Acute Care Nurse Practitioner Sepsis and Septic Shock Management 1 — Questions and Answers
Question 1: According to the Sepsis-3 consensus definition (2016), sepsis is best defined as:
- Infection with at least 2 of 4 SIRS criteria (fever, tachycardia, tachypnea, leukocytosis)
- Life-threatening organ dysfunction caused by a dysregulated host response to infection (Correct answer)
- Bacteremia with documented fever and leukocytosis on two separate blood cultures
- Any infection associated with a systolic blood pressure below 90 mmHg
Correct answer: Life-threatening organ dysfunction caused by a dysregulated host response to infection
Sepsis-3 (2016) redefined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, replacing the older SIRS-based criteria.
Question 2: An acute increase in the total Sequential Organ Failure Assessment (SOFA) score of ≥ ___ points indicates organ dysfunction consistent with sepsis:
- 1
- 2 (Correct answer)
- 3
- 4
Correct answer: 2
An acute change in total SOFA score ≥2 points above baseline indicates organ dysfunction in the setting of suspected infection, meeting the Sepsis-3 definition of sepsis.
Question 3: According to Sepsis-3 criteria, septic shock is distinguished from sepsis by the requirement for which combination of findings?
- MAP < 65 mmHg despite 30 mL/kg IV crystalloid resuscitation
- Vasopressor requirement to maintain MAP ≥ 65 mmHg AND serum lactate > 2 mmol/L despite adequate volume resuscitation (Correct answer)
- Systolic BP < 90 mmHg unresponsive to 1 L IV normal saline and lactate > 4 mmol/L
- Serum lactate > 4 mmol/L regardless of hemodynamic status or vasopressor use
Correct answer: Vasopressor requirement to maintain MAP ≥ 65 mmHg AND serum lactate > 2 mmol/L despite adequate volume resuscitation
Septic shock requires both vasopressor dependence to maintain MAP ≥65 mmHg and serum lactate >2 mmol/L despite adequate resuscitation, indicating profound circulatory and cellular metabolic abnormalities.
Question 4: The quick SOFA (qSOFA) score is a bedside screening tool for sepsis risk. Which three parameters comprise the qSOFA score?
- Temperature > 38.3°C, heart rate > 90 bpm, respiratory rate > 20 breaths/min
- Altered mental status, respiratory rate ≥ 22 breaths/min, systolic BP ≤ 100 mmHg (Correct answer)
- WBC > 12,000/mm³, serum lactate > 2 mmol/L, urine output < 0.5 mL/kg/hr
- Glasgow Coma Scale ≤ 13, mean arterial pressure < 70 mmHg, PaO₂/FiO₂ < 300
Correct answer: Altered mental status, respiratory rate ≥ 22 breaths/min, systolic BP ≤ 100 mmHg
qSOFA uses three bedside variables: altered mentation, RR ≥22/min, and SBP ≤100 mmHg; a score ≥2 identifies patients at high risk for poor outcomes outside the ICU.
Question 5: In a patient with suspected sepsis, when should blood cultures optimally be collected relative to antibiotic administration?
- Only after antibiotics are started to avoid contaminating the results with contaminant organisms
- Before antibiotic administration, with at least 2 sets drawn from separate venipuncture sites (Correct answer)
- From the existing central venous catheter only, to minimize patient discomfort and time
- Only if the patient has a temperature greater than 39.0°C at the time of collection
Correct answer: Before antibiotic administration, with at least 2 sets drawn from separate venipuncture sites
At least 2 sets of blood cultures from separate venipuncture sites should be obtained before initiating antibiotics to maximize pathogen identification while reducing contamination false positives.
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?
- Insert a pulmonary artery catheter, obtain an echocardiogram, and start vasopressors
- Measure lactate, obtain blood cultures before antibiotics, administer broad-spectrum antibiotics, and give 30 mL/kg crystalloid if hypotensive (Correct answer)
- Begin continuous renal replacement therapy, correct coagulopathy with FFP, and initiate vasopressors
- Administer hydrocortisone 200 mg IV, obtain a CT scan for source identification, and start fluconazole
Correct answer: Measure lactate, obtain blood cultures before antibiotics, administer broad-spectrum antibiotics, and give 30 mL/kg crystalloid if hypotensive
The SSC Hour-1 Bundle requires measuring lactate, obtaining blood cultures before antibiotics, administering broad-spectrum antibiotics, and beginning fluid resuscitation in hypotensive or hyperlactatemic patients.
Question 7: Elevated serum lactate in sepsis most primarily reflects:
- Decreased renal clearance of lactate due to acute kidney injury
- Anaerobic metabolism from tissue hypoperfusion and mitochondrial dysfunction (Correct answer)
- Hepatic failure causing impaired hepatic lactate uptake and conversion
- Increased intestinal lactate absorption secondary to mesenteric ischemia
Correct answer: Anaerobic metabolism from tissue hypoperfusion and mitochondrial dysfunction
Hyperlactatemia in sepsis is primarily driven by tissue hypoperfusion leading to anaerobic glycolysis, though mitochondrial dysfunction and impaired hepatic clearance contribute as well.
Acute Care Nurse Practitioner Sepsis and Septic Shock Management 1
According to the Sepsis-3 consensus definition (2016), sepsis is best defined as: