Medical Emergencies Essentials for the Dental Professional 2nd Edition By Ellen B. Grimes TEST BANK

B. evaluating the patient’s level of consciousness.

C. positioning the patient appropriately.

D. implementing the appropriate emergency protocol.

9. Which of the following is a contributing factor in the increase in medical emergencies in the dental setting?

A. Decreasing age of the population B. Advances in healthcare C. Advances in dentistry D. None of the above 10. Patient vital signs include all of the following EXCEPT: A. pulse.

B. respiration.

C. blood pressure.

D. weight.

True/False 1. Patients who are tachycardic or bradycardic are less likely to experience a medical emergency in the dental office than those that have a normal heart rhythm.

True False 2. For patients taking corticosteroids the operator needs to be alert to the signs and symptoms of adrenal insufficiency.

True False 3. Patients who are tachypnic may be more likely to experience a medical emergency.

True False 4. A patient who can walk up two flights of stairs or two city blocks would be considered in the ASA III category.

True False 5. Current CPR is necessary to be able to treat almost any medical emergency.

True False

Fill in the Blank 1. _________________ % of medical emergencies in the dental office are due to a mild allergic reaction.

2. _________________ of all medical emergencies in the dental office are life threatening.

3. If a patient states they have a bleeding disorder the operator needs to be alert to _________________ during patient treatment.

4. A patient with a mild systemic disease would be considered in the _________________ category.

5. Two important pieces of equipment needed for use during a medical emergency are a/an _________________ and a/an _________________.

Short Answer 1. Explain the responsibility of each dental staff person during a medical emergency using the emergency team structure recommended in the text.

2. Explain the ASA Classification system.

CHAPTER 2 Multiple Choice 1. All of the following should be taken into account when developing an emergency kit EXCEPT: A. proximity to emergency department.

B. proximity to EMS. C. familiarity of dental team with kit contents.

D. age of dental team members.

2. Which of the following drugs is used for a severe allergic reaction?

A. Albuterol B. Chlorpheneramine C. Epinephrine D. None of the above 3. Which is the only emergency for which oxygen is NOT usually recommended?

A. Anaphylaxis B. Hyperventilation C. Hypoglycemia D. Asthma attack 4. Nitroglycerine is indicated for all of the following emergencies EXCEPT: A. cerebrovascular accident.

B. acute angina.

C. myocardial infarction.

D. heart failure.

5. Albuterol: A. is administered intramuscularly.

B. has a quick onset.

C. lasts about 30 minutes.

D. the adult dose is one spray and should not be repeated.

6. The appropriate dosage of aspirin for use in an MI is: A. 81 mg.

B. 162 mg.

C. one baby aspirin.

D. one-half baby aspirin.

7 An unconscious patient suffering from severe hypoglycemia should receive: A. oral carbohydrate.

B. SoluCortef IM. C. glucagon IM. D. nitroglycerine sublingually.

8. What is the pediatric dose of diphenhydramine?

A. 1 mg/kg of body weight B. 2 mg/kg of body weight C. 3 mg/kg of body weight D. 4 mg/kg of body weight 9. An automated external defibrillator is an additional item for the emergency kit to care for which emergency?

A. Asthma attack

B. Cardiac arrest C. Broken instrument tip D. Anaphylaxis

True/False 1. Diphenhydramine IM is used for moderate allergic reactions that include primarily dermatologic signs with some respiratory symptoms.

True False 2. The duration of action of albuterol is one to two hours.

True False 3. Administration of a corticosteroid is indicated for the prevention of a recurrence of an anaphylactic reaction.

True False 4. Nitroglycerine tablets lose their effectiveness in 12 weeks if exposed to light or air.

True False 5. An injectable benzodiazepine is necessary for the management of cerebrovascular accident.

True False

Fill in the Blank 1. A/an _________________ is a magnetized device used for the removal of broken instrument tips.

2. A/an _________________ should be included in the emergency kit to determine if a patient is suffering from pyrexia.

3. The use of steroids will help in the management of an allergic reaction by reducing the release of _________________.

4. An oral carbohydrate is necessary to reduce the symptoms of _________________ in a conscious patient.

5. The MOST important component of the emergency kit is _________________.

Short Answer Questions 1. List the essential drugs of an emergency kit.

2. List the supplemental drugs of an emergency kit.

CHAPTER 3 Multiple Choice 1. Your patient’s pulse rate is 102. This would be considered: A. normal.

B. bradycardia.

C. tachycardia.

D. none of the above.

2. What is the MOST common artery used to take a patient’s pulse rate in the dental office?

A. Radial B. Branchial C. Femoral D. Carotid 3. All of the following are common causes of tachycardia EXCEPT: A. fever.

B. exercise.

C. stimulant drugs.

D. syncope.

4. The strength of the pulse against the blood vessel is referred to as the: A. cardiac output.

B. pulse.

C. stroke volume.

D. pulse pressure.

5. The use of oxygen and the production of carbon dioxide and their exchange between the cells and blood is: A. internal respiration.

B. external respiration.

C. bradypnea.

D. orthopnea.

6. Brain damage or coma can occur if a patient has oxygen deprivation lasting for: A. 1 minute.

B. 3 minutes.

C. 5 minutes.

D. 10 minutes.

7. Your patient’s respiratory rate is 16 per minute. This would be considered: A. normal.

B. bradypnea.

C. hypernea.

D. orthopnea.

8. Cyclic patterns of increased rate and depth of breathing alternating with periods of apnea is referred to as: A. Kussmaul respirations.

B. Biot’s respirations.

C. Cheyne-Stokes respirations.

D. None of the above.

9. All of the following are factors that affect respiration rate EXCEPT: A. age.

B. body position.

C. exercise.

D. temperature.

10. Your patient has a blood pressure of 180/110. This would be considered: A. prehypertension.

B. Stage I hypertension.

C. Stage II hypertension.

D. normal blood pressure.

11. The force of blood against the blood vessel walls during ventricular contraction is: A. systolic blood pressure.

B. diastolic blood pressure.

C. pulse pressure.

D. hypertension.

12. All of the following factors affect blood pressure EXCEPT: A. blood volume.

B. blood viscosity.

C. blood stenosis.

D. blood vessel resistance.

13. Normal blood pressure in children is based on their age, sex, and height and is at the _____ percentile or lower.

A. 54th B. 76th C. 89th D. 95th 14. The FIRST sound you hear when deflating the blood pressure cuff is the: A. diastolic blood pressure.

B. systolic blood pressure.

C. pulse pressure.

D. radial pulse.

15. The blood pressure cuff should be inflated: A. 20–30 mmHg higher than the reading when you no longer feel the radial pulse.

B. to 200 mmHg. C. until the branchial pulse is no longer heard in the stethoscope.

D. none of the above.

16. A temperature of 99.8 degrees is considered: A. normal.

B. hypothermia.

C. low grade.

D. pyrexia.

17. Individuals with hypertension are at higher risk for: A. cerebrovascular accident.

B. diabetes.

C. seizures.

D. asthma.

18. All of the following would be types of end organ damage signifying hypertensive emergency EXCEPT: A. cerebral hemorrhage.

B. liver failure.

C. renal insufficiency.

D. aortic dissection.

19. Symptoms of orthostatic hypotension include: A. dimming of vision.

B. increased blood pressure.

C. tachycardia.

D. all of the above.

20. All of the following are symptoms of hypertensive urgency EXCEPT: A. dysarthria.

B. headache.

C. tinnitus.

D. epistaxis.

True/False 1. A reduction in systolic or diastolic blood pressure of 15–20 mmHg is considered hypotension.

True False 2. Hypertensive urgency is a significant severe rise in blood pressure with target end organ damage.

True False 3. Patients with hypertension have a 70% increased risk of cerebrovascular accident.

True False 4. Normal pulse rate is approximately 90–120 beats per minute.

True False 5. External respiration is the intake of oxygen and elimination of carbon dioxide via the lungs.

True False 6. Cessation of breathing is termed tachypnea.

True False 7. Biot’s respirations are characterized by periods of shallow breathing alternating with periods of apnea.

True False 8. Stridor is a high-pitched sound usually heard on respiration.

True False 19. A normal adult diastolic reading is 60–80 mmHg. True False

Fill in the Blank 1. An irregular pulse is indicative of a/an _________________.

2. Labored breathing is termed _________________.

3. A heart rate of less than 60 beats per minute is _________________.

4. Normal breathing is _________________.

5. _________________ ______________ are an increased depth and rate of respirations over 20 per minute.

6. _________________ may occur in children with extremely high fevers.

7. _________________ is a state in which the individual’s body temperature is below normal range.

8. A normal adult pulse pressure is _________________.

9. The devices used to take a manual blood pressure reading are a stethoscope and a/an _________________.

10. The condition that was formerly known as hypertensive crisis is _________________.

Short Answer 1. Explain the importance of baseline vital signs as it relates to medical emergencies in the dental office.

2. Explain the difference between hypertensive emergency and hypertensive urgency.

3. State the appropriate treatment for hypertensive urgency.

CHAPTER 4 Multiple Choice 1. A size E oxygen cylinder will provide _____ minutes of oxygen.

A. 15 B. 30 C. 45 D. 60 2. The portion of the oxygen equipment that allows the operator to determine the amount of oxygen delivered to a patient is the: A. regulator.

B. reducing valve.

C. flow meter.

D. cylinder.

3. The preferred type of oxygen delivery device used for patients in cardiac arrest is: A. nasal cannula.

B. non-rebreather bag.

C. bag mask.

D. pocket mask.

4. The amount of oxygen delivered through a bag mask is: A. 2–4 liters/minute.

B. 4–6 liters/minute.

C. 8–12 liters/minute.

D. an oxygen tank should not be used with this device.

5. To determine that you have a tight seal with a bag mask the operator should look for: A. the chest to rise.

B. the pupils to constrict.

C. the nasal passages to dilate.

D. none of the above.

True/False 1. The reducing valve allows for the safe release of the highly pressurized oxygen.

True False 2. The nasal cannula rests on the tip of the patient’s nose and is looped around the ears.

True False 3. The non-rebreather bag has a one-way valve on the exhalation port to prevent room air from entering the mask.

True False

4. A non-rebreather bag is recommended for patients suffering from an asthma attack or angina pectoris.

A. True B. False 5. When applying the bag mask, the third, fourth, and fifth fingers should be placed on the bony portion of the mandible and the thumb and index finger placed on the mask to attain a tight seal.

A. True B. False

Fill in the Blank 1. Oxygen tanks are _________________ in color.

2. A size _________________ oxygen cylinder is recommended for dental office use.

3. The amount of oxygen delivered to a patient via a nasal cannula is _________________ to _________________ Liters per minute.

4. The structure to which the reducing valve and flow meter are joined is the _________________.

5. To maintain an open airway while using the bag mask the _________________ should be used.

Short Answer 1. List the three different types of oxygen delivery devices and provide one emergency for which each type is used.

2. List the different parts of the oxygen tank.

CHAPTER 5 Multiple Choice 1. Syncope: A. is a primary disease process.

B. is often associated with a stressful situation.

C. is caused by increased cerebral oxygenation.

D. all of the above.

2. In children syncope is often caused by: A. dehydration.

B. lack of sleep.

C. coughing.

D. medications.

3. The type of syncope often observed as a result of hyperventilation or metabolic diseases is: A. cardiac syncope.

B. noncardiac syncope.

C. vasovagal syncope.

D. neurocardiac syncope.

4. Forced expiratory effort against a closed airway, such as when an individual holds his/her breath and tightens the muscles in a concerted, strenuous effort is: A. micturition.

B. Valsalva maneuver.

C. hyperventilation.

D. orthostatic hypotension.

5. The type of syncope that is often associated with some noxious stimuli is: A. cardiac.

B. noncardiac.

C. neurocardiogenic.

D. all of the above.

6. Activation of the sympathetic nervous system during vasodepressor syncope with a lack of physical activity will lead to: A. tachycardia.

B. cerebral ischemia.

C. hypertension.

D. Valsalva maneuver.

7. All of the following are signs and symptoms of presyncope EXCEPT: A. pupil constriction.

B. diaphoresis.

C. piloerection.

D. yawning.

8. The patient in syncope should be positioned: A. supine with head and feet parallel.

B. supine with feet above the head.

C. semisupine.

D. upright.

9. Reoccurrence of another syncopal event is at higher risk for the first _____ hours.

A. 24 B. 36 C. 48 D. 72 10. If the patient remains in syncope for an extended period of time it is more likely that he or she will experience a/an: A. CVA. B. seizure.

C. coma.

D. hypertensive emergency.

True/False 1. Arrhythmias are a common cause of syncope.

True False 2. Hair grooming and neck stretching can result in syncope.

True False 3. Syncope as a result of hypoglycemia would be considered vasodepressor syncope.

True False 4. Presyncopal symptoms indicate a 20–30% reduction in blood flow to the brain.

True False 5. The amount of oxygen that should be delivered to a patient suffering from syncope is 4–6 liters/minute.

True False

Fill in the Blank 1. The type of syncope that occurs as a result of serious underlying heart disease is _________________ syncope.

2. The syncopal episode that occurs when returning patients to an upright position from a supine position is often the result of _________________ _________________.

3. The skin color of a syncopal patient will be _________________.

4. _________________ is the MOST common medical emergency in the dental office.

5. Once consciousness is lost from syncope the pulse will be _________________ and _________________.

Short Answer 1. Explain four stress-reduction protocols for patients with a history of vasovagal syncope.

2. List the signs and symptoms of syncope and the appropriate treatment for this condition.

CHAPTER 6 Multiple Choice 1. Which stage of shock is characterized by failure of the vital organs and is irreversible?

A. Refractory B. Compensatory C. Progressive D. Initial 2. Severe hemorrhage or dehydration can lead to which type of shock?

A. Obstructive B. Anaphylactic C. Hypovolemic D. Cardiogenic 3. In hypovolemic shock, the blood loss causes the body to initially compensate by: A. increasing heart rate.

B. decreasing heart rate.

C. heart rate is unaffected.

D. none of the above.

4. In all forms of shock the MOST important step for treatment is to: A. administer oxygen.

B. administer IV fluids.

C. contact EMS immediately.

D. none of the above.

5. All of the following are common etiologies of cardiogenic shock EXCEPT: A. cerebrovascular accident.

B. myocardial infarction.

C. cardiac arrhythmias.

D. cardiac dysfunction.

6. The blood pressure of a patient in cardiogenic shock will be: A. elevated.

B. reduced.

C. stable.

7. Which of the following forms of shock is considered to be in the distributive shock category?

A. Septic B. Cardiogenic C. Hypovolemic D. Obstructive 8. The type of shock caused by a severe allergic response is: A. septic.

B. obstructive.

C. cardiogenic.

D. anaphylactic.

9. All of the following are signs of septic shock EXCEPT: A. fever.

B. increased cardiac output.

C. tissue edema.

D. pale, cool skin.

10. Your patient has a disease of the brain stem and is now in shock. From which form of shock would you suspect he is suffering?

A. Obstructive B. Neurogenic C. Cardiogenic D. Septic 11. The primary symptom of obstructive shock is: A. severe hypotension.

B. bronchiole constriction.

C. increased urination.

D. none of the above.

12. During shock the body tissues attempt to use anaerobic metabolic processes that produces _____, which is harmful to the cardiovascular system.

A. alkalosis B. acidosis C. hemorrhage D. nocturia

True/False 1. During the initial stage of shock the cells are deprived of oxygen inhibiting their ability to produce energy.

True False 2. Cell death and damage occur during the refractory stage of shock.

True False 3. Due to fluid loss in hypovolemic shock, the body initially compensates by decreasing the heart rate.

True False 4. The skin of a person in cardiogenic shock will be cold, clammy, and cyanotic.

True False 5. Septic shock occurs due to an invasion of bacteria, particularly gram-negative bacilli, into the bloodstream.

True False 6. Hypertension and tachycardia are common symptoms of neurogenic shock.

True False 7. Surgical intervention is common for the treatment of obstructive shock.

True False 8. Septic shock is usually seen in the elderly and critically ill individuals.

True False

Fill in the Blank 1. A reduction in urine output is termed _________________.

2. The stage of shock when the compensatory mechanisms of the body are beginning to fail is the _________________ stage.

3. A patient suffering from hypovolemic shock due to internal hemorrhage will require a/an _________________ _________________.

4. Beta-blockers, vasodilators, and positive inotropes are medications usually given for the treatment of _________________ shock.

5. Antimicrobial therapy and fluid resuscitation are needed for the treatment of _________________ shock.

6. _________________ _________________ is the compression of the heart produced by blood accumulating in the pericardial sac.

Short Answer 1. List four types of shock and their associated etiologies.

2. Explain the basic treatment for a patient suffering from any type of shock.

CHAPTER 7 Multiple Choice 1. Respirations per minute for a patient suffering from hyperventilation will be: A. 6–10.

B. 10–16.

C. 16–20.

D. 22–40.

2. The lack of carbon dioxide during hyperventilation produces a condition called: A. respiratory alkalosis.

B. respiratory acidosis.

C. hypocalcemia.

D. pulmonary embolism.

3. All of the following are manifestations of the hypocalcemia caused by progressive hyperventilation EXCEPT: A. tetany.

B. Chvostek’s sign.

C. carpopedal spasms.

D. impaired vision.

4. The MOST common etiology of hyperventilation is: A. cerebral ischemia.

B. psychological event.

C. pregnancy.

D. cardiac arrhythmia.

5. The condition for which the symptoms of hyperventilation are often mistaken is: A. pulmonary embolus.

B. cerebral embolus.

C. cardiac embolus.

D. none of the above.

6. A significant method to differentiate hyperventilation from pulmonary embolism is: A. presence of circumoral parasthesia.

B. increased rate of breathing.

C. presence of diaphoresis.

D. presence of dizziness.

7. The previous treatment of hyperventilation of breathing into a paper bag has been discontinued, as it has been shown to cause: A. suffocation.

B. syncope.

C. CVA. D. pulmonary embolism.

8. The appropriate position for treatment of a patient suffering from hyperventilation is: A. supine.

B. semisupine.

C. upright.

D. trendelenberg.

9. The recommended medication to administer to a patient who is suffering from uncontrolled and continuous hyperventilation is: A. lorazepam.

B. nitrous oxide.

C. albuterol.

D. aspirin.

10. All of the following are symptoms of improper cerebral oxygenation during hyperventilation EXCEPT: A. impaired problem-solving abilities.

B. dizziness.

C. Chvostek’s sign.

D. impaired vision.

True/False 1. Carpopedal spasms seen in hyperventilation are caused by hypocalcemia.

True False

2. Females in the 50–60 age range are the group MOST likely to suffer from hyperventilation.

True False 3. Heart palpitations and chest pain during hyperventilation result from vasodilation of the coronary blood vessels leading to increased cardiac output.

True False 4. A pulmonary embolism is a blockage of the pulmonary artery by some type of obstruction.

True False 5. The MOST important step in the control of hyperventilation is to work with the patient to control his or her rate of respirations.

True False 6. Hyperventilation is common in individuals who are exposed to high altitudes, are pregnant, and experience anxiety states.

True False

Fill in the Blank 1. Lack of carbon dioxide in the arterial blood system resulting from hyperventilation is termed _________________.

2. Respiratory alkalosis associated with hyperventilation is indicated by a rise in the pH of the blood above _________________.

3. Sharp flexion of the wrists and ankles associated with hyperventilation is termed _________________ ________________.

4. The level of carbon dioxide in the bloodstream of an individual suffering from hyperventilation will quickly fall from the normal level of _________________ mmHg resulting in significant physiologic effects.

5. Treatment of hyperventilation involves having the patient breathe through _________________ _______________ to help slow breathing.

Short Answer 1. List six symptoms associated with hyperventilation.

2. Describe the management of hyperventilation.

CHAPTER 8 Multiple Choice 1. A seizure caused by stress, hypoglycemia, or fever would be considered: A. congenital.

B. hereditary.

C. isolated, unprovoked.

D. generalized, provoked.

2. _____% of seizures are idiopathic.

A. 20 B. 30 C. 40 D. 50 3. The MOST common neurological disorder seen in pediatric patients is: A. CVA. B. myocardial infarction.

C. diabetes mellitus.

D. seizures.

4. Which of the following are used to classify seizure disorders?

A. Aura B. Duration C. Etiology D. All of the above 5 .Which of the following are etiologies of secondary seizures?

A. Metabolic disorders B. CNS injuries C. Medications D. All of the above 6. The type of seizure caused by exposure to flickering lights is: A. meningeal seizures.

B. photosensitive epilepsy.

C. hypoxic seizures.

D. ischemic epilepsy.

7. Which of the following would be the MOST likely cause of a seizure in the dental setting?

A. Asthma B. Syncope C. Tetanus D. CNS tumor 8. An aura is now considered a: A. simple partial seizure.

B. complex partial seizure.

C. generalized tonic-clonic seizure.

D. febrile seizure.

9. Which phase of a generalized tonic-clonic seizure is characterized by the patient falling if standing?

A. Prodromal B. Preictal C. Ictal D. Postictal 10. Respiratory arrest is MOST likely to occur during which phase of the tonic-clonic seizure?

A. Prodroma B. Ictal C. Preictal D. Postictal 11. Which of the following is TRUE of generalized absence seizures?

A. Episode usually lasts 2–5 minutes B. Patients will remember the episode once it has ceased C. Blinking and eye rolling are common D. Usually seen in geriatric individuals 12. Which of the following is associated with increased seizure activity?

A. Sleep deprivation B. Stress C. Hormonal imbalances D. All of the above 13. One of the MOST common adverse reactions to many antiseizure medications is: A. sedation.

B. hyperactivity.

C. hypoglycemia.

D. hyperglycemia.

14. All of the following times are optimal for providing dental treatment to the seizure patient EXCEPT: A. late afternoon appointments.

B. after the patient has eaten breakfast.

C. within a few hours of taking medication.

15. The primary task of the dental professional in the treatment of a seizure is to: A. determine the etiology of the seizure.

B. prevent injury to the patient.

C. provide treatment to cause the cessation of the seizure.

D. administer antiseizure medication.

16. All of the following are symptoms of status epilepticus EXCEPT: A. decreased body temperature.

B. bradycardia.

C. significantly elevated blood pressure.

D. severe hypotension.

True/False 1. A seizure or convulsion is characterized by spontaneous, electric discharges from neurons in the cerebral cortex.

True False 2. Seizures are usually life threatening.

True False 3. Rapid withdrawal of addictive drugs may cause a primary seizure.

True False 4. After age 60, cerebrovascular diseases are the MOST common cause of seizures.

True False

5. Generalized absence seizures often have a genetic tendency and respond well to medication.

True False 6. Fractured teeth and soft tissue scarring are commonly seen during the extra oral examination of seizure patients.

True False 7. A mouth prop should be placed in the patient’s mouth during a generalized tonic-clonic seizure to prevent swallowing of the tongue.

True False

Fill in the Blank 1. The procedure used to determine the electric activity in the brain is a/an _________________.

2. The condition where seizures do NOT stop or begin again shortly after recovery is termed _________________ _______________.

3. Secondary seizures account for _________________% of seizure disorders.

4. Seizure-provoking medications are referred to as _________________.

5. Subjective, sensory symptoms occurring at the onset of a seizure is a/an _________________.

6. The _________________ phase of the seizure is characterized by the patient having an auditory, visual, or gustatory sensation.

7. Generalized absence seizures are rare after the age of _________________.

8. Minor facial movements associated with generalized absence seizures are called _________________.

9. Isolated seizures in well-controlled adult seizure patients are referred to as _________________ seizures.

10. The MOST important procedure in treating the postictal phase of a GTCS is _________________ _________________ ______________.

Short Answer 1. List the signs and symptoms of a generalized tonic-clonic seizure and the appropriate treatment for this condition.

2. List the four phases of a generalized tonic-clonic seizure.

CHAPTER 9 Multiple Choice 1. During a CVA there is a lack of oxygen to the cerebral tissues or: A. aneurysm.

B. ischemia.

C. infarction.

D. embolus.

2. All of the following are risk factors for a CVA EXCEPT: A. increasing age.

B. atherosclerosis.

C. black race.

D. middle-aged women.

3. Atherosclerosis is a common etiology of CVAs due to the formation of: A. thrombi.

B. emboli.

C. clots.

D. all of the above.

4. Individuals suffering from atrial fibrillation are more prone to CVAs due to an increase in: A. aneurysms.

B. blood pressure.

C. thrombi.

D. none of the above.

5. A brief episode of neurological dysfunction caused by ischemia of the brain lasting less than one hour is a/an: A. TIA (transient ischemic attack).

B. aneurysm.

C. embolus.

D. fibrillation.

6. The MOST common type of CVA is: A. thrombotic.

B. embolic.

C. intracerebral hemorrhage.

D. subarachnoid hemorrhage.

7. The central zone of ischemia of a CVA is the: A. penumbra.

B. core.

C. medulla.

D. subarachnoid.

8. All of the following are factors leading to a hemorrhagic CVA EXCEPT: A. substance abuse.

B. hypertension.

C. atrial fibrillation.

D. aneurysm.

9. Which area of the brain has pressure placed on it during a subarachnoid hemorrhage?

A. Cerebrum B. Cerebellum C. Pons D. Medulla 10. What is the major difference between the signs and symptoms of a thrombotic and an embolic CVA? A. Embolic strokes have a more abrupt onset B. Thrombotic strokes have a more abrupt onset C. Embolic strokes tend to cause unconsciousness more often D. Thrombotic strokes tend to cause unconsciousness more often 11. The pupils of CVA patients are often: A. equal and dilated.

B. equal and constricted.

C. unequal and dilated.

D. unequal and constricted.

12. A specific sign of a subarachnoid CVA is: A. headache.

B. papillary malalignment.

C. hypertension.

D. neck pain.

True/False 1. Individuals suffering from TIAs are less likely to suffer from CVAs. True False 2. Hemorrhagic strokes have a higher mortality rate than do occlusive strokes.

True False 3. CVA is the fifth leading cause of death in the United States with nearly 200,000 new cases per year.

True False 4. Women taking oral contraceptives and diabetics are at higher risk for CVAs. True False 5. Thrombolytic agents are the treatment of choice for hemorrhagic CVAs. True False 6. An increased blood pressure reading is a symptom usually associated with hemorrhagic CVA. True False

Fill in the Blank 1. _________________ _________________ is now being used as a common lay term for a CVA to educate the public regarding the seriousness of the condition.

2. Approximately _________________ % of all CVAs are the hemorrhagic type.

3. Thrombolytic agents have been found to be effective if given within _________________ hours of the onset of symptoms.

4. The first and MOST important step in the treatment of a suspected CVA would be to _________________ _______________.

5. The area of ischemic tissue surrounding the core of the CVA is known as the _________________ and is potentially salvageable.

6. A/an _________________ is a weakening or ballooning of a blood vessel which, if it bursts, can lead to a CVA.

Short Answer 1. Discuss the difference between a TIA and a CVA.

2. Explain the process for administration of the Prehospital Cincinnati Stroke Scale.

3. List the signs and symptoms of a cerebrovascular accident and the appropriate treatment for this condition.

CHAPTER 10 Multiple Choice 1. The MOST common cause of ischemic heart disease is: A. atherosclerosis.

B. hypertension.

C. diabetes.

D. none of the above.

2. The pathological condition of the myocardium that is reversible and caused by a lack of oxygen to the tissue is” A. CVA. B. myocardial infarction.

C. angina.

D. pulmonary edema.

3. Which of the following are risk factors for CAD that cannot be changed?

A. Gender B. Increased age C. Heredity D. All of the above 4. All of the following are risk factors for CAD that are modifiable EXCEPT: A. race.

B. obesity.

C. high cholesterol.

D. physical activity.

5. Which of the following poses a greater risk for CAD in women than in men?

A. Elevated HDL B. Increasing age C. Heredity D. Smoking 6. MOST new onset coronary artery disease occurs after age: A. 35.

B. 45.

C. 55.

D. 65.

7. The highest CAD mortality rates in the United States occur in which ethnic group?

A. Caucasian B. African Americans C. Hispanic D. Asians 8. Approximately _____ of adults are unaware that they are hypertensive.

A. 10% B. 20% C. 30% D. 40% 9. All of the following are true of cigarette smoking EXCEPT one. Which one is the exception?

A. Accelerates the development of coronary plaques

B. Decreases plaque rupture C. Promotes coronary thrombosis 10. Your patient’s blood pressure is 130/84. This is considered: A. normal.

B. prehypertension.

C. stage I hypertension.

D. stage II hypertension.

11. Your patient’s blood pressure is 152/96. This is considered: A. normal.

B. prehypertension.

C. stage I hypertension.

D. stage II hypertension.

12. Optimal total serum cholesterol levels are less than: A. 200 mg/dL. B. 250 mg/dL. C. 300 mg/dL. D. 350 mg/dL. 13. Which of the following can cause damage to the arterial walls?

A. Diabetes B. Tobacco smoke C. High cholesterol D. All of the above 14. The type of angina that presents with predictable and reproducible discomfort in the left area of the chest lasting from 1–15 minutes induced by some form of stress is: A. stable.

B. unstable.

C. variant.

D. Prinzmetal’s.

15. Which of the following is an etiology of unstable angina?

A. A nonocclusive thrombus on a preexisting plaque B. A coronary spasm C. Inflammation or infection of the heart D. All of the above 16. The type of angina that is referred to as atypical or vasoplastic and occurs spontaneously is: A. stable.

B. unstable.

C. variant.

D. Prinzmetal’s.

17. All of the following are true of Prinzmetal’s angina EXCEPT one. Which one is the exception?

A. More common in women under 50 B. Occurs while the person is exercising C. Occurs at odd hours of the day and night D. Can occur in persons without coronary artery disease 18. All of the following are signs and symptoms of an anginal attack EXCEPT one. Which one is the exception?

A. Pressure, burning, or heaviness in the chest area B. Hypotension C. Diaphoresis D. Pallor 19. All of the following are precipitating factors of an anginal attack EXCEPT one. Which one is the exception?

A. Exercise B. Full stomach C. Low altitude D. Smoking 20. The appropriate dosage of nitroglycerine for an anginal attack is: A. .1–.3 mg.

B. .3–.6 mg.

C. .6–.9 mg.

D. .9–.12 mg.

21. If an anginal patient is experiencing chest pain that has NOT responded to two doses of nitroglycerine in a 10-minute period the clinician should: A. provide the patient with a double dose of nitroglycerine.

B. administer atropine 10 mg IM. C. call 9-1-1.

D. none of the above.

22. Dysrhythmia may present as: A. bradycardia.

B. atrial tachycardia.

C. diastole.

D. none of the above.

23. The classic sign of an acute myocardial infarction is: A. chest pain lasting 20 minutes or longer.

B. sharp pain in the chest.

C. pain radiating down the right arm and upper back.

D. regular pulse rate.

24. If chest pain treated with nitroglycerine diminishes and then returns, the patient: A. is ready to be sent home.

B. should be managed as an AMI. C. should be given 10 mg atropine IM. D. none of the above.

25. The appropriate dosage of aspirin to be administered to a patient suspected of experiencing an AMI is: A. 42–81 mg.

B. 81–162 mg.

C. 162–325 mg.

D. aspirin should not be given to a patient suspected of experiencing an AMI. 26. Aspirin given to a suspected AMI patient works due to its: A. antithrombotic effect.

B. analgesic effect.

C. antiinflammatory effect.

D. all of the above.

True/False 1. All chest pain is cardiac in origin.

True False 2. CAD is the leading cause of death in women in the United States.

True False

3. Endogenous estrogens seem to negatively affect cardiovascular health.

True False 4. African American women have higher CAD mortality rates than non-Hispanic women.

True False 5. In individuals over the age of 50, systolic blood pressure is a more important risk factor for cardiovascular disease than diastolic blood pressure.

True False 6. An LDL level of 180 is considered high and places the individual at risk for atherosclerosis.

True False 7. Approximately 30% of patients with diabetes die from some form of cardiovascular disease or complication.

True False 8. Ischemic heart disease, commonly angina or myocardial infarction, is the third leading cause of death in the United States.

True False 9. Patients with stable angina can receive dental care, but should be scheduled for short, minimally stressful appointments.

True False 10. Vasoconstrictors in local anesthetics are acceptable to use on patients with unstable angina.

True False 11. Patients with unstable angina should only receive emergency dental treatment following consultation with a physician.

True False 12. Early morning appointments are recommended for anginal patients as endogenous epinephrine levels peak after this time of day.

True False 13. The chest pain associated with an anginal attack is often described as sharp and severe.

True False

Fill in the Blank 1. The greatest number of deaths in the United States each year occur as a result of complications from _________________ _______________ _______________.

2. The use of _________________ _____________ _______________ in postmenopausal women decreases the risk for CAD. 3. Smokers are _________________ to _________________ times more likely to develop CAD than nonsmokers.

4. _________________ % of patients being treated for hypertension are NOT controlled to blood pressure levels below 140/90.

5. A waxlike substance made in the liver that leads to atherosclerosis is known as _________________.

6. _________________ is a term referring to the damage done to large blood vessels in diabetics as a result of atherosclerosis.

7. A slow, complex inflammatory arterial disease that starts in childhood and often progresses with age is _________________.

8. When a patient presses his or her fist to the sternum it is referred to as the _________________ _______________.

9. Nitroglycerine is contraindicated in patients with _________________.

10. Nitroglycerine will normally reduce or eliminate anginal symptoms within a/an _________________ to _________________ minute time frame.

11. A necrosis of a portion of the myocardium due to total or partial occlusion of a coronary artery is a/an _________________ ________________ _______________.

12. _________________ dilates the coronary blood vessels to decrease cardiac work load in an anginal attack.

Short Answer 1. List six risk factors for coronary heart disease.

2. Describe the appropriate treatment for a patient suffering from angina pectoris in the dental setting.

3. Describe the appropriate treatment for a patient suffering from myocardial infarction in the dental setting.

CHAPTER 11 Multiple Choice 1. The condition that occurs when the heart muscle is impaired and can NO longer pump efficient volumes of oxygenated blood to the body’s tissues and organs is: A. hypertension.

B. pulmonary edema.

C. atherosclerosis.

D. heart failure.

2. Which is the MOST frequent cause of heart failure?

A. Myocardial infarction B. Diabetes mellitus C. Valvular heart disease D. Degenerative heart conditions 3. Nonvascular conditions associated with heart failure include all of the following EXCEPT one. Which one is the exception?

A. Thyroid disease B. Cerebrovascular accident C. Pulmonary disease D. Renal insufficiency 4. The cardinal sign of left heart failure is: A. diaphoresis.

B. dyspnea.

C. pitting.

D. pulmonary edema.

5. The backup of fluid into the lungs seen in left ventricular heart failure often leads to: A. pulmonary edema.

B. cardiac arrhythmias.

C. myocardial infarction.

D. none of the above.

6. Heart failure patients being treated in the dental office often require: A. longer appointment times.

B. nitrous oxide sedation.

C. upright positioning.

D. premedication with antibiotics.

7. Edema of the abdomen in patients with heart failure indicates: A. progression of right heart failure to liver and spleen engorgement.

B. edema of the central nervous system.

C. renal failure.

D. arrhythmias.

8. All of the following are symptoms of right heart failure EXCEPT one. Which one is the exception?

A. Pitting edema B. Distended jugular veins C. Nocturia D. Pulmonary edema 9. The use of a local anesthetic agent containing epinephrine may cause a significant rise in blood pressure in heart failure patients taking: A. calcium channel blockers.

B. diuretics.

C. beta-blockers.

D. statins.

10. ASA Class III heart failure patients present with fatigue, dyspnea, and orthopnea at all times. Class III heart failure patients present a definite risk and the patient should be treated in a hospital setting.

A. The first statement is true; the second statement in false.

B. The first statement is false; the second statement is true.

C. Both statements are true.

D. Both statements are false.

11. All of the following are symptoms of heart failure EXCEPT one. Which one is the exception?

A. Excessive unexplained weight gain B. Cyanosis of lips and nailbeds C. Prominent carotid artery when patient is sitting upright D. Grayish-blue mucous membranes 12. The MOST dramatic life-threatening symptom of right heart failure is pulmonary edema. Acute pulmonary edema is the result of rapid accumulation of fluid in the lungs.

A. The first statement is true; the second statement is false.

B. The first statement is false; the second statement is true.

C. Both statements are true.

D. Both statements are false.

13. All of the following statements describe a bloodless phlebotomy EXCEPT one. Which one is the exception?

A. Tourniquets or blood pressure cuffs are applied to three extremities at a time.

B. The tourniquet or blood pressure cuff should be tight enough so that an arterial pulse can be felt mesial to the tourniquet/cuff.

C. The pressure applied to the cuff should be less than the systolic pressure and greater than the diastolic pressure.

D. The cuffs should be placed four inches below the shoulder and six inches above the groin.

14. For a patient experiencing acute pulmonary edema, oxygen should be administered via a nonrebreather bag at a rate of: A. 2–3 liters/minute.

B. 4–6 liters/minute.

C. 6–8 liters/minute.

D. 10 or more liters/minute.

True/False 1. The number of patients suffering from heart failure is increasing as the population is living longer.

True False 2. Heart failure results from almost any kind of cerebrovascular disease.

True False 3. Symptoms of left heart failure are MORE prominent at night.

True False 4. Right heart failure usually occurs before left heart failure.

True False 5. Cheyne-Stokes respirations are common with left heart failure due to the increased time it takes for the blood to be circulated from the heart to the brain.

True False 6. Congestion of the GI tract can cause nausea, vomiting, and anorexia in heart failure patients.

True False 7. Statins and diuretics are often used to treat heart failure resulting from hypertension.

True False 8. A patient suffering from acute pulmonary edema should be placed in a supine position.

True False

9. Nitroglycerin is indicated in the treatment of acute pulmonary edema in patients with a blood pressure below 95/75.

True False 10. A meal high in sodium may precipitate acute pulmonary edema in patients with heart failure.

True False

Fill in the Blank 1. The physiological and psychological stress of the dental appointment can _________________ the symptoms of heart failure.

2. Difficulty breathing during sleep that causes the patient to awaken gasping for air is _________________ _______________ _______________.

3. _________________ is difficulty breathing while in a supine position.

4. A dry, nonproductive cough is associated with patients suffering from _________________ heart failure.

5. The alternation between strong and weak pulses seen in left heart failure patients is termed _________________ ________________.

6. Patients diagnosed with heart failure presenting as mild dyspnea and fatigue are considered ASA Class _________________.

7. A patient presenting with heart failure in the dental setting should be placed in a/an _________________ position or _________________ position for treatment.

8. Patients with heart failure may present with an elevated blood pressure and especially an elevated _________________ blood pressure.

9. _________________ _____________ lung sounds indicate the terminal stages of acute pulmonary edema.

10. _________________ _______________ or malnutrition and wasting of the tissues may be evident in the late stage of heart failure.

Short Answer 1. Compare the signs and symptoms of right heart failure versus left heart failure.

2. Describe the appropriate treatment for a patient suffering from heart failure in the dental setting.

3. List the signs and symptoms of pulmonary edema and the appropriate treatment for this condition.

CHAPTER 12 Multiple Choice 1. The portion of the pacemaker that powers the device is the:

A. lead.

B. generator.

C. curing light.

D. TENS. 2. Tachyarrhythmias can cause all of the following symptoms EXCEPT: A. dizziness.

B. palpitations.

C. syncope.

D. increased cardiac output.

3. Which of the following is NOT safe to use with cardiac pacemaker patients?

A. Dental handpieces B. Curing lights C. TENS D. Radiographs 4. All of the following are symptoms of pacemaker malfunction EXCEPT: A. dizziness.

B. dyspnea.

C. regular pulse rate.

D. hiccoughing.

5. The MOST important step in the management of pacemaker malfunction is to: A. turn off possible interference source.

B. monitor pulse rate.

C. administer 4–6 liters/minute of oxygen.

D. monitor blood pressure.

True/False 1. The number of cardiac pacemakers and ICD implants is on the decline.

True False 2. Once a pacemaker is implanted it will last for the lifetime of the patient.

True False 3. Pacemakers with bipolar electrodes are LESS sensitive to extraneous interference.

True False 4. Muscle twitching and swelling of the extremities are signs and symptoms of pacemaker malfunction.

True False 5. Electromagnetic interference is the MOST common form of pacemaker malfunction.

True False

Fill in the Blank 1. Pacemaker patients using electric toothbrushes should ensure a distance of at least _________________ between the toothbrush and their pacemaker.

2. Pacemakers are usually implanted for patients suffering from _________________.

3. ICDs are usually implanted for patients suffering from _________________.

4. The longevity of a pacemaker or ICD generator is usually _________________–_________________

years.

5. _________________ and _________________ are dental equipment safe to use with cardiac pacemakers.

6. _________________ and _________________ are dental equipment unsafe to use with cardiac pacemakers.

7. Electromagnetic interference may cause an ICD to erroneously interpret an arrhythmia and cause an inappropriate _________________.

Short Answer 1. List eight signs and symptoms of pacemaker malfunction.

2. Discuss the appropriate time to contact EMS during the treatment of pacemaker or ICD malfunction.

CHAPTER 13 Multiple Choice 1. Asthma is characterized by all of the following symptoms EXCEPT: A. pulmonary edema.

B. dyspnea.

C. wheezing.

D. coughing.

2. Asthma is the result of an abnormal _____ response in the bronchial airways.

A. immune B. biochemical C. nutritional D. none of the above 3. The chief physiological concern with asthma patients during an attack is: A. excess sputum production.

B. narrowing of the airways.

C. hypertension.

D. myocardial ischemia.

4. The high prevalence of asthma in urban settings has been linked to: A. overcrowding.

B. increased household insects.

C. air pollution.

D. increased mold spores.

5. All of the following are types of asthma EXCEPT: A. intrinsic.

B. extrinsic.

C. viral.

D. latent.

6. Which of the following would cause an extrinsic asthma attack in the dental office?

A. Taking a dental impression B. Self-imposed stress

C. Application of cold air to a tooth 7. The type of asthma attack where the patient has significant dyspnea and can only speak in phrases or partial sentences would be considered: A. mild.

B. moderate.

C. severe.

D. inconsequential.

8. Other than the patient’s own medication, the drug of choice for a patient suffering from an asthma attack is: A. epinephrine.

B. corticosteroids.

C. glucose.

D. albuterol.

9. The appropriate position for a patient suffering from an asthma attack is: A. upright with the head tilted to the side.

B. supine with the head tilted upright.

C. semisupine.

D. upright with the arms forward.

10. In addition to a constriction of the bronchioles the inflammatory response that occurs during an asthmatic attack results in: A. increased blood pressure.

B. decreased arrhythmias.

C. increased mucus production.

D. none of the above.

True/False 1. Stress-induced asthma is the type MOST likely to be seen in the dental setting.

True False 2. Intrinsic asthma is the MOST common type of asthma.

True False 3. Patients experiencing a severe asthma attack will have a rapid respiration rate and will only be able to speak in single words.

True False 4. Local anesthetics containing epinephrine are NOT recommended for asthmatic patients.

True False 5. Bacterial infections are the MOST common cause of infectious asthma.

True False

Fill in the Blank 1. The antibody that is specific for environmental allergens is _________________.

2. Examples of asthma _________________ ______________ include pollen, dust, and mold.

3. Asthma attacks that lead to total airway obstruction and respiratory tract failure are termed _________________ ____________________.

4. Albuterol is the drug of choice for an asthmatic attack as it is fast acting and lasts for a/an

_________________-hour period.

5. If albuterol is ineffective in treating the asthma attack patients may require the administration of _________________.

Short Answer 1. List the five types of asthma.

2. List the signs and symptoms of an asthma attack.

CHAPTER 14 Multiple Choice 1. All of the following are signs and symptoms of a partially obstructed airway EXCEPT: A. inability to cough or speak.

B. cyanosis.

C. wheezing.

D. dyspnea.

2. The FIRST step in the treatment of a partially obstructed airway is to: A. apply back blows.

B. position the patient upright.

C. perform the Heimlich maneuver.

D. place the patient in a supine position.

3. All of the following can be used for diagnosis of an aspirated foreign object EXCEPT: A. chest x-ray.

B. bronchoscopy.

C. CT scan.

4. The BEST method for the prevention of an obstructed airway in the dental office is: A. use of a rubber dam.

B. use of a gauze throat screen.

C. attaching dental floss to restorations and appliances.

D. all of the above.

5. Ingestion of a dental object could result in: A. abscesses.

B. collapsed lung.

C. stupor.

D. diaphoresis.

True/False 1. Patients with a completely obstructed airway will be unable to cough, speak, or breathe.

True False 2. One of the cardinal signs of an obstructed airway is the patient placing the hands in the area of the throat.

True False

3. The signs and symptoms of foreign body aspiration into the lungs are always severe and life threatening.

True False 4. A finger sweep should be performed on an unconscious patient suffering from an obstructed airway following chest compressions.

True False 5. Patients experiencing a partially obstructed airway with poor air exchange should be left untreated until they lose consciousness or the obstruction is removed.

True False

Fill in the Blank 1. A crowing noise or _________________ during breathing indicates a poor exchange of oxygen.

2. 90% of ingested dental objects pass through the digestive tract and are excreted within 2–12 _________________.

3. If a patient is still able to cough but is having difficulty breathing, this would be considered a/an _________________ obstruction.

4. Treatment of a conscious victim with a completely obstructed airway is by using the _________________ _________________.

5. In adults, foreign objects usually lodge in the _________________ bronchial tree.

Short Answer 1. List three methods that could be employed to prevent aspiration of a foreign body.

2. List the signs and symptoms of foreign body aspiration and the appropriate treatment for this condition.

CHAPTER 15 Multiple Choice 1. The MOST severe form of allergy is referred to as: A. epistaxis.

B. dyspnea.

C. anaphylaxis.

D. urticaria.

2. All of the following are factors that affect the severity of an allergic reaction EXCEPT: A. amount of the allergen.

B. rate of exposure.

C. route of exposure.

D. type of allergen.

3. The type of allergic reaction that is an immediate hypersensitivity caused by immunoglobulin E is: A. Type I. B. Type II. C. Type III. D. Type IV. 4. The FIRST time a patient is exposed to an allergen is referred to as the: A. challenge dose.

B. half-life dose.

C. sensitizing dose.

D. none of the above.

5. Following the challenge dose the mast cells and basophils: A. undergo degranulation and release chemical mediators.

B. destroy the allergen.

C. block the release of the chemical mediators and histamine.

D. none of the above.

6. Painless swelling of the lips, eyes, and hands during an allergic response is referred to as: A. bronchospasm.

B. pruritus.

C. angioedema.

D. rhinitis.

7. If a patient experiences an allergic reaction and the symptoms are resolved and then reoccur several hours later, this is referred to as a/an: A. anaphylactoid reaction.

B. biphasic reaction.

C. pruritic reaction.

D. all of the above.

8. All of the following are symptoms of a mild allergic reaction EXCEPT one. Which one is the exception?

A. Slight pruritus B. Angioedema C. Localized redness D. Mild edema 9. The drug of choice for an anaphylactic reaction is: A. epinephrine .3 mg 1: 1,000.

B. epinephrine .1 mg 1: 3,000.

C. diphenhydramine 50 mg.

D. diphenhydramine 100 mg.

10. All of the following are symptoms of a severe allergic response requiring immediate treatment EXCEPT: A. pruritus.

B. hypotension.

C. dyspnea.

D. laryngeal edema.

11. The drug of choice for a mild allergic response as it produces minimal drowsiness is: A. diphenhydramine 50 mg IM. B. epinephrine 1,000 mg IM. C. chlorpheneramine 10 mg orally.

D. hydrocortisone 25 mg orally.

12. The MOST reliable test to determine if a patient has a true allergy to a particular substance is the: A. skin prick test.

B. skin scratch test.

C. radioallergosorbent test.

D. all of the above are equally reliable.

13. The release of histamine during an allergic reaction causes: A. reduced vascular permeability.

B. systemic vasodilation.

C. reduced cardiovascular function.

D. smooth muscle relaxation.

14. Bronchospasm occurs during an allergic reaction due to the effect of the histamine on the: A. chronotropic factors.

B. inotropic factors.

C. alpha receptors.

D. beta receptors.

15. A patient with systemic symptoms, but with normal blood pressure, pulse, and respirations, would be considered to be having which type of allergic reaction?

A. Mild B. Moderate C. Severe D. None of the above

True/False 1. Patients who are experiencing an allergic reaction due to an allergen entering the body via an oral route are more likely to experience respiratory symptoms.

True False 2. A change in position from sitting to standing or vice versa can exacerbate allergic symptoms and can be potentially fatal due to the change in blood flow.

True False 3. Men and children are more likely to experience death from an allergic response from cardiovascular collapse or respiratory arrest.

True False 4. A delayed allergic response taking more than 12 hours to develop is considered a Type III allergic response.

True False 5. The initial exposure of an individual to an allergen is referred to as the sensitizing dose.

True False 6. In an allergy the particular antibody produced to attempt to fight off the antigen is IgA. True False 7. Smooth, raised, red lesions due to vasodilation of the capillaries is termed pruritus.

True False 8. Biphasic reactions commonly occur within 3–10 hours of the initial allergic response.

True False 9. Two areas where you should administer epinephrine during a severe allergic response are the deltoid

or quadriceps muscles.

True False 10. A positive result of the skin prick test will result in a small, raised area within 15 minutes of the injection.

True False

Fill in the Blank 1. Epinephrine _________________ the release of chemical mediators and therefore it is the drug of choice for severe allergic reactions.

2. The release of _________________ during an allergic response causes flushed skin tone, edema, urticaria, reduced blood pressure, and increased heart rate.

3. During an allergic response the effect of histamine on the beta 2 receptors in the lungs will result in _________________.

4. The appropriate dose of epinephrine for a child aged 6–12 years for a severe allergic reaction is _________________.

5. The _________________ test is performed in the laboratory to test for amounts of specific IgE antibodies.

6. The type of allergic reaction that is cytolitic in nature is Type _________________.

7. _________________% of the world population is estimated to have allergies.

8. A/an _________________ is a hypersensitive reaction to an ordinarily harmless substance.

9. After the primary introduction to the allergen the immunoglobulin attaches to the _________________ and _________________ and lies dormant until the body is exposed to the allergen a second time.

10. Severe hypotension due to a severe allergic response can lead to _________________ collapse.

Short Answer 1. List the treatments for each type of allergic reaction: mild, moderate, and severe.

2. List five common etiologies of allergic reactions.

CHAPTER 16 Multiple Choice 1. The MOST common form of diabetes mellitus is: A. Type I. B. Type II. C. Type III. D. gestational.

2. Which type of diabetes is characterized by the absolute lack of circulating insulin due to the destruction of the pancreatic beta cells?

A. Type I

B. Type II C. Impaired glucose tolerance D. Gestational 3. All of the following are possible sequelae of untreated gestational diabetes affecting the fetus EXCEPT: A. fetal macrosomia.

B. hypocalcemia.

C. hypobilirubinanemia.

D. hypertension.

4. Which of the following is a reason for the increase in Type II diabetes in the United States?

A. Increase in life span B. Sedentary lifestyles C. Obesity D. All of the above 5. The condition characterized by microangiopathic changes whereby the basement membrane of the capillaries thickens and causes the formation of thrombi is: A. diabetic retinopathy.

B. diabetic nephropathy.

C. diabetic neuropathy.

D. candidiasis.

6. Diabetic neuropathy increases the individual’s risk of which of the following conditions?

A. CVA B. Hyperventilation C. Hepatitis D. Adrenal insufficiency 7. The BEST method for diabetes to prevent systemic complications is: A. increase insulin levels monthly.

B. decrease insulin levels monthly.

C. increase glucose levels as needed.

D. maintain optimum blood glucose levels.

8. All of the following are oral complications of diabetes EXCEPT: A. periodontal disease.

B. delayed healing.

C. retinopathy.

D. lichen planus.

9. Your patient has a blood glucose level of 45 mg/dL. This reading indicates that the patient is experiencing: A. hyperglycemia.

B. hypoglycemia.

C. a normal glucose range.

D. none of the above.

10. Which of the following are variations in types of insulin?

A. Time of onset B. Peak effectiveness C. Maximal duration D. All of the above 11. All of the following are common medications for Type II diabetes EXCEPT one. Which one is the exception?

A. Metformin B. GTlyburide C. Humalog

D. Tolbutamide 12. Which of the following is TRUE regarding patients with insulin pumps?

A. Have their medication delivered via subcutaneous catheter B. Need to be changed every four to six years C. Eliminates the need for daily glucose monitoring 13. Strategies that should be incorporated when treating a diabetic patient include: A. afternoon appointments.

B. checking the patient’s blood glucose prior to the procedure.

C. longer appointments.

D. asking the patient not to eat prior to the appointment.

14. DKA is MOST likely to occur to: A. newly diagnosed Type 1 diabetics.

B. diabetics not medicating properly.

C. diabetics suffering from an infection.

D. all of the above.

15. All of the following are TRUE of DKA EXCEPT one. Which one is the exception?

A. Patients will exhale large amounts of carbon monoxide.

B. Patients will have an increase in the acids in their blood.

C. The body will use fatty acids for energy during this condition.

D. Patients will have significantly reduced insulin levels.

16. Which of the following is a key symptom of DKA? A. Fruity odor on the breath B. Hypertension C. Cool, moist skin D. Seizures 17. All of the following are symptoms of hypoglycemia EXCEPT one. Which one is the exception?

A. Confusion B. Warm, dry skin C. Seizures D. Aggressive behavior 18. The MOST critical step in the treatment of hypoglycemia for diabetics is: A. administer 20 gm of some form of sugar.

B. monitor vital signs.

C. administer insulin IM. D. administer oxygen at 15 liters/minute.

True/False 1. Diabetes mellitus is caused by a reduction in or absence of the production of insulin.

True False 2. Type I diabetes is increasing in the adolescent population due to poor diet and lack of exercise.

True False 3. A fasting plasma glucose test result of 100 signals the patient has diabetes.

True B. False 4. Diabetic retinopathy is a leading cause of blindness in adults.

True False 5. The HbA1c glycated hemoglobin test reveals the patient’s blood glucose level for that day.

True False 6. The delivery of insulin via an inhalation device has proven to be the MOST effective method for insulin delivery.

True False 7. The use of alcohol and cocaine by diabetic patients has been implicated in the development of DKA in these patients.

True False 8. DKA is caused by an excessive insulin level in the blood.

True False 9. If a patient is suffering from DKA, the dental clinician should administer twice the normal dosage of the patient’s insulin.

True False 10. DKA is more likely to occur in the dental setting than hypoglycemia.

True False

Fill in the Blank 1. Another term for prediabetes is _________________ _______________.

2. Diabetes mellitus is a metabolic disorder characterized by _________________.

3. _________________ is the hormone that aids in the conversion of sugars and starches to be used as energy by the body.

4. Gestational diabetes affects approximately _________________% of the population.

5. A result of 140–199 mg/dL on an oral glucose tolerance test indicates _________________.

6. Damage to the kidneys as a result of diabetes mellitus is referred to as _________________ _______________.

7. The normal blood glucose range is _________________ to _________________ mg/dl.

8. Continuous infusion therapy is also known as a/an _________________ _________________.

9. Severe hypoglycemia affects approximately _________________% of diabetics.

10. Once sugar has been administered to a hypoglycemic diabetic patient, recovery should occur within _________________ to _________________ minutes.

Short Answer 1. Compare the signs and symptoms of DKA and hypoglycemia.

2. Describe the appropriate treatment for a patient suffering from DKA and hypoglycemia in the dental setting.

CHAPTER 17 Multiple Choice 1. The adrenal glands are located on top of the: A. kidneys.

B. liver.

C. stomach.

D. pancreas.

2. Which of the following is an etiology of primary adrenal insufficiency?

A. Autoimmune disease B. Adrenal hemorrhage C. AIDS D. All of the above 3. The portion of the adrenal glands that secretes hormones, such as cortisone, is the: A. medulla.

B. cortex.

C. core.

D. none of the above.

4. Adrenal crisis often occurs to individuals: A. taking corticosteroids experiencing stress.

B. who have taken too much corticosteroids.

C. with psychiatric problems.

D. none of the above.

5. The body requires cortisol to: A. maintain carbohydrate metabolism.

B. maintain protein metabolism.

C. maintain immune system function.

D. all of the above.

6. All of the following are signs and symptoms of adrenal crisis EXCEPT one. Which one is the exception?

A. Lethargy B. Hypertension C. Diaphoresis D. Vomiting 7. Patients experiencing adrenal crisis are in severe need of: A. glucose.

B. glucocorticoids.

C. ACTH. D. insulin.

8. The primary symptom of adrenal crisis seen in dental patients is: A. bradycardia.

B. orthopnea.

C. hypotension.

D. pulmonary edema.

9. All of the following are appropriate steps in the treatment of the patient in adrenal crisis EXCEPT one.

Which one is the exception?

A. Maintain airway B. Monitor vital signs C. Contact EMS D. Administer oxygen 15 liters/minute 10. Dental patients taking corticosteroids:

A. should increase their dosage by at least 20 mg.

B. should reduce their dosage by at least 20 mg.

C. should be administered oxygen via nasal cannula during treatment.

D. do not require additional steroids unless they are phobic.

True/False 1. The common etiology of secondary adrenal insufficiency is disease of the pituitary gland.

True False 2. Cortisol produced by the adrenal glands aids in elimination of body nutrients.

True False 3. Adrenal insufficient patients experiencing hypotension without appropriate glucocorticoids during stressful situations can suffer from severe shock.

True False 4. Adrenal crisis is where the body is severely lacking glucose.

True False 5. If a patient taking steroids finds dental work stressful, an additional dose of 5–10 mg of hydrocortisone is recommended.

True False

Fill in the Blank 1. Secondary adrenal insufficiency occurs as a result of an insufficient production of _________________.

2. Primary adrenal insufficiency is also known as _________________ ________________.

3. Primary adrenal insufficiency usually occurs in the _________________ decade of life and usually affects the _________________ gender.

4. The drug of choice for adrenal crisis to be administered intravenously in the emergency department is _________________.

5. The risk of adrenal crisis remains for up to _________________months after the patient is no longer taking exogenous steroids.

Short Answer 1. List the signs and symptoms of adrenal crisis and the appropriate treatment for this condition.

2. Explain the differences between primary and secondary adrenal insufficiency.

CHAPTER 18 Multiple Choice 1. The action of the thyroid hormones includes all of the following EXCEPT one. Which one is the exception?

A. Metabolic rate B. Growth rate C. Conduction rate 2. Cold intolerance, weight gain, dry skin, constipation, and mental slowing are all symptoms of what condition?

A. Hypothyroidism B. Hyperthyroidism C. Graves’ disease D. Adrenal crisis 3. A disorder of an enlarged thyroid gland is: A. hypothyroidism.

B. myxedema coma.

C. adrenal crisis.

D. Graves’ disease.

4. The treatment of hyperthyroidism that uses radioactive iodine to disable the thyroid gland is: A. thyroid surgery.

B. ablation therapy.

C. antithyroid drug medications.

D. none of the above.

5. Which of the following patients with hypothyroidism would be more susceptible to myxedema coma?

A. A 72-year-old female living in Vermont with bronchitis B. A 50-year-old male living in Arizona who had a car accident C. A 36-year-old male living in Florida who was taking a diuretic D. A 20-year-old living in Texas who is taking penicillin 6. The major goal when treating a patient suffering from myxedema coma is to: A. normalize the patient’s blood pressure.

B. normalize the patient’s pulse rate.

C. normalize the patient’s temperature.

D. normalize the patient’s blood glucose level.

7. Levothyroxine, corticosteroids, and warming blankets are often used in the treatment of which medical emergency in the emergency department?

A. Thyroid storm B. Myxedema coma C. Adrenal crisis D. None of the above 8. Which of the following is the classic symptom of thyroid storm?

A. Restlessness B. Nausea C. Jaundice D. Fever 9. The amount of oxygen that should be used when treating a patient suffering from thyroid storm is: A. 2–4 liters/minute.

B. 4–6 liters/minute.

C. 8–12 liters/minute.

10. Exophthalmos is a symptom often seen in which condition?

A. Adrenal crisis

B. Myxedema coma C. Epistaxis D. Hyperthyroidism

True/False 1. Coma is a rare occurrence with myxedema coma.

True False 2. Thyrotoxicosis is often the result of Graves” disease.

True False 3. Following ablation therapy the patient will need to be medicated with a synthetic hormone replacement.

True False 4. Certain medications, such as beta-blockers, barbiturates, and phenothiazines, are known to trigger thyroid storm.

True False 5. Hypothermia, macroglossia, cool skin, and bradycardia are common symptoms of myxedema coma.

True False 6. Sedatives and tranquilizers are the MOST effective treatment of myxedema coma.

True False 7. High fever, diaphoresis, and increased systolic blood pressure are common symptoms of thyroid storm.

True False 8. A patient suffering from thyroid storm, once arriving in the emergency department, will be placed on IV fluids and will likely be given either porphylthouracil or methimazole.

True False

Fill in the Blank 1. The thyroid gland is located anterior to the _________________.

2. A condition where there is NOT enough thyroid hormone produced by the thyroid gland is _________________.

3. The treatment of last resort for a hyperthyroid patient is _________________ _________________ of the thyroid gland.

4. _________________ involves using radioactive iodine to disable the thyroid gland.

5. Myxedema coma is more common in the _________________ gender and individuals over age 70.

6. The mortality rate for _________________ ______________ is 30–60% and therefore the condition requires rapid, definitive treatment.

7. Tachycardia, widened pulse pressure, and arrhythmias are common in _________________ _______________.

Short Answer 1. List the signs and symptoms of thyroid storm and the appropriate treatment for this condition.

2. List the signs and symptoms of myxedema coma and the appropriate treatment for this condition.

CHAPTER 19 Multiple Choice 1. _____ % of nosebleeds requires medical attention.

A. 3 B. 6 C. 10 D. 15 2. The MOST common etiology of epistaxis is: A. dry weather.

B. digital manipulation.

C. cold weather.

D. gender.

3. Posterior nosebleeds usually occur at: A. Kiesselbach’s plexus.

B. Little’s area.

C. Woodruff’s plexus.

D. none of the above.

4. All of the following are systemic factors that can cause epistaxis EXCEPT: A. neoplasms.

B. anemia.

C. hypertension.

D. COPD. 5. The MOST important step in treating a patient with epistaxis is: A. ensuring an airway.

B. applying direct pressure for one minute.

C. positioning the patient supinely.

D. placing an ice pack on the nose.

6. Epistaxis prevention methods include all of the following EXCEPT: A. increasing water intake.

B. application of lubricant to nostrils.

C. use of a humidifier.

D. taking .81 mg of aspirin daily.

True/False 1. Nosebleeds can be life threatening.

True False

2. Use of an icepack on the nose for epistaxis aids in vasodilation to control bleeding.

True False 3. Following a nosebleed the patient should be instructed to keep the head elevated for 10 hours.

True False 4. Nosebleeds from the posterior portion of the nasal cavity will usually produce profuse bleeding of dark red blood.

True False

Fill in the Blank 1. _________________ nosebleeds usually occur at Kiesselbach’s plexus.

2. Individuals with hypertension are _________________ times more likely to experience epistaxis.

3. Anterior nosebleeds will ooze _________________ red blood.

4. Epistaxis treatment in the emergency department includes cauterization of the nasal cavity with _________________ _______________.

Short Answer 1. List the signs and symptoms of epistaxis and the appropriate treatment for this condition.

2. List four possible etiologies of epistaxis.

CHAPTER 20 Multiple Choice 1. A hereditary bleeding disorder where there is a deficiency in one of the factors necessary for blood coagulation is: A. hemophilia.

B. von Willenbrand’s disease.

C. cerebrovascular accident.

D. hematoma.

2. Which of the following medications may cause a patient to have excessive bleeding following an extraction?

A. Aspirin B. Warfarin C. Heparin D. All of the above 3. All of the following are complications that can occur during or after an extraction EXCEPT: A. infection.

B. reaction to the local anesthetic agent.

C. hemophilia.

D. excessive bleeding.

4. A hematoma is usually caused by: A. trauma.

B. medication.

C. heredity.

D. none of the above.

5. The effective ingredient in tea bags for their use in the treatment of excessive bleeding is: A. heparin.

B. tannic acid.

C. salicylic acid.

D. fluoride.

6. Which of the following is recommended to be inserted into the alveolus of a hemophiliac patient following an extraction?

A. Warfarin tablets B. Recombinant factor C. Gelatin packing D. None of the above 7. A normal INR is in the range of: A. 1.0–2.0.

B. 2.0–3.0.

C. 3.0–4.0.

D. 4.0–5.0.

8. Patients taking warfarin who are in need of a dental extraction and who are considered in the moderate risk category: A. require no change in medication.

B. should discontinue taking the medication 48 hours prior to the procedure.

C. should discontinue taking the medication 72 hours prior to the procedure.

D. will be prescribed heparin for the day of the procedure.

9. Patients on lowdose aspirin therapy who are having minor oral surgery: A. are at low risk for postextraction bleeding.

B. are at high risk for postextraction bleeding.

C. should discontinue taking the aspirin for one week prior to the procedure.

D. should discontinue taking the aspirin for one month prior to the procedure.

10. In addition to excessive bleeding, patients should be instructed to watch for which of the following indications of an abnormal reaction following an extraction?

A. Hypotension B. Fever C. Altered mental capacity D. All of the above

True/False 1. Anticoagulants vary in potency and the risk of excessive bleeding is dependent upon the type and dosage of the drug.

True False 2. The MOST important step in the treatment of a hematoma following a local anesthetic injection is to administer antibiotics.

True False

3. It is normal for some oozing of blood to occur after a dental extraction, but it is NOT normal for it to be a steady flow.

True False 4. Your patient is taking coumarin following a CVA six months ago. He had his INR test yesterday and it was 1.5, which indicates that his coagulation is in the normal range.

True False 5. Reducing the amount of warfarin a patient is taking may lead to hypercoagulability.

True False

Fill in the Blank 1. Type _________________ hemophilia is the MOST common form.

2. If bleeding from an extraction site is unaffected by compression lasting up to _________________ hours then this is NOT within normal limits.

3. A collection of blood trapped beneath the skin is referred to as a/an _________________.

4. Following a dental extraction, a patient should NOT exercise for _________________– _________________ hours.

5. The initials INR referring to the test to determine a patient’s clotting time stands for _________________.

Short Answer 1. List the appropriate treatment for excessive bleeding following an extraction.

2. List three conditions that might place a patient at risk for excessive bleeding following a dental extraction.

CHAPTER 21 Multiple Choice 1. Which of the following areas of the eye is MOST commonly affected by intraocular foreign bodies?

A. Cornea B. Globe C. Iris D. None of the above 2. The metal compounds that are NOT well tolerated by the eye and tend to cause infections are: A. iron and copper.

B. nickel and aluminum.

C. stainless steel and lead.

D. none of the above.

3. All of the following are consequences of an intraocular foreign body affecting the sclera EXCEPT: A. infection.

B. meningitis.

C. blindness.

D. epistaxis.

4. When using the irrigation method of intraocular foreign body removal the solution should be directed from the: A. superior to inferior portion of the eye.

B. inferior to superior portion of the eye.

C. medial to lateral portion of the eye.

D. lateral to medial portion of the eye.

5. When using the cotton-tipped applicator method for the removal of an intraocular foreign body the clinician should direct the object away from the: A. cornea.

B. globe.

C. pupil.

D. conjunctiva.

True/False 1. The primary type of eye injury that might occur in the radiography area would be a chemical splash.

True False 2. Hammering is the MOST common source of eye injury.

True False 3. High-velocity intraocular foreign objects can cause little or NO visible damage.

True False 4. When irrigating an eye due to intraocular foreign body you should pour the irrigating solution directly onto the cornea.

True False 5. Using a cotton swab is the BEST method for removal of chemical splash eye injuries.

True False

Fill in the Blank 1. Using a moistened cotton swab with force for removal of an intraocular foreign body can cause _________________ ______________, so it should only be used for superficial objects.

2. _________________-velocity intraocular foreign bodies are more likely to cause vision loss and light sensitivity.

3. Removal of a suspected embedded intraocular foreign body should be _________________ _____________ ______________ ________________.

4. Screwing up of the eyeballs, which usually occurs with corneal intraocular foreign bodies, is termed _________________.

5. Stone, plaster, and glass intraocular foreign bodies are examples of _________________ _____________ compounds.

Short Answer 1.Label the diagram of the anatomy of the eye below.

2. List three organic and four inorganic types of intraocular foreign bodies and state their effects on the eye.

CHAPTER 22 Multiple Choice 1. All of the following are etiologies of a broken instrument tip EXCEPT: A. application of excessive force on instrument.

B. defective production of instrument.

C. excessive sharpening of instrument.

D. appropriate instrument adaptation.

2. The FIRST step in the treatment of a broken instrument tip is to: A. suction the area.

B. isolate the area.

C. rinse the area.

D. use compressed air on the area.

3. If the tip cannot be located after close inspection the clinician should: A. refer the patient to an oral surgeon.

B. refer the patient to a periodontist.

C. take a periapical radiograph of the area.

D. none of the above.

4. When attempting to locate a broken instrument tip in the sulcus the clinician should use a/an: A. horizontal stroke.

B. vertical stroke.

C. ultrasonic scaler.

D. hemostat.

5. When attempting to remove the broken instrument tip from the sulcus care should be taken to: A. avoid embedding the object in gingiva.

B. avoid letting the patient know there is a problem.

C. carefully rinse the area.

D. use the ultrasonic scaler on its lowest setting.

True/False 1. Using the proper instrument for the area being treated is one mechanism for reducing the risk of a broken instrument tip.

True B. False 2. Use of the ultrasonic scaler on patients with heavy deposits will help reduce the risk of a broken instrument tip.

True False 3. Asking the patient to swallow is an important step in the treatment of a broken instrument tip.

True False

Fill in the Blank 1. The magnetized instrument used to remove a broken instrument tip is a/an _________________.

2. The MOST common cause of a broken instrument tip is _________________.

3. Once the tip has been removed from the sulcus, thorough _________________ of the event should occur.

Short Answer 1. List the appropriate treatment for a broken instrument tip.

2. Explain three strategies that can be used to reduce the risk of a broken instrument tip.

CHAPTER 23 Multiple Choice 1. The drug often referred to as uppers, crank, crystal, ice, or chalk is: A. methamphetamine.

B. barbiturates.

C. cocaine.

D. opiates.

2. All of the following are results of the stimulation of the sympathetic autonomic nervous system EXCEPT:

A. increased heart rate.

B. dilation of bronchioles.

C. increased blood flow to the brain.

D. pupil constriction.

3. All of the following are signs and symptoms of amphetamine toxicity EXCEPT: A. euphoria.

B. agitation.

C. bradycardia.

D. seizures.

4. Activated charcoal is used for amphetamine toxicity to: A. reduce hypertension.

B. adsorb the toxic agent.

C. control agitation.

D. reduce hyperthermia.

5. Which of the following are effects of cocaine on the user?

A. Hypothermia B. Hypotension C. Tachycardia D. None of the above 6. Continuous use of intranasal cocaine causes ischemia and necrosis as cocaine is a potent: A. vasoconstrictor.

B. vasodilator.

C. analgesic.

D. antihistamine.

7. Cocaine’s mechanism of action is primarily to prevent the reuptake of: A. epinephrine.

B. norepinephrine.

C. dopamine.

D. serotonin.

8. The route of administration of cocaine that produces the highest blood levels of cocaine is: A. intranasal.

B. oral ingestion.

C. IV injection.

D. inhalation.

9. The symptoms of agitation, hyperthermia, seizures, cerebral hemorrhage, and hallucinations are a result of: A. rapid stimulation of the CNS. B. rapid stimulation of the CVS. C. rapid stimulation of the respiratory system.

D. none of the above.

10. All of the following are procedures in the treatment of cocaine toxicity EXCEPT: A. contact EMS. B. apply external cooling measures.

C. induce vomiting.

D. monitor vital signs every 15 minutes.

11. Which of the following is a drug that is administered to a patient for the treatment of cocaine toxicity?

A. Diazepam B. Propanolol C. Activated charcoal

D. All of the above 12. The effective antidote for opioid toxicity is: A. methamphetamine.

B. benzodiazepine.

C. naloxone.

D. none of the above.

13. All of the following are signs and symptoms of mild to moderate barbiturate toxicity EXCEPT: A. lethargy.

B. chest pain.

C. ataxia.

D. slurred speech.

14. Which of the following is a benzodiazepine drug?

A. Lorazepam B. Propanolol C. Morphine D. All of the above 15. All of the following are signs and symptoms of benzodiazepine toxicity EXCEPT: A. tachycardia.

B. mental confusion.

C. ataxia.

D. lethargy.

True/False 1. Intracranial hemorrhage is likely with amphetamine toxicity due to hypertension or cerebral vasculitis.

True False 2. An emetic agent should be administered for amphetamine overdose to prevent seizures.

True False 3. Increased dopamine levels are associated with higher incidence of bruxism and tooth wear in cocaine users.

True False 4. Local anesthetics with epinephrine are contraindicated in cocaine users as it can lead to myocardial infarction or cerebrovascular accident.

True False 5. Morphine and codeine are produced from the poppy plant.

True False 6. Opioid agents excite the CNS and cause sedation, euphoria, and reduction in pain.

True False 7. Induction of vomiting in patients experiencing opioid toxicity causes a significant risk of airway obstruction.

True False 8. The primary procedure for treating a patient with barbiturate and benzodiazepine toxicity is to activate EMS.

True False 9. Benzodiazepines have a narrow therapeutic index.

True False 10. Signs and symptoms of opioid toxicity include agitation, tachycardia, and hyperthermia.

True False

Fill in the Blank 1. Amphetamines prevent the _________________ of excitatory neurotransmitters.

2. External cooling of the skin during treatment of amphetamine toxicity aids in the reduction of _________________.

3. Free basing is when an individual _________________ the pure form of cocaine.

4. The _________________ _______________ is the maximum response of the drug in the biological tissues.

5. An increase in hyperactivity in cocaine users may lead to _________________ _______________ or _________________ _________________ in the oral cavity.

6. Incompetent contractions within the ventricles of the heart due to stimulation of individual heart muscle fibers often seen in cocaine toxicity is _________________ _________________.

7. The drug administered to a patient experiencing cocaine toxicity to control seizures, tachycardia, and hyperactivity is _________________.

8. Substances that enhance the effects of other substances are _________________.

9. Flumazenil can be administered as a/an _________________ to the effects of benzodiazepines.

10. Patients suffering from benzodiazepine toxicity should be placed in a supine position to treat the major symptom of _________________.

Short Answer 1. List the signs and symptoms of methamphetamine toxicity and the appropriate treatment for this condition.

2. List the signs and symptoms of cocaine toxicity and the appropriate treatment for this condition.

3. List the signs and symptoms of opiate toxicity and the appropriate treatment for this condition.

4. List the signs and symptoms of barbiturate toxicity and the appropriate treatment for this condition.

5. List the signs and symptoms of benzodiazepine toxicity and the appropriate treatment for this condition.

Copyright © 2014 by Pearson Education, Inc.

Test Bank Answer Key CHAPTER 1 INTRODUCTION ANSWER KEY Multiple Choice 1. C 2. C 3. C 4. D 5. D 6. B 7. A 8. D 9. B 10. D

True/False 1. F 2. T 3. T 4. F 5. T

Fill in the Blank 1. 8 2. One-third 3. bruising, hemorrhage 4. ASA II 5. AED; oxygen tank

Short Answer 1.

Person Person 1 Person 2 Person 3 Office Receptionist

Responsibility Stays with patient; performs appropriate emergency treatment Assists P1; takes vital signs and administers oxygen, records events and time of medication delivery Retrieves emergency kit; prepares emergency drugs Makes necessary phone calls

2.

ASA Classification ASA I

Patient Characteristics Normal health patient

Examples of Conditions

ASA II

Can walk up two flights of stairs or walk two city blocks without shortness of breath Mild systemic disease Can walk up one flight of stairs or two level city blocks, but may have shortness of breath when walk completed

ASA III

Sever systemic disease that limits activity, but not incapacitating Able to walk up one flight of stairs or one city block, but may have to stop during the walk due to shortness of breath

ASA IV

Incapacitating systemic disease that is a constant threat to life Unable to walk up a single flight of stairs or one city block and may have shortness of breath or respiratory distress at rest

ASA V

Moribund patient not expected to survive 24 hours with or without operation

CHAPTER 2 EMERGENCY KIT ANSWER KEY Multiple Choice 1. D 2. C 3. B 4. A 5. B 6. B 7. C 8. A 9. B

True/False 1. T 2. F

Adult onset diabetes Epilepsy Blood pressure greater than 140/90 Uncontrolled asthma Severe allergies Pregnancy Unstable angina MI longer than 6 months ago Well-controlled type 1 diabetes Heart-failure Blood pressure greater than 160/95 MI within in the past 6 months Unstable angina Heart failure Uncontrolled diabetes Uncontrolled epilepsy Blood pressure greater than 200/115

3. T 4. T 5. F

Fill in the Blank 1. perioretrievier 2. thermometer 3. histamine 4. hypoglycemia 5. oxygen

Short Answer 1. • Oxygen • Epinephrine • Nitroglycerine • Diphenhydramine or chlorpheneramine • Albuterol • Aspirin • Oral carbohydrate 2. • Glucagon • Atropine • Corticosteroid • Injectable benzodiazepine

CHAPTER 3 VITAL SIGNS AND HYPERTENSIVE URGENCY AND EMERGENCYANSWER KEY Multiple Choice 1. C 2. A 3. D 4. C 5. A 6. D 7. A 8. C 9. D 10. C 11. A 12. C 13. C 14. B 15. A 16. D 17. A 18. B 19. A 20. A

True/False 1. T 2. F 3. F 4. F 5. T 6. F 7. T 8. F 9. T

Fill in the Blank 1. arrhythmia 2. dyspnea 3. bradycardia 4. involuntary 5. Kussmaul respirations 6. Convulsions 7. Hypothermia 8. 30–40 mmHg 9. sphygmomanometer 10. hypertensive emergency

Short Answer 1. • These measurements determine the body’s ability to pump blood and breathe, which are essential elements for sustaining human life. Determining baseline vital signs enables the healthcare provider to compare what are normal readings for a patient with readings that are occurring during a medical emergency, which will help determine the severity of the emergency. In addition, vital signs are taken to determine the health status of the patient.

2. • In each case, the patient presents with an extremely high blood pressure reading. The major difference is that in hypertensive emergency the patient would experience some form of target end organ damage.

3. • Treatment for hypertensive urgency in the dental office would begin by retaking the blood pressure to ensure the first reading was accurate. If the first reading is correct, the conscious patient should be seated upright and the unconscious patient supinely. EMS should be contacted and the blood pressure should be routinely monitored every five minutes. Oxygen should be administered if the patient complains of shortness of breath.

Once in the emergency department the patient will be treated with some type of antihypertensive medication, particularly if his or her blood pressure level remains high. Presently, there is a variety of medication options, including Furosemide, Captopril, Propanolol, Metoprolol, or Nicardipine.

CHAPTER 4 OXYGEN ADMINISTRATION ANSWER KEY Multiple Choice 1. B 2. C 3. C 4. B 5. A

True/False 1. T 2. F 3. T 4. T 5. T

Fill in the Blank 1. green 2. E 3. 2; 5 4. regulator 5. head tilt and jaw thrust

Short Answer 1. • Nasal cannula—CVA or MI • Non-rebreathing face mask—asthma or angina • Bag mask—cardiac arrest 2. • Cylinder • Regulator • Flow meter

CHAPTER 5 SYNCOPE ANSWER KEY Multiple Choice 1. B 2. A 3. B 4. B 5. C 6. B 7. A 8. B 9. A 10. B

True/False 1. T 2. T 3. F 4. F 5. T

Fill in the Blank 1. cardiac

2. cerebral hypoxia 3. pale 4. Syncope 5. slow; weak

Short Answer 1. • Early appointment times • Use of oxygen via nasal cannula during the appointment • Use of nitrous oxide • Oral sedation prior to the appointment with a benzodiazepine 2. Presyncopal signs and symptoms: • Pupil dilation • Diaphoresis or a cold sweat • Excitation of the piloerector muscles, resulting in goose flesh • Weakness • Dizziness • Vertigo • Nausea • Yawning and sighing • Visual changes, particularly darkening or blurring of vision or seeing spots • Blood pressure elevated • Pulse elevated • Shortness of breath • Heart palpitation • Chest pain • Pallor

Syncopal signs and symptoms: • Unconsciousness • Weak, slow pulse < 30 beats per minute

Treatment: • Suspend dental procedures • All objects should be removed from the oral cavity • If consciousness is lost—place patient in a supine position with legs slightly elevated • Open the airway • Assess circulation • Loosen tight clothing • Administer oxygen at 4–6 liters/minute • If unconsciousness persists, summon EMS

CHAPTER 6 SHOCK ANSWER KEY Multiple Choice 1. A 2. C 3. A 4. C 5. A 6. B

7. A 8. D 9. D 10. B 11. A 12. B

True/False 1. T 2. T 3. F 4. T 5. T 6. F 7. T 8. T

Fill in the Blank 1. oliguria 2. progressive 3. blood transfusion 4. cardiogenic 5. septic 6. Cardiac tamponade

Short Answer 1. • Hypovolemic shock—hemorrhage or dehydration • Cardiogenic shock—myocardial infarction, cardiac arrhythmias, and cardiac dysfunction • Distributive shock—three types anaphylactic—allergic response septic—bacterial invasion neurogenic—a disease, a drug, or traumatic injury to the brain stem or spinal cord • Obstructive shock—arterial stenosis (narrowing of arterioles), pulmonary embolism (blockage of the pulmonary artery located in the lungs), and cardiac tamponade 2. • Position patient supinely • Contact EMS • Implement CABs of CPR • Monitor vital signs • Ensure adequate oxygenation • Transport the patient to the emergency department as soon as possible

CHAPTER 7 HYPERVENTILATION ANSWER KEY Multiple Choice 1. D 2. A 3. D 4. B

5. A 6. A 7. A 8. C 9. A 10. C

True/False 1. T 2. F 3. F 4. T 5. T 6. T

Fill in the Blank 1. hypocapnia 2. 7.5 3. carpopedal spasms 4. 40 5. pursed lips

Short Answer 1. • Abnormally prolonged rapid and deep respirations • Heart palpitations • Possible chest pain • Impairment of problem-solving abilities, motor coordination, balance and perceptual tasks, vision • Lightheadedness • Dizziness • Seizures • Tetany—twitching of the muscles or spasms with sharp flexion of the wrist and ankle joints (carpopedal spasms) • Parasthesia or numbness in the extremities • Chvostek’s sign—abnormal spasm of the facial muscles elicited by light taps on the facial nerve • Apprehension • Diaphoresis • Trembling • Fatigue • Circumoral parasthesia • Unconsciousness following stress-induced deep, rapid breathing 2. • Operator needs to remain calm and keep a nonjudgmental attitude • Place the patient in the position of his or her choice—usually sitting upright • Loosen tight clothing around the neck region • Work with the patient to control the rate of respirations • Monitor vital signs • If the condition does not improve, consider intramuscular or oral administration of lorazepam in a dose of 1–2 mg or diazepam in a dose of 2–5 mg • Transportation by EMS to an emergency department to determine if the patient may be suffering from a more

serious condition, such as a pulmonary embolism, may be required

CHAPTER 8 SEIZURES ANSWER KEY Multiple Choice 1. C 2. C 3. D 4. D 6. D 6. B 7. B 8. A 9. B 10. D 11. C 12. D 13. A 14. A 15. B 16. A

True/False 1. T 2. F 3. F 4. T 5. F 6. F 7. F

Fill in the Blank 1. EEG/electroencephalogram 2. status epilepticus 3. 35 4. epileptogenic 5. aura 6. prodromal 7. automatisms 8. one-third 9. breakthrough 10. protecting the airway

Short Answer 1. Signs and symptoms: • Aura

• Loss of consciousness • Total contraction of muscles • Hyperextension of the spine • Convulsions • Heavy, labored breathing • Clenched jaw • Froth at the mouth

Treatment: • Supine position • Maintain open airway • Prevent injury to patient • Gently restrain patient • Monitor vital signs 2. • Prodromal or aura • Preictal • Ictal • Postictal

CHAPTER 9 CEREBROVASCULAR ACCIDENT ANSWER KEY Multiple Choice 1. B 2. D 3. D 4. C 5. A 6. A 7. B 8. C 9. B 10. A 11. C 12. D

True/False 1. F 2. T 3. F 4. T 5. F 6. T

Fill in the Blank 1. Brain attack 2. 15 3. three 4. contact 9-1-1 5. penumbra

6. aneurysm

Short Answer 1. • TIA or a Transient Ischemic Attack is a brief episode of neurological dysfunction caused by ischemia of the brain in a specific location, with symptoms lasting less than one hour with no evidence of an acute stroke.

• A cerebrovascular accident (CVA) or stroke is an abnormal condition of the brain characterized by occlusion or hemorrhage of a blood vessel resulting in a lack of oxygen to the brain tissues (ischemia) that normally receive their blood supply from the damaged vessels. This lack of blood supply to the blood vessels results in a loss of proper oxygenation to the brain cells and eventually cell death.

2. • The patient is asked to smile while the healthcare provider observes the patient for weakness on one side of the face.

• The patient is asked to hold both arms out with palms up and eyes closed for 10 seconds while the healthcare provider observes for weakness in one arm. If there is a weakness in both arms or if normal strength is determined, then the patient tests negative for CVA. • The patient is asked to repeat a simple sentence—“The sky is blue in Cincinnati”—while the healthcare provider observes for difficulty in speech.

If any of the three components are found to be abnormal then it should be assumed that the patient is experiencing a stroke and should be treated as such.

3. Signs and symptoms: • Severe headache • Increased BP • Neck pain or stiffness • Inability to stand or walk • Unequal pupils • Vision changes • Difficulty swallowing • Nausea and vomiting • Facial paralysis • Parasthesia on one side of body • Speech impairment • Altered level of consciousness

Treatment: • Position patient semi-upright • Contact EMS • Administer O2 if needed • Monitor vital signs

CHAPTER 10 ANGINA/MYOCARDIAL INFARCTION ANSWER KEY Multiple Choice 1. A 2. C 3. D 4. A 5. A 6. D 7. B 8. B 9. B 10. B

11. C 12. A 13. D 14. A 15. D 16. C 17. B 18. B 19. C 20. B 21. C 22. A 23. A 24. B 25. B 26. A

True/False 1. F 2. T 3. F 4. T 5. T 6. T 7. F 8. F 9. T 10. F 11. T 12. F 13. F

Fill in the Blank 1. IHD—ischemic heart disease 2. HRT—Hormone Replacement Therapy 3. two; four 4. 66 5. cholesterol 6. Macroangiopathy 7. atherosclerosis 8. Levine sign 9. hypotension 10. two; four 11. acute myocardial infarction 12. Nitroglycerine

Short Answer 1. • Gender, increasing age and heredity (including race), obesity, physical inactivity, use of tobacco, high blood pressure, and high cholesterol 2. • Terminate procedure • Upright or semisupine position • CABs • Administer O2 4–6 liters/minute • Monitor vital signs • Administer nitroglycerine if patient not hypotensive—patient is preferably or spray from kit • Can administer three doses in 15-minute period • If episode ceases can resume treatment if patient feels well enough • If pain more severe than normal or if pain does not cease contact EMS and treat as MI 3. • Terminate treatment • If hx of angina treat for angina • If no hx of angina • Position comfortably • CAB • EMS • Administer O2 4–6 liters/minute • Monitor vital signs • Administer nitroglycerine from kit if patient not hypotensive • If pain not relieved in two to four minutes administer two more doses of nitroglycerine • If pain not relieved administer 162–325 mg chewable aspirin • Monitor vital signs • Prepare for CPR if necessary

CHAPTER 11 HEART FAILURE ANSWER KEY Multiple Choice 1. D 2. A 3. B 4. B 5. A 6. C 7. A 8. D 9. C 10. C 11. C 12. B 13. D 14. D

True/False 1. T 2. F 3. T

4. F 5. T 6. T 7. F 8. F 9. F 10. T

Fill in the Blank 1. exacerbate 2. paroxysmal nocturnal dyspnea 3. Orthopnea 4. left 5. pulsus alternans 6. II 7. semisupine;, upright 8. diastolic 9. Death rattle 10. Cardiac cachexia

Short Answer 1. • Left heart failure—inadequate blood pumped to circulation; blood coming to left ventricle from lungs “backs up” causing fluid to lead into the lungs • Right heart failure—inability of heart to pump blood from systemic venous circulation to lungs for oxygenation; systemic congestion in venous system 2. • Position patient upright or semi-upright • CABs • Administer O2 3–5 liters/minute • Monitor vital signs • EMS if symptoms not alleviated

Signs and symptoms: 3. • Gasping for air • Rapid pulse • Cool, moist skin • Cyanotic lips, nail beds • Anxiety • Cough with frothy, blood-tinged sputum • Crackle sound in lungs

Treatment: • Position patient upright or semi-upright • CABs • EMS • Administer O2 10 liters/minute • Monitor vital signs • Bloodless phlebotomy • Vasodilator (nitroglycerine) • CPR if necessary

CHAPTER 12 PACEMAKER/ICD MALFUNCTION ANSWER KEY Multiple Choice 1. B 2. D 3. C 4. C 5. A

True/False 1. F 2. F 3. T 4. T 5. T

Fill in the Blank 1. 6 inches 2. bradycardia 3. tachyarrhythmias 4. 7; 10 5. Handpieces; curing lights, or sonic/piezoelectric ultrasonic scalers 6. Magnetostrictive ultrasonic scalers;TENS, or ultrasonic baths or electrosurgical units 7. defibrillation

Short Answer 1. • Lightheadedness • Dizziness • Dyspnea • Moist, pale skin • Weakness • Bradycardia or tachycardia, depending on reason for implantation • Chest pain • Swelling in extremities • Prolonged hiccoughing • Muscle twitching • Possible altered mental status 2. • If normal pulse rate does not resume or if consciousness is lost contact EMS and prepare for CPR

CHAPTER 13 ASTHMA ANSWER KEY Multiple Choice 1. A 2. A 3. B 4. C 5. D

6. A 7. B 8. D 9. D 10. C

True/False 1. T 2. F 3. T 4. T 5. F

Fill in the Blank 1. IgE 2. triggers/stimuli 3. status asthmaticus 4. four to six 5. epinephrine

Short Answer 1. • Extrinsic • Intrinsic • Drug induced • Exercise induced • Infectious 2. • Dyspnea • Wheezing • Coughing • Chest tightness • Pallor

CHAPTER 14 OBSTRUCTED AIRWAY/ASPIRATION OR INGESTION OF FOREIGN OBJECT ANSWER KEY Multiple Choice 1. A 2. B 3. C 4. D 5. A

True/False 1. T 2. T 3. F 4. T

5. T

Fill in the Blank 1. stridor 2. days 3. partial 4. Heimlich maneuver 5. right

Short Answer 1. • Rubber dam • Gauze throat screen • Bonded dental floss to fixed restoration • Attachment of orthodontic elastic chain to wax pattern prior to investment and casting 2. Signs and symptoms: • Dependent on location of foreign object • Dyspnea • Hoarseness • Wheezing • Coughing • Decreased breath sounds • Cyanosis • Excessive sputum production • Possible suffocation

Treatment: • EMS and transport to ED • Chest x-ray • Bronchoscopy to remove object

CHAPTER 15 ALLERGIC REACTIONS ANSWER KEY Multiple Choice 1. C 2. D 3. A 4. C 5. A 6. C 7. B 8. B 9. A 10. A 11. C 12. C 13. B 14. D 15. B

True/False 1. T 2. T 3. F 4. F 5. T 6. F 7. F 8. T 9. T 10. T

Fill in the Blank 1. suppresses 2. histamine 3. bronchospasm, dyspnea, or wheezing 4. .25 mL of 1:1000 5. RAST/radiollergosobent 6. II 7. 15 8. allergy 9. basophils; mast cells 10. cardiovascular

Short Answer 1. Mild: • Administer chlorpheneramine 10 mg orally for three days

Moderate: • Administer diphenhydramine 50 mg IM • Administer chlorpheneramine 10 mg orally for three days • Administer O2 as needed • Monitor vital signs

Severe: • EMS • Position the patient supinely with legs elevated • Administer epinephrine 0.2 mL–0.5 mL IM • Administer O2 4–6 liters/minute • Administer 100–500 mg hydrocortisone IM • Administer diphenhydramine 50 mg IM • Monitor vital signs 2. • Dust • Pollen • Latex • Foods • Insect stings • Medications

CHAPTER 16 DIABETES–RELATED EMERGENCIES ANSWER KEY Multiple Choice 1. B 2. A 3. D 4. D 5. C 6. A 7. D 8. C 9. B 10. D 11. C 12. A 13. B 14. D 15. A 16. A 17. B 18. A

True/False 1. T 2. F 3. F 4. T 5. F 6. F 7. T 8. F 9. F 10. F

Fill in the Blank 1. glucose intolerance 2. hyperglycemia 3. Insulin 4. 2–5 5. prediabetes 6. diabetic nephropathy 7. 50; 150 8. insulin pump 9. 30 10. 10; 15

Short Answer 1.

Hypoglycemia: • Confusion • Seizures • Dizziness • Weakness • Headache • Hunger • Cold, clammy skin • Diaphoresis • Irritability or aggressive behavior

DKA: • Poor skin turgor • Warm, dry skin • Thirst • Muscle weakness • Fatigue • Nausea/vomiting • Blurred vision • Tachypnea/Kussmaul breathing • Fruity odor on breath • Hypotension • Tachycardia 2. Hypoglycemia:

Conscious patient: • 20 gm of some form of sugar • Maintain airway • Monitor vital signs

Unconscious patient: • EMS • Glucagon 1 mg SC of IM • Monitor vital signs • Administer O2 4–6 liters/minute

DKA: • EMS • Determine blood glucose level • Monitor vital signs • Administer O2 4–6 liters/minute

CHAPTER 17 ADRENAL INSUFFICIENCY AND CRISIS ANSWER KEY Multiple Choice 1. A 2. D 3. B 4. A 5. D 6. B

7. B 8. C 9. D 10. D

True/False 1. T 2. F 3. T 4. F 5. T

Fill in the Blank 1. ACTH 2. Addison’s disease 3. fourth; female 4. hydrocortisone 5. 12

Short Answer 1. Signs and symptoms: • Fatigue • Lethargy • Muscular weakness • Headache • Confusion • Fever • Nausea • Vomiting • Abdominal pain • Hypotension • Tachycardia • Diaphoresis • Dehydration

Treatment: • EMS • Administer O2 4–6 liters/minute • Monitor vital signs 2. • Primary adrenal insufficiency or Addison’s disease is a result of the destruction of the adrenal cortex of the adrenal gland. Secondary adrenal insufficiency occurs when there is an insufficient amount of adrenocorticotropic hormone (ACTH) to stimulate the adrenal cortex.

CHAPTER 18 THYROID EMERGENCIES ANSWER KEY Multiple Choice 1. C

2. A 3. D 4. B 5. A 6. C 7. B 8. D 9. B 10. D

True/False 1. T 2. T 3. T 4. F 5. T 6. F 7. T 8. T

Fill in the Blank 1. trachea 2. hypothyroidism or myxedema 3. surgical removal 4. Ablation therapy 5. male 6. myxedema coma 7. thyroid storm

Short Answer 1. Signs and symptoms: • Fever • Diaphoresis • Restlessness • Confusion • Anxiety • Psychosis • Nausea/vomiting • Increased systolic BP • Tachycardia • Widened pulse pressure

Treatment: • Position patient supinely • EMS • Administer O2 4–6 liters/minute • Monitor vital signs 2. Signs and symptoms:

• Confusion • Apathy • Depression • Possible psychosis • Hypothermia < 95 degrees F • Hair loss • Facial changes • Cool, dry skin • Bradycardia • Seizures

Treatment: • Position patient supinely • Normalize temperature with blankets • Administer O2 4–6 liters/minute • Monitor vital signs • EMS

CHAPTER 19 EPISTAXIS ANSWER KEY Multiple Choice 1. B 2. B 3. C 4. A 5. A 6. D

True/False 1. T 2. F 3. F 4. T

Fill in the Blank 1. Anterior 2. three 3. bright 4. silver nitrate

Short Answer 1. Signs and symptoms: • Nasal bleeding • Bright red color—anterior nosebleed • Dark red color—posterior nosebleed

Treatment: • Personal protective equipment • Position patient upright

• Maintain airway • Suction blood from mouth if necessary • Have patient tilt head slightly forward • Apply direct pressure by pinching lower part of nose for 10–20 minutes • Have patient breathe through mouth • Place ice pack over bridge of nose 2. Local factors: • Allergies • Cocaine • Environmental irritants • Foreign bodies • Nasal sprays • Neoplasms • Digital manipulation • Septal deviation or perforation • Sinusitis • Trauma • Upper respiratory infections • Sneezing

Systemic Factors: • Anemia • Anticoagulant therapy • Arteriosclerosis • Blood dyscrasia • Chronic obstructive pulmonary disease (COPD) • Hypertension

CHAPTER 20 EXCESSIVE BLEEDING EMERGENCIES ANSWER KEY Multiple Choice 1. A 2. D 3. C 4. A 5. B 6. C 7. B 8. B 9. A 10. D

True/False 1. T 2. F 3. T 4. F 5. T

Fill in the Blank 1. A 2. two 3. hematoma 4. 12; 24 5. international normalized ratio

Short Answer 1. • Compression with gauze • Tea bag with firm pressure for 20 minutes • If bleeding persists contact physician for follow-up treatment 2. • Anticoagulants • Hemophilia • Hematoma

CHAPTER 21 INTRAOCULAR FOREIGN BODY ANSWER KEY Multiple Choice 1. A 2. A 3. D 4. C 5. C

True/False 1. T 2. T 3. T 4. F 5. F

Fill in the Blank 1. corneal abrasion 2. High 3. referred to a specialist 4. blepharospasm 5. inorganic nonmetallic

Short Answer 1.

2. Organic: • Dirt • Wood • Vegetable matter

Inorganic: • Steel • Iron, lead • Aluminum • Other metal alloys • Stone • Plastic • Glass • Other minerals

CHAPTER 22 BROKEN INSTRUMENT TIP ANSWER KEY Multiple Choice 1. D 2. B 3. C 4. A 5. A

True/False 1. T 2. T

3. F

Fill in the Blank 1. perioretriever 2. excessively thinned instrument from sharpening 3. documentation

Short Answer 1. • Isolate area • Ask patient not to swallow • Examine sulcus for tip • Remove with curet or magnetized retriever • If tip cannot be located clinically, take radiograph to locate tip and remove • Document in patient chart 2. • Maintain instrument integrity through proper sharpening • Replace thin instruments • Use the proper instrument for the area being treated • Use the instrument correctly • Use the ultrasonic scaler on patients with heavy deposits

CHAPTER 23 DRUG OVERDOSE AND TOXICITY ANSWER KEY Multiple Choice 1. A 2. D 3. C 4. B 5. C 6. A 7. C 8. C 9. A 10. C 11. D 12. C 13. B 14. A 15. A

True/False 1. T 2. F 3. T 4. T 5. T 6. F 7. T

8. T 9. F 10. F

Fill in the Blank 1. reuptake 2. hyperthermia 3. smokes 4. peak effect 5. cervical abrasion; gingival laceration 6. ventricular fibrillation 7. diazepam 8. agonists 9. antidote 10. hypotension

Short Answer 1. Signs and symptoms: • Euphoria • Restlessness • Talkativeness • Anxiety • Agitation • Confusion • Flushing • Diaphoresis • Anorexia • Seizures • Tachycardia • Hypertension • Intracranial hemorrhage • Chest pains • Heart palpitations

Treatment: • Contact EMS • BLS • Monitor vital signs frequently • External cooling measures • Can administer a benzodiazepine to control agitation 2. Signs and symptoms: • Anxiety • Agitation • Hyperthermia • Chest pain • Tachycardia • Hypertension • Arrhythmias • Dyspnea

• Seizures • Hallucinations • Cerebral hemorrhage • Ventricular fibrillation • MI • CVA

Treatment: • Contact EMS • BLS • Monitor vital signs frequently • External cooling measures • Can administer a benzodiazepine to control agitation 3. Signs and symptoms: • Lethargy • Myosis • Shallow respirations • Hypotension • Hypothermia • Bradycardia • Flaccid muscles

Severe overdose: • Coma • Respiratory depression • Death

Treatment: • Contact EMS • BLS • Administer O2 4–6 liters/minute • Monitor vital signs frequently • External warming measures 4. Signs and symptoms: • Dose dependent

Moderate toxicity: • Lethargy • Slurred speech • Ataxia • Nystagmus

Severe toxicity: • Hypothermia • Myosis • Hypotension • Bradycardia • Pulmonary edema • Coma • Respiratory arrest

Treatment: • Contact EMS • BLS • Monitor vital signs frequently

• External cooling measures • Can administer a benzodiazepine to control agitation 5. Signs and symptoms: • Lethargy • Slurred speech • Ataxia • Mental confusion • Hypotension • Coma • Respiratory arrest

Treatment: • Contact EMS • Supine position • BLS • Administer O2 4–6 liters/minute • Monitor vital signs frequently • External warming measures

Person Responsibility Person 1 Stays with patient; performs appropriate emergency treatment Person 2 Assists P1; takes vital signs and administers oxygen, records events and time of medication delivery Person 3 Retrieves emergency kit; prepares emergency drugs Office receptionist Makes necessary phone calls ASA Classification Patient Characteristics Examples of Conditions ASA I Normal healthy patient Can walk up two flights of stairs or walk two city blocks without shortness of breath ASA II Mild systemic disease Can walk up one flight of stairs or two level city blocks, but may have shortness of breath when walk completed Adult onset diabetes Epilepsy Blood pressure greater than 140/90 Uncontrolled asthma Severe allergies Pregnancy Copyright © 2009 by Pearson Education, Inc.

ASA Classification Patient Characteristics

Examples of Conditions ASA III Severe systemic disease that limits activity, but not incapacitating Able to walk up one flight of stairs or one city block, but may have to stop during the walk due to shortness of breath Unstable angina MI longer than six months ago Well-controlled Type I diabetes Heart failure Blood pressure greater than 160/95 ASA IV Incapacitating systemic disease that is a constant threat to life Unable to walk up a single flight of stairs or one city block and may have shortness of breath or respiratory distress at rest MI within past six months Unstable angina Heart failure Uncontrolled diabetes Uncontrolled epilepsy Blood pressure greater than 200/115 ASA V Moribund patient not expected to survive 24 hours with or without operation Copyright © 2009 by Pearson Education, Inc.