Wilkins Chapter 36 Anxiety and Pain Control

pain perception

Which of the following is true of pain perception?

a) It is interpreted in the brain as pain.

b) It is highly variable between individuals with intact nervous systems.

c) It is a combination of the interpretation and the response to the pain message.

d) It accounts for the variability seen between patients.

e) It is influenced by age, fatigue, emotional state, and learned behaviors.

It is interpreted in the brain as pain.

Which of the following would require a medical consult prior to the use of local anesthetics?

A) Malignant hyperthermia

B) Hyperthyroidism

C) Hypothyroidism

D) Impaired liver of kidney function

Malignant hyperthermia

(1) The gas flow rate is 6-7 liters per minute for adults. (2) The gas flow rate is 4-5 liters per minute for children.

A) The first statement is true; the second statement is false.

B) The first statement is false; the second statement is true.

C) Both statements are true.

D) Both statements are false.

C) Both statements are true.

The physical process of receiving a painful stimulus and transmitting it to the brain is interpreted as

A) pain perception.

B) pain reaction.

C) pain overreaction.

D) anxiety and pain.

A) pain perception.

Which is an advantage of local anesthesia?

A) No risk of toxicity

B) No systemic side effects

C) No change in the patient's level of consciousness

D) No potential for soft-tissue injury postinjection

No change in the patient's level of consciousness

A recommended technique for preventing injection of local anesthetic solution directly into the circulatory system is known as

A) aspiration.

B) inhalation.

C) titration.

D) noninjectable local anesthesia.

aspiration.

Which of the following topical anesthetics has an average duration of 20-60 minutes?

A) Benzocaine

B) Tetracaine HCl

C) Lidocaine transoral patch

D) Dyclonine+F14

Tetracaine HCl

What does a scavenger system do?

A) Collects nitrous oxide for inhalation

B) Removes exhaled nitrous oxide

C) Recycles exhaled nitrous oxide

D) Recycles exhaled oxygen

Removes exhaled nitrous oxide

Which of the following is an example of the method of depressing the central nervous system?

A) Local and topical anesthesia

B) Infiltration anesthesia

C) Nitrous oxide, oxygen conscious sedation

D) General anesthesia

General anesthesia

When administering nitrous oxide-oxygen sedation, the initial concentration should be titrated to what concentration of nitrous oxide?

A) 5 to 10 percent

B) 10 to 15 percent

C) 15 to 20 percent

D) 20 to 25 percent

10 to 15 percent

Personal interpretation and response to pain is known as

A) pain perception.

B) pain reaction.

C) pain overreaction.

D) pain and anxiety reaction

pain reaction.

(1) Ester anesthetics have a high incidence of allergic reactions. (2) Ester anesthetics are often used in topical anesthetics.

A) The first statement is true; the second statement is false.

B) The first statement is false; the second statement is true.

C) Both statements are true.

D) Both statements are false.

C) Both statements are true.

Which of the following has been demonstrated to be a disadvantage of nitrous oxide/oxygen sedation?

A) Potential for recreational abuse by health professionals

B) More stressful appointment for the clinician

C) Long recovery time for the patient

D) Patients are commonly allergic

Potential for recreational abuse by health professionals

(1) Analgesia is a loss of feeling or sensation, with or without consciousness. (2) Anesthesia is the elimination of pain in the conscious patient.

A) The first statement is true; the second statement is false.

B) The first statement is false; the second statement is true.

C) Both statements are true.

D) Both statements are false.

Both statements are false.

If 100% oxygen is not administered at the end of the sedation procedure, __________ can occur.

A) diffusion hypoxia

B) aspiration

C) iatrosedation

D) titration

diffusion hypoxia

What is the approximate duration of Oraqix, a noninjectable anesthesia?

A) 10 minutes

B) 20 minutes

C) 30 minutes

D) 45 minutes

B) 20 minutes

OraVerse has an FDA pregnancy category of

A) A

B) B

C) C

D) X

C

(1) The first dental anesthetic was procaine (Novocain), which is an ester. (2) It has not been available in dental cartridges in the United States since 1947.

A) The first statement is true; the second statement is false.

B) The first statement is false; the second statement is true.

C) Both statements are true.

D) Both statements are false.

A) The first statement is true; the second statement is false.

Which of the following is an example of psychosedation?

A) Local and topical anesthetics

B) Avoiding dental appointment

C) Nitrous oxide, oxygen conscious sedation

D) Iatrosedation

Iatrosedation

The duration for 4% prilocaine plain for nerve block anesthesia is

A) 1.5 to 2 hours.

B) 2 to 4 hours.

C) 4 to 5 hours.

D) 4 to 6 hours.

E) 5 to 7 hours.

2 to 4 hours.

At the end of the dental hygiene appointment, the recovery time at 100% oxygen should be a minimum of

A) 2 minutes.

B) 3 minutes.

C) 4 minutes.

D) 5 minutes.

D) 5 minutes.

The neurologic experience of pain is known as

A) pain perception.

B) pain reaction.

C) pain overreaction.

D) pain and anxiety reaction.

A) pain perception.

All of the following are advantages of nitrous oxide/oxygen sedation EXCEPT one. Which one is the EXCEPTION?

A) Mild analgesia

B) Mild sedative

C) Reduces patient's reaction to pain by raising pain threshold

D) Allows the patient to breathe through the mouth

D) Allows the patient to breathe through the mouth

Which condition is an absolute contraindication for nitrous oxide-oxygen sedation?

A) Mild-to-moderate anxiety

B) Significant respiratory compromise

C) Cardiovascular disease

D) Stress-induced bronchial asthma

B) Significant respiratory compromise

A lack of adequate amounts of oxygen that can result from the rapid diffusion of nitrous oxide molecules from the blood stream into the lungs which occurs if 100% oxygen is not administered at the conclusion of a nitrous oxide-oxygen sedation procedure is known as

A) diffusion hypoxia.

B) hypoxia.

C) ambient diffusion.

D) ambient hypoxia.

diffusion hypoxia.

(1) Drug distribution and effectiveness of local anesthetics in areas of inflammation may be diminished due to high pH. (2) Block anesthesia is recommended rather than infiltration in areas of inflammation.

A) The first statement is true; the second statement is false.

B) The first statement is false; the second statement is true.

C) Both statements are true.

D) Both statements are false.

B) The first statement is false; the second statement is true.

Which of the following blocks the pathway of the pain message?

A) Local and topical anesthetic

B) Avoiding dental appointments

C) Nitrous oxide/oxygen conscious sedation

D) NSAIDS

A) Local and topical anesthetic

Which injection technique, when done correctly, blocks the mandibular nerve?

D) Gow-Gates technique

(1) Nitrous oxide-oxygen sedation can be safely administered to a pregnant patient. (2) The second and third trimesters are the safest in which to use this form of anxiety control.

A) The first statement is true; the second statement is false.

B) The first statement is false; the second statement is true.

C) Both statements are true.

D) Both statements are false.

C) Both statements are true.

(1) Local anesthesia refers to injecting the anesthetic solution locally to the nerve trunk. (2) Block anesthesia refers to blocking the nerve close to the site where anesthesia is needed.

A) The first statement is true; the second statement is false.

B) The first statement is false; the second statement is true.

C) Both statements are true.

D) Both statements are false.

D) Both statements are false.

(1) Greater concentrations of nitrous oxide are required at higher altitudes than at lower altitudes. (2) Nitrous oxide diffuses into an area of lower concentration more rapidly than oxygen.

C) Both statements are true.

(1) If a dental patient is currently experiencing anxiety, they are predisposed to feeling more pain than usual. (2) A dental patient who is not experiencing anxiety is less likely to feel pain

A) The first statement is true; the second statement is false.

B) The first statement is false; the second statement is true.

C) Both statements are true.

D) Both statements are false.

C) Both statements are true.

A) It is not important to match the pain control method to the patient's treatment needs and medical status. B) All pain management techniques are more effective when utilized before the patient experiences pain.

a) Statement A is true and statement B is false.

b) Statement A is false and statement B is true.

c) Both statements are true.

d) Both statements are false.

Statement A is false and statement B is true.

Mr. Jones is a new patient to your dental practice. He has very sensitive teeth and grips the chair when you start to put the mirror in his mouth. You put the instruments down and talk calmly with Mr. Jones for a few minutes before you start the scaling. By building a trust relationship, you let him feel in control without the use of pharmacologic techniques. Which of the five pain control mechanisms best describes the technique you utilized?

a) Remove the painful stimulus.

b) Block the pathway of the pain message.

c) Raise the pain reaction threshold.

d) Depress the central nervous system.

e) Psychosedation methods (iatrosedation).

Psychosedation methods (iatrosedation).

Which of the following medications is the drug of choice for dental pain?

a) NSAIDs

b) Acetylsalicylic acid

c) St. John's wort

d) Morphine sulfate

e) Acyclovir

NSAIDs

The diminution or elimination of pain in the patient experiencing conscious sedation is called:

a) local anesthesia.

b) psychosedation.

c) topical anesthetic.

d) analgesia.

e) general anesthesia.

analgesia.

A) Dental local anesthetic drugs can be divided chemically into two major groups, esters and amides. B) Except for topicals, all currently used anesthetic agents are amides.

a) Statement A is true and statement B is false.

b) Statement A is false and statement B is true.

c) Both statements are true.

d) Both statements are false.

Both statements are true.

What is the purpose of the vasoconstrictor in a local anesthetic cartridge?

a) To increase the rate of metabolism

b) To increase the duration of the anesthetic effect

c) To decrease the depth and profoundness of the anesthetic

d) To decrease the sensitivity to the anesthetic

e) To prevent the risk of hemostasis

To increase the duration of the anesthetic effect

All of the following are criteria for drug selection of local anesthetics except one. Which one is the exception?

a) Duration of anesthesia required

b) Medical status of the patient

c) Preference of the dentist

d) Potential for prolonged discomfort after treatment

e) Potential for self-inflicted injury before anesthetic wears off

Preference of the dentist

Mr. Jones is scheduled for scaling and root planing on the maxillary right quadrant. He currently has 4-mm pockets and very inflamed tissue. It appears as though he has an abscess on tooth #3. What effect would his dental conditions have on the use and effect of local anesthetics?

a) Local anesthetic is not required for scaling and root planing.

b) An Oraquix dispenser is best in pockets for more profound anesthesia.

c) Increase the dose as inflamed tissue has a low pH, which inhibits anesthetic.

d) Try to use topical anesthetic since the pockets are only 4 mm deep.

e) Send the patient for a medical consultation prior to anesthetic use.

Increase the dose as inflamed tissue has a low pH, which inhibits anesthetic.

Which of the following statements is true with respect to the gauge of the needle?

a) They are ranked from largest to smallest: 25, 27, and 30 gauges.

b) The gauge of the needle refers to the length.

c) The 40-mm needle is used for most injections.

d) The 30-gauge needles are stiffer and deflect less as they penetrate.

e) The smaller-gauge needles provide easier and more accurate aspiration.

They are ranked from largest to smallest: 25, 27, and 30 gauges.

Mr. Smith was in the office for scaling and root planing yesterday. The mandibular left quadrant was anesthetized with an amide anesthetic. He just called the office to complain that he cannot open his mouth very easily and his jaw is sore. What is the most common cause of this condition?

a) Hematoma

b) Paresthesia

c) Epithelial desquamation

d) Trismus

e) Psychogenic reaction

Trismus

Which of the following topical anesthetics is the most widely used topical agent and has the potential to cause an allergic reaction?

a) Lidocaine

b) Lidocaine hydrochloride

c) Benzocaine

d) Tetracaine hydrochloride

e) Dyclone

Benzocaine

Which of the following may result in slow removal of the drug, ester, from the blood, resulting in toxicity?

a) Controlled diabetes

b) Atypical plasma cholinesterase

c) Heart murmur

d) None of these are correct.

Atypical plasma cholinesterase

Which of the following injections is used for tooth #4?

a) PSA

b) MSA

c) ASA

d) GP

e) NP

MSA

Mepivacaine's proprietary name is:

a) Citanest.

b) Carbocaine.

c) Articaine.

d) None of these are correct.

Carbocaine and polocaine

Which of the following has the lowest risk of systemic toxicity?

a) Bupivacaine

b) Articaine

c) Prilocaine

d) Carbocaine

Articaine

Mr. Jones is a 50-year-old male periodontal patient. He has been alternating scaling and root planing appointments every 3 months with your office and the periodontist. He has nitrous oxide sedation at each visit and says that it is the only way a hygienist can touch him. He suffers from stress-induced bronchial asthma and severe allergies. When you asked to review the medical history with him, he said that he had no changes other than an eye surgery last month. Which of the following is the best reason to justify the use of nitrous oxide sedation?

a) The analgesic effect is most pronounced on the root surfaces of the teeth

b) To help reduce his strong gag reflex

c) To help prevent his stress-induced bronchial asthma

d) To help prevent a heart attack

e) To help prevent a stroke

To help prevent his stress-induced bronchial asthma

Mr. Jones is a 50-year-old male periodontal patient. He has been alternating scaling and root planing appointments every 3 months with your office and the periodontist. He has nitrous oxide sedation at each visit and says that it is the only way a hygienist can touch him. He suffers from stress-induced bronchial asthma and severe allergies. When you asked to review the medical history with him, he said that he had no changes other than an eye surgery last month. Mr. Jones's recent eye surgery a month ago required the use of intraocular gases; Perfluoropropane and sulfur hexafluoride. Would nitrous oxide be contraindicated for this appointment?

a) No, there is no problem since it was a month ago.

b) No, there is no contraindication from his surgery.

c) Yes, you need to wait due to use of the intraocular gas Perfluoropropane.

d) Yes, you should never again use nitrous as vision damage could result.

Yes, you need to wait due to use of the intraocular gas Perfluoropropane.

Mr. Jones is a 50-year-old male periodontal patient. He has been alternating scaling and root planing appointments every 3 months with your office and the periodontist. He has nitrous oxide sedation at each visit and says that it is the only way a hygienist can touch him. He suffers from stress-induced bronchial asthma and severe allergies. When you asked to review the medical history with him, he said that he had no changes other than an eye surgery last month. You will start Mr. Jones on a 20% concentration. How soon could you assess this initial dose?

a) 0 to 1 minute

b) 1 to 2 minutes

c) 2 to 3 minutes

d) 3 to 4 minutes

e) 4 to 5 minutes

1 to 2 minutes

Mr. Jones is a 50-year-old male periodontal patient. He has been alternating scaling and root planing appointments every 3 months with your office and the periodontist. He has nitrous oxide sedation at each visit and says that it is the only way a hygienist can touch him. He suffers from stress-induced bronchial asthma and severe allergies. When you asked to review the medical history with him, he said that he had no changes other than an eye surgery last month. It is indicated in Mr. Jones's record that the concentration he needs is 20% to 40%. What percentage of patients fit into this dose requirement?

a) 30%

b) 40%

c) 50%

d) 60%

e) 70%

70%

Mr. Jones is a 50-year-old male periodontal patient. He has been alternating scaling and root planing appointments every 3 months with your office and the periodontist. He has nitrous oxide sedation at each visit and says that it is the only way a hygienist can touch him. He suffers from stress-induced bronchial asthma and severe allergies. When you asked to review the medical history with him, he said that he had no changes other than an eye surgery last month. You have just finished scaling Mr. Jones's teeth. You get up, take off your gloves, and rinse your hands off. The receptionist is waving at you to come up to the front desk. One of your morning patients is on the phone and wants to ask you a question. What should you do?

a) Go to the phone since Mr. Jones has nitrous a lot and is okay.

b) Turn up the oxygen and then go to the phone to answer the question.

c) Stay in the room with Mr. Jones and tell the recept

Stay in the room with Mr. Jones and tell the receptionist to take a message.

Mr. Jones is a 50-year-old male periodontal patient. He has been alternating scaling and root planing appointments every 3 months with your office and the periodontist. He has nitrous oxide sedation at each visit and says that it is the only way a hygienist can touch him. He suffers from stress-induced bronchial asthma and severe allergies. When you asked to review the medical history with him, he said that he had no changes other than an eye surgery last month. Mr. Jones takes his mask off immediately when you finish scaling and says he has to use the restroom. When he stands up he complains of a headache and faints. What is the cause of his syncope?

a) Inadequate oxygen in the alveoli

b) Blood loss from your root planing appointment

c) He simply got up too fast

d) Postural hypotension

Inadequate oxygen in the alveoli

Ms. Phillips is your 9 A.M. patient. They are 30 years old and present for NSPT. When you update the medical history, they advise you they have begun using medically prescribed cannabis for chronic back pain. When you ask the patient the last time they took a dose of the cannabis, they inform you they smoked some the night before, around 9 P.M. What, if any, concerns do you have regarding this patient's cannabis use?

You intended to use a local anesthetic with epinephrine