chapter questions anesthesia part II – Flashcards
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a technique that deposits anesthetic solution near larger terminal nerve branches for treatment near the site of an injection is called: a. an infiltration b. a ligamental c. a field block d. a nerve block
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c. a field block
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what one of the following describes the target site for local anesthetic solutions a. needle pathway b. deposition site c. penetration site d. aspiration site
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b. deposition site
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the first step in the administration of local anesthetic solutions is to: a. assemble the armamentarium b. obtain informed consent c. assess the patient before proceeding d. make sure that solution is able to exit the needle
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c. assess the patient before proceeding
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a primary benefit of orienting needle bevels towards bone during injections is that it: a. reduces trauma to the periosteum when bone is contacted b. deflects the needle away from the bone during penetration c. prevents false negative aspirations within a vessel d. reduces discomfort from the advancing needle
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a. reduces trauma to the periosteum when bone is contacted
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which one of the following is most appropriate local anesthesia chart entry? a. 10/21/2002: rev HHX BP: 120/80. 2 carts 2% lido, 1:1000k epi, no complications b. Review HHX. BP 120/80. 2 carts 2% lido, w/1:100k epi, Rt IA, LB c. Rev HHX. BP 120/80. 72 mg of 2% lido w/.036 mg 1:100k epi, IA, LB d. 10/21/2002: Rev HHX. BP 120/80. 2 cartridges 2% lido (72 mg) w/1:100k epi (.036 mg), Rt IA, LB (-) aspiration. No adverse reactions
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d. 10/21/2002: Rev HHX. BP 120/80. 2 cartridges 2% lido (72 mg) w/1:100k epi (.036 mg), Rt IA, LB (-) aspiration. No adverse reactions
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when is it safe to deposit local anesthetic solution? a. after a negative aspiration, where no blood is drawn into the cartridge b. after negative aspiration, following a positive aspiration where blood was visible in the cartridge only as a small trickle of blood or worm like thread c. following a positive aspiration that obscures the results of subsequent aspirations d. A and B
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d. A and B
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the MOST important safety step during a local anesthetic injection is: a. aspirate before depositing b. administer local anesthetic slowly c. direct the bevel away from bone d. aspirate before depositing and administer drugs slowly
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d. aspirate before depositing and administer drugs slowly
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upon completion of an injection, the most important subsequent step is to: a. rinse the pts mouth b. calculate the volume of drug delivered c. make the needle safe with a one-handed technique d. determine if the patient experienced discomfort
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c. make the needle safe with a one-handed technique
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which one of the following statements best describes the needle pathway for an infiltration injection technique? a. the needle is parallel to the long axis of the tooth, passing through thin mucosal tissues to superficial fascia containing loose connective tissue, and past small vessels and microvasculature and nerve endings b. the needle is distal to the long access of the tooth, passing through thin mucosal tissue to deep fascia of connective tissue and past small vessels, alveolar bone and nerve endings c. the needle is parallel to the long axis of the tooth, passing through tin mucosal tissues to superficial tissue and past small vessels, nerves and bone
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a. the needle is parallel to the long axis of the tooth, passing through thin mucosal tissues to superficial fascia containing loose connective tissue, and past small vessels and microvasculature and nerve endings
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when infiltration injections are unsuccessful it may be helpful to: a. change the length of the needle and repeat the injection b. visualize, palpate, check radiographs and reassess the technique c. establish contact with bone before administering one cartridge of anesthetic solution d. repeat the same injection and deposit more solution
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b. visualize, palpate, check radiographs and reassess the technique
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t/f the middle superior alveolar nerve is absent in approximately 28 to 505 of individuals
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true
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t/f in a typical adult pt the infraorbital foramen is approximately 8 to 10 mm below the infraorbital ridge
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true
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which one of the following provides the most accurate description of the field of anesthesia in the PSA injection a. pulps of maxillary premolars and molars and their facial gingiva, PDL and alveolar bone b. pulps of max and man molars on side injected c. pulps of max teeth at midline and facial gingiva, PDL and alveolar bone d. pulps of max molars, except sometimes the mesiobuccal root of the first molar, and their facial gingiva, PDL and alveolar bone on the injected side
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d. pulps of max molars, except sometimes the mesiobuccal root of the first molar, and their facial gingiva, PDL and alveolar bone on the injected side
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which one of the following is most likely to increase the risk of hematoma following a PSA nerve block? a. the needle is inserted too deep or too posterior to the deposition site on the posterior surface of the maxilla b. the needle is inserted too inferior to the posterior surface of the maxilla c. the porous bony surface of the maxilla allows the needle to penetrate the maxilla-piercing blood vessels d. a long needle is inserted contacting the bony periosteum on the surface of the maxilla
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a. the needle is inserted too deep or too posterior to the deposition site on the posterior surface of the maxilla
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which one of the following statements best describes the deposition site for the nasopalatine nerve block? a. within the nasopalatine canal b. near the wall of the incisive canal c. anterior to the opening of the anterior palatine foramen d. near the junction between vertical alveolar process and horizontal palatal process
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b. near the wall of the incisive canal
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the most common cause of failure for palatal injection technique is: a. solution is deposited too far from the associated bone or foramen b. inadequate volumes of solution deposited c. both B and C d. both A and B
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d. both A and B
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The AMSA technique can provide anesthesia for areas traditionally anesthetized by which one of the following groups of injections? a. ASA, MSA, PSA, NP and GP b. ASA, MSA, NP and GP c. PSA and GP d. NP and MSA
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b. ASA, MSA, NP and GP
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which one of the following statements is true of NP nerve blocks a. they have the highest rate of positive aspiration in the palate b. they have the second highest rate of positive aspiration in the palate c. the provide more durable anesthesia compared with other palatal techniques d. they provide bilateral anesthesia
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d. they provide bilateral anesthesia
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which one of the following is an important consideration in all palatal LA procedures? a. always apply topical anesthetic for 1 to 2 minutes b. always administer solution slowly c. always use patch anesthetics
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b. always administer solution slowly
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t/f AMSA nerve blocks provide bilateral anesthesia of palatal tissues at least 20% of the time
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false
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the rate of positive aspiration in the IA nerve block is the highest of all techniques and approximates which one of the following a. 2 to 5% b. 5 to 10% c. 10 to 15% d. 15 to 20%
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c. 10 to 15%
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which one of the following techniques is an alternative to nearly all mandibular anesthesia techniques a. gow-gates b. vazirani-akinosi c. PDL d. infiltrations
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c. PDL
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which one of the following results in pulpal anesthesia? a. buccal nerve block b. mental nerve block c. A and B d. neither A nor B
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d. neither A nor B
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when administering a Gow-Gates mandibular nerve block, all of the following are essential except: a. performing on or more aspirations b. meeting bony resistance c. determining the site, height and depth of penetration as well as the syringe barrel orientation d. having the client removal all ear jewelry before administering
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d. having the client removal all ear jewelry before administering
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palpating anatomy prior to all mandibular anesthetic procedures is: a. an unnecessary step b. helpful in some techniques and useless in others c. least important aspect d. critical to success of techniques
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b. helpful in some techniques and useless in others
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which one of the following is the correct order, from inferior to superior location of the mandibular techniques listed in relation to the pterygomandibular space? a. IA, Gow-Gates, Akinosi b. IA, Akinosi, Gow-Gates c. Gow-Gates, IA, Akinosi d. Akinosi, IA, Gow-Gates
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b. IA, Akinosi, Gow-Gates
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a clinician is administering an IA nerve block prior to therapy when the pt suddenly jerks and the needle breaks. The embedded portion is not visible. What should the clinician do? a. attempt removal b. refer for removal c. reappoint to remove once the needle has developed a fibrous cocoon around it d. refer for evaluation
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d. refer for evaluation
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a second cartridge of 2% lidocaine has been administered for an IA nerve block when the 160 lbs pt becomes anxious and states that she doesn't feel well, even a little nauseous. she becomes less anxious as she becomes increasingly fatigued and her speech becomes slurred, with a reported numb feeling all around the pts mouth. Which one of the following statements best describes these observations a. pt is likely suffering from severe anxiety and fatigue b. pt is likely suffereing from drug overdose due to excessive administered doses c. pt is likely suffering form drug over dose due to intravascular administration d. pt is likely suffering from allergy to lidocaine
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c. pt is likely suffering from drug over dose due to intravscular administration
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allergies to topical anesthetic drugs that cause mucosal signs and symptoms hours to days after exposure are explained best by which one of the following reactions a. delayed hypersensitivity b. anaphylaxis c. angioedemia d. immunopathology
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a. delayed hypersensitivity
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a pt calls several days after IA and reports numbness is still present along with annoying occasional sharp pains. which of the following best describes what is occurring a. paresthesia, anesthesia b. paresthesia, hypoesthesia c. paresthesia, dysethesia d. anesthesia, hyperesthesia
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paresthesia, dyesthesia
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which of the following responses is most appropriate after rapid tissue swelling is noticed after PSA? a. get ice pack and place pressure on area with pack b. place pressure on area for 10 minutes and continue working c. place pressure on area while someone else looks for ice, terminate procedure d. reassure pt and continue with planned therapy once numb
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c. place pressure on area while someone else looks for ice, terminate procedure
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of the following possible adverse reactions which one occurs most frequently a. allergy b. idiosyncratic response c. overdose
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c. overdose
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considering all of the following measures for preventing overdose, which one is most important a. calculating doses b. slow administration c. aspiration d. reassuring pts
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b. slow administration
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there is a new pt in the chair. during appropriate intros, including handshaking, it is noticed the pts hands are clammy and he has perspiration on his upper lip. he appears very stiff and responds with brief yes or no at attempts to engage in conversation. to discern whether or not his is apprehensive about dental tx he is scheduled to receive the most appropriate strategy would be to: a. try to distract pt by offering to let him watch a movie or listen to music b. get nitrous oxide/oxygen sedation ready c. check out observations by asking pt about possible concerns about tx d. avoid saying anything about anxiety or fear because it may upset the pt and risk not being able to get tx completed
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c. check out observations by asking pt about possible concerns about tx
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establishing trust in the pt-clinician relationship is especially important for fearful pts because they need to learn a. how to pa for services provided b. how to be assertive c. clinicians never recommend tx pt cannot tolerate d. clinicians are professionals and know what is best for pt
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b. how to be assertive
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providing pt with information is an important means of increasing their sense of control in dental environment. when providing information to a fearful pt about an aversive procedure: a. clinician should explain how steps taken during procedure are necessary for benefit of clinicians work b. emphasis should be on scientific rationale for tx, procedures, materials and equipment used c. better not to tell pt what will happen because it might make them more fearful d. procedure should be described in simple steps, including sensations the pt will experience so the pt knows what to expect
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d. procedure should be described in simple steps, including sensations the pt will experience so the pt knows what to expect
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it is important to have skills and confidence necessary to teach anxious and fearful pts how to relax in the dental chair. when a pt learns the physical relaxation skills of deep breathing and muscle relaxation: a. the pt benefits by having an active means to relieve the discomfort, both physical and mental, which is experienced as a result of anxiety b. clinician benefits because it is easier to achieve pain control in a relaxed pt c. none of the above d. both A and B
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d. both A and B
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pts who are fearful of dental injections can benefit from having the opportunity to rehearse the procedure before receiving the actual injection the objective of the rehearsal is to: a. find out the pt is sincere about wanting to overcome dental fears b. allow pt to learn how his role and the clinician's role are synchronized before proceeding with the injection and tx c. determine the tx plan for the pt by gaining knowledge about which tx the pt will be capable of tolerating d. test pt for intolerance and allergies to LA
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b. allow pt to learn how his role and the clinician's role are synchronized before proceeding with the injection and tx
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some pts will report a history of receiving dental care without being adequately anesthetized. They may not be anxious about the injection procedure, but will be reluctant to proceed with tx after the administration of LA. Despite soft tissue signs and symptoms of anesthesia, they do not believe the teeth are numb. The next step for these patients would be to : a. verify that the tooth is adequately anesthetized by testing preferably with an electronic pulp tester before beginning tx b. reassure pt that the correct amount and type of anesthetic has been used for the area of the mouth to be treated c. reassure pt that if pain is felt in the tooth, tx will cease the minute the hand signal to stop is given d. give pt more anesthetic to be on the safe side before attempting to proceed with tx
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a. verify that the tooth is adequately anesthetized by testing preferably with an electronic pulp tester before beginning tx
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why is it generally more critical to consider toxicity of LA in pediatric pts than adults a. children react differently to LA than adults b. LA doses are based on body weight c. anesthetic agents that are appropriate for children are different than for adults d. crying and screaming may allow more rapid anesthetic uptake
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b. LA doses are based on body weight
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how does excellent anesthesia serve as a management tool for children? a. restorative procedures become tolerable if not pain free b. clamp placement for rubber dam is simplified c. quadrant treatment can be completed in one visit d. all of the above
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d. all of the above
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which of the following ways do anatomic variantions affect the choice of injection techniques for children a. roots of primary teeth are generally shorter than permanent tooth roots b. cortical plate is thicker and less porous in children than in adults c. inferior alveolar foramen is often more superior in children than adults d. all of the above
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a. roots of primary teeth are generally shorter than permanent tooth roots
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which of the following describe ways in which an assistant can play a vital role in a successful administration of LA to children? a. showing the pt the needle to prepare the child b. calming the parent during the injection by explaining what is happening c. placing one hand on the child's forehead and the other on the child's hands for safety d. none of the above
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c. placing one hand on the child's forehead and the other on the child's hands for safety
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which of the following are benefits of using age appropriate terminology and specific positive feedback during the successful anesthetic administration in pediatric pts a. using understandable terms to demystify the child's experiences b. using specific positive feedback teaches children what is expected and going well c. avoiding frightening words to reduce the chances of resistance d. all of the above
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d. all of the above
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which of the following is true when considering injection techniques in children? a. mandibular infiltrations rarely work for children b. deposition of anesthetic solutions for mandibular blocks are more inferior compared to adults c. long needles are usually necessary d. all of the above are true
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b. deposition of anesthetic solutions for mandibular blocks are more inferior compared to adults
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when children traumatize soft tissue immediately following injection, what is the best mangement a. place cold pack immediately b. place warm pack immediately c. always put the child on antibiotic for infection d. A and C
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a. place cold pack immediately
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which one of the following methods of adjusting doses of LA drugs for children is recommended in this chapter a. clarks rule b. rule of inference c. youngs rule d. heuristic rule
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a. clarks rule
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specific challenges in oral and maxillofacial LA include all of the following except a. frequent management of oral infections, some of which are life threatening b. limiting the potential for needle tract infections c. achieving adequate LA in the presence of infections d. all of the above
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d. all of the above
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which one of the follwoing is not a LA consideration in oral and maxillofacial surgery when treating an infected pt a. use a greater amount of LA to help overcome acidity created by infection b. use regional nerve block away from area of inflammation c. use LA agent with lower pH d. discard the needle after injection in or near an infection of inflammation
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c. use LA agent with lower pH
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which one of the following is NOT an adverse event following local anesthetic injections a. trismus b. normal durations of numbness c. postoperative soreness d. infection
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b. normal durations of numbness
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which one of the following is not an option for treatment of pt with true LA allergies a. use of alternative LA b. 1% benadryl c. .09% benzyl alcohol d. .1% sodium benzoate
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d. .1% sodium benzoate
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systemic complications related to inferior alveolar block include all of the following except a. hematomas b. syncope c. overdose reactions d. allergic reactions
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a. hematomas
