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| Section | Weight | Objectives |
|---|---|---|
| Pain Management and Analgesia | 7% | - Pain Control
|
| Surgical Nursing | 11% | - Perioperative Procedures
|
| Anesthesia | 15% | - Anesthetic Procedures
|
| Diagnostic Imaging | 7% | - Imaging Techniques
|
| Pharmacy and Pharmacology | 12% | - Medication Preparation
|
| Dentistry | 8% | - Dental Procedures
|
| Animal Care and Nursing | 20% | - Patient Care
|
| Emergency Medicine and Critical Care | 8% | - Emergency Procedures
|
| Laboratory Procedures | 12% | - Diagnostic Testing
|
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NEW QUESTION # 1206
When thinking about your preanesthetic plan, you need to consider the benefits of selected agents and any contraindications to their use. What condition in your patient would prevent you from using an anticholinergic as part of your premedication protocol?
Answer: B
Explanation:
Anticholinergics are not true anesthetics, and these drugs are, instead, used to thwart the effects of parasympathetic nervous system stimulation. Anticholinergics are used to prevent or treat vagally stimulated bradycardia, such as may occur with surgical manipulation or secondary to specific medications, such as alpha2-agonists or opioids. They work by increasing the heart rate through the antagonistic action against acetylcholine. As a result, this increases blood pressure, cardiac output, and heart rate. They can be given as part of the premedication but may not be warranted in many cases.
Additional benefits and/or negative effects of anticholinergics include:
*Decreased secretions
*Bronchodilation - This can cause a significant increase in anatomical dead space, increasing the risk of hypoxemia and decreased ventilation
*Mydriasis (especially in cats)
*May create thicker mucus within the airways in horses, ruminants, and cats - caution with dosing
*Decreases GI activity through the ability to inhibit peristalsis
However, contraindications, regardless of benefit, include:
*Patients with underlying tachyarrhythmias and primary cardiac disease
*Patients with concurrent diseases that cannot tolerate tachycardia
*Geriatric patients without complete workups - a decreased function of organ systems in general with age +/- any underlying disease
*Patients with constipation or ileus - could be made much worse by the use of anticholinergics
*Can induce colic in horses or bloat in ruminants
*Not recommended for rabbits. Part of this recommendation pertains to concerns for ileus. However, many rabbits produce atropine esterase, which causes the breakdown of atropine, rendering it ineffective.
Examples of anticholinergics include atropine and glycopyrrolate.
Because these drugs decrease gastric motility and can worsen ileus and constipation, these drugs should be avoided in patients with underlying conditions or species like rabbits, horses, and ruminants that may be predisposed to severe disease if peristalsis is decreased.
Anticholinergics treat bradycardia and slow down the gut, likely improving diarrhea and drying up secretions, so patients with excessive ptyalism would benefit from their use.
NEW QUESTION # 1207
Which of the following identifies a primary benefit of local anesthetic drugs in pain management?
Answer: A
Explanation:
Local anesthetic drugs are effective, relatively inexpensive, and can be used safely in most animals. They can reduce the dosing needs of other medications that have more adverse effects. Examples include lidocaine, mepivacaine, and bupivacaine.
Local anesthetic drugs do not directly improve joint health or have sedative side effects, and they sting on administration, so continued use of injectable nerve blocks is limited.
NEW QUESTION # 1208
Tidal volume (volume of air moving with a normal breath) can be estimated as which of the following calculations?
Answer: D
NEW QUESTION # 1209
You are admitting a patient for a day case. The cat is a 13-year-old DSH here for a blood glucose curve. You obtain the patient's medications and dosing frequency and ask the owner if there are any changes in eating, drinking, and urination. The owner reports that she is on subcutaneous fluids (SQF) at home for chronic kidney disease, glargine insulin 3 units q 12 hours, and liquid gabapentin q 8 to 12 hours for pain. The owner requests a refill of the SQF and tells you that she got the wrong one last time. She called and was told it was safe to use, but it seemed to sting. She told you she got plasma-something last time but wants the one she had the time before that.
What are fluid solutions commonly sent home or used in hospitals for SQF administration?
Answer: C
Explanation:
Fluids administered subcutaneously need to be isotonic, such as 0.9% NaCl or lactated Ringer's (LR). For isotonic fluids, the osmolality should approximate the extracellular fluid spaces (280-310 milliosmoles). The osmolality of 0.9% NaCl is 308, with LRS at 278. Plasmalyte, while also isotonic, has been known to sting when administered via the SQ route due to its acidic pH.
0.45% NaCl or half-strength saline is hypotonic. Therefore, its osmolality of only 154 milliosmoles is lower than that of plasma and would not properly absorb via the SQ route.
Fluids containing dextrose should not exceed a 2.5% solution, or skin sloughing and abscessation can occur.
NEW QUESTION # 1210
Which of the following sedatives is reversed by yohimbine?
Answer: B
Explanation:
Yohimbine is an antagonist for xylazine and reverses its effects. Xylazine is an alpha-2 agonist primarily used for sedation in large animals.
Yohimbine also has some antagonist effects on dexmedetomidine (another alpha-2 agonist), but atipamezole is the specifically intended reversal agent.
NEW QUESTION # 1211
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