20 free VTNE practice questions

Correct answer: C · 0.88 mL

The Rimadyl (carprofen) injectable label gives the subcutaneous dose for dogs as 2 mg/lb (4.4 mg/kg) once daily, or 1 mg/lb (2.2 mg/kg) twice daily, and the product is 50 mg/mL. Step by step: 22 lb ÷ 2.2 = 10 kg; 10 kg × 4.4 mg/kg = 44 mg; 44 mg ÷ 50 mg/mL = 0.88 mL. Checking with the label's per-pound dose: 22 lb × 2 mg/lb = 44 mg. Multiplying the weight in pounds by the per-kilogram dose gives 96.8 mg, or 1.94 mL, more than double the dose. A volume of 0.44 mL is the twice-daily dose of 2.2 mg/kg, not the once-daily order. A volume of 8.8 mL is a decimal error. The VTNE outline lists calculating medications based on the appropriate dosage under Pharmacy and Pharmacology (task C).

Look for this next time: Convert pounds to kilograms before using a mg/kg dose, then divide the dose in mg by the concentration in mg/mL.

Correct answer: A · Only hydromorphone, because it is a Schedule II controlled substance

Under 21 CFR 1305.03, a DEA Form 222 or its electronic equivalent is required for each distribution of a Schedule I or II controlled substance, with limited exceptions. The DEA schedules list hydromorphone in Schedule II (21 CFR 1308.12), buprenorphine in Schedule III (21 CFR 1308.13), and butorphanol in Schedule IV (21 CFR 1308.14). So only the hydromorphone order needs the Form 222; the Schedule III and IV drugs are ordered without it, although the practice must still keep the required records and inventory logs. Not every controlled substance uses the form. Butorphanol is Schedule IV, not II. Veterinary practices registered with DEA follow the same ordering rules as other registrants. The VTNE outline lists maintaining controlled drug inventory and logbooks under Pharmacy and Pharmacology (task E).

Look for this next time: DEA Form 222, or its electronic version, is needed only for Schedule I and II drugs such as hydromorphone.

Correct answer: D · No, it is banned from extralabel use in food-producing animals

FDA's extralabel drug use rules, 21 CFR 530.41(a), list drugs that are prohibited for extralabel animal and human drug uses in food-producing animals, and chloramphenicol is first on the list, along with clenbuterol, diethylstilbestrol, nitroimidazoles, nitrofurans, fluoroquinolones, and glycopeptides. A calf is a food-producing animal, so no prescription, relationship, or extended withdrawal time makes extralabel chloramphenicol legal. A veterinarian-client-patient relationship does not make a prohibited drug permissible. Lengthening the withdrawal time does not change the prohibition, and the rule has no age exception for calves. The technician refers the producer to the veterinarian for a lawful alternative. The VTNE outline lists legal requirements for drugs among its knowledge statements.

Look for this next time: Chloramphenicol is prohibited from extralabel use in any food-producing animal, whatever the prescription or withdrawal time.

Correct answer: B · Treat it as not sterile, set it aside, and report it for reprocessing

CDC's Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) recommends monitoring each load with mechanical and chemical indicators, both internal and external, and says not to use processed items if the mechanical or chemical indicators suggest inadequate processing. External tape shows only that the pack was exposed to a cycle. The internal indicator shows whether conditions inside the pack, where the instruments are, were met. A failed internal indicator means the contents cannot be considered sterile, so the pack is set aside, a new pack is opened, and the failure is reported so the load can be investigated and reprocessed. No layer of the pack is exempt, and an alcohol wipe is not sterilization. The VTNE outline lists sterilizing equipment and supplies under Surgical Nursing (task I).

Look for this next time: If an internal chemical indicator has not changed, do not use the pack, whatever the outside tape shows.

Correct answer: C · Complete aeration of the items before patient use

CDC's Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) says to completely aerate surgical and medical items sterilized in an EtO sterilizer before use, and gives polyvinyl chloride tubing as an example that needs 12 hours at 50 °C or 8 hours at 60 °C. Ethylene oxide residues left in materials such as tubing can harm patients and staff, so aeration is part of the process, not an optional extra. A finished cycle without aeration is not ready for use. Rinsing with water is not a substitute and is not how EtO residue is removed. Ten minutes at room temperature falls far short of the required aeration. The VTNE outline lists sterilizing equipment and supplies by the appropriate method, including gas, under Surgical Nursing (task I).

Look for this next time: Items sterilized with ethylene oxide must be fully aerated before use; PVC tubing needs hours of mechanical aeration.

Correct answer: A · Remove it from use and send it to be repackaged and resterilized

CDC's Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) says packaged sterile items can be used indefinitely under event-related storage unless the packaging is compromised, and directs staff to check packages for tears, wetness, or punctures and to repack and reprocess any compromised package before use. A damp, punctured wrap is compromised, so the pack is removed and resterilized. A recent date does not override damage. Drying it does not reverse contamination that may have entered while it was wet. Overwrapping hides the problem without reprocessing the contents. Storage near a sink also makes this kind of event more likely, which is worth reporting. The VTNE outline lists maintaining the surgical environment, instruments, and supplies under Surgical Nursing (task H).

Look for this next time: A wet or punctured sterile pack is compromised regardless of its date; reprocess it before use.

Correct answer: D · The left mandibular canine

The American Veterinary Dental College calls the modified Triadan system the tooth numbering system of choice in veterinary dentistry. The first digit gives the quadrant and the last two give the tooth, counted from the midline, so in the dog 01 to 03 are incisors, 04 is the canine, and 05 to 08 are the premolars. AVDC's own example records 'LV304' as linguoversion of the left mandibular canine tooth, and uses 202 for the left maxillary second incisor, which puts the left maxilla in quadrant 2 and the left mandible in quadrant 3. Tooth 304 is therefore the left mandibular canine. The right maxillary canine is 104, the left maxillary canine is 204, and the left mandibular fourth premolar is 308. The VTNE outline lists dental charting under its dentistry knowledge statements.

Look for this next time: Triadan: first digit is the quadrant (1 right maxilla, 2 left maxilla, 3 left mandible, 4 right mandible), and 04 is the canine.

Correct answer: B · Forcing the blood through the small needle into the tube

Red-tinged serum after centrifugation indicates hemolysis. The WHO guidelines on drawing blood (2010) list among the factors that increase hemolysis a needle of too small a gauge and pressing the syringe plunger to force blood into a tube, which increases shear force on red cells; they advise letting the tube's vacuum draw the blood in instead. Hemolysis can falsely change chemistry results, so the specimen may need to be redrawn. The choice of vein does not explain red-tinged serum. A serum tube is correct for serum chemistry. Clotting before centrifugation is required for serum, not a cause of hemolysis. The VTNE outline lists preparing and maintaining specimens for laboratory evaluation under Laboratory Procedures (task B).

Look for this next time: Forcing blood through a small needle damages red cells; let the tube vacuum fill, or remove the needle and transfer gently.

Correct answer: A · A lavender-top EDTA tube, filled properly and gently inverted to mix

The WHO guidelines on drawing blood (2010) list the purple or lavender EDTA tube for hematology, explaining that EDTA prevents clotting by binding calcium, and advise gently inverting tubes with additives to mix thoroughly, because poor mixing can give erroneous results. A complete blood count needs anticoagulated whole blood, so the EDTA tube is the choice, mixed gently rather than shaken. A red-top tube lets the blood clot, which makes a whole-blood count impossible. A fluoride tube is meant for glucose, and shaking any tube vigorously causes hemolysis. A citrate tube is used for coagulation testing, and leaving any additive tube unmixed invites clots. The VTNE outline lists performing hematology among laboratory tests and procedures (task C).

Look for this next time: Use a lavender EDTA tube for a CBC and invert it gently; never shake an additive tube.

Correct answer: C · Get a U-40 syringe and draw to its 10-unit mark, as the label directs

The FDA-approved label for this porcine insulin zinc suspension (Vetsulin) states that it contains 40 IU/mL, that vials are used with U-40 syringes, and that using a syringe other than a U-40 syringe will result in incorrect dosing. Step by step: 10 IU ÷ 40 IU/mL = 0.25 mL, which is the 10-unit mark on a U-40 syringe. A U-100 syringe is scaled for 100 units per mL, so its 10-unit mark holds only 0.10 mL, and 0.10 mL × 40 IU/mL = 4 IU, less than half the order. Drawing 0.1 mL in a tuberculin syringe gives the same 4 IU. Splitting the dose delays treatment and still needs the right syringe. The label also says to shake the vial until the suspension is uniformly milky. The VTNE outline lists administering medications via the appropriate routes under Animal Care and Nursing (task G).

Look for this next time: Measure U-40 insulin only with U-40 syringes; a U-100 syringe's unit marks do not match a 40 IU/mL product.

Correct answer: D · Blood glucose, checked serially even while the dog looks normal

The FDA explains that in dogs xylitol is rapidly absorbed and can cause a potent release of insulin, leading to a rapid and profound drop in blood sugar that can occur within 10 to 60 minutes and can quickly become life-threatening. It also notes that hypoglycemia and other serious effects may not appear for up to 12 to 24 hours, which is why dogs may be hospitalized for monitoring. Serial blood glucose checks are therefore the key nursing task, and a normal-looking dog is not proof of safety. Urine specific gravity at admission and discharge, a packed cell volume at discharge, or frequent temperatures do not detect the main early danger. The VTNE outline lists ongoing patient evaluations and clinical procedures under Animal Care and Nursing (tasks B and D).

Look for this next time: After xylitol ingestion, monitor blood glucose serially; hypoglycemia can be fast or delayed up to 12 to 24 hours.

Correct answer: B · Keep the dog warm and monitor its temperature until full recovery

The Dexdomitor (dexmedetomidine) label says that a decrease in body temperature is likely unless it is externally maintained, that once established, hypothermia may persist longer than the sedation and analgesia, and that treated animals should be kept warm and at a constant temperature during the procedure and until full recovery. It also calls for frequent monitoring of cardiovascular function and body temperature. A cool room and a thin mat invite heat loss, so the technician provides warmth and checks the temperature regularly. Withholding water for a day is not part of this guidance. Walking a sedated dog risks falls and does not clear the drug. Waiting for shivering misses hypothermia that the label warns may outlast sedation. The VTNE outline covers ongoing patient evaluation under Animal Care and Nursing.

Look for this next time: After dexmedetomidine, keep the patient warm and monitor temperature until full recovery; hypothermia can outlast sedation.

Correct answer: A · Wash with soap and water, then dry with a single-use towel

The WHO guidelines on drawing blood (2010) describe hand hygiene as washing with soap and water and drying with single-use towels, or, if hands are not visibly contaminated, using an alcohol rub until dry. Visibly soiled hands therefore call for soap and water. Alcohol rub is meant for hands that are not visibly dirty, and it does not remove soil. Wiping on a towel spreads contamination without cleaning. Gloves are not a substitute for hand hygiene and can tear again. Clean hands between patients protect both the next patient and the staff, which matters with diarrhea that may be infectious. The VTNE outline lists providing a safe, sanitary environment for the patient and personnel under Animal Care and Nursing (task E).

Look for this next time: When hands are visibly soiled, wash with soap and water; save alcohol rub for hands that are not visibly dirty.

Correct answer: C · Position the sedated dog with sandbags and foam, and stand back during exposure

The U.S. Nuclear Regulatory Commission defines ALARA, as low as is reasonably achievable, as making every reasonable effort to keep exposures as far below the dose limits as is practical (10 CFR 20.1003), and its rules require procedures and engineering controls that achieve ALARA (10 CFR 20.1101). X-ray machines are regulated by each state, but the principle is the same. With the patient sedated, positioning aids let everyone stand back, and distance sharply reduces exposure. Hand-holding puts a person right beside the patient and the beam, which ALARA aims to avoid when positioning aids can do the job. Extra exposures raise the dose for everyone. Rotating holders spreads the dose instead of reducing it. The VTNE outline lists producing images following protocols for safety under Diagnostic Imaging (task B).

Look for this next time: ALARA means avoiding exposure when you can: use positioning aids and distance instead of manual restraint.

Correct answer: D · Atipamezole is given IM and reverses analgesia too, so plan for pain

The Antisedan (atipamezole) label says it is for intramuscular use in dogs and is given intramuscularly for reversal regardless of the route used for dexmedetomidine, with a different dose depending on whether the sedative was given IV or IM. The Dexdomitor (dexmedetomidine) label adds that because analgesic as well as sedative effects are reversed, pain management may need to be addressed. So the technician gives it IM as ordered and watches for pain after reversal. Giving it IV goes against the label. Saying the analgesia remains is false. The dexmedetomidine label states that atipamezole has not been evaluated as a routine reversal agent in cats, and that dyspnea has been reported after its use in cats. The VTNE outline lists monitoring and responding to patient status during all stages of anesthesia (task F).

Look for this next time: Atipamezole is given IM in dogs and reverses analgesia along with sedation, so plan pain control after reversal.

Correct answer: B · Give it slowly to effect, with airway, oxygen, and ventilation ready

The Alfaxan Multidose IDX (alfaxalone) label says to administer the drug slowly to effect when given by IV injection, titrating against the patient's response, and warns that rapid administration may increase cardiorespiratory depression or apnea. It requires continuous monitoring and immediate access to a patent airway, artificial ventilation, and oxygen, and says apnea is treated with endotracheal intubation, oxygen, and intermittent positive pressure ventilation. A rapid bolus is exactly what the label warns against. Skipping airway equipment ignores the apnea risk. The label also notes that preanesthetics may reduce the induction dose, so the premedication matters. The VTNE outline lists assisting with the anesthetic plan and establishing a patent airway with endotracheal intubation under Anesthesia (tasks B and E).

Look for this next time: Give alfaxalone IV slowly to effect, and have intubation, oxygen, and ventilation ready for apnea.

Correct answer: A · A dog with existing bradycardia and low blood pressure

The Dexdomitor (dexmedetomidine) label says dexmedetomidine should not be administered in the presence of preexisting hypotension, hypoxia, or bradycardia, and that because of its pronounced cardiovascular effects, only clinically healthy dogs and cats in ASA classes I and II should be treated. A dog that already has bradycardia and low blood pressure is the clear exclusion. Healthy dogs having radiographs or a minor biopsy fit the label's intended population, as does an ASA II dog with mild, stable disease. The label also calls for frequent monitoring of cardiovascular function and body temperature in any treated animal, and notes that apnea may occur. The VTNE outline lists assisting in the development of the anesthetic plan to ensure patient safety under Anesthesia (task B).

Look for this next time: Dexmedetomidine is for healthy ASA I to II patients; avoid it with existing bradycardia, hypotension, or hypoxia.

Correct answer: C · Bring the cat in immediately, with the plant or its photo

The FDA explains that in true lilies and daylilies the entire plant is toxic to cats, including the stem, leaves, flowers, pollen, and even vase water, and that eating a small amount of a leaf or petal can cause fatal kidney failure in less than 3 days. Early treatment greatly improves the prognosis, but if treatment is delayed 18 hours or more, the cat generally develops irreversible kidney failure. The FDA advises calling a veterinarian immediately and bringing the plant or a photo. Seeming normal at one hour is expected, because kidney signs start later. Waiting for vomiting wastes the treatment window. The petal, not just the bulb, is dangerous. Home remedies delay care. The VTNE outline lists triage of toxicity under Emergency Medicine/Critical Care (task B).

Look for this next time: Any lily exposure in a cat is an emergency, even without signs; treatment delayed 18 hours or more often fails.

Correct answer: D · Avoid the combination; consider a washout before switching to the NSAID

The Rimadyl (carprofen) label says concomitant use with other anti-inflammatory drugs, such as other NSAIDs or corticosteroids, should be avoided because of the potential increase in adverse reactions, including gastrointestinal ulceration and perforation. It also advises considering appropriate washout times when switching from corticosteroid use to NSAID use, and suggests alternative analgesia rather than another NSAID if more pain relief is needed. So the safe answer is to avoid the combination and let the veterinarian plan a washout or another analgesic. Combining them is what the label warns against. The injectable label says safety has not been established for IV use. Doubling the dose raises the risk of toxicity. The VTNE outline lists assisting with the pain management plan under Pain Management/Analgesia (task C).

Look for this next time: Do not combine carprofen with corticosteroids or other NSAIDs; the label advises a washout when switching.

Correct answer: B · Let someone else clean the litter box; avoid cat feces and undercooked meat

MedlinePlus, the National Library of Medicine's health site, says pregnant women and people with weakened immune systems should not clean cat litter boxes and should not touch anything that may contain cat feces, and it also advises not eating undercooked meat and washing hands after handling raw meat. That makes having someone else take over the litter box, avoiding contact with feces, and avoiding undercooked meat the consistent advice, with any further questions referred to her own physician. A dust mask while scooping still means cleaning the box. Scratches are not the route MedlinePlus describes; litter, cat feces, and undercooked meat are. Scooping less often still involves cleaning the box. The VTNE outline lists educating clients about zoonoses under Communication and Veterinary Professional Support Services (task A).

Look for this next time: Pregnant clients should not clean the litter box, should avoid cat feces, and should avoid undercooked meat.