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

The SSC guidelines recommend at least 30 mL/kg of isotonic crystalloid (normal saline or lactated Ringer's) within 3 hours for sepsis-induced hypoperfusion or hypotension.

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

Norepinephrine is the first-line vasopressor for septic shock due to its potent alpha-1 adrenergic vasoconstriction with modest beta-1 effects, reliably raising MAP with less tachycardia than dopamine.

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

Empiric therapy for septic shock requires broad-spectrum coverage including MRSA (vancomycin) and gram-negative organisms (pip-tazo or carbapenem) until cultures guide de-escalation.

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

Vasopressin at 0.03-0.04 units/min is recommended as an adjunct to norepinephrine in refractory septic shock, acting on V1 receptors independently of catecholamine pathways to reduce norepinephrine requirements.

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

Hydrocortisone 200 mg/day IV is recommended for septic shock not adequately stabilized with fluid resuscitation and vasopressors, not as routine first-line therapy for all sepsis patients.

Acute Care Nurse Practitioner Practice Test

Acute Care Nurse Practitioner Practice Test

Acute Care Nurse Practitioner Sepsis and Septic Shock Management 2