PCCN PCCN Multisystem Conditions and Shock 2 — Questions and Answers
Question 1: A progressive care patient meets SIRS criteria and has a suspected infection. According to current definitions, this patient has:
- Sepsis (Correct answer)
- Septic shock
- SIRS without sepsis
- Bacteremia
Correct answer: Sepsis
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection; SIRS + infection meets the older sepsis definition and warrants treatment.
Question 2: A patient with MODS (multiple organ dysfunction syndrome) has the following: creatinine 3.1, bilirubin 4.2, PaO2/FiO2 ratio of 180, and GCS of 12. How many organ systems are affected?
- Two
- Three
- Four (Correct answer)
- Five
Correct answer: Four
Renal (creatinine), hepatic (bilirubin), pulmonary (PaO2/FiO2 < 300), and neurological (GCS) dysfunction indicate four organ systems are failing.
Question 3: Which lactate level is most consistent with significant tissue hypoperfusion in a critically ill patient?
- 0.8 mmol/L
- 1.5 mmol/L
- 2.2 mmol/L
- 4.5 mmol/L (Correct answer)
Correct answer: 4.5 mmol/L
A lactate ≥ 4 mmol/L indicates severe tissue hypoperfusion and is associated with increased mortality, meeting the threshold for septic shock workup.
Question 4: A patient in neurogenic shock following a cervical spine injury presents with hypotension and bradycardia. This pattern is caused by:
- Massive hemorrhage from cord injury
- Loss of sympathetic nervous system tone below injury level (Correct answer)
- Parasympathetic overstimulation due to pain
- Increased intracranial pressure
Correct answer: Loss of sympathetic nervous system tone below injury level
Cervical cord injury disrupts sympathetic outflow, causing loss of vasomotor tone and cardiac acceleration, resulting in hypotension and bradycardia.
Question 5: Which assessment finding indicates the progressive care patient with systemic inflammatory response is developing organ hypoperfusion?
- Temperature of 38.4°C
- Heart rate of 96 bpm
- Urine output of 0.3 mL/kg/hr for 3 hours (Correct answer)
- WBC of 13,000/mm³
Correct answer: Urine output of 0.3 mL/kg/hr for 3 hours
Oliguria (< 0.5 mL/kg/hr) is an early indicator of renal hypoperfusion and impending organ dysfunction in sepsis.
Question 6: A patient in obstructive shock due to a massive pulmonary embolism is hemodynamically unstable. The nurse anticipates which intervention?
- Systemic thrombolysis with alteplase (Correct answer)
- Immediate surgical embolectomy
- Intravenous heparin and observation
- Oral anticoagulation initiation
Correct answer: Systemic thrombolysis with alteplase
Massive PE with hemodynamic instability is an indication for systemic thrombolytic therapy to rapidly dissolve the clot and restore perfusion.
PCCN PCCN Multisystem Conditions and Shock 2
A progressive care patient meets SIRS criteria and has a suspected infection.
According to current definitions, this patient has: