DEN 7234 Nitrous Juice

Nitrous oxide

A. Is metabolized in the kidney and is excreted as NO in the urine

B. Is taken up by arterial smooth muscle where it is converted to a Viagra like substance

C. Remain unchanged in the blood, rapidly replaces N2, and 99% is eliminated through the lungs without biotransformation

D. Is stored unchanged in fat cells where it gradually displaces DDT

C. Remain unchanged in the blood, rapidly replaces N2, and 99% is eliminated through the lungs without biotransformation

Nitrous oxide has an impeccable safety record which has stood the test of time longer than any drug.

A. True

B. False

A. True

Why is it important to study the history of dentistry and anesthesia?

A. We did so you have to do it as well

B. It adds an hour of lecture to the

C. It is an accreditation requirement

D. We owe it to those who sacrificed much in the pursuit of knowledge

D. We owe it to those who sacrificed much in the pursuit of knowledge

Which of the following statements regarding nitrous oxide is not true?

A. It is only inorganic inhalation anesthetic

B. It is neither flammable nor explosive, but It can support combustion

C. It can be used as a sole source of pain control

D. Combined with oxygen, it can have a sweet, pleasant odor

E. All of the above statements are true

E. All of the above statements are true

At normal atmospheric pressure, N2O/O2 should be able to produce a profound anesthesia.

A. True

B. False

B. False

Sedation is a continuum and it is always possible to predict how an individual will respond.

A. True

B. False

B. False

Desirable characteristics of nitrous oxide include:

A. Rapid onset of action

B. Can easily be titrated

C. Amnestic properties

D. Minimal side effects

E. All of the above

E. All of the above

Users of nitrous oxide include:

A. Health professionals

B. Food industry

C. Racing industry

D. Silicone industry

E. All of the above

E. All of the above

The Minimum Alveolar Concentration (MAC) is defined as what percentage of patients not responding (with movement) to a surgical injection?

A. 50%

B. 100%

C. 45%

D. 37.5%

A. 50%

Which of the following is the dentist who is now credited with "Discovery of Anesthesia"?

A. Gardner Coulton

B. Horace Wells

C. William Morton

D. John Henry "Doc" Holliday

B. Horace Wells

Since the MAC valued for nitrous oxide is 105%, it is a potent inhalation agent.

A. True

B. False

B. False

Patients are routinely placed on 100% oxygen following nitrous oxide to prevent which of the following conditions?

A. Syncope

B. Isobaric Counterdiffusion

C. Calsson's Disease

D. Diffusion Hypoxia

D. Diffusion Hypoxia

Gas exchange begins at what level of the respiratory system?

A. Trachea

B. Bronchii

C. Bronchioles

D. Alveoli

C. Bronchioles

Which of the following is credited with the discovery of nitrous oxide and oxygen?

A. William Morton

B. Horace Wells

C. Joseph Priestly

D. Francesco Angelozzi

C. Joseph Priestly

Nitrous oxide is often used in combination with more potent inhalation agents to decrease the percentage of inhaled agents and to diminish unwanted side effects.

A. True

B. False

A. True

What is the normal minute volume for the average person?

A. 3‐4 L/min

B. 4‐5 L/min

C. 5‐6 L/min

D. 6‐7 L/min

D. 6‐7 L/min

It is mandatory to use a pulse oximeter on patients undergoing N2O/O2 sedation

A. True

B. False

B. False

In the United States, the color of a N20 cylinder is

A. Lavender

B. Orange

C. Green

D. Blue

D. Blue

Horace Wells lived a long life giving demonstrations on the use of nitrous oxide as an anesthetic while gaining worldwide fame for this contribution to both dentistry and medicine

A. True

B. False

B. False

There is a physiobiochemical relationship between N20 and opioids, analgesic concentrations of N2O may act on the opioid receptor and/or activate the release of endogenous opiates.

A. True

B. False

A. True

At which level of sedation or anesthesia might we to be concerned that a patient may have trouble maintaining their own airway and ventilation?

A. Mild sedation

B. Moderate sedation

C. Deep sedation

D. General anesthesia

D. General anesthesia

Patients must have someone else drive them home after nitrous oxide.

A. True

B. False

B. False

A pulse oximeter:

A. Measures the absorption of selected wavelength of light by HbO2 and Hb

B. Determines O2 saturation chemically

C. Displays the O2 saturation (of arterial blood) as a percentage

D. Can be used to determine total blood Hb

E. All of the above

F. A and D only

G. A and C only

G. A and C only

In an aspiration event, in which lung is a foreign object most likely to lodge (due to anatomy)?

A. Right lung

B. Left lung

C. There is an equal chance for either

A. Right lung

25. All of the following are benefits of nitrous oxide sedation except one?

A. It has analgesic properties

B. It has anxiolyic properties

C. It has a slow onset time

D. It is easily titrated

C. It has a slow onset time

1. The individual credited for the discovery of nitrous oxide was

A. Humphrey Davy.

B. Joseph Priestley.

C. Gardner Quincy Colton.

D. Horace Wells.

B. Joseph Priestley.

2. The individual responsible for lecturing about the virtues of nitrous oxide and sporting it as entertainment in town halls was

A. Humphrey Davy.

B. Joseph Priestley.

C. Gardner Quincy Colton.

D. Horace Wells.

C. Gardner Quincy Colton.

The individual who has posthumously been recognized as the "Father of Anesthesia"

because of his clinical use of nitrous oxide is

A. Humphrey Davy.

B. Joseph Priestley.

C. Gardner Quincy Colton.

D. Horace Wells.

D. Horace Wells.

The first clinical procedure using nitrous oxide as the anesthetic agent was

A. limb amputation.

B. tooth extraction.

C. abscess drainage.

D. laceration repair. (Clark 11)

B. tooth extraction.

The number of deaths associated with N2O/O2 sedation in a dental office as the sole sedative agent and using appropriate equipment and technique is

A. none.

B. approximately 10.

C. approximately 100.

D. approximately 1000.

A. none.

Current "best practice guidelines" for N2O/O2 sedation use in the United States are recommended by each of the following organizations except one. Which one is the exception?

A. ASA

B. ADA

C. FDA

D. AAP/AAPD

C. FDA

The primary objective of physiologic pain is to

A. provide protection for the body against potential damage.

B. prevent nerve impulses from reaching the brain.

C. alert the individual of the need for pharmacologic intervention.

D. signal the need for oxygen.

A. provide protection for the body against potential damage.

All of the following are factors that can influence an individual's response to pain except

one. Which one is the exception?

A. Current stress level

B. Illness/infection presence

C. Eye color

D. Cultural expectations

C. Eye color

The following are disadvantageous characteristics of which route of pharmacologic

administration?

• Inability to titrate dose

• Unreliable absorption affected by gastric contents

• Prolonged duration

• Significant latent period

• Potential patient noncompliance, especially with children

A. Oral

B. Intramuscular

C. Intravenous

D. General

A. Oral

The drug-induced state during which patients respond normally to verbal commands and have possible cognitive and coordination impairment, but ventilatory and cardiovascular functions are unaffected is

A. minimal sedation.

B. moderate sedation.

C. deep sedation.

D. general anesthesia.

A. minimal sedation

Each of the following is a sign that an individual may be anxious EXCEPT one. Which one is this exception?

A. Tight grip on chair or "white knuckles"

B. Beads of perspiration

C. Tendency to fall asleep

D. Cool, clammy skin

C. Tendency to fall asleep

Which of the following would best describe the amnestic effect associated with N2O/O2 sedation on a patient?

A. The patient does not recognize his/her surroundings.

B. The patient does not remember what procedure was being completed or who the clinicianwas.

C. The patient believes less time passed than was actually spent at the appointment.

D. The patient will forget he/she was anxious and/or afraid after leaving the office.

C. The patient believes less time passed than was actually spent at the appointment.

The rapid onset of action with N2O/O2 sedation is advantageous. Effects are usually first seen within ________ minutes.

A. 5

B. 15

C. 30

D. 45

A. 5

Each of the following is considered an anxiolytic effect of N2O/O2 sedation except one.

Which one is this exception?

A. Calm

B. Tolerant

C. Relaxed

D. Comfortable

E. Stressed

E. Stressed

A patient will not cognitively recover from N2O/O2 sedation for many hours following its administration. Like all other forms of sedation, every patient must be escorted from the office by a friend or family member following N2O/O2 sedation.

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.

B. Both statements are false.

The drug most commonly delivered concomitantly with N2O and O2 in the dental setting is

A. a local anesthetic.

B. an anti-hypertensive medication.

C. a selective serotonin reuptake inhibitor (SSRI).

D. a non-steroidal, anti-inflammatory drug (NSAID).

A. a local anesthetic.

Nitrous oxide gas by itself is not flammable. If nitrous oxide comes into contact with a

flame, it will explode.

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.

A. Both statements are true.

18. Nitrous oxide is __________ than air.

A. lighter

B. heavier

B. heavier

Oxygen makes up approximately __________% of the atmosphere.

A. 7

B. 21

C. 52

D. 75

B. 21

A drug that diffuses immediately into the blood and is rapidly distributed across the body is considered

A. highly soluble.

B. relatively insoluble.

C. insoluble.

A. highly soluble.

All of the following are reasons why nitrous oxide is not used as a sole anesthetic agent for surgery in the operating room at a hospital except one. Which one is this exception?

A. Because it is the least potent (weakest) of all inhalation general anesthetics

B. Because it has a MAC value of 104% to 105%

C. Because profound surgical anesthesia is unattainable unless it is used under hyperbaric conditions

D. Because it is much more expensive than halothane or sevoflurane, which are agents commonly used

D. Because it is much more expensive than halothane or sevoflurane, which are agents commonly used

Hydrocarbons such as oil, grease, or other lubricants should not be used near valves, gauges, regulators, or any fittings on N2O/O2 equipment because they may cau

A. leaking of the gas cylinder.

B. malfunctioning of the regulator.

C. a catastrophic explosion.

D. rusting inside the gauges.

C. a catastrophic explosion.

The oxygen in the N2O molecule is not available for use by the body because N2O does not break down in the body.

A. Both the statement and the reason are correct and related.

B. Both the statement and the reason are correct but NOT related.

C. The statement is correct but the reason is NOT.

D. The statement is NOT correct but the reason is correct.

E. NEITHER the statement NOR the reason is correct.

A. Both the statement and the reason are correct and related.

Nitrous oxide is often used during induction of general anesthesia because it promotes the rapid uptake of a more potent general anesthesia agent. This property is called

A. the concentration effect.

B. the second-gas effect.

C. diffusion hypoxia.

D. respiratory depression.

E. hypoxic drive.

B. the second-gas effect.

Minute ventilation is approximated by multiplying ______ by _____.

A. tidal volume, respiration rate

B. tidal volume, cardiac output

C. oxygen concentration, tidal volume

D. nitrous concentration, tidal volume

E. tidal volume, weight in kilograms

A. tidal volume, respiration rate

A common area of spasm evidenced by significant cough and gag reflex occurs at the

A. larynx.

B. trachea.

C. carina.

D. nasopharynx.

A. larynx.

A pulse oximeter is a device that may be used during N2O/O2 sedation to assess the level of

A. N2O levels in the body.

B. O2 saturation of arterial blood.

C. percentage of O2 used during sedation procedures.

D. cardiac output and intensity.

B. O2 saturation of arterial blood.

The pulse oximeter uses light wavelengths to measure the amount of oxygen saturation of arterial blood. Which of the following values would be considered normal for a healthy

individual?

A. 68

B. 78

C. 88

D. 98

D. 98

Although proven clinically insignificant, the term used to define the decrease in blood oxygen saturation caused by the rapid exit of nitrous oxide upon its discontinuation is called

A. diffusion hypoxia.

B. pulmonary effusion.

C. arterial anoxia.

D. aortic stenosis.

A. diffusion hypoxia.

The bronchus with minimal divergence from the trachea and thereby likely to receive a foreign body is on the patient's

A. right.

B. left.

A. right.

N2O/O2 has a significant negative impact on which of the following body systems?

A. Hepatic

B. Endocrine

C. Genitourinary

D. Renal

E. None of the above

E. None of the above

All of the following are relative contraindications of N2O/O2 use except one. Which one of the following indicates when N2O/O2 should be used?

A. Hypersensitive gag reflex

B. Severely claustrophobic patients

C. Current upper respiratory tract infection

D. First trimester of pregnancy

E. Alcohol intoxication or drug use

A. Hypersensitive gag reflex

An absolute contraindication to the use of N2O/O2 sedation would be a patient with

A. angina.

B. a gastric ulcer.

C. Parkinson's Disease.

D. cancer therapy using bleomycin sulfate.

D. cancer therapy using bleomycin sulfate

On which of the following systems does nitrous oxide have the greatest impact?

A. Central nervous system

B. Hepatic

C. Skeletal/muscular

D. Cardiovascular

A. Central nervous system

All of the following are relative contraindications to the use of N2O/O2 sedation except one. Which one is this exception?

A. Patient with psychotic illness taking several medications

B. Patient who does not have the mental capacity to understand the procedure

C. Operator who cannot communicate with the patient because of a language barrier

D. Patient has undiagnosed anorexia.

D. Patient has undiagnosed anorexia. (if it's undiagnosed it can't be a contraindication)

Which of the following represents a blood pressure value classified as prehypertension?

A. 116/76 mm Hg

B. 120/80 mm Hg

C. 140/90 mm Hg

D. 160/100 mm Hg

B. 120/80 mm Hg

A 52-year-old patient with hypertension being controlled by daily medication would be classified as an ASA

A. 1.

B. 2.

C. 3.

D. 4.

B. 2.

A pulse rate of 95 beats per minute for a 6-year-old child would be considered

A. low.

B. normal.

C. high.

B. normal.

Preprocedural fasting is a mandated requirement for patients undergoing nitrous oxide/oxygen sedation by the ADA and the AAP/AAPD in an ambulatory setting BECAUSE a frequent side effect of nitrous oxide drug is vomiting.

A. Both the statement and the reason are correct and related.

B. Both the statement and the reason are correct but NOT related.

C. The statement is correct, but the reason is NOT.

D. The statement is NOT correct, but the reason is correct.

E. NEITHER the statement NOR the reason is correct.

E. NEITHER the statement NOR the reason is correct.

Preprocedural instructions must be given to the patient before N2O/O2 sedation. Each of

the following would be appropriate except one. Which one is the exception?

A. Expectations of sedation outcomes

B. Signs and symptoms of appropriate sedation

C. Specific amount of drug to be delivered

C. Specific amount of drug to be delivered

Pts using MJ exp heightened hallucinogenic effect of MJ if given N2O. T/F

True (?)

Your pt reports, on his health hx, that he uses viagra. How long after his last dose of viagra is it safe to administer N2O?

24 hrs

For N2O to work, a pt must buy into, psychologically the effectiveness of N2O.

• True

Indications for N2O use on pt are:

• G) All of the above (anxious pt, child undergoing long dental procedure, certain special needs pts, gagger, pt who is unable to achieve profound LA)

General anesthesia is impossible to achieve using N2O

• False (difficult to reach, but not impossible)

Mild sedation is usually achieved at N2O concentrations at 50% or less

• True

Empathy is best expressed through eye contact w/our pts

• True

Severe anxiety in pts is demonstrated by the following symptoms:

• All of the above (dilated pupils, increase in BP, increase in HR, excessive sweating)

The general theory of the process of Dental Fear is based on three higher-order categories. An unsupportive dentist is one of these categories.

• Both statements are true

Dental phobia rarely develops during adulthood

• True

20% of female dental anxious pts have a past history of sexual abuse

• True

The modified Dental Anxiety Scale (MDAS) had the highest ratings for injections and drilling

• True

40% of high dental anxious patients will report suffering from PTSD symptoms

• True

Dental anxious pts will exhibit the following

• All of the above (Flight or fight response, panic attacks, more sensitivity to pain, sleep disturbances)

Females present with higher levels of dental anxiety than males

• True

Nitrous is metabolized through the liver

• False

Nitrous is contraindicated for asthma patients.

False

Nitrous oxide is often used in combination w more potent inhalation agents to decrease the percentage of inhaled agents and to diminish unwanted effects

True?

Desirable characteristics of nitrous oxide includes

All of the above

Is it safe to administer N2O to pts taking nitroglycerine for angina or pts taking erectile dysfunction drugs such as viagra

False

Nitrous oxide

D. Remain unchanged in the blood, rapidly replaces N2, and 99% eliminated through the lungs without biotransformation

Severely dento-phobic patients will ALWAYS benefit from NO use

FALSE

Which of the following should be routinely obtained prior to NO administration?

a. Blood oxygen level

b. Blood pressure

c. HR

d. A&B

e. B&C

e. B&C

Which is an advantage of NO?

easily titrated

CDC has strict guidelines for animals in dental office

FALSE

If using animal assisted therapy in dental office, informed consent is NOT required

FALSE

In Animal Assisted Therapy, what have been shown to be the most effective in aging populations, pediatric care and pain reduction.

A. Dogs

B. Cats

C. Monkeys

D. Birds

A. Dogs

Recent research in Virtual reality has shown that Nature scenes have the lowest ability to reduce stress and anxiety.

FALSE

According to the Elaborated Intrusion theory, imagined experiences not only stimulate the sights and sounds of the experience but incorporates the actual emotions associated with the experience. TRUE or FALSE

TRUE

Research has shown that viewing aquariums in a dental office can:

A. Lower a patient's blood pressure

B. Lower a patient's anxiety level

C. Increases a patient's pain threshold

D. Lower the A1c levels of a diabetic

E. All of the above

E. ALL OF THE ABOVE

Let's be clear. Viewing aquariums in a dental office DOES NOT lower A1c levels!!! Clearly Dr. Shoen does not know what an A1c level is or what it indicates. But since he said in class that looking at aquariums can lower A1c, you should put that answer on the test. But remember that in real life it is not true!

Acupuncture has been shown to be effective against pre-treatment dental anxiety.

TRUE

Hypnosis can be used on patients with mental health issues, personality disorders or neurodegenerative disorders

FALSE

The most common relaxation techniques taught to patients is Jacobsen's Progressive Muscular Relaxation technique.

TRUE

At 30-40% N2O is equal to 15 mg of morphine

TRUE

Which of the following can be signs of moderate anxiety?

A. History of multiple cancelled appts

B. Patient seeks only emergency care

C. Patient is not very talkative or helpful

D. Patient exhibits tense body posture

E. A & D

F. B & C

G. A, B, & D

G. A, B, & D