Acute Care Nurse Practitioner Sepsis and Septic Shock Management 3

Question 1

Serial serum lactate measurement is recommended to guide resuscitation in sepsis. An initial lactate > 2 mmol/L should prompt which action?

Accepted Answer

Repeat lactate measurement within 2 hours and optimize perfusion targeting lactate normalization

Answer

Immediate endotracheal intubation and initiation of mechanical ventilation

Answer

Emergent renal replacement therapy to facilitate lactate clearance

Answer

IV sodium bicarbonate infusion to correct the metabolic acidosis and neutralize lactate

Question 2

Which hemodynamic pattern best characterizes the pathophysiology of distributive shock in early septic shock?

Accepted Answer

Massive vasodilation with decreased SVR, relative hypovolemia, and often high or normal cardiac output

Answer

Low cardiac output, high SVR, and elevated CVP indicating cardiogenic dysfunction

Answer

Obstructed pulmonary circulation causing right ventricular failure and low cardiac output

Answer

Absolute intravascular volume depletion from fever and third-spacing with normal SVR

Question 3

Procalcitonin (PCT) is used as a biomarker in sepsis management. For which clinical application is PCT most supported by evidence?

Accepted Answer

Guiding antibiotic de-escalation and earlier discontinuation when PCT levels significantly decline

Answer

Definitively diagnosing bacterial versus viral infection at initial presentation

Answer

Predicting 30-day mortality in all patients meeting Sepsis-3 criteria

Answer

Differentiating septic shock from other distributive shock states such as anaphylaxis

Question 4

In sepsis management, 'source control' refers to which intervention?

Accepted Answer

Identifying and physically eliminating or controlling the anatomical infection source through drainage, debridement, or device removal

Answer

Administering broad-spectrum empiric antibiotics until organism-specific sensitivities are available

Answer

Isolating the septic patient to prevent nosocomial transmission of the causative pathogen

Answer

Monitoring serial blood cultures to confirm clearance of bacteremia from the bloodstream

Question 5

An arterial blood gas from a patient in septic shock shows: pH 7.15, PaCO₂ 28 mmHg, HCO₃ 10 mEq/L, lactate 6 mmol/L. What is the correct interpretation?

Accepted Answer

High anion gap metabolic acidosis with appropriate respiratory compensation

Answer

Respiratory alkalosis with appropriate metabolic compensation

Answer

Pure mixed metabolic acidosis and primary respiratory alkalosis simultaneously

Answer

Metabolic alkalosis with a superimposed respiratory acidosis

Question 6

If a patient with sepsis-associated acute respiratory failure requires intubation and mechanical ventilation, which ventilator strategy is preferred?

Accepted Answer

Low tidal volume ventilation (6 mL/kg IBW) with plateau pressure < 30 cmH₂O and permissive hypercapnia

Answer

High tidal volumes (10-12 mL/kg IBW) to prevent atelectasis and optimize CO₂ clearance

Answer

Pressure-controlled ventilation with PEEP set at 15 cmH₂O universally regardless of oxygenation parameters

Answer

High-frequency oscillatory ventilation (HFOV) as the preferred first-line ventilation modality

Question 7

When is antibiotic de-escalation most appropriate in a patient recovering from sepsis?

Accepted Answer

When culture and sensitivity results identify a specific pathogen and clinical improvement allows narrowing to the most targeted effective agent

Answer

Automatically at 48-72 hours regardless of clinical response or culture data

Answer

Only after completing a minimum 14-day course of broad-spectrum therapy to prevent relapse

Answer

De-escalation should not occur until the patient has been afebrile for at least 48 consecutive hours