Deck 11: Fundamentals for Administration of Local Anesthetic Agents

Question 1

Match the following

-Aspiration test

A) Bevel contacts vessel wall
B) Piercing point
C) Near nerve endings
D) Target
E) Delivery rate
F) Supraperiosteal
G) Near nerve trunk
H) Passageway
I) PREP
J) Blood in cartridge

Answer 1

Blood in cartridge

Question 2

Match the following

-Deposition site

A) Bevel contacts vessel wall
B) Piercing point
C) Near nerve endings
D) Target
E) Delivery rate
F) Supraperiosteal
G) Near nerve trunk
H) Passageway
I) PREP
J) Blood in cartridge

Answer 2

Target

Question 3

Match the following

-False-negative aspiration

A) Bevel contacts vessel wall
B) Piercing point
C) Near nerve endings
D) Target
E) Delivery rate
F) Supraperiosteal
G) Near nerve trunk
H) Passageway
I) PREP
J) Blood in cartridge

Answer 3

Bevel contacts vessel wall

Question 4

Match the following

-Field block injection

A) Bevel contacts vessel wall
B) Piercing point
C) Near nerve endings
D) Target
E) Delivery rate
F) Supraperiosteal
G) Near nerve trunk
H) Passageway
I) PREP
J) Blood in cartridge

Question 5

Match the following

-Infiltration injection

A) Bevel contacts vessel wall
B) Piercing point
C) Near nerve endings
D) Target
E) Delivery rate
F) Supraperiosteal
G) Near nerve trunk
H) Passageway
I) PREP
J) Blood in cartridge

Question 6

Match the following

-Needle pathway

A) Bevel contacts vessel wall
B) Piercing point
C) Near nerve endings
D) Target
E) Delivery rate
F) Supraperiosteal
G) Near nerve trunk
H) Passageway
I) PREP
J) Blood in cartridge

Question 7

Match the following

-Nerve block injection

A) Bevel contacts vessel wall
B) Piercing point
C) Near nerve endings
D) Target
E) Delivery rate
F) Supraperiosteal
G) Near nerve trunk
H) Passageway
I) PREP
J) Blood in cartridge

Question 8

Match the following

-Penetration site

A) Bevel contacts vessel wall
B) Piercing point
C) Near nerve endings
D) Target
E) Delivery rate
F) Supraperiosteal
G) Near nerve trunk
H) Passageway
I) PREP
J) Blood in cartridge

Question 9

Match the following

-Speed and volume

A) Bevel contacts vessel wall
B) Piercing point
C) Near nerve endings
D) Target
E) Delivery rate
F) Supraperiosteal
G) Near nerve trunk
H) Passageway
I) PREP
J) Blood in cartridge

Question 10

Match the following

-Supportive communication

A) Bevel contacts vessel wall
B) Piercing point
C) Near nerve endings
D) Target
E) Delivery rate
F) Supraperiosteal
G) Near nerve trunk
H) Passageway
I) PREP
J) Blood in cartridge

Question 11

Informed consent should be obtained from a patient or guardian prior to administering injections.

Question 12

The deposition site for a nerve block injection is at a greater distance from the penetration site than for a field block or infiltration injection.

Question 13

The greater the distance from penetration to deposition site, the greater the potential for deviation of the needle.

Question 14

False-negative aspirations typically occur when a clinician has failed to develop adequate negative pressure with the thumb ring.

Question 15

The two most important patient safety steps during an injection are locating the penetration site and deposition sites.

Question 16

The first step of the Standard Operating Procedure for all injections is locating and preparing armamentarium.

Question 17

A patient's head should be in a position higher than the heart for comfort during injections.

Question 18

Most topical anesthetic agents will reach peak effectiveness in about 5 minutes.

Question 19

Gently pulling the mucosa taut will ease penetration of the needle and establish a point of stability for the syringe.

Question 20

Regardless of the amount of blood in a cartridge following positive aspiration, the best practice is to withdraw the needle and reinject.

Question 21

If there are repeated positive aspirations at the same injection site, rescheduling should be considered.

Question 22

The safest rate of deposition of local anesthetics allows for the delivery of approximately1.0 mL of solution per minute.

Question 23

The most stable position when using a syringe is palm up.

Question 24

Resting an elbow on a patient's shoulders or chest during injection creates good stabilization and is a safe ergonomic practice.

Question 25

A clinician should not stand during the administration of local anesthesia injections.

Question 26

The ________ refers to the specific location where a needle first pierces mucosa.

Question 27

The ________ refers to the route a needle travels as it advances to the deposition site.

Question 28

The ________ is defined as the anatomical location at which a drug is deposited.

Question 29

The two most important safety steps in the delivery of local aesthetic agents are ________.

Question 30

________ tests reduce the risk of inadvertent deposition of drugs into the bloodstream.

Question 31

A ________ aspiration can occur when a bevel is in contact with a vessel wall.

Question 32

An ________ injection deposits local anesthetics directly at or near small terminal nerve endings.

Question 33

Efforts to reduce stress from the beginning to the end of an injection are enhanced by maintaining positive, ________ with the patient.

Question 34

The greater the distance from penetration site to deposition site, the greater the potential for ________ of the needle tip.

Question 35

A ________ injection deposits local anesthetics near larger terminal nerve branches.

Question 36

A ________ injection deposits local anesthetic near major nerve trunks at a greater distance from the area of treatment, which provides wider areas of anesthesia.

Question 37

Drying tissue with gauze can reduce ________ of topical agents and improve their uptake into mucosa.

Question 38

Most topical anesthetic agents will reach peak effectiveness in about ________ minute(s).

Question 39

The final safety step during an injection procedure is to properly ________ the needle prior to disposal.

Question 40

Which of the following is not an element of informed consent in local anesthesia?

A) Discussing risks
B) Providing alternatives
C) Providing information in a language patients understand
D) Explaining the costs of procedures

Question 41

What are the two most important safety steps during a local anesthetic injection?

A) Aspiration before depositing and recapping needles
B) Slow administration and recapping needles
C) Patient evaluation and aspiration
D) Aspiration before depositing and administering drugs slowly

Question 42

Which of the following is important but is not a recommended step in the PREP strategy?

A) Prepare patient
B) Rehearse injection
C) Empower patient
D) Plan debriefing

Question 43

Supportive communication includes all of the following, except:

A) It should begin during the pre-injection period
B) It should involve positive comments focusing on patient behavior during injections
C) It lets patients know that injections will be more comfortable compared to previous injections
D) It includes rehearsing injections and providing ways for patients to communicate with clinicians during injection

Question 44

An injection technique that deposits anesthetic solution near terminal nerve endings is called:

A) A periodontal ligament injection
B) A field block injection
C) An infiltration injection
D) A nerve block injection

Question 45

An injection that deposits anesthetic solution near a major nerve trunk is called:

A) A periodontal ligament injection
B) A supraperiosteal injection
C) A field block injection
D) A nerve block injection

Question 46

A field block injection is also called:

A) A superperiosteal injection
B) A periodontal ligament injection
C) A nerve block injection
D) An interpapillary injection

Question 47

Which of the following describes the penetration site?

A) Needle pierces mucosa
B) Needle pierces the muscle
C) Needle pierces a vessel
D) Anesthetic solution is deposited

Question 48

Which of the following describes the target site for local anesthetic solution?

A) Penetration site
B) Needle pathway
C) Aspiration site
D) Deposition site

Question 49

What is the first step in preparation for local anesthesia injections?

A) Obtain informed consent
B) Prepare the armamentarium
C) Make sure solution will flow through the needle
D) Assess the patient

Question 50

What is the primary reason it is recommended to orient needle bevels toward bone during infiltration injections?

A) Needles should be angled away from bone during penetration
B) Trauma to periosteum is lessened if bone is inadvertently contacted
C) False aspirations can be prevented
D) Discomfort from needles is reduced

Question 51

Which of the following is the most appropriate documentation following local anesthesia injections?

A) 03/03/2014: Review health history. BP 115/78. Two cartridges of 4% prilocaine (144 mg) w/epi 1:100,000 (0.036 mg), benzocaine topical, Rt PMC, MMC, GP, (-) aspiration. No adverse reactions.
B) Review health history. BP 120/70. Three cartridges 3% mepivacaine w/1:20,000 levonordefrin. No adverse reactions.
C) 05/03/2014: Review health history. Two cartridges 2% lidocaine w/epi, (-) aspiration.
D) 07/07/14: Review health history. BP normal. One and a half cartridges (27 mg) of 2% lido w/1:100:00 epi, Left IA and buccal, (-) aspiration. No adverse reactions.

Question 52

Which of the following is the most important safety step following an injection?

A) Rinsing the patient's mouth
B) Assessing the patient for adverse reactions
C) Recapping the needle with a one-handed technique
D) Making a complete chart entry

Question 53

Which statement describes the correct positioning of the long window of the syringe?

A) Toward the clinician to permit visibility throughout the injection
B) Away from the patient to block visibility throughout the injection
C) Toward the patient to permit assessment of the duration of the injection
D) Either toward or away from the clinician because both sides of the syringe have an opening

Question 54

Which statement best describes why retraction of tissue keeping the tissue taut is important during injections?

A) The patient's mouth is open and it improves visibility for the clinician.
B) It eliminates the need for stabilization of syringe and fulcrum.
C) It allows better identification of landmarks.
D) It allows for ease of needle penetration and establishes a point of stability for the syringe.

Question 55

What is the minimum recommended rate of injection?

A) 0.5 mL per minute
B) l.8 mL per minute
C) 1.0 mL per two minutes
D) 3.0 mL per minute

Question 56

Which statement describes how to avoid a false-negative aspiration?

A) Withdraw the syringe slightly and reaspirate to release the bevel from a vessel wall
B) Rotate the syringe a quarter turn then reaspirate to release the bevel from a vessel wall
C) Apply greater force on the thumb ring to permit blood to enter cartridge
D) Avoid injections in highly vascular areas

Question 57

Which of the following procedures represents the correct response following a positive aspiration when a small wormlike thread enters the cartridge?

A) Withdraw the syringe and reinject
B) Reposition the syringe away from the area of the positive aspiration, and deposit solution following a negative aspiration
C) Withdraw the syringe, change the cartridge, clear the needle of blood and reinject
D) Rotate the syringe a quarter turn, reaspirate and continue to deposit solution

Question 58

What is the most important goal of ergonomic positioning?

A) Prevention of cumulative trauma disorders
B) Stabilization of the syringe
C) Prevention of patient injury
D) Patient comfort and safety

Question 59

Which of the following is not a basic element of good ergonomic positioning?

A) Keep wrists at a neutral angle
B) Bend from the waist
C) Bend from the hips
D) Do not raise arms more than 30 degrees

Question 60

What elements are included in an informed consent?

Question 61

Explain how an aspiration test performed?

Question 62

Discuss management of a positive aspiration.

Question 63

What is a false-negative aspiration and how can it be prevented?

Question 64

What information is documented in a patient record for local anesthetic injections? Provide an example.

Question 65

Discuss the basic elements of good ergonomic position and balance.