. NEITHER the statement NOR the reason is correct.

ANS: E

NEITHER the statement NOR the reason is correct. Supraperiosteal injection techniques are more clinically effective in mandibular primary molars compared to mandibular permanent molars because of the decrease in density of mandibular bone in younger children.

DIF: Recall REF: 308 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 18. Children between the ages of 6-9 may receive effective pain control, equivalent to the IA

block, from buccal supraperiosteal infiltrations. Some extraction procedures can be accomplished utilizing mandibular supraperiosteal injections. a. Both statements are true. b. Both statements are false.

NURSINGTB.COM

Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. Children between the ages of 6-9 may receive effective pain control, equivalent to the IA block, from buccal supraperiosteal infiltrations. Some extraction procedures can be accomplished utilizing mandibular supraperiosteal injections.

DIF: Recall REF: 308 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 19. Which of the following describes why the IA block has a greater success rate in children than

adults? a. The mandibular foramen is located more inferior in children than adults. b. The soft tissue is thicker overlying the IA nerve. c. Bone does not need to be contacted prior to deposition. d. All options listed.

ANS: A

The mandibular foramen is located more inferior in children than adults. Because the mandibular foramen is more inferior, injections that are administered “too low” are more likely to be successful. The soft tissue is thinner overlying the IA nerve, facilitating the use of a short needle. The bone must be contacted prior to deposition.

DIF: Recall REF: 308 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control N R I G B.C M

U S N T

O

20. Which of the following are useful strategies for behavioral management of children during

provision of local anesthesia? a. Show-tell-do communication b. Utilizing a dental assistant to stabilize the child’s head and hands c. Discuss the process using the child’s terminology d. All options listed ANS: D

All options listed. Useful strategies for behavioral management of children during provision of local anesthesia include show-tell-do communication, utilizing a dental assistant to stabilize the child’s head and hands, and discussing the process using the child’s terminology.

DIF: Recall REF: 306 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

NURSINGTB.COM

Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank

Chapter 15: Local Anesthetic Complications Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition MATCHING

Match the term with the definition that most closely describes it. Terms will be used only once. a. Localized complication b. Systemic complication c. Primary complication d. Mild complication e. Transient complication f. Diaphoresis g. Syncope h. Hyperventilation i. Angina pectoris j. Myocardial infarction k. Stroke l. Hypoglycemia m. Hyperglycemia n. Asthma 1. Sudden, transient loss of consciousness 2. An example is when a patient experiences a burning sensation at the time of drug 3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

administration CoOnM Terminate procedure, positioN nU paRtiS enIt N upGriT ghBt,.m itor and record vital signs, administer oxygen and nitroglycerine for three doses or until pain is relieved Sudden weakness of one side, difficulty of speech, temporary loss of vision, and change in mental status Excessive sweating Occurs in the region of the injection and can be attributed to the anesthetic needle, administration technique, and/or the anesthetic drug administered Excessive thirst, urination, and hunger, acetone breath Confusion, irritation, increased anxiety that requires termination of procedure and administration of oral sugar Abnormally prolonged rapid and deep respirations with light-headedness and dizziness Minor complications that will resolve without requiring treatment May appear severe at the time of its observance but will eventually resolve without any residual effect Mild to severe chest pain; pain in left arm and jaw that is not relieved by nitroglycerine Are usually caused by high plasma concentrations of local anesthetic drugs that result from inadvertent intravascular injection, excessive dose, rate of injection, delayed drug clearance, or administration into vascular tissue Shortness of breath or wheezing with chest tightness and increased pulse rate.

1. ANS: G DIF: Recall REF: 331-332 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank 2. ANS: C DIF: Recall REF: 313 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 3. ANS: I DIF: Recall REF: 331-332 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 4. ANS: K DIF: Recall REF: 331-332 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 5. ANS: F DIF: Recall REF: 331-332 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 6. ANS: A DIF: Recall REF: 313 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 7. ANS: M DIF: Recall REF: 331-332 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 8. ANS: L DIF: Recall REF: 331-332 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 9. ANS: H DIF: Recall REF: 331-332 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 10. ANS: D DIF: Recall REF: 313 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 11. ANS: E DIF: ReNcallR I GREB 313 M OBJ: 1 S N Dental TF:.C O Care| NBDHE, TOP: NBDHE, 3.0 Planning and U Managing Hygiene 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 12. ANS: J DIF: Recall REF: 331-332 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 13. ANS: B DIF: Recall REF: 324-325 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 14. ANS: N DIF: Recall REF: 331-332 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control ESSAY 1. List good questions to ask the patient if he/she reports an alleged allergic reaction to local

anesthetic.

ANS:

When was the last time you experienced this response?

Describe exactly what happened.

What position were you in during the injection?

What was the time sequence of events?

What drug was used?

NURSINGTB.COM

Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank What amount of drug was administered?

Did the drug contain a vasoconstrictor?

Were you taking any other medication at the time of the incident?

What is the name and address of the doctor who was treating you when the reaction occurred?

DIF: Recall REF: 328 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control MULTIPLE CHOICE 1. How might overdose reactions be avoided? a. Know the anatomy. b. Aspirate in two planes. c. Use 25- or 27-gauge needle. d. Administer drug slowly. e. All options listed.

ANS: E

All options listed. Overdose reactions can be avoided by knowing the anatomy; aspirating in two planes; using a 25- or 27-gauge needle; and administering the drug slowly are all important factors in preventing an overdose.

DIF: Recall REF: 325-326 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control

N R I G B.C M

2. Cardiovascular signs of toxicitU y ofSlocN al aT nesthetiO c solution include which of the following? a. Myocardial depression b. Cardiac dysrhythmias c. Cardiotoxicity in pregnancy d. All options listed ANS: D

All options listed. Cardiovascular signs of toxicity of local anesthetic solution include myocardial depression, cardiac dysrhythmias, and cardiotoxicity in pregnancy.

DIF: Recall REF: 326-327 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 3. Which is the highest dose of epinephrine? a. 1:50,000 b. 1:100,000 c. 1:200,000 d. 1:250,000 ANS: A

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank The highest dose of epinephrine is 1:50,000, which is twice as potent as the 1:100,000 concentration and four times as potent as the 1:200,000 concentration. It has been stated that a dilution of 1:250,000 provides adequate duration of pain control for dental procedures with minimal risk of toxicity.

DIF: Recall REF: 327 OBJ: 3 TOP: NBDHE, 6.0 Pharmacology| NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control 4. What does the clinician need to know about a possible epinephrine overdose? a. The body is not very efficient at removing vasoconstrictors. b. Adverse effects associated with epinephrine may last 20 minutes or longer. c. Epinephrine overdose produces overstimulation of adrenergic receptors. d. Normal signs and symptoms of an epinephrine overdose resemble CNS depression.

ANS: C

Epinephrine overdose produces overstimulation of adrenergic receptors, which can produce signs and symptoms normally observed from CNS stimulation. The body is very efficient at removing vasoconstrictors, and adverse effects associated with epinephrine may last 5-10 minutes or longer.

DIF: Recall REF: 327 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 5. All of the following are true of topical anesthetics used in dentistry EXCEPT one. Which one

is the EXCEPTION? a. Lidocaine may contain prN esUeR rvS atI ivN esGsT ucBh.asCtO heMparabens that could induce an allergic response. b. Topical anesthetics are possible allergens. c. Benzocaine is a commonly used amide topical anesthetic that can contribute to an allergic reaction. d. Tetracaine can contribute to an allergic response.

ANS: C

EXCEPTION: Benzocaine is a commonly used amide topical anesthetic that can contribute to an allergic reaction.

Benzocaine is a commonly used ester topical anesthetic that can contribute to an allergic reaction. Lidocaine may contain preservatives such as the parabens that could induce an allergic response. Topical anesthetics are possible allergens. Tetracaine can contribute to an allergic response.

DIF: Recall REF: 327-329 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 6. The preanesthetic patient assessment is the most important measure the dental hygienist can

complete to prevent an allergic reaction. Patients who report they are susceptible to asthma, hay fever, and allergies to foods have an increased potential to develop an allergic response to medications. a. Both statements are true.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. The preanesthetic patient assessment is the most important measure the dental hygienist can complete to prevent an allergic reaction. Patients who report they are susceptible to asthma, hay fever, and allergies to foods have an increased potential to develop an allergic response to medications.

DIF: Recall REF: 328-329 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 7. Recommended treatment of allergic reactions includes which of the following? a. 25- to 50-mg adult dose Benadryl for mild cutaneous reactions b. 1:1000 epinephrine for more serious reactions c. 60-mg methylprednisolone for severe allergic reactions d. All options listed ANS: D

All options listed. Recommended treatments of allergic reactions include 25- to 50-mg adult dose Benadryl for mild cutaneous reactions or 1:1000 epinephrine for more serious reactions.

DIF: Recall REF: 328-329 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control

N R I G B.C M

8. Delayed signs and symptoms oU f anSallN ergiT c reactioOn are more intense and serious. If skin

reactions develop immediately following the injection, anaphylaxis may occur. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: D

The first statement is false, the second statement is true. Delayed signs and symptoms of an allergic reaction are less serious. If skin reactions develop immediately following the injection, anaphylaxis may occur.

DIF: Recall REF: 328-329 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 9. What documentation about local anesthesia should be recorded in the patient’s chart? a. Postanesthetic instructions given to patient b. Type and dose of drug/drugs administered c. Patient’s response to anesthesia d. Appropriate consultations or referrals e. All options listed ANS: E

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank All options listed. Postanesthetic instructions; type and dose of drug(s) administered; patient’s response to anesthesia; and appropriate consultations or referrals are all important to record in the patient’s chart in order to be thorough with documentation.

DIF: Recall REF: 333 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 10. On reviewing the dental patient’s health history and dental history, what would be a best

practice in dealing with information that could adversely affect dental treatment? a. Tell the supervising dentist. b. Record the conditions in red as a medical alert on the patient’s medical history. c. Document in the chart notes that you checked the patient’s health history. d. Refer patient to a specialist.

ANS: B

Conditions that place the patient at risk for an emergency should be recorded in red as a medical alert on the patient’s medical history. Depending upon the circumstances, informing the dentist and referring the patient to a specialist may be actions taken after proper documentation. Simply documenting in the chart notes that the patient’s medical health history has been checked does not provide adequate information regarding potential conditions that may put a patient at risk for an emergency.

DIF: Recall REF: 333 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 11. What instructions should theN clU inR icS iaI nN giG veTtB o. thC eO paMtient after he receives local anesthetic and

before he leaves the dental office? a. Do not drink hot fluids b. Do not test anesthesia by biting the numb area c. Recommend warm saline rinses to decrease swelling and discomfort d. All options listed ANS: D

All options listed. Best practices to help prevent soft tissue trauma after local anesthetic include warning the patient not to eat or drink hot fluids or to test anesthesia by biting the numb area. Recommendations to use warm saline rinses to decrease swelling and discomfort are also good patient instructions.

DIF: Recall REF: 314-315| 322 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 12. What is the proper length of time to allow topical anesthetic to remain on the tissue at the

injection site? a. 1 to 2 minutes b. 2 to 4 minutes c. 5 to 6 minutes d. Until patient reports that he is numb ANS: A

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank To prevent tissue sloughing, the proper length of time to allow topical anesthetic to remain on the tissue at the injection site is 1 to 2 minutes.

DIF: Recall REF: 314-315| 324 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 13. Which of the following best practices will help to prevent infection caused by the

administration of local anesthetic? a. Wipe needle with disinfectant b. Store anesthetic cartridges in disinfectant solutions c. Sheath needle before and immediately after injection d. All options listed ANS: C

Best practices to help to prevent infection from the administration of local anesthetic include keeping the sheath on the needle before and replacing the sheath immediately after the injection. Needles come presterilized, and if contamination occurs, the needle should be properly discarded. Storing the anesthetic cartridges in disinfectant solutions is contraindicated because it may contaminate the anesthetic or corrode the aluminum cap.

DIF: Recall REF: 314-315| 321 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 14. What should the clinician do if she notices that the patient is developing a hematoma? a. Apply direct pressure immediately b. Apply heat immediately NURSINGTB.COM c. Advise patient that swelling and discoloration will disappear within 1 to 2 months d. All options listed ANS: A

If the clinician notices the development of a hematoma, she should apply direct pressure immediately. Ice should be applied to the region to reduce swelling. Heat may be applied the next day. The swelling and discoloration will disappear within 7-14 days.

DIF: Recall REF: 314-315| 317 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 15. Which of the following could result if local anesthetic solution is inadvertently deposited in

the parotid gland? a. Incomplete anesthesia of teeth b. Hematoma c. Facial paralysis d. All options listed ANS: C

If local anesthetic is deposited in the parotid gland during the IANB injection, facial paralysis could result. There are no contraindications to completing the scheduled treatment because anesthesia is not usually affected. A hematoma develops when a blood vessel is punctured or lacerated by the needle.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank

DIF: Recall REF: 314-315| 317-319 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 16. What could cause a burning sensation during the administration of local anesthetic? a. Expired anesthetic solution b. Possible contamination with disinfecting solution c. Anesthetic placed in sunny window to warm gently d. All options listed ANS: D

All options listed. A burning sensation during the administration of local anesthetic could be caused by an expired anesthetic solution, a possible contamination with disinfecting solution, or heated anesthetic.

DIF: Recall REF: 314-315| 317 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 17. Best practices to prevent needle breakage include which of the following? a. Use a long, small-gauge needle b. Use good technique c. Bend needle for correct angulation d. All options listed ANS: B

Best practices to prevent needle breakage include use of good technique. A large-gauge needle N Rhou IN Ge B.C M of proper length for the injectioUn sS ld bT used. O Bending the needle compromises the integrity of the needle and increases the risk for breakage.

DIF: Recall REF: 316 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control 18. Which of the following could be cause for pain during injection? a. Dull needle b. Barbed needle c. Rapid deposition d. All options listed ANS: D

All options listed. Causes associated with pain during injection include dull or barbed needles, as well as rapid deposition.

DIF: Recall REF: 314-316 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.2 Recognition of Emergency Situations and Provision of Appropriate Care| NBDHE, 3.4 Anxiety and Pain Control

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank

Chapter 16: Legal Considerations and Risk Management Logothetis: Local Anesthesia for the Dental Hygienist, 2nd Edition TRUE/FALSE 1. The dental hygienist must follow the most current postexposure guidelines set by OSHA. ANS: F

Correct: The dental hygienist must follow the most current postexposure guidelines set by the U.S. Public Health Service.

DIF: Recall REF: 339| 342 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 2. For a percutaneous injury, details of the incident report should include the depth of the wound,

the gauge of the needle, and whether fluid was injected.

ANS: T DIF: Recall REF: 340 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 3. The qualified health care provider corresponds directly with the exposed health care worker so

as not to violate HIPPA. ANS: F

The qualified health care proN viU deRr S seI ndNsGaTwB ri. tteCnOoM pinion to the employer, indicating that the exposed employee has been informed of the evaluation results and the need for further follow-up treatment, whether the HBV vaccine was indicated, and if the employee received the vaccine. All other findings are confidential.

DIF: Recall REF: 340 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 4. Postexposure management’s goal is to contain the injury to reduce the possibility of disease

transmission.

ANS: T DIF: Recall REF: 340 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 5. All dental facilities that employ more than 15 people must have a postexposure management

protocol for occupational exposures.

ANS: F

Correct: All dental facilities must have a postexposure management protocol for occupational exposures.

DIF: Recall REF: 339 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 6. Any dental history regarding a patient’s psychologic state as related to injections or

nervousness is subjective and should not be included in dental notes.

ANS: F

Correct: Dental history regarding the patient’s psychologic state as related to injections and nervousness should be included in the patient’s record.

DIF: Recall REF: 338-339 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.4 General 7. Any refusal of treatment by the patient and a brief statement documenting the discussion of

risks associated with refusal of treatment should be documented in the patient record.

ANS: T DIF: Recall REF: 338-339 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.4 General 8. A dental hygienist does not necessarily need to purchase his/her own liability insurance

because he/she is typically covered under the umbrella of the supervising dentist’s professional liability insurance.

ANS: F

Correct: The dental hygienist should obtain his/her own professional liability insurance because he/she cannot rely on being covered against malpractice under the employer’s insurance policy.

NURSINGTB.COM DIF: Recall REF: 336-338 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.4 General 9. The dental hygienist should always follow the lead direction of the supervising dentist.

ANS: F

Correct: It is the responsibility of the dental hygienist to educate the dentist on the supervision laws related to the practice of dental hygiene.

DIF: Recall REF: 336-338 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 10. The dental hygienist should report only gross negligence by a health care provider to the

responsible authorities.

ANS: F

Correct: The dental hygienist should report any illegal activities by a health care provider to the responsible authorities.

DIF: Recall REF: 336-338 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain

NURSINGTB.COM

Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 11. Most states require the dental hygienist to apply for a local anesthesia license or certificate in

addition to the regular dental hygiene license to legally administer local anesthetics.

ANS: T DIF: Recall REF: 336-338 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 12. The individual state licensing boards are responsible for making sure that dental hygienists

maintain professional competency, credentials, and continuing educational requirement fulfillments.

ANS: F

Correct: The dental hygienist is responsible for making sure that he/she maintains individual professional competency, credentials, and continuing educational requirement fulfillments.

DIF: Recall REF: 336-338 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 13. Due to the high standards of the dental hygiene curriculum, the licensed dental hygienist is

prepared for any experience within the dental office.

ANS: F

Correct: The dental hygienist may experience unanticipated and problematic outcomes.

DIF: Recall REF: 33N 6URSINGOB 4 OM TBJ:.C TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.4 General 14. A dental hygienist may be charged with malpractice if he/she induces harm to the patient or if

a breach of duty exists.

ANS: T DIF: Recall REF: 336-338 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance MULTIPLE CHOICE 1. In some states, the scope of dental hygiene practice for all dental hygiene treatment, including

local anesthesia, requires the physical presence of a dentist. In other states, supervision laws do not require the physical presence of the dentist for dental hygiene treatment but do require it during the administration of local anesthesia. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Both statements are true. In some states, the scope of dental hygiene practice for all dental hygiene treatment, including local anesthesia, requires the physical presence of a dentist. In other states, supervision laws do not require the physical presence of the dentist for dental hygiene treatment but do require it during the administration of local anesthesia.

DIF: Recall REF: 336-338 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 2. What is contact of the mucous membrane with blood, saliva, tissue, or other body fluids that

are potentially infectious called? a. Occupational exposure b. Occupational hazard c. Primary prevention d. Tertiary prevention ANS: A

Occupational exposure is contact of the mucous membrane with blood, saliva, tissue, or other body fluids that are potentially infectious. An occupational hazard is an accepted risk associated with a particular occupation. Primary prevention is to strive to use all protocols to prevent the injury from occurring. Tertiary prevention is to strive to return the patient to a functional state and prevent future injuries.

DIF: Recall REF: 339 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 3. The primary objective of proN viU diR ngSdIeN ntG alThB yg.ieCnO eM care is to assist patients in preventing

disease and maintaining oral health. With the delivery of these services, the dental hygienist may experience unanticipated and problematic outcomes. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. The primary objective of providing dental hygiene care is to assist patients in preventing disease and maintaining oral health. With the delivery of these services, the dental hygienist may experience unanticipated and problematic outcomes.

DIF: Recall REF: 336 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.4 General 4. Due to the scope of practice for dentists, they are more at risk for litigation. Risk management

identifies methods to negotiate the risk of legal actions associated with the delivery of oral care. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; second statement is true.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank ANS: C

The first statement is true, the second statement is false. Due to the scope of practice for dentists, they are more at risk for litigation. Risk management identifies preventive methods to minimize or eliminate the risk of legal actions associated with the delivery of oral care.

DIF: Recall REF: 336 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.4 General 5. Which of the following factors may serve to decrease the risk of possible litigation? a. Minimizing misunderstandings b. Resolving problems as they arise c. Developing a one-on-one relationship with the patient to build trust and confidence d. All options listed ANS: D

All options listed. Minimizing misunderstandings and resolving problems as they arise during the dental hygiene treatment reduces the likelihood of lawsuits. It is important to develop a one-on-one relationship with the patient to build confidence and trust.

DIF: Recall REF: 336 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.3 Patient and Professional Communication 6. Which of the following is true regarding the best practice in obtaining informed consent? a. Clearly present only the benefits associated with the procedure. b. Ultimately, it is the patien isio nw he. thC erOtM o accept a procedure or not.

Nt’s URdec SI NG TB c. Presenting the risks of the procedure could possibly scare the patient into choosing

not to have the procedure performed. d. Tweens and teenagers are capable of granting their own informed consent for

treatment.

ANS: B

Ultimately, it is the patient’s decision whether to accept a procedure or not. It is essential for the dental hygienist to clearly present the benefits and risks associated with the procedure. The patient has the right to accept no treatment. In the case of a minor, informed consent must be given by the parent or guardian.

DIF: Recall REF: 336 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.1 Ethical Principles, Including Informed Consent| NBDHE, 7.3 Patient and Professional Communication 7. Initially patients may decline the use of local anesthesia for nonsurgical periodontal

procedures because they do not fully understand the benefits of its use. a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but NOT related. c. The statement is correct, but the reason is NOT. d. NEITHER the statement NOR the reason is correct.

ANS: A

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Both the statement and reason are correct and related. Initially patients may decline the use of local anesthesia for nonsurgical periodontal procedures because they do not fully understand the benefits of its use.

DIF: Recall REF: 336 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.3 Patient and Professional Communication 8. Dental hygienist–employer communication best practices include: a. Open discussion regarding the potential liabilities for dental personnel b. Brainstorming liability prevention strategies c. Writing or reviewing the office protocol d. All options listed ANS: D

All options listed. The dental hygienist should have an open discussion with his/her employer regarding the potential liabilities and prevention strategies for dental hygienists. Office protocols should be written and reviewed periodically by all office employees.

DIF: Recall REF: 336 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.3 Patient and Professional Communication 9. Which of the following legal issues pertain to the dental hygienist? a. Contractual obligation to the patient b. Assumption of own legalNresR sibil Upon SI NGityTB.COM c. Accountability if the patient’s periodontal status declines d. All options listed ANS: D

All options listed. A licensed dental hygienist has a contractual obligation to the patient, must assume responsibility for his/her actions, and may be held accountable if the patient’s periodontal status declines.

DIF: Recall REF: 336-338 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 10. Whatever the situation may be, malpractice may be determined if the contractual obligations

are not met by the dental hygienist. A dental hygienist may commit a negligent act during the administration of local anesthetics by causing paresthesia. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

ANS: A

Both statements are true. Whatever the situation may be, malpractice may be determined if the contractual obligations are not met by the dental hygienist. A dental hygienist may commit a negligent act during the administration of local anesthetics by causing paresthesia.

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank

DIF: Recall REF: 336-338 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 11. What should the dental hygienist do to prevent the possibility of litigation? a. Practice life-long learning b. Document accurately and thoroughly c. Obtain informed consent before treatment d. All options listed ANS: D

All options listed. To prevent the possibility of litigation, the dental hygienist should practice life-long learning, document accurately and thoroughly, and obtain informed consent before treatment.

DIF: Recall REF: 336-338 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.1 Ethical Principles, Including Informed Consent 12. Always be sure to administer the appropriate volume of anesthetic for the area that can

reasonably be completed during one appointment. On completion of one quadrant of nonsurgical periodontal treatment, the clinician can administer more anesthetic, even if the MRD has been reached. a. Both statements are true. b. Both statements are false. c. The first statement is trueN ;U thR e se con d sta SI NG TBte.mCent OMis false. d. The first statement is false; the second statement is true.

ANS: C

The first statement is true, the second statement is false. Always be sure to administer the appropriate volume of anesthetic for the area that can reasonably be completed during one appointment. On completion of one quadrant of nonsurgical periodontal treatment, the clinician can administer more anesthetic unless the MRD has been reached.

DIF: Recall REF: 336-338 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.4 General 13. Striving to utilize all protocols to prevent injury from occurring is which category of

prevention and management of injury? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Risk reduction protocol ANS: A

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank Primary prevention is when the dental hygienist strives to utilize all protocols to prevent the injury from occurring. Secondary prevention is when, if an injury occurs, the dental hygienist should strive to contain the injury. Tertiary prevention is when the dental hygienist should strive to return the patient to a functional state and prevent future injuries. Risk reduction protocol describes steps that are taken to reduce risks.

DIF: Recall REF: 339 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.4 General 14. According to the Centers for Disease Control and Prevention, which of the following

conditions constitute occupational exposures in dentistry? a. Contact of mucous membrane with body fluids that are potentially infectious b. A percutaneous injury c. When skin that is chapped, abraded, or affected by dermatitis is exposed to blood or saliva d. All options listed ANS: D

All options listed. According to the Centers for Disease Control and Prevention, a percutaneous injury or contact of mucous membrane or nonintact skin (such as skin that is chapped, abraded, or affected by dermatitis) with blood, saliva, tissue, or other body fluids that are potentially infectious constitutes an occupational exposure in dentistry.

DIF: Recall REF: 339 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance

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15. What must the qualified health care professional consider when assessing the need for

follow-up of occupational exposures? a. Susceptibility of exposed person b. Infectious status of source c. Amount of fluid/tissue involved in the exposure d. All options listed ANS: D

All options listed. The qualified health care professional must consider the susceptibility of the exposed person, the infectious status of the source, and the amount of fluid or tissue involved in the exposure when assessing the need for follow-up of occupational exposures.

DIF: Recall REF: 340 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 16. How long does the qualified health care provider have to provide the employer with a written

report? a. 10 days b. 15 days c. 1 month d. As long as necessary ANS: B

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank The qualified health care provider has 15 days to provide the employer with a written report.

DIF: Recall REF: 340 OBJ: 8 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.2 Regulatory Compliance 17. What guides the conduct of the health care professionals? a. Ethical principles b. State laws c. National laws d. Knowledge ANS: A

Ethical principles guide the conduct of the health care professions regarding moral duties and obligations to the profession, to one’s self, to employers, and to patients. State and national laws and knowledge provide a general framework of obligations and responsibilities.

DIF: Recall REF: 336-338| 342 OBJ: 1 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.1 Ethical Principles, Including Informed Consent 18. What does the statement “A dental hygienist must meet the standard of care set by other

practitioners with similar training” mean? a. The dental hygienist must pass a written and clinical board. b. The dental hygienist is expected to gain knowledge and skills throughout her career. c. The dental hygienist onlyNhasRto I goBo. dC asOthMe least-educated person on staff.

U SbeNaGs T d. Dental hygienists with an associate’s degree are not expected to be as knowledgeable as dental hygienists with a bachelor’s degree.

ANS: B

The dental hygienist is expected to gain knowledge and skills throughout her career, also called life-long learning. Standard of care is always evolving and provides a minimal level of acceptance expected to be met by a reasonably prudent practitioner in a similar situation. It is not reliant upon previous education or passing a board exam but rather the current standards determined by the profession.

DIF: Recall REF: 336-338| 342 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.1 Ethical Principles, Including Informed Consent 19. Which of the following are dental hygiene considerations? a. Confidentiality b. Meeting the standards set by other practitioners c. Informed consent d. All options listed ANS: D

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Local Anesthesia for the Dental Hygienist 2nd Edition Logothetis Test Bank All options listed. Dental hygiene considerations include confidentiality of patient records, obtaining informed consent prior to beginning treatment, and meeting the standards set by other practitioners.

DIF: Recall REF: 336-338| 342 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care| NBDHE, 3.4 Anxiety and Pain Control| NBDHE, 7.0 Professional Responsibility| NBDHE, 7.1 Ethical Principles, Including Informed Consent

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