Test Bank for Applied Pharmacology for the Dental Hygienist 8th Edition by Haveles

Test Bank for Applied Pharmacology for the Dental

Hygienist 8th Edition by Haveles

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Chapter 10: General Anesthetics
Haveles: Applied Pharmacology for the Dental Hygienist, 8th Edition

MULTIPLE CHOICE

1. Which of the following dental specialists is most likely to use general anesthetic drugs in
their offices?
a. Prosthodontist
b. Endodontist
c. Oral and maxillofacial surgeon
d. Orthodontist
e. Pediatric dentist
ANS: C
Oral and maxillofacial surgeons are the most likely to use general anesthetic drugs in their
offices. General dentists are more likely to use nitrous oxide to provide conscious sedation
and pain control. The other choices do not represent the dental specialist most likely to use
general anesthesia in a dental office.

DIF: Recall REF: Introduction | p. 112 OBJ: 1

TOP: NBDHE, 6.0. Pharmacology

2. Which of the following general anesthetic agents was introduced in the middle 1800s and
led to a dramatic reduction in surgically related mortality?
a. Propofol
b. Isoflurane
c. Ether
d. Nitrous oxide
ANS: C
In 1846, surgically related mortality dropped dramatically with the introduction of ether.
Ether is not used today because modern operating rooms have a lot of electrical equipment
and ether is highly explosive. Propofol is a recent addition to the general anesthetic
armamentarium. Isoflurane was not introduced in the middle 1800s. Nitrous oxide was
discovered in 1776, but it is not used as a general anesthetic.

DIF: Recall REF: History | p. 112 OBJ: 1

TOP: NBDHE, 6.0. Pharmacology

3. According to Guedel’s description of the stages and planes of anesthesia, the induction
period refers to stage
a. I.
b. II.
c. I and II.
d. I, II, and III.
e. None of the above is correct.
ANS: C
 The term induction refers to all the preparation and medication necessary for a patient up
to the time the operation begins. This includes all preoperative medication, adjunctive
drugs to anesthesia, and anesthetics required for induction. Induction includes both stage I
and stage II but not stage III, the point at which surgical anesthesia is attained.

DIF: Application REF: Mechanism of Action (Stages and Planes of Anesthesia) | p. 112
OBJ: 2 TOP: NBDHE, 6.0. Pharmacology

4. Nitrous oxide, as used in the dental office, maintains the patient in stage _____ of
Guedel’s system of stages and planes.
a. I
b. II
c. III
d. IV
ANS: A
Nitrous oxide maintains the patient in stage I. Stage I analgesia is characterized by the
development of analgesia or reduced sensation to pain. The patient is conscious and can
still respond to commands. Reflexes are present, and respiration remains regular. Some
amnesia may also be present. Stage II begins with unconsciousness and is associated with
involuntary movement and excitement. Stage III is the stage in which most major surgery
is performed. Stage IV is characterized by cessation of all respiration.

DIF: Comprehension
REF: Mechanism of Action (Stages and Planes of Anesthesia) | p. 112
OBJ: 2 TOP: NBDHE, 6.0. Pharmacology

5. The loss of respiratory control (i.e., diminished carbon dioxide response, paralysis of
intercostal muscles) first occurs during which of Guedel’s stages of anesthesia?
a. Stage I
b. Stage II
c. Stage III
d. Stage IV
ANS: C
Paralysis of intercostal muscles begins in plane III and is complete in plane IV of stage III
anesthesia. The other choices do not represent the correct Stage of anesthesia as described
by Guedel in 1920. Respiration remains regular in Stage I. Respiration becomes irregular
in Stage II.

DIF: Application REF: Mechanism of Action (Stages and Planes of Anesthesia) | p. 113
OBJ: 2 TOP: NBDHE, 6.0. Pharmacology

6. Which of the following intravenous general anesthetic agents can be administered

intramuscularly (IM)?
a. Methohexital (Brevital)
b. Ketamine (Ketalar)
c. Diazepam (Valium)
d. Propofol (Diprivan)
ANS: B
 Although most injectable general anesthetics are administered intravenously (IV), one
agent, ketamine, can also be given intramuscularly (IM). Methohexital is an
ultrashort-acting barbiturate that is administered intravenously. Diazepam is a
benzodiazepine that has been used intravenously for many years. Propofol is an IV
anesthetic.

DIF: Recall
REF: General Anesthetics (Induction Anesthesia [Intravenous Anesthetics]) | p. 113| General
Anesthetics (Induction Anesthesia [Ketamine]) | p. 114 OBJ: 3
TOP: NBDHE, 6.0. Pharmacology

7. Recovery from a single intravenous dose of methohexital (Brevital) is accelerated as a

result of _______ to lean tissues.
a. drug excretion
b. drug redistribution
c. drug metabolism
d. enzyme induction
ANS: B
Brevital is an ultrashort-acting barbiturate. These drugs are highly lipid soluble and
repeated dosing during anesthesia can result in a prolonged recovery period. However,
blood and brain levels quickly decrease as the drugs redistribute to lean tissues. Drug
excretion and metabolism occur with methohexital sodium (Brevital), but they are
preceded by drug redistribution. Enzyme induction is a long-term action of barbiturates
and is not responsible for termination of a single dose of Brevital.

DIF: Comprehension
REF: General Anesthetics (Induction Anesthesia [Ultrashort-Acting Barbiturates]) | p. 113 & 114
OBJ: 3 TOP: NBDHE, 6.0. Pharmacology

8. The following are characteristics of propofol except which one?

a. Rapid onset of action
b. Produces little vomiting
c. Undergoes phase II metabolism in the liver
d. Intravenous anesthetic
e. Structurally related to barbiturates
ANS: E
Propofol is an agent that is unrelated to any other general anesthetic. Patients “feel better”
and begin ambulation sooner than with other agents. It is popular for outpatient surgery.
Propofol is ultrashort acting, produces little vomiting and may have antiemetic effects,
metabolized in the liver, and administered intravenously.

DIF: Application REF: General Anesthetics (Induction Anesthesia [Propofol]) | p. 114

OBJ: 3 TOP: NBDHE, 6.0. Pharmacology

9. Which of the following effects is not a characteristic of the action of ketamine?

a. Produces “dissociative” anesthesia
b. Causes xerostomia
c. Increases cardiac output
d. Causes recovery associated with delirium and hallucinations
 ANS: B
Ketamine does not cause xerostomia. Atropine is a necessary premedication because
excessive salivation is a common finding with ketamine. An advantage of ketamine is that
it may be administered intravenously or intramuscularly. Ketamine does produce a
dissociative anesthesia, increases cardiac output, and can cause delirium and
hallucinations. Ketamine is primarily used by oral surgeons. It is not used in general
dentistry.

DIF: Comprehension
REF: General Anesthetics (Induction Anesthesia [Ketamine]) | p. 114
OBJ: 3 TOP: NBDHE, 6.0. Pharmacology

10. Which of the following is the major disadvantage of the use of opioids as an adjunctive
drug to general anesthesia in preanesthetic medication?
a. Hypertensive crisis
b. Respiratory depression
c. Hallucinations
d. Salivary stimulation
ANS: B
Prolonged respiratory depression is the major disadvantage and requires careful attention
to ventilatory function throughout the anesthetic period. The remaining choices are not
associated with the use of opioids during general anesthesia.

DIF: Comprehension
REF: General Anesthetics (Induction Anesthesia [Opioids]) | p. 114
OBJ: 3 TOP: NBDHE, 6.0. Pharmacology

11. Nitrous oxide has _____ onset and _____ solubility in blood.
a. rapid; high
b. rapid; low
c. slow; high
d. slow; low
ANS: B
Nitrous oxide has low solubility (0.47), which correlates well with its rapid onset and
recovery. It is the least soluble in blood of all inhalation anesthetics. It has little potency
and is used in clinical outpatient dentistry as an inhaled agent that results in conscious
sedation. High solubility in blood often retards onset of action. Halothane has a higher
solubility (2.30) than nitrous oxide and has a longer induction and recovery and changes in
level of anesthesia occur more slowly.

DIF: Application
REF: General Anesthetics (Induction and Maintenance Anesthesia [Physical Factors]) | p. 115
OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

12. Nitrous oxide combined with oxygen (N2O/O2) has become a primary part of dental
office _____ procedures.
a. anxiety reduction
b. general anesthesia
c. sleep apnea
 d. bruxism
ANS: A
Nitrous oxide is used for anxiety reduction. It provides anxiety relief coupled with
analgesia. When nitrous oxide is properly administered, the patient remains conscious with
protective reflexes intact. Nitrous oxide is not used to relieve sleep apnea or bruxism.

DIF: Recall REF: General Anesthetics (Nitrous Oxide) | p. 115

OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

13. The average percentage of nitrous oxide required for patient comfort is
a. 10%.
b. 25%.
c. 35%.
d. 50%.
ANS: C
The average percentage of nitrous oxide required for patient comfort is 35%. The
percentage of nitrous oxide required for comfort is variable and may range from 10% to
50%.The other choices do not represent the average percentage of nitrous oxide needed for
patient comfort. Fifty percent nitrous oxide is the maximum that can be delivered by
modern nitrous oxide machines.

DIF: Recall REF: General Anesthetics (Nitrous Oxide) | p. 115

OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

14. At the termination of a N2O/O2 sedation procedure, the patient should be placed on 100%
oxygen for at least _____ minutes.
a. 2
b. 5
c. 8
d. 11
ANS: B
At the termination of a N2O/O2 sedation procedure, the patient should be placed on 100%
oxygen for at least 5 minutes. If the mask is removed without the oxygen recovery period
and the patient is allowed to breathe room air, a phenomenon known as diffusion hypoxia
may result. It is very important to place the patient on 100% oxygen for a sufficient
amount of time at the end of the procedure in order to avoid diffusion hypoxia.

DIF: Recall REF: General Anesthetics (Nitrous Oxide) | p. 116

OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

15. Diffusion hypoxia may occur if insufficient 100% oxygen is delivered at the termination
of a nitrous oxide procedure because
a. the lungs are insufficiently inflated.
b. the loss of carbon dioxide could decrease ventilation.
c. nitrous oxide is highly soluble in blood.
d. nitrous oxide has a slow onset and recovery.
ANS: B
 Diffusion hypoxia occurs because of the rapid outward flow of nitrous oxide accompanied
by oxygen and carbon dioxide. The loss of carbon dioxide, a stimulant to the respiratory
drive, could decrease ventilation with resultant hypoxia. The patient may complain of
headaches or other side effects if this occurs. Nitrous oxide does not cause deflation of the
lungs. Nitrous oxide is very insoluble in blood, which leads to quick onset and recovery.

DIF: Comprehension REF: General Anesthetics (Nitrous Oxide) | p. 116

OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

16. The best indicator of the degree of sedation under nitrous oxide is
a. response to a painful stimulus.
b. percent nitrous oxide being delivered.
c. response to questions.
d. muscle tone.
e. eye movements.
ANS: C
The best indicator of the degree of sedation is the patient’s response to questions. Perform
repeated evaluations throughout the dental procedure. Response to a painful stimulus
should only be evaluated after one is confident that adequate sedation has been achieved.
The percentage of nitrous oxide is a poor indicator of degree of sedation. Muscular
relaxation in response to nitrous oxide cannot be demonstrated in most patients. Eye
movements are not predictive of adequate sedation by nitrous oxide.

DIF: Recall REF: General Anesthetics (Nitrous Oxide) | p. 116

OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

17. The correct method for administration of nitrous oxide is to put the patient on
a. 100% oxygen for 2 to 3 minutes and then put the nitrous oxide level at 20% of the
level of oxygen.
b. 100% oxygen for 2 to 3 minutes and then put the nitrous oxide level at 50% of the
level of oxygen.
c. 100% oxygen for 2 to 3 minutes and add nitrous oxide in 5 to 10% increments
until sedation is achieved.
d. 50% oxygen and 50% nitrous oxide.
e. 75% oxygen and 25% nitrous oxide.
ANS: C
The patient should be put on 100% oxygen for 2 to 3 minutes to determine the tidal
volume. The nitrous oxide should be titrated until the patient response indicates an effect.
The percentage required to achieve sedation may be different from one day to the next for
the same patient. Titration of nitrous oxide is the key principle, meaning that the
percentage of nitrous oxide is incrementally adjusted for that patient on that day until the
desired effect is achieved.

DIF: Comprehension REF: General Anesthetics (Nitrous Oxide) | p. 115

OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

18. Nitrous oxide cylinders are _____ and oxygen cylinders are _____: (1) red, (2) green, (3)
blue, (4) orange, and (5) tan.
a. 1; 2
 b. 3; 2
c. 2; 4
d. 3; 4
e. 3; 5
ANS: B
Nitrous oxide cylinders are blue, and oxygen cylinders are green. The cylinders are also
“pin coded” to prevent inadvertent mixing of cylinders and lines. The remaining choices
are not correct.

DIF: Recall REF: General Anesthetics (Nitrous Oxide [Adverse Reactions]) | p. 116
OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

19. A patient for whom nitrous oxide is to be administered should be warned to avoid eating a
large meal within _____ hours of the appointment.
a. 2
b. 3
c. 4
d. 5
ANS: B
The patient should eat a light meal before the appointment but should be warned to avoid
eating a large meal within 3 hours of the appointment. A patient planning to receive
nitrous oxide should be warned to avoid eating a large meal. The time frame is very
specific.

DIF: Recall REF: General Anesthetics (Nitrous Oxide [Adverse Reactions]) | p. 116
OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

20. Nitrous oxide has been shown to reduce the activity of methionine synthetase, the enzyme
involved with the function of which vitamin?
a. Vitamin B1
b. Vitamin K
c. Vitamin B6
d. Folic acid
e. Vitamin B12
ANS: E
Chronic nitrous oxide abuse can produce a neuropathy that is thought to be caused by the
inhibition of this enzyme and its effect on the utilization of vitamin B12. The remaining
choices are not involved with methionine synthetase.

DIF: Recall REF: General Anesthetics (Nitrous Oxide [Adverse Reactions]) | p. 116
OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

21. Nitrous oxide is contraindicated for use in a patient with which of the following
conditions?
a. Diabetes
b. Emphysema
c. Hypertension
d. Glaucoma
e. None of the above
 ANS: B
Use of nitrous oxide is contraindicated in patients with any type of upper respiratory or
pulmonary obstruction. Patients with chronic obstructive pulmonary disease (COPD),
particularly emphysema, have respirations that are driven by a lack of oxygen and not by
elevated carbon dioxide levels. These patients would have a great difficulty if they
received more oxygen than they normally breathe. Diabetes and glaucoma are not
contraindications to nitrous oxide administration. Nitrous oxide causes vasodilation; thus it
does not exacerbate hypertension.

DIF: Comprehension
REF: General Anesthetics (Nitrous Oxide [Contraindications and Dental Issues]) | p. 116
OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

22. Approximately 15% of halothane is metabolized in the liver, and these metabolites have
been suggested as a cause of renal damage.
a. Both parts of the statement are true.
b. Both parts of the statement are false.
c. The first part of the statement is true; the second part is false.
d. The first part of the statement is false; the second part is true.
ANS: A
Approximately 15% of halothane is metabolized in the liver, and these metabolites have
been suggested as a cause of liver damage. Although halothane has proved to be a reliable
and effective general anesthetic for many years, the occurrence of this adverse effect has
diminished its popularity. It also can cause hypotension and cardiac depression. Halothane
is primarily eliminated through the lungs, and the liver metabolizes approximately 15% of
the drug. Its metabolites are thought to cause hepatotoxicity.

DIF: Comprehension
REF: General Anesthetics (Halogenated Hydrocarbons [Halothane]) | p. 117
OBJ: 5 TOP: NBDHE, 6.0. Pharmacology

23. Which inhalational agent has a pungent smell and can cause respiratory acidosis with
deeper levels of anesthesia?
a. Isoflurane
b. Halothane
c. Enflurane
d. Sevoflurane
e. Nitrous oxide
ANS: A
Of the agents listed, only isoflurane is irritating and causes significant respiratory acidosis.
Halothane, enflurane, sevoflurane, and nitrous oxide are not associated with respiratory
acidosis or excessive irritation.

DIF: Recall REF: General Anesthetics (Halogenated Hydrocarbons [Isoflurane]) | p.

117
OBJ: 5 TOP: NBDHE, 6.0. Pharmacology

24. Which of the following types of agents is used during balanced general anesthesia to help
the patient pass from stage I to stage III and skip over the signs of stage II?
 a. Ketamine
b. Propofol
c. Ultrashort-acting IV barbiturate
d. Opioids
ANS: C
The ultrashort IV barbiturates accomplish this readily. These barbiturates are combined
with the N2O-O2 in combination, which are then administered with a volatile inhalation
anesthetic. The remaining choices are not agents used to help the patient avoid signs of
stage II.

DIF: Recall REF: Balanced General Anesthesia | p. 117

OBJ: 6 TOP: NBDHE, 6.0. Pharmacology

25. The more soluble the anesthetic is in body tissues, the more rapid the onset and recovery
will be.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true, the second is false.
d. The first statement is false, the second is true.
ANS: D
The less soluble the anesthetic is in body tissues, the more rapid the onset and recovery
will be. Nitrous oxide has a low solubility, so it is harder to push it into the lung tissue
alveoli and it is rapidly cleared. This is very useful in clinical practice, because if the
patient does not like the effect of nitrous oxide he or she can breathe through the mouth
and quickly recover. A more soluble anesthetic will remain in the body longer. A less
soluble anesthetic will be excreted more rapidly.

DIF: Comprehension
REF: General Anesthetics (Induction and Maintenance Anesthesia [Physical Factors]) | p. 115
OBJ: 3 TOP: NBDHE, 6.0. Pharmacology

26. Features of nitrous oxide administration include each of the following except one. Which
is the exception?
a. Nitrous oxide has low solubility in blood.
b. Nitrous oxide alone is a good choice for a general anesthetic.
c. Nitrous oxide has a quick onset.
d. The patient will recover quickly following termination of administration of nitrous
oxide.
ANS: B
Nitrous oxide cannot produce complete anesthesia alone. It may be used in combination
with other anesthetics for general anesthesia. When nitrous oxide is administered properly,
the patient remains conscious. Nitrous oxide has very low solubility in blood, which
means the patient will recover quickly from the effects of administration of nitrous oxide.

DIF: Comprehension
REF: Physical Properties of Selected Inhalation General Anesthetics | p. 115
OBJ: 3 TOP: NBDHE, 6.0. Pharmacology
27. A patient should be given 100% oxygen for 5 minutes after treatment with nitrous oxide to
prevent
a. neuropathy.
b. dissociative anesthesia.
c. diffusion hypoxia.
d. respiratory paralysis.
ANS: C
Diffusion hypoxia may result because of the rapid outward flow of nitrous oxide
accompanied by oxygen and carbon dioxide. The loss of carbon dioxide, a stimulant to
respiratory drive, could decrease ventilation with resultant hypoxia. Neuropathy may be a
consequence of chronic nitrous oxide misuse. Dissociative anesthesia is associated with
the use of ketamine. Respiratory paralysis is associated with Guedel’s Stage IV of
anesthesia.

DIF: Recall REF: General Anesthetics (Nitrous Oxide) | p. 116

OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

28. Each of the following is true of patient instructions prior to the administration of nitrous
oxide except one. Which is the exception?
a. The patient should eat a light meal before the appointment.
b. The patient should avoid eating a large meal within 3 hours of the appointment.
c. The patient must bring another person to transport them home as the patient should
not drive himself or herself home alone following administration of nitrous oxide.
d. Nitrous oxide is an excellent choice for a needle-phobic patient.
ANS: C
Nitrous oxide is the only anesthetic for conscious sedation available where the patient can
drive home alone following the appointment. The patient should eat a light meal before the
appointment but should be warned to avoid eating a large meal within 3 hours of the
appointment. Often a patient with anxiety about the dental procedure also has anxiety
about needles. Nitrous oxide is an excellent choice for these patients.

DIF: Application REF: General Anesthetics (Nitrous Oxide [Adverse Reactions]) | p. 116
OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

29. A patient who has been administered nitrous oxide often will think the procedure is shorter
than it was due to which quality of nitrous oxide?
a. Euphoria
b. Anesthesia
c. Analgesia
d. Amnesia
ANS: D
The amnestic qualities may help the patient assume that the procedure was much shorter
than it actually was. Euphoria is a feeling of elation. Anesthesia is insensitivity to a painful
stimulus. Analgesia is a reduction in the level of pain.

DIF: Recall REF: General Anesthetics (Nitrous Oxide) | p. 116

OBJ: 4 TOP: NBDHE, 6.0. Pharmacology
MULTIPLE RESPONSE

1. Which of the following are types of intravenous general anesthetics? (Select all that
apply.)
a. Opioids
b. Enflurane
c. Etomidate
d. Isoflurane
e. Propofol
ANS: A, C, E
The opioids have long been used as adjunctive drugs to general anesthesia in preanesthetic
medication and to provide analgesia during and after a surgical procedure. Etomidate is a
short-acting intravenous anesthetic agent used for the induction of general anesthesia and
for sedation. Propofol is an intravenous anesthetic that produces an onset of anesthesia in
30 seconds. Enflurane is a halogenated ether anesthetic. Isoflurane is chemically related to
enflurane.

DIF: Comprehension
REF: Classification of General Anesthetics by Route of Administration | p. 114
OBJ: 3 TOP: NBDHE, 6.0. Pharmacology

2. Which of the following are true of etomidate? (Select all that apply.)
a. It is a halogenated hydrocarbon for general anesthesia.
b. It is used for induction of general anesthesia.
c. It can cause adrenal suppression.
d. It produces dissociative anesthesia.
ANS: B, C
Etomidate is a short-acting intravenous anesthetic agent used for induction of general
anesthesia and for sedation. It has a rapid onset of action and a safe cardiovascular profile.
It can cause adrenal suppression, especially after repeated dosing. It is an intravenous
anesthetic. Ketamine produces dissociative anesthesia.

DIF: Comprehension
REF: General Anesthetics (Induction Anesthesia [Etomidate]) | p. 114
OBJ: 3 TOP: NBDHE, 6.0. Pharmacology

3. Which of the following are benzodiazepines that are used for conscious sedation and
preanesthetic medication prior to general anesthesia? (Select all that apply.)
a. Diazepam (Valium)
b. Fentanyl (Sublimaze)
c. Midazolam (Versed)
d. Methohexital sodium (Brevital)
ANS: A, C
Diazepam (Valium) has been used intravenously for many years. It is highly lipid soluble,
has a quick onset, and is concentrated in adipose tissue. Midazolam (Versed) is water
soluble and does not need a solvent for solution, so one of diazepam’s major side effects,
thrombophlebitis, can be avoided by using midazolam. Fentanyl (Sublimaze) is an opioid.
Methohexital sodium (Brevital) is an ultrashort-acting barbiturate.
 DIF: Comprehension
REF: General Anesthetics (Induction Anesthesia [Benzodiazepines]) | p. 114 & 115
OBJ: 3 TOP: NBDHE, 6.0. Pharmacology

4. Which of the following statements are true about volatile general anesthetics? (Select all
that apply.)
a. They are liquids that evaporate easily at room temperature.
b. They are classified as halogenated hydrocarbons and ethers.
c. They are known to have good solubility in body tissues.
d. They are administered intravenously (IV).
ANS: A, B
Volatile general anesthetics are liquids with low boiling points. They are classified as
halogenated hydrocarbons and halogenated ethers because they contain fluorine, chlorine,
or bromine. Volatile general anesthetics have limited solubility in body tissues. They are
administered as volatile liquids, not IV.

DIF: Comprehension
REF: General Anesthetics (Induction and Maintenance Anesthesia [Inhalation Anesthetics]) | p.
115
OBJ: 3 TOP: NBDHE, 6.0. Pharmacology

5. The less soluble the anesthetic is in body tissues, the more rapid the _____. (Select all that
apply.)
a. onset
b. breathing rate
c. heart rate
d. recovery
ANS: A, D
Less solubility will lead to rapid onset and recovery. An anesthetic drug with a higher
solubility will have a longer induction and slower recovery. Changes in the level of
anesthesia will occur more slowly. The heart rate and breathing rate are not correlated with
anesthetic solubility.

DIF: Comprehension
REF: General Anesthetics (Induction and Maintenance Anesthesia [Physical Factors]) | p. 115
OBJ: 3 TOP: NBDHE, 6.0. Pharmacology

6. What are the goals of surgical anesthesia? (Select all that apply.)
a. Good patient control
b. Adequate muscle relaxation
c. Reduced respiratory rate
d. Reduced cardiac output
e. Pain relief
ANS: A, B, E
The goals of surgical anesthesia are good patient control, adequate muscle relaxation, and
pain relief. There are many agents that can produce good general anesthesia. Each drug
has its own adverse reaction profile. Reduced respiratory rate and cardiac output are not
goals of general anesthesia.
 DIF: Comprehension REF: Balanced General Anesthesia | p. 117
OBJ: 6 TOP: NBDHE, 6.0. Pharmacology

TRUE/FALSE

1. The more soluble the anesthetic is in body tissues, the more rapid the onset and recovery
will be.

ANS: F
The less soluble the anesthetic is in body tissues, the more rapid the onset and recovery
will be.

DIF: Recall
REF: General Anesthetics (Induction and Maintenance Anesthesia [Physical Factors]) | p. 115
OBJ: 3 TOP: NBDHE, 6.0. Pharmacology

2. Nitrous oxide is a complete anesthetic.

ANS: F
Nitrous oxide cannot produce complete anesthesia alone.

DIF: Recall REF: Physical Properties of Selected Inhalation General Anesthetics | p.

115
OBJ: 3 TOP: NBDHE, 6.0. Pharmacology

3. To prevent diffusion hypoxia, patients should be given 100% oxygen for 5 minutes after
treatment with nitrous oxide.

ANS: T
Diffusion hypoxia may result because of the rapid outward flow of nitrous oxide
accompanied by oxygen and carbon dioxide. The loss of carbon dioxide, a stimulant to
respiratory drive, could decrease ventilation with resultant hypoxia.

DIF: Recall REF: General Anesthetics (Nitrous Oxide) | p. 116

OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

4. Patients should be instructed to fast before a dental procedure using nitrous oxide.

ANS: F
The patient should eat a light meal before the appointment but should be warned to avoid
eating a large meal within 3 hours of the appointment.

DIF: Recall REF: General Anesthetics (Nitrous Oxide [Adverse Reactions]) | p. 116
OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

5. Nitrous oxide has amnestic qualities.

ANS: T
The amnestic qualities may help the patient assume that the procedure was much shorter
than it actually was.
Test Bank for Applied Pharmacology for the Dental Hygienist 8th Edition by Haveles

DIF: Recall REF: General Anesthetics (Nitrous Oxide) | p. 116

OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

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