Local Anesthesia for the Dental

Hygienist 1st Edition Logothetis Test

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Logothetis: Local Anesthesia for the Dental Hygienist
Chapter 07: Preanesthetic Assessment

Test Bank

MATCHING

Match the drug or medical condition in the left-hand column with the description of the
significant concern in the right-hand column. Each description is used only once.

a. Life-threatening syndrome caused by general anesthetics

b. Avoid use of vasopressors; may lead to myocardial infarction
c. Competitively inhibits PABA in microorganisms
d. Will inhibit the reuptake of vasoconstrictor
e. Frequently prescribed for the treatment of myasthenia gravis and glaucoma
f. Increases effects of epinephrine; avoid levonordefrin
g. Use esters or amides judiciously because they may increase risk of toxicity
h. Administer prilocaine or articaine because this drug reduces liver capacity to
metabolize amides
i. Administer prilocaine or articaine as these drugs decrease hepatic blood flow
j. Limit amount of vasopressor because it can increase ocular pressure

1. Patients taking tricyclic antidepressants

2. Patients taking sulfonamides
3. Patients with renal dysfunction
4. Patients taking beta blockers
5. Cocaine abusers
6. Patients taking cholinesterase inhibitors
7. Patients with glaucoma
8. Patients taking cimetidine on a regular basis
9. Patients taking MAOI
10. Patients with malignant hyperthermia

1. ANS: F REF: Page 116 and Table 7-8

2. ANS: C REF: Page 119
3. ANS: G REF: Page 121 and Table 7-11
4. ANS: I REF: Page 116 and Table 7-8
5. ANS: B REF: Page 117
6. ANS: E REF: Page 119
7. ANS: J REF: Page 119 and Table 7-9
8. ANS: H REF: Page 119
9. ANS: D REF: Page 118, Table 7-9
10. ANS: A REF: Page 120 and Table 7-11

TRUE/FALSE

1. A patient who has had heart bypass surgery 1 year ago should not have local
anesthetics with vasoconstrictors.

ANS: F
Correct: A patient who has had heart bypass surgery within the last 6 months should not
have local anesthetics with vasoconstrictors.

REF: Page 118 and Table 7-9

2. Vasoconstrictors are an absolute contraindication for a patient with uncontrolled

diabetes.

ANS: T REF: Table 7-6, Table 7-1

3. Vasoconstrictors can increase a patient’s blood pressure.

ANS: T REF: Page 109

4. Patients who report an allergy to sulfa drugs should be given the local anesthetic
articaine.

ANS: F
Correct: Patients who report an allergy to sulfa drugs should not be given the local
anesthetic articaine.

REF: Page 119, Table 7-10

5. Dilantin will decrease the efficacy of epinephrine.

ANS: T REF: Page 118, Table 7-9

6. Local anesthetics containing a vasoconstrictor are relative contraindications for a

patient who reports experiencing an allergic reaction to local anesthetics in the past.

ANS: F
Correct: Local anesthetics containing a vasoconstrictor are absolute contraindications for
a patient who reports experiencing an allergic reaction to local anesthetics in the past.
REF: Pages 118, 119

7. Local anesthetics containing a vasoconstrictor are an absolute contraindication for a

patient who reports being allergic to wine and dried fruits.

ANS: T REF: Page 119, Table 7-10

8. The use of amide local anesthetic agents, not prilocaine or topical benzocaine, is
recommended for a patient with methemoglobinemia.

ANS: T REF: Page 120 and Table 7-11

MULTIPLE CHOICE

1. What is the term that describes a situation in which a drug should not be administered
to an individual under any circumstances?
a. Absolute contraindication
b. Relative contraindication
c. Atypical contraindication
d. Drug to drug interaction

ANS: A
Absolute contraindication is the term that describes a situation in which a drug should not
be administered to an individual under any circumstances.

REF: Page 116

2. What does the collection of preanesthetic data guide the dental hygienist in
determining?
a. Need for medical consultation
b. Appropriateness of administering a local anesthetic or vasoconstrictor
c. Modification of dental care plan
d. All of the above
e. Some combination

ANS: D
The collection of preanesthetic data guides the dental hygienist in determining the need
for medical consultation, the appropriateness of administering a local anesthetic or
vasoconstrictor, and the need for medication of the dental care plan.

REF: Page 108

3. For which of the following conditions are prophylaxis antibiotics recommended?

a. Patients who have had joint replacements within the past 2 years
b. Patients with history of previous prosthetic joint infection
c. Joint replacement patients who are immunocompromised
d. All of the above

ANS: D
Prophylaxis antibiotics are recommended for patients who have had joint replacements
within the past 2 years, patients with a history of previous prosthetic joint infection, and
for patients who have had joint replacements who are immunocompromised.

REF: Page 128

4. Best practices include which of the following?

1. Take preanesthetic vital signs to provide a standard of comparison in the event of an
emergency.
2. Take preanesthetic blood pressure readings to provide baseline information.
3. Take preanesthetic blood pressure readings to determine whether to use a local
anesthetic with a vasoconstrictor.
4. Take preanesthetic vital signs to identify diagnosed or undiagnosed conditions.
a. 1, 2, 3, 4
b. 2, 3, 4
c. 1, 2
d. Some other combination

ANS: A
Best practices include the taking of preanesthetic vital signs and blood pressure readings.
They are important to provide a standard of comparison in the event of an emergency; to
identify diagnosed or undiagnosed conditions; to provide baseline information; and to
determine whether to use a local anesthetic with a vasoconstrictor.

REF: Page 109

5. Which of the following are best practices to use to reduce a dental patient’s level of
anxiety about dental treatment?
1. Consider appointment length and time of day.
2. Administer adequate pain control during treatment and after the operation.
3. Premedicate the patient for anxiety control.
4. Telephone the patient after treatment
a. 1, 2, 4
b. 1, 2, 3, 4
c. 2, 3, 4
d. Some other combination

ANS: B
All of the above are best practices to use to reduce a dental patient’s level of anxiety
about dental treatment. Consideration should be given for the length of the appointment
and for the time of day it is scheduled. Adequate pain control, during treatment and after
the operation, should be considered as well as premedication the evening before or
immediately before the dental appointment. Telephoning the patient after treatment to
relay a message of caring and concern is also a best practice.

REF: Page 114, Box 7-5

6. A patient presents to your dental office with a toothache. His blood pressure is
200/116. What should you do?
a. Refuse treatment and refer the patient immediately to the hospital emergency.
b. Implement anxiety control measures, including the use of nitrous oxide/oxygen
analgesia.
c. Take no unusual precautions related to patient management based on blood
pressure readings after medical approval is obtained are warranted.
d. Have the dentist retake the patient’s blood pressure and have him initial the
patient’s chart, granting you permission to treat this patient.

ANS: B
When a patient presents to the dental office with high blood pressure readings, wait 5
minutes then retake the BP. Begin stress-reduction protocol and administer nitrous
oxide/oxygen sedation as needed.

REF: Table 7-2

7. What is the standard prophylaxis for an adult not allergic to amoxicillin?

a. 500 mg orally 1 hour prior to dental procedures
b. 600 mg orally 1 hour prior to dental procedures
c. 600 mg within 30 minutes prior to dental procedures
d. 2 g orally 1 hour prior to dental procedures

ANS: D
Standard prophylaxis for an adult not allergic to amoxicillin is 2 g orally 1 hour prior to
dental procedures.

REF: Table 7-13

8. Your patient reports taking birth control medications and herbal supplements. You
should consider:
a. Using an ester derivative local anesthetic
b. Using a local anesthetic with a higher concentration of vasoconstrictor
c. Reducing the amount of vasoconstrictors to 0.04 mg per appointment
d. Reducing the amount of vasoconstrictors to 0.4 mg per appointment

ANS: C
Your patient reports taking birth control medications and herbal supplements. You should
consider reducing the amount of vasoconstrictors to 0.04 mg per appointment.

REF: Page 111 (Table 7-1)

9. The body’s response to fear provokes symptoms that could include:

a. Irritability
b. Muscular tension
c. Increase blood pressure
d. All of the above

ANS: D
The body’s response to fear provokes symptoms that could include irritability, muscular
tension, and an increase in blood pressure.

REF: Page 114

10. What does this statement mean? “The potentially adverse action of the released
catecholamines on cardiovascular function in the patient with clinically significant
heart or blood vessel disease warrants the inclusion of vasoconstrictors in the local
anesthetic solution.”
a. The release of catecholamines has the potential to adversely affect a patient’s
cardiovascular function.
b. Without adequate control of pain, sedation and stress reduction are impossible to
achieve; however, use of local anesthetic plus a vasoconstrictor will help to ensure
adequate pain control.
c. A patient with significant heart or blood vessel disease should always have a local
anesthetic plus a vasoconstrictor solution.
d. A patient with significant heart or blood vessel disease should never have a local
anesthetic plus a vasoconstrictor solution.

ANS: B
Without adequate control of pain, sedation and stress reduction are impossible to achieve;
however, use of local anesthetic plus a vasoconstrictor will help to ensure adequate pain
control.

REF: Page 115

11. What is the name of the inherited syndrome that is triggered by the exposure to
certain drugs used for general anesthesia and the neuromuscular blocking agent
succinylcholine?
a. Methemoglobinemia
b. Cirrhosis
c. Malignant hyperthermia
d. Cancer
ANS: C
Malignant hyperthermia is the name of the inherited syndrome that is triggered by the
exposure to certain drugs used for general anesthesia and the neuromuscular blocking
agent succinylcholine.

REF: Page 120 and Table 7-11

12. Which of the listed local anesthetics could produce an emergency situation
characterized by the inability of the blood to bind to oxygen?
a. Prilocaine
b. Mepivacaine
c. Lidocaine
d. Epinephrine

ANS: A
Prilocaine administered in high doses may produce an emergency situation characterized
by the inability of the blood to bind to oxygen.

REF: Page 120

13. What is the best reason for the relative contraindication to amide local anesthetics for
patients with liver disease?
a. Amides are metabolized to ortho-toluidine.
b. Biotransformation of the amides occurs primarily in the liver.
c. Ester derivative drugs that are metabolized primarily in the lungs are available.
d. Cyanosis of the lips and mucous membranes may be observed.

ANS: B
Liver disease could interrupt the biotransformation of the amides that are primarily
metabolized in the liver.

REF: Page 120

14. Which of the following statements is the best definition of teratogenic?

a. The development of abnormal structures in an embryo
b. The death of an embryo
c. The degree of danger to a developing fetus
d. The term for the contraindication for dental treatment of a pregnant patient

ANS: A
Teratogenic means the development of abnormal structures in an embryo.

REF: Page 121

15. Which of the following statements is the correct consideration regarding the use of
amide local anesthetic plus vasoconstrictor in treating a patient with a known
bleeding disorder?
a. The amide local anesthetic should not be used because it has a vasodilatory effect.
b. A high concentration of vasoconstrictor should be utilized.
c. The risk of a positive aspiration is the greatest concern.
d. All of the above

ANS: C
Patients who have bleeding clotting disorders should be assessed for the potential to
develop excessive bleeding as a result of puncturing a blood vessel. Injection techniques
that pose a risk of positive aspirations should be avoided.

REF: Page 121