NERB Local Anesthesia Exam

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SuzyZee in Carmel, Indiana

35 months ago

Math calculation answers:
The patient you are treating is a 30 year old healthy female. The patient weighs approximately 140 pounds. During the appointment you will be debriding the maxillary left quadrant and your patient requests anesthesia due to gingival recession and sensitivity. The recession is only on the buccal surfaces. She doesn’t appear to have sensitivity on the lingual surfaces. The patient will be given 2% lidocaine (Xylocaine) with 1:100,000 epi. State the maximum safe dose of anesthetic this patient can receive.

• The MRD based on the patients weight is 2.0 mg/lb X 140 lbs = 280 mg

1. Based upon this, how many carpules of 2% lidocaine (Xylocaine) could this patient safely receive?

• Each cartridge of 2% lidocaine contains 20 mg/ml X 1.8 ml/cartridge = 36 mg of lidocaine (See table 4-4 in Malamed)

• If the maximum dose for this patient is 280 mg, then 280mg divided by 36 mg per cartridge = 7.8 cartridges are needed to deliver the maximum safe dose

2. Calculate the maximum safe dose of 4% Citanest (prilocaine) for a 120 pound female.

• The MRD for Prilocaine is 2.7 mg per lb.

• 2.7 mg/lb X 120 lbs = 324 mg, (which is below the absolute maximum of 400 mg.)

3. Based upon this information, how many carpules of 4% Citanest can this patient safely receive?

• The concentration of 4% Prilocaine is 40 mg/ml

• 40 mg/ml x 1.8 ml per cartridge = 72 mg of Prilocaine per cartridge

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SuzyZee in Carmel, Indiana

35 months ago

Math answers cont.

Your patient weighs 64 kilograms. The dentist has completed a quadrant of restorative on the maxillary left quadrant during which he used 3 carpules of 2% lidocaine (Xylocaine) with 1:100,000 epi. You now will be debriding #2 & 3. The patient is uncomfortable and requests anesthesia. The dentist injects another carpule.

4. Calculate the amount of anesthetic (mg) the patient has received.
• The dentist has administered a total of 4 carpules in this case.
• Each carpule of 2% lidocaine contains 36 mg of lidocaine
• 36 mg per cartridge x 4 cartridges = 144 mg of lidocaine have been administered

5. Does this amount exceed the maximum safe dose of local anesthetic drug for this patient?
• The maximum safe dose of 2% lidocaine is 4.4 mg per kg of body weight
• The patient weighs 64 kilograms
• 64 kg X 4.4 mg/kg = 281 mg of lidocaine is the MRD for this patient
• Since the patient has received 144 mg, the maximum safe dose has not been exceeded.

6. Calculate the amount of epinephrine in mg that has been administered to this patient.
• Each cartridge of 2% lidocaine 1:100,000 contains 0.01 mg of epinephrine per ml of solution
• mg/ml x 1.8 ml solution per cartridge = 0.018 mg epinephrine per cartridge
• the patient has received 4 cartridges of anesthetic
• 4 cartridges x 0.018 mg per cartridge = 0.072 mg of epinephrine has been delivered

7. Calculate the maximum safe dose of 3% mepivicaine (Carbocaine) for a 90-pound patient.
• The MRD for 3% mepivacaine is 2 mg per ob of body weight
• 2 mg/lb x 90 lb = 180 mg as the MRD

8. Based upon the answer to #6, how many carpules of 3% mepivicaine (Carbocaine) could the patient be given?
• Each cartridge of 3% mepivacaine has 30 mg per ml. 30 mg/ml x 1.8 ml per cartridge = 54 mg total per cartridge
• 180 mg (MRD) divided by 54 mg per cartridge = 3.3 cartridges would contain the MRD dose for this patient

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SuzyZee in Carmel, Indiana

35 months ago

Math calculation answers cont.
Your patient is a 230 pound male. The patient is being seen by the hygienist first to debride the lower right quadrant. The dentist requests to use 2% lidocaine (Xylocaine) with 1:100,000 epi. The dentist administers 2 carpules of anesthetic. The patient is then seen by the dentist for restorative work. During the procedure the patient experiences sensitivity.

9. How many additional carpules can the dentist safely administer to this patient?
• The MRD for this patient is 300 mg (the maximum dose anyone can receive, regardless of weight. If you said the MRD was 460, you forgot to consider the absolute maximum on the table)
• He has already received 2 carpules of 2% lidocaine.
• 2 cartridges x 36 mg/cartridge = a total dose of 72 mg has been administered
• 300 (maximum recommended dose) – 72 mg (dose already administered) = 228 mg that could yet be administered.
• 228 mg/36 mg per cartridge = 6.3 cartridges could still be delivered to this patient within the MRD

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SuzyZee in Carmel, Indiana

35 months ago

Hopefully the above posts of study guide in one locations and math calculations will help those that I cannot email directly and future posters can find information. I will monitor my posts in a few days from this point on.
I wish to also thank original poster and all that have contributed to this forum.

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SuzyZee in Carmel, Indiana

35 months ago

Melissa in Auburn, Indiana said: Hi could someone please send me the LA study guide also....I'm signed up to take it in a couple of weeks and am terrified! I feel like I don't remember anything. It would really help calm my nerves. Thank you so much! Melcoolman@gmail.com

I was too. Be confident in the sooner you take after course the fresher. Review all my posts from tonight ( forum page 8-9) here. It all should help. I will respond back on Sunday to any questions.

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Neise in Beltsville, Maryland

35 months ago

Suzyzee in Carmel, Indiana said: I immediately made notes and highlited the study guide after I did the prometric LA test:
These points I found -not exact questions but the general idea of what to know that concept I recall:
1.)Beta blockers decrease blood pressure
2.)Why is the significance of giving an amide anesthetic to a patient with cirrhosis? Due to amide anesthetics being metabolized by the liver.
3.)Myelinated nerve question - impulses travel faster than unmyelinated
4.)What is a poss cause of pain upon removal of the needle? Needle barb
5.)needle gauge and which lumen is smallest? Smaller number, larger the lumen
6.)What sensation is lost first - pain (skeletal last and recovers in reverse order)
7.)What function sodium chloride provides in LA solutions? Makes the solution isotonic
8.) sodium bisulfite question -. antioxidant preventing biodegration of LA (if see sodium hydrochloride-it is buffer for pH)
9.) action of vasodepressors - they increase duration of LA
10.)What injection numb lower lip -IANB
11.)What cause if patient had lesion lower lip next day - bit lip
12.)Why infiltration works better in maxilla than mandible - mandible more dense
13.)Where is epi naturally found in body ? Which system -adrenal gland, endocrine
14.)Which anesthetic is not an amide? Procaine (all amides have an "i" in prefix)
15.)If patient has liver disease (cirrhosis), you would use caution with an amide because: it is metab in liver
16.)What is anesthetic suggested deposit rate? 1ml/min
This should help! I also have study guide if need it too

Hey Suzyzee when you get a chance please email me your study guide. I'll be taking the LA exam in a few weeks. My email is csa4998@yahoo.com. Thank you!

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Elissa in Newburgh, Indiana

34 months ago

SuzyZee in Carmel, Indiana said: 40.Location for buccal injection? Distal and buccal to last molar in buccal tissue

41 What injection numb lower lip -IANB

42 Why does anesthetic fail work near abcessed tooth? Ph – acidic,inflammation (not sure exact wording)

43.If ask allergic reaction to anesthetic- choose ester option

44.Which nerve anesthetizes with soft palate? Lesser palantine

45.After injection patient starts getting a rash,says cannot breathe and BP is 9-/60 or something very low-what should you do? Admin epi

46.Injection site for #2 maxillary molar lingual infiltration? 5-10mm from free gingival, vs mucoging junction,papilla,

47.If want hemostasis what injection best choice? Infiltration

48.Know first sign of local anesthetic overdose? CNS Excitement

49.Injection site if want infiltrate #13 lingual? apex of tooth

50.What happens if inject at rate 1mL/sec? I selected No problems as this is recommended rate

Suzy, I was seeing if you could email me your study guide? I would really appreciate it. I am taking the test soon and would sure like something else to study.
Thank you!

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Suzyzee in Carmel, Indiana

34 months ago

Elissa from Newburgh -need your email address.

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Elissa in Newburgh, Indiana

34 months ago

Suzyzee in Carmel, Indiana said: Elissa from Newburgh -need your email address.

marathonmomma366@yahoo.com

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Lauren in Louisville, Kentucky

34 months ago

Suzyzee in Carmel, Indiana said: Elissa from Newburgh -need your email address.

Do you care to email it to me, also???

Lauren.gahafer@yahoo.com

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Micki2866 in Baltimore, Maryland

34 months ago

Can someone please forward via email their study guide for the Local anesthetic exam please.... my email is micki2866@yahoo.com... been studying for the past 2 weeks but would like it for a final review. Tomorrow is the big day! I feel prepared!

Thanks!
Michelle

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emily1204 in Parkville, Maryland

34 months ago

Lindsey in Washington, District of Columbia said: 63 if ask about allergic reaction to an anesthetic, choose the ester option
64 innervation of soft palate is lesser palatine nerve
65 Which nerve is not a branch of the mandibular nerve?
66 What causes a droopy eyelid? Anesthesia of the facial nerve
67 which root is not anesthesia with the psa injections
68 Where do you dispose of used needles?
69 Know allergic reactions – immediate onset verses delayed and how would you manage epinephrine for an immediate and severe, benadryl for delayed
70 pain on injection related to too fast
71 burning on injections could be due to too fast or lower ph from vasoconstrictor
72 Generic and brand names of anesthesia
73 injection site for lingual infiltration of maxillary molars – 5-10mm from the free gingival margin
74 if you want hemostasis, infiltration procedure of choice
Good LUCK, follow this guide, and I guarantee you will ACE IT!
I'm in VA, NERB certified from Michigan!

Hi, i didnt get the study guide from 1-20. I am taking the NERB in a few days and I think i am missing some of the questions. Please help!! thanks!

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emily1204 in Parkville, Maryland

34 months ago

Ellierdh in Fredericksburg, Virginia said: Hi Suzy!

Can you please email me your study guide. I hope its not too late to get it. My email is ellierdh@hotmail.com. Thank you for genuinely helping your fellow hygienist.

I was wondering if you would be able to email the study guide as well? I am Emily from Baltimore and am taking the NERB in a few days. It would be greatly appreciated. Thanks! emgarayoa@yahoo.com

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Hgunsell in Flushing, Michigan

34 months ago

Rhonda March in Interlochen, Michigan said: please email me I will go in my books and get local nerb, our collage gave us 90% of the questions, I remember nitrous neb and got 97% let me know if I can help

Hi i will be taking the nitrous NERB soon and was wondering if you had a study guide? My email is lockerheather@yahoo.com thanks for any help

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emersonhygienist in Wakefield, Massachusetts

34 months ago

Could you please email me study guide for LA NERB? Thank you so much!!! Taking exam in one week. emersonhygienist@yahoo.com

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JALLEN24 in TOLEDO, Ohio

34 months ago

Hello! I was wondering if I could be get a copy of the study guide. I take the exam Friday November 8. jenniferallen@bex.net. Thank you so much

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sammy david in Alexandria, Virginia

34 months ago

thank you all

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emersonhygienist in Wakefield, Massachusetts

34 months ago

Hi SuzyZee,
Was hoping that you could email me the study guide. Thank you so very much!
emersonhygienist@yahoo.com

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emersonhygienist in Wakefield, Massachusetts

34 months ago

Does anyone else have the studyguide that SuzyZee kindly put together that they could forward to me? My exam is scheduled for tomorrow.
Thank you!
emersonhygienist@yahoo.com

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ellierdh in Fredericksburg, Virginia

34 months ago

I just returned from taking the LA exam. First of all I would like to thank Lindsey and Suzy for this study guide. It helped tremendously! A few things to consider that was on my test that was not in the study guide.
There was a question pertaining to para-aminobenzoic acid(PABA)-cannot recall question but something about which anesthetic you would use or not used.
Question on hyperthyroidism-contraindications of which anesthesia(cannot recall if local or topical).
Know how local anesthetic works and relation to depolarization, firing threshold etc. The question about inject at 1ml/min rate had choices like systemic toxicity, patient discomfort, few adverse reaction and something about being too rapid. There wasn't a choice for it being the recommended rate.
Unsure of this question but something to the effect of what would be a contraindication for infiltration: heavy cortical bone, aphthous ulcer, biopsied area, cant remember the other choice.
How far to insert needle on IANB: Be careful because my test did not have 3/4 as the choice but rather 2/3 (Malamed mentioned that's the range)
Question on COPD
What to do if positive aspiration occurs: withdraw needle completely, change cartridge and reinsert; reposition and aspirate again; continue with injection; I can't recall the other choice (I don't recall that question mentioning how much blood was noticed because Malamed have different answer depending on the amount of blood present in the cartridge.
This is all I can recall for now. If anything else comes to mind I will post it, otherwise wish you all the best in your dental hygiene career and thank you all for contributing helpful information!

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ellierdh in Fredericksburg, Virginia

34 months ago

emersonhygienist in Wakefield, Massachusetts said: Does anyone else have the studyguide that SuzyZee kindly put together that they could forward to me? My exam is scheduled for tomorrow.
Thank you!
emersonhygienist@yahoo.com

I just emailed it to you.

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JALLEN24 in TOLEDO, Ohio

34 months ago

Would someone kindly send me a study guide as well? I take the exam Friday. Thank you. jenniferallen@bex.net

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linda lou

34 months ago

Hey Suzy,
Can you please email me the study guide that everyone has said is so helpful. I could really use the help. My email is lindalougarrett@gmail.com or if anyone else who has it sees this can someone email me it.

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dcw711 in Northborough, Massachusetts

34 months ago

I am in MA and preparing for the NERB LA test. Could you please mail a copy of your study guide? My email address is: carbonewelch@aol.com

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Jammie Costello in Monroe, Michigan

34 months ago

Hi Suzy, Can you please email me the study guide for local anesthesia that everyone is talking about?
My email is jcostello3013@live.com .Thanks so much!

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dcw711 in Northborough, Massachusetts

34 months ago

Hello SuzyZee!
I am in MA and preparing for the NERB LA test. Could you please mail a copy of your study guide? My email address is: carbonewelch@aol.com Really appreciate you taking the time.

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marge in Jersey City, New Jersey

34 months ago

I am taking my NERB exam next week. Was wondering if you would be able to email me the study guide please. Margarettraina@verizon.net

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Suzyzee in Carmel, Indiana

34 months ago

JALLEN24 in TOLEDO, Ohio said: Would someone kindly send me a study guide as well? I take the exam Friday. Thank you. jenniferallen@bex.net
I have just emailed everyone from here down thru marge in NJ. Hope everyone receives in timely manner.
Suzy

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Suzyzee in Carmel, Indiana

34 months ago

Ellierdh in Fredericksburg, Virginia said:
from Suzy to Ellie and others: Looking at my notes from class:
~PABA:What is the prevalence of allergic reactions to the actual anesthetic drugs - a true allergy is very rare. Allergic reactions to the esters is usually due to a sensitivity to their metabolite, para-aminobenzoic. So beleive one would not use an ester.

~Question on hyperthyroidism-contraindications of which anesthesia(cannot recall if local or topical).
from Suzy: Uncontrolled hyperthyroidism – Risk thyroid crisis –thyrotoxicosis –thyroid storm. Hyperthyroid sensitive to catecholamines.-vaso use increase risk cardio stimulation. avoid all dental until under control. Absolute no vaso use. Once controlled cardiac dose .04mg and .2 levonordefrin

~Know how local anesthetic works and relation to depolarization, firing threshold etc.
When a stimulus excites a nerve, the following events occur in this sequence:
-slow depolarization whereby the electrical potential in the nerve becomes slightly less negative
-when this electrical potential reaches a critical level, there is then a rapid phase of depolarization called threshold potential or firing threshold (-55mv)
-this depolarization brings about a reversal of the electrical potential across the nerve membrane - the interior of the nerve is now positive in relation to the negative exterior
NA+ in.The phase of conduction affected by local anesthetics is the depolarization phase.

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Suzyzee in Carmel, Indiana

34 months ago

The question about inject at 1ml/min rate had choices like systemic toxicity, patient discomfort, few adverse reaction and something about being too rapid. There wasn't a choice for it being the recommended rate.
~my notes were: Burn- PH inject slow 1mL/min, check exp date,don’t warm (patient discomfort)

question on + aspiration what to do:
~Describe effective aspiration technique and discuss what to do if a positive aspiration is encountered.
To change pressure in cartridge from positive to neg by pull back 1-2mm, 2nd plane rotate syringe 45° and reaspirate.. Any clear bubble or none is considered neg aspiration. If get a positive aspiration and still clearly see, can slightly reposition needle, if clouds,or not see must change cartridge/needle.

One more note on PABA:Hypersensitivity reactions can occur with esters (procaine-type LAs) with immunologic sensitivity to
para-aminobenzoic acid (PABA), a metabolite of ester cleavage in some drugs.

~Depth IANB 20-25mm or 2/3-3/4 depth of long needle
Hope this helps - had to dig hru my final study guide.
No notes on COPD- but in general could not find any contraindications

Suzy

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Monique S. in Fort Washington, Maryland

34 months ago

Neise in Beltsville, Maryland said: Hey Suzyzee when you get a chance please email me your study guide. I'll be taking the LA exam in a few weeks. My email is csa4998@yahoo.com. Thank you!

Hey Niese,

I was wondering can you email a copy of the study guide mo31072@msn.com.

Thanks

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Monique S. in Fort Washington, Maryland

34 months ago

Suzyzee in Carmel, Indiana said: I have just emailed everyone from here down thru marge in NJ. Hope everyone receives in timely manner.
Suzy

Hey suzyzee, can you please send me a copy of the study guide? I take the exam next Friday . Email mo31072@msn.com

Thanks

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Suzyzee in Carmel, Indiana

33 months ago

Monique S. in Fort Washington, Maryland said: Hey suzyzee, can you please send me a copy of the study guide? I take the exam next Friday . Email mo31072@msn.com

Thanks

Sending now

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mjanders50 in Washington, District of Columbia

33 months ago

Can someone please also send me the study guide? I am taking the exam very soon. Thanks, Mandy My email address is mjanders50@hotmail.com.

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ShaniN in Cleveland, Ohio

33 months ago

Hey Suzy and patty. I take the NERB next week. Could you please email me your study guides? If anyone has patti's please feel free to email it...I sent her an email last week and have not heard back from her...maybe she is out of town....my email is szg6@yahoo.com
Thanks!

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ShaniN in Cleveland, Ohio

33 months ago

Sorry, I see your name is suzyzee:)

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SuzyZee in Carmel, Indiana

33 months ago

ShaniN in Cleveland, Ohio said: Sorry, I see your name is suzyzee:)

No you were right--my ne is Suzy last name starts with a Z. Sending now to you,Shannon and mjanders.

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hillary in Big Rapids, Michigan

33 months ago

Anyone with any study guide for the Nitrous or the LA nerb exam could you please email me ASAP i take the exam next week! it will be greatly appreciated!

Hillary_karlene@yahoo.com

-Hilary

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hillary in Big Rapids, Michigan

33 months ago

Hgunsell in Flushing, Michigan said: Hi i will be taking the nitrous NERB soon and was wondering if you had a study guide? My email is lockerheather@yahoo.com thanks for any help

Did you ever get a nitrous study guide? if so could you email me it!! thank you so much!

hillary_karlene@yahoo.com

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Katie in Seminole, Florida

33 months ago

Lindsey in Washington, District of Columbia said: 27 when do you use a long needle?
28 What causes a hematoma, common in the pterygoid plexus following PSA injection and how would you manage symptoms
29 questions on esters and amides: allergy issues and contraindications
30 Question on the volume of a single cartridge of LA
a. 1.8 ml; how much in 2? 3.6ml
31 needle gauge and which lumen is smallest? Smaller number, larger the lumen
32 what sensation is lost first
a. pain
33 what function sodium chloride provides in LA solutions?
a. Makes the solution isotonic
34 sodium bisulfite question
a. antioxidant preventing biodegration of LA
35 action of vasodepressors
a. increasing duration
36 multiple questions on what injections you would use if you were scaling specific areas
37 Questions about maxillary and mandibular nerves
a. are they sensory, motor or both
38 trismus, what causes it and management
39 what would cause a dry cornea
40 difference between block and filtration
41 anatomical landmarks for various injections
42 post op infection management

Hi my name is Katie and I take the LA NERB exam in a month, Im just curious to see if you read the entire book for LA or just studied certain study guides. ANY KIND of advice would help me so much!! :)

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Katie in Seminole, Florida

33 months ago

hillary in Big Rapids, Michigan said: Anyone with any study guide for the Nitrous or the LA nerb exam could you please email me ASAP i take the exam next week! it will be greatly appreciated!

Hillary_karlene@yahoo.com

-Hilary

Hilary, did you get a study guide from anyone? Please let me know and send me an email if you did!! katiestid@hotmail.com
Katie

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Katie in Seminole, Florida

33 months ago

ShaniN in Cleveland, Ohio said: Hey Suzy and patty. I take the NERB next week. Could you please email me your study guides? If anyone has patti's please feel free to email it...I sent her an email last week and have not heard back from her...maybe she is out of town....my email is szg6@yahoo.com
Thanks!

Hi! Im just curious if you got a review for the LA NERB exam! I take mine in a month and am looking for a review as well. Let me know! My email is katiestid@hotmail.com

Katie

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Katie in Seminole, Florida

33 months ago

Suzyzee in Carmel, Indiana said: I have just emailed everyone from here down thru marge in NJ. Hope everyone receives in timely manner.
Suzy

Hi there! I saw that you sent out a review for the Local Anesthesia exam and i take mine next month and am wondering if you would send me one if you have it, it would mean so much!
Thank you! my email is katiestid@hotmail.com
Katie

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hillary in Big Rapids, Michigan

33 months ago

Tina in Macomb, Michigan said: Does anyone have a study guide for the Nitrous NERB exam? If so, can you email it to me at tguidi78@yahoo.com

Hey tina did you get any study guide? If so could you send it to me! Thanks!
hillary_karlene@yahoo.com

Thanks!!!

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SzyZee in Carmel, Indiana

33 months ago

hillary in Big Rapids, Michigan said: Anyone with any study guide for the Nitrous or the LA nerb exam could you please email me ASAP i take the exam next week! it will be greatly appreciated!

Hillary_karlene@yahoo.com

-Hilary


Sending out study guide in a few minutes.
Suzy

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vk0209 in Stevensville, Maryland

33 months ago

After 13 1/2 years as a hygienist, I've decided to move on. Yesterday, I applied to a local college for nursing. I need to retake basic biology, chemistry and developmental psychology. I am 53 years old and I don't regret this change one bit. I know I'll get the bottom of the barrel of shifts but I feel I'll have more options in the future. I like to continue work well into my 60's. Our profession is not in demand as it once was when I first got into the field. If you have graduated hygiene less than 7 - 10 years it's easier to get accepted into nursing school.

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vk0209 in Stevensville, Maryland

33 months ago

Hi Patty!
Could you send me a copy of your review LA questions? Liszt01@aol.com
Thank you

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SuzyZee in Carmel, Indiana

33 months ago

Sent email out to vk0209

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ellabella1123 in Columbia, Maryland

33 months ago

vk0209 in Stevensville, Maryland said: After 13 1/2 years as a hygienist, I've decided to move on. Yesterday, I applied to a local college for nursing. I need to retake basic biology , chemistry and developmental psychology. I am 53 years old and I don't regret this change one bit. I know I'll get the bottom of the barrel of shifts but I feel I'll have more options in the future. I like to continue work well into my 60's. Our profession is not in demand as it once was when I first got into the field. If you have graduated hygiene less than 7 - 10 years it's easier to get accepted into nursing school.

I just moved to Maryland. What made you change your career? Is being a hygienist in Maryland that bad?

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shivani in Somerset, New Jersey

33 months ago

could someone please email me the studyguide at shivu258@gmail.com. thank you.

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