Deck 18: Management of Pain and Anxiety

Question 1

How many milligrams of lidocaine does 1 mL of 2% lidocaine contain?

A)2 mg
B)20 mg
C)200 mg
D)2 g
E)20 g

Answer 1

20 mg

Question 2

Which of the following would be the LONGEST lasting for inferior alveolar nerve block (IANB) anesthesia?

A)Prilocaine
B)Lidocaine
C)Mepivacaine
D)Procaine
E)Articaine

Answer 2

Prilocaine

Question 3

The maximum safe dose of carbocaine is 300 mg. How many cartridges of a 2% solution can be injected so as not to exceed the maximum?

A)5 cartridges
B)6 cartridges
C)7 cartridges
D)8 cartridges
E)9 cartridges

Answer 3

8 cartridges

Question 4

Repolarization of the nerve after stimulation is primarily caused by:

A)Active transport of potassium (K) out of the cell
B)Active transport of sodium (Na) out of the cell
C)Diffusion of Na into the cell along the concentration gradient
D)Diffusion of K out of the cell along the concentration gradient

Question 5

The amount of anesthetic in a cartridge of 4% prilocaine is

A)36 mg
B)30 mg
C)54 mg
D)72 mg
E)90 mg

Question 6

Why do local anesthetics NOT work well in infected tissues?

A)The lower pH of infected tissue
B)Increased edema
C)Increased vascularity
D)All of the above

Question 7

Tissues with higher pH will cause:

A)Rapid hydrolysis of the anesthetic solution
B)Decreased disassociation of the anesthetic drug
C)None of the above

Question 8

The two stages of an action potential are:

A)Equilibrium/membrane potential
B)Positive/negative
C)Depolarization/repolarization
D)Relative/absolute refractory period
E)Myelinated/nonmyelinated

Question 9

The maximum safe dose of 2% carbocaine for a normal adult client is:

A)5.5 cartridges
B)8.3 cartridges
C)6.9 cartridges
D)None of the above

Question 10

All of the statements concerning local anesthetic cartridges are true EXCEPT one. Which one is the EXCEPTION?

A)The glass dental cartridge should not be autoclaved
B)No alcohol should be present around the cartridges when they are stored outside the packaging container
C)The rubber plunger is treated with silicone to decrease the incidence of "sticky stoppers"
D)Cartridges exposed to extended periods of direct sunlight may have their contents undergo accelerated destruction
E)Manufacturers recommend freezing cartridges so that they may be used beyond the posted expiration date

Question 11

Local anesthetic agents prevent depolarization by:

A)Blocking the sodium-potassium pump
B)Preventing the transfer of K ions from exiting the nerve cell membrane
C)Preventing transfer of Na ions from the interior of the nerve to the exterior
D)Preventing transfer of Na ions from the exterior of the nerve to the interior

Question 12

All of the statements concerning local anesthetic needles are true EXCEPT one. Which one is the EXCEPTION?

A)The term gauge refers to the diameter of the lumen of the needle
B)The weakest portion of the needle is at its hub
C)Larger needles provide more reliable aspirations
D)Disposable needles will not normally become dull for at least 10 insertions
E)Larger needles should be employed when a greater risk of positive aspiration exists

Question 13

Lidocaine is metabolized primarily in the:

A)Liver
B)Kidney
C)Plasma
D)Bloodstream

Question 14

It takes 2 minutes to deliver 1.8 mL of anesthetic using the Wand fast flow rate; this is the ideal flow rate for a traditional injection according to Malamed (2007).

A)Both statements are TRUE
B)Both statements are FALSE
C)The first statement is TRUE; the second statement is FALSE
D)The first statement is FALSE; the second statement is TRUE

Question 15

Complete the sentence with the MOST accurate phrase. Local anesthetics______________________.

A)Combine lipid-soluble acids and basic esters
B)Form water-soluble salts with strong acids, which are unionized
C)Dissociate in the tissues, liberating free base, which can diffuse through the nerve membrane
D)Form amides, which transform to esters in tissues
E)Are synthetic and do not contain amino groups

Question 16

The purpose of aspirating before injecting a local anesthetic solution is to prevent:

A)Allergic reactions
B)Intravascular injections
C)Traumatic injections
D)Trismus

Question 17

How does a nerve conduct an impulse?

A)By blocking K from leaving the inside of the cell membrane
B)By sequential neuron cell membrane depolarization from segment to segment or node to node
C)By rapid influx of chloride ions across the neuronal cell membrane
D)By blocking Na from entering the cell membrane

Question 18

Once the minimal threshold stimulus has been reached, the impulse will travel the entire length of the fiber without stimulation. This explains:

A)Pain perception
B)Pain reaction threshold
C)Absolute refractory period
D)Membrane potential
E)All-or-none law

Question 19

All of the following statements about local anesthesia are true EXCEPT for one. Which one is the EXCEPTION?

A)Hemostasis is only achieved when the vasoconstrictor is deposited into the area of bleeding
B)Maximum dosages of all drugs administered by injection should be calculated by body weight
C)Children can tolerate adult doses of local anesthetics because of their faster metabolism, and overdose is of little concern
D)The possible causes of decreased anesthetic effect include edema, pH, and vascularity
E)Overdose reactions are dose related; allergic reactions are not dose related

Question 20

The gauge of a dental needle MOST recommended for intraoral injections with high risk of aspiration is:

A)18 gauge
B)30 gauge
C)27 gauge
D)25 gauge
E)23 gauge

Question 21

How many milligrams of epinephrine are in a cartridge of local anesthetic with 1 : 200,000?

A)0.005 mg
B)0.036 mg
C)0.009 mg
D)0.36 mg
E)0.01 mg

Question 22

Trismus noted in a client the day following an inferior alveolar nerve block MOST likely results from:

A)Failure to use an aspirating syringe
B)Irritation of the medial pterygoid muscle
C)Accidental injection of the solution near a branch of the facial nerve
D)Allowing the needle tip to rest beneath the periosteum during injection
E)Accidental injection of the solution near a major branch of the trigeminal nerve

Question 23

The maximum safe dose of 4% prilocaine is:

A)300 mg
B)500 mg
C)400 mg
D)None of the above

Question 24

The maximum safe dose (MSD) of epinephrine for clients with significant cardiovascular disease is:

A)0.02 mg
B)0.04 mg
C)0.4 mg
D)0.020 mg
E)0.1 mg

Question 25

All of the following statements about intraoral injections are false EXCEPT one. Which one is the EXCEPTION?

A)IANB does not block the mylohyoid nerve
B)Periodontal ligament (PDL) injections are only administered using a specialized syringe
C)Infraorbital injections block the entire maxillary nerve
D)The success rate of the IANB is 80% to 85%

Question 26

What is the average adult depth of penetration for the mental nerve block?

A)12 mm
B)6 mm
C)9 mm
D)Until the bevel is covered
E)Until bone is contacted

Question 27

Which of the following statements about the metabolism of local anesthetic agents is TRUE?

A)Amides undergo biotransformation by pseudo-cholinesterase
B)Vasoconstrictors are broken down in the liver
C)The rate of metabolism does not have any effect on potential toxicity
D)The location of biotransformation is dependent on drug classification
E)The metabolism of local anesthetic agents occurs in the kidneys

Question 28

What is(are) the overdose effect(s) of epinephrine?

A)Palpitation
B)Tachycardia
C)Hypertension
D)Headache
E)All of the above

Question 29

Which of the following nerves should be adequately anesthetized to scale and root-debride a maxillary first molar?

A)GP/PSA
B)LP/GP/NP
C)PSA/MSA/GP
D)ASA/MSA/GP
E)PSA/MSA/LP

Question 30

Terminal deposition for the inferior alveolar nerve block is the:

A)Mental foramen
B)Mandibular foramen
C)Cingulum
D)Infraorbital foramen

Question 31

During the administration of an inferior alveolar nerve block, the needle is inserted:

A)Medial to the pterygomandibular raphe
B)Medial to the medial pterygoid muscle
C)Lateral to the pterygomandibular raphe
D)At the height of the maxillary tuberosity
E)Lateral to the ramus of the mandible

Question 32

The problem(s) with topical anesthesia is(are):

A)Dosage control
B)All are esters except 5% lidocaine
C)Concentrations used exceed concentrations administered by injection
D)Topical anesthetic agents containing benzocaine are, by far, the most common
E)All of the above

Question 33

Rapid biotransformation will result in:

A)Increased systemic toxicity
B)Decreased systemic toxicity
C)Increased disassociation of the anesthetic drug
D)Decreased disassociation of the anesthetic drug

Question 34

The following injection(s) should be administered when scaling and root debridement of a mandibular second molar:

A)Mental nerve block
B)Buccal nerve block
C)Inferior alveolar nerve block
D)B and C
E)None of the above

Question 35

What purpose(s) does epinephrine serve when added to a local anesthetic agent?

A)Prolongation of anesthesia
B)Reduction of hemorrhage in field of operation
C)Constriction of blood vessels in area of injection
D)Prevention of toxic effects from too-rapid absorption
E)All of the above

Question 36

All of the following statements about intraoral injections are false EXCEPT one. Which one is the EXCEPTION?

A)The incisive nerve block provides lingual soft tissue anesthesia
B)An initial negative aspiration ensures no risk for intravascular injection, and additional aspiration is unnecessary during solution deposition
C)The site of needle insertion for a posterior superior alveolar nerve block is the height of the mucobuccal fold above the maxillary second molar
D)The recommended amount of time to inject a 1.8-mL cartridge with regard to client safety and comfort is 30 seconds

Question 37

Inadvertent rapid intravenous injection of a local anesthetic containing a vasoconstrictor may cause:

A)Convulsions
B)Palpitations
C)Unconsciousness
D)Depressed respiration
E)All of the above

Question 38

Amides are inactivated by the enzyme:

A)Plasma cholinesterase
B)Protease
C)Lipase
D)Monoamine oxidase
E)Amylase

Question 39

The maximum safe dose of epinephrine for the healthy adult is 0.2 mg. How many cartridges of 1 : 100,000 epinephrine can be administered?

A)2 cartridges
B)5 cartridges
C)9 cartridges
D)10 cartridges
E)11 cartridges

Question 40

Within seconds following a posterior superior alveolar injection, a client's face becomes distended and swollen on the injected side. The appropriate action by the hygienist would be to:

A)Have the dentist administer an antihistamine
B)Have the dentist administer an antibiotic
C)Have the dentist incise and drain
D)Counsel the client, apply pressure to the site, and ice to the area
E)Ask the client to exhale

Question 41

Which of the following signs or symptoms may indicate the use of an excessive concentration of N₂O?

A)Slight smile on the client's face
B)Panicky look in the client's eyes
C)The client feeling a sense of floating or sinking
D)Mild diaphoresis (perspiration) experienced by the client

Question 42

All of the following are relative contraindications to the elective use of nitrous oxide-oxygen conscious sedation EXCEPT one. Which one is the EXCEPTION?

A)Communication difficulty
B)Epilepsy
C)Asthma
D)Nasal obstruction
E)Chronic obstructive pulmonary disease

Question 43

What structures are anesthetized with the AMSA (anterior middle superior alveolar) Wand injection?

A)Muscles of facial expression
B)Mandibular lingual gingiva and palatal mucosa
C)Upper lip
D)Mandibular facial gingiva from the central incisor to the second premolar
E)Maxillary central incisor through the second premolar

Question 44

Within seconds following a posterior superior alveolar injection, a client's face becomes distended and swollen on the injected side. The condition suspected in this situation is most likely a/an:

A)Aneurysm
B)Hematoma
C)Angioedema
D)Allergy
E)Infection

Question 45

All of the following statements about N₂O are false EXCEPT one. Which one is the EXCEPTION?

A)The toxic reaction is associated with too much N₂O, which causes hypoxia.
B)N2O is metabolized in the lungs
C)N₂O works by blocking pain perception
D)N₂O affects heart rate, blood pressure, liver, and kidney
E)N₂O makes the client perceive time as passing slowly

Question 46

If the nitrous oxide (N₂O) flow rate is 2 liters/minute (L/min) and that of O₂ is 4 L/min, what is the percentage of the N₂O ?

A)33%
B)67%
C)50%
D)None of the above

Question 47

A client develops paralysis of a half of his face and inability to close his eye on the side of an attempted inferior alveolar nerve block. The MOST logical explanation is that the injection was given into the:

A)Parotid gland
B)Masseter muscle
C)Maxillary artery
D)Posterior facial vein
E)Pterygo-mandibular ligament

Question 48

Which statement regarding the Wand PDL injection is TRUE?

A)Aspiration is required
B)Anterior teeth have one injection site, and posterior teeth have two injection sites
C)The penetration site on the maxilla is on the lingual aspect; it is on the facial aspect on the mandible
D)One half cartridge is delivered at each site
E)Fast or slow flow can be used

Question 49

Which of the following regarding the palatal-anterior superior alveolar (P-ASA) Wand injection is TRUE?

A)Anesthetizes six teeth
B)Is a two-stage injection
C)Requires aspiration
D)Involves the administration of one cartridge
E)All of the above

Question 50

What needs to be recorded in the client's treatment notes following the use of nitrous oxide-oxygen conscious sedation during nonsurgical periodontal therapy?

A)Oxygenation period
B)Duration of sedation
C)Concentrations of N₂O and O₂ administered
D)Tidal volume
E)All of the above