Question 1

All the following are advantages to the metallic breech loading Aspirating syringe except:

Accepted Answer

The metal syringe is heavier than the plastic syringes, which may compromise the operator's control during the application of the anesthetic. Being autoclavable is an advantage in controlling waste and cost. Being able to see the cartridge is paramount in delivering anesthetic safely. Being able to use the syringe repeatedly is an advantage. It controls waste and cost.

Question 2

The trigeminal nerve is the seventh and largest of the 12 cranial nerves. It has three divisions that include the ophthalmic (V₁), maxillary (V₂), and mandible (V₃).

Accepted Answer

The trigeminal nerve is the fifth cranial nerve. The second statement is True. The first statement is False. The trigeminal nerve is the fifth cranial nerve. The first statement is False, and the second statement is True. The first statement is False, but the second statement is True.

Question 3

Which of the following are ways to decrease pain during an injection?

Accepted Answer

Repeated insertions of a needle into tissue can dull the needle tip and cause discomfort to the client on future injections. Only apply a small amount of topical because of the high concentration of the drug and the possibility of toxicity. Removing the needle quickly can cause tissue trauma and patient discomfort. Shaking the tissue can cause tissue trauma during insertion of the needle and the operator loses focus on the penetration and deposition site.

Question 4

Amide local anesthetics undergo biotransformation in the:

Accepted Answer

Amide local anesthetics undergo biotransformation in the liver by microsomal enzymes. The kidneys excrete the metabolic products of the amide local anesthetic. The intestines are not involved with amide local anesthetic biotransformation. The nerve cell is not involved with amide local anesthetic biotransformation.

Question 5

There is seldom a need to administer more than ____ cartridges during any appointment involving dental hygiene care, and the maximum number of cartridges of any type of anesthesia that the manufacturers recommend is ____.

Accepted Answer

The procedures done by a dental hygienist in an hour appointment would rarely require more than four cartridges. Four cartridges is the correct choice for the first part of this answer; however, the maximum dose depends on the calculation of the client's body weight and type of anesthesia being used. Two cartridges are a common amount used for a dental hygiene appointment of one quadrant of scaling and root planing, but the maximum safe dose must be calculated using the client's body weight and the type of anesthetic solution being used. Four cartridges is the correct choice for the first part of this answer; however, the maximum dose depends on the calculation of the client's body weight and type of anesthesia being used.

Question 6

A nerve is polarized or in a resting state when:

Accepted Answer

The nerve is polarized or in a resting state when a balance exists between positive sodium ions on the outside of the nerve membrane and negative potassium ions on the inside of the membrane. A resting state or polarization is achieved when there is a balance of ions, not a change or depolarization of ions. This is a partial answer. The nerve membrane becomes less
permeable to sodium ions and keeps them on the outside of the nerve membrane and the potassium ions remain inside the nerve membrane. Calcium (CA⁺⁺⁾ ions are not involved with nerve conduction. The sodium (Na⁺) and potassium (K⁺) ions are not together inside the nerve membrane.

Question 7

Two newer developments in anesthetic solutions are buffering agents that decrease the burning or stinging sensation of an acidic solution and a vasodilator to shorten the time of soft tissue anesthesia; however, both types of anesthetic solutions require the mixing of these additives to the cartridge right before use.

Accepted Answer

The first statement is True. There are new anesthetic solutions that can decrease the stinging or burning of anesthetic solution as it enters the tissue, and there is another type of LA solution that helps to reduce the time of soft-tissue anesthesia, but just the sodium bicarbonate that reduces the stinging needs to be mixed with the LA before injecting it. The second statement is False, because the solution that contains the vasodilator is placed in the cartridge during the manufacturing process.

Question 8

Symptoms of epinephrine overdose include all of the following except:

Accepted Answer

Dizziness, throbbing headache, fear and anxiety, and palpitations are all symptoms of an epinephrine overdose; however, nausea is not. The majority of side effects or symptoms are related to the circulatory and pulmonary systems, but not the gastrointestinal system.

Question 9

The client is scheduled for scaling and root planing of the upper right quadrant. You have administered the ASA, MSA, GP, and NP using a short 27-gauge needle and now are preparing to do the PS a. Before administering the PSA, you draw the needle across a piece of sterile gauze and it becomes caught on the gauze. You should clear the needle from the gauze and:

Accepted Answer

A needle that catches the gauze when drawn across it indicates there is administration. A short 25-gauge needle is recommended for this area of the mouth because using a long needle increases the risk of a hematoma forming. The 25-gauge needle provides a larger lumen to make the aspiration process easier. The needle getting caught on the gauze indicates a barb is present and the needle should be changed to aid in client comfort during the injection. A long needle used in this area of the mouth increases the risk of a hematoma forming. The larger the gauge of a needle, the smaller the lumen. A larger lumen, 25 or 27, is preferred to decrease the difficulty in aspirating.

Question 10

What is the next step when you aspirate and get a positive aspiration?

Accepted Answer

When there is a positive aspiration of any size, both the needle and the cartridge must be changed. Changing only the cartridge can lead to another positive aspiration because of blood remaining in the needle lumen. Any size droplet of blood can mean the needle is in a blood vessel; thus the procedure needs to be stopped and the needle and cartridge changed. If blood is present in the cartridge, it will be difficult to access if there is another positive aspiration with the next injection even though a new needle is being used.

Question 11

Your client is a 56-year-old male who has a medical history of a heart attack 2 years prior and is taking blood pressure medication and a daily dose of aspirin. He is scheduled for one quadrant of scaling and root planing with local anesthesia (LA). His preanesthetic assessment would include:

Accepted Answer

A complete preanesthetic client assessment includes, reviewing the medical history, assessing the client's ability to physically tolerate the anesthetic, reviewing the client's past experiences with LA, and consulting the client's physician. Incomplete information will be gained for assessing risks. It's a good idea to review the past LA experiences to gain information on possible risks, but more information regarding his medications is also needed. A medical consult is a good tool for decreasing risks with LA; however, more information is needed. The most complete assessment includes looking at the client's past history with LA.

Question 12

What two branches of nerves descend from the infraorbital nerve?

Accepted Answer

The MSA nerve branches off the infraorbital nerve within the infraorbital canal, and the ASA nerve branches off the infraorbital nerve just before the latter's exit from the infraorbital foramen. The PSA descends from the main trunk of the maxillary nerve. The NP nerve passes through the pterygopalatine ganglion. The NP and the GP pass through the pterygopalatine ganglion.

Question 13

Topical anesthetic agents, such as benzocaine are applied before needle insertion to anesthetize the terminal nerve endings and thus promote client comfort. Thus a significant amount is needed to facilitate diffusion of the drug through the mucous membrane and can be reapplied numerous times due to the low toxicity of a topical medication.

Accepted Answer

The first statement is correct, but the reason is not. Only a small amount of topical agent is needed and because of the high concentration necessary to aid in the diffusion through the mucous membrane, toxicity is a concern.

Question 14

The bevel of the needle should:

Accepted Answer

Having the bevel of the needle facing the bone allows for the solution to be deposited in the appropriate area for maximum uptake by the nerve. Having the bevel away from the bone allows the solution to be deposited into tissue away from the nerve. For some injections (e.g., the inferior alveolar), gently touching the bone gives the operator confirmation regarding landmarks for a successful injection. Bevel toward the bone is a key to a successful injection and the needle may need to be turned slightly to achieve this orientation.

Question 15

Contraindications to local anesthetics and vasoconstrictors are divided into two categories: absolute and relative. Absolute contraindications require that the drug in question not be administered to the individual under any circumstances and a relative contraindication means that the drug in question may be administered to the client after careful weighing of the risk of using the drug against its potential benefit.

Accepted Answer

Both statements are True. Absolute contraindications require that the drug never be administered to a client because it would present a life-threatening risk. An example of this is a documented local anesthetic allergic reaction. Relative contraindications require careful consideration of the risks involved. This would be done through careful review of the medical history and medical consult with the client's physician.

Question 16

Referring to the client in question 4 whose medical consult shows no contraindications to its use, what anesthetic would you chose for an appointment that is scheduled for 1 hour?

Accepted Answer

Lidocaine HCl 2% with epinephrine 1:100,000 will provide 60 minutes of pulpal anesthesia and 180 to 240 minutes of soft-tissue anesthesia. Articaine provides 75 minutes of pulpal anesthesia and 180 to 300 minutes of soft-tissue anesthesia. Mepivacaine provides only 20 to 40 minutes of pulpal anesthesia and 120 to 180 minutes of soft-tissue anesthesia.

Question 17

For each anesthetic, select short, medium, or long duration for pulpal and soft-tissue anesthesia, using each answer once only.
A) Short duration
B) Intermediate duration
C) Long duration
1) Bupivacaine HCL 0.5% epinephrine 1:200,000
2) Mepivacaine HCL 3%
3) Lidocaine HCL 2% epinephrine 1:50,000

Accepted Answer

The answer of For each anesthetic, select short, medium, or...

Quiz 40: Local Anesthesia

All the following are advantages to the metallic breech loading Aspirating syringe except:

The trigeminal nerve is the seventh and largest of the 12 cranial nerves. It has three divisions that include the ophthalmic (V₁) , maxillary (V₂) , and mandible (V₃) .