Text Chapter Questions Flashcards
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 clinician was.
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.
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
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.
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.
B. tooth extraction.
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.
Lecture: It can support combustion, but it is not going to spontaneously combust.
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.
B. relatively insoluble.
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 cause
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.
The raw ingredient ______________ is heated to create nitrous oxide and water plus a few impurities.
A. nitrogen dioxide
B. ammonium nitrate
C. nitric oxide
D. ammonium chloride
B. ammonium nitrate
A full cylinder of nitrous oxide is likely to be approximately ______% liquid and ______% gas.
A. 50, 50
B. 75, 25
C. 95, 5
C. 95, 5
Oxygen gas is pressurized in the cylinder at 750psi. The oxygen gauge will constantly show an accurate amount of gas remaining in the cylinder.
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.
D. The first statement is false; the second statement is true.
Nitrous oxide is used in the racing industry to
A. enhance engine performance.
B. make cars safer.
C. protect the driver.
D. entertain the audience.
A. enhance engine performance.
The color code for oxygen in the United States is green; however, the universal color most commonly associated with oxygen in many other parts of the world is
A. blue.
B. white.
C. black.
D. gray.
B. white.
Reducing pressure from the cylinder to an appropriate level for patient inhalation is accomplished by the
A. nasal hood.
B. non-rebreathing valve.
C. regulator.
D. oxygen flush valve.
C. regulator.
The safety device that prevents inadvertent attachment of the N2O cylinder to the O2 yoke on a portable unit is called the
A. diameter index safety system.
B. pin index safety system.
C. oxygen fail-safe system.
B. pin index safety system.
The oxygen fail-safe device that is required on all N2O/O2 sedation machines ensures that
A. 100% N2O cannot be delivered.
B. 100% O2 is being delivered.
C. equal amounts of N2O and O2 are being delivered.
D. there is sufficient O2 remaining in the cylinder.
A. 100% N2O cannot be delivered.
Conduction tubing connects the ___________ to the ________________ on the N2O/O2 sedation machine.
A. oxygen flush valve, face mask
B. regulator, flowmeter
C. flowmeter, nasal hood
D. cylinder, flowmeter
C. flowmeter, nasal hood
From the following list, select three items associated with a central gas supply N2O/O2 sedation system.
A. Manifold
B. Large cylinders (G, H)
C. Small cylinders (E)
D. Regulator
E. Yoke stand
A. Manifold
B. Large cylinders (G, H)
D. Regulator
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.
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
A patient who does not show any signs or symptoms during the administration of N2O/O2 sedation is considered to be
A. hyporesponsive.
B. hyperresponsive.
A. hyporesponsive.
Each of the following can be accomplished using the titration technique for N2O/O2 sedation except one. Which one is the exception?
A. Allows for individual biovariability.
B. Minimizes oversedation potential.
C. Delivers only the amount of drug necessary.
D. Standardizes all patient reactions.
E. Uncovers idiosyncratic reactions early.
D. Standardizes all patient reactions.
The concept of individual biovariability when administering drugs is based on the premise that
A. the majority of people react the same way to the same drug.
B. individuals may not react similarly to the same drug on different days.
C. individuals are likely to require the same amount of a drug when prescribed at different times.
D. all people will react to a drug regardless of the dose.
B. individuals may not react similarly to the same drug on different days.
All but one of the following are signs of an appropriate level of sedation using N2O/O2. Which one is this exception?
A. Patient is comfortably warm.
B. Patient smiles easily.
C. Patient is unable to keep mouth open.
D. Patient indicates tingling in extremities.
C. Patient is unable to keep mouth open.
All but one of the following are signs of patient oversedation when using N2O/O2 sedation. Which one is this exception?
A. Slow blink rate
B. Dizziness
C. Nausea
D. Slurred speech
E. Floating sensation
A. Slow blink rate
A tingling sensation in the extremities is a sign seen with all patients using N2O/O2 sedation. All patients appropriately sedated using N2O/O2 sedation will have intact cough and gag reflexes.
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.
D. The first statement is false; the second statement is true.
Which of the following presents a sign with respect to hearing that would indicate an appropriate level of sedation?
A. Voices may seem further away.
B. Normal sounds are now very loud and clear.
C. Humming noises drown out normal sounds.
D. No sound is detectable
A. Voices may seem further away.
Monitoring a patient’s signs and symptoms throughout the entire sedation experience is vital to success. Which of the following indicates an appropriate sequence of events leading to a relaxed and comfortable patient?
A. Awareness of surroundings to detachment of environment
B. Active eyes to slowed blink rate to inability to keep eyes open
C. Appropriate verbal response to conversation to slurred, inaudible speech
D. Slight tingling in extremities to vasodilation in face and neck
D. Slight tingling in extremities to vasodilation in face and neck
As you begin N2O/O2 administration, you deliver 7L/min oxygen while securing the nasal hood to the patient. As the patient inhales, you notice the reservoir bag collapsing. What is your next course of action?
A. Ask the patient to take deeper respirations.
B. Ask the patient to take shallower respirations.
C. Increase the oxygen flow to the patient.
D. Decrease the oxygen flow to the patient.
C. Increase the oxygen flow to the patient.
All of the following statements are true regarding the technique for administering N2O/O2 sedation except one. Which one is this exception?
A. Always titrate the amount of nitrous oxide being used.
B. Begin the procedure with 100% O2 when establishing minute volume.
C. Oxygenate the patient for a minimum of 5 minutes following termination of N2O.
D. Squeeze out the mixture of gases in the reservoir bag before postoxygenation.
D. Squeeze out the mixture of gases in the reservoir bag before postoxygenation.
An acceptable amount of nitrous oxide to begin the titration technique for an adult requiring 7L/min would be ________ on a machine with floating balls in glass tubes.
A. 1 to 1½ liters
B. 2 to 2½ liters
C. 3 to 3½ liters
A. 1 to 1½ liters
Which of the following indicates the procedure to follow when a patient suddenly feels uncomfortable in any way during N2O/O2 sedation?
A. Direct the patient to relax and breathe slowly.
B. Decrease the percentage of nitrous oxide being delivered to the patient.
C. Monitor the patient for further signs of distress.
D. Activate the emergency medical system (EMS).
B. Decrease the percentage of nitrous oxide being delivered to the patient.
Which of the following would be an appropriate example of the recommended titration technique?
A. Administer a dose of nitrous oxide and wait 10 to 15 seconds before administering the next dose.
B. Begin by administering 25% nitrous oxide and add 25% each minute thereafter.
C. Administer a 50/50 dose at the outset of the procedure.
D. Wait to administer a subsequent dose until there is sufficient time to evaluate the effects from the preceding dose.
D. Wait to administer a subsequent dose until there is sufficient time to evaluate the effects from the preceding dose.
Which of the following would indicate inadequate recovery of a patient following nitrous oxide/oxygen sedation?
A. After 5 minutes of 100% O2, the patient is feeling normal.
B. Postoperative vital signs are within close range of preoperative values.
C. Patient indicates an altered sense of time taken for the procedure.
D. Patient indicates a “groggy, lethargic” feeling.
D. Patient indicates a “groggy, lethargic” feeling.
Which of the following is the appropriate procedure to follow when the patient indicates he/she is still dizzy following the initial 5 minutes of postoperative 100% oxygen?
A. Direct the patient to wait in the reception area for a period of 15 minutes.
B. Contact an escort to accompany the patient from the office.
C. Administer an additional 5 minutes of 100% oxygen and reassess.
D. Dismiss the patient and document the patient should not receive N2O/O2 sedation at the next visit.
C. Administer an additional 5 minutes of 100% oxygen and reassess.
In addition to dentistry, N2O/O2 sedation has had a long-standing history of use in
A. obstetrics.
B. psychiatry.
C. occupational therapy.
D. optometry.
A. obstetrics.
A recent increase in use of N2O/O2 sedation has been noted in emergency medicine. All of the following are potential indications within the emergency department (ED) except one. Which one is the exception?
A. Radiograph acquisition
B. Laceration repair
C. Wound débridement
D. Angioplasty
D. Angioplasty
Health disciplines other than dentistry using N2O/O2 sedation are likely to use a full face mask for gas delivery. N2O/O2 sedation used in the ambulance is likely to be a 50:50% system with demand flow.
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.
A. Both statements are true.
N2O/O2 sedation can be useful when taking oral radiographs because it
A. allows the patient to open his/her mouth wider.
B. depresses the oral gag reflex.
C. reduces the amount of radiation delivered to the patient.
B. depresses the oral gag reflex.
The initial flow of N2O/O2 in liters per minute (L/min) for a child between 3 and 5 years of age should be set to
A. 0.1 to 3.
B. 3 to 5.
C. 5 to 7.
D. 7 to 9.
B. 3 to 5.
Each of the following is relevant to pediatric N2O/O2 sedation except one. Which one is the exception?
A. Unobstructed upper airway
B. Medications taken
C. Patient’s acceptance of the nasal mask
D. Patient’s weight
D. Patient’s weight
Which of the following has the largest impact on adverse events?
A. Age of patient
B. Duration of nitrous oxide exposure
C. Nitrous oxide concentration
D. Gender of patient
B. Duration of nitrous oxide exposure
Inadequate sedation or failure is more frequently reported when N2O/O2 is administered in patients with
A. sickle cell disease.
B. intellectual disability.
C. mild asthma.
D. epilepsy.
B. intellectual disability.
The least frequently observed sign of N2O/O2 sedation in children is
A. open eyes.
B. limp legs.
C. open hands.
D. laughter.
D. laughter.
Scavenging devices recommended to minimize N2O concentrations in a dental operatory include all of the following except one. Which one is this exception?
A. Recirculating exhaust ventilation system
B. Adequate suction systems that vent outside
C. Use of scavenging mask/nasal hood
D. Regular inspection of equipment for leakage
A. Recirculating exhaust ventilation system
The maximum exposure limit of 500ppm N2O for dental personnel set by NIOSH in 1977 is still in effect today. This Occupational Exposure Limit for the United States was based on sound biologic data from valid, reliable research.
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.
D. The first statement is false; the second is true.
It is recommended to periodically calibrate and perform routine maintenance on the flowmeter. Manufacturers’ recommendations may vary but a typical timeframe is every _____ years.
A. 2
B. 5
C. 16
D. 20
A. 2
A scavenging mask/nasal hood prevents waste gas from being eliminated through the patient’s mouth.
A. This statement is true.
B. This statement is false.
B. This statement is false.
A major source of trace nitrous oxide that contaminates the ambient air in a dental office is from:
A. the patient talking.
B. cracked reservoir bags.
C. leaking valve stems on the cylinder.
D. improperly soldered central piping.
A. the patient talking.
Each of the following could be a typical product used as an inhalant except one. Which one is the exception?
A. Airplane glue
B. Butter
C. Paint thinner
D. Shoe polish
B. Butter
Symptoms of neuropathy commonly seen in persons who chronically abuse N2O include all of the following except one. Which one is this exception?
A. Unsteady gait, clumsiness
B. Tingling and/or paresthesia in extremities
C. Impaired psychomotor function and dexterity
D. Insomnia, acute sensitivity, hyperactivity
D. Insomnia, acute sensitivity, hyperactivity
Research studies claim chronic exposure to nitrous oxide can inhibit which vitamin B12–dependent enzyme?
A. Methionine synthase
B. Monoamine oxidase
C. Catechol-O-methyl transferase
D. Reverse transcriptase
E. ATPase
A. Methionine synthase
N2O has been shown to affect vitamin B12 metabolism. It oxidizes the cobalt ion in the vitamin B12 cofactor, rendering the enzyme methionine synthase inactive in folate metabolic pathways. Methionine synthase plays a vital role in the production of DNA. Megaloblastic hematopoiesis and leukopenia result after prolonged exposure to N2O.
Each of the following is true regarding inhaling chemicals EXCEPT one. Which one is the EXCEPTION?
A. The chemicals are found in a variety of household products.
B. All chemical inhalants are illegal to sell to minors.
C. The “high” is short-lived and quickly obtained.
D. Products typically inhaled are relatively inexpensive.
B. All chemical inhalants are illegal to sell to minors.
The definition of “direct supervision” found in a state’s medical or dental practice act regarding the administration of N2O/O2 sedation by an auxiliary would indicate the __________ presence of a physician or dentist.
A. mandatory
B. voluntary
A. mandatory
The legal parameters of N2O/O2 sedation administration are found in a state’s codified law. Legal parameters of N2O/O2 sedation administration are the same for every state in the United States.
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.
C. The first statement is true; the second statement is false.
Informed consent for N2O/O2 sedation should be obtained each time it is administered. It is recommended that ____________ consent be acquired.
A. verbal
B. written
B. written
Administering nitrous oxide and oxygen to a patient who requests it “because it makes me feel like I’m high and I like that” would be considered
A. appropriate.
B. unethical.
C. the standard of care.
B. unethical.
