Local Anesthetics Evolve Quizzes
4. Most adverse reactions occur within _______ of injection. a. 5 to 10 minutes b. 15 to 20 minutes c. 1 to 2 hours d. 1 day
A
5. Prior to injection, _______ local anesthetic solutions are _______. a. all, acidic b. no, acidic c. all, basic d. 80% of, acidic
A
6. The ___________ dictates the dental hygienist's continuing education requirements. a. state licensing board b. dentist c. hygienist d. American Dental Hygiene Association
A
1. Most local anesthetic dental cartridges contain _______ of solution. a. 2.5 mL b. 2.0 mL c. 1.8 mL d. 1.5 mL
C
1. The vasoconstrictor is responsible for which of the following? a. A decreased duration of the anesthetic's effect b. Increased blood flow c. Decreased toxicity d. All of the above
C
11. Identify the true statement. a. Paresthesia is most frequently associated with the long buccal and mental nerves. b. Paresthesia occurs fairly often but is preventable. c. Paresthesia will usually resolve within 8 weeks. d. The dentist should examine the patient experiencing paresthesia every 2 weeks until the return of normal sensation.
C
11. Injecting local anesthetic into a patient's blood vessel _______ the risk of an overdose. a. decreases b. has no significant effect on c. increases d. eliminates
C
12. Allergic reactions to topical anesthetic are _______. a. very common b. somewhat common c. rare d. unheard of
C
12. Which of the following is a recommendation set forth by the American Heart Association (AHA) in regard to the administration of local anesthesia? a. Inject the anesthetic as quickly as possible b. Administer no more than the maximum recommended dose of 0.5 mg of epinephrine per visit (healthy patient) c. Administer the lowest possible effective dose d. Both B and C
C
12. Which type of patient should NOT be administered a longer acting local anesthetic? a. A teenage patient with a cold b. A geriatric man with controlled hypertension c. A child with cerebral palsy d. A middle-aged woman with AIDS
C
13. Which injection may be needed for children because the thick zygomatic process may overlie the buccal roots of the second primary and first permanent molars, limiting the clinical effectiveness of a supraperiosteal injection? a. MSA b. IO c. PSA d. IA
C
13. Which of the following is the appropriate action with a patient who has a true sulfite allergy? a. Amide anesthetics should not be administered to this patient. b. Ester anesthetics should not be administered to this patient. c. Vasoconstrictors should not be administered to this patient. d. Vasoconstrictors should only be administered at a reduced dosage.
C
14. Levonordefrin is available with 2% mepivacaine. These cartridges of mepivacaine also contain sodium bisulfite to preserve the levonordefrin. 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.
C
14. OraVerse is administered at a 1:1 (cartridge to cartridge) ratio. OraVerse will reduce the length of prolonged anesthesia by nearly half of the original duration. 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.
C
15. In the event of a sharps injury, which of the following is not recommended? a. If possible, get consent from the source patient for testing. b. Wash a flesh or puncture wound with soap and water. c. Gently suck the contaminates from the wound. d. Complete the incident report form.
C
16. Which anesthetic is the least toxic? a. Lidocaine b. Mepivacaine c. Prilocaine d. Articaine
C
16. Which of the following factors does NOT trigger adverse systemic complications? a. Excessive dose of anesthetic b. Rapid deposition of anesthetic c. Contaminated anesthetic needle d. Compromised biotransformation in the body
C
18. Documentation of a percutaneous injury would NOT ordinarily include a. the depth of the wound. b. the gauge of the needle. c. the duration of contact. d. whether or not fluid was injected.
C
18. Read the following statement and select the best choice below: Only the minimum effective dose should be administered without exceeding the maximum recommended dose. a. This statement only applies to vasoconstrictors. b. This statement only applies to local anesthetic agents. c. This statement applies to both vasoconstrictors and local anesthetic agents. d. None of the above
C
18. Which of the following modifications would apply when administering anesthesia to a patient with thrombophilia (clotting disorder)? a. The hygienist should administer an anesthetic with a high concentration of vasoconstrictor (1:50,000). b. The hygienist should administer a plain anesthetic (no vasoconstrictor). c. The hygienist should administer infiltration anesthesia in place of block injections, which pose a greater risk of puncturing a blood vessel (PSA, IA, and so on). d. The administration of local anesthesia is an absolute contraindication for patients with bleeding or clotting disorders.
C
19. A patient who has just been administered Oraqix gel (2.5% lidocaine and 2.5% prilocaine) can expect a comfortable duration of anesthesia of approximately _______. a. 60 minutes b. 45 minutes c. 20 minutes d. 10 minutes
C
19. Careful consideration should be made to MRDs of local anesthetic in children who are taking opioid/sedative medications. Systemic toxicity is less common in children. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.
C
3. Local anesthesia system toxicity initially manifests as ___________ followed by _____________ of the CNS and to a lesser extent of the CVS. a. depression, excitation b. short acting, long acting c. excitation, depression d. long acting, excitation
C
4. Generally speaking, the administration of a local anesthetic will _________ blood pressure. a. sporadically fluctuate b. drop c. elevate d. not affect
C
1. A _______ complication is experienced at the time of the injection and will resolve on its own. a. mild, primary b. severe, secondary c. secondary, transient d. mild, permanent
A
10. When the vasoconstrictor is absolutely contraindicated, the dental hygienist should a. not, under any circumstance, administer vasoconstrictors. b. administer vasoconstrictors with great caution, mindful of the increased risk of an adverse reaction. c. administer vasoconstrictors only after the patient signs an informed consent. d. administer vasoconstrictors at full dosage.
A
10. Which of the following variations in anatomic structure would NOT affect the administration of anesthesia? a. Malocclusion b. Density of bone c. Flaring palatal roots of maxillary molars d. Lower than normal zygomatic arch
A
11. In the event of a malpractice lawsuit, the dental hygienist's best defense is _______. a. documentation in the patient's chart b. the dental hygiene code of ethics c. appropriate physician consultations and referrals d. professional liability insurance
A
12. A patient who is unresponsive to heat therapy, exercise, and analgesics in the management of trismus may be experiencing ______________. a. a bacterial infection b. soft tissue trauma c. tissue sloughing d. a local anesthetic overdose
A
12. Once absorbed into the bloodstream, local anesthetic accumulates in the tissues of the body, including the heart, liver, kidneys, and lungs. Fortunately, local anesthetics cannot cross the blood-brain barrier. 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.
A
12. What is the likelihood that your patient will experience a true allergic reaction to an amide local anesthetic? a. Extremely unlikely b. Somewhat unlikely c. Likely d. Very likely
A
13. An anesthetic containing a _______ concentration of epinephrine provides the most effective hemorrhage control. a. 1:50,000 b. 1:100,000 c. 1:200,000 d. 1:300,000
A
13. Trismus is usually observed by the patient _______, and symptoms will fade within _______. a. the day after treatment, 48 hours b. immediately following treatment, 24 hours c. within 2 or 3 days after treatment, 7 days d. the day of treatment, 3 hours
A
14. The FDA has released a Public Health Advisory alerting consumers to the potential risk of life-threatening or fatal reactions to over-the-counter topical anesthetics. Some of these over-the-counter topical anesthetics are available in concentrations twice the strength of those used in the dental office. 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.
A
15. Which amide is metabolized in both the liver and the lungs? a. Prilocaine b. Procaine c. Mepivacaine d. Articaine
A
15. Which of the following is NOT an ideal property of an oral topical anesthetic? a. It produces dependency on repeated use. b. It remains at the site of application. c. It has an acceptable taste. d. It permits a comfortable (pain-free) application.
A
16. On receiving the maximum recommended dose of prilocaine, the patient's lips and mucous membranes turn blue. Which of the following is a possible explanation? a. This patient has methemoglobinemia. b. This patient has liver disease. c. This patient has kidney disease. d. This patient has atypical plasma cholinesterase.
A
16. The adverse effects of a vasoconstrictor overdose last approximately _______. a. 5 to 10 minutes b. 10 to 15 minutes c. 60 to 80 minutes d. 120 minutes
A
16. Which disease is NOT likely to spread through an occupational exposure to blood? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. HIV
A
17. Which topical anesthetic has the most rapid onset of action? a. Benzocaine b. Lidocaine c. Dyclonine hydrochloride d. Tetracaine hydrochloride
A
18. Show-tell-do communication is a useful strategy when communicating with children. Utilizing a dental assistant to stabilize the child's head and hands assists in behavioral management. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.
A
18. To effectively aspirate on two planes, the clinician should _______. a. aspirate once, rotate the barrel of the syringe 45 degrees, and aspirate a second time b. aspirate once, extend or retract the depth of the needle approximately 2 mm, and aspirate a second time c. aspirate once, wait 5 seconds, and aspirate a second time d. aspirate once, move the needle medially or laterally 2 mm, and aspirate a second time
A
19. In which of the following anesthetic cartridges is epinephrine available in both concentrations: 1:50,000 and 1:100,000? a. 2% lidocaine b. 3% mepivacaine c. 4% prilocaine d. 0.5% bupivacaine
A
19. The dental hygienist should always maintain patient confidentiality in accordance with the _______ guidelines. a. HIPAA b. ADA c. ADHA d. QHPC
A
19. What should you do if your patient experiences a mild anesthetic overdose? a. Monitor vital signs, allow the patient to recover, and discharge. b. Manage the seizure: protect the patient from injury. c. Alert the EMS for transport to a hospital. d. Both B and C
A
19. Which of the following overdose symptoms are most likely to develop into a serious reaction? a. Rapidly occurring symptoms (occurring within 5 minutes of administration) b. Delayed symptoms (occurring after 5 minutes of administration) c. Developed symptoms (occurring 12 to 14 hours after administration) d. Anticonvulsant symptoms (occurring 24 to 48 hours after administration)
A
2. All injectable local anesthetics used in dental offices today belong to the ________ group. a. amide b. ester c. Both A and B d. Neither A nor B
A
2. To achieve the optimal anesthetic effect, topical anesthesia should remain at the site of application for _______. a. 1 to 2 minutes b. 3 to 5 minutes c. 5 to 10 minutes d. 10 to 12 minutes
A
2. Which of the following vasoconstrictors are added to local anesthetic solutions in the United States? a. Epinephrine and levonordefrin b. Epinephrine and norepinephrine c. Levonordefrin and norepinephrine d. Epinephrine and phenylephrine
A
20. In children versus adults, inferior alveolar blocks are more successful because the mandibular foramen is more inferior. In children supraperiosteal injections are more effective in both the maxillary and mandibular arch due to the less dense bone. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.
A
20. In extremely high doses, which agent may cause methemoglobinemia? a. Prilocaine b. Lidocaine c. Bupivacaine d. Mepivacaine
A
20. The most potent of all local anesthetics, _______ has the highest pka and the slowest onset of action. a. bupivacaine b. lidocaine c. tetracaine d. articaine
A
3. It has been reported that up to _______ of patients with an asthmatic condition are allergic to bisulfite. a. 10% b. 20% c. 50% d. 100%
A
3. The ____________ will provide the hygienist with a comparable baseline, in the event that an emergency situation should arise during treatment. a. vital signs b. psychological evaluation c. visual examination d. dental history
A
3. Which of the following actions will NOT prevent needle breakage? a. Advance the needle as quickly as possible through the tissue. b. Communicate clearly with the patient. c. Avoid inserting the needle to the hub. d. Avoid bending the needle.
A
4. In response to inadequate anesthesia, the amount of endogenous epinephrine released in a patient's system may be _______ than the exogenous amount introduced in a routine dental injection. a. much greater b. much less c. equal to d. slightly less
A
7. On occasion, a local anesthetic may be used for hemostasis (i.e., to control bleeding) in an area that is already numb. These higher concentrations of epinephrine (1:50,000) also prolong the duration of the anesthesia. 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.
A
7. Short-acting anesthetics do not contain a vasoconstrictor. Bupivacaine is the only short-acting anesthetic. 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.
A
7. To prevent the overestimation of body weight in a child, a standard scale should be used to provide the clinician with the child's accurate body weight. The use of a topical anesthetic applied prior to the local anesthetic injection should be factored into the total administered dose as it can infiltrate into the vascular system. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.
A
7. Which of the following is a eutectic mixture that will thicken into a gel once inserted into a periodontal pocket, relieving pain associated with nonsurgical periodontal therapy? a. Oraqix (2.5% lidocaine/2.5% prilocaine gel) b. EMLA (2.5% lidocaine/2.5% prilocaine cream) c. Cetacaine (benzocaine, butamben, tetracaine) d. Dyclonine hydrochloride
A
8. Which of the following is an effect of the additive sodium bisulfite? a. Prolonged shelf life b. Hemostasis c. Increased anesthetic duration d. Pulpal anesthesia
A
8. Which of the following statements is generally TRUE? a. Induction time is shorter than recovery time. b. Recovery time is shorter than induction time. c. Induction time is longer than recovery time. d. Recovery time is equal to induction time.
A
9. In which of the following patients is epinephrine a relative contraindication? a. A patient taking digitalis glycosides b. A patient you suspect is high on cocaine c. A patient with a blood pressure reading exceeding 200/115 d. A patient with uncontrolled diabetes
A
9. Of the following patients, which is most likely to have a negative reaction to topical anesthetic? a. A child b. A patient of Middle Eastern ancestry c. A patient with type O+ blood d. All of the above
A
9. Which local anesthetic is NOT recommended for children because it will increase the risk of soft tissue injury? a. Bupivacaine b. Articaine c. Mepivacaine d. Prilocaine
A
9. _____________ is/are always preventable. a. Facial nerve paralysis b. Pain during injection c. Syncope d. Postanesthetic lesions
A
1. Local anesthetics work by preventing the nerve from reaching a state of polarization. The conduction of the nerve impulse is prevented as long as the anesthetic is bound to the receptor cites. 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.
B
10. The most common area for self-inflicted soft tissue injury is the ____________. a. upper lip b. lower lip c. cheek d. tongue
B
10. Which of the following will decrease the duration of a local anesthetic? a. A firm binding to the receptor site b. Increased vascularity c. Presence of a vasoconstrictor in the anesthetic d. All of the above
B
11. A toxic overdose of topical anesthetic may result in which of the following? a. Hypertension b. Bradycardia c. Tachycardia d. Both A and B
B
11. In the event of an inadvertent intravascular injection, the effects of epinephrine first begin to show ____________. a. within 30 seconds b. within 1 minute c. within 5 minutes d. within 10 minutes
B
11. Which of the following injection techniques will increase soft tissue and pulpal anesthesia? a. Supraperiosteal infiltration b. Nerve block c. Local infiltration d. Surface anesthesia
B
12. The amount of anesthetic drug administered should be documented in the chart in _______. a. milliliters (mL) b. milligrams (mg) c. cartridges d. ccs
B
12. Treatment of soft tissue injury includes ________ on the day of the injury and ___________ the next day. a. applying pressure, applying an ice pack b. applying an ice pack, applying a warm pack c. applying a warm pack, applying an ice pack d. applying a warm pack, applying pressure
B
13. Mild allergic reactions to topical anesthetic can include _______, _______, and _______. a. hematoma, cyanosis, nausea b. swelling, raised welts, itching c. slurred speech, drowsiness, difficulty breathing d. seizures, unconsciousness, respiratory arrest
B
14. In which of the following patients is the administration of an ester anesthetic NOT contraindicated? a. A patient taking sulfonamide drugs b. A patient with a true sulfite allergy c. A patient taking cholinesterase inhibitor drugs d. A patient with atypical plasma cholinesterase
B
14. On removing the needle from the syringe, the cartridge-penetrating end of the needle inadvertently sticks the clinician. Which of the following is an appropriate response? a. The cartridge-penetrating end of the needle is sterile: postexposure treatment is not necessary. b. The cartridge-penetrating end of the needle is contaminated: proceed with postexposure protocol. c. Check the cartridge for signs of a positive aspiration. If there is no sign of blood in the cartridge, postexposure treatment is not necessary. d. Dispose of the needle, wash the wound with soap and water, and report the incident at the end of the day.
B
14. Which of the following anesthetic agents is available in both topical and injectable forms? a. Mepivacaine b. Lidocaine c. Articaine d. Prilocaine
B
14. Which of the following is LEAST likely to cause an allergic reaction? a. Procaine b. Lidocaine c. Tetracaine d. Benzocaine
B
15. Supraperiosteal injection techniques are more clinically effective in mandibular primary molars than mandibular permanent molars because ____________. a. primary molars have shorter roots b. the bone is less dense in younger children c. the zygomatic process is thinner d. All of the above
B
15. Which of the following is true? a. Malignant hyperthermia is a hereditary condition characterized by the inability of blood to bind to oxygen. b. Malignant hyperthermia can be fatal if not treated quickly. c. Malignant hyperthermia occurs more frequently in adults than it does in children. d. Amide local anesthetics are absolutely contraindicated for patients with a history of malignant hyperthermia.
B
15. Which of the following vasoconstrictors is no longer used in dentistry, due to the possibility of tissue necrosis? a. Levonordefrin b. Norepinephrine c. Felypressin d. Phenylephrine
B
17. Overdose symptoms of the CNS and CVS begin as __________ signs and then progress to potentially fatal __________ signs. a. depressive, resurgent b. excitatory, depressive c. depressive, excitatory d. excitatory, resurgent
B
17. The _______ is the most common cause of local anesthetic toxicity. a. unusually rapid absorption of anesthetic b. unintended intravascular injection of anesthetic c. excessive dosage of anesthetic d. rapid delivery of anesthetic during deposition
B
17. The ____________ educates and empowers the patient, while protecting the hygienist, by allowing the patient to formally accept or deny services. a. incident report form b. informed consent form c. treatment plan d. permanent chart documentation
B
19. In which scenario is antibiotic premedication recommended? a. The placement of a rubber dam b. The placement of a dental implant c. The placement of orthodontic brackets d. Postoperative suture removal
B
2. Needle breakage rarely occurs, but if a needle fragment deeply embeds in the tissue, _______. a. attempt to locate and remove it by palpating and pinching the tissue b. specialized radiographic and surgical procedures by an oral maxillofacial surgeon are required for its removal c. position the patient in an upright position and activate the EMS d. it poses no risk to the patient: document the incident in the chart and proceed with treatment
B
2. The pulse rate of a school-aged child is ______________ than that of an adult. a. much faster b. slightly faster c. slightly slower d. much slower
B
20. Due to a recent knee replacement, your patient must be medicated with an antibiotic before receiving periodontal therapy. If his care plan requires four appointments, each appointment should be scheduled at least ______ apart. a. 12 days b. 9 days c. 5 days d. 3 days
B
20. Immediately after being administered a local anesthetic with epinephrine, your patient complains of a throbbing headache, increased feelings of anxiety, and a "racing heart." Which of the following would explain this reaction? a. Your patient is experiencing a sodium bisulfite overdose. b. Your patient is experiencing a vasoconstrictor overdose. c. Your patient is exhibiting signs of dental phobia. d. There is nothing abnormal about your patient's response: all patients have this response to local anesthesia.
B
20. Which of the following will NOT effectively manage syncope? a. Place a cool, damp cloth on the patient's forehead. b. Place the patient in a semisupine position. c. Administer oxygen. d. Pass a crushed ammonia capsule under the patient's nose.
B
3. In the event of malpractice litigation, the _______ bears the burden of legal responsibility for the dental hygienist. a. dentist (or employer) b. dental hygienist c. employer's insurance company d. state
B
3. Topical anesthesia will anesthetize the affected area _______ into the tissue. a. 1 to 2 mm b. 2 to 3 mm c. 3 to 5 mm d. 5 to 7 mm
B
4. The dental hygienist may only be charged with malpractice if he/she induces harm to the patient, not for a negligent act. However, the hygienist may be legally liable if he/she is unable to provide thorough treatment because the patient refuses anesthesia. 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.
B
5. Patients who have experienced a myocardial infarction, coronary bypass surgery, or a cerebrovascular accident within the past _______ should not be given a local anesthetic with a vasoconstrictor. a. 6 weeks b. 6 months c. 12 weeks d. 12 months
B
6. Which of the following anesthetics is the best choice when a vasoconstrictor is contraindicated? a. Articaine b. Mepivacaine c. Bupivacaine d. All of the above
B
6. Which of the following is NOT an effective stress reduction measure? a. Minimize the patient's waiting time b. Schedule the appointment in the afternoon c. Administer adequate pain control during therapy d. Personally call the anxious patient, later the same day, following treatment
B
7. A _______ is characterized by asymmetrical swelling and discoloration of tissue and develops as a result of a punctured or pierced blood vessel. a. facial nerve paralysis b. hematoma c. paresthesia d. trismus
B
7. The mantle bundles innervate the anterior teeth at the end of the nerve fiber. The further anterior a tooth is located along a nerve fiber, the less likely it is to experience profound anesthesia. 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.
B
7. Which of the following procedures always requires a dentist's physical presence? a. Dental radiography b. Local anesthesia c. Preventive prophylaxis d. Fluoride administration
B
4. Topical anesthesia is available in many different forms: liquid, gel, spray, and patch. Topical anesthesia distributed in single dose applications decreases the possibility of cross-contamination. 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.
C
4. Which of the following choices does NOT act as a buffer in local anesthetic solutions? a. Sodium hydroxide b. Sodium chloride c. Sodium bisulfite d. Both A and B
C
4. Which of the following is TRUE regarding topical anesthetic agents? a. Topical anesthetics do not pose a risk of toxicity, even when applied in large amounts. b. The application of a topical anesthetic is more effective than a submucosal injection. c. Topical anesthetics are highly concentrated. d. Topical anesthetics are applied below the surface of the mucous membrane.
C
5. An anesthetic that has been contaminated with disinfecting solution will _______. a. itch and tingle upon injection b. discolor the injected tissue c. burn and sting during the injection d. prolong the anesthetic effect for days, weeks, or months
C
5. The pulse rate is an important vital sign with respect to local anesthesia because it can identify a patient with ___________________. a. uncontrolled hypertension b. uncontrolled hyperthyroidism c. uncontrolled cardiac dysrhythmias d. uncontrolled diabetes
C
5. Which of the following statements is NOT true in regard to dental hygiene licensure? a. Each state sets forth individualized requirements for licensure. b. Most states require additional licensure for local anesthesia. c. The practice of dental hygiene is regulated and licensed nationally through the American Dental Board. d. Educational and examination credentials must be met prior to applying for licensure.
C
6. The amount of epinephrine in a cartridge of local anesthetic is identified by a _______. a. percentage (2%) b. fraction (1/10) c. ratio (1:100,000) d. whole number (2)
C
6. The oral tissues of a patient with an inflamed dental infection will be more acidic. A lower tissue pH makes effective dental anesthesia more difficult. 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.
C
6. When administering local anesthesia, decrease the normal mild stinging sensation by slowly depositing the anesthetic solution at a rate of _______ of solution per minute. a. 3.6 mL b. 0.05 mL c. 1 mL d. 1.8 mL
C
6. Which topical anesthetic is not classified as an ester or an amide, but as a ketone? a. Benzocaine b. Lidocaine c. Dyclonine hydrochloride d. Tetracaine hydrochloride
C
7. Which of the following is a sign that your patient is experiencing moderate anxiety? a. Red-toned complexion b. Bradycardia c. Perspiration on forehead and hands d. Hypotension
C
8. All of the following are true regarding 3% mepivacaine EXCEPT: a. It is a short-acting pulpal anesthesia. b. It provides similar soft tissue anesthesia duration as 2% lidocaine with 1:100,000 epinephrine. c. It is more difficult to reach or exceed MRD with it than with 2% lidocaine with 1:100,000 epinephrine. d. It contains 50% more local anesthetic per cartridge than 2% lidocaine with 1:100,000 epinephrine.
C
8. Which of the following is true? a. A hematoma that emerges following the IA injection will present as an extraoral bruise. b. Hematomas are most likely to develop following a palatal injection. c. Trismus and mild pain may accompany the development of a hematoma. d. Although the swelling should disappear after 7 to 14 days, the discoloration that accompanies the swelling is permanent.
C
8. Your afternoon patient arrives for nonsurgical periodontal therapy (requiring local anesthesia), but the dentist hasn't returned from lunch. Which of the following is an appropriate way to proceed? a. As long as the dentist has authorized the treatment, proceed to administer local anesthesia. b. Apply topical anesthesia and wait for the dentist to return. c. Explain the situation to the patient and wait for the dentist to return before administering anesthesia. d. Complete the treatment without local anesthesia.
C
9. When the complexity of nonsurgical periodontal therapy is unknown, administer the local anesthetic for ___________. a. bilateral full-mouth treatment b. unilateral half-mouth treatment and complete the treatment in that area before proceeding c. just one quadrant and complete the treatment in that area before proceeding d. just one tooth and complete the treatment in that area before proceeding
C
17. Before using a vasoconstrictor, a physician's consult is recommended for which of the following conditions? a. A patient with a history of a myocardial infarction (within 2 years) b. A patient who underwent coronary bypass surgery within 12 months c. A patient with controlled hypertension d. A patient with uncontrolled diabetes
D
1. A thorough health history guides the clinician in determining a. the patient's physical ability to tolerate a vasoconstrictor. b. anesthetic hypersensitivity. c. current medications that may interact with an administered anesthetic agent. d. All of the above
D
1. Effective communication is an essential risk management tool. Which of the following exemplifies effective communication? a. Clearly present the benefits and risks associated with the procedure. b. Use laymen terms and simplify technical explanations. c. Avoid discussing the treatment procedures. d. Both A and B
D
1. Which of the following is NOT an appropriate use for topical anesthesia? a. To increase comfort during minor dental hygiene procedures b. To reduce a patient's gag reflex while taking dental impressions c. To minimize the pain associated with needle insertion d. To achieve pulpal anesthesia prior to restorative dental procedures
D
1. Which of the following situations describes when a dental hygienist is most likely to provide local anesthesia for pediatric patients? a. Prior to restorative work provided by a dentist b. Prior to restorative work provided by a dental hygienist c. When the patient has an appointment with the dental hygienist prior to a restorative appointment with the dentist d. All of the above
D
10. During the administration of an IA block, you notice a small bruiselike mark developing intraorally. Which of the following is recommended to prevent malpractice litigation? a. Do not tell the patient. This will only alarm the patient and increase the risk of malpractice litigation. b. Wait until the appointment is complete to notify the patient. c. Immediately notify the patient during the administration of the injection, even if the syringe is still in the patient's mouth. d. Notify the patient once the needle is recapped and allow the patient to examine the hematoma. Document the incident in the patient's chart.
D
10. Which of the following are symptoms of a localized reaction to topical anesthetic? a. Irritation, burning, and stinging at the site of application b. Dizziness, tinnitus, and involuntary muscular activity c. Tissue sloughing or discoloration and temporary change in taste perception d. Both A and C
D
10. Which of the following is an appropriate response in the event that your patient experiences facial paralysis following an IA block? a. Ask the patient to remove contact lenses (if applicable) and manually close the affected eyelid. b. If the patient agrees to continue treatment, readminister the IA block. c. Document the incident and the patient's reaction in the chart. d. All of the above
D
10. Which of the following is considered a beneficial use of epinephrine? a. Increasing cardiac efficiency b. Treating anaphylactic attacks c. Hemostasis d. Both B and C
D
11. A patient who presents for dental treatment with uncontrolled hyperthyroidism should receive a. the maximum recommended dose of vasoconstrictors. b. the standard dosage of vasoconstrictors. c. only the smallest effective dose of vasoconstrictors, not to exceed 0.04 mg per appointment. d. no vasoconstrictors until the hyperthyroidism is under control.
D
11. For which of the following agents is phentolamine mesylate useful in reversal of soft tissue anesthesia? a. Topical lidocaine b. 4% prilocaine, plain c. 3% mepivacaine d. Articaine
D
13. Levonordefrin is a _______ vasoconstrictor and is ________ as potent as epinephrine. a. synthetic, one tenth b. naturally produced, one half c. naturally produced, one third d. synthetic, one sixth
D
13. Which of the following does not need to be documented in the chart following the administration of local anesthesia? a. The patient's MRD b. The gauge and type of needle c. The time of anesthetic administration d. The type of syringe
D
13. Which of the following will influence a local anesthetic's toxicity? a. The anesthetic's half-life b. The patient's emotional state c. Other medications the patient may be taking d. Both A and C
D
14. Which of the following is true regarding the provision palatal injections for children? a. Use of the C-CLAD increases comfort. b. The NP block technique is the same as it is for adults. c. The GP block technique is different than it is for adults. d. All of the above
D
15. Mepivacaine produces severe vasodilation and is only available with a vasoconstrictor. Mepivacaine is metabolized in the blood plasma. 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.
D
15. Which technique is recommended to prevent tissue sloughing? a. The smallest effective dose of topical anesthetic should be applied for a maximum of 1 to 2 minutes. b. When possible, the hygienist should avoid using concentrated vasoconstrictors. c. Place cotton rolls between the teeth and soft tissues to protect the tissue. d. Both A and B
D
16. Patients with liver disease/dysfunction will best metabolize which local anesthetic? a. Lidocaine b. Bupivacaine c. Mepivacaine d. Articaine
D
16. Topical anesthetics are available in a variety of forms. Which method of delivery is most likely to produce a toxic reaction? a. Patch b. Gel c. Applicator swab d. Spray
D
16. When a PSA block is indicated, the ____________ should be greatly reduced for the pediatric patient to prevent ____________. a. needle gauge, hematomas b. depth of insertion, trismus c. needle gauge, trismus d. depth of insertion, hematomas
D
17. Local anesthetics are teratogenic and pose a moderate risk to the unborn fetus. The administration of all local anesthetic agents is an absolute contraindication in the first and second trimesters of pregnancy. 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.
D
17. Which anesthetic agent is not recommended, by some authors, to use for the IA block due to reports of paresthesia? a. Lidocaine b. Mepivacaine c. Procaine d. Articaine
D
17. Which of the following considerations is true regarding provision of the IA block for children? a. The mandibular foramen is located at or below the occlusal plane. b. The depth of insertion is approximately 20 mm. c. A 27-gauge short needle may be utilized in younger children. d. Both A and C
D
18. A nerve is more likely to sustain an anesthetic-induced injury from which of the following solutions? a. Bupivacaine 0.5% b. Lidocaine 2% c. Mepivacaine 3% d. Articaine 4%
D
18. Moderate overdose levels in the cardiovascular system may occur with the administration of _______ cartridges of local anesthetic. a. two b. three c. four d. five
D
18. Oraqix gel (2.5% lidocaine and 2.5% prilocaine) produces an anesthetic effect within ____________. a. 15 minutes b. 10 minutes c. 5 minutes d. 30 seconds
D
19. Which anesthetic has anticonvulsant properties? a. Lidocaine b. Bupivacaine c. Mepivacaine d. Both A and C
D
2. System toxicity is most commonly a result of which of the following? a. Administering the anesthetic agent over the patient's MRD b. Inadvertent intravascular injection c. Administering the anesthetic agent very slowly d. Both A and B
D
2. Which of the following is NOT beneficial to effective communication within the dental office? a. Office protocol should be written. b. The hygienist should openly discuss potential liabilities with the dentist (or employer). c. The hygienist should discuss his/her license limitations/regulations with the dentist (or employer). d. The dentist should strategize prevention tactics and inform the staff.
D
2. Which of the following is another term for vasoconstrictor? a. Sympathomimetic drug b. Adrenergic drug c. Catecholamine d. All of the above
D
20. Drying the mucosa with 2 × 2 gauze, prior to the application of topical anesthesia, assists in _______. a. accurate placement of the topical anesthetic b. increasing the visibility c. increasing the penetration depth to 5 mm d. Both A and B
D
3. Although epinephrine is the most widely used dental vasoconstrictor, it is not an ideal choice for patients with _______. a. severe cardiovascular disease b. high blood pressure c. hyperthyroidism d. All of the above
D
3. The _______ lipid soluble an anesthetic is, the _______ its potency. a. more, lower b. less, greater c. less, lower d. more, greater
D
4. A dull needle is usually the result of _______. a. rapidly depositing the anesthetic solution b. hitting bone during the administration of anesthetic c. faulty manufacturing d. repeated needle penetrations with the same needle
D
5. Which of the following contributes to increased risk of complications from local anesthesia? a. Immature organ function b. Lowering MRD c. Long duration local anesthetics d. Both A and C
D
5. Which topical anesthetic has the longest average duration? a. Benzocaine b. Lidocaine c. Dyclonine hydrochloride d. Tetracaine hydrochloride
D
5. Your patient remembers having an allergic reaction to local anesthesia prior to 1984 but for many years since has been administered local anesthesia with no complication. Your patient may actually have an allergy to _______, which was removed in 1984. a. lidocaine b. epinephrine c. sodium chloride d. methylparaben
D
6. Which of the following is important when providing local anesthesia for the overweight child? a. Use of lowest effective dose b. Use of Ideal Body Weight Index c. Lowering AAPD MRD d. All of the above
D
8. In most cases, patients with cardiovascular involvement a. cannot receive an amide anesthetic drug. b. cannot receive vasoconstrictors. c. may receive an amide anesthetic drug, but only in limited doses. d. may receive vasoconstrictors, but only in limited doses.
D
8. Topical anesthetics have a lower concentration of anesthetic than their injectable counterparts. This is necessary because some topical anesthetics contain a vasoconstrictor. 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.
D
8. Which of the following actions is an appropriate response to a patient who is more (or less) sensitive to local anesthesia? a. Make no adjustment in the dosage of anesthesia. Administer the same amount for every patient, regardless of the patient's response. b. Modify the amount of anesthesia administered to better accommodate the patient's needs, without exceeding the maximum recommended dose. c. Make a notation in the patient's chart identifying the variation of response and the modification you made to achieve anesthesia. d. Both B and C.
D
9. A patient with a sulfite allergy can be administered which of the following? a. 3% mepivacaine b. 2% lidocaine c. 4% prilocaine d. Both A and C
D
9. Due to increased vascularity, inflamed tissue will display a/an _______ onset of action and a/an _______ duration. a. increased, extended b. decreased, extended c. increased, shortened d. decreased, shortened
D
9. Which of the following best defines tachyphylaxis? a. An equation used to calculate the pH of a buffer solution b. The decreased potency of an anesthetic in acidic tissues c. The study of the action of drugs within the body d. A term used to describe an increased tolerance to a drug
D
