Acute Care Nurse Practitioner Sepsis and Septic Shock Management 2

Question 1

What is the recommended initial fluid resuscitation volume for sepsis-induced tissue hypoperfusion according to Surviving Sepsis Campaign guidelines?

Accepted Answer

30 mL/kg of isotonic crystalloid administered within 3 hours

Answer

10 mL/kg of isotonic crystalloid administered over 30 minutes

Answer

1 L of 5% albumin solution administered over 1 hour

Answer

500 mL of normal saline followed by immediate reassessment before further fluids

Question 2

Which vasopressor is recommended as first-line therapy for septic shock to maintain mean arterial pressure ≥ 65 mmHg?

Accepted Answer

Norepinephrine at 0.01-3 mcg/kg/min

Answer

Dopamine at 5-20 mcg/kg/min

Answer

Epinephrine at 0.01-0.5 mcg/kg/min

Answer

Vasopressin at 0.03-0.04 units/min

Question 3

Which empiric antibiotic regimen is most appropriate for a patient with community-acquired septic shock of unknown source?

Accepted Answer

Vancomycin plus piperacillin-tazobactam or meropenem, with atypical coverage if pneumonia is suspected

Answer

Vancomycin plus cefazolin for narrow-spectrum gram-positive coverage

Answer

Azithromycin plus amoxicillin-clavulanate as oral equivalent if hemodynamically stable

Answer

Ciprofloxacin 400 mg IV q8h monotherapy for broad enteric gram-negative coverage

Question 4

A patient in septic shock remains hypotensive on norepinephrine 0.25 mcg/kg/min with MAP of 58 mmHg. What is the most appropriate next step for vasopressor management?

Accepted Answer

Add vasopressin 0.03-0.04 units/min as a norepinephrine-sparing adjunct to raise MAP

Answer

Escalate norepinephrine to the maximum dose of 3 mcg/kg/min before adding any second agent

Answer

Switch from norepinephrine to dopamine as second-line monotherapy

Answer

Add phenylephrine 100 mcg/min to augment alpha-adrenergic vasoconstriction

Question 5

Under which clinical circumstances should intravenous hydrocortisone be administered in septic shock?

Accepted Answer

When septic shock remains refractory to adequate fluid resuscitation and vasopressor therapy

Answer

All patients with septic shock should receive hydrocortisone 200 mg/day prophylactically

Answer

Only when confirmed primary adrenal insufficiency is documented by cosyntropin (ACTH) stimulation testing

Answer

When the patient's core temperature exceeds 39.5°C and blood cultures remain negative

Question 6

According to current Surviving Sepsis Campaign guidelines, packed red blood cells should be transfused in septic shock when hemoglobin falls below:

Accepted Answer

7 g/dL in adults without active myocardial ischemia, severe hypoxemia, or acute hemorrhage

Answer

10 g/dL in all patients with septic shock to optimize oxygen delivery

Answer

8 g/dL when concurrent serum lactate is greater than 2 mmol/L

Answer

9 g/dL in all patients requiring mechanical ventilation

Question 7

What is the recommended blood glucose target for patients in septic shock receiving insulin therapy?

Accepted Answer

Blood glucose ≤ 180 mg/dL using a validated protocol with frequent glucose monitoring

Answer

Tight glycemic control targeting 80-110 mg/dL to minimize infectious complications

Answer

Permissive hyperglycemia with a target of 140-200 mg/dL to reduce hypoglycemia risk

Answer

Blood glucose < 150 mg/dL with no specified lower limit for hypoglycemia avoidance