Ch 18 Darby Pain Management
How many cartridges of lidocaine 2% 1:100,000 epinephrine anesthetic agent can be safely administered to a 120-lb patient taking tricyclic antidepressants? a. 1.1 cartridges b. 2.2 cartridges c. 3.3 cartridges d. 4.4 cartridges
2.2 cartridges ex: Taking tricyclic antidepressants is a relative contraindication to the use of vasoconstrictors and the cardiac dose for epinephrine must be used making epinephrine the limiting drug in this situation. The cardiac dose for epinephrine is 0.04 mg or 2.2 cartridges
Which of the following gauge numbers indicates the needle with the smallest lumen? a. 30 b. 27 c. 25 d. 23
30 ex: The larger the gauge number, the smaller the diameter of the lumen.
The ideal concentration range of N2O is a. 10% to 25%. b. 30% to 50%. c. 50% to 60%. d. 60% to 70%.
30% to 50%. ex: The ideal concentration range of N2O is 30% to 50%
What is the pressure in a HALF full tank of N2O? a. 650 to 900 psi b. 900 to 1100 psi c. 1400 to 1600 psi d. 1800 to 2100 psi
650 to 900 psi ex: . 650 to 900 psi is the same as if it was a full tank because as long as you have 1/8 of a tank of liquid to convert to the gaseous state, the pressure gauge will read full.
What is the pressure in a FULL tank of nitrous oxide (N2O)? a. 650 to 900 psi b. 900 to 1100 psi c. 1400 to 1600 psi d. 1800 to 2100 psi
650 to 900 psi ex: 650 to 900 psi is the pressure in a full tank of nitrous
How many cartridges of prilocaine 4% anesthetic agent can a healthy 130-lb patient receive? a. 6.8 cartridges b. 7.2 cartridges c. 7.8 cartridges d. 8.3 cartridges
7.2 cartridges ex: For prilocaine, the maximum dose in milligrams per pound is 4.0. To determine the maximum recommended dose for this patient in milligrams , multiply 130 pds × 4.0 mg/lb = 520 mg, MRD. To convert to cartridges: because a 4% solution has 72 mg in one cartridge, divide 520 mg by 72 mg = 7.2 cartridges.
What is the pressure of a HALF-full tank of O2? a. 700 to 800 psi b. 900 to 1100 psi c. 1400 to 1600 psi d. 1800 to 2100 psi
900 to 1100 psi ex: 900 to 1100 psi is half of 1800 to 2100
Sodium bisulfite is added to a cartridge of anesthetic to increase the stability of the a. distilled water. b. vasoconstrictor. c. hydrochloride salt. d. plasma cholinesterase.
vasoconstrictor. ex: Vasoconstrictors are unstable in solution, so a preservative is added to the solution in order to prevent the oxidation of the vasoconstrictor. The preservative competes with the vasoconstrictor for the available oxygen in the cartridge. Because the preservative is more active, it readily oxidizes (sodium bisulfate), thus allowing the vasoconstrictor to remain stable.
The dental hygienist administered 2.4 cartridges of 3% mepivacaine. How many milligrams were administered? a. 129.6 mg b. 137.5 mg c. 138.4 mg d. 125.2 mg
129.6 mg ex: There is 54 mg in one cartridge of 3% mepivacaine. To determine how many milligrams are in 2.4 cartridges, multiply 54 by 2.4, and the answer is 129.6 mg.
What is the pressure in a FULL tank of oxygen (O2)? a. 700 to 800 psi b. 900 to 1100 psi c. 1400 to 1600 psi d. 1800 to 2100 psi
1800 to 2100 psi ex: 1800 to 2100 psi is the pressure in a full tank of oxygen.
For what purpose is epinephrine added to either prilocaine or lidocaine local anesthetic agent? a. Prolongation of anesthesia b. Reduction of hemorrhage in field of operation c. Constriction of blood vessels in area of injection d. Prevention of toxic effects from too rapid absorption e. All of the above
All of the above
The patient's medical history indicates past liver damage. Why is the amount of amide-based anesthetic solution a relative contraindication? a. Amides increase the risk of an allergic reaction. b. Amides undergo biotransformation in the liver. c. Without action by the liver, amides will be reabsorbed. d. Amides are absorbed much slower at the injection site.
Amides undergo biotransformation in the liver. ex: Amide-based local anesthetic drugs are metabolized in the liver, thereby the patient would have more difficulty metabolizing the anesthetic
Which nerve is involved when anesthetizing the facial gingiva of the maxillary canine? a. Middle superior alveolar nerve b. Nasopalatine nerve c. Infraorbital nerve d. Anterior superior alveolar nerve e. Inferior alveolar nerve
Anterior superior alveolar nerve ex: This nerve innervates the maxillary anterior teeth and the facial gingiva of those teeth.
When does depolarization of a nerve fiber occur? a. During the resting state of the fiber b. Because of the sodium pump c. During the relative refractory period d. Between the polarization stage and reverse polarity
Between the polarization stage and reverse polarity ex: Depolarization of a nerve fiber occurs between the polarization stage and reverse polarity.
How can you determine a positive aspiration with the computer-controlled local anesthetic delivery date? a. Blood will be noticed in the glass cartridge. b. Blood will be noticed in the plastic tubing only. c. Blood will be noticed at the needle hub. d. The unit will beep rapidly if aspiration is positive.
Blood will be noticed at the needle hub. ex: The initial point where blood is visualized is the hub.
Where are vasoconstrictors metabolized? a. Liver b. Plasma c. Bloodstream d. Kidneys
Bloodstream ex: Vasoconstrictors are inactivated or broken down in the bloodstream by the enzyme monoamine oxidase (MAO).
The lipophilic portion of an anesthetic molecule allows the anesthetic solution to diffuse through the interstitial tissues; the hydrophilic portion allows the solution to diffuse through the nerve membrane. a. Both statements are TRUE. b. Both statements are FALSE. c. The first statement is TRUE; the second is FALSE. d. The first statement is FALSE; the second is TRUE.
Both statements are FALSE. ex: The lipophilic portion of the anesthetic molecule allows the solution to diffuse through the nerve membrane, the hydrophilic portion allows the solution to diffuse through the interstitial tissues.
When anesthetizing the mental nerve, which of the following tissues will be affected? a. Buccal gingiva of mandibular molars b. Floor of the mouth as well as lower lip c. Lingual gingiva of mandibular teeth d. Buccal gingiva of mandibular anterior teeth and mandibular first premolar e. Skin of upper cheek as well as lower chin
Buccal gingiva of mandibular molars ex: The buccal block anesthetizes the buccal periodontium and gingiva of the mandibular molars.
Which injection anesthetizes the palatal gingiva and palatal mucosa of tooth #14? a. Middle superior alveolar nerve block b. Posterior superior alveolar nerve block c. Anterior middle superior alveolar nerve block (palatal approach) d. Greater palatine nerve block
Greater palatine nerve block ex: The GP anesthetizes (1) the lingual gingiva of maxillary posterior teeth and (2) the palatal mucosa to the midline.
Which acid is most often combined with a local anesthetic drug? a. Sodium bisulfite b. Sodium chloride c. Acetic acid d. Hydrochloric acid
Hydrochloric acid
Which nerve is involved when anesthetizing the mandibular first premolar? a. Middle superior alveolar nerve b. Nasopalatine nerve c. Infraorbital nerve d. Anterior superior alveolar nerve e. Inferior alveolar nerve
Inferior alveolar nerve ex: This nerve innervates the mandibular posterior teeth.
Which of the following is TRUE concerning N2O? a. A full tank would read approximately 2100 psi. b. It exists as a gas in the tank and is delivered as a gas. c. It can be administered and monitored by dental hygienists in all states. d. It may induce nerve damage if used chronically.
It may induce nerve damage if used chronically. ex: N2O-O2 may induce nerve damage if used chronically.
What is the target area for the inferior alveolar nerve block? a. Mandibular foramen b. Lateral surface of mandibular ramus c. Anteromedial border of neck of mandibular condyle d. Retromolar pad or triangle
Mandibular foramen ex: The target area for the inferior alveolar block is the mandibular foramen.
What is the injection site for the posterior superior alveolar nerve block? a. Retromolar pad or triangle b. Maxillary tuberosity c. Pterygopalatine fossa d. Superior to maxillary canines
Maxillary tuberosity ex: The injection site for the PSA block is the height of the maxillary mucobuccal fold superior to the apex of the maxillary second molar at the area of the maxillary tuberosity.
After administering a posterior superior alveolar nerve block, the maxillary first molar remains sensitive, but the maxillary second and third molars are anesthetized. Which of the following would be the BEST explanation? a. Anesthetic agent was deposited too high. b. Not enough anesthetic agent was deposited. c. Mesiobuccal root is normally not anesthetized by posterior superior alveolar nerve block. d. Anesthetic agent was deposited too low.
Mesiobuccal root is normally not anesthetized by posterior superior alveolar nerve block. ex: The maxillary first molar is innervated by the MSA and the PSA nerves.
Which nerve is involved when anesthetizing the palatal gingiva of the maxillary lateral incisor. a. Middle superior alveolar nerve b. Nasopalatine nerve c. Infraorbital nerve d. Anterior superior alveolar nerve e. Inferior alveolar nerve
Nasopalatine nerve ex: This nerve innervates lingual gingiva of maxillary anterior teeth and palatal mucosa in the premaxillary area.
Which of the following vasoconstrictor agents is used with mepivacaine (Carbocaine) 3%? a. Neo-Cobefrin b. Epinephrine c. Levophed d. Benzocaine e. None of the above
None of the above ex: Carbocaine 3% does not contain a vasoconstrictor; only Carbocaine 2% contains 1:20,000 Neo-cobefrin.
When lingual nerve is anesthetized, which of the following tissue will NOT be affected? a. Anterior two-thirds of the tongue b. Floor of the mouth c. Lingual gingiva d. Palatal periodontium e. Lower lip
Palatal periodontium ex: The palatal periodontium is affected by the greater palatine and nasopalatine blocks and not when the lingual nerve is anesthetized.
Which of the following patients would NOT be a good candidate for the use of N2O? a. "Gagger" b. Pediatric patient c. Patient with heart disease or a heart attack d. Patient with a chronic obstructive pulmonary disease
Patient with a chronic obstructive pulmonary disease ex: A patient with a chronic obstructive pulmonary disease (COPD) would not be a good patient for the use of nitrous oxide. This could produce apnea in a susceptible patient.
To prepare the maxillary right premolars for nonsurgical periodontal therapy, which of the following nerves need to be anesthetized? a. Right buccal nerve only b. Right MSA and greater palatine nerves c. Right ASA only d. Right PSA only
Right MSA and greater palatine nerves ex: The MSA anesthetizes the maxillary premolars and mesiobuccal root of first molar, plus the facial gingival and the greater palatine anesthetizes the lingual.
The maxillary division of the trigeminal nerve is a. sensory only. b. motor only. c. sensory and motor simultaneously. d. mostly sensory and minimally motor.
Sensory only ex: No motor branches are found in the maxillary division.
In monitoring the use of N2O, the patient should be in which stage of general anesthesia? a. Stage I b. Stage II c. Stage III d. Stage IV
Stage I ex: Stage I is the analgesia stage. This stage has three planes; the first two planes are appropriate for dental hygiene care.
Local anesthetic drugs are bases; the local anesthetic solution injected into the tissues are weak bases. a. Both statements are TRUE. b. Both statements are FALSE. c. The first statement is TRUE; the second is FALSE. d. The first statement if FALSE; the second is TRUE.
The first statement is TRUE; the second is FALSE. ex: Local anesthetics are bases, the solutions injected into the tissues are an acidic salt.
Which of the following explains why the administration of a local anesthetic into an area of inflammation has a decreased effect? a. Inflamed tissue has a high pH. b. The local anesthetic remains in the salt form (ionized). c. Vascularity is decreased in the area of the inflammation. d. The local anesthetic is converted to the free base (unionized).
The local anesthetic remains in the salt form (ionized). ex: Disassociation is hastened by injecting an acidic salt into a basic environment. When an acidic salt is injected into an acidic environment, disassociation is prolonged.
After the administration of local anesthesia to anesthetize teeth #1 to #3, you notice a faint bluish discoloration on her cheek. You check intraorally and find the same discoloration near the injection site along with swelling. What is the most probable cause of this mark? a. The anesthetic cartridge was contaminated with alcohol. b. The needle created a tear in the blood vessel. c. The hygienist used a needle of too fine a gauge. d. The hygienist injected too rapidly.
The needle created a tear in the blood vessel. ex: The mark is a hematoma developed by creating a tear in the blood vessel during the PSA block.
After starting the root-planing procedure, you encounter considerable bleeding from the client's sulcular tissues. After consulting with the dentist, it is decided to administer a local anesthetic for hemostasis. Which component of the local anesthetic will help to achieve hemostasis? a. Anesthetic salt b. Vasoconstrictor c. Sodium bisulfite d. Distilled water
Vasoconstrictor ex: Vasoconstrictors reduce the blood flow through the area by constricting the blood vessels.
The anesthetic solutions injected into the tissues are a. acidic salts. b. strong acids. c. weak bases. d. alkaloids.
acidic salts. ex: Basic drug + HCL (acid) ➔ Acidic salt
The soft tissue of alveolar process of the mandible is innervated by a. buccal and lingual nerves only. b. buccal and mental nerves only. c. buccal, lingual, and mental nerves. d. buccal and inferior alveolar nerves only.
buccal, lingual, and mental nerves ex: The buccal nerve innervates the facial gingiva of the mandibular molars. The lingual nerve innervates the lingual gingiva of the mandible. The mental nerve innervates the facial gingiva of the mandibular anterior teeth and first premolar.
The lipophilic portion of an anesthetic molecule allows the anesthetic solution to a. diffuse through the nerve tissue. b. diffuse through osseous tissue. c. diffuse through the interstitial tissues. d. be absorbed by the blood supply.
diffuse through the nerve tissue. ex: Because the nerve membrane is lipid, the lipophilic portion of an anesthetic molecule allows the solution to diffuse through the nerve membrane.
The sensory receptors responsible for the initiation of pain perception are a. Meissner's corpuscles. b. Ruffine's end organs. c. free nerve endings. d. Pacini's corpuscles.
free nerve endings. ex: The sensory receptors responsible for the initiation of pain perception are free nerve endings or nociceptors.
The nerve that travels the mental foramen is a branch of the a. inferior alveolar nerve. b. middle superior alveolar. c. lingual nerve. d. posterior superior alveolar nerve.
inferior alveolar nerve. ex: The mental nerve is a branch of the inferior alveolar nerve.
All the following statements are TRUE about lidocaine EXCEPT a. it is an amide-linked compound. b. it is used in 2% concentrations. c. it forms a salt with a strong acid that is water soluble. d. its lipophilic portion is ester-linked to the amino group.
its lipophilic portion is ester-linked to the amino group. ex: Lidocaine is an amide.
The potency of an anesthetic agent is primarily a result of its a. water solubility. b. protein solubility. c. lipid solubility. d. carbohydrate solubility.
lipid solubility. ex: The greater the potency, the greater the lipid solubility.
An environmental change capable of initiating a nerve impulse is termed a. minimal threshold stimulus. b. initiation stimulus. c. firing mechanism. d. the "all or none" law.
minimal threshold stimulus. ex: Minimal threshold stimulus is the magnitude of the stimulus (environmental change) required to initiate a nerve impulse.
The type and size of a nerve plays an important part in the development of adequate anesthesia. All the following are TRUE about nerves and anesthesia EXCEPT a. myelinated nerves require a greater concentration to be blocked. b. myelinated nerves require less time to be blocked. c. smaller nerve fibers are the last to regain sensation. d. smaller nerve fibers are blocked before the larger ones.
myelinated nerves require less time to be blocked. ex: A-fibers are the last to be blocked and the first to regain sensation.
Anesthetics decrease or limit the sensation of pain by a. decreasing the firing threshold. b. preventing depolarization. c. repolarizing the nerve membrane. d. causing hyperpolarization
preventing depolarization. ex: Depolarization must occur for an impulse to be conducted.
Saltatory conduction refers to a. rapid transmission of nerve impulses along a myelinated nerve fiber. b. diffusion of sodium into the nerve cell during impulse conduction. c. conduction of an impulse along a nonmyelinated nerve fiber at the nodes of Ranvier. d. None of the above
rapid transmission of nerve impulses along a myelinated nerve fiber. ex: Saltatory conduction is faster because nodes depolarize, and it only occurs on myelinated nerve fibers.
Vasoconstrictors are added to local anesthetic agents to increase duration and a. reduce toxicity by increasing the efficiency of the heart. b. reduce toxicity by slowing absorption. c. extend the overall shelf life. d. help speed up the detoxification process.
reduce toxicity by slowing absorption. ex: By slowing down absorption, the body has more time to metabolize anesthetics, thereby reducing toxicity and increasing duration.
The use of a scavenging system with N2O sedation equipment is desirable because it a. removes the odor of nitrous from the room. b. assists the patient's respiration. c. removes any potentially toxic waste gas from the environment. d. allows the patient to inhale room air through the nosepiece.
removes any potentially toxic waste gas from the environment. ex: It reduces a potential 900 ppm of nitrous down to 30 ppm and OSHA says you must have 50 ppm in order for it to be acceptable in a health care system.
All the following ingredients are contained within an anesthetic solution EXCEPT a. sodium chloride. b. sodium bisulfate. c. water. d. vasoconstrictor.
sodium bisulfate. ex: Sodium bisulfite, NOT bisulfate, is a preservative found in an anesthetic solution.
