Darbys Review Chapter 18 - Management of Pain and Anxiety

23. 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

e. All of the above

47. 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

e. Inferior alveolar nerve

24. 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

e. None of the above

35. 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

a. 129.6 mg

6. Which of the following gauge numbers indicates the needle with the smallest lumen? a. 30 b. 27 c. 25 d. 23

a. 30

27. 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

a. 650 to 900 psi

29. 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

a. 650 to 900 psi

38. 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

a. Mandibular foramen

33. 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

a. Stage I

15. 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.

a. diffuse through the nerve tissue.

2. 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.

a. inferior alveolar nerve.

13. 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.

a. minimal threshold stimulus.

8. 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.

a. myelinated nerves require a greater concentration to be blocked.

10. 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

a. rapid transmission of nerve impulses along a myelinated nerve fiber.

7. 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.

a. sensory only.

36. 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

b. 2.2 cartridges

34. The ideal concentration range of N2O is a. 10% to 25%. b. 30% to 50%. c. 50% to 60%. d. 60% to 70%.

b. 30% to 50%.

37. 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

b. 7.2 cartridges

28. 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

b. 900 to 1100 psi

17. 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.

b. Amides undergo biotransformation in the liver.

39. 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

b. Maxillary tuberosity

41. 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

b. Nasopalatine nerve

48. 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

b. Right MSA and greater palatine nerves

4. 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).

b. The local anesthetic remains in the salt form (ionized).

50. 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.

b. The needle created a tear in the blood vessel.

25. 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

b. Vasoconstrictor

9. 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.

b. preventing depolarization.

21. 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.

b. reduce toxicity by slowing absorption.

18. All the following ingredients are contained within an anesthetic solution EXCEPT a. sodium chloride. b. sodium bisulfate. c. water. d. vasoconstrictor.

b. sodium bisulfate.

14. The anesthetic solutions injected into the tissues are a. acidic salts. b. strong acids. c. weak bases. d. alkaloids.

b. strong acids.

3. 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.

b. vasoconstrictor.

40. 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.

c. Blood will be noticed at the needle hub.

22. Where are vasoconstrictors metabolized? a. Liver b. Plasma c. Bloodstream d. Kidneys

c. Bloodstream

42. 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.

c. Mesiobuccal root is normally not anesthetized by posterior superior alveolar nerve block.

11. 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.

c. free nerve endings.

1. The potency of an anesthetic agent is primarily a result of its a. water solubility. b. protein solubility. c. lipid solubility. d. carbohydrate solubility.

c. lipid solubility.

31. 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.

c. removes any potentially toxic waste gas from the environment.

26. 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

d. 1800 to 2100 psi

43. 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

d. Anterior superior alveolar nerve

12. 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

d. Between the polarization stage and reverse polarity

46. 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

d. Greater palatine nerve block

16. Which acid is most often combined with a local anesthetic drug? a. Sodium bisulfite b. Sodium chloride c. Acetic acid d. Hydrochloric acid

d. Hydrochloric acid

30. 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.

d. It may induce nerve damage if used chronically.

44. 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

d. Palatal periodontium

32. 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

d. Patient with a chronic obstructive pulmonary disease

45. 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.

d. buccal and inferior alveolar nerves only.

5. 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.

d. its lipophilic portion is ester-linked to the amino group.