Cumulative level test: Support Under Pressure: Oxygen, Perfusion, Metabolism and the Care That Continues

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12 questions · 80% to pass · no timer. This longer test revisits both units in the level. These authored questions assess recognition and application of the taught distinctions, not professional qualification. You may review the lessons and retry. Repeat attempts reuse the question bank; a remembered answer is not proof of transfer to a new situation.

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Question 1

A fictional 7 kg cat with a urethral obstruction arrives with a potassium of 8.1 mEq/L and a heart rate of 90 beats per minute with poor pulse quality. The technician connects the ECG, places the patient on oxygen and prepares the catheter trolley. Explain what the ECG is being used to detect, why the potassium result needs a handling check before it is treated as real, and who decides the interventions.The ECG is there to detect the conduction consequences of hyperkalaemia, namely bradycardia, tall T waves, widening of the QRS complex, loss of P waves and progression toward a sine wave pattern. The handling check covers pseudohyperkalaemia from thrombocytosis, extreme leukocytosis, haemolysis in breeds such as the Akita and Shiba Inu, EDTA contamination and delayed serum separation. Relief of obstruction and any electrolyte or fluid intervention are veterinarian decisions, with the technician monitoring, documenting and escalating.The ECG is there to confirm the potassium result, and because the value is above 7 mEq/L the technician should start the potassium-lowering fluidbag that is kept prepared in the crash cart.

Question 2

A fictional 22 kg dog with a perforated intestine is four hours post-operative. Blood pressure is 78/40 mm Hg with a mean of 52 mm Hg, lactate is 4.6 mmol/L, urine output is 0.3 mL/kg/h, and the dog is quiet but responsive. A colleague describes the patient as 'stable because the temperature is normal'. Build the argument that corrects this description, using the sepsis consensus material.The patient is stable because a normal temperature excludes sepsis, and the low blood pressure is expected after anaesthesia.Sepsis is defined as a life-threatening syndrome from a dysregulated host response to infection that produces organ dysfunction, and septic shock is the subset with cardiovascular instability and metabolic abnormalities despite adequate fluid resuscitation. This patient has hypotension below the mean arterial target of 60 mm Hg, hyperlactataemia and oliguria, which are organ dysfunction, so the correct description is a patient with sepsis and possible septic shock who needs urgent veterinary assessment, not a stable patient.

Question 3

A fictional practice measures blood pressure in every cat over nine years of age using an oscillometric device, one measurement, with the cuff on the tail while the cat is held in lateral recumbency by two people. A 12-year-old cat reads 185 mm Hg systolic and the veterinarian is asked to start treatment. Identify the three protocol failures and state what the ACVIM statement requires before a diagnosis.The failures are single rather than repeated measurement, a device and site used without regard to validation and standard technique, and restraint and posture that generate situational hypertension. The statement requires reliable measurement with a standard protocol, ideally by an experienced operator, and confirmation on more than two occasions unless target organ damage is present; a reading of 180 mm Hg or more without target organ damage is still not a diagnosis on one occasion.The only failure is using the tail rather than a forelimb, and a single reading above 180 mm Hg is sufficient to treat because the risk category is severe.

Question 4

A fictional 3.6 kg cat with a newly diagnosed diabetic crisis has a blood glucose of 486 mg/dL, venous pH 7.21, beta-hydroxybutyrate 4.8 mmol/L and potassium 3.2 mEq/L. The veterinarian starts an insulin infusion. List the four variables the technician should be measuring, with the interval and the reason for each.Blood glucose every six hours is sufficient, and potassium can wait for the next day because a low value will correct itself once insulin is running.Blood glucose every one to two hours because the infusion is titrated to it and the fall should not exceed 50 to 100 mg/dL per hour; potassium every four to six hours initially because insulin drives potassium into cells and total body potassium is already depleted; venous pH or bicarbonate to track resolution of acidosis toward a pH above 7.35; and urine output plus hydration and mentation to track the osmotic diuresis and the response to fluids.

Question 5

A fictional 6 kg cat with pancreatitis has not eaten for four days and vomits when fed by mouth. Compare a naso-oesophageal tube with an oesophagostomy tube for this patient, naming one advantage, one contraindication and one daily maintenance task for each, and state the caloric starting point.A naso-oesophageal tube needs no general anaesthesia and suits short-term use of roughly three to five days, but it is contraindicated in a patient that is vomiting and requires liquid diets, with daily checks of position, fixation and nasal comfort. An oesophagostomy tube needs anaesthesia and is suited to longer use with blended diets, is also contraindicated while vomiting is uncontrolled, and requires daily stoma cleaning, a light dressing and flushing after every feed. Feeding starts at about one third of the resting energy requirement over the first 12 to 24 hours.Both tubes are equivalent, so the choice should be made on cost alone, and feeding should start at the full resting energy requirement because the patient has a four-day deficit.

Question 6

A fictional 5 kg cat is admitted with a blocked urethra. The technician is asked to prepare the catheterisation trolley and the monitoring sheet. Describe the aseptic and system choices that matter, one piece of evidence about closed systems, and the two urine volumes that would make the technician escalate.The closed system is the only thing that matters, so the catheter can be disconnected for flushing as often as needed as long as the bag is sterile.Use a sterile, soft indwelling catheter of appropriate French size, a strict aseptic placement protocol, secure fixation and a closed collection system that is not disconnected for convenience. The randomised trial in 51 dogs found nosocomial bacteriuria in 11.1 percent of open systems and 8.3 percent of closed systems, not significantly different, and concluded that a strict placement and maintenance protocol was likely the key factor. Escalate a urine output below about 0.5 mL/kg/h, and escalate the high output of post-obstructive diuresis, which can exceed the normal 1 to 2 mL/kg/h by a wide margin.

Question 7

A fictional 30 kg dog is recumbent after a fibrocartilaginous embolus. It is incontinent of urine, cannot turn itself, and has a dry cornea on the dependent eye. Build a nursing plan with four timed elements and the physiological reason for each.Reposition every two hours from left lateral to right lateral to sternal, because unrelieved pressure over the trochanter, ischium and scapula causes capillary occlusion and pressure injury; inspect and clean the skin at each turn, with moisture control because urine macerates skin; lubricate and check both eyes at least every four hours, because recumbency reduces blink and tear spread and the dependent cornea is exposed; and provide passive range of motion and sling or hoisting sessions, because immobility costs joint range, muscle mass and ventilation.Reposition every six hours and focus on keeping the patient clean, because skin hygiene is the only modifiable risk in recumbency.

Question 8

A fictional client must give subcutaneous fluids to a 4 kg cat at home twice weekly. The veterinarian has prescribed the volume. The technician has ten minutes at discharge. Design the teaching sequence and name two things that must be documented.Give the client a printed sheet and ask them to watch a video at home, because ten minutes is not enough for a demonstration and adults learn best from written instructions.Explain the purpose in plain language, demonstrate the full sequence with the equipment the client will use, then ask the client to perform it while the technician observes and coaches, using teach-back rather than asking whether they understood. Document the demonstration, the client's performance and any part still uncertain, the equipment and needle size supplied, the prescribed volume and frequency as written by the veterinarian, and the follow-up contact plan.

Question 9

A fictional 11-year-old Labrador is euthanased at home. The owner asks whether the eyes will stay open, whether the body can be buried in the garden, and how the technician knows the dog has died. Answer all three, naming the limits of each answer.The eyes may remain open and the cornea will dull, which is a normal post-mortem change and not evidence of suffering; burial is a legal and practical question that depends on local rules, depth, distance from water and whether the drug used leaves residue hazardous to scavengers, so the practice must give the owner the locally correct options; death is confirmed on a combination of absent pulse, breathing, corneal reflex and pain response, no audible heartbeat, grey mucous membranes and eventually rigor mortis, with confirmation belonging to the veterinarian.The eyes closing is the reliable sign of death, and burial is always acceptable because the drug is broken down within hours in soil.

Question 10

A fictional 8 kg pug with brachycephalic obstructive airway syndrome is recovering from anaesthesia. The technician must choose between flow-by oxygen, a facemask and a nasal line, and must state what would make each choice wrong. Construct the comparison.Intubation is the correct answer whenever saturation is below 95 percent, because it delivers 100 percent oxygen and removes the airway problem.Flow-by is the least invasive and delivers roughly 25 to 40 percent, useful while the patient is waking but easily displaced and dependent on the operator; a facemask reaches roughly 35 to 60 percent but is poorly tolerated in a dyspnoeic brachycephalic patient and risks carbon dioxide accumulation if too tight; a unilateral nasal line reaches roughly 30 to 50 percent with less handling but requires patience, fixation and humidification, and is wrong if the patient resents it or the nares are obstructed.

Question 11

A fictional ward has one monitor, one oxygen cage and two critical patients: a 5 kg cat with sepsis and a 40 kg dog with pneumonia. The technician must allocate the equipment for the next hour and justify the choice using measured variables rather than diagnosis.Allocate by the variable most likely to change management within the hour: the cat's small size makes blood pressure and urine output the most informative and most easily lost signals, and its sepsis makes perfusion the priority, so the monitor and a warmed, quiet cage go to the cat, while the dog receives oxygen by a technique that does not need the cage and a written observation set at fixed intervals. Both get a documented rationale and a review time, with escalation if either fails to improve.Give both resources to the dog, because a 40 kg patient has less physiological reserve than a 5 kg patient and larger patients deteriorate faster.

Question 12

A fictional technician is asked to write the one-page standard for the practice's oxygen, blood pressure and feeding-tube checks. Write the four rules you would insist on, each with the error it prevents.Record the values in the same place each day and let the veterinarian interpret them at ward rounds, because standardisation of the form is what makes a monitoring system reliable.Record the delivered technique and flow with every saturation, because a number without its oxygen conditions cannot be trended; measure blood pressure with a standard protocol, repeated readings and minimal restraint, because single stressed readings create diagnoses; calculate and record actual calories delivered against the resting energy requirement, because a tube in place is not the same as nutrition delivered; and write the escalation threshold next to each variable, because a value without a trigger is an observation nobody acts on.

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