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

Elevated lactate triggers repeat measurement within 2 hours and resuscitation efforts targeting perfusion; lactate clearance ≥10% per hour correlates with improved survival.

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

Distributive/septic shock is characterized by profound vasodilation (low SVR) creating relative hypovolemia, with cardiac output typically normal or elevated early due to catecholamine surge.

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

While PCT aids early sepsis diagnosis, its strongest evidence-based application is guiding antibiotic de-escalation — a declining PCT trajectory supports earlier discontinuation of antibiotics.

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

Source control involves procedural interventions — such as abscess drainage, infected tissue debridement, or removal of infected catheters/devices — to physically eliminate the infection nidus.

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

The low pH, markedly low bicarbonate, and compensatory hypocapnia with elevated lactate confirm high anion gap metabolic acidosis (lactic acidosis) with an appropriate respiratory compensation.

Acute Care Nurse Practitioner Practice Test

Acute Care Nurse Practitioner Practice Test

Acute Care Nurse Practitioner Sepsis and Septic Shock Management 3