TEST BANK for Medical Emergencies;Essentials for the Dental Professional 2nd Edition by Ellen Grimes

TEST BANK

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.

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.

4.

The phagocytosis process involves three distinct steps. What is the initial step in the process?

A)

Engulfment

B)

Intracellular killing

C)

Antigen margination

D)

Recognition and adherence

5.

Which of the following mediators of inflammation causes increased capillary permeability and pain?

A)

Serotonin

B)

Histamine

C)

Bradykinin

D)

Nitric oxide

6.

Inflammatory exudates are a combination of several types. Which of the following exudates is composed of enmeshed necrotic cells?

A)

Serous

B)

Fibrinous

C)

Suppurative

D)

Membranous

7.

The acute-phase systemic response usually begins within hours of the onset of inflammation and includes:

A)

fever and lethargy.

B)

decreased C-reactive protein.

C)

positive nitrogen balance.

D)

low erythrocyte sedimentation rate.

8.

In contrast to acute inflammation, chronic inflammation is characterized by which of the following phenomena?

NURSING TEST BANK

A)

Profuse fibrinous exudation

B)

A shift to the left of granulocytes

C)

Metabolic and respiratory alkalosis

D)

Lymphocytosis and activated macrophages

9.

Exogenous pyrogens (interleukin-1) and the presence of bacteria in the blood lead to the release of endogenous pyrogens that:

A)

stabilize thermal control in the brain.

B)

produce leukocytosis and anorexia.

C)

block viral replication in cells.

D)

inhibit prostaglandin release.

10 .

An older adult patient has just sheared the skin on her elbow while attempted to boost herself up in bed, an event that has precipitated acute inflammation in the region surrounding the wound. Which of the following events will occur during the vascular stage of the patients inflammation?

A)

Outpouring of exudate into interstitial spaces

B)

Chemotaxis

C)

Accumulation of leukocytes along the epithelium

D)

Phagocytosis of cellular debris

11 .

Which of the following individuals most likely has the highest risk of experiencing chronic inflammation?

A)

A patient who has recently been diagnosed with type 2 diabetes

B)

A patient who is a carrier of an antibiotic-resistant organism

C)

A patient who is taking oral antibiotics for an upper respiratory infection

D)

A patient who is morbidly obese and who has a sedentary lifestyle

12 .

Which of the following core body temperatures is within normal range?

A)

35.9C (96.6F) NURSING TEST BANK

B)

38.0C (100.4F)

C)

35.5C (95.9F)

D)

37.3C (99.1F)

13 .

A postsurgical patient who is recovering in the postanesthetic recovery unit states that she is freezing cold. Which of the following measures is likely to be initiated in the patients hypothalamus in an effort to reduce heat loss?

A)

Opening of arteriovenous (AV) shunts

B)

Reduced exhalation of warmed air

C)

Contraction of pilomotor muscles

D)

Decreased urine production

14 .

An elderly patient is dressed only in a hospital gown and complains of a draft in her room. Consequently, she has requested a warm blanket while she sits in her wheelchair. Which of the following mechanisms of heat loss is most likely the primary cause of her request?

A)

Evaporation and conduction

B)

Radiation and convection

C)

Conduction and convection

D)

Convection and evaporation

15 .

Which of the following pathophysiologic processes are capable of inducing the production of pyrogens? Select all that apply.

A)

Acute inflammation

B)

Obesity

C)

Myocardial infarction

D)

Malignancy

E)

Renal failure

16 .

Which of the following patients is most likely to be susceptible to developing a neurogenic fever?

NURSING TEST BANK

A)

A patient who has stage II Alzheimer disease

B)

A patient who has sustained a head injury in a bicycle crash

C)

A patient who has become delirious after the administration of a benzodiazepine

D)

A patient who has begun taking a selective serotonin-reuptake inhibitor (SSRI) for the treatment of depression

17 .

Patients are commonly administered antipyretics when their oral temperature exceeds 37.5C (99.5F). Which of the following statements related to the rationale for this action is most accurate?

A)

Temperatures in excess of 37.5C (99.5F) can result in seizure activity.

B)

Lower temperatures inhibit the protein synthesis of bacteria.

C)

There is little empirical evidence for this treatment modality.

D)

Most common antipyretics have been shown to have little effect on core temperature.

18 .

A patient has sought care because of recent malaise and high fever. Upon assessment, the patient states that his current fever began two days earlier, although he states that for the last 2 weeks he is in a cycle of high fever for a couple of days followed by a day or two of normal temperature. Which of the following fever patterns is this patient experiencing?

A)

Recurrent fever

B)

Remittent fever

C)

Sustained fever

D)

Intermittent fever

19 .

A)

A febrile, 3-week-old infant has been brought to the emergency department by his parents and is currently undergoing a diagnostic workup to determine the cause of his fever. Which of the following statements best conveys the rationale for this careful examination?

The immature hypothalamus is unable to perform normal thermoregulation.

NURSING TEST BANK

B)

Infants are susceptible to serious infections because of their decreased immune function.

C)

Commonly used antipyretics often have no effect on the core temperature of infants.

D)

Fever in neonates is often evidence of a congenital disorder rather than an infection.

20 .

An 84-year-old patients blood cultures have come back positive, despite the fact that his oral temperature has remained within normal range. Which of the following phenomena underlies the alterations in fever response that occur in the elderly?

A)

Disturbance in the functioning of the thermoregulatory center

B)

Increased heat loss by evaporation

C)

The presence of comorbidities that are associated with lowered core temperature

D)

Persistent closure of arteriovenous shunts

Answer Key

1.

C

2.

B

3.

C

4.

D

5.

C

6.

D

7.

A

8.

D

9.

B

10 .

A

11 .

D

NURSING TEST BANK

12 .

D

13 .

C

14 .

B

15 .

A, C, D

16 .

B

17 .

C

18 .

D

19 .

B

20 .

A

2. CHEMICAL AND BIOCHEMICAL FOUNDATIONS

1.

Ischemia and other toxic injuries increase the accumulation of intracellular calcium as a result of:

A)

release of stored calcium from the mitochondria.

B)

improved intracellular volume regulation.

C)

decreased influx across the cell membrane.

D)

attraction of calcium to fatty infiltrates.

2.

The patient is found to have liver disease, resulting in the removal of a lobe of his liver. Adaptation to the reduced size of the liver leads to of the remaining liver cells.

NURSING TEST BANK

A)

metaplasia

B)

organ atrophy

C)

compensatory hyperplasia

D)

physiologic hypertrophy

3.

A person eating peanuts starts choking and collapses. His airway obstruction is partially cleared, but he remains hypoxic until he reaches the hospital. The prolonged cell hypoxia caused a cerebral infarction and resulting in the brain.

A)

caspase activation

B)

coagulation necrosis

C)

rapid phagocytosis

D)

protein p53 deficiency

4.

Bacteria and viruses cause cell damage by , which is unique from the intracellular damage caused by other injurious agents.

A)

disrupting the sodium/potassium ATPase pump

B)

interrupting oxidative metabolism processes

C)

replicating and producing continued injury

D)

decreasing protein synthesis and function

5.

The patient has a prolonged interruption in arterial blood flow to his left kidney, causing hypoxic cell injury and the release of free radicals. Free radicals damage cells by:

A)

destroying phospholipids in the cell membrane.

B)

altering the immune response of the cell.

C)

disrupting calcium storage in the cell.

D)

inactivation of enzymes and mitochondria.

6.

Injured cells have impaired flow of substances through the cell membrane as a result of:

NURSING TEST BANK

A)

increased fat load.

B)

altered permeability.

C)

altered glucose utilization.

D)

increased surface receptors.

7.

Reversible adaptive intracellular responses are initiated by:

A)

stimulus overload.

B)

genetic mutations.

C)

chemical messengers.

D)

mitochondrial DNA.

8.

Injured cells become very swollen as a result of:

A)

increased cell protein synthesis.

B)

altered cell volume regulation.

C)

passive entry of potassium into the cell.

D)

bleb formation in the plasma membrane.

9.

A diabetic patient has impaired sensation, circulation, and oxygenation of his feet. He steps on a piece of glass, the wound does not heal, and the area tissue becomes necrotic. The necrotic cell death is characterized by:

A)

rapid apoptosis.

B)

cellular rupture.

C)

shrinkage and collapse.

D)

chronic inflammation.

10 .

A 99-year-old woman has experienced the decline of cell function associated with age. A group of theories of cellular aging focus on programmed:

A)

changes with genetic influences.

B)

elimination of cell receptor sites.

C)

insufficient telomerase enzyme.

NURSING TEST BANK

D)

11 .

DNA mutation or faulty repair.

An 89-year-old female patient has experienced significant decreases in her mobility and stamina during a 3-week hospital stay for the treatment of a femoral head fracture. Which of the following phenomena most likely accounts for the patients decrease in muscle function that underlies her reduced mobility?

A)

Impaired muscle cell metabolism resulting from metaplasia

B)

Dysplasia as a consequence of inflammation during bone remodeling

C)

Disuse atrophy of muscle cells during a prolonged period of immobility

D)

Ischemic atrophy resulting from vascular changes while on bedrest

12 .

A 20-year-old college student has presented to her campus medical clinic for a scheduled Papanicolaou (Pap) smear. The clinician who will interpret the smear will examine cell samples for evidence of:

A)

changes in cell shape, size, and organization.

B)

the presence of unexpected cell types.

C)

ischemic changes in cell samples.

D)

abnormally high numbers of cells in a specified field.

13 .

Which of the following pathophysiologic processes is most likely to result in metastatic calcification?

A)

Benign prostatic hyperplasia

B)

Liver cirrhosis

C)

Impaired glycogen metabolism

D)

Hyperparathyroidism

14 .

A)

Despite the low levels of radiation used in contemporary radiologic imaging, a radiology technician is aware of the need to minimize her exposure to ionizing radiation. What is the primary rationale for the technicians precautions?

Radiation stimulates pathologic cell hypertrophy and hyperplasia.

NURSING TEST BANK

B)

Radiation results in the accumulation of endogenous waste products in the cytoplasm.

C)

Radiation interferes with DNA synthesis and mitosis.

D)

Radiation decreases the action potential of rapidly dividing cells.

15 .

The parents of a 4-year-old girl have sought care because their daughter has admitted to chewing and swallowing imported toy figurines that have been determined to be made of lead. Which of the following blood tests should the care team prioritize?

A)

White blood cell levels with differential

B)

Red blood cell levels and morphology

C)

Urea and creatinine levels

D)

Liver function panel

16 .

A 70-year-old male patient has been admitted to a hospital for the treatment of a recent hemorrhagic stroke that has left him with numerous motor and sensory deficits. These deficits are most likely the result of which of the following mechanisms of cell injury?

A)

Free radical injury

B)

Hypoxia and ATP depletion

C)

Interference with DNA synthesis

D)

Impaired calcium homeostasis

17 .

Which of the following processes associated with cellular injury is most likely to be reversible?

A)

Cell damage resulting from accumulation of fat in the cytoplasm

B)

Cellular changes as a result of ionizing radiation

C)

Cell damage from accumulation of free radicals

D)

Apoptosis

18 .

The extrinsic pathway of apoptosis can be initiated by:

NURSING TEST BANK

A)

damage to cellular DNA.

B)

decreased ATP levels.

C)

activation of the p53 protein.

D)

activation of death receptors on the cell surface.

19 .

A patient with severe peripheral vascular disease has developed signs of dry gangrene on the great toe of one foot. Which of the following pathophysiologic processes most likely contributed to this diagnosis?

A)

Inappropriate activation of apoptosis

B)

Bacterial invasion

C)

Impaired arterial blood supply

D)

Metaplastic cellular changes

20 .

Which of the following facts underlies the concept of replicative senescence?

A)

Genes controlling longevity are present or absent in varying quantities among different individuals.

B)

Telomeres become progressively shorter in successive generations of a cell.

C)

The damaging influence of free radicals increases exponentially in later generations of a cell.

D)

Aging produces mutations in DNA and deficits in DNA repair.

Answer Key

1.

A

2.

C

3.

B

4.

C

5.

A

6.

B

NURSING TEST BANK

7.

C

8.

B

9.

B

10 .

A

11 .

C

12 .

A

13 .

D

14 .

C

15 .

B

16 .

B

17 .

A

18 .

D

19 .

C

20 .

B

3. MOLECULAR BIOLOGY, GENETICS, AND GENETIC DISEASES

1.

A)

Genetic disorders that involve a single gene trait are characterized by: multifactorial gene mutations.

NURSING TEST BANK

B)

chromosome rearrangements.

C)

Mendelian patterns of transmission.

D)

abnormal numbers of chromosomes.

2.

In addition to having a 50% chance of inheriting an autosomal dominant disorder from an affected parent, such a disorder is characterized by:

A)

aneuploidy of genes in all cells.

B)

deficiencies in enzyme synthesis.

C)

affected X transmission to daughters.

D)

varied gene penetration and expression.

3.

Autosomal recessive disorders are characterized by:

A)

age of onset later in life.

B)

abnormal protein structure.

C)

inborn errors of metabolism.

D)

one in two risk of a carrier child.

4.

When a male child inherits an X-linked disorder from his heterozygous carrier mother,

A)

his sons will be carriers.

B)

his father has the disorder.

C)

some of his sisters will be carriers.

D)

his daughters will have the disorder.

5.

Multifactorial inheritance disorders, such as cleft palate, are often caused by during fetal development.

A)

multiple gene mutations

B)

dominant gene expression

C)

X-linked crossover problem

D)

polyploidy of chromosomes NURSING TEST BANK

6.

The newborn has the distinctive physical features of trisomy 21, Down syndrome, which includes:

A)

upward slanting of eyes.

B)

large, protruding ears.

C)

thin lips and small tongue.

D)

long fingers with extra creases.

7.

Aneuploidy of the X chromosome can result in a monosomy or polysomy disorder. The manifestations of monosomy X, Turner syndrome, differ from polysomy X disorders in numerous ways that include:

A)

short-stature female individual..

B)

mental retardation.

C)

enlarged breasts.

D)

early onset puberty.

8.

A teratogenic environmental agent can cause birth defects when:

A)

inherited as a recessive trait.

B)

intense exposure occurs at birth.

C)

disjunction occurs during meiosis.

D)

retained during early pregnancy.

9.

Fetal alcohol syndrome (FAS) is unlike other teratogens in that the harmful effects on the fetus:

A)

directly result in liver damage.

B)

extend throughout the pregnancy.

C)

is most noticeable in adulthood.

D)

cause death in early childhood.

10 .

Prenatal diagnosis methods include the use of ultrasonography for identifying abnormalities.

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A)

cytogenic

B)

skeletal

C)

chromosomal

D)

a-fetoprotein

11 .

A woman who is a carrier for which of the following diseases possesses the greatest likelihood of passing the disease to her future children when heterozygous pairing exists?

A)

Phenylketonuria (PKU)

B)

Tay-Sachs disease

C)

Neurofibromatosis

D)

Cystic fibrosis

12 .

Which of the following statements is true of autosomal recessive disorders?

A)

Onset is typically late in childhood or early in adulthood.

B)

Symptomatology is less uniform than with autosomal dominant disorders.

C)

Mitochondrial DNA is normally the site of genetic alteration.

D)

Effects are typically the result of alterations in enzyme function.

13 .

The parents of a newborn infant are relieved that their baby was born healthy, with the exception of a cleft lip that will be surgically corrected in 10 or 12 weeks. Which of the nurses following statements to the parents best conveys the probable cause of the infants cleft lip?

A)

Though you are both healthy, you likely both carry the gene for a cleft lip.

B)

Provided one of you had the gene for a cleft lip, your baby likely faced a 50/50 chance of having one.

C)

Your childs cleft lip likely results from the interplay between environment and genes.

D)

A cleft lip can sometimes result from taking prescription drugs, even when theyre taken as ordered.

NURSING TEST BANK

14 .

Which of the following practitioners is most likely to be of assistance in the early care of an infant with a cleft lip?

A)

Lactation consultant

B)

Respiratory therapist

C)

Occupational therapist

D)

Social worker

15 .

A 41-year-old woman has made the recent decision to start a family, and is eager to undergo testing to mitigate the possibility of having a child with Down syndrome. Which of the following tests is most likely to provide the data the woman seeks?

A)

Genetic testing of the woman

B)

Genetic testing of the woman and the father

C)

Prenatal blood tests

D)

Ultrasonography

16 .

Genetic testing has revealed that a male infant has been born with an extra X chromosome. What are the most likely implications of this finding?

A)

The child is unlikely to survive infancy

B)

The child is likely to have no manifestations of this chromosomal abnormality

C)

The child will have significant neurological and cognitive defects

D)

The child will be unable to reproduce

17 .

Which of the following variables determine the extent of teratogenic drug effects? Select all that apply.

A)

Maternal health history

B)

Molecular weight of the drug

C)

Stage of pregnancy when the drug was taken

D)

Duration of drug exposure

E)

Fetal blood type

NURSING TEST BANK

18 .

A woman who has just learned that she is pregnant for the first time has sought advice from her healthcare provider about the safe use of alcohol during pregnancy. What advice should the clinician provide to the woman?

A)

Its likely best to eliminate alcohol from your diet while youre pregnant.

B)

Moderation in alcohol use is critical while you are pregnant.

C)

You should limit yourself to a maximum of one drink daily while youre pregnant.

D)

You should drink no alcohol until you are in your second trimester.

19 .

Which of the following health problems may be identified by a TORCH screening test?

A)

Rubella and herpes

B)

Tenovaginitis and human papillomavirus

C)

Rhinovirus and Ormond disease

D)

Chlamydia and rickets

20 .

Ultrasonography is most likely to detect which of the following fetal abnormalities?

A)

Neural tube defects

B)

Skeletal abnormalities

C)

Chromosomal defects

D)

Single-gene disorders

Answer Key

1.

C

2.

D

3.

C

4.

C

5.

A

6.

A NURSING TEST BANK

7.

A

8.

D

9.

B

10 .

B

11 .

C

12 .

D

13 .

C

14 .

A

15 .

C

16 .

B

17 .

B, C, D

18 .

A

19 .

A

20 .

B

4. CELL PHYSIOLOGY AND PATHOPHYSIOLOGY

1.

A)

Epithelialization, the first component of the proliferative phase of wound healing, is delayed in open wounds until after has formed. granulation tissue

NURSING TEST BANK

B)

fibrinous meshwork

C)

capillary circulation

D)

collagenous layers

2.

A mutation has occurred during mitosis of an individuals bone marrow cell.

This event may be the result of the failure of which of the following?

A)

Progenitor cells

B)

Fibroblasts

C)

Stem cells

D)

Cyclins

3.

A patient has experienced a myocardial infarction with accompanying necrosis of cardiac muscle, a permanent tissue. What are the ramifications of the fact that cardiac muscle is a permanent tissue?

A)

The cardiac muscle cells will remain perpetually in the G1 stage of mitosis.

B)

Regeneration of the patients cardiac muscle will be exceptionally slow.

C)

The necrotic cells will be replaced with muscle cells that have limited metabolism.

D)

The cells will not proliferate and will be replaced with scar tissue.

4.

A couple have chosen to pay for the harvesting and storage of umbilical cord blood after the delivery of their child to secure a future source of embryonic stem cells. What is the most likely rationale for the couples decision?

A)

The stem cells may be able to produce a wide range of body cells.

B)

The embryonic stem cells allow stable and permanent tissues to enter mitosis.

C)

The stem cells can change the proliferative capacity of other cells.

D)

The embryonic stem cells remove cyclin-dependent kinase inhibitors from the body.

NURSING TEST BANK

5.

The basement membrane surrounding a patients foot wound remains intact, a fact that bodes well for the wound-healing process. Which of the following components constitute this form of the extracellular matrix? Select all that apply.

A)

Prostaglandins

B)

Fibrous structural proteins

C)

Lymphocytes

D)

Water-hydrated gels

E)

Glycoproteins

6.

A nursing student is cleaning and changing the dressing on a patients sacral ulcer. The student has vigorously cleansed the wound bed to remove all traces of the beefy, red tissue that existed in the wound bed. The student has most likely removed:

A)

Necrotic tissue

B)

Granulation tissue

C)

Stem cells

D)

The extracellular matrix

7.

A 12-year-old boys severe wound that he received from a dog bite has begun to heal and currently shows no signs of infection. Which of the following processes occurred first during this process of repair by connective tissue deposition?

A)

Reorganization of fibrous tissue

B)

Angiogenesis

C)

Emigration of fibroblasts to the wound site

D)

Deposition of the extracellular matrix

8.

Which of the following wounds is most likely to heal by secondary intention?

A)

A finger laceration that a cook received while cutting up onions

B)

A boys road rash that he got by falling off his bicycle

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C)

A needlestick injury that a nurse received when injecting a patients medication

D)

The incision from a teenagers open appendectomy

9.

A patient underwent an open cholecystectomy 4 days ago and her incision is now in the proliferative phase of healing. What is the dominant cellular process that characterizes this phase of the patients healing?

A)

Hemostasis and vasoconstriction

B)

Keloid formation

C)

Collagen secretion by fibroblasts

D)

Phagocytosis by neutrophils

10 .

Which of the following surgical patients is most likely to experience enhanced wound healing as a result of his or her diet?

A)

A patient who eats a high-calorie diet and large amounts of red meat

B)

A patient who is a vegetarian and who eats organic foods whenever possible

C)

A patient who practices carefully calorie control and who avoids animal fats

D)

A patient who is receiving total parenteral nutrition due to recurrent nausea

11 .

Which of the following patients is most likely to experience impaired wound healing?

A)

A patient with a diagnosis of type 1 diabetes and a history of poor blood sugar control

B)

A child whose severe cleft lip and palate have required a series of surgeries over several months

C)

A patient who takes nebulized bronchodilators several times daily to treat chronic obstructive pulmonary disease

D)

A patient with persistent hypertension who takes a b-adrenergic blocker and a potassium-wasting diuretic daily

Answer Key NURSING TEST BANK

1.

A

2.

D

3.

D

4.

A

5.

B, D, E

6.

B

7.

B

8.

B

9.

C

10 .

A

11 .

A

5. INFECTIOUS DISEASE

1.

Although growth rate is variable among types of bacteria, the growth of bacteria is dependent on:

A)

biofilm communication.

B)

availability of nutrients.

C)

an intact protein capsid.

D)

individual cell motility.

2.

Treponema pallidum, the cause of syphilis, is a spirochete bacterium that is spread from human to human by:

A)

tick or lice vector bites.

B)

direct physical contact.

C)

exposure to infected urine.

NURSING TEST BANK

D)

3.

inhaling airborne particles.

Chlamydiaceae, a rather common sexually transmitted infectious organism, has characteristics of both viruses and bacteria. The infectious form of this organisms life cycle is until it enters the host cell.

A)

an elementary body

B)

adhered to cholesterol

C)

propelled by filaments

D)

encapsulated hyphae

4.

Because dermatophytes are capable of growing mainly found on cutaneous surfaces of the body.

A)

a powdery colony

B)

in moist skin folds

C)

on cooler tissue

D)

branching filaments

5.

Although both eukaryotes and prokaryotes are capable of causing infectious diseases in humans, eukaryotes are unique because they have a distinct:

A)

organized nucleus.

B)

circular plasmid DNA.

C)

cytoplasmic membrane.

D)

variation of shape and size.

6.

, the infection is

Whatever the mechanism of entry, the human-to-human transmission of infectious agents is directly related to the:

A)

source of contact.

B)

site of infection.

C)

number of pathogens absorbed.

D)

virulence factors.

NURSING TEST BANK

7.

The course of any infectious disease progresses through several distinct stages after the pathogen enters the host. Although the duration may vary, the hallmark of the prodromal stage is:

A)

tissue inflammation and damage.

B)

initial appearance of symptoms.

C)

progressive pathogen elimination.

D)

containment of infectious pathogens.

8.

Although bacterial toxins vary in their activity and effects on host cells, a small amount of gram-negative bacteria endotoxin:

A)

is released during cell growth.

B)

inactivates key cellular functions.

C)

uses protein to activate enzymes.

D)

in the cell wall activates inflammation.

9.

Serology testing includes the measurement of which of the following?

A)

Antibody titers

B)

Culture growth

C)

Direct antigens

D)

DNA sequencing

10 .

Prions cause transmissible neurodegenerative diseases and are characterized by:

A)

a lack of reproductive capacity.

B)

hypermetabolism.

C)

enzyme production.

D)

chronic inflammation.

11 .

Which of the following individuals is experiencing a health problem that is the result of a parasite?

NURSING TEST BANK

A)

A college student who contracted Chlamydia trachomatis during an unprotected sexual encounter

B)

A man who acquired malaria while on a tropical vacation

C)

A hospital patient who has developed postoperative pneumonia

D)

A woman who developed hepatitis A from eating at an unhygienic restaurant

12 .

Which of the following traits is characteristic of saprophytes?

A)

They derive energy from decaying organic matter.

B)

They are beneficial components of human microflora.

C)

They have RNA or DNA, but never both.

D)

They are capable of spore production.

13 .

A hospital patient was swabbed on admission for antibiotic-resistant organisms and has just been informed that methicillinresistant Staphylococcus aureus (MRSA) is present in his groin. The patient has a normal core temperature and white blood cell count. This patient is experiencing which of the following?

A)

Infection

B)

Proliferation

C)

Colonization

D)

Inflammation

14 .

A 33-year-old patient who is a long-term intravenous user of heroin has been recently diagnosed with hepatitis C. Which of the following portals of entry most likely led to the patients infection?

A)

Direct contact

B)

Vertical transmission

C)

Ingestion

D)

Penetration

NURSING TEST BANK

15 .

A 9-month-old infant has been diagnosed with botulism after he was fed honey. The childs mother was prompted to seek care because of this childs sudden onset of neuromuscular deficits, which were later attributed to the release of substances by Clostridium botulinum bacteria. Which virulence factor contributed to this childs illness?

A)

Endotoxins

B)

Adhesion factors

C)

Exotoxins

D)

Evasive factors

16 .

A patient with a long-standing diagnosis of Crohn disease has developed a perianal abscess. Which of the following treatments will this patient most likely require?

A)

Antiviral therapy

B)

Antibiotic therapy

C)

Surgical draining

D)

Pressure dressing

17 .

A patients primary care provider has ordered direct antigen detection in the care of a patient with a serious symptomatology of unknown origin. Which of the following processes will be conducted?

A)

Detecting DNA sequences that are unique to the suspected pathogen

B)

Growth of biofilms on various media in the laboratory setting

C)

Quantification of IgG and IgM antibodies in the patients blood

D)

Introduction of monoclonal antibodies to a blood sample from the patient

18 .

A patient has begun taking acyclovir, an antiviral medication, to control herpes simplex outbreaks. What is this drugs mechanism of action?

A)

Inhibition of viral adhesion to cells

B)

Elimination of exotoxin production

C)

Antagonism of somatic cell binding sites

D)

Interference with viral replication processes NURSING TEST BANK

19 .

International travel has contributed to increased prevalence and incidence of nonindigenous diseases by increasing which of the following?

A)

Portals of entry

B)

Sources of infection

C)

Virulence

D)

Disease course

20 .

A public health nurse should recognize that sexually transmitted infections (STIs) are typically spread by which of the following mechanisms?

A)

Penetration

B)

Vertical transmission

C)

Direct contact

D)

Ingestion

Answer Key

1.

B

2.

B

3.

A

4.

C

5.

A

6.

C

7.

B

8.

D

9.

A

10 .

A

11 .

B

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12 .

A

13 .

C

14 .

D

15 .

C

16 .

C

17 .

D

18 .

D

19 .

B

20 .

C

6. THE IMMUNE SYSTEM AND LEUKOCYTE FUNCTION

1.

The mediators involved in type I hypersensitivity allergic responses are released from:

A)

mast cells.

B)

plasma cells.

C)

monocytes.

D)

arachidonic acid.

2.

A)

A genetically determined hypersensitivity to common environmental allergens causes reactions, such as: atopic; urticaria.

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B)

autoimmune; diarrhea.

C)

IgM-mediated; infections.

D)

delayed; poison ivy rash:

3.

Mismatched blood transfusion reaction with hemolysis of blood cells is an example of type II, mediated hypersensitivity reaction.

A)

T-cell

B)

antibody

C)

leukotriene

D)

complement

4.

Type III hypersensitivity immune responses can be harmful when immune complex deposits in tissue activate that can directly damage area tissues.

A)

inflammation

B)

autoantibodies

C)

cytotoxic cells

D)

immunoglobulins

5.

The mechanism by which humans recognize self-cells from non-self (antigens)-cells is .

A)

autoimmunity

B)

self-tolerance

C)

non-self anergy

D)

immunocompatibility

6.

Organ rejection is a complication of organ transplantation caused by recipient immune cells:

A)

destroying the host T cells.

B)

attack on the donor cells.

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C)

combining with grafts HLA.

D)

being recognized as foreign.

7.

The leading cause of death for people with HIV is opportunistic .

A)

leukemia

B)

tuberculosis

C)

pneumonia

D)

toxoplasmosis

8.

Wasting syndrome, an AIDS-defining illness, is characterized by involuntary weight loss of at least 10% of baseline body weight in the presence of:

A)

diarrhea.

B)

hypermetabolism.

C)

weakness and fever.

D)

glucose intolerance.

9.

The window period of HIV infection refers to the period of time between infection and:

A)

transmission.

B)

seroconversion.

C)

initial symptoms.

D)

antibody screening.

10 .

HIV-positive persons that display manifestations of laboratory category 3 or clinical category C are considered to have:

A)

zero viral load.

B)

seroconversion.

C)

complete remission.

D)

AIDS-defining illnesses.

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11 .

Contact with poison ivy has resulted in intense pruritus, erythema, and weeping on a patients forearm. Which of the following processes resulted in the patients signs and symptoms?

A)

IgE-mediated mast cell degranulation

B)

Formation of antigen-antibody complexes

C)

Cytokine release by sensitized T cells

D)

Formation of antibodies against cell surface antigens

12 .

A patient with a long history of hay fever has recently begun a series of immunotherapy (allergy shots). How will this treatment potentially achieve a therapeutic effect?

A)

By blocking cytokine release from sensitized mast cells

B)

By preventing mast cells from becoming sensitized

C)

By causing T cells to be sequestered in the thymus for longer periods

D)

By stimulating production of IgG to combine with antigens

13 .

A patient with a diagnosis of cirrhosis has experienced an acute rejection of a donor liver. Which of the following cells is central to the rejection of the patients transplanted organ?

A)

Natural killer cells

B)

Mast cells

C)

T cells

D)

Neutrophils

14 .

A patient with a diagnosis of aplastic anemia has undergone allogenic bone marrow transplantation. Which of the following signs and symptoms would most clearly suggest the existence of graft-versus-host disease (GVHD)?

A)

Shortness of breath, audible crackles, and decreasing PaO2

B)

Presence of a pruritic rash that has begun to slough off

C)

Development of metabolic acidosis

D)

Diaphoresis, fever, and anxiety

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15 .

A patient has developed pericarditis after developing acute glomerulonephritis, a development that may be attributable to the presence of similar epitopes on group A, b-hemolytic streptococci and the antigens in the patients heart tissue. Which of the following has most likely accounted for this patients autoimmune response?

A)

Breakdown of T-cell anergy

B)

Release of sequestered antigens

C)

Superantigens

D)

Molecular mimicry

16 .

A 70-year-old female patient has had her mobility and independence significantly reduced by rheumatoid arthritis. Which of the following processes likely contributed to the development of her health problem?

A)

Delayed-type hypersensitivity (DTH) reaction

B)

Proliferation of cytotoxic T cells

C)

Failure of normal self-tolerance

D)

Deletion of autoreactive B cells

17 .

Which of the following would constitute a normal assessment finding in a neonate?

A)

Minimal or absent levels of IgA and IgM

B)

Absence of plasma cells in the lymph nodes and spleen

C)

Undetectable levels of all immunoglobulins

D)

Absence of mature B cells with normal T-cell levels and function

18 .

A patient was diagnosed as HIV positive several years ago. Which of the following blood tests is most clinically useful for determining the stage and severity of her disease?

A)

Plasma levels

B)

CD4+ cell counts

C)

Viral load

D)

White blood cell count with differential NURSING TEST BANK

19 .

A patient has been admitted to the hospital for the treatment of HIV infection, which has recently progressed to overt AIDS. Which of the following nursing actions should the nurse prioritize when providing care for this patient?

A)

Frequent neurologic vital signs and thorough skin care

B)

Hemodynamic monitoring and physical therapy

C)

Careful monitoring of fluid balance and neurologic status

D)

Astute infection control and respiratory assessments

20 .

Shortly after being diagnosed with HIV, a patient has begun highly active antiretroviral therapy (HAART). What is the primary goal of the patients drug regimen?

A)

To limit the latent period of HIV

B)

To slow the progression of the disease

C)

To minimize opportunities for transmission

D)

To prevent seroconversion

Answer Key

1.

A

2.

A

3.

B

4.

A

5.

B

6.

B

7.

B

8.

A

9.

B

10 .

D

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11 .

C

12 .

D

13 .

C

14 .

B

15 .

D

16 .

C

17 .

A

18 .

B

19 .

D

20 .

B

7. NEOPLASIA

1.

Unlike the tissue growth that occurs with hypertrophy and hyperplasia, the growth of a malignancy is:

A)

adaptive.

B)

specialized.

C)

predictable.

D)

autonomous.

2.

In contrast to malignancies, benign tumors are characterized by: NURSING TEST BANK

A)

a fibrous capsule.

B)

distant infiltration.

C)

rapid replication.

D)

undifferentiated cells.

3.

Because of their rapid growth, malignant tumors affect area tissues by:

A)

increasing tissue blood flow.

B)

providing essential nutrients.

C)

liberating enzymes and toxins.

D)

forming fibrous membranes.

4.

The metastatic spread of tumor cells is facilitated by invasion and movement to distant tissues.

A)

cell cohesiveness

B)

enzyme secretion

C)

contact inhibition

D)

cell-to-cell signaling

5.

The angiogenesis process, which allows tumors to develop new blood vessels, is triggered and regulated by tumor-secreted:

A)

procoagulants.

B)

growth factors.

C)

attachment factors.

D)

proteolytic enzymes.

6.

that enables

Cancerous transformation of a cell requires the activation of:

A)

cell cycle apoptosis.

B)

multiple mutations.

C)

a single gene mutation.

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D)

7.

tumor suppressor genes.

Although clinical manifestations vary with the type of cancer and organs involved, abnormal tumor growth causes general manifestations that include:

A)

copious lymph flow.

B)

sleep disturbances.

C)

involuntary weight gain.

D)

visceral organ expansion.

8.

Paraneoplastic syndromes are manifestations of cancer that often result from:

A)

radiation and chemotherapy.

B)

compression of area vessels.

C)

tumor-related tissue necrosis.

D)

inappropriate hormone release.

9.

Although both grading and staging are methods for classifying cancer and selecting a treatment plan, staging is used to determine the:

A)

number of mitoses.

B)

tissue characteristics.

C)

level of differentiation.

D)

extent of disease spread.

10 .

Early diagnosis of childhood cancers is often difficult because the signs and symptoms are:

A)

already present at birth.

B)

absent until the late stage.

C)

similar to those of other childhood diseases.

D)

seen as developmental delays.

NURSING TEST BANK

11 .

A lung biopsy and magnetic resonance imaging have confirmed the presence of a benign lung tumor in a patient. Which of the following characteristics are associated with this patients neoplasm?

A)

The tumor will grow by expansion and is likely encapsulated.

B)

The cells that constitute the tumor are undifferentiated, with atypical structure.

C)

If left untreated, the patients tumor is likely to metastasize.

D)

The tumor is likely to infiltrate the lung tissue that presently surrounds it.

12 .

Which of the following processes characterizes an epigenetic contribution to oncogenesis?

A)

A DNA repair mechanism is disrupted.

B)

A tumor suppressor gene is present, but it is not expressed.

C)

Cells lose their normal contact inhibition.

D)

Regulation of apoptosis in impaired, resulting in accumulation of cancer cells.

13 .

A farmers long-term exposure to pesticides has made the cells in his alveoli and bronchial tree susceptible to malignancy. Which of the following processes has taken place in the farmers lungs?

A)

Promotion

B)

Progression

C)

Initiation

D)

Differentiation

14 .

Genetic screening may be indicated for individuals who have a family history of which of the following neoplasms?

A)

Liver cancer

B)

Multiple myeloma

C)

Leukemia

D)

Breast cancer

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15 .

A public health nurse has cited a reduction in cancer risk among the many benefits of maintaining a healthy body-mass index. Which of the following facts underlies the relationship between obesity and cancer?

A)

Obesity can cause inflammation and hormonal changes that are associated with cancer.

B)

Adipose tissue is more susceptible to malignancy than other types of connective tissue.

C)

Increased cardiac workload and tissue hypoxia can interfere with normal cell differentiation.

D)

Increased numbers of body cells increase the statistical chances of neoplastic cell changes.

16 .

Which of the following dietary guidelines should a nurse provide to a group of older adults to possibly decrease their risks of developing colon cancer?

A)

As much as possible, try to eat organic foods.

B)

Regular vitamin supplements and a low-carbohydrate diet are beneficial.

C)

Try to minimize fat and maximize fiber when youre planning your meals.

D)

Eat enough fiber in your diet that you have bowel movement at least once daily.

17 .

A male patient with a diagnosis of liver cancer has been recently admitted to a palliative care unit following his recent development of bone metastases.

Despite his familys encouragement, the patient has experienced precipitous weight loss in recent weeks. Which of the following factors may underlie the patients loss of fat and muscle mass?

A)

The action of cytokines and consequent inflammation

B)

Loss of appetite due to fatigue and pain

C)

Changes in peptide hormone levels

D)

Production of onconeural antigens by cancerous cells

18 .

A)

A 51-year-old patient has been diagnosed with stage IV breast cancer with lung metastases. Which of the following treatment options is most likely to treat both her primary and distant cancer sites?

Radiation therapy NURSING TEST BANK

B)

Chemotherapy

C)

Surgery

D)

Hormone therapy

19 .

A patients oncologist has presented the possibility of implementing biotherapy in the treatment of the patients brain tumor. Which of the following mechanisms of action provide the therapeutic effects of biotherapy? Select all that apply.

A)

Stimulating the immune response to tumor cells

B)

Inhibiting tumor protein synthesis

C)

Reversing angiogenesis

D)

Altering the hormonal environment of tumor cells

E)

Causing breaks in the DNA of tumor cells

20 .

A 5-year-old girls diagnosis of bone cancer required an aggressive treatment regimen. Which of the following considerations forms the most significant threat to her future health?

A)

Retention of chemotherapeutic drugs in the healthy bone matrix

B)

Unwanted effects of chemotherapy and radiation therapy

C)

Resistance to chemotherapy and radiation if required later in life

D)

Risk for recurrence of the primary neoplasm after puberty

Answer Key

1.

D

2.

A

3.

C

4.

B

5.

B

6.

B

7.

B

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8.

D

9.

D

10 .

C

11 .

A

12 .

B

13 .

C

14 .

D

15 .

A

16 .

C

17 .

A

18 .

B

19 .

A, B

20 .

B

8. BLOOD AND CLOTTING

1.

With the exception of the first two steps, what is required in all steps of the clotting process?

A)

Calcium

B)

Prothrombin

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C)

Tissue factor

D)

Plasminogen

2.

The first step of hemostasis occurs as a:

A)

fibrin clot.

B)

platelet plug.

C)

clot retraction.

D)

vessel spasm.

3.

To form a platelet plug, platelets are attracted to the damaged vessel, and then platelet occurs.

A)

adhesion

B)

fibrinolysis

C)

thrombosis

D)

thromboxane A2

4.

Blood coagulation is initiated by either of two pathways. The intrinsic pathway requires circulating to begin the step-wise coagulation cascade.

A)

protein C

B)

thrombin

C)

factor XII

D)

tissue factor

5.

Increased platelet function, and consequent hypercoagulability, can be caused by:

A)

factor V mutation.

B)

platelet insensitivity.

C)

vascular wall damage.

D)

decreased platelet numbers.

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6.

Immune thrombocytopenia purpura (ITP) is a/an destroys .

A)

allergic; fibrinogen

B)

alloimmune; factor VIII

C)

autoimmune; platelets

D)

immunoglobulin; B cells

7.

Thrombotic thrombocytopenic purpura (TTP) causes which of the following manifestations? Select all that apply.

A)

Purpura

B)

Jaundice

C)

Petechiae

D)

Erythema

E)

Confusion

8.

Hemophilia A is a hereditary blood disorder caused by inadequate activity or absent:

A)

factor VIII.

B)

prothrombin.

C)

vWF complex.

D)

intrinsic factor.

9.

Disseminated intravascular coagulation (DIC) is characterized by:

A)

headaches.

B)

platelet loss.

C)

hypertension.

D)

hemorrhage.

10 .

disorder that

In persons with a bleeding disorder caused by vascular defects, laboratory tests will most often reveal:

NURSING TEST BANK

A)

normal values.

B)

hypocalcemia.

C)

polycythemia.

D)

thrombocytopenia.

11 .

Removal of a patients peripheral intravenous catheter resulted in brief bleeding and the loss of a small amount of blood. Which of the following processes occurred during the formation of the platelet plug that helped to stop blood flow?

A)

Activation of factor X

B)

Conversion of prothrombin to thrombin

C)

Release of von Willebrand factor from the epithelium

D)

Conversion of fibrinogen to fibrin threads

12 .

A 69-year-old patient who is obese and has a diagnosis of angina pectoris has been prescribed clopidogrel (Plavix) by his primary care provider. The patients medication achieves its therapeutic effect in which of the following ways?

A)

Prevention of platelet aggregation

B)

Activation of plasminogen

C)

Inhibition of the intrinsic clotting pathway

D)

Deactivation of factor X

13 .

A public health nurse is conducting a health promotion campaign under the auspices of the local community center. Which of the following measures that the nurse is promoting are likely to influence the participants risk of hypercoagulability disorders? Select all that apply.

A)

Smoking cessation

B)

Blood glucose screening

C)

Weight management

D)

Cholesterol screening and management

E)

Blood pressure screening and management NURSING TEST BANK

14 .

During a patients admission assessment prior to reduction mammoplasty surgery, the nurse notes a reference to a Leiden mutation in the patients history. The nurse would recognize the patients increased risk for

A)

Hemorrhage

B)

Myocardial infarction

C)

Hemophilia A or B

D)

Deep vein thrombosis

15 .

The most recent blood work of a patient with a diagnosis of acute myelogenous leukemia (AML) reveals thrombocytopenia. Where is the patient most likely to experience abnormal bleeding as a result of low platelets?

A)

In the brain

B)

Skin and mucous membranes

C)

Sclerae of the eyes

D)

Nephrons and ureters

16 .

A patient was started on a protocol for the prevention of deep vein thrombosis shortly after admission, and has been receiving 5000 units of heparin twice daily for the last 5 days. An immune response to this treatment may increase the patients chance of developing which health problem?

A)

Antiphospholipid syndrome

B)

Disseminated intravascular coagulation (DIC)

C)

Von Willebrand disease

D)

Thrombocytopenia

17 .

In light of the presence of numerous risk factors for coronary artery disease, a patients primary care provider has recommended that he take low-dose aspirin once daily. Doing so will reduce the patients risk of myocardial infarction by altering which of the following stages of hemostasis?

A)

Vessel spasm

B)

Platelet plug formation NURSING TEST BANK

C)

Blood coagulation

D)

Clot lysis

18 .

A 23-year-old female patient has been diagnosed with von Willebrand disease following a long history of heavy periods and occasional nosebleeds.

Which of the patients following statements demonstrates a sound understanding of her new diagnosis?

A)

Im really disappointed that I wont be able to do sports anymore.

B)

I read on a website that I might have to get blood transfusions from time to time.

C)

Ill make sure to take Tylenol instead of aspirin when I get aches and pains.

D)

I hope my insurance covers the injections that Ill need to help my blood clot.

19 .

Which of the following patients likely faces the highest risk of an acquired hypocoagulation disorder and vitamin K deficiency?

A)

A patient who has a diagnosis of liver failure secondary to alcohol abuse

B)

A patient who has chronic renal failure as a result of type 1 diabetes mellitus

C)

A patient who is immunocompromised as a result of radiation therapy for the treatment of lung cancer

D)

A patient with dehydration and hypokalemia that have resulted from Clostridium difficileassociated diarrhea

20 .

A healthy, primiparous (first-time) mother delivered a healthy infant several hours ago, but the mother has experienced postpartum hemorrhage. Which of the following disorders is most likely to underlie the patients excessive bleeding after delivery?

A)

Disseminated intravascular coagulation

B)

Hemophilia A

C)

Von Willebrand disease

D)

Thrombotic thrombocytopenic purpura (TTP)

NURSING TEST BANK

Answer Key

1.

A

2.

D

3.

A

4.

C

5.

C

6.

C

7.

A, C, E

8.

A

9.

D

10 .

A

11 .

C

12 .

A

13 .

A, B, C, D, E

14 .

D

15 .

B

16 .

D

17 .

B

18 .

C

19 .

A

NURSING TEST BANK

20 .

A

9. CIRCULATION

1.

The pathophysiology of heart failure involves an interaction between decreased pumping ability and the to maintain cardiac output.

A)

aortic hypertrophy

B)

compensatory mechanisms

C)

electrical conductivity

D)

parasympathetic system

2.

Cardiac output is the

A)

volume load

B)

blood pumped

C)

stroke volume

D)

force generated

3.

each minute.

One of the principal mechanisms by which the heart compensates for increased workload is:

A)

myocardial hypertrophy.

B)

sodium and water retention.

C)

endothelin vasoconstrictors.

D)

ventricular wall tension increase.

4.

In right-sided heart failure, peripheral edema is evidenced by:

A)

weight gain.

B)

copious urination.

C)

shortness of breath.

NURSING TEST BANK

D)

5.

decreased blood pressure.

The most common causes of left-sided heart failure include:

A)

acute myocardial infarction.

B)

chronic pulmonary disease.

C)

impaired renal blood flow.

D)

tricuspid valve regurgitation.

6.

Hypovolemic shock occurs as a result of:

A)

myocardial infarction.

B)

excessive vasoconstriction.

C)

chronic intracellular fluid shift.

D)

acute intravascular volume loss.

7.

In shock, one of the best indicators of blood flow to vital organs is:

A)

warm legs.

B)

urine output.

C)

blood pressure.

D)

consciousness.

8.

Anaphylactic shock is directly associated with:

A)

loss of blood volume.

B)

bacterial blood infection.

C)

failure of the heart as a pump.

D)

type I hypersensitivity response.

9.

A)

Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by: hyperventilation.

NURSING TEST BANK

B)

excessive surfactant.

C)

hyperinflated alveolar sacs.

D)

ventilation-perfusion mismatch.

10 .

A common symptom of the ischemia associated with gastrointestinal redistribution of blood flow is:

A)

gastric bleeding.

B)

nausea and vomiting.

C)

irritable bowel syndrome.

D)

copious high volume diarrhea.

11 .

A patient has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. Results of this diagnostic test suggest that the patients end-diastolic volume is insufficient. Which of the following parameters of cardiac performance will directly decrease as a result of this?

A)

Inotropy

B)

Cardiac contractility

C)

Preload

D)

Afterload

12 .

Which of the following health problems is associated with heart failure as a result of diastolic dysfunction?

A)

Uncontrolled hypertension

B)

Chronic bradycardia

C)

Ischemic heart disease

D)

Myocardial hypertrophy

13 .

Assessment of an elderly female patient reveals the presence of bilateral pitting edema of the patients feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the patients lungs reveals clear air entry to bases, and the patients oxygen saturation level is 93% and vital signs are within reference ranges. What is this patients most likely health problem?

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A)

Right-sided heart failure

B)

Left-sided heart failure

C)

Cardiogenic shock

D)

Cor pulmonale

14 .

The most recent blood work of a patient with a diagnosis of heart failure indicates increased levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). What are the most likely effects of these peptides on the patients physiology?

A)

Water retention

B)

Increased tubular sodium reabsorption

C)

Inhibition of the renin-angiotensin-aldosterone system

D)

Sympathetic nervous stimulation

15 .

A nurse is performing patient health education with a 68-year-old man who has recently been diagnosed with heart failure. Which of the following statements demonstrates an accurate understanding of his new diagnosis?

A)

Ill be sure to take my beta blocker whenever I feel short of breath.

B)

Im going to avoid as much physical activity as I can so that I preserve my strength.

C)

I know its healthy to drink a lot of water, and Im going to make sure I do this from now on.

D)

Im trying to think of ways that I can cut down the amount of salt that I usually eat.

16 .

Electrical burns over a large surface area of a patients body have resulted in hypovolemic shock after the loss of large amounts of blood and plasma.

Which of the following mechanisms is the patients body likely to implement to compensate for this loss of fluid?

A)

Increased heart rate

B)

Vasodilation

C)

Diuresis

NURSING TEST BANK

D)

17 .

Inhibition of ADH

A patient who developed a deep vein thrombosis during a prolonged period of bedrest has deteriorated as the clot has dislodged and resulted in a pulmonary embolism. Which of the following types of shock is this patient at risk of experiencing?

A)

Cardiogenic shock

B)

Hypovolemic shock

C)

Obstructive shock

D)

Distributive shock

18 .

For which of the following types of shock might intravenous antibiotic therapy be indicated?

A)

Obstructive shock

B)

Distributive shock

C)

Cardiogenic shock

D)

Hypovolemic shock

19 .

An 86-year-old male patient is disappointed to learn that he has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which of the following age-related changes predisposes older adults to developing heart failure?

A)

Increased vascular stiffness

B)

Orthostatic hypotension

C)

Increased cardiac contractility

D)

Loss of action potential

20 .

A)

A patient with a diagnosis of heart failure has returned from a visit with his primary care provider with a prescription for a change in his daily medication regimen. Which of the following drugs is likely to improve the patients cardiac function by increasing the force and strength of ventricular contractions?

A b-adrenergic blocker NURSING TEST BANK

B)

A diuretic

C)

A cardiac glycoside

D)

An ACE inhibitor

Answer Key

1.

B

2.

B

3.

A

4.

A

5.

A

6.

D

7.

B

8.

D

9.

D

10 .

A

11 .

C

12 .

D

13 .

A

14 .

C

15 .

D

16 .

A

17 .

C

NURSING TEST BANK

18 .

B

19 .

A

20 .

C

10. HEART

1.

Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by:

A)

fixed coronary obstruction.

B)

increased collateral circulation.

C)

intermittent vessel vasospasms.

D)

excessive endothelial relaxing factors.

2.

Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a:

A)

red thrombus.

B)

large lipid core.

C)

calcified lesion.

D)

vessel wall injury.

3.

Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac and the heart.

A)

ruptures; releases

B)

thickens; stretches

C)

contracts; friction rubs

D)

fills rapidly; compresses

NURSING TEST BANK

4.

In adults, sudden death from an acute myocardial infarction is usually caused by:

A)

acute myocarditis.

B)

high troponin levels.

C)

acute ventricular arrhythmia.

D)

hypertrophic cardiomyopathy.

5.

On the second or third day after an acute myocardial infarction, the area of necrosis is:

A)

soft and yellow.

B)

acutely inflamed.

C)

granulation tissue.

D)

fibrous scar tissue.

6.

In aortic regurgitation, failure of aortic valve closure during diastole causes an abnormal drop in diastolic pressure. This change in pressure causes decreased:

A)

stroke volume.

B)

left ventricular size.

C)

coronary perfusion.

D)

arterial pulse pressure.

7.

Patients with ischemic coronary vessel disease and acute coronary syndrome (ACS) are classified as low or high risk for acute myocardial infarction based on characteristics that include significant:

A)

heart murmurs.

B)

ECG changes.

C)

pulmonary disease.

D)

pericardial effusion.

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8.

Dilated cardiomyopathy with left ventricular dysfunction is characterized by increased wall:

A)

rigidity.

B)

thinning.

C)

thickness.

D)

contractility.

9.

Endocarditis and rheumatic heart disease are both cardiac complications of systemic infections. Characteristics include a new or changed heart murmur caused by:

A)

chronic atrial fibrillation.

B)

myocardial inflammation.

C)

left ventricle hypertrophy.

D)

vegetative valve destruction.

10 .

Congenital heart defects can cause a right heart to left heart shunting of blood that results in increased:

A)

pulmonary blood volume.

B)

right ventricle workload.

C)

unoxygenated blood flow.

D)

right atrial blood volume.

11 .

Which of the following assessment findings of a cardiac patient would be suggestive of cardiac tamponade?

A)

Increasing PaCO2 and decreasing PaO2

B)

Audible crackles on chest auscultation and presence of frothy sputum

C)

20 mm Hg Drop in systolic blood pressure during respiration

D)

Normal ECG combined with complaints of chest pain and shortness of breath

NURSING TEST BANK

12 .

The plaques in a patients coronary arteries are plentiful and most have smallto moderate-sized lipid cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which of the following diagnoses?

A)

Stable angina

B)

Non-ST-segment elevation MI

C)

ST-Segment elevation MI

D)

Unstable angina

13 .

Which of the following individuals is suffering the effects of acute coronary syndrome (ACS)?

A)

A patient whose most recent ECG indicates that silent myocardial ischemia has occurred

B)

A patient who occasionally experiences persistent and severe chest pain when at rest

C)

A patient who sometimes experiences chest pain when climbing stairs

D)

A patient who has recently been diagnosed with variant (vasospastic) angina

14 .

Coronary artery bypass grafting (CABG) is a relevant treatment modality for which of the following disorders of cardiac function?

A)

Atherosclerosis with history of MI

B)

Pericardial effusion and cardiac tamponade

C)

Dilated cardiomyopathies

D)

Aortic valve regurgitation and aortic stenosis

15 .

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to an enlarged heart.

Which of the following disorders was the players most likely cause of death?

A)

Takotsubo cardiomyopathy

B)

Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)

C)

Hypertrophic cardiomyopathy (HCM)

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D)

16 .

Dilated cardiomyopathy (DCM)

Implantation of a pacemaker is most likely to benefit a patient with which of the following cardiomyopathies?

A)

Myocarditis

B)

Takotsubo cardiomyopathy

C)

Dilated cardiomyopathy (DCM)

D)

Primary restrictive cardiomyopathy

17 .

A childs history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a diagnostic workup and a diagnosis of rheumatic fever.

What are the treatment priorities for this child?

A)

Cardiac catheterization and corticosteroid therapy

B)

Implanted pacemaker and b-adrenergic blockers

C)

Antibiotics and anti-inflammatories

D)

Pain control and oxygen therapy

18 .

An elderly female patient with complaints of increasing fatigue has been diagnosed with aortic stenosis, a disease which her primary care provider believes may have been long-standing. Which of the following compensatory mechanisms has most likely maintained the womans ejection fraction until recently?

A)

Left ventricular hypertrophy

B)

Increased blood pressure

C)

Increased heart rate and stroke volume

D)

Aortic dilation

19 .

Persistent cyanosis has led an infants care team to suspect a congenital heart defect. Which of the following assessment findings would suggest coarctation of the infants aorta?

A)

The child has a split S2 heart sound on auscultation.

B)

ECG reveals atrial fibrillation.

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C)

The child experiences apneic spells after feeding.

D)

Blood pressure in the childs legs is lower than in the arms.

20 .

Which of the following assessment findings of a cyanotic infant is incongruent with a diagnosis of tetralogy of Fallot?

A)

The child has ventricular septal defect.

B)

The infants pulmonary outflow channel is narrowed.

C)

The child has right ventricular hypertrophy.

D)

The infants aorta is narrowed.

Answer Key

1.

A

2.

B

3.

D

4.

C

5.

B

6.

C

7.

B

8.

B

9.

D

10 .

C

11 .

C

12 .

A

13 .

B

14 .

A

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15 .

C

16 .

C

17 .

C

18 .

A

19 .

D

20 .

D

11. LUNGS

1.

A distinguishing feature of viral influenza is:

A)

direct contact transmission.

B)

abrupt-onset, profound malaise.

C)

constant pounding headache.

D)

profuse watery nasal discharge.

2.

A common cause of bacterial pneumonia in both community and hospital setting is:

A)

E. coli

B)

S. aureus.

C)

Enterobacter.

D)

S. pneumoniae.

3.

Legionnaire disease is a form of bronchopneumonia caused by an organism frequently found in:

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A)

warm, standing water.

B)

public restrooms.

C)

fermenting yogurt.

D)

potted plant dirt.

4.

The pathogenic capacity of the tubercle bacillus is related to:

A)

formation of a Ghons focus lesion.

B)

its inherent destructive capabilities.

C)

rapid viral replication in host cells.

D)

the initiation of a cell-mediated immune response.

5.

People infected with HIV and tuberculosis lack a hypersensitivity response to the tuberculin test as a result of:

A)

inherent anergy.

B)

host cell depletion.

C)

poor lung perfusion.

D)

boosting phenomenon.

6.

Which of the four categories of bronchogenic carcinoma has the greatest association with tobacco smoking and tends to metastasize to the brain?

A)

Small cell

B)

Large cell

C)

Squamous cell

D)

Adenocarcinoma

7.

Increased upper airway resistance and decreased airflow into the lungs in neonates (0 to 4 weeks of age) can result from:

A)

frequent crying.

B)

sleeping supine.

C)

nasal congestion.

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D)

8.

productive coughing.

Most respiratory disorders in infants produce a decrease in:

A)

lung compliance.

B)

airway resistance.

C)

oxygen demand.

D)

respiratory rate.

9.

Which of the following acute respiratory infections in children poses the greatest threat of severe hypoxia caused by inflammatory edema?

A)

Croup

B)

Asthma

C)

Epiglottitis

D)

Bronchiolitis

10 .

The cold viruses are rapidly spread from person to person. The greatest source of spread is:

A)

fingers.

B)

sneezing.

C)

plastic toys.

D)

eye mucosa.

11 .

A college student is lamenting the fact that she has developed a cold on the weekend prior to exam week. Which of the following statements shows that the student has an accurate understanding of her upper respiratory infection?

A)

Im just going to try to rest as much as I can until these bacteria clear up.

B)

I think Ill go to the campus clinic and see if I can get a prescription for antibiotics.

C)

I suppose I should have been washing my hands more in the past few days.

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D)

If I can just start some antihistamines as soon as possible I bet Ill get over this faster.

12 .

A patient has presented to an ambulatory clinic complaining of a persistent headache. What assessments should the clinician conduct to differentiate between rhinosinusitis and alternative health problems?

A)

Take a sputum sample for culture and sensitivity.

B)

Compare the patients oral, tympanic, and axillary temperatures and order a white blood cell count.

C)

Palpate the patients lymph nodes and inspect the ears with an otoscope.

D)

Perform transillumination and ask the patient if bending forward exacerbates the headache.

13 .

Which of the following individuals should be prioritized for receiving a seasonal influenza vaccination?

A)

An 81-year-old resident of a long-term care facility

B)

A 19-year-old man who was admitted to a hospital for an appendectomy

C)

A neonate who was born in a busy, inner-city hospital in late October

D)

An 86-year-old patient whose flu symptoms have required hospitalization

14 .

A patient has been admitted to a medical unit of a hospital for the treatment of pneumonia that is attributable to S. pneumonia. Which of the following considerations is the priority in this patients treatment?

A)

Maintaining the patients activities of daily living

B)

Maintaining the patients airway

C)

Monitoring and treating the patients pain

D)

Preventing and treating the patients fever

15 .

A)

A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborneMycobacterium tuberculosis bacteria and has subsequently developed latent tuberculosis infection. Which of the following is true of this nurse?

The nurse is likely asymptomatic.

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B)

The nurse is now immune to more severe tuberculosis infection.

C)

The nurse can spread tuberculosis to others.

D)

The nurse has active tuberculosis infection.

16 .

Which of the following types of lung cancer is associated with the best prognosis in the majority of patients?

A)

Small cell lung cancer

B)

Adenocarcinoma

C)

Squamous cell carcinoma

D)

Large cell carcinoma

17 .

Which of the following individuals is most clearly in need of diagnostic testing for lung cancer?

A)

A patient who has required hospitalization with a fever and the production of copious lung secretions

B)

A patient with a history of secondary tuberculosis who failed to complete his prescribed course of antibiotics

C)

A woman who complains of recurrent lower respiratory infections and who has sought care for increasing shortness of breath

D)

A man who demonstrates wasting of the pelvic and shoulder muscles combined with signs of hypercalcemia

18 .

Which of the following characteristics of the lungs of infants and small children creates an increased risk of respiratory disorders?

A)

Type II alveoli in children may overproduce surfactant.

B)

Smaller airways create a susceptibility to changes in airway resistance and airflow.

C)

The pneumotaxic center in the pons in underdeveloped until 8 years of age.

D)

There are fewer chemoreceptors in the young medulla.

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19 .

Which of the following respiratory infections in children is associated with the poorest outcomes?

A)

Viral croup

B)

Rhinosinusitis

C)

Epiglottitis

D)

Spasmodic croup

20 .

A 6-month-old infant has been hospitalized with acute bronchiolitis. Which of the following treatments should be prioritized in the infants care?

A)

Supplementary oxygen therapy

B)

Intravenous antibiotics

C)

Transfusion of fresh frozen plasma

D)

Tracheotomy

Answer Key

1.

B

2.

B

3.

A

4.

D

5.

A

6.

A

7.

C

8.

A

9.

C

10 .

A

11 .

C

12 .

D

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13 .

A

14 .

B

15 .

A

16 .

C

17 .

D

18 .

B

19 .

C

20 .

A

12. KIDNEYS

1.

The most common indicator of acute renal failure is:

A)

anemia.

B)

uremia.

C)

edema.

D)

azotemia.

2.

A patient had excessive blood loss and prolonged hypotension during surgery. His postoperative urine output is sharply decreased and his blood urea nitrogen (BUN) is elevated. The most likely cause for the change is acute:

A)

prerenal inflammation.

B)

bladder outlet obstruction.

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C)

ischemic tubular necrosis.

D)

intrarenal nephrotoxicity.

3.

A patient is beginning to recover from acute tubular necrosis. The recovery phase of ATN is characterized by:

A)

edema.

B)

diuresis.

C)

proteinuria.

D)

hypokalemia.

4.

Regardless of the cause, chronic kidney disease results in progressive permanent loss of nephrons, glomerular filtration and renal:

A)

tubule dysplasia.

B)

vascular pressure.

C)

endocrine functions.

D)

hypophosphatemia.

5.

As chronic kidney disease progresses, the second stage (renal insufficiency) is identified by:

A)

isotonic polyuria.

B)

metabolic acidosis.

C)

hyperparathyroidism.

D)

diminished renal reserve.

6.

Both high-turnover and low-turnover renal osteodystrophy, the skeletal complications of chronic kidney disease, are manifested by abnormal and defective bone .

A)

shape; joint motion

B)

absorption; remodeling

C)

matrix density; marrow

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D)

7.

parathyroid hormone; surface

Impaired skin integrity and skin manifestations are common in persons with chronic kidney disease. Pale skin and subcutaneous bruising are often present as a result of:

A)

thrombocytopenia.

B)

anticoagulant therapy.

C)

decreased vascular volume.

D)

impaired platelet function.

8.

When acute tubular necrosis (ATN) has occurred instead of prerenal azotemia, laboratory test findings will show the presence of excessive urine:

A)

protein.

B)

glucose.

C)

calcium.

D)

sodium.

9.

Manifestations of childhood renal disease are varied and may differ from adult onset renal failure. Features of childhood chronic kidney disease include:

A)

mental retardation.

B)

developmental delays.

C)

bladder incontinence.

D)

early sexual maturity.

10 .

Reduced glomerular filtration rate (GFR), with a serum creatinine level that remains in the normal range, is associated with aging because is reduced in elderly persons.

A)

calcium intake

B)

muscle mass

C)

drug tolerance

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D)

11 .

renal perfusion

An 86-year-old female patient has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to prevent urinary incontinence. The patients most recent laboratory results are suggestive of acute renal failure. How would this patients renal failure be categorized?

A)

Prerenal

B)

Postrenal

C)

Intrinsic

D)

Intrarenal

12 .

A patient with significant burns on his lower body has developed sepsis on the third day following his accident. Which of the following developments is most clearly suggestive of ischemic acute tubular necrosis rather than prerenal failure?

A)

The patient exhibits pulmonary and peripheral edema.

B)

The patients GFR does not increase after restoration of renal blood flow.

C)

Emergency hemodialysis does not result in decreased BUN and creatinine.

D)

The patient exhibits oliguria and frank hematuria.

13 .

Which of the following individuals likely faces the greatest risk for the development of chronic kidney disease?

A)

A first-time mother who recently lost 1.5 L of blood during a postpartum hemorrhage

B)

A patient whose diagnosis of thyroid cancer necessitated a thyroidectomy

C)

A patient who experienced a hemorrhagic stroke and now has sensory and motor deficits

D)

A patient with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet

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14 .

The primary care provider for a newly admitted hospital patient has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The patients GFR will be extrapolated from serum levels of:

A)

urea.

B)

protein.

C)

creatinine.

D)

myoglobin.

15 .

The nurse is providing care for a patient who has a diagnosis of kidney failure. Which of the following laboratory findings is consistent with this patients diagnosis?

A)

Metabolic alkalosis

B)

Hypophosphatemia

C)

Hypocalcemia

D)

Hypokalemia

16 .

A patient with a recent diagnosis of renal failure that will require hemodialysis is being educated in the dietary management of the disease.

Which of the patients following statements shows an accurate understanding of this component of treatment?

A)

Ive made a list of high-phosphate foods so that I can try to avoid them.

B)

Im making a point of trying to eat lots of bananas and other food rich in potassium.

C)

Im going to try a high-protein, low-carbohydrate diet.

D)

I dont think Ive been drinking enough, so I want to include 8 to 10 glasses of water each day.

17 .

A patient with a diagnosis of chronic kidney disease (CKD) may require the administration of which of the following drugs to treat the consequences of CKD?

A)

Antihypertensive medications

B)

Antiarrhythmic medications

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C)

Opioid analgesics

D)

Nonsteroidal anti-inflammatory drugs (NSAIDs)

18 .

A patient with a longstanding diagnosis of chronic kidney disease has been experiencing increasing fatigue, lethargy, and activity intolerance in recent weeks. His care team has established that his GFR remains at a low, but stable, level. Which of the following assessments is most likely to inform a differential diagnosis?

A)

Blood work for white cells and differential

B)

Cystoscopy and ureteroscopy

C)

Assessment of pancreatic exocrine and endocrine function

D)

Blood work for hemoglobin, red blood cells, and hematocrit

19 .

Which of the following descriptions is true of peritoneal dialysis?

A)

Vascular access is achieved through an internal arteriovenous fistula or an external arteriovenous shunt.

B)

Treatments typically occur three times each week for three to four hours.

C)

The dialyzer is usually a hollow cylinder composed of bundles of capillary tubes.

D)

Treatment involves the introduction of a sterile dialyzing solution, which is drained after a specified time.

20 .

Which of the following integumentary problems most often accompanies chronic kidney disease?

A)

Dry skin and pruritus

B)

Petechiae and purpura

C)

Hirsutism and psoriasis

D)

Alopecia

Answer Key

NURSING TEST BANK

1.

D

2.

C

3.

B

4.

C

5.

A

6.

B

7.

D

8.

A

9.

B

10 .

B

11 .

A

12 .

B

13 .

D

14 .

C

15 .

C

16 .

A

17 .

A

18 .

D

19 .

D

20 .

A

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13. GASTROINTESTINAL TRACT

1.

A major complication of persistent gastroesophageal reflux is:

A)

strictures.

B)

heartburn.

C)

chest pain.

D)

hoarseness.

2.

Acute gastritis refers to a transient inflammation of the gastric mucosa that is most commonly associated with:

A)

diarrhea.

B)

food allergies.

C)

gastric reflux.

D)

alcohol intake.

3.

The Helicobacter pylori protobacteria cause peptic ulceration by producing:

A)

acids

B)

toxins

C)

ischemia

D)

bleeding

4.

A hallmark of irritable bowel syndrome is abdominal pain:

A)

relieved by defecation.

B)

most severe at night.

C)

with blood in the stool.

D)

after and between meals.

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5.

Inflammatory bowel diseases are accompanied by systemic manifestations that include:

A)

autoimmune anemia.

B)

rheumatoid arthritis.

C)

thrombocytopenia.

D)

lactose intolerance.

6.

Crohns type of inflammatory bowel disease is characterized by:

A)

granulomatous lesions.

B)

ulcerative erosions.

C)

fibrotic smooth muscle.

D)

necrotic crypt abscesses.

7.

Unlike the Crohn type of inflammatory bowel disease, the ulcerative colitis type is characterized by:

A)

skip lesions.

B)

steatorrhea.

C)

gastric ulcers.

D)

pseudopolyps.

8.

Diverticulitis, a complication of diverticulosis, is manifested by acute:

A)

rectal bleeding.

B)

abdominal distention.

C)

large-volume diarrhea.

D)

lower left quadrant pain.

9.

Major causes of mechanical bowel obstruction include:

A)

chemical irritation.

B)

ruptured appendix.

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C)

abdominal distention.

D)

postoperative adhesions.

10 .

As a protective measure to keep abdominal inflammation and infection localized, the peritoneum:

A)

constricts bowel contents.

B)

secretes fibrous exudate.

C)

increases intestinal motility.

D)

abdominal vasoconstriction.

11 .

Which of the following signs and symptoms most clearly suggests the need for endoscopy to rule out esophageal cancer?

A)

Heartburn after an individual consumes high-fat meals

B)

Dysphagia in an individual with no history of neurologic disease

C)

A new onset of gastroesophageal reflux in a previously healthy individual

D)

Recurrent episodes of gastritis that do not respond to changes in diet

12 .

A 60-year-old male patient has presented to his primary care provider to follow up with his ongoing treatment for peptic ulcer disease. What is the most likely goal of this patients pharmacologic treatment?

A)

Inhibiting gastric acid production

B)

Promoting hypertrophy of the gastric mucosa

C)

Increasing the rate of gastric emptying

D)

Increasing muscle tone of the cardiac sphincter

13 .

Which of the following individuals most likely faces the greatest risk of developing Clostridium difficile colitis?

A)

A 55-year-old man who takes proton pump inhibitors for the treatment of peptic ulcers

B)

A 79-year-old hospital patient who is being treated with broad-spectrum antibiotics

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C)

A premature neonate who has developed hyperbilirubinemia and is receiving phototherapy

D)

A 30-year-old patient who has a history of Crohn disease and has been admitted to a hospital to treat a recent flare-up

14 .

A 66-year-old woman has been diagnosed with diverticular disease based on her recent complaints and the results of a computed tomography (CT) scan.

Which of the patients following statements demonstrates an accurate understanding of this diagnosis?

A)

From now on, Im going to stick to an organic diet and start taking more supplements.

B)

I think this might have happened because Ive used enemas and laxatives too much.

C)

Ive always struggled with heartburn and indigestion, and I guess I shouldnt have ignored those warning signs.

D)

I suppose I should try to eat more fiber and become a bit more active.

15 .

An ultrasound has confirmed appendicitis as the cause of a 20-year-old mans sudden abdominal pain. Which of the following etiologic processes is implicated in the development of appendicitis?

A)

Obstruction of the intestinal lumen

B)

Elimination of normal intestinal flora

C)

Sloughing of the intestinal mucosa

D)

Increased osmolality of intestinal contents

16 .

Which of the following characteristics differentiates inflammatory diarrhea from the noninflammatory type?

A)

Larger volume of diarrhea

B)

Electrolyte imbalances

C)

Absence of blood in the stool

D)

Infection of intestinal cells

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17 .

Which of the following patients should the nurse observe most closely for the signs and symptoms of paralytic ileus?

A)

A patient who is postoperative day 1 following gall bladder surgery

B)

A patient whose acute diarrhea has necessitated the use of antidiarrheal medications

C)

An obese patient who refuses to ambulate because he complains of shortness of breath

D)

A patient with a longstanding diagnosis of irritable bowel syndrome

18 .

Which of the following meals is most likely to exacerbate an individuals celiac disease?

A)

Spaghetti with meatballs and garlic bread

B)

Stir-fried chicken and vegetables with rice

C)

Oatmeal with milk, brown sugar, and walnuts

D)

Barbecued steak and a baked potato with sour cream

19 .

Which of the following statements is true of colorectal cancer?

A)

Aspirin and NSAIDs are implicated in the etiology.

B)

It is one of the few cancers that is known to sometimes have an infectious etiology.

C)

Most cases are quite advanced before symptoms become apparent.

D)

Survival rates for colorectal cancer are less than 20%, but are increasing.

20 .

Following the analysis of a recent barium enema and colonoscopy with biopsy, a patient has been diagnosed with colorectal cancer. Which of the following treatment modalities will be the mainstay of this patients treatment?

A)

Chemotherapy

B)

Radiation therapy

C)

Pharmacologic therapies

D)

Surgery NURSING TEST BANK

Answer Key

1.

A

2.

D

3.

B

4.

A

5.

A

6.

A

7.

D

8.

D

9.

D

10 .

B

11 .

B

12 .

A

13 .

B

14 .

D

15 .

A

16 .

D

17 .

A

18 .

A

19 .

C

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20 .

D

14. LIVER

1.

Abnormally high accumulation of bilirubin in the blood causes:

A)

jaundice.

B)

cholestasis.

C)

xanthomas.

D)

biliary cirrhosis.

2.

The mechanisms of liver damage in viral hepatitis include:

A)

direct cellular injury.

B)

fatty liver changes.

C)

disrupted bile flow.

D)

bile duct inflammation.

3.

Alcoholic liver disease manifests in three stages. The intermediate stage, alcoholic hepatitis, is characterized by liver cell:

A)

necrosis.

B)

nodules.

C)

atrophy.

D)

hypertrophy.

4.

A major factor in the development of hepatic encephalopathy is:

A)

hypersplenism.

B)

high sodium level.

C)

neurotoxin accumulation.

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D)

5.

steroid hormone deficiency.

Kupffer cells function as to remove harmful substances or cells from the portal blood as it moves through the venous sinusoids.

A)

filters

B)

channels

C)

phagocytes

D)

cytotoxic cells

6.

Both prehepatic and posthepatic causes of portal hypertension include the formation of:

A)

fibrous nodules.

B)

venous thrombosis.

C)

collateral circulation.

D)

portosystemic shunts.

7.

The late manifestations of cirrhosis are related to liver failure and:

A)

hepatomegaly.

B)

diffuse liver fibrosis.

C)

portal hypertension.

D)

hepatorenal syndrome.

8.

Factors that contribute to the formation of gallstones, or acute cholelithiasis, include:

A)

chronic pancreatitis.

B)

rapid elimination of bile.

C)

gallbladder inflammation.

D)

excessive alcohol intake.

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9.

The patient has right upper quadrant pain caused by acute choledocholithiasis. If the common bile duct becomes obstructed, manifestations will also include:

A)

ascites.

B)

vomiting.

C)

bilirubinuria.

D)

hemorrhage.

10 .

Acute pancreatitis involves activated pancreatic enzymes that escape into surrounding tissues to cause .

A)

fatty deposits

B)

autodigestion

C)

bowel obstruction

D)

abscess formation

11 .

Individuals with liver disease often experience the effects of excess serum ammonia as a result of impairment of the livers ability to process ammonia.

How does the liver process ammonia in healthy individuals?

A)

By converting it into bilirubin which is then excreted intestinally

B)

By processing ammonia into nitrogen and hydrogen ions for excretion

C)

By processing it into urea and releasing it into the circulation

D)

By combining it with oxygen to create ammonium oxide

12 .

A patients longstanding diagnosis of congenital hemolytic anemia often manifests itself with jaundice. What type of jaundice does this patient most likely experience?

A)

Prehepatic

B)

Intrahepatic

C)

Posthepatic

D)

Infectious

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13 .

A decrease in the serum level of which of the following substances is suggestive of liver injury?

A)

g-Glutamyltransferase (GGT)

B)

Albumin

C)

Alanine aminotransferase (ALT)

D)

Alkaline phosphatase

14 .

Antibody testing has confirmed that a man is positive for hepatitis A virus (HAV). Which of the patients statements suggests that he understands his new diagnosis?

A)

I guess Im an example of why you should always use condoms.

B)

Im embarrassed that Ill be a carrier of hepatitis from now on.

C)

Im still trying to deal with the fact that this will forever change my life.

D)

I dont know why I didnt bother to get vaccinated against this.

15 .

A 16-year-old girl has been admitted to the emergency department after ingesting 20 g of acetaminophen (Tylenol) in a suicide attempt. The care team would recognize that this patient faces a severe risk of:

A)

acute fulminant hepatitis.

B)

hepatitis D virus infection.

C)

secondary biliary cirrhosis.

D)

portal hypertension.

16 .

Which of the following factors accounts for the poor prognosis that typically accompanies a diagnosis of primary hepatocellular cancer?

A)

Surgical options do not exist because removal of all or part of the liver is a threat to health.

B)

Liver cancer typically metastasizes at a much earlier stage than other cancers.

C)

Liver tumors are poorly differentiated due to the low density of hepatic tissue.

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D)

17 .

The nonspecific symptomatology of liver cancer means that diagnosis often happens at a late stage.

Which of the following factors is most strongly associated with the pathogenesis of gallstones?

A)

Excess serum ammonia and urea levels

B)

Portal hypertension

C)

Abnormalities or stasis of bile

D)

High cholesterol diet

18 .

Which of the following individuals most likely faces the highest risk of developing chronic pancreatitis?

A)

A woman who has six to eight drinks each evening

B)

A man who has become profoundly ill during a tropical vacation

C)

A woman who takes two Tylenol tablets five to six times a day

D)

An obese man who has a high-fat diet and has a sedentary lifestyle

19 .

The nurse who is providing care for a patient with pancreatic cancer should prioritize which of the following assessments?

A)

Assessment for ascites and close monitoring of fluid balance

B)

Respiratory assessment and monitoring of arterial blood gases

C)

Vigilant monitoring of blood glucose levels

D)

Assessment for deep vein thrombosis

20 .

Which of the following signs and symptoms is most suggestive of acute cholecystitis?

A)

Upper right quadrant or epigastric pain

B)

Fever and sudden abdominal distention

C)

Appearance of undigested fat in feces

D)

Nausea resulting in greenish vomitus

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Answer Key

1.

A

2.

A

3.

A

4.

C

5.

C

6.

B

7.

C

8.

C

9.

C

10 .

B

11 .

C

12 .

A

13 .

B

14 .

D

15 .

A

16 .

A

17 .

C

18 .

A

19 .

D

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20 .

A

15. NERVOUS SYSTEM

1.

The intracranial volume that is most capable of compensating for increasing intracranial pressure is the:

A)

brain cell tissue.

B)

intravascular blood.

C)

surface sulci fluid.

D)

cerebrospinal fluid.

2.

A late indicator of increased intracranial pressure is:

A)

tachycardia.

B)

right-sided heart failure.

C)

narrow pulse pressure.

D)

high mean arterial pressure.

3.

Extreme cerebral edema may cause the brain to herniate into another compartment. Upward herniation from the infratentorial compartment against the aqueduct of Sylvius causes:

A)

hydrocephalus.

B)

cardiac arrest.

C)

tissue infarction.

D)

intracranial bleeding.

4.

A)

Coup and contrecoup cerebral contusion caused by blunt head trauma against a fixed object results in: diffuse axonal injuries.

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B)

cerebrovascular infarction.

C)

momentary unconsciousness.

D)

permanent brain tissue damage.

5.

An intracranial epidural hematoma causes focal symptoms that can include:

A)

ipsilateral pupil dilation.

B)

ipsilateral hemiparesis.

C)

diffuse venous bleeding.

D)

commuting hydrocephalus.

6.

The earliest signs of decreased level of consciousness include:

A)

stupor.

B)

lethargy.

C)

delirium.

D)

inattention.

7.

Metabolic factors that increase cerebral blood flow include:

A)

increased oxygen saturation.

B)

increased carbon dioxide level.

C)

decreased serum sodium level.

D)

decreased hydrogen ion concentration.

8.

Transient ischemic attacks (TIAs) are characterized by ischemic cerebral neurologic deficits that:

A)

indicate aneurysm leakage.

B)

cause minor residual deficits.

C)

affect diffuse cerebral functions.

D)

resolve within one hour of onset.

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9.

Common manifestations of acute meningococcal meningitis, a highly contagious and lethal form of meningitis, include:

A)

diplopia.

B)

petechiae.

C)

papilledema.

D)

focal paralysis.

10 .

The moderate stage of the progressive degenerative Alzheimer-type dementia is manifested by behaviors that include:

A)

confusion.

B)

incontinence.

C)

decreased level of consciousness.

D)

social withdrawal.

11 .

A patients recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Which of the following treatment measures is most likely to resolve this health problem?

A)

Aggressive diuresis

B)

Placement of a shunt

C)

Administration of hypertonic intravenous solution

D)

Lumbar puncture

12 .

A high school senior sustained a concussion during a football game. Which of the following signs and symptoms would indicate the presence of postconcussion syndrome in the days and weeks following his injury?

A)

Headaches and memory lapses

B)

Recurrent nosebleeds and hypersomnia

C)

Unilateral weakness and decreased coordination

D)

Neck pain and decreased neck range of motion

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13 .

An elderly male patient has been brought to the emergency department after experiencing stroke-like symptoms a few hours ago, and has been subsequently diagnosed with an ischemic stroke. The care team is eager to restore cerebral perfusion despite the likely death of the brain cells directly affected by the stroke. What is the rationale for the care teams emphasis on restoring circulation?

A)

Failure to restore blood flow creates a severe risk for future transient ischemic attacks.

B)

Necrosis will continue unabated throughout the brain unless blood flow is restored.

C)

Cells of the penumbra may be saved from hypoxic damage if blood flow is promptly restored.

D)

Unless blood flow is restored, the patient faces the risk of progressing to hemorrhagic stroke.

14 .

A patients emergency magnetic resonance imaging (MRI) has been examined by the physician and tPA has been administered to the patient.

What was this patients most likely diagnosis?

A)

Status epilepticus

B)

Subarachnoid hemorrhage

C)

Ischemic stroke

D)

Encephalitis

15 .

A patient has been diagnosed with a cerebral aneurysm and placed under close observation before treatment commences. Which of the following pathophysiologic conditions has contributed to this patients diagnosis?

A)

Weakness in the muscular wall of an artery

B)

Impaired synthesis of clotting factors

C)

Deficits in the autonomic control of blood pressure

D)

Increased levels of cerebrospinal fluid

16 .

Which of the following pathophysiologic processes occurs in cases of bacterial meningitis?

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A)

Infection in the cerebrospinal fluid causes vasoconstriction and cerebral hypoxia.

B)

Trauma introduces skin-borne pathogens to the cerebrospinal fluid.

C)

Infection in the cerebrospinal fluid causes spinal cord compression and neurologic deficits.

D)

Inflammation allows pathogens to cross into the cerebrospinal fluid.

17 .

Which of the following individuals has the highest chance of having a medulloblastoma?

A)

An 88-year-old man who has begun displaying signs and symptoms of increased ICP

B)

A 60-year-old woman who is soon to begin radiation therapy for the treatment of breast cancer

C)

A 4-year-old child who has become uncoordinated in recent months

D)

A 68-year-old man who is a smoker and has a family history of cancer

18 .

A patient with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. After stopping this repetitive action, the patient appears confused and is oriented to person and place but not time.

What type of seizure did this patient most likely experience?

A)

Simple partial seizure

B)

Atonic seizure

C)

Myoclonic seizure

D)

Complex partial seizure

19 .

A patient with a long history of cigarette smoking and poorly controlled hypertension has experienced recent psychomotor deficits as a result of hemorrhagic brain damage. The patients psychomotor deficits are likely the result of:

A)

Alzheimer disease.

B)

frontotemporal dementia (FTD).

C)

vascular dementia.

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D)

Wernicke-Korsakoff syndrome.

20 .

Which of the following statements by the husband of a patient with Alzheimer disease demonstrates an accurate understanding of his wifes medication regimen?

A)

Im really hoping these medications will slow down her mental losses.

B)

Were both holding out hope that this medication will cure her Alzheimers.

C)

I know that this wont cure her, but we learned that it might prevent a bodily decline while she declines mentally.

D)

I learned that if we are vigilant about her medication schedule, she may not experience the physical effects of her disease.

Answer Key

1.

D

2.

D

3.

A

4.

D

5.

A

6.

D

7.

B

8.

D

9.

B

10 .

A

11 .

B

12 .

A

13 .

C

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14 .

C

15 .

A

16 .

D

17 .

C

18 .

D

19 .

C

20 .

A

16. MUSCULOSKELETAL SYSTEM

1.

Characteristics of a patient that is at high risk for falling and fracturing a hip include:

A)

obesity and short stature.

B)

excessive sugar intake.

C)

hearing impairment.

D)

chronic osteoporosis.

2.

A pathologic stress fracture occurs in bones subjected to:

A)

sudden direct force.

B)

weakening by disease.

C)

repeated excessive use.

D)

massive muscle contraction.

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3.

Shortly after a closed fracture has occurred, early manifestations include localized:

A)

tetany.

B)

deformity.

C)

necrosis.

D)

numbness.

4.

In order to initiate the cellular events essential to bone healing, there must be formation at the fracture site.

A)

callous

B)

hematoma

C)

ossification

D)

fibrin meshwork

5.

In contrast to structural scoliosis, postural scoliosis:

A)

compresses vertebrae.

B)

corrects with bending.

C)

is apparent at birth.

D)

becomes painful.

6.

Factors that may adversely affect bone healing include

A)

immobilization

B)

weight bearing

C)

delayed union

D)

tight alignment

7.

of the bone.

The distinguishing characteristic of chronic osteomyelitis is the presence of:

A)

sequestrum bone.

B)

abscess formation.

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C)

severe bone pain.

D)

external drainage.

8.

Developmental dysplasia of the hip (DDH), formerly known as congenital hip dislocation, is suspected when an infant has:

A)

gluteal fold asymmetry.

B)

lengthening of the thigh.

C)

joint capsule tightness.

D)

delay of knee crawling.

9.

Osteonecrosis is most often caused by:

A)

stress fractures.

B)

bacterial infection.

C)

synovial inflammation.

D)

bone marrow ischemia.

10 .

The patient has a fractured tibia. After the cast is applied he is at high risk for compartment syndrome caused by:

A)

inflammation.

B)

joint immobility.

C)

muscle atrophy.

D)

extremity elevation.

11 .

A college baseball player has seen his season cut short by a rotator cuff injury. Rotator cuff injuries are frequent because of:

A)

the inherent instability of the shoulder.

B)

the absence of ligaments at the glenohumeral joint.

C)

the vulnerability of the shoulder menisci.

D)

the large mass of the humeral head.

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12 .

A patients clavicular fracture has healed in the weeks following a bicycle accident. Which of the following events takes place in the remodelling stage of bone healing?

A)

Formation of granulation tissue

B)

Development of fibrocartilage that resembles the appearance of the original bone

C)

Deposition of mineral salts into the callus

D)

Reduction in the size of the callus

13 .

A child has been hospitalized for the treatment of hematogenous osteomyelitis. The defining characteristic of this type of osteomyelitis is:

A)

the presence of dead bone tissue.

B)

introduction of microorganisms from the bloodstream.

C)

bacterial proliferation in the absence of the classic signs of infection.

D)

destruction of the vascular network in the endosteum.

14 .

Following a lengthy series of diagnostic tests, a patients chronic hip pain has been attributed to advanced osteonecrosis. What treatment is this patient most likely to require?

A)

Joint replacement surgery

B)

Intravenous antibiotics

C)

Injections of corticosteroids into the synovial space

D)

Transfusion of packed red blood cells

15 .

Which of the following neoplasms of the skeletal system is likely to require the most timely and aggressive treatment?

A)

Exostosis

B)

Osteochondroma

C)

Endochondroma

D)

Osteosarcoma

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16 .

A patient with a diagnosis of small cell lung carcinoma has developed bone metastases, a finding that has prompted a series of new interventions. What are the primary goals of the treatment regimen for this patients bone cancer?

A)

Prevention of brain metastasis and early identification of osteonecrosis

B)

Promotion of bone remodeling at tumor sites through calcium and vitamin D supplements

C)

Prevention of pathologic fractures and maximization of function

D)

Pain management and prevention of osteomyelitis

17 .

Metastatic bone disease is most closely associated with:

A)

cervical cancer and ovarian cancer.

B)

acute myelogenous leukemia (AML) and malignant melanoma.

C)

non-Hodgkin lymphoma and bladder cancer.

D)

breast cancer and prostate cancer.

18 .

A couple has just learned that their newborn infant has been diagnosed with osteogenesis imperfecta, and they have responded by seeking out as much information as possible about their childs diagnosis. What should the clinician teach the couple about their childs health problem?

A)

This is something that your child may have inherited from one or both or you.

B)

This might have been caused by something you were exposed to during the early part of your pregnancy.

C)

Youll have to be vigilant of your childs safety for the next few years, but the disease often resolves spontaneously.

D)

With aggressive treatment, most children with osteogenesis imperfecta are cured within several months.

19 .

A child with a diagnosis of Legg-Calv-Perthes disease will exhibit:

A)

defective synthesis of type I collagen.

B)

congenital dislocation of the acetabulofemoral joint.

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C)

necrosis of the proximal femoral head.

D)

intoeing due to metatarsus adductus.

20 .

Assessment of a newborn infant reveals the presence of developmental dysplasia of the hip (DDH) that is currently demonstrated by subluxation of the babys hip joint and a general laxity in the babys ligaments. What measures should be emphasized in this infants treatment?

A)

Corticosteroid therapy

B)

Close observation

C)

Open reduction

D)

Joint reconstruction

Answer Key

1.

D

2.

B

3.

D

4.

B

5.

B

6.

C

7.

A

8.

A

9.

D

10 .

A

11 .

A

12 .

D

13 .

B

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14 .

A

15 .

D

16 .

C

17 .

D

18 .

A

19 .

C

20 .

B

17. ENDOCRINE SYSTEM

1.

A predominant effect of a prolonged excessive growth hormone level is:

A)

short stature with obesity.

B)

high androgen hormone levels.

C)

increased blood glucose levels.

D)

insulin-like growth factor (IGF) depletion.

2.

The most common cause of hypothyroidism is:

A)

goiter.

B)

myxedema.

C)

thyroidectomy.

D)

autoimmune thyroiditis.

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3.

Thyroid hormone deficit organs in the body.

A)

decreases metabolism

B)

increases protein synthesis

C)

causes vitamin deficiencies

D)

enhances absorption of glucose

4.

The most common cause of thyrotoxicosis is Graves disease, which has the distinguishing characteristic of in addition to a diffuse goiter.

A)

muscle fatigue

B)

facial myxedema

C)

ophthalmopathy

D)

decreased cholesterol

5.

The major adrenal cortical hormones are steroids and are synthesized from acetate and:

A)

ACTH.

B)

albumin.

C)

amino acids.

D)

cholesterol.

6.

, which alters the function of all major

Primary adrenal insufficiency is manifested by:

A)

truncal obesity and edema.

B)

hypokalemia and hypervolemia.

C)

hyponatremia and hypoglycemia.

D)

hypopigmentation and hypertension.

7.

A)

One of the earliest signs of Cushing syndrome is the loss of variable diurnal secretion of cortisol-releasing hormone (CRH) and: GH.

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B)

TSH.

C)

DHEA.

D)

ACTH.

8.

The iatrogenic form of Cushing syndrome is caused by:

A)

long-term cortisone therapy.

B)

pituitary tumor-secreting ACTH.

C)

benign or malignant adrenal tumor.

D)

ectopic ACTH secreting lung tumor.

9.

The major manifestations of Cushing syndrome include:

A)

excessive salt loss.

B)

muscle hypertrophy.

C)

overt diabetes mellitus.

D)

hair and weight loss.

10 .

The immune suppressive and anti-inflammatory effects of cortisol cause:

A)

moderate insulin resistance.

B)

increased capillary permeability.

C)

increased cell-mediated immunity.

D)

inhibition of prostaglandin synthesis.

11 .

Which of the following individuals is experiencing the effects of a primary endocrine disorder?

A)

A patient with adrenal cortical insufficiency due to pituitary hyposecretion of ACTH

B)

A patient who has hypothyroidism as a result of low TSH production

C)

A patient whose dysfunctional hypothalamus has resulted in endocrine imbalances

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D)

12 .

A patient who has low calcium levels because of the loss of his parathyroid gland

Which of the following physiologic processes is a direct effect of the release of growth hormone by the anterior pituitary?

A)

Development of cartilage and bone

B)

Production of insulin-like growth factors (IGFs) by the liver

C)

Increase in overall metabolic rate and cardiovascular function

D)

Positive feedback of the hypothalamic-pituitary-thyroid feedback system

13 .

Which of the following individuals displays the precursors to acromegaly?

A)

An adult with an excess of growth hormone due to an adenoma

B)

A girl who has been diagnosed with precocious puberty

C)

An adult who has a diagnosis of Cushing syndrome

D)

A patient who has recently developed primary adrenal carcinoma

14 .

Which of the following residents of a long-term facility is exhibiting signs and symptoms that are indicative of hypothyroidism?

A)

An 80-year-old woman who has uncharacteristically lost her appetite of late and often complains of feeling cold

B)

A 90-year-old woman with a history of atrial fibrillation whose arrhythmia has recently become more severe

C)

An 88-year-old man with a history of Alzheimer disease who has become increasingly agitated and is wandering more frequently

D)

A 91-year-old man with a chronic venous ulcer and a sacral ulcer who has developed sepsis

15 .

Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of:

A)

Cushing syndrome.

B)

Graves disease.

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C)

Addison disease.

D)

Cushing disease.

16 .

A patient has developed the facial appearance that is characteristic of myxedema, along with an enlarged tongue, bradycardia, and voice changes.

Which of the following treatment modalities is most likely to benefit this patient?

A)

Synthetic preparations of T3 or T4

B)

b-Adrenergic blocking drugs and antithyroid drugs

C)

Corticosteroid replacement therapy

D)

Oral or parenteral cortisol replacement

17 .

A 33-year-old patient has been admitted to the hospital for the treatment of Graves disease. Which of the following assessments should the patients care team prioritize?

A)

Assessment of the patients level of consciousness and neurologic status

B)

Assessment of the patients peripheral vascular system and assessing for thromboembolism

C)

Assessment of the patients vision and oculomotor function

D)

Cardiac monitoring and assessment of peripheral perfusion

18 .

A patient who has been taking 80 mg of prednisone, a glucocorticoid, each day has been warned by his primary care provider to carefully follow a plan for the gradual reduction of the dose rather than stopping the drug suddenly.

What is the rationale for this directive?

A)

Sudden changes in glucocorticoid dosing may reverse the therapeutic effects of the drug.

B)

Stopping the drug suddenly may shock the HPA axis into overactivity.

C)

Sudden cessation of a glucocorticoid can result in adrenal gland necrosis.

D)

Stopping the drug suddenly may cause adrenal insufficiency.

19 .

The signs and symptoms of abrupt cessation of pharmacologic glucocorticoids closely resemble those of: NURSING TEST BANK

A)

Addison disease.

B)

Cushing disease.

C)

Cushing syndrome.

D)

Graves disease.

20 .

Which of the following pathophysiologic phenomena may result in a diagnosis of Cushing disease?

A)

Hypopituitarism

B)

Excess ACTH production by a pituitary tumor

C)

Autoimmune destruction of the adrenal cortex

D)

Malfunction of the HPA system

Answer Key

1.

C

2.

D

3.

A

4.

C

5.

D

6.

C

7.

D

8.

A

9.

C

10 .

D

11 .

D

12 .

B

13 .

A

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14 .

A

15 .

B

16 .

A

17 .

C

18 .

D

19 .

A

20 .

B

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