Deck 10: Patient Assessment for Local Anesthesia

Question 1

Match the following:

-Absolute contraindication

A) ASA
B) Somewhat inadvisable
C) Ibuprofen
D) Amoxicillin
E) Allergy
F) Drugs used together
G) Permission to treat
H) Objective evaluation
I) Reduced oxygen carrying capacity
J) Unwanted outcome

Answer 1

Allergy

Question 2

Match the following:

-Adverse reactions

A) ASA
B) Somewhat inadvisable
C) Ibuprofen
D) Amoxicillin
E) Allergy
F) Drugs used together
G) Permission to treat
H) Objective evaluation
I) Reduced oxygen carrying capacity
J) Unwanted outcome

Answer 2

Unwanted outcome

Question 3

Match the following:

-Antibiotic premedication

A) ASA
B) Somewhat inadvisable
C) Ibuprofen
D) Amoxicillin
E) Allergy
F) Drugs used together
G) Permission to treat
H) Objective evaluation
I) Reduced oxygen carrying capacity
J) Unwanted outcome

Answer 3

Amoxicillin

Question 4

Match the following:

-Anti-inflammatory premedication

A) ASA
B) Somewhat inadvisable
C) Ibuprofen
D) Amoxicillin
E) Allergy
F) Drugs used together
G) Permission to treat
H) Objective evaluation
I) Reduced oxygen carrying capacity
J) Unwanted outcome

Question 5

Match the following:

-Concomitant

A) ASA
B) Somewhat inadvisable
C) Ibuprofen
D) Amoxicillin
E) Allergy
F) Drugs used together
G) Permission to treat
H) Objective evaluation
I) Reduced oxygen carrying capacity
J) Unwanted outcome

Question 6

Match the following:

-Informed consent

A) ASA
B) Somewhat inadvisable
C) Ibuprofen
D) Amoxicillin
E) Allergy
F) Drugs used together
G) Permission to treat
H) Objective evaluation
I) Reduced oxygen carrying capacity
J) Unwanted outcome

Question 7

Match the following:

-Methemoglobinemia

A) ASA
B) Somewhat inadvisable
C) Ibuprofen
D) Amoxicillin
E) Allergy
F) Drugs used together
G) Permission to treat
H) Objective evaluation
I) Reduced oxygen carrying capacity
J) Unwanted outcome

Question 8

Match the following:

-Physical status classification

A) ASA
B) Somewhat inadvisable
C) Ibuprofen
D) Amoxicillin
E) Allergy
F) Drugs used together
G) Permission to treat
H) Objective evaluation
I) Reduced oxygen carrying capacity
J) Unwanted outcome

Question 9

Match the following:

-Relative contraindication

A) ASA
B) Somewhat inadvisable
C) Ibuprofen
D) Amoxicillin
E) Allergy
F) Drugs used together
G) Permission to treat
H) Objective evaluation
I) Reduced oxygen carrying capacity
J) Unwanted outcome

Question 10

Match the following:

-Risk assessment

A) ASA
B) Somewhat inadvisable
C) Ibuprofen
D) Amoxicillin
E) Allergy
F) Drugs used together
G) Permission to treat
H) Objective evaluation
I) Reduced oxygen carrying capacity
J) Unwanted outcome

Question 11

A patient with severe systemic disease is classified as ASA IV.

Question 12

If a patient is described as ASA III due to blood pressure levels, recommended dental treatment may be initiated provided that intraoperative monitoring of blood pressure is considered and patients are referred to physicians within one month.

Question 13

A score of 18 on Corah's Dental Anxiety Scale indicates mild fear.

Question 14

Abnormally slow or fast breathing can be an indicator of disease or anxiety, or both.

Question 15

A pulse oximeter attached to a patient's finger may detect the presence of methemoglobinemia.

Question 16

Most local anesthetic injections through tissue are considered invasive and require premedication for at-risk patients.

Question 17

Patients with hemophilia do not require antibiotic premedication for injections of local anesthesia.

Question 18

Metabolism of both amide and ester-type local anesthetics may be compromised in patients with serious liver dysfunction.

Question 19

Atypical plasma cholinesterase is a relative contraindication to amide type anesthetics.

Question 20

Patients with artificial heart valves placed more than two years ago do not require antibiotic premedication.

Question 21

Patients diagnosed with congestive heart failure (CHF) should not be placed in a supine position because this can quickly lead to serious pulmonary edema.

Question 22

Local anesthetics are CNS stimulants and should be used with caution when patients have taken large doses of narcotics.

Question 23

Articaine may be the anesthetic drug of choice for a patient with liver dysfunction because only 5 to 10 % is metabolized in the liver.

Question 24

Epinephrine is an absolute contraindication for patients with poorly controlled or uncontrolled hyperthyroidism.

Question 25

Epinephrine can cause dangerous elevations in blood sugar in patients with cardiac compromise and severe diabetes.

Question 26

Drugs that are in a patient's system when local anesthetics are administered are referred to as ________.

Question 27

Making a determination of a patient's ability to withstand local anesthetic procedures prior to initiating them is called ________.

Question 28

According to the American Society of Anesthesiologists, the most important goal in the delivery of anesthesia is ________.

Question 29

ASA II describes a patient with ________.

Question 30

ASA IV describes a patient with ________.

Question 31

A patient with asthma is classified as ASA type ________.

Question 32

A patient with congestive heart failure is classified as ASA type ________.

Question 33

Objective information about a patient's physical condition can be obtained from an evaluation of his or her ________.

Question 34

Normal pulse rates range from ________ beats per minute depending on a person's general health and fitness.

Question 35

A genetic or acquired condition that reduces the oxygen-carrying capacity of the blood is called ________.

Question 36

Patients with poorly controlled diabetes may have a relative contraindication to the use of ________.

Question 37

Patients who have taken narcotic drugs prior to injections of local anesthetics are at risk due to the risk for additional CNS ________.

Question 38

According to the American Heart Association, antibiotic premedication is indicated for patients with exceptional risks of developing ________.

Question 39

Patients with congestive heart failure should be placed in a ________ position to avoid pulmonary edema.

Question 40

Which of the following is not one of the six elements of the ASA Medical Components of Care associated with regional anesthesia?

A) Pre-anesthetic evaluation of the patient
B) Prescription of the anesthetic plan
C) Remain present during the course of the anesthesia
D) Tooth charting and periodontal evaluation to determine treatment plan

Question 41

A patient with chronic obstructive pulmonary disease (COPD) requiring oxygen is classified as:

A) ASA II
B) ASA III
C) ASA IV
D) ASA V

Question 42

A patient with well-controlled, noninsulin-dependent diabetes is classified as:

A) ASA I
B) ASA II
C) ASA III
D) ASA IV

Question 43

Which of the following, when considering patient evaluation, is the least pertinent when obtaining local anesthetic informed consent?

A) Specific risks of procedure in light of medical status
B) Benefits of the procedure
C) Identifying a surrogate to provide health information
D) The timing of appointments and cost

Question 44

Which one of the following drugs is absolutely contraindicated for patients with bisulfite sensitivity?

A) All injectable local anesthetics with amides
B) All injectable local anesthetics with esters
C) All injectable local anesthetics with vasoconstrictors
D) All topical anesthetics

Question 45

For an uncontrolled diabetic patient, which factor is the most critical to consider when planning to use a local anesthetic with epinephrine?

A) Appointment time
B) Blood sugar level
C) Cardiac compromise
D) Meal time

Question 46

Epinephrine is contraindicated in a patient with:

A) Uncontrolled hyperthyroidism
B) Diabetes
C) Heart disease
D) Asthma

Question 47

According to the 2007 American Heart Association guidelines, which of the following conditions does not require antibiotic premedication for the prevention of infective endocarditis?

A) Previous endocarditis
B) Prosthetic heart valve
C) Hemophilia
D) Congenital heart disease

Question 48

Which of the following is not a consideration for patients with hemophilia for local anesthetic injections?

A) Antibiotic premedication
B) Types of injections
C) Types of drugs
D) Doses of local anesthesia

Question 49

Which of the following local anesthetic drugs may represent a relative contraindication for patients with compromised liver function?

A) Levonordefrin
B) Benzocaine
C) Lidocaine
D) Epinephrine

Question 50

What is the maximum recommended dose of epinephrine for patients in category ASA III with cardiovascular disease?

A) 1.8 mg
B) 0.4 mg
C) 0.2 mg
D) 0.04 mg

Question 51

Following a myocardial infarction, what is the current guideline recommended when considering elective dental treatment?

A) A minimum of 4weeks delay, following appropriate consultation and risk analysis
B) A minimum of 3 months delay, following appropriate consultation and risk analysis
C) A minimum of 6 months delay, following appropriate consultation and risk analysis
D) A minimum of 12 months delay, following appropriate consultation and risk analysis

Question 52

Following a CVA, TIA, or RIND, how long should elective dental treatment be delayed?

A) 1 to 6 months, following appropriate consultation and risk analysis
B) A minimum of 3 months, following appropriate consultation and risk analysis
C) A minimum of 6 months, following appropriate consultation and risk analysis
D) A minimum of 12 months, following appropriate consultation and risk

Question 53

Which local anesthetic drugs would it be advisable to avoid when a patient is taking significant amounts of acetaminophen?

A) Prilocaine and benzocaine
B) Lidocaine and mepivacaine
C) Bupivacaine and benzocaine
D) Procaine and cocaine

Question 54

Which one of the following activities does not describe an activity to meet the 4 MET level?

A) Walk one block on level ground at 4 mph
B) Play golf
C) Walk up a hill
D) Ski down hill

Question 55

Which one of the following activities describes an activity that meets the 1 MET level?

A) Walk one block on level ground at 2 mph
B) Run a short distance
C) Walk up a hill
D) Ski downhill

Question 56

Which one of the following conditions does not indicate the need to limit the dose of vasoconstrictors?

A) Patient taking digitalis gylcosides for heart failure
B) Patient prone to arrhythmia
C) Patient with cardiovascular disease and controlled hypothyroidism
D) Patient taking nonselective beta-blockers

Question 57

Which of the following are initial signs and symptoms of methemoglobinemia?

A) Dizziness and headache
B) CNS depression and seizures
C) Gray cyanosis of mucous membranes, lips, nail beds
D) Flushed, clammy skin

Question 58

Provide four reasons why it is important for a clinician to know which concomitant drugs a patient is taking prior to the administration of local anesthetics.

Question 59

Discuss situations that require a medical consultation prior to treatment.

Question 60

Explain the risks associated with the concomitant use of local anesthetic drugs and cocaine.

Question 61

Explain the risks associated with the concomitant use of local anesthetic drugs and methamphetamine.

Question 62

Define and discuss methemoglobinemia.

Question 63

Tucker Johnson is a 49-year-old male who recently moved to the area to search for a new job. He says he has not had dental care for several years because nothing hurts. His chief complaint is stained teeth and bad breath. His medical history is positive for smoking. He takes acetaminophen for stress-induced headaches most days of the week. Vital signs are: blood pressure 155/92, respiration 20, and weight 215 pounds. Intraoral findings include the presence of periodontal infection and six teeth in need of restorations.

-Considering the factors presented, what is Mr. Johnson's ASA physical classification?

Question 64

Tucker Johnson is a 49-year-old male who recently moved to the area to search for a new job. He says he has not had dental care for several years because nothing hurts. His chief complaint is stained teeth and bad breath. His medical history is positive for smoking. He takes acetaminophen for stress-induced headaches most days of the week. Vital signs are: blood pressure 155/92, respiration 20, and weight 215 pounds. Intraoral findings include the presence of periodontal infection and six teeth in need of restorations.

-Are any precautions necessary given Mr. Johnson's blood pressure of 155/92?

Question 65

Tucker Johnson is a 49-year-old male who recently moved to the area to search for a new job. He says he has not had dental care for several years because nothing hurts. His chief complaint is stained teeth and bad breath. His medical history is positive for smoking. He takes acetaminophen for stress-induced headaches most days of the week. Vital signs are: blood pressure 155/92, respiration 20, and weight 215 pounds. Intraoral findings include the presence of periodontal infection and six teeth in need of restorations.

-What local anesthetics should be avoided in light of his frequent use of acetaminophen? Why?

Question 66

Tucker Johnson is a 49-year-old male who recently moved to the area to search for a new job. He says he has not had dental care for several years because nothing hurts. His chief complaint is stained teeth and bad breath. His medical history is positive for smoking. He takes acetaminophen for stress-induced headaches most days of the week. Vital signs are: blood pressure 155/92, respiration 20, and weight 215 pounds. Intraoral findings include the presence of periodontal infection and six teeth in need of restorations.

-What is the significance of Mr. Johnson's weight related to the maximum recommended dose of local anesthetic drugs?