Deck 21: Medical Emergencies

Question 1

Use Case C to answer The Following questions
CASE C
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.
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

Answer 1

Activate the EMS, obtain a defibrillator, check for a pulse, and begin chest compressions if no pulse is present

Question 2

Use Case D to answer The Following questions
CASE D
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.
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

Answer 2

Treating the client in the semi-supine or upright position

Question 3

Use Case A to answer The Following questions
CASE A
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

Answer 3

Both pulse rate and respirations are within normal limits

Question 4

Use Case B to answer The Following questions
CASE B
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.
Insulin is normally produced in the:

A)Gall bladder
B)Liver
C)Pancreas
D)Small intestine

Question 5

Use Case A to answer The Following questions
CASE A
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.
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

Question 6

Use Case B to answer The Following questions
CASE B
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.
Before the emergency, the blood pressure reading obtained would be classified as:

A)Normal
B)Prehypertension
C)Stage I hypertension
D)Stage II hypertension

Question 7

Use Case A to answer The Following questions
CASE A
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 is NOT a sign or symptom of acute fluoride toxicity?

A)Nausea
B)Excessive salivation
C)Nosebleed
D)Thirst

Question 8

Use Case C to answer The Following questions
CASE C
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.
This client will benefit from administration of:

A)Insulin
B)Glucocorticosteroid
C)Oxygen
D)Nitroglycerin
E)Both oxygen and nitroglycerin

Question 9

Use Case C to answer The Following questions
CASE C
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.
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

Question 10

Use Case B to answer The Following questions
CASE B
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.
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

Question 11

Use Case C to answer The Following questions
CASE C
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.
Symptoms being experienced by the patient are also associated with:

A)Aspiration of a foreign object
B)Asthma
C)Cerebrovascular accident
D)Myocardial infarction

Question 12

Use Case C to answer The Following questions
CASE C
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

Question 13

Use Case B to answer The Following questions
CASE B
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.
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

Question 14

Use Case A to answer The Following questions
CASE A
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.
When obtaining the pulse rate for this client, which location is used?

A)Brachial pulse
B)Carotid pulse
C)Radial pulse
D)Femoral pulse

Question 15

Use Case D to answer The Following questions
CASE D
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.
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

Question 16

Use Case A to answer The Following questions
CASE A
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.
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

Question 17

Use Case B to answer The Following questions
CASE B
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

Question 18

Use Case B to answer The Following questions
CASE B
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.
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

Question 19

Use Case D to answer The Following questions
CASE D
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

Question 20

Use Case D to answer The Following questions
CASE D
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.
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

Question 21

Use Case D to answer The Following questions
CASE D
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.
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

Question 22

Use Case D to answer The Following questions
CASE D
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.
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

Question 23

Use Case D to answer The Following questions
CASE D
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.
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

Question 24

Use Case D to answer The Following questions
CASE D
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.
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

Question 25

Use Case D to answer The Following questions
CASE D
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.
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

Question 26

Use Case D to answer The Following questions
CASE D
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.
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

Question 27

Use Case D to answer The Following questions
CASE D
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.
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

Question 28

Use Case D to answer The Following questions
CASE D
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.
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

Question 29

Use Case D to answer The Following questions
CASE D
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.
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

Question 30

Use Case D to answer The Following questions
CASE D
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.
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

Question 31

Use Case D to answer The Following questions
CASE D
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.
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

Question 32

Use Case D to answer The Following questions
CASE D
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.
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

Question 33

Use Case D to answer The Following questions
CASE D
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.
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

Question 34

Use Case D to answer The Following questions
CASE D
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.
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

Question 35

Use Case D to answer The Following questions
CASE D
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.
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

Question 36

Use Case D to answer The Following questions
CASE D
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.
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

Question 37

Use Case D to answer The Following questions
CASE D
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.
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

Question 38

Use Case D to answer The Following questions
CASE D
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.
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

Question 39

Use Case D to answer The Following questions
CASE D
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.
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

Question 40

Use Case D to answer The Following questions
CASE D
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.
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

Question 41

Use Case D to answer The Following questions
CASE D
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.
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

Question 42

Use Case D to answer The Following questions
CASE D
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.
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

Question 43

Use Case D to answer The Following questions
CASE D
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.
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.

Question 44

Use Case D to answer The Following questions
CASE D
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.
A male dental client with a history of heart dis?ease 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

Question 45

Use Case D to answer The Following questions
CASE D
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.
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

Question 46

Use Case D to answer The Following questions
CASE D
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.
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

Question 47

Use Case D to answer The Following questions
CASE D
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.
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

Question 48

Use Case D to answer The Following questions
CASE D
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.
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

Question 49

Use Case D to answer The Following questions
CASE D
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.
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

Question 50

Use Case D to answer The Following questions
CASE D
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.
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