Chapter 21 Mosby's Review Medical Emergencies
The respiratory rate for this patient falls into: a Faster than the normal range b Slower than the normal range c Within the normal range d No normal range for respirations
A. A respiratory rate of 26 is faster than the normal range of 12 to 20 respirations per minute for an adult. Since the client walks slowly using a cane, the dental hygienist may rule out running or other excessive physical activity as a cause for the increased respirations. The client may be showing a decline in the ability to engage in normal activity because of decreased oxygen supply to muscles and other organs.
Which of the following symptoms would the dental hygienist observe in a client undergoing acute adrenal insufficiency? a Abdominal pain, altered level of consciousness, weakness, hypotension b Aura, purposeless movements, blank stare c Hypoglycemia, anxiousness, pale moist skin, bizarre behavior d Nausea, dizziness, hemiparesis
A. Abdominal pain, altered level of consciousness, weakness, and hypotension are some of the signs and symptoms of acute adrenal insufficiency.
A 3-year-old child in the waiting room begins choking on a pretzel. He cannot speak and has poor air exchange. Emergency treatment should begin with: a Abdominal thrusts until the pretzel is expelled or the child becomes unconscious b Blind finger-sweeps until the pretzel is removed or the child becomes unconscious c CPR d Five back blows until the pretzel is expelled or the child becomes unconscious
A. Abdominal thrusts would be performed on a choking child until the object is expelled or the child becomes unconscious.
The BEST course of action during any emergency situation in which the client's medical condition fails to improve is to: a Activate the EMS b Ask a family member to transport the client to the emergency room c Initiate CPR d Transport the client with a staff member to the emergency room
A. Activation of the EMS is the best course of action when a client's medical condition does not improve during the management of a medical emergency
Treatment for acute fluoride toxicity includes all of the following EXCEPT one. Which one is the EXCEPTION? a Administration of glucose orally b Administration of 1% calcium gluconate orally c Administration of calcium chloride orally d Administration of milk
A. Administration of glucose will not benefit a child suffering from acute fluoride toxicity. Glucose administration is used to treat diabetes-related emergencies
An automated external defibrillator (AED) has been used on a client who is not breathing and has no pulse. From the following scenarios, choose the one that is MOST correct. a If a shock is indicated, "clear" the client and press the "shock" button, following recommended CPR/AED techniques b If a shock is indicated, press the "shock" button as quickly as possible regardless of other rescuers or bystanders c If no shock is indicated, press the "shock" button anyway d If no shock is indicated, then CPR is not necessary
A. If a shock is indicated, the rescuer should clear the client to decrease the chance of shocking a bystander or other rescuer, press "shock," and follow the recommended CPR/AED (automated external defibrillator) guidelines.
A male dental client with a history of heart disease has experienced chest pain during treatment. Treatment is discontinued. The client self-administers one nitroglycerin tablet, which relieves his discomfort. Because the nitroglycerin relieves the symptoms, the client MOST likely suffered a(n): a Angina attack b Asthma attack c Myocardial infarction d Transient ischemic attack
A. If pain and difficulty breathing experienced by a patient being treated for heart disease is relieved by the administration of nitroglycerin, then angina is the most likely cause of the symptoms.
Clinical death may be reversible. This is more likely if life support measures are initiated within 6 to 10 minutes. 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 FALSE d Both statements are TRUE
A. The first statement is true, but the second statement is false. Clinical death, which is the cessation of breathing and heart function, may be reversible through life support measures, especially if they are initiated within 4 to 6 minutes
Assessment and documentation of pretreatment vital signs is essential in care planning. If the client states that he or she is healthy and no medical problems were noted at the last dental visit 6 months ago, no complications should occur during treatment. 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 FALSE d Both statements are TRUE
A. The first statement is true. Vital signs provide important information about the physical status of the client. The second statement is false. Even though a client may report that he or she feels healthy, abnormal vital signs help the clinician decide whether or not to treat the client. Assessment of vital signs is essential in providing dental practitioners with important information for treatment planning and prevention of potential medical emergencies. A client's medical status can change significantly in a 6-month period without the client's knowledge.
Cardiopulmonary resuscitation (CPR) is being performed on a 73-year-old client who is not breathing and has no pulse. Choose the statement that BEST describes the correct compression technique. a With both hands, depress the sternum to at least 2 inches, release pressure fully, and push hard and fast providing at least 100 compressions per minute b With both hands, depress the sternum inches to 2, release pressure fully, and push hard at 60 compressions per minute c With both hands, depress the sternum 1 to inches, release pressure fully, and push hard at 80 compressions per minute d With both hands, depress the sternum to 1 inch, release pressure, and push hard at any rate possible
A. While performing cardiopulmonary resuscitation (CPR) on an adult, the sternum is compressed with both hands about 1½ to 2 inches at a rate of about 100 compressions per minute. The rescuer should push hard and fast, allowing the chest to recoil after each compression.
Before the emergency, the blood pressure reading obtained would be classified as: a Normal b Prehypertension c Stage I hypertension d Stage II hypertension
B. A blood pressure reading of 138/88 mm Hg falls into the prehypertensive range.
Low-flow oxygen is administered to a conscious client through a(n): a Ambu bag b Nasal cannula c Non-rebreather mask d Pocket mask
B. A nasal cannula is used to provide low-flow oxygen up to 6 L/min.
An apparently healthy 34-year-old female client begins to complain of sudden severe headache. She smokes 10 cigarettes a day. The only medication listed in the health history is a birth control pill. The client becomes extremely anxious and confused. She states she has slightly blurred vision in her left eye. She is MOST likely undergoing: a An asthma attack b A stroke c A nonconvulsive (petit mal) seizure d Syncope
B. Confusion, anxiety, and blurred vision in one eye are indicators that a stroke may be occurring. Cigarette smoking and use of birth control medication are risk factors for stroke.
If this victim loses consciousness and is not breathing, which one of the following actions should occur first? a Activate the EMS, and open the airway b Activate the EMS, obtain a defibrillator, check for a pulse, and begin chest compressions if no pulse is present c Activate the EMS, and begin CPR starting with respirations d Check radial pulse, and begin chest compressions if no radial pulse is present
B. Current CPR guidelines recommend that a rescuer activate the EMS and obtain a defibrillator if possible, check for a pulse and begin chest compressions if no pulse is present
The dental hygienist observes an older adult client as he walks toward her. She notes that he uses a cane, walks slowly, and appears to be short of breath. As she reviews the health history with him, the client tells her that he takes a diuretic and a "drug for his heart," which she recognizes as an angiotensin-converting enzyme (ACE) inhibitor. His respirations are 26 per minute and shallow. Pulse rate is 90 beats per minute and regular. After consultation with the client's physician, who confirms that the client is being treated for congestive heart failure (CHF) but is healthy enough for routine dental treatment, the dental hygienist begins an initial assessment. Other signs of CHF that the hygienist might expect to observe in this client include: a Confusion, sudden severe headache, and hemiparesis b Cyanosis, prominent jugular veins, and swollen ankles c Hyperglycemia, pale skin, and hyperventilation d Hyperventilation, aura, and involuntary muscle contractions
B. Cyanosis, prominent jugular veins, swelling of the ankles, fatigue, weakness, cyanosis, difficulty breathing, orthopnea, and acute pulmonary edema or cough are some of the signs and symptoms of congestive heart failure.
Decreasing the risk of an emergency related to toxic overdose of a local anesthetic can be accomplished by all of the following EXCEPT one. Which one is the EXCEPTION? a Aspiration before the injection b Blood pressure not assessed before treatment c Staying within the maximum safe dose d Use of a vasoconstrictor
B. Measuring the blood pressure before treatment and especially before the administration of a local anesthetic agent (in this case one containing epinephrine) will provide important information about the client's health status.
A 61-year-old male client expresses concern over receiving an injection of local anesthesia for periodontal debridement. The client explains that he had a bad experience many years ago. The client has a history of smoking, high blood pressure, and coronary atherosclerosis. He takes a calcium channel blocker medication. Vital signs obtained at the start of the appointment were blood pressure of 146/92 mm Hg; pulse rate of 66, regular; and respirations at 16 per minute. The hygienist begins treatment but stops when the client states that the procedure hurts during debridement. After a discussion with the client and the dentist, the hygienist administers a posterosuperior alveolar (PSA) nerve block depositing of a cartridge of lidocaine with epinephrine 1:100,000. The dental hygienist reassures the client while administering the anesthetic and monitors him during the onset of anesthesia. After a few minutes, the client complains of a squeezing pressure or tightness in his chest. The dental hygienist discontinues treatment and raises the chair to a semi-sitting position for client comfort. The client is experiencing some difficulty breathing. Which of the following choices is MOST likely the cause of the client's symptoms? a Allergic reaction b Angina pectoris c Congestive heart failure d Shock
B. The client is taking a calcium channel blocker medication and is being treated for atherosclerosis. Tightness of the chest and difficulty breathing indicate a possible cardiac emergency
The ratio of compressions to breaths and compression rate for one rescuer providing CPR for a 9-month-old infant would be: a 30 compressions to 2 breaths at a rate of 80 compressions per minute b 30 compressions to 2 breaths at a rate of at least 100 compressions per minute c 15 compressions to 2 breaths at a rate of 60 compressions per minute d 15 compressions to 2 breaths at a rate of at least 100 compressions per minute
B. The ratio of compressions to breaths would be 30:2, and at least 100 compressions per minute would be the rate of compressions for one rescuer providing CPR to a 9-month-old infant
If it becomes necessary to administer oxygen to this client, which of the following oxygen delivery devices would be the BEST choice? a Ambu bag b Nasal cannula c Non-rebreather mask d Pocket mask
C. A non-rebreather mask at 10 L/min flow would be the initial oxygen delivery device of choice for the client. If the client's condition worsens, the EMS should be activated and the client monitored to determine if a higher flow is indicated.
Treatment modifications for this client would include: a Having a source of sugar available b Placing a folded towel under the right hip when supine c Treating the client in the semi-supine or upright position d Treat client in the Trendelenburg position
C. Clients with congestive heart failure may need to be placed in the upright position to facilitate breathing.
Severe bleeding from a dental extraction is BEST managed by: a Direct pressure applied to the carotid artery b Direct pressure applied to the facial artery c Direct pressure applied with gauze over the bleeding extraction site d High-volume suction applied over the bleeding extraction site
C. Direct pressure to the extraction site would be the first step to control bleeding from a dental extraction. A wet tea bag held firmly against the bleeding site may also be effective since tannic acid has hemostatic properties
At the end of a periodontal debridement appointment, a 63-year-old female client becomes shaky, pale, and weak. The client is under a physician's care for diabetes, which she states is controlled by oral medication. Vital signs obtained at the start of the appointment included a blood pressure of 138/88 mm Hg; pulse rate of 76, regular and strong; and regular respirations of 16. The client states that she ate breakfast about 2 hours before her appointment; her most recent blood glucose reading is 100 mg/dL. The hygienist notifies the dentist, and together they reassure the client while managing the emergency. Which of the following actions would be the MOST important one in managing this potential emergency safely? a Administration of the client's oral medication b Administration of insulin c Administration of sugar d Administration of a sugar-free energy drink
C. During a diabetes-related emergency, if the dental hygienist is uncertain about the origin of the problem, sugar may be administered if the client is conscious. Hypoglycemic emergencies are more common than diabetic coma, and the administration of sugar may improve the client's condition.
If this client becomes unconscious, which of the following actions would be CONTRAINDICATED? a Activation of the EMS b Application of high-flow oxygen c Administration of orange juice d Monitoring vital signs
C. During a diabetic emergency in the dental office, sugar may be administered to a conscious person. However, dental personnel should not administer any food or liquids to an unconscious person. The emergency medical system (EMS) should be notified, oxygen administered, and the client monitored until the arrival of EMS personnel.
Which statement concerning management of convulsive seizures in the dental setting is MOST accurate? a After the seizure is over, place the client in the Trendelenburg position b Terminate procedures, and place the client in a semi-supine position c Terminate procedures, and place the client in a supine position d Terminate procedures, and restrain the client to prevent injury
C. In the dental setting, management of a client having a seizure includes terminating the procedure and placing the client in the supine position. The client should be prevented from injuring himself or herself by clearing the area of potentially injurious objects, , if possible, but the client should not be restrained. The airway should be established and maintained as much as possible. The client should remain in the chair, which should be lowered to the supine position
Insulin is normally produced in the: a Gall bladder b Liver c Pancreas d Small intestine
C. Insulin is produced in the pancreas.
Which of the following is NOT a sign or symptom of acute fluoride toxicity? a Nausea b Excessive salivation c Nosebleed d Thirst
C. Nosebleed is not a sign of acute fluoride toxicity.
In which of the following emergency situations would you NOT administer oxygen to a conscious client? a Anaphylactic allergic reaction b Angina c Hyperventilation d Toxic overdose of anesthetic
C. Oxygen would not be provided to a client who is hyperventilating. The client needs to slow down the breathing. The client should be reassured and coached to breathe slowly until the balance of oxygen and carbon dioxide is restored.
What is the MOST likely adverse reaction that may occur in a client who has an excessive fear of a dental injection? a Acute allergic reaction b Decreased pulse and respiratory rates c Psychogenic shock d Toxic overdose
C. Psychogenic shock or syncope would be the most likely result of an excessive fear of a dental injection. Syncope involves a sudden, transient loss of consciousness and is the most common medical emergency encountered in dental settings.
Before treatment, the client's blood glucose levels were: a High, hyperglycemic b Low, hypoglycemic c Within a normal range d Not a factor in treatment
C. Since the client reports that she had eaten and taken medications according to her usual routine, the blood glucose reading of 100 mg/dL 2 hours after the meal was within normal limits. Many factors affect the determination of what is normal for each client. Factors such as physical activity, the type of food eaten, recent illness, fasting, and age can affect blood glucose levels in a client. Clients who are under a physician's care and follow prescribed guidelines for disease management are often very knowledgeable about what is normal for them.
A 142/92 mm Hg blood pressure reading has been obtained for a 32-year-old male client. This is the third consecutive appointment that the diastolic reading has been above 90 mm Hg. The blood pressure for this client would be categorized as: a Normal b Prehypertension c Stage I hypertension d Stage II hypertension
C. Stage I hypertension is diagnosed when the after three consecutive appointments, the readings remain as follows: 140 to 159 mm Hg systolic, 90 to 99 mm Hg diastolic, or both.
When measuring blood pressure, how many additional mm Hg above the disappearance of the radial pulse should the cuff be inflated? a 10 mm Hg b 20 mm Hg c 30 mm Hg d 40 mm Hg
C. The blood pressure cuff should be pumped an additional 30 mm Hg above the number at which the radial pulse was no longer felt by palpation
Determining if a pulse is present in a 15-year-old client before initiation of CPR is accomplished by palpation of the: a Aortic artery b Brachial artery c Carotid artery d Radial artery
C. The carotid pulse, obtained at the carotid sinus, is used to determine if a pulse is present when assessing the need to perform CPR on an adult
A dental client becomes unconscious but is breathing and has a pulse. The EMS has been activated. While monitoring respirations, the dental hygienist notices that the rate has dropped to three respirations per minute. The BEST treatment while waiting for the EMS to arrive would be to: a Allow the client to continue breathing at three respirations per minute b Apply a face mask with low-flow oxygen c Use an Ambu bag to administer supplemental high-flow oxygen and ventilate at about 10 to 12 times per minute d Use an Ambu bag to administer supplemental high-flow oxygen and ventilate at least 20 times per minute
C. The client is not breathing adequately. Supplemental high-flow oxygen can be administered with an Ambu bag to ventilate the client at about 12 respirations per minute.
Use of a blood pressure cuff that is 20% larger than the diameter of the client's arm will most likely result in a blood pressure reading that is: a Artificially elevated b Artificially low c Correct d Difficult to hear
C. The cuff width should be 20% greater than the diameter of the arm for accurate measurement.
When obtaining the pulse rate for this client, which location is used? a Brachial pulse b Carotid pulse c Radial pulse d Femoral pulse
C. The radial pulse is used for determining the pulse rate of a child in a non-emergency situation.
How safe is the maximum amount of fluoride potentially ingested by the child? a Any amount of fluoride ingested is considered safe b The amount ingested is above the certainly lethal dose (CDL) c The amount ingested is below the safely tolerated dose (STD) d The amount was only a single dose and only long-term ingestion is of concern
C. The safely tolerated dose for a 6- to 8-year-old falls between 135 mg and 164 mg. A calculation of the amount of fluoride available for ingestion can be made using the following formula: Multiply the percentage of the compound by the molecular weight to get the percentage of fluoride (%F) in grams per deciliter (g/dL). Then multiply %F in gm/dl X 10 to get the mg F/ml. This number is multiplied by the quantity used in treatment to get the total fluoride ingested by the client. For 2 milliliters(mL) of 2% sodium fluoride (NaF) in a tray: 2% ´ {1/2.2} = 0.91% F ´ 10 = 9.1 mg F/mL ´ 2 mL = 18.2 mg F. This is below the maximum safely tolerated dose.
A 5-year-old boy playing in the reception area "swallows" his older brother's Lego block. Shortly afterward, the 5-year-old stops breathing and becomes unconscious. After the EMS has been activated, which of the following sequences of care should be initiated? a Give five back blows followed by five chest thrusts repeated until the object is expelled b Perform subdiaphragmatic abdominal thrusts until the object is removed c Activate the EMS, lower the child to the ground, and begin CPR with chest compressions by compressing the chest about 1 inches. d Open the airway, perform blind finger-sweeps, attempt to ventilate, reposition the head, re-attempt ventilations, and start CPR by beginning with chest compressions, compressing the chest about 1 inch.
C. The sequence to follow if a 5-year-old child becomes unconscious and stops breathing with a suspected foreign body obstructed airway is to activate the EMS, lower the child to the ground and begin CPR starting with chest compressions. When opening the airway to administer rescue breaths, look for the object and remove it if possible. If an object is not seen, CPR is continued for 2 minutes and the EMS is activated if that has not already been done. The chest is compressed about 1 ½ inches during CPR
A dental patient experiencing a toothache learns that endodontic treatment is necessary. After discussing the procedure, the patient reports feeling dizzy and begins to breathe rapidly. Her respirations are 30 and her pulse is 100. She states that she feels like she is having heart palpitations. Which of the following procedures would NOT be recommended when assisting this patient? a Reassure the patient b Place the dental chair in the upright position c Encourage the patient to breathe slowly and deeply d Administer high-flow oxygen e Terminate dental procedures
D. Administration of oxygen would not be recommended if hyperventilation is spected. The client has more than enough oxygen if she is hyperventilating.
Prevention of a diabetic emergency would include all of the following steps EXCEPT one. Which one is the EXCEPTION? a Medications are taken according to prescription b Minimize stress and anxiety during treatment c Schedule appointments after meals d Schedule appointments before meals
D. Appointments should be scheduled after meals, not before them. The client should follow his or her normal meal and medication routine. Morning appointments are usually recommended. The dental hygienist should verify that this has occurred before treatment.
If the tip of a curet breaks during subgingival scaling, the hygienist should follow all of the following procedures EXCEPT one. Which one is the EXCEPTION? a Asking the client to spit into a cup b Informing the client and advise him or her not to swallow c Isolating, drying, and examining the area where breakage occurred d Suctioning the area carefully to remove the broken tip
D. Avoid suctioning. It will be more difficult to ascertain if the broken tip has been swallowed or aspirated if suctioning is performed
Reimplantation of an avulsed tooth will have the best chance of success if: a The tooth is thoroughly cleaned of all debris before re-implantation b The tooth is placed back into the socket after good clot formation has occurred c The tooth has been placed in low-fat milk and left out of the socket for at least 24 hours d The tooth has been transported in low-fat milk and re-implanted as soon as possible
D. Avulsed teeth should be placed in low-fat milk and transported along with the client to the dentist for reimplantation as soon as possible. The tooth should not be cleaned of any debris.
A 7-year-old patient arrives for an afternoon appointment with the dental hygienist. The vital signs are recorded. A blood pressure reading is not obtained, but pulse rate is 110 beats per minute, regular and strong. Respirations are 18 per minute, regular and easy. At the end of the appointment, it is determined that sodium fluoride (NaF) treatment would be beneficial. Using trays, 2 mL of 2% NaF (cherry flavor) gel is administered. During the fluoride treatment, the child swallows some of the fluoride gel. The mother is advised that the child should not eat or drink for 30 minutes and that some fluoride gel has been ingested. The dental hygienist does not anticipate any problems but informs the mother of symptoms to watch for and that she should contact her physician if she has any concerns after the appointment. Which of the following statements concerning the client's vital signs are correct? a Pulse rate is within normal limits, but respirations are high b Respirations are within normal limits, but pulse rate is normal c Both pulse rate and respirations are high d Both pulse rate and respirations are within normal limits
D. Both pulse and respirations are within normal limits. A normal pulse range for a child falls between 80 and 120 beats per minute (beats/min). The normal respiration rate for a child is approximately 20 respirations per minute.
A 26-year-old female client is 7 months pregnant. During treatment, client positioning should include: a Placing the head lower than the feet b Placing a folded towel under the middle of her back c Placing a folded towel under her left hip d Placing a folded towel under her right hip
D. Placing a folded towel or a small pillow under the right hip will help alleviate any effects on circulation caused by compression of the abdominal aorta, the inferior vena cava, or both by the enlarged uterus. This would decrease the risk of development of a supine hypotensive syndrome.
All of the following dental care strategies should be avoided when treating this client EXCEPT one. Which one is the EXCEPTION? a Scheduling long appointments b Using anesthetics containing vasoconstrictors c Making frequent quick chair position changes d Using stress management protocols
D. Stress management protocols should be used for all dental clients, especially for those clients with a decreased ability to respond to stressful situations.
The compression rate for CPR for a 9-year-old child is: a At least 40 compressions per minute b At least 60 compressions per minute c At least 80 compressions per minute d At least 100 compressions per minute
D. The compression rate for CPR for a child (including a 9-year-old) is at least 100 per minute.
Symptoms being experienced by the patient are also associated with: a Aspiration of a foreign object b Asthma c Cerebrovascular accident d Myocardial infarction
D. Tightness of the chest and difficulty breathing may be signs of myocardial infarction. If the client has a nitroglycerin prescription, failure of the nitroglycerin, after appropriate administration, to relieve pain may indicate a myocardial infarction.
A dental client reports that he feels weak, lightheaded, and has a slight tingling in his fingers during treatment. His skin appears flushed, and it is dry and warm. Which action should be taken? a Administer epinephrine b Administer sugar c Raise the chair to the upright position d Recline the client into the Trendelenburg position
D. Weakness, lightheadedness, and tingling fingers are signs and symptoms of presyncope and if the client is reclined into the Trendelenburg position with the head lower than the legs, syncope (reduced blood flow to the brain) may be prevented.
This client will benefit from administration of: a Insulin b Glucocorticosteroid c Oxygen d Nitroglycerin e Both oxygen and nitroglycerin
E. Administration of both oxygen and a prescribed nitroglycerin would be appropriate for this client.
While waiting for his mother to complete her dental treatment, a 17-year-old male with a history of breathing difficulties begins to complain of pressure in his chest. Audible wheezing becomes apparent when he breathes. He states that it feels like he is unable to breathe. The young man's condition should improve after administration of: a An anticonvulsant medication b A prescribed bronchodilator c Nitroglycerin d Oxygen e Both B and D
E. Both B and D will help improve the symptoms of a person experiencing difficulty breathing (caused by an asthma attack). A prescribed bronchodilator and oxygen will both benefit the person having an asthma attack.
When it is necessary to perform CPR for an infant, which of the following would be correct? a The heel of one hand is placed on the center of the infant's chest between the nipples b The heel of one hand is placed on the center of the infant's chest between the nipples and the heel of the other hand is placed on top of the first hand c Two fingers are placed in the center of the infant's chest just below the nipple line d The hands encircle the infant's chest with the thumbs of both hands placed over the middle of the chest just below the nipple line when two rescuers are performing CPR e Both C and D
E. Both C and D are correct. When performing CPR on an infant, two fingers are placed in the center of the chest just below the nipple line, or the hands can encircle the chest with both thumbs placed over the middle of the chest just below the nipple line.