Behavior Guidance

Question 1

Name the two primary side effects of nitrous oxide

Answer 1

1) Sweating, nausea
2) GI Discomfort, vomiting

Inhibition of airway reflexes also possible

Question 2

T/F: Nitrous oxide is contraindicated in 1st trimester (fetal hypoxia)
Category C: although problems in patients have not been documented, studies in rats have shown that nitrous oxide causes fetal death, growth retardation, and skeletal anomalies

Answer 2

True

Question 3

Where does diazepam act?

Answer 3

cortex, limbic system, thalamus, hypothalamus

Question 4

Which is associated with Erikson?

a) Psycho-sexual
b) Psycho-social
c) Classical conditioning
d) Operant conditioning and selective reinforcement
e) Cognitive theory
f) Hierarchy of needs

Answer 4

b) Psycho-social

Question 5

What is the reversal agent for diazepam and midazolam?

Answer 5

Flumazenil 0.01mg/kg

Question 6

Valium: 0.25 mg/kg orally. Versed 0.5 mg/kg orally. Flumazenil is the reversal agent for benzoes and the does is 0.01 mg/kg repeated up to a total of ___ mg

Answer 6

1 mg. reversal effect doesn’t occur for up to 1-2 minutes

Question 7

What is the narcotic reversal dosage for demerol/meperidine?

Answer 7

Naloxone 0.1 mg/kg

Question 8

Behavior shaping incorporates TSD, but also corrects any mis-behavior

Answer 8

As well as demanding the reinforcement of cooperative behavior, behavior shaping also includes the need to retrace steps if misbehavior occurs. For example, if a child is shown an instrument and looks away, the dentist must revert to the explanatory portion of the procedure. Behavior shaping requires that the “Desired behavior” be observed along the way. If the dentist proceeds along the sequential steps and begins performing treatment when the desired behavior is not present, there is deviation from the learning model and a greater likelihood of increased misbehavior

Question 9

Where does nitrous oxide act?

Answer 9

CNS depressant, minimal CV or respiratory effects. Anxiolytic and minimal analgesia

Question 10

term for change per unit time?

Answer 10

velocity

Question 11

T/F: Nitrous oxide is contraindicated for patients with patients with potential closed-space diseases such as bowel obstruction, middle ear disease, pneumothorax, pneumocephaly, TB, moderate-severe wheezing, otitis media, nasopharyngeal obstruction (secondary to sinus infection, anatomy, etc.)

Answer 11

True

Question 12

Which is associated with Freud?

a) Psycho-sexual
b) Psycho-social
c) Classical conditioning
d) Operant conditioning and selective reinforcement
e) Cognitive theory
f) Hierarchy of needs

Answer 12

a_ Psycho-sexual

Question 13

What drug is a narcotic that we use for sedation?

Answer 13

Demerol/Meperidine. It can cause CNS, CV, respiratory depression

Reversal is nalozone 0.1 mg/kg

Question 14

Reversal for opioid / mg?

Answer 14

Narcan/Naloxone 0.1 mg/kg. Meperidine is a narcotic

Question 15

Which is associated with Piaget?

a) Psycho-sexual
b) Psycho-social
c) Classical conditioning
d) Operant conditioning and selective reinforcement
e) Cognitive theory
f) Hierarchy of needs

Answer 15

e) Cognitive theory

how children think vs what they know, thoughts influence future actions and ideas

Question 16

Which is associated with Skinner?

a) Psycho-sexual
b) Psycho-social
c) Classical conditioning
d) Operant conditioning and selective reinforcement
e) Cognitive theory
f) Hierarchy of needs

Answer 16

d) Operant conditioning and selective reinforcement

Question 17

What are the effects of diazepam (valium)?

Answer 17

amnesia, ataxia (Note: The reversal agent for valium and versed is flumazenil 0.01 mg/kg)

Question 18

term for linear direction overall

Answer 18

magnitude

Question 19

What are the effects of Diazepam (Benzo)?

Answer 19

CNS depression with minial CV or respiratory effects (similar to nitrous oxide)

Sedative, hypnotic

Question 20

What is considered the conerstone of behavior management?

Answer 20

TSD - use successive approximations. More than 4 decages ago, Addelston formalized a technique that encompasses several concepts from learning theory. It was called the tell-show-do technique. Since its introduction in 1959, it has remained a cornerstone of behavior management. TSD is a series of successive approximations. It is a component of behavior shaping that should be routinely used by all members of the dental team who work with children

Question 21

Which is associated with Pavlov?

a) Psycho-sexual
b) Psycho-social
c) Classical conditioning
d) Operant conditioning and selective reinforcement
e) Cognitive theory
f) Hierarchy of needs

Answer 21

c) Classical conditioning-reflex

Question 22

What does nitrous do during minutes 3-5 of administration?

Answer 22

Because of its low solubility in blood, it has a very rapid onset and recovery time. Nitrous oxide will become saturated in blood within 3-5 minutes following administration and is physically dissolved in the serum fraction of the blood. There is no biotransformation, and the gas is rapidly excreted by the lungs when the concentration gradient is reversed. Very small amounts may be found in excreted body fluids and intestinal gas

Question 23

What are some side effects of hydroxyzine (vistaril)?

Answer 23

Antiemetic
Antihistamine
Anxiolytic
Bronchodilator
Analgesia
Dry Mouth

Question 24

Which is associated with Maslow?

a) Psycho-sexual
b) Psycho-social
c) Classical conditioning
d) Operant conditioning and selective reinforcement
e) Cognitive theory
f) Hierarchy of needs

Answer 24

f) Hierarchy of needs

Question 25

T/F: Valium - onset 45-60 minutes peak at 60 minutes. Versed onset is 15 minutes, 30-40 minute working time

Answer 25

True

Question 26

What is considered the gold standard for monitoring ventilatory status and will reveal respiratory compromise within 15 seconds?

Answer 26

Capnography - the capnography monitor detects both the presence and the quality of ventilation by analyzing the concentration of carbon dioxide in the exhaled gasses through differential infared absorption. The end-tidal carbon dioxide concentration is the concentration of carbon dioxide measured at the terminal portion

Question 27

T/F: valium - amnesia and ataxia. Versed - amnesia only

Answer 27

True

Question 28

What is the relationship between nitrous and the enzyme MTHFR, which is involved with the metabolism of folate B9? (and also with children with other vitB deficiencies)

Answer 28

Nitrous oxide inhibits the enzyme methylene-tetrahydrofolate reductase (MTHFR), which can limit the synthesis of DNA severely, causing megaloblastic changes in blood cells and bone marrow. In healthy, neurotypical patients, there generally is no problem when DNA synthesis is inhibited and MRHFR is synthesized quickly. However, there are case reports describing the death of children with a specific genetic enzyme deficiency involved in these chemical pathways

B12 is needed to make red blood cells. Deficiency in B12 can indirectly cause iron deficiency. Folate B9 binds to red blood cells when there is an iron deficiency