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Chapter 01: Patient Evaluation and Risk Assessment
ss ss ss ss ss ss
Little: Dental Management of the Medically Compromised Patient, 9th Edition
ss ss ss ss ss ss ss ss ss
MULTIPLE CHOICE ss
1. Elective dental care should be deferred for patients with severe, uncontrolled
ss ss ss ss ss ss ss ss ss ss
ss hypertension, meaning that the blood pressure is greater than or equal to mm Hg.
ff ss ss ss ss ss ss ss ss ss ss ss ss
a. 200/140
b. 180/140
c. 180/110
d. 160/110
ANS: C ss
Elective dental care should be deferred for patients with severe, uncontrolled
ss ss ss ss ss ss ss ss ss ss
hypertension,which is blood pressure greater than or equal to 180/110 mm Hg, until the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
condition can bebrought under control.
ss ss ss ss ss
2. The American Heart Association currently recommends antibiotic prophylaxis for a
ss ss ss ss ss ss ss ss ss
patient with which of the following cardiac conditions?
ss ff ss ss ss ss ss ss
a. Mitral valve prolapse ss ss
b. Prosthetic heart valve ss ss
c. Rheumatic heart disease ss ss
d. Pacemakers for cardiac arrhythmias ss ss ss
ANS: B ss
Previously, the American Heart Association (AHA) recommended antibiotic prophylaxis
ss ss ss ss ss ss ss ss
formany patients with heart murmurs caused by valvular disease (e.g., mitral valve
ss ss ss ss ss ss ss ss ss ss ss ss
prolapse, rheumatic heart disease) in an effort to prevent infective endocarditis; however,
ss ss ss ss ss ss ss ss ss ss ss ss
current guidelines omit this recommendation on the basis of accumulated scientific
ss ss ss ss ss ss ss ss ss ss ss
evidence. If a murmur is due to certain specific cardiac conditions (e.g., previous
ss ss ss ss ss ss ss ss ss ss ss ss ss
endocarditis, prosthetic heart valve, complex congenital cyanotic heart disease), the AHA
ss ss ss ss ss ss ss ss ss ss ss
continues to recommend antibiotic prophylaxis for most dental procedures.
ss ss ss ss ss ss ss ss ss
3. One consequence of chronic hepatitis (B or C) or cirrhosis of the liver is decreased ability
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
ss of the body to
ff ss ss certain drugs, including local anesthetics and analgesics.
ss ss ss ss ss ss
a. absorb
b. distribute
c. metabolize
d. excrete
ANS: C ss
Patients also may have chronic hepatitis (B or C) or cirrhosis, with
s s s s ss s s ss s s ss s s ss s s s s
impairment of liver function. This deficit may result in prolonged bleeding and less
ss s s ss ss ss ss ss ss ss ss ss ss ss
efficient metabolism ofcertain drugs, including local anesthetics and analgesics.
ss ss ss ss ss ss ss ss ss
4. Which of the following symptoms and signs is most consistent with allergy?
ss ss ss ss ss ss ss ss ss ss ss
a. Heart palpitations ss
b. Itching
c. Vomiting
d. Fainting
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ANS: B ss
Symptoms and signs consistent with allergy include itching, urticaria (hives), rash,
ss ss ss ss ss ss ss ss ss ss
swelling,wheezing, angioedema, runny nose, and tearing eyes. Isolated signs and
ss ss ss ss ss ss ss ss ss ss
symptoms such as nausea, vomiting, heart palpitations, and fainting generally are not of
ss ss ss ss ss ss ss ss ss ss ss ss ss
s an allergic origin but rather are manifestations of drug intolerance, adverse side effects,
s ss ss ss ss ss ss ss ss ss ss ss ss
or psychogenic reactions.
ss ss ss
5. Which of the following is true of the patient with a history of tuberculosis?
ss ss ss ss ss ss ss ss ss ss ss ss ss
a. A positive result on skin testing means that the person has active TB.
ss ss ss ss ss ss ss ss ss ss ss ss
b. Most patients who become positive skin testers develop active disease.
ss ss ss ss ss ss ss ss ss
c. Patients with acquired immunodeficiency syndrome (AIDS) have a high
ss ss ss ss ss ss ss ss
incidence of tuberculosis.
ss ff ss
d. A diagnosis of active TB is made by a purified protein derivative (PPD) skin test.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
ANS: s s C
The potential coexistence of tuberculosis and acquired immunodeficiency syndrome
ss ss ss ss ss ss ss ss
(AIDS) should be explored because patients with AIDS have a high incidence of
ss ss ss ss ss ss ss ss ss ss ss ss ss
tuberculosis. A positive result on skin testing means specifically that the person has at
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
some time been infected with TB, not necessarily that active disease is present. Most
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
patients who become positive skin testers do not develop active disease. A diagnosis of
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
active TB is made by chestx-ray, imaging, sputum culture, and clinical examination.
ss ss ss ss ss ss ss ss ss ss ss ss
6. Vasoconstrictors should be avoided in patients who cocaine or methamphetamine ss ss ss ss ss ss ss ss ss
usersbecause these agents may precipitate
ss ss ss ss ss .
a. severe hypotension ss
b. severe hypertension ss
c. respiratory depression ss
d. cessation of intestinal peristalsis ss ss ss
ANS: B ss
Vasoconstrictors should be avoided in patients who are cocaine or methamphetamine ss ss ss ss ss ss ss ss ss ss
usersbecause the combination may precipitate arrhythmias, MI, or severe hypertension.
ss ss ss ss ss ss ss ss ss ss
7. It has been shown that the risk for occurrence of a serious perioperative cardiovascular
ss ss ss ss ss ss ss ss ss ss ss ss ss
event (e.g., MI, heart failure) is increased in patients who are unable to meet a -MET
ss ff ss ss ss ss ss ss ss ss ss ss ss ss ss ss
(metabolic equivalent of task) demand during normal daily activity.
ss ss ss ss ss ss ss ss ss
a. 4
b. 6
c. 8
d. 10
ANS: A ss
Daily activities requiring 4 METs include level walking at 4 miles/hour or climbing a flight
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
ofstairs. Activities requiring greater than 10 METs include swimming and singles tennis. An
ss ss ss ss ss ss ss ss ss ss ss ss ss
exercise capacity of 10 to 13 METs indicates excellent physical conditioning.
ss ss ss ss ss ss ss ss ss ss ss
8. Which of the following alterations in the fingernails is associated with cirrhosis?
ss ss ss ss ss ss ss ss ss ss ss
a. Yellowing
b. Clubbing
c. White discoloration ss
d. Splinter hemorrhages ss
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ANS: C ss
Alterations in the fingernails, such as clubbing (seen in cardiopulmonary insufficiency),
ss ss ss ss ss ss ss ss ss ss
white discoloration (seen in cirrhosis), yellowing (from malignancy), and splinter
ss ff ss ss ss ss ss ss ss ss
hemorrhages (from infective endocarditis) usually are caused by chronic disorders.
ss ss ss ss ss ss ss ss ss ss
9. A blood pressure cuff should be placed on the upper arm and inflated until
ss ss ss ss ss ss ss ss ss ss ss ss ss .
a. the radial pulse disappears
ss ss ss
b. the radial pulse disappears and then inflated an additional 20 to 30 mm Hg
ss ss ss ss ss ss ss ss ss ss ss ss ss
c. two fingers cannot fit comfortably under the cuff
ss ss ss ss ss ss ss
d. the pulse no longer can be heard with the stethoscope
ss ss ss ss ss ss ss ss ss
ANS: B ss
While the radial pulse is palpated, the cuff is inflated until the radial pulse
ss ss ss ss ss ss ss ss ss ss ss ss ss
disappears (approximate systolic pressure); it is then inflated an additional 20 to 30 mm Hg.
ss ff ss ss ss ss ss ss ss ss ss ss ss ss ss
10. Which of the following is true of a patient classified ASA III according to the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
ss AmericanSociety of Anesthesiologists (ASA) Physical Status Classification System?
ss ss ss ss ss ss ss
a. Patient has mild systemic disease. ss ss ss ss
b. Patient’s disease has significant impact on daily activity.
ss ss ss ss ss ss ss
c. Patient’s disease is unlikely to have impact on anesthesia and surgery.
ss ss ss ss ss ss ss ss ss ss
d. Patient is moribund. ss ss
ANS: B ss
Patient with severe systemic disease is a constant threat to life (e.g., recent myocardial
ss ss ss ss ss ss ss ss ss ss ss ss ss
infarction, stroke, transient ischemic attach [<3 months], ongoing cardiac ischemia,
ss ss ss ss ss ss ss ss ss ss
severe valve dysfunction, respiratory failure requiring mechanical ventilation). Serious
ss ss ss ss ss ss ss ss ss
limitation of daily activity; likely major impact on anesthesia and surgery.
ss ss ff ss ss ss ss ss ss ss ss
WWW.NURSYLAB.COM
Stuvia.com - The Marketplace to Buy and Sell your Study
Page 1 of 74
WWW.NURSYLAB.COM
, WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study
Page 1 of 74
Chapter 01: Patient Evaluation and Risk Assessment
ss ss ss ss ss ss
Little: Dental Management of the Medically Compromised Patient, 9th Edition
ss ss ss ss ss ss ss ss ss
MULTIPLE CHOICE ss
1. Elective dental care should be deferred for patients with severe, uncontrolled
ss ss ss ss ss ss ss ss ss ss
ss hypertension, meaning that the blood pressure is greater than or equal to mm Hg.
ff ss ss ss ss ss ss ss ss ss ss ss ss
a. 200/140
b. 180/140
c. 180/110
d. 160/110
ANS: C ss
Elective dental care should be deferred for patients with severe, uncontrolled
ss ss ss ss ss ss ss ss ss ss
hypertension,which is blood pressure greater than or equal to 180/110 mm Hg, until the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
condition can bebrought under control.
ss ss ss ss ss
2. The American Heart Association currently recommends antibiotic prophylaxis for a
ss ss ss ss ss ss ss ss ss
patient with which of the following cardiac conditions?
ss ff ss ss ss ss ss ss
a. Mitral valve prolapse ss ss
b. Prosthetic heart valve ss ss
c. Rheumatic heart disease ss ss
d. Pacemakers for cardiac arrhythmias ss ss ss
ANS: B ss
Previously, the American Heart Association (AHA) recommended antibiotic prophylaxis
ss ss ss ss ss ss ss ss
formany patients with heart murmurs caused by valvular disease (e.g., mitral valve
ss ss ss ss ss ss ss ss ss ss ss ss
prolapse, rheumatic heart disease) in an effort to prevent infective endocarditis; however,
ss ss ss ss ss ss ss ss ss ss ss ss
current guidelines omit this recommendation on the basis of accumulated scientific
ss ss ss ss ss ss ss ss ss ss ss
evidence. If a murmur is due to certain specific cardiac conditions (e.g., previous
ss ss ss ss ss ss ss ss ss ss ss ss ss
endocarditis, prosthetic heart valve, complex congenital cyanotic heart disease), the AHA
ss ss ss ss ss ss ss ss ss ss ss
continues to recommend antibiotic prophylaxis for most dental procedures.
ss ss ss ss ss ss ss ss ss
3. One consequence of chronic hepatitis (B or C) or cirrhosis of the liver is decreased ability
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
ss of the body to
ff ss ss certain drugs, including local anesthetics and analgesics.
ss ss ss ss ss ss
a. absorb
b. distribute
c. metabolize
d. excrete
ANS: C ss
Patients also may have chronic hepatitis (B or C) or cirrhosis, with
s s s s ss s s ss s s ss s s ss s s s s
impairment of liver function. This deficit may result in prolonged bleeding and less
ss s s ss ss ss ss ss ss ss ss ss ss ss
efficient metabolism ofcertain drugs, including local anesthetics and analgesics.
ss ss ss ss ss ss ss ss ss
4. Which of the following symptoms and signs is most consistent with allergy?
ss ss ss ss ss ss ss ss ss ss ss
a. Heart palpitations ss
b. Itching
c. Vomiting
d. Fainting
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ANS: B ss
Symptoms and signs consistent with allergy include itching, urticaria (hives), rash,
ss ss ss ss ss ss ss ss ss ss
swelling,wheezing, angioedema, runny nose, and tearing eyes. Isolated signs and
ss ss ss ss ss ss ss ss ss ss
symptoms such as nausea, vomiting, heart palpitations, and fainting generally are not of
ss ss ss ss ss ss ss ss ss ss ss ss ss
s an allergic origin but rather are manifestations of drug intolerance, adverse side effects,
s ss ss ss ss ss ss ss ss ss ss ss ss
or psychogenic reactions.
ss ss ss
5. Which of the following is true of the patient with a history of tuberculosis?
ss ss ss ss ss ss ss ss ss ss ss ss ss
a. A positive result on skin testing means that the person has active TB.
ss ss ss ss ss ss ss ss ss ss ss ss
b. Most patients who become positive skin testers develop active disease.
ss ss ss ss ss ss ss ss ss
c. Patients with acquired immunodeficiency syndrome (AIDS) have a high
ss ss ss ss ss ss ss ss
incidence of tuberculosis.
ss ff ss
d. A diagnosis of active TB is made by a purified protein derivative (PPD) skin test.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
ANS: s s C
The potential coexistence of tuberculosis and acquired immunodeficiency syndrome
ss ss ss ss ss ss ss ss
(AIDS) should be explored because patients with AIDS have a high incidence of
ss ss ss ss ss ss ss ss ss ss ss ss ss
tuberculosis. A positive result on skin testing means specifically that the person has at
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
some time been infected with TB, not necessarily that active disease is present. Most
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
patients who become positive skin testers do not develop active disease. A diagnosis of
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
active TB is made by chestx-ray, imaging, sputum culture, and clinical examination.
ss ss ss ss ss ss ss ss ss ss ss ss
6. Vasoconstrictors should be avoided in patients who cocaine or methamphetamine ss ss ss ss ss ss ss ss ss
usersbecause these agents may precipitate
ss ss ss ss ss .
a. severe hypotension ss
b. severe hypertension ss
c. respiratory depression ss
d. cessation of intestinal peristalsis ss ss ss
ANS: B ss
Vasoconstrictors should be avoided in patients who are cocaine or methamphetamine ss ss ss ss ss ss ss ss ss ss
usersbecause the combination may precipitate arrhythmias, MI, or severe hypertension.
ss ss ss ss ss ss ss ss ss ss
7. It has been shown that the risk for occurrence of a serious perioperative cardiovascular
ss ss ss ss ss ss ss ss ss ss ss ss ss
event (e.g., MI, heart failure) is increased in patients who are unable to meet a -MET
ss ff ss ss ss ss ss ss ss ss ss ss ss ss ss ss
(metabolic equivalent of task) demand during normal daily activity.
ss ss ss ss ss ss ss ss ss
a. 4
b. 6
c. 8
d. 10
ANS: A ss
Daily activities requiring 4 METs include level walking at 4 miles/hour or climbing a flight
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
ofstairs. Activities requiring greater than 10 METs include swimming and singles tennis. An
ss ss ss ss ss ss ss ss ss ss ss ss ss
exercise capacity of 10 to 13 METs indicates excellent physical conditioning.
ss ss ss ss ss ss ss ss ss ss ss
8. Which of the following alterations in the fingernails is associated with cirrhosis?
ss ss ss ss ss ss ss ss ss ss ss
a. Yellowing
b. Clubbing
c. White discoloration ss
d. Splinter hemorrhages ss
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ANS: C ss
Alterations in the fingernails, such as clubbing (seen in cardiopulmonary insufficiency),
ss ss ss ss ss ss ss ss ss ss
white discoloration (seen in cirrhosis), yellowing (from malignancy), and splinter
ss ff ss ss ss ss ss ss ss ss
hemorrhages (from infective endocarditis) usually are caused by chronic disorders.
ss ss ss ss ss ss ss ss ss ss
9. A blood pressure cuff should be placed on the upper arm and inflated until
ss ss ss ss ss ss ss ss ss ss ss ss ss .
a. the radial pulse disappears
ss ss ss
b. the radial pulse disappears and then inflated an additional 20 to 30 mm Hg
ss ss ss ss ss ss ss ss ss ss ss ss ss
c. two fingers cannot fit comfortably under the cuff
ss ss ss ss ss ss ss
d. the pulse no longer can be heard with the stethoscope
ss ss ss ss ss ss ss ss ss
ANS: B ss
While the radial pulse is palpated, the cuff is inflated until the radial pulse
ss ss ss ss ss ss ss ss ss ss ss ss ss
disappears (approximate systolic pressure); it is then inflated an additional 20 to 30 mm Hg.
ss ff ss ss ss ss ss ss ss ss ss ss ss ss ss
10. Which of the following is true of a patient classified ASA III according to the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
ss AmericanSociety of Anesthesiologists (ASA) Physical Status Classification System?
ss ss ss ss ss ss ss
a. Patient has mild systemic disease. ss ss ss ss
b. Patient’s disease has significant impact on daily activity.
ss ss ss ss ss ss ss
c. Patient’s disease is unlikely to have impact on anesthesia and surgery.
ss ss ss ss ss ss ss ss ss ss
d. Patient is moribund. ss ss
ANS: B ss
Patient with severe systemic disease is a constant threat to life (e.g., recent myocardial
ss ss ss ss ss ss ss ss ss ss ss ss ss
infarction, stroke, transient ischemic attach [<3 months], ongoing cardiac ischemia,
ss ss ss ss ss ss ss ss ss ss
severe valve dysfunction, respiratory failure requiring mechanical ventilation). Serious
ss ss ss ss ss ss ss ss ss
limitation of daily activity; likely major impact on anesthesia and surgery.
ss ss ff ss ss ss ss ss ss ss ss
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