Acute Care Nurse Practitioner Sepsis and Septic Shock Management

Question 1

According to the Sepsis-3 consensus definition (2016), sepsis is best defined as:

Accepted Answer

Life-threatening organ dysfunction caused by a dysregulated host response to infection

Answer

Infection with at least 2 of 4 SIRS criteria (fever, tachycardia, tachypnea, leukocytosis)

Answer

Bacteremia with documented fever and leukocytosis on two separate blood cultures

Answer

Any infection associated with a systolic blood pressure below 90 mmHg

Question 2

An acute increase in the total Sequential Organ Failure Assessment (SOFA) score of ≥ ___ points indicates organ dysfunction consistent with sepsis:

Accepted Answer

2

Answer

1

Answer

3

Answer

4

Question 3

According to Sepsis-3 criteria, septic shock is distinguished from sepsis by the requirement for which combination of findings?

Accepted Answer

Vasopressor requirement to maintain MAP ≥ 65 mmHg AND serum lactate > 2 mmol/L despite adequate volume resuscitation

Answer

MAP < 65 mmHg despite 30 mL/kg IV crystalloid resuscitation

Answer

Systolic BP < 90 mmHg unresponsive to 1 L IV normal saline and lactate > 4 mmol/L

Answer

Serum lactate > 4 mmol/L regardless of hemodynamic status or vasopressor use

Question 4

The quick SOFA (qSOFA) score is a bedside screening tool for sepsis risk. Which three parameters comprise the qSOFA score?

Accepted Answer

Altered mental status, respiratory rate ≥ 22 breaths/min, systolic BP ≤ 100 mmHg

Answer

Temperature > 38.3°C, heart rate > 90 bpm, respiratory rate > 20 breaths/min

Answer

WBC > 12,000/mm³, serum lactate > 2 mmol/L, urine output < 0.5 mL/kg/hr

Answer

Glasgow Coma Scale ≤ 13, mean arterial pressure < 70 mmHg, PaO₂/FiO₂ < 300

Question 5

In a patient with suspected sepsis, when should blood cultures optimally be collected relative to antibiotic administration?

Accepted Answer

Before antibiotic administration, with at least 2 sets drawn from separate venipuncture sites

Answer

Only after antibiotics are started to avoid contaminating the results with contaminant organisms

Answer

From the existing central venous catheter only, to minimize patient discomfort and time

Answer

Only if the patient has a temperature greater than 39.0°C at the time of collection

Question 6

According to the Surviving Sepsis Campaign (SSC) Hour-1 Bundle, which actions must be completed within the first hour of recognizing sepsis or septic shock?

Accepted Answer

Measure lactate, obtain blood cultures before antibiotics, administer broad-spectrum antibiotics, and give 30 mL/kg crystalloid if hypotensive

Answer

Insert a pulmonary artery catheter, obtain an echocardiogram, and start vasopressors

Answer

Begin continuous renal replacement therapy, correct coagulopathy with FFP, and initiate vasopressors

Answer

Administer hydrocortisone 200 mg IV, obtain a CT scan for source identification, and start fluconazole

Question 7

Elevated serum lactate in sepsis most primarily reflects:

Accepted Answer

Anaerobic metabolism from tissue hypoperfusion and mitochondrial dysfunction

Answer

Decreased renal clearance of lactate due to acute kidney injury

Answer

Hepatic failure causing impaired hepatic lactate uptake and conversion

Answer

Increased intestinal lactate absorption secondary to mesenteric ischemia