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Local Anesthesia for the Dental Hygienist 1st

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Local Anesthesia for the Dental Hygienist 1st Edition by Logothetis – Test Bank

Sample Questions

Logothetis: Local Anesthesia for the Dental Hygienist

Chapter 06: Topical Anesthetic Agents

Test Bank

ESSAY
1. List common forms of topical anesthetics used in dentistry.

ANS:

Gel, spray, liquid, ointment, and one patch form

REF: Page 94 and Table 6-1

2. List the methods for delivery of topical anesthetic drugs.

ANS:

Cotton tip applicators, sprays, brushes, patches, blunted cannulas and/or syringes, and single-
dose applicator swabs

REF: Page 94

TRUE/FALSE

1. The over-the-counter product Anbesol with benzocaine can be safely used by all family
members.

ANS: F

Correct: Anbesol comes in a variety of strengths. One concentration cannot be used safely by all
family members.

REF: Page 97, Table 6-2


2. Although topical anesthetics are generally regarded as safe, if used improperly they can produce
adverse reactions that are fatal.

ANS: T REF: Pages 100, 102 and Box 6-2

3. A patient presents to your dental office the day after her dental appointment, complaining of
swelling and itching on the right side of her face. You should reassure the patient that it is not
possible that her symptoms are related to dental anesthesia.

ANS: F

Correct: Some allergic reactions occur up to 2 days after the anesthetic is given.

REF: Page 102

4. Benzocaine topical anesthetic exists almost entirely in its base form, making absorption into
circulation high.

ANS: F

Correct: Benzocaine topical anesthetic exists almost entirely in its base form, making absorption
into circulation low.

REF: Page 97

5. The published maximum dosage recommendation for the topical anesthetic benzocaine is 200
mg.
ANS: F

Correct: The published maximum dosage recommendations for benzocaine have not been
established and do not exist.

REF: Page 97

6. Lidocaine is metabolized in the liver and excreted via the kidneys with less than 10% remaining
unchanged.

ANS: T REF: Page 98

7. The most commonly found form of lidocaine is in base form because it is water soluble and can
easily penetrate and be absorbed into the tissues.

ANS: F

Correct: The base form is poorly soluble in water and has poor penetration and absorption
abilities.

REF: Page 98

8. Tetracaine hydrochloride has a rather slow onset of action; however, it can last approximately
45 minutes.

ANS: T REF: Page 98


MULTIPLE CHOICE

1. What is the name of a common ester topical anesthetic?

a. Lidocaine

b. Dyclonine hydrochloride

c. Prilocaine 2.5%

d. Benzocaine

ANS: D

Benzocaine is the name of a common ester topical anesthetic.

REF: Page 91

2. What is the name of a common ketone topical anesthetic?

a. Lidocaine

b. Dyclonine hydrochloride

c. Tetracaine hydrochloride

d. Benzocaine

ANS: B

Dyclonine hydrochloride is the name of a common ketone topical anesthetic.

REF: Page 91
3. What is the name of the most potent ester topical anesthetic?

a. 2.5% Lidocaine and 2.5% prilocaine cream

b. Dyclonine hydrochloride

c. Tetracaine hydrochloride

d. Benzocaine

ANS: C

Tetracaine hydrochloride is the name of the most potent ester topical anesthetic.

REF: Page 91

4. Which of the following are considered advantages for the use of topical anesthetic agents?
5. Pain control
6. Stimulation of gag reflex
7. Can be purchased over the counter
8. Ease of use

a. 1, 4

b. 1, 3, 4

c. 1, 2, 3, 4

d. Some other combination

ANS: A

Pain control and ease of use are two advantages for the use of topical anesthetic agents. Topical
anesthetic agents can be used to reduce the patient’s gag reflex. The fact that topical anesthetic
agents can be purchased over the counter is not necessarily an advantage when one considers the
risk of toxicity.
REF: Page 92

5. Which of the following characteristics could contribute to the properties of an ideal intraoral
topical anesthetic?

a. Allergenic

b. Allow pain-free application

c. Dissolves readily at the site of application

d. Produces some systemic toxicity

ANS: B

Ideal properties of an intraoral topical anesthetic would include the pain-free application of the
agent.

REF: Page 93

6. What is the main difference in the mechanism of action between topical anesthetics and
injectable anesthetics?

a. Location of the blocking of nerve conduction

b. Increase of depolarization

c. Decrease of excitability threshold

d. All of the above

ANS: A
Topical anesthetics work by blocking nerve conduction at the surface of the skin or mucous
membrane.

REF: Page 93

7. To obtain the most benefit from the use of topical anesthetics, a fairly substantial amount of
topical should be placed on the cotton tip applicator. This amount mixes with the saliva and may
numb the tongue, soft palate, or pharynx.

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.

ANS: D

Only a small amount of the gel or ointment on the applicator tip is necessary to achieve the
desired results. An excess amount mixes with the saliva and may numb the tongue, soft palate, or
pharynx, which usually leads to patient dissatisfaction of the whole process.

REF: Page 94

8. Which of the following properties are advantages to topical anesthetics being in a liquid form?

a. Provides anesthesia to a widespread area

b. Useful to decrease a patient’s gag reflex

c. Can be applied to site-specific areas with an applicator

d. All of the above

e. Some combination of the above


ANS: D

Liquids are great for providing anesthesia to a widespread area. They are especially useful when
trying to decrease a patient’s gag reflex, and the use of a liquid for a more site-specific procedure
requires an applicator.

REF: Page 94

9. Which of the following properties is an advantage of purchasing a single-dose unit of a topical


anesthetic?

a. Dose manageable

b. Cost-effective

c. Less cross-contamination

d. a and c

e. All of the above

ANS: D

Individual packaging of topical anesthetic is not only less messy; it also helps to prevent possible
cross-contamination and allows monitoring of the dosage being used.

REF: Page 95

10. What is a drawback to the use of an unmetered topical anesthetic spray?

a. Cost

b. Not dose manageable


c. Cross-contamination

d. Site-specific

ANS: B

Unmetered sprays are not recommended because they do not allow the operator control of the
amount of anesthetic dispensed.

REF: Page 95

11. Which topical anesthetic has warnings about the risk of methemoglobinemia?

a. Benzocaine creams

b. Benzocaine sprays

c. Tetracaine hydrochloride

d. Dyclonine hydrochloride

ANS: B

Warnings have been issued about the possibility of benzocaine sprays causing
methemoglobinemia.

REF: Page 95

12. Which of the following are considered advantages of the application of dental topical
anesthetics in a patch form?

a. Site-specific
b. Multiple choices

c. Cost-effective

d. All of the above

ANS: A

The advantage of patches over other methods of administration in that they can be placed
directly to desired sites. Patches available for intraoral topical anesthesia are limited.

REF: Page 95

13. Which of the following is/are true regarding topical anesthetics?

a. Allergic reactions can occur up to 2 days after the anesthetic is given.

Benzocaine and tetracaine are both amides, which increases their potential for causing an
b.
allergic reaction.

If there were an allergic reaction, it is likely to present immediately at the time of


c.
anesthesia.

d. All of the above

e. Some combination of the above

ANS: A

Allergic reactions can occur up to 2 days after the anesthetic is given.

REF: Page 94
14. Possible localized adverse effects of topical anesthetics could include which of the following?
15. Stinging at the site of application
16. Tissue discoloration
17. Sloughing

a. 1, 2

b. 2, 3

c. 2, 3

d. 1, 2, 3

e. Some other combination

ANS: D

Possible localized adverse effects of topical anesthetics could include stinging at the site of
application, tissue discoloration and sloughing.

REF: Page 102

15. What is the reason that concentrations of topical anesthetic agents are higher than those of
their injectable counterparts?

a. Topical agents are not natural vasoconstrictors like injectable anesthetic agents.

b. They facilitate high plasma concentrations of topical anesthetic agents.

c. They facilitate diffusion of the topical anesthetic agent through the mucous membranes.

d. With topical anesthetic agents, systemic absorption decreases.

ANS: C

The reason that concentrations of topical anesthetic agents are higher than that of their injectable
counterparts is to facilitate diffusion of the topical anesthetic agent through the mucous
membranes.
REF: Page 100

16. Which patients may be more susceptible to adverse effects to topical anesthetic agents?

a. Children

b. Elderly

c. Medically compromised

d. All of the above

ANS: D

Children, elderly, and medically compromised individuals are more susceptible to the adverse
reactions to topical anesthetics.

REF: Page 100

17. Why does the local and systemic absorption of topical anesthetics increase the risk of toxicity?

a. Topical anesthetics do not contain vasoconstrictors.

b. Topical anesthetics are formulated in high concentrations.

Topical anesthetics are absorbed quickly into the tissue and blood stream due to
c.
vasodilation of the area.

d. All of the above

ANS: D
With the higher concentrations of the topical anesthesia and in the absence of vasoconstricting
abilities, the risk of local and systemic absorption increases with the use of topical anesthetics.

REF: Page 100

18. What is the available concentration of Oraqix?

a. 5% lidocaine and 5% prilocaine

b. 2.5% lidocaine and 2.5% prilocaine

c. 14% Benzocaine, 2% butamben, and 2% tetracaine hydrochloride

d. 20% Benzocaine and 5% lidocaine

ANS: B

Oraqix is available for dental use in a 2.5% lidocaine and 2.5% prilocaine concentration.

REF: Page 100

19. What is the maximum recommended dose of Oraqix at one dental treatment session?

a. Two cartridges

b. Four cartridges

c. Five cartridges

d. Eleven cartridges

ANS: C
The maximum recommended dose of Oraqix at one dental treatment session is five cartridges.

REF: Page 100

20. What FDA Category does Oraqix fall into?

a. Category A

b. Category B

c. Category C

d. Categories B or C, depending on the concentration used.

ANS: B

Oraqix falls into FDA Category B.

REF: Page 100

21. While at room temperature, Oraqix is in gel form in the cartridge. It will liquidate as it reaches
body temperature in the periodontal pocket.

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.

ANS: B
While at room temperature, Oraqix is in liquid form in the cartridge. It will gel as it reaches body
temperature in the periodontal pocket.

REF: Page 100

22. What has the combined lidocaine/prilocaine cream been approved and effectively used for?

a. Medical procedures

b. Dental procedures

c. Topical anesthetic for skin abrasions

d. All of the above

ANS: A

The combined lidocaine/prilocaine cream been approved and effectively used for medical
procedures.

REF: Page 99

23. Which of the following are best practices to follow when administering local anesthesia of any
kind in the dental office?
24. Review the patient’s health and dental history at all appointments.
25. Use the lowest concentration of anesthesia to satisfy clinical requirements.
26. Limit the area of application.
27. Know the concentration of the drug being used.

a. 2, 3, 4

b. 1, 3

c. Some other combination

d. All of the above


ANS: D

Best practices to follow when administering local anesthesia of any kind in the dental office
include: Review the patient’s health and dental history at all appointments; use the lowest
concentration of anesthesia to satisfy clinical requirements; limit the area of application; and
know the concentration of the drug being used.

REF: Pages 96, 102 and Box 6-3

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

Administer prilocaine or articaine because this drug reduces liver capacity to metabolize
h.
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?


5. Take preanesthetic vital signs to provide a standard of comparison in the event of an
emergency.
6. Take preanesthetic blood pressure readings to provide baseline information.
7. Take preanesthetic blood pressure readings to determine whether to use a local anesthetic with
a vasoconstrictor.
8. 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?
6. Consider appointment length and time of day.
7. Administer adequate pain control during treatment and after the operation.
8. Premedicate the patient for anxiety control.
9. 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.

Take no unusual precautions related to patient management based on blood pressure


c.
readings after medical approval is obtained are warranted.

Have the dentist retake the patient’s blood pressure and have him initial the patient’s
d.
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.”

The release of catecholamines has the potential to adversely affect a patient’s


a. cardiovascular function.

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

A patient with significant heart or blood vessel disease should always have a local
c.
anesthetic plus a vasoconstrictor solution.

A patient with significant heart or blood vessel disease should never have a local
d.
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