Dental Hygiene Theory And Practice 4th edition by Michele Leonardi Darby – Test Bank A+

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Chapter 06: Cultural Competence

Darby & Walsh: Dental Hygiene: Theory and Practice, 4th Edition

MULTIPLE CHOICE

1. Statement 1: Symbols can play an important role in culture. Statement 2: Culture is set by historical developments and will not change.

a.	Statement 1 is correct; statement 2 is incorrect.
b.	Statement 1 is incorrect; statement 2 is correct.
c.	Statements 1 and 2 are both correct.
d.	Statements 1 and 2 are both incorrect.

ANS: A

Symbols, rituals, and practices are prominent features of cultures. Cultures are complex and their basic characteristics quite often are historically determined, but cultures are developing and changing continuously.

REF: Culture, Cultural Competence, and Cultural Sensitivity | 71

1. Statement 1: Ethnic identity describes the common cultural, historic, and geographic experiences of a group. Statement 2: Individuals of a group who share an ethnic identity also share the same attitude, interests, and dialects.

a.	Statement 1 is correct; statement 2 is incorrect.
b.	Statement 1 is incorrect; statement 2 is correct.
c.	Statements 1 and 2 are both correct.
d.	Statements 1 and 2 are both incorrect.

ANS: A

A larger group may share common cultural, historic and geographic experiences (ethnic identity), but the individuals within the primary culture may belong to various different subcultures. Within any group, heterogeneity is more likely than homogeneity.

REF: Culture, Cultural Competence, and Cultural Sensitivity | 71

1. Statement 1: Complex societies are homogenous. Statement 2: Immigrants of the first generation share the same culture as the second or third generation of immigrants.

a.	Statement 1 is correct; statement 2 is incorrect.
b.	Statement 1 is incorrect; statement 2 is correct.
c.	Statements 1 and 2 are both correct.
d.	Statements 1 and 2 are both incorrect.

ANS: D

Complex societies are never homogenous; people will almost always form separate subgroups with their own features. Culture is a dynamic process, and traditional cultures (first immigrants) can differ from newly acquired cultures of the second or third generation of immigrants).

REF: Culture, Cultural Competence, and Cultural Sensitivity | 71

1. Statement 1: Beliefs and practices within a culture do not influence the access to healthcare services. Statement 2: The way people make sense of illness is in part culturally determined.

a.	Statement 1 is correct; statement 2 is incorrect.
b.	Statement 1 is incorrect; statement 2 is correct.
c.	Statements 1 and 2 are both correct.
d.	Statements 1 and 2 are both incorrect.

ANS: B

Health and illness are not only physical conditions. Culture can contribute to how members of a specific group determine how causes of illness can be explained and to whom they turn to if they become ill. These beliefs can facilitate or act as barriers to accessing healthcare services.

REF: Culture and Health | 71

1. At the first oral care visit, the culturally sensitive oral health professional should:

a.	first assess the core values of the group to which the client belongs.
b.	base his or her judgment on the characteristics of the specific culture to which the client belongs.
c.	assesses the core cultural values for each client individually rather than focusing on the group to which the client belongs.
d.	apply stereotyping as a tool to determine the possible core values of the client.

ANS: C

It is important to assess the core values for each individual client to identify the areas of potential cultural differences with the clients and not just those who appear to belong to different groups. It is the opposite of stereotyping.

REF: Box 6-2: Guidelines for Cross-Cultural Dental Hygiene | 77

1. Stereotyping:

a.	is effective in a strange environment with new people to ascertain the characteristics of a member of a particular group.
b.	can be described as an inaccurate, biased assessment of another human being based on group characteristics.
c.	is an essential step in analyzing cultural differences.
d.	recognizes the uniqueness of the individual and allows an accurate perception of the individual.

ANS: B

Stereotyping fails to recognize the uniqueness of the individual and prevents an accurate perception of those who appear different. It is a biased opinion. Stereotyping should not be promoted as a strategy.

REF: Culture and Health | 72

1. Cultural competence starts with:

a.	awareness of the client’s background and cultural beliefs and values.
b.	understanding the client’s perspective and social context.
c.	applying a variety of communication skills to appeal to the client’s identity.
d.	awareness of one’s own cultural beliefs and practices.

ANS: D

Cultural competence begins with the awareness of one’s own cultural beliefs and practices, and the recognition that others believe in different truths/realities than one’s own. Cultural competence starts with self-exploration, as well as awareness and elimination of one’s own biases.

REF: Developing Cultural Competence | 72

1. Statement 1: Patients are usually willing to share their ideas and customs with those who express a willingness to understand them. Statement 2: The clinician should assume the presence of cultural differences, and therefore, the clinician needs extensive knowledge of every cultural practice and belief.

a.	Statement 1 is correct; statement 2 is incorrect.
b.	Statement 1 is incorrect; statement 2 is correct.
c.	Statements 1 and 2 are both correct.
d.	Statements 1 and 2 are both incorrect.

ANS: A

“If you don’t ask, you won’t know.” By displaying genuine interest in the client and by asking a client to share beliefs, clinicians can increase their cultural knowledge as they practice. Extensive knowledge is not needed. It is most important to develop the understanding that each client’s preferences and values are unique.

REF: Culture and Health | 72

1. An equitable, culturally sensitive environment is characterized by:

a.	the care provider initiating a cultural encounter.
b.	reciprocal inquiry between the client and care provider.
c.	the client initiating sharing information about his or her cultural beliefs.
d.	the care provider tailoring the information to the mindset of the client.

ANS: B

The goal of effective communication is to maximize the understanding between the communicators. To communicate effectively, both parties have to move beyond cultural biases that could create barriers in care. In the most ideal situation, cross-cultural communication is a means of reciprocal inquiry. This means that both the care provider and client inform each other about their beliefs and expectations.

REF: Maximizing Effectiveness of Cross-Cultural Communication | 74

1. A client from a collectivist environment:

a.	makes decisions about the proposed treatment on his or her own.
b.	likes to discuss the treatment options with the healthcare provider alone.
c.	prefers a “doctor-centered” approach.
d.	might not display the characteristics of the group and therefore might make a decision on his or her own.

ANS: D

It is important to realize that individual clients from both collectivist and individualist cultures might have different point of views. It is the responsibility of the clinician to identify the client’s preference for shared decision making and to incorporate those preferences into the care provided.

REF: Shared Decision Making in Cross-Cultural Settings | 75

1. Ignoring or devaluing the models and practices embedded in other cultures can be described as:

a.	evidence-based practice.
b.	ethnocentrism.
c.	stereotyping.
d.	bias.

ANS: B

Demonstrating willingness to cooperate with alternative healers or incorporate traditional treatments can be important. Ignoring or devaluing the models and practices embedded in other cultures can be described as ethnocentrism and leads away from best practices in healthcare.

REF: Culture and Health | 72

1. A mother is standing beside her child in the dental office. The child is experiencing a terrible toothache. The mother is crying. She wants to know why God is doing this to her child. What would be the best response of the care provider?

a.	Explain to her that God has nothing to do with the cause of this toothache.
b.	Explain to her that she is making the child anxious.
c.	Listen actively and allow her to express her feelings.
d.	Do not pay too much attention to her crying, but focus on the child and try to examine the cause of the toothache.

ANS: C

By allowing the client to express her feelings, the oral health professional learns more about the client’s perspective and beliefs. This allows respectful communication and a suitable explanation of the possible causes. Culturally sensitive care is based on mutual respect and understanding. The other alternatives do not display respect to the cultural beliefs of the mother.

REF: Building Relationships | 74

1. Nonverbal communication is important in a culturally sensitive environment. The clinician should be sensitive to:

a.	gestures.
b.	eye contact.
c.	personal space.
d.	all of the above.

ANS: D

Cultural differences might be experienced in relation to various forms of nonverbal communication including gestures, handshakes, eye contact, or physical proximity. Follow the client’s lead and explore his or her expectations and beliefs.

REF: Nonverbal Communciation | 74-75

1. If a client does not speak the language of the care provider, the best strategy to interact would be to:

a.	use a medical interpreter with no relationship to the client.
b.	speak slowly and ask client if he or she understands the instructions.
c.	ask a family member to translate.
d.	use body language to communicate you care.

ANS: A

When language is a barrier, it is most appropriate to use a medical interpreter with no relationship to the client.

REF: Verbal Communication | 70

1. Statement 1: Health care literacy is the ability to understand health or disease. Statement 2: Poverty is not a barrier to access healthcare.

a.	Statement 1 is correct; statement 2 is incorrect.
b.	Statement 1 is incorrect; statement 2 is correct.
c.	Statements 1 and 2 are both correct.
d.	Statements 1 and 2 are both incorrect.

ANS: A

Health care literacy refers to understanding of the ability to understand how the healthcare system works. Poverty is a major barrier to healthcare access and prevents individuals from meeting their basic human needs for systemic and oral health.

REF: Healthcare Literacy | 77

1. Statement 1: Poverty is associated with poor oral health. Statement 2: Being part of an ethnic majority group leads a person to have poor oral health.

a.	Statement 1 is correct; statement 2 is incorrect.
b.	Statement 1 is incorrect; statement 2 is correct.
c.	Statements 1 and 2 are both correct.
d.	Statements 1 and 2 are both incorrect.

ANS: A

Children with the most advanced oral disease are found within minority, poor, homeless, and immigrant populations. Therefore, poverty has a strong association with poor oral health. It is important to realize that within all racial/ethnic groups that there are substantial differences in beliefs and behaviors. This inevitably leads to varying degrees of health status.

REF: Healthcare Literacy | 77

1. When adapting behavioral interventions for minorities, it is important to:

a.	use community recourses to publish the intervention and to increase accessibility.
b.	identify barriers to access and participation.
c.	couple the initiatives with culturally accepted values or respected figures.
d.	do both a and c.
e.	do a, b, and c.

ANS: E

It is very important to identify barriers to access and participation before implementing behavioral interventions using community resources. When possible, coupling initiatives with culturally accepted values and respected figures maximizes uptake and efficacy. All alternatives are correct.

REF: Implementation Phase | 77

1. Statement 1: Culturally sensitive care starts with the care provider exploring the cultural beliefs of the client. Statement 2: Cultural differences occur in every clinical encounter.

a.	Statement 1 is correct; statement 2 is incorrect.
b.	Statement 1 is incorrect; statement 2 is correct.
c.	Statements 1 and 2 are both correct.
d.	Statements 1 and 2 are both incorrect.

ANS: B

The care provider should become aware of her or his own bias and perceptions before the clinical encounter with a client. Since oral health professionals have their own professional culture, it is expected that there will always be some sort of cultural difference between the care provider and the client.

REF: Developing Cultural Competence | 72-73

1. A 42-year-old female client brought her 14-year-old son to a first appointment with an oral health professional. The oral health professional plans to obtain a medical history, but the client and the clinician do not speak the same language. The client’s son offers to be the interpreter. Which answer is the most appropriate solution?

a.	The clinician agrees with the proposal and is happy with this efficient solution.
b.	The clinician prefers an official interpreter, which can be arranged by phone.
c.	The clinician uses a medical history in the language of the client and asks the client to complete the questionnaire.
d.	The clinician refers the client to a different dental office at the other side of the city, where the oral health professional speaks the language of the client.

ANS: B

A family member as interpreter can be unreliable due to personal and confidentiality issues. In some cases, the client or the family member in the role of interpreter can be embarrassed with the information provided. Misinterpretation of the information by family members can also occur, which can lead to incorrect diagnoses.

REF: Verbal Communication | 74

Chapter 07: Professional Portfolios

Darby & Walsh: Dental Hygiene: Theory and Practice, 4th Edition

MULTIPLE CHOICE

1. The primary purpose of reflection in a student portfolio is to demonstrate:

a.	the student’s ability to recall a clinical event or activity.
b.	veracity as an admirable trait in the student hygienist.
c.	critical thinking and problem-solving skills.
d.	the clinical skill level of the student hygienist.

ANS: C

Reflection plays an important role in the development of critical thinking and problem-solving skills, which are considered to be desirable qualities in a healthcare professional. Recalling a clinical event is an appropriate journal log entry but is not a reflection. Veracity is the ability to adhere to the truth. Clinical skill level does not demonstrate the student’s ability to apply these skills in practice.

REF: Reflection and the Profession Portfolio | 82

1. A dental hygiene student portfolio has limited use after graduating from the dental hygiene program. The primary purpose of the dental hygiene professional portfolio is to document professional development courses.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true, and the second statement is false.
d.	The first statement is false, and the second statement is true.

ANS: B

The student portfolio can easily be transitioned to a professional portfolio to serve as a foundation for lifelong self-assessment and documentation of professional growth and development. While some licensing agencies require a professional development portfolio for relicensure, it is not the sole purpose of a portfolio.

REF: Transitioning the Student Portfolio | 88

1. Artifact is a term used in a professional portfolio to describe which of the following?

a.	Community service projects
b.	Patient care logs
c.	Continuing education logs
d.	All of the above

ANS: D

An artifact can be any type of evidence used in a portfolio to demonstrate an individual’s competency or achievements.

REF: Box 7-3: Portfolio Sample Template | 82

1. All references cited in a dental hygiene portfolio must be formatted according to the National Library of Medicine Style Guide. It is not necessary to reference sources obtained from the Internet if they are open access.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true, and the second statement is false.
d.	The first statement is false, and the second statement is true.

ANS: B

National Library of Medicine style is one of many formats used for citing references. All outside sources must be cited regardless of the medium. Internet citations must include the URL and the date that they were accessed.

REF: References and Citations | 83-84

1. A portfolio required by a state licensing board would most likely be a:

a.	working portfolio.
b.	best work portfolio.
c.	professional development portfolio.
d.	curriculum vitae.

ANS: C

State licensing boards are most likely to require a portfolio documenting an individual’s continuing education/professional development coursework. Some boards may require some sort of self-assessment with the professional development portfolio. A working portfolio is the term given to the complete collection of artifacts and documents belonging to an individual. A best work portfolio would be a portfolio used to demonstrate selected projects and accomplishments of an individual. A curriculum vitae is a complete listing of an individual’s education, employment, professional accomplishments, and life’s work.

REF: Professional Development Measure | 80

1. Which of the following steps should come first in creating an e-portfolio?

a.	Writing reflections
b.	Selecting a design template
c.	Collecting the artifacts
d.	Finding a portfolio web site for publishing

ANS: C

The first step in creating a portfolio is to begin to collect the various artifacts and documents. Reflection statements should accompany the artifacts chosen for a portfolio that will be shared with others. The design template should be chosen after selecting the web site to host the e-portfolio. The web site can be chosen once there are artifacts to display.

REF: Creating the Student Portfolio | 81

1. The use of music lyrics or poetry to add interest to a portfolio:

a.	is always allowed under the fair use guidelines.
b.	requires permission from the copyright holder.
c.	is not appropriate in a professional portfolio.
d.	is exempt from copyright laws.

ANS: B

Musical lyrics and poetry are protected by copyright, and permission from the copyright holder must be obtained before use. Correct attribution must be given to the copyright holder. While portions of another person’s work may be used for educational purposes under fair use, provided that there is no intended profit, it is always best to get permission from the copyright holder. Work from outside sources should be used sparingly in a professional portfolio since the portfolio is designed to be a representation of the individual’s own work. The writers of poetry and music along with authors and artists and other creators of work are protected by copyright law for the lifetime of the creator plus a specified number of years. The copyright owner must give consent to have their work used.

REF: Copyright and Fair Use | 84-85

1. The student is creating an artifact for the e-portfolio and would like to use some radiographs and intraoral images of a client. The student asks the client for and receives permission to use the images in his project. While grading the project an instructor notices the student forgot to remove the client’s name from the radiographs. Which core ethical principal did the student violate?

a.	Justice
b.	Beneficence
c.	Confidentiality
d.	Autonomy

ANS: C

Confidentiality is the duty of healthcare professionals to carefully guard a client’s privacy. Leaving the name on the radiographs is a violation of the core ethical principal: confidentiality. Justice is a principal concerning fairness. Beneficence is an ethical principal to do with the well-being of clients, meaning the dental hygienist has a duty to benefit or “do good” for the client. Autonomy is the right of the client to make decisions regarding his or her healthcare.

REF: Confidentiality and Permissions | 84

1. A recent dental hygiene graduate is preparing to apply for jobs and wants to use her portfolio as part of the interview process. She has heard that the dentist is looking for a dental hygienist with experience with a very diverse client population. The student decides to amend her charts of client experiences to show a greater number of clients seen than she actually cared for during her dental hygiene education. Which ethical principal did the student violate?

a.	Autonomy
b.	Veracity
c.	Nonmaleficence
d.	Beneficence

ANS: B

Veracity is the duty to be honest and tell the truth. In this case the dental hygienist was altering her portfolio, which is dishonest. Autonomy is the right of the client to make decisions regarding his or her healthcare. Nonmaleficence is an ethical term that means “do no harm.” Beneficence is an ethical principal to do with the well-being of clients, meaning the dental hygienist has a duty to benefit or “do good” for the client.

REF: Portfolio Authorship and Ethical Principles | 86

1. Which of the following uses would most likely be acceptable in a student’s portfolio under the fair use doctrine?

a.	The portfolio is open access on the Internet.
b.	The image is a copyrighted source.
c.	A large portion of an author’s work is used.
d.	An image from Creative Common’s is used, with attribution.

ANS: D

Creative Commons has creative works available for public use via the Internet; however, always use the appropriate attribution and reference. A portfolio or other types of work that are open to the public should have permission to use any copyrighted materials that are posted. Under U.S. copyright laws, using any creative materials that are copyrighted is a legal violation, unless the owner/author has given specific permissions. The fair use doctrine in the United States permits some copying and distribution without asking direct permission of the copyright holder; however, only in certain applications and only a small percentage of the total work.

REF: Copyright and Fair Use | 84-85

1. Copyright is the legal protection for authors and creators of original works, including writing, composing, graphic and visual arts, and architectural and industrial designs, from others copying their work. Copyright prohibits all forms or replication or copying.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true, and the second statement is false.
d.	The first statement is false, and the second statement is true.

ANS: C

Copyright is the legal protection for authors and creators of original works; however, the fair use doctrine allows for some copying and distribution without asking direct permission of the copyright holder.

REF: Copyright and Fair Use | 84-85

1. Which of the terms do not belong in the four “Rs” model for reflective thinking and writing?

a.	Revisit
b.	React
c.	Relate
d.	Reply

ANS: D

Reply is not one of the “4 Rs” of reflection. Revisit is the process of recalling the event in the initial step of writing a reflection. React is the process of thinking about the experience and what effect it had. Relate is the concept of thinking about the significance of the experience on a deeper level, focusing on one’s feelings, values, or assumptions surrounding the activity or event.

REF: Box 7-5: Formulating Reflection Statements | 83

1. An electronic portfolio has the following advantages when compared to a paper based portfolio except e-portfolios are:

a.	more adaptable over time.
b.	more compact and portable.
c.	easier to learn than a paper-based portfolio.
d.	a “greener” approach to documenting work.

ANS: C

Initially an e-portfolio will take some time to learn the platform and requires some technical skills, such as word processing, uploading documents, images, and other electronic files. The e-portfolio does have the advantage over a paper-based portfolio in terms of archiving artifacts electronically. Historical artifacts can be saved as a career progresses. The e-portfolio has the advantage over a paper-based portfolio in being portable and compact due to the nature of the electronic format. The e-portfolio is “greener” because paper is not required and the storage of it is electronic.

REF: Porfolio Formats | 80

1. A résumé is a summary of your experiences and skills relevant to the field of work you are entering. A curriculum vitae (CV) is a written description of your work experience, educational background and skills that is more detailed than a résumé.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true, and the second statement is false.
d.	The first statement is false, and the second statement is true.

ANS: A

A résumé should be a brief document succinctly summarizing an individual’s education, employment history, and experiences relevant to a specific employment position. The curriculum vitae (CV), as the Latin term implies, is an overview of a person’s lifetime of professional activities. The CV is an ongoing documentation of one’s employment, education, teaching, publications, honors, and volunteer activities.

REF: Introduction and Biographic Data | 83

1. When writing a Philosophy of Practice statement, the dental hygienist should consider the following topics to include except one. What is the one exception?

a.	Define career goals and objectives.
b.	Highlight your personal life, family, and hobbies.
c.	Discuss the ethical considerations of dental hygiene practice.
d.	Discuss your commitment to cultural diversity.

ANS: B

Posting personal information about personal life, family, and hobbies is not appropriate in a student or professional portfolio and is not germane to a Philosophy of Practice statement. Defining career goals and objectives makes it clear to potential employers or graduate schools what the intended career development path is and if it is a good fit mutually. Knowledge and application of the ethical considerations of dental hygiene practice is a valid aspect in a portfolio and a Philosophy of Practice statement. Commitment and experience with cultural diversity is an important skill for the dental hygienist and could strengthen a Philosophy of Practice statement.

REF: Transitioning the Student Portfolio | 89

Chapter 09: Infection Control

Darby & Walsh: Dental Hygiene: Theory and Practice, 4th Edition

MULTIPLE CHOICE

1. Which federal agency develops guidelines and recommendations for healthcare settings?

a.	Centers for Disease Control and Prevention(CDC)
b.	Occupational Safety and Health Administration(OSHA)
c.	Food and Drug Administration(FDA)
d.	Environmental Protection Agency(EPA)

ANS: A

The CDC develops guidelines and recommendations; among these are infection control recommendations for healthcare settings. OSHA enforces workplace safety regulations. FDA and EPA provide regulatory oversight in the area of products used in the application of infection-control procedures.

REF: 102

1. Which of the following is associated with principle 2 of infection control?

a.	Hand hygiene
b.	Effective use of PPE
c.	Cleaning and surface disinfection
d.	Immunizations

ANS: B

Principle 2: Avoid contact with blood and other infectious body substances. Effective use of personal protective equipment (PPE) (e.g., gloves, face masks, protective eyewear, protective gowns). Hand hygiene and immunizations are associated with principle 1: take action to stay healthy. Cleaning and surface disinfection is associated with principle 3: make client care items safe for use.

REF: 103

1. How often is a tetanus-diphtheria (td) booster recommended for adults?

a.	Every year
b.	Every 2 years
c.	Every 10 years
d.	No booster needed

ANS: C

Adults must receive the tetanus-diphtheria (td) booster every 10 years, and more often if recommended or indicated because of exposure.

REF: 103-104

1. Which of the following immunizations strongly recommended for healthcare providers is administered in 1 annual dose, either intramuscularly or intranasally?

a.	Hepatitis B
b.	Influenza
c.	MMR
d.	Varicella
e.	Meningococcal

ANS: B

Influenza immunization is strongly recommended: 1 dose of TIV (intramuscularly) or LAIV (intranasally) annually. Hepatitis B is given in a 3-dose series (dose #1 now, #2 in 1 month, #3 approximately 5 months after #2). Healthcare personnel (HCP) born in 1957 or later without evidence of immunity or prior vaccination receive 2 doses of MMR, 4 weeks apart. For varicella immunizations, HCP with no serologic proof of immunity, prior vaccination, or history of varicella disease get 2 doses of varicella vaccine, 4 weeks apart. One dose of meningococcal immunization is given to microbiologists who are routinely exposed to isolates of N. meningitidis.

REF: 104

1. For which of the following infectious diseases are healthcare personnel restricted from client contact, contact with client environment, and food handling until 7 days after onset of jaundice?

a.	Hepatitis A
b.	Acute or chronic hepatitis B surface antigenemia
c.	Acute or chronic hepatitis B e-antigenemia
d.	Hepatitis C
e.	Herpes simples (orofacial)

ANS: A

The U.S. Public Health Service recommends work restrictions for HCP with hepatitis A: restricted from client contact, contact with client environment, and food handling until 7 days after onset of jaundice. HCP with hepatitis B are restricted until hepatitis B e-antigen status is negative. HCP with hepatitis C have no restrictions on professional activity, and herpes simplex–infected healthcare workers should evaluate the need to be restricted from the care of clients who are at high risk.

REF: 106

1. Which of the following restrictions would apply to a healthcare provider who has been diagnosed with active rubella?

a.	No restrictions
b.	Exclude from duty
c.	Restrict from client care, contact with patient environment, and food handling
d.	No restrictions; prophylaxis recommended

ANS: B

Healthcare personnel with active rubella should be excluded from duty. No restrictions are placed on healthcare providers with PPD converter tuberculosis or cytomegalovirus infections. Restrictions from client care, contact with patient environment, and food handling should be placed on healthcare providers with hepatitis A, diarrheal diseases, and Staphylococcus aureus infections that have active or draining skin lesions. No restrictions are needed, but prophylaxis is recommended for pertussis postexposure-asymptomatic personnel.

REF: 106

1. Which of the following precautions apply to blood and all moist body substances?

a.	Universal precautions
b.	Standard precautions
c.	Transmission-based precautions
d.	None of the above

ANS: B

Standard precautions apply to blood and all moist body substances. Transmission-based precautions are used when the routes of transmission are not interrupted completely using standard precautions alone.

REF: 107

1. Which type of hand hygiene is recommended on all surfaces of hands and fingers for at least 15 seconds?

a.	Routine hand washing
b.	Antiseptic hand wash
c.	Antiseptic hand rub
d.	Surgical antisepsis
e.	Both A and B

ANS: E

For routine and antiseptic hand washing, use water and either nonantimicrobial soap or antimicrobial soap on all surfaces of fingers and hands for 15 seconds. Antiseptic hand rubs are used on all surfaces of hands and fingers until hands are dry. Surgical antiseptics are used on hands and forearms for 2 to 6 minutes.

REF: 111

1. Which of the following gloves are packaged individually, sterilized, and packaged in sized pairs?

a.	Medical examination gloves
b.	Sterile surgeon’s gloves
c.	Heavy-duty utility gloves
d.	Nonlatex gloves

ANS: B

Sterile surgeon’s gloves (indicated for oral surgical procedures) are individually packaged in sized pairs. To maintain sterility of gloves, do not open package until ready to use for surgical procedures. Medical examination gloves are nonsterile gloves that are available in a variety of sizes and materials, powdered and unpowdered, and either ambidextrous or right- or left-hand specific. Heavy-duty utility gloves are puncture-resistant gloves (Figure 9-9) used during cleaning and disinfection procedures to reduce risk of accidental puncture.

REF: 110

1. Direct cross-contamination occurs when a worker fails to change gloves between patients. Indirect cross-contamination occurs when handling a container with contaminated gloves.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true, and the second is false.
d.	The first statement is false, and the second is true.

ANS: A

Direct cross-contamination occurs when a worker fails to change gloves between patients or fails to clean and sterilize instruments properly between uses. Indirect cross-contamination occurs when handling a container with contaminated gloves.

REF: 112

1. Clinical contact surfaces that need to be disinfected or barrier-protected include which of the following?

a.	Switches
b.	Knobs
c.	Hoses
d.	Keyboards
e.	All of the above

ANS: D

Clinical contact surfaces are surfaces that become contaminated from spray or droplets of oral fluids or by touching with gloved hands during the procedure. Disinfect or barrier-protect clinical contact surfaces including keyboards. Housekeeping surfaces are areas that may be difficult or impossible to clean and include switches, knobs, hoses, brackets, and many other items used in the delivery of care.

REF: 112

1. Which of the following sterilization systems uses high heat for a specific amount of time to achieve sterile results?

a.	Unsaturated chemical vapor
b.	Gravity displacement
c.	Autoclave
d.	Dry heat

ANS: D

Dry-heat sterilization uses high heat for a specific amount of time to achieve sterile results. An unsaturated chemical vapor sterilizer uses a process similar to that of the autoclave; however, in place of steam, a chemical vapor enters the pressurized sterilization chamber. Gravity displacement sterilization relies on gravity to evacuate the air from the sterilizer chamber and an autoclave uses steam in a pressurized chamber to sterilize heat-stable instruments and devices.

REF: 113

1. Which of the following sterilization indicators are also called spore tests and offer the highest level of verification?

a.	Chemical indicators
b.	Multiparameter indicators
c.	Biologic indicators
d.	Integrators

ANS: C

Biologic indicators, also called spore tests, are the highest level of verification. Chemical indicators allow the operator to determine the presence of certain necessary parameters such as heat or steam. Multiparameter indicators, also called integrators, are a higher level of sterilization assurance and indicate that more than one parameter required for sterilization was present.

REF: 114

1. Which level of prevention and management of injury program strives to contain the injury?

a.	Primary prevention
b.	Secondary prevention
c.	Tertiary prevention
d.	Risk reduction

ANS: B

Secondary prevention strives to contain the injury. Primary prevention strives to prevent the injury in the first place. Tertiary prevention strives to return to a functional state of no exposure and prevent similar injuries from occurring again.

REF: 115

1. Given the types of exposures found in dental settings, more than 70% are associated with needles or other sharp devices. The CDC determined that most occur outside the mouth and on the hands of fingers of co-workers.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true, and the second is false.
d.	The first statement is false, and the second is true.

ANS: D

Given the types of exposures found in dental settings, more than 90% are associated with needles or other sharp devices. The CDC determined that most occur outside the mouth and on the hands and fingers of the worker.

REF: 115

1. In performing immediate first aid in an area of percutaneous exposure, what is an unacceptable washing agent?

a.	Water
b.	Saline
c.	Sterile irrigant
d.	Bleach

ANS: D

Perform immediate first aid measures such as washing an area of percutaneous exposure or flushing nose, mouth, eyes, or skin with clean water, saline, or sterile irrigants. The exposed worker should NOT use caustic agents such as bleach.

REF: 116

1. Recommendations for an exposed worker to begin postexposure treatment as soon as possible (within 2 hours) is a situation in which there has been an occupational exposure to a source patient who either has or is considered likely to have which of the following disease?

a.	HBV
b.	HCV
c.	HIV
d.	HPV

ANS: C

Recommendations for HIV postexposure prophylaxis (PEP) are based on situations in which there has been an occupational exposure to a source patient who either has or is considered likely to have HIV infection. If indicated, the worker should begin postexposure treatment as soon as possible (within 2 hours). HBV follow up depends on the HBsAg status of the source client and the vaccination and anti-HBs response of the exposed worker. There is neither pre-exposure vaccination nor PEP for occupational exposure to HCV.

REF: 118

1. For HBV the risk of infection ranges from 6% to 30% in persons not protected by vaccination or previous infection. Source individuals who are hepatitis e-antigen positive are potentially more infectious and more likely to transmit diseases.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true, and the second is false.
d.	The first statement is false, and the second is true.

ANS: A

For HBV the risk of infection ranges from 6% to 30% in persons not protected by vaccination or previous infection. Source individuals who are hepatitis e-antigen positive are potentially more infectious and more likely to transmit diseases. The best protection is vaccination against HBV.

REF: 118

1. For HIV, the average risk after a percutaneous exposure is approximately_________.

a.	less than 0.1%
b.	0.1%
c.	0.3%
d.	0.4%

ANS: C

For HIV, average risk after a percutaneous exposure is about 0.3%. The risk after exposure to eyes, nose, or mouth is about 0.1%, and the risk to skin is estimated to be less than that unless the skin is damaged or compromised, in which case the risk would be higher.

REF: 118

1. Evidence-based standard precautions are a standard of care. Healthcare personnel who render services using current standards of care place themselves at risk for civil and criminal violations.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true, and the second is false.
d.	The first statement is false, and the second is true.

ANS: C

Evidence-based standard precautions are a standard of care. Healthcare personnel who fail to render services using current standards of care place themselves at risk for civil and criminal violations.

REF: 118

MULTIPLE RESPONSE

1. Identify the steps associated with principle 1 of infection control. (Select all that apply.)

a.	Hand hygiene
b.	Post exposure management
c.	Effective use of PPE
d.	Cleaning and surface disinfection
e.	Cleaning reusable client care items
f.	Immunizations
g.	Environment infection control

ANS: A, B, F

Principle 1: take action to stay healthy, which includes immunizations for vaccine-preventable diseases, hand hygiene, postexposure management, and education and training.

REF: 103

1. Identify the steps associated with principle 2 of infection control. (Select all that apply.)

a.	Hand hygiene
b.	Postexposure management
c.	Effective use of PPE
d.	Cleaning and surface disinfection
e.	Cleaning reusable client care items
f.	Immunizations
g.	Environment infection control

ANS: C

Avoid contact with blood and other infectious body substances, which includes effective use of PPE and safe handling of sharp instruments and objects.

REF: 103

1. Identify the steps associated with principle 3 of infection control. (Select all that apply.)

a.	Hand hygiene
b.	Post exposure management
c.	Effective use of PPE
d.	Cleaning and surface disinfection
e.	Cleaning reusable client care items
f.	Immunizations
g.	Environment infection control

ANS: E

Make client care items safe for use, which includes cleaning, sterilization, or disinfection of reusable client care items.

REF: 103

1. Identify the steps associated with principle 4 of infection control. (Select all that apply.)

a.	Hand hygiene
b.	Postexposure management
c.	Effective use of PPE
d.	Cleaning and surface disinfection
e.	Cleaning reusable client care items
f.	Immunizations
g.	Environment infection control

ANS: D, G

Limit the spread of blood and other infectious body substances, which includes environment infection control and effective management of regulated waste.

REF: 103

1. From the following list, select three semicritical surfaces or instruments. (Select all that apply.)

a.	Surgical instruments
b.	Dental mouth mirror
c.	Dental handpieces
d.	X-ray head or cone
e.	Blood pressure cuff
f.	Periodontal scalers
g.	Most hand instruments

ANS: B, C, G

Examples of semicritical instruments or surfaces include; dental mouth mirrors, amalgam condensers, dental handpieces, and most hand instruments. Examples of critical would include surgical instruments, periodontal scalers, and surgical dental burs. Examples of noncritical would include the x-ray head or cone, blood pressure cuff, and facebow.

REF: 113

Chapter 11: Ergonomics

Darby & Walsh: Dental Hygiene: Theory and Practice, 4th Edition

MULTIPLE CHOICE

1. Sharp instruments are essential to the elimination of fatigue and stress on the clinician’s hand, wrist, arm, and shoulders, which cause repetitive stress injuries (RSIs). Dull instruments that deviate from their original design cause the clinician to apply additional force, resulting in increased lateral pressure, excess stroke repetitions, and a tightened grasp.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true, and the second statement is false.
d.	The first statement is false, and the second statement is true.

ANS: A

Sharp instruments minimize the amount of lateral pressure used by the clinician, the tightness of the grasp, and the number of working strokes needed. Dull instruments that deviate from their original design will ultimately promote unsound ergonomic motions by the clinician during treatment.

REF: Hand Instrument Cutting Edge Sharpness | 148

1. One environmental factor to consider to reduce the occurrence of repetitive stress injuries is the temperature of the workplace; this is because a cold room temperature is related to less-relaxed, less-flexible muscles and tendons.

a.	Both the statement and the reason are correct, and they are related.
b.	Both the statement and the reason are correct, but they are 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

ANS: A

Muscles and tendons must be warm for maximum comfort and flexibility when working, and to reduce muscle and tendon injury.

REF: Environmental Factors | 144

1. What is the foremost risk factor for carpal tunnel syndrome (CTS)?

a.	Holding instruments too tightly
b.	Repetition
c.	Use of vibrating instruments
d.	Cold room temperatures

ANS: B

Although all the choices are risk factors for CTS, repetition and continued motion are the leading risk factors.

REF: Risk Factors | 153

1. Which nerve is affected when carpal tunnel syndrome is evident?

a.	Ulnar nerve
b.	Radial nerve
c.	Median nerve
d.	Nerves from the brachial plexus

ANS: C

The median nerve is located in the carpal tunnel between the carpal bones of the wrist and the transverse carpal ligament. Repetitive motions and forces to the wrist cause tendon inflammation and swelling within the carpal tunnel, causing pressure on the median nerve.

REF: Carpal Tunnel Syndrome | 151

1. Which is a common symptom of thoracic outlet compression?

a.	Numbness and tingling in the fingertips
b.	Neck and shoulder muscle spasms
c.	Warm extremities
d.	Prominent or enhanced radial pulse

ANS: B

Thoracic outlet compression is a repetitive stress injury resulting in compression of the brachial artery and plexus nerve trunk at the thoracic outlet. This compression occurs at the neck.

REF: Symtoms | 155

1. Which nerve is affected when Guyon’s canal syndrome is evident?

a.	Ulnar nerve
b.	Radial nerve
c.	Median nerve
d.	Nerves from the brachial plexus

ANS: A

The ulnar nerve becomes entrapped in a tunnel formed by the pisiform and hamate bones and the ligaments that connect them.

REF: Guyon’s Canal Syndrome | 156

TRUE/FALSE

1. The fulcrum finger must remain locked during instrument activation.

ANS: T

A locked fulcrum allows the clinician to pivot on and gain strength from the fulcrum finger.

REF: Fulcrum and Hand Stabalizations | 147

1. Digital motion is an acceptable hand movement during treatment instrument activation.

ANS: F

Digital motion increases hand muscle fatigue, along with causing decreased instrument power and stability.

REF: Wrist Motion During Instrument Activation | 147

SHORT ANSWER

1. Name the two symptoms of de Quervain’s syndrome.

ANS:

Symptoms include aching and weakness of the thumb along the base, and pain migrating into the forearm.

REF: De Quervain’s Syndrome | 157

1. List three chairside preventive measures to minimize the occurrence of carpal tunnel syndrome.

ANS:

Maintain a neutral elbow position during procedures, alter instrument grasps, and avoid repetitive crossing of arms across the chest.

REF: Chairside Preventive Measures | 153

1. What causes the shoulder injury trapezius myalgia?

ANS:

Trapezius myalgia is caused by static loading in the shoulder or stabilizing muscles over a long period of time.

REF: Risk Factors | 158

1. List three chairside preventive measures to reduce the incidence of lumbar joint dysfunction.

ANS:

Avoid twisting the back and spine, properly support body weight, and modify equipment placement to avoid twisting to reach.

REF: Chairside Preventive Measures | 159

MATCHING

Match the categories of motion with the proper classification.

a.	Movement of fingers, wrist, and arms
b.	Movement of fingers only
c.	Movement of the entire arm and shoulder
d.	Movement of fingers and wrist
e.	Movement of arm and twisting of body

1. Class I

1. Class II

1. Class III

1. Class IV

1. Class V

1. ANS: B REF: Table 11-2: Five Categories of Motion | 147

1. ANS: D REF: Table 11-2: Five Categories of Motion | 147

1. ANS: A REF: Table 11-2: Five Categories of Motion | 147

1. ANS: C REF: Table 11-2: Five Categories of Motion | 147

1. ANS: E REF: Table 11-2: Five Categories of Motion | 147

Match the exercise that will improve the function of the associated body part.

a.	Sit-ups
b.	Hyperextension
c.	Neck isometric
d.	Rubber ball squeeze
e.	Doorway stretch
f.	Suspension from a bar

1. Lumbar spine

1. Abdominal muscles and lumbar spine

1. Lower back

1. Upper and lower back

1. Cervical spine and neck

1. Hand and fingers

1. ANS: B REF: Box 11-1: Strengthening Exercises | 152

1. ANS: A REF: Box 11-1: Strengthening Exercises | 152

1. ANS: F REF: Box 11-1: Strengthening Exercises | 152

1. ANS: E REF: Box 11-1: Strengthening Exercises | 152

1. ANS: C REF: Box 11-1: Strengthening Exercises | 152

1. ANS: D REF: Box 11-1: Strengthening Exercises | 152Chapter 17: Oral Hygiene Assessment: Soft and Hard DepositsDarby & Walsh: Dental Hygiene: Theory and Practice, 4th Edition

   MULTIPLE CHOICE

   1. What is the correct order of the stages in dental biofilm formation?
   2. Lag in bacterial growth with filamentous forms replaced by cocci
   3. Clinically evident inflammation with activation of host immune response
   4. Deposition of salivary components
   5. Slime matrix produced to protect microcolonies of polysaccharides

   a.	1, 2, 3, 4
   b.	2, 3, 1, 4
   c.	3, 2, 1, 4
   d.	3, 1, 4, 2

   ANS: D

   The stages of biofilm formation are initial adherence, lag phase, and colonization followed by steady state.

   REF: Stages of Oral Biofilm Formation | 284-286

   1. A dental index converts specific clinical observations into a numeric value (score) to measure the level of oral hygiene of an individual or population. A high numeric value or index score indicates good oral hygiene.

   a.	Both statements are true.
   b.	Both statements are false.
   c.	The first statement is true, and the second statement is false.
   d.	The first statement is false, and the second statement is true.

   ANS: C

   The first statement is an accurate definition of a dental index. A low numeric value or index score indicates good oral hygiene.

   REF: Oral Hygiene | 291

   1. An acceptable and efficient dental index of an individual need only evaluate a few select teeth. Healthy dental plaque contains aerobic, gram-negative rods and cocci and a few motile organisms.

   a.	Both statements are true.
   b.	Both statements are false.
   c.	The first statement is true, and the second statement is false.
   d.	The second statement is false, and the first statement is true.

   ANS: B

   Bacteria associated with healthy dental plaque are aerobic gram-positive rods and cocci, with very few motile species. An acceptable dental index of an individual should evaluate the entire dentition rather than a few select teeth.

   REF: Indices Used for Assessing Oral Deposits | 291-292

   1. Of the following variables, which is not an important variable to measure during baseline assessment?

   a.	Extent of oral biofilm
   b.	Amount of calculus
   c.	Location of deposits
   d.	Presence of food debris

   ANS: D

   The location, amount and extent of oral biofilm, stain and calculus, and to a lesser degree food debris are important variables to measure and record during baseline assessment.

   REF: Concepts for Oral Hygiene Assessment | 282-283

   1. A major risk factor for caries and periodontal diseases is:

   a.	amount of materia alba.
   b.	food debris.
   c.	dental plaque.
   d.	extrinsic stain.

   ANS: C

   Materia alba, food debris, and extrinsic stain are not major risk factors for caries and periodontal diseases.

   REF: Assessment | 287

   1. There is a need for knowledge about effective control of oral biofilm because a high percentage of the population exhibits some type of periodontal disease.

   a.	Both the statement and the reason are correct, and they are related.
   b.	Both the statement and the reason are correct, but they are 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.

   ANS: A

   Approximately 50% to 90% of the population exhibits some type of periodontal disease indicating a corresponding need for knowledge about effective oral biofilm control.

   REF: Oral Biofilm | 283

   1. Bacterial plaque as a biofilm is a risk factor for periodontal disease and oral malodor, whereas dental calculus does not cause oral disease.

   a.	Both parts of the statement are true.
   b.	Both parts of the statement are false.
   c.	The first part of the statement is true, and the second part of the statement is false.
   d.	The first part of the statement is false, and the second part of the statement is true.

   ANS: A

   Both of these statements are true. The other choices are incorrect.

   REF: Concepts for Oral Hygiene Assessment | 282

   1. Which of the following bacteria is not associated with a healthy periodontium?

   a.	Streptococcus oralis
   b.	Actinomyces sp.
   c.	Treponema
   d.	Streptococcus mitis

   ANS: C

   Treponema is associated with dental plaque-induced gingival disease, not a healthy periodontium.

   REF: Dental Calculus | 288

   1. Oral biofilm in a healthy mouth is located mainly supragingivally but grows subgingivally in plaque-induced gingival disease. In the presence of mature bacterial plaque, the host immune response is activated.

   a.	Both statements are true.
   b.	Both statements are false.
   c.	The first statement is true, and the second statement is false.
   d.	The first statement is false, and the second statement is true.

   ANS: A

   Oral biofilm begins as supragingival and subgingival biofilm does not form until the relationship between the tooth and the gingiva is altered, for example, by inflammation in gingivitis. As plaque matures and produces toxins, the host immune response is activated.

   REF: Supragingival Microorganisms | 284

   1. The most commonly used disclosing ingredient is:

   a.	methylene blue.
   b.	erythrosine dye.
   c.	formaldehyde.
   d.	fluorescein dye.

   ANS: B

   Erythrosine dye is the most commonly used ingredient in disclosants.

   REF: Supragingival Microorganisms AND Subgingival Microorganisms | 284

   1. The best time to apply a disclosant is:

   a.	after the periodontal assessment.
   b.	after the oral prophylaxis.
   c.	before the oral assessment.
   d.	before the client sees the oral findings.

   ANS: A

   The best time to apply a disclosant is after the periodontal assessment.

   REF: Disclosing Agents | 286

   1. Disease occurs when bacteria cause destruction that exceeds the reparative ability of the host. Furthermore, the quantity (amount) of the plaque is more important than the types (quality) of microorganisms present.

   a.	The first statement is true, and the second statement is false.
   b.	The first statement is false, and the second statement is true.
   c.	Both statements are true.
   d.	Both statements are false.

   ANS: A

   Disease occurs when bacteria cause destruction that exceeds the reparative ability of the host and the quality of the plaque is more important than the quantity present.

   REF: Disclosing Agents | 286

   MULTIPLE RESPONSE

   1. A significant percentage of the population exhibits some type of periodontal disease. Effective oral hygiene assessment provides which of the following benefits? Select all that apply.
   
   

   a.	Communicates unmet needs to a client
   b.	Instructs a client in effective, individualized self-care
   c.