Pharm Ch 23

27. Albuterol is a short-acting β2-adrenergic agonist that produces bronchoconstriction.

ANS: False Albuterol produces bronchodilation. It is used in the management of an acute asthma attack or respiratory distress accompanying anaphylaxis. REF: p. 296

28. Most dental offices are well equipped to treat cardiac arrhythmias.

ANS: False The specific arrhythmia should be identified before an antiarrhythmic agent is selected. Most dental offices are not equipped to treat arrhythmias. REF: p. 297

26. The drug of choice for anaphylactic shock is sublingual or intramuscular injection of epinephrine.

ANS: True Parenteral epinephrine is the drug of choice and must be administered immediately in cases of severe anaphylactic shock. It may be given in the deltoid muscle or injected under the tongue. REF: p. 292

24. Drugs are not necessary for the proper management of most emergencies.

ANS: True The use of drug therapy is only ancillary to the primary measures of maintaining adequate circulation and respiration. REF: p. 291

25. Convulsions are generally self-limiting, and treatment should include protecting the patient from self-harm.

ANS: True Treatment should include protecting the patient from self-harm, moving any sharp objects out of the patient's reach, and turning the patient's head to the side to prevent aspiration. REF: p. 292

21. The following treatments are accepted for malignant hyperthermia, except one. Which one is the exception? a. Succinylcholine b. Baths and aspirin c. Dantrolene d. Fluid replacement e. Sodium bicarbonate

ANS: a Correct: Succinylcholine is an agent that may precipitate malignant hyperthermia, not treat it. Incorrect choices: The other options are all accepted methods of managing malignant hyperthermia. REF: p. 294

3. Which of the following is a method of preventing an emergency in the dental office? a. Taking a complete patient history b. Training of personnel c. Posting the telephone numbers for the closest physician, emergency room, and ambulance service d. Having a well-stocked and up-to-date emergency kit

ANS: a Correct: Taking a complete patient history can minimize and prevent emergencies. Incorrect choices: The other choices are measures to take in case of an emergency but not to prevent an emergency. REF: pp. 290-291

14. Anaphylactic shock is characterized by a __________ pulse. a. Weak, rapid b. Weak, slow c. Strong, rapid d. Strong, slow

ANS: a Usually, a weak, rapid pulse and a profound decrease in blood pressure occur with anaphylactic shock. Dyspnea and severe bronchial constriction occur. The reaction usually begins within 5 to 30 minutes after ingestion or administration of the antigen. REF: p. 292

20. Tepid baths and aspirin are indicated for: a. Myocardial infarction b. Thyroid storm c. Acute adrenocortical insufficiency d. All of the above e. None of the above

ANS: b Correct: One symptom of thyroid storm is hyperpyrexia. To reduce body temperature, aspirin and tepid baths are indicated. Incorrect choices: An aspirin tablet is indicated for myocardial infarction but not a tepid bath. Neither aspirin nor tepid bath is indicated for acute adrenocortical insufficiency. REF: p. 294

12. Which of the following statements is true concerning treatment for a patient who is hyperventilating? a. Opioid analgesics or diazepam will resolve the situation. b. The treatment is calm reassurance. c. Steroids and aminophylline may be administered. d. Parenteral epinephrine is the drug of choice.

ANS: b Correct: The treatment is calm reassurance. The dental professional should encourage patients to hold their breath or "rebreathed" into a paper bag or an unconnected face mask. Incorrect choices: Opioid analgesics or diazepam may be used to treat angina pectoris. Steroids, antibiotics, and aminophylline may be administered for aspiration. Parenteral epinephrine is the drug of choice for anaphylactic shock. REF: p. 292

6. The most important component in the treatment of syncope is: a. Placing the patient in the Trendelenburg position b. Exhibiting confidence in action and voice c. Administering spirits of ammonia by inhalation d. Placing the patient's head between their legs

ANS: b If the hygienist shows control over the situation, the patient will be less anxious and apprehensive. REF: p. 291

9. Which of the following treatment options is administered if a hypoglycemic patient lapses into unconsciousness and does not have a swallowing reflex? a. Apple juice or an apple cut into small pieces b. Intravenous dextrose c. Cake icing injected by syringe into the back of the mouth d. A dollop of peanut butter on the tongue

ANS: b If the patient lapses into unconsciousness and has no swallowing reflex, dextrose must be given intravenously. REF: p. 292

8. The patient with hypoglycemia has a __________ pulse and __________ respiration. a. Rapid, increased b. Rapid, decreased c. Slow, increased d. Slow, decreased

ANS: b Patients with hypoglycemia have a rapid pulse and decreased respiration. They are very talkative (loquacious). Hunger, dizziness, weakness, and occasionally tremor of the hands can occur. Other signs of hypoglycemia include diaphoresis, nausea, and mental confusion. REF: p. 292

17. Which of the following drugs is the agent of choice for drug-induced laryngospasm? a. Aminophylline b. Succinylcholine c. Parenteral epinephrine d. Diazepam

ANS: b Succinylcholine, a neuromuscular blocking agent, and positive-pressure oxygen are the agents of choice when drug-induced laryngospasm is present. The operator must have training and equipment to breathe artificially for the patient before succinylcholine is administered. REF: p. 292

4. Which of the following signs is the most common emergency in the dental office? a. Acute airway obstruction b. Syncope c. Hypoglycemia d. Diabetic coma

ANS: b The emergency most often encountered in the dental office is simple syncope or transient unconsciousness. The release of excessive epinephrine results in a pooling of the blood in the peripheral muscles, a decrease in total peripheral resistance, and a sudden fall in blood pressure. REF: p. 291

5. Treatment for syncope is to place patients: a. Prone on their stomach with their head tilted to one side b. Supine with their head tilted to one side c. Seated with their head tilted back d. Seated with their head tilted forward

ANS: b Treatment for syncope is to place patients supine with their head tilted to one side. They should be tilted back even further in the dental chair so that their head is below the level of the heart and turned to one side. This position causes blood to rush to the head, which has the effect of giving patients a transfusion of whole blood. The old practice of putting the head between the legs should be avoided because venous return is cut off by the slumped position. REF: p. 291

2. Advanced Cardiac Life Support (ACLS) training is: a. Necessary for all staff b. Necessary if the office is in a rural setting c. Necessary if the office performs conscious sedation d. Not necessary for a dentist's office e. None of the above

ANS: c ACLS training is required for personnel in dentist's offices in which preoperative or conscious sedation is performed. REF: p. 291

19. An automated external defibrillator (AED), if administered within the first 5 minutes of cardiac arrest, can save up to __________ of persons experiencing cardiac arrest. a. 10% b. 30% c. 50% d. 70% e. 90%

ANS: c An AED can save up to 50% of persons experiencing cardiac arrest if it is administered within the first 5 minutes of cardiac arrest. In March 2002 the American Dental Association Council on Scientific Affairs recommended that dentists consider purchasing an AED for their dental offices if emergency medical services personnel with defibrillation skills and equipment are not available within a reasonable time period. REF: p. 293

18. Symptoms that differentiate myocardial infarction from angina pectoris include: a. Heaviness in the chest b. Pain that radiates across the chest to other parts of the body c. Pain unrelieved by nitroglycerin d. Rapid pulse

ANS: c Anginal pain is generally relieved by administration of nitroglycerin. If three doses of nitroglycerin do not relieve the pain, then myocardial infarction is strongly suspected. REF: p. 293

16. All of the following actions are indicated for the management of acute airway obstruction except one. Which one is the exception? a. Placing the patient in a Trendelenburg position b. Clearing the pharynx and pulling the tongue forward c. Allowing the patient to sit upright d. Administering the Heimlich maneuver e. Performing cricothyrotomy

ANS: c Correct: Allowing the patient with acute airway obstruction to sit up is contraindicated. Incorrect choices: The other measures may be used to dislodge an acute airway obstruction. REF: p. 292

22. The drug of choice for opioid overdose is: a. Intravenous diphenhydramine b. Prochlorperazine c. Naloxone d. Flumazenil

ANS: c Correct: Naloxone is an opioid-receptor antagonist that can specifically reverse the actions of the opioids. Incorrect choices: Diphenhydramine is not a treatment of choice for opioid overdose, although it might reverse some of its actions. Prochlorperazine is not a treatment of choice for opioid overdose and may exacerbate the symptoms. Flumazenil is a benzodiazepine-receptor antagonist and would probably not influence the opioid overdose one way or the other. REF: p. 294

11. Diazepam may be administered for treatment of which of the following emergencies? a. Hyperglycemia b. Hypoglycemia c. Seizures d. Asthma e. Anaphylactic shock

ANS: c Diazepam may be administered intravenously in some situations for the treatment of convulsions or seizures, but observation of the patient is often sufficient. REF: p. 292

15. Which of the following choices would be the correct sequence for administration of emergency drugs for anaphylactic shock? (1) albuterol, (2) parenteral epinephrine, (3) intravenous corticosteroids a. 1, 2, 3 b. 1, 3, 2 c. 2, 1, 3 d. 2, 3, 1 e. 3, 1 ,2

ANS: c Parenteral epinephrine is the drug of choice and must be administered immediately in cases of severe anaphylactic shock. It may be given in the deltoid muscle or injected under the tongue. If bronchoconstriction is predominant, albuterol administered by inhalation or nebulization may suffice. Intravenous corticosteroids, intramuscular diphenhydramine, and aminophylline may also be used after the life-threatening symptoms have been controlled. REF: p. 292

10. Which of the following symptoms is associated with diabetic coma? a. Decreased pulse b. Increased appetite c. Acetone breath d. Cool, moist skin

ANS: c Symptoms of frequent urination, loss of appetite, nausea, vomiting, and thirst are noted. Acetone breath; hypercapnia; warm, dry skin; rapid pulse; and a decrease in blood pressure can occur. Treatment is undertaken only in a hospital setting and includes insulin after proper laboratory results are obtained. REF: p. 292

7. The most common cause of hypoglycemia is: a. Stress or anxiety b. Insufficient hydration with water c. An excessive dose of insulin in a patient with diabetes d. Cardiac medication

ANS: c The most common cause of hypoglycemia is an excessive dose of insulin in a patient with diabetes. Patients often inject their daily dose of insulin but fail to eat before coming to the dental office. REF: p. 292

23. Toxic reactions to epinephrine occur most often after the placement of a gingival retraction cord. The treatment of choice is to administer an adrenergic-receptor antagonist. 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.

ANS: c The treatment of choice is to remove the retraction cord and reassure the patient. In a calm patient, the epinephrine will be metabolized, and the episode will not precipitate the release of endogenous epinephrine. REF: p. 294

13. For an asthma attack that is unresponsive to topical 2-agonist administration, what treatment recourse does the dental office have available? a. Parenteral or oral aminophylline b. Parenteral corticosteroids c. Parenteral epinephrine d. Inhaled oxygen

ANS: d Correct: For an asthma attack that is unresponsive to topical 2-agonist, hospitalization should be considered for subsequent drug treatment. However, oxygen can and should be administered. Incorrect choices: The other options should be considered at the hospital rather than the dentist's office. REF: p. 292

1. Which of the following reasons is why the chance of an emergency occurring in the dental office continues to increase? a. The average age of the dental patient has increased. b. Dental offices are administering more complicated regimens. c. Dental appointments are taking longer than they used to take. d. Dental patients are, on average, getting sicker. e. All of the above are reasons.

ANS: e All statements are correct. REF: p. 290