Deck 18: Care of the Patient With Sepsis

Question 1

Which action should the nurse implement to help reduce the fever in a patient with sepsis?
1) A cooling blanket is often considered when the patient's temperature reaches 103°F.
2) Shivering should be avoided because it causes a decreased metabolic rate.
3) Prevent shivering by keeping the patient's hands and feet on the cooling blanket.
4) Sedation should be avoided during the use of the cooling blanket because it masks potential shivering.

Answer 1

1
Explanation: 1. Exogenous cooling is recommended when a patient's temperature reaches 103°F.
2. Shivering increases rather than decreases the metabolic rate.
3. The hands and feet should be kept off the cooling blanket to prevent shivering.
4. The use of sedation is preferable because it decreases shivering and helps to decrease the temperature.

Question 2

What should the nurse do when administering antibiotics to a patient with sepsis?
1) Antibiotics should be administered as soon as the patient has received a fluid bolus.
2) Antibiotics should always be administered after blood cultures are obtained.
3) Administer the antibiotic with the shortest administration time first so that all antibiotics are administered quickly.
4) Wait for the results of liver and renal function tests before beginning antibiotic therapy.

Answer 2

2
Explanation: 1. Antibiotics should be administered as soon as possible to decrease mortality.
2. Blood cultures must be obtained prior to the administration of antibiotics in order to successfully isolate the infecting organism.
3. The broad-spectrum antibiotic should be administered first.
4. Medication dosage adjustments are made to compensate for liver and kidney dysfunction rather than limiting the choices of antibiotics.

Question 3

Which phrase should the nurse use to explain why serum lactate is elevated in a patient with sepsis?
1) Increased systemic inflammation
2) The endogenous by-products of bacterial contamination
3) Anaerobic cellular metabolism
4) Greatly accelerated coagulation

Answer 3

3
Explanation: 1. This is not related to the elevation of serum lactate in sepsis.
2. This is not related to the elevation of serum lactate in sepsis.
3. Lactic acid is produced as a by-product of anaerobic cellular metabolism.
4. This is not related to the elevation of serum lactate in sepsis.

Question 4

Which statement best describes the pathophysiology of multiple organ dysfunction syndrome (MODS) in a patient with sepsis?
1) The primary cause of MODS is decreased blood pressure.
2) Endothelial dysfunction is a primary cause of MODS.
3) Increased microvascular bleeding causes MODS.
4) Circulating pathogens cause destruction of organs, resulting in MODS.

Question 5

What should the nurse include in the management plan for a patient with sepsis?
1) Use high tidal volumes on the ventilator to prevent adult respiratory distress syndrome (ARDS).
2) Assess capillary blood glucose and prevent hyperglycemia.
3) Stabilize and debride an infected wound after administering antibiotics for 24 hours.
4) Avoid CT and MRI scans until the patient is stable.

Question 6

Which action is a part of the bundle of measures used to prevent nosocomial catheter-related infections?
1) Chlorhexidine is most effective when swabbed starting at the insertion site and moving outward in a circular motion.
2) It is recommended that transparent dressings be changed every 72 hours to prevent growth of bacteria on the skin.
3) Current recommendations support changing IV tubing every 48 hours on patients at risk for catheter-related infections.
4) During insertion of a central line, the doctor should wear a cap and mask, sterile gloves, and a gown, and the patient should have a full body drape.

Question 7

What is the overall goal of providing fluid resuscitation and vasopressors to a patient in septic shock?
1) Increase the systolic arterial pressure.
2) Provide adequate vasoconstriction.
3) Increase tissue perfusion.
4) Increase the metabolic rate.

Question 8

The nurse implementing the sepsis management bundle for a patient in the intensive care unit is aware of which information about this bundle?
1) The nurse should select items to implement from the bundle according to patient need.
2) The sepsis management bundle has not received uniform support.
3) The purpose of the sepsis management bundle is to improve the patient's hemodynamics within 3 hours.
4) The Surviving Sepsis Campaign recommends the use of the bundle elements upon admission to the intensive care unit.

Question 9

The nurse evaluates a patient with sepsis for the development of disseminated intravascular coagulation (DIC). What is a sign that the patient may have developed this complication?
1) Ecchymoses of the gums or skin
2) Resistance when flushing a capped port of a central venous catheter
3) A reduction in the D-dimer
4) Increased fibrinogen levels

Question 10

What are the two most common sources of infection that can lead to sepsis when caring for an older patient?
1) Pneumonia and urinary tract infections
2) Skin infections and diabetes
3) Surgical incisions and abdominal wounds
4) Traumatic wounds and abdominal surgeries

Question 11

The nurse assesses a patient for septic shock. Which statement best describes this health problem?
1) Sepsis with hypotension that does not correct itself when a fluid challenge is administered
2) Sepsis with hypotension accompanied by decreased protein C levels and coagulation abnormalities
3) Sepsis with hypotension accompanied by increased creatinine and absent bowel sounds
4) Sepsis with hypotension accompanied by altered mental status and lactic acidosis

Question 12

Why should the nurse identify interventions to prevent the development of sepsis in an older patient?
1) Mortality rates from sepsis are 70% worldwide.
2) If managed early and aggressively, the majority of patients with sepsis may be managed outside of the ICU environment.
3) The guidelines provided by the Surviving Sepsis Campaign are expected to decrease the incidence of sepsis.
4) Sepsis rates rise sharply with age.

Question 13

Which evidence-based intervention should the nurse use to prevent pneumonia in the patient receiving mechanical ventilation?
1) Aseptic technique when performing oral hygiene
2) Administration of an H₂ antagonist to prevent peptic ulcers
3) Elevation of the head of the bed to 15 degrees to prevent aspiration
4) Changing the ventilator circuit daily

Question 14

The nurse assesses a patient for severe sepsis. Which finding indicates that the patient is developing this health problem?
1) Decreased capillary filling and mottling
2) Fever and decreased urine output
3) Hypotension and lactic acidosis
4) Increased glomerular filtration rate and increased D-dimer levels

Question 15

What should the nurse realize when meeting the nutritional needs of a patient experiencing sepsis?
1) TPN is the preferable means to administer nutrition.
2) Nutritional needs are usually addressed after 72 hours in order to conserve energy expenditure.
3) Enteral feedings are often avoided because hyperglycemia often results from feedings.
4) Enteral feedings prevent translocation of bacteria from the gastrointestinal tract.

Question 16

The goal of antibiotic therapy in a patient with sepsis is to narrow the therapy to one narrow-spectrum antibiotic. What purpose does this goal serve in the patient's care to aid in the prevention of antibiotic resistance?
1) The use of one antibiotic ensures that the prescribed dose will result in serum concentrations that are clinically effective.
2) The use of one antibiotic has been shown to cause less organ dysfunction.
3) The use of one antibiotic reduces mortality in patients with sepsis.
4) The use of one antibiotic limits the cost to the patient.

Question 17

Which hemodynamic parameters should the nurse expect to see in the patient with septic shock?
1) Central venous pressure (CVP) 4 mm Hg, pulmonary artery pressure (PAP) 30/15 mm Hg, and systemic vascular resistance (SVR) 1,200 dynes/sec/cm^-5
2) Central venous pressure (CVP) 8 mm Hg, pulmonary artery pressure (PAP) 26/10 mm Hg, and systemic vascular resistance (SVR) 1,000 dynes/sec/cm^-5
3) Central venous pressure (CVP) 2 mm Hg, pulmonary artery pressure (PAP) 20/8 mm Hg, and systemic vascular resistance (SVR) 800 dynes/sec/cm^-5
4) Central venous pressure (CVP) 6 mm Hg, pulmonary artery pressure (PAP) 40/20 mm Hg, and systemic vascular resistance (SVR) 700 dynes/sec/cm^-5

Question 18

The nurse evaluates a patient for the presence of systemic inflammatory response syndrome (SIRS). Which assessment data indicates the presence of SIRS?
1) Temperature 36.4°C, respiratory rate 22, pulse rate 112, and PaCO₂ 34
2) Temperature 38.4°C, respiratory rate 23, pulse rate 92, and PaCO₂ 31
3) Temperature 37.2°C, respiratory rate 24, pulse rate 102, and PaCO₂ 44
4) Temperature 38.8°C, respiratory rate 25, pulse rate 88, and PaCO₂ 48

Question 19

Why should the nurse implement actions to prevent the onset of catheter-related infections in a patient receiving care in the intensive care unit?
1) Statistics report that as many as one in five individuals who develop a catheter-related infection die from it.
2) Nosocomial catheter-related infections prolong hospitalization by an average of 4 days.
3) The increased cost of care due to the development of a blood-borne infection averages between $1,700 and $17,000.
4) Central venous catheters have about the same rate of infection as peripherally inserted catheters.

Question 20

Which statement accurately describes the purpose of sedation interruption for a patient to prevent ventilator-associated pneumonia?
1) Interrupting sedation relieves stress, which decreases the chance of infection.
2) During sedation interruption the patient has a chance to take deep breaths and improve ventilation while more awake.
3) The patient's own tidal volume and respiratory rate can be evaluated during sedation interruption.
4) New data show that sedation interruption is no longer recommended because there is concern about the safety of doing it.

Question 21

A patient with severe sepsis develops disseminating intravascular coagulation (DIC). Which treatment should the nurse prepare to administer to this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Platelets
2) Plasmapheresis
3) Cryoprecipitate
4) Fresh frozen plasma
5) Packed red blood cells

Question 22

The nurse has standing orders to implement the sepsis management bundle in a patient with severe sepsis. Which intervention should the nurse prepare to administer? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Measure serum lactate level.
2) Obtain blood cultures.
3) Administer insulin coverage for blood glucose greater than 150 mg/dL.
4) Administer a fluid challenge.
5) Administer vasopressors as prescribed.

Question 23

While caring for a patient with sepsis, the nurse suspects that disseminated intravascular coagulation is developing. What did the nurse assess in the patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Cyanosis of the fingers
2) Patient complains of finger pain
3) Diminished pulses
4) New onset of confusion
5) Urine output 60 mL/hr

Question 24

A patient receives a fluid challenge as part of care for sepsis. Which outcome indicates that the challenge was successful? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) CVP 10 mm Hg
2) MAP 72 mm Hg
3) Peripheral edema
4) Heart rate 90 bpm
5) Weight gain 1.5 kg

Question 25

The nurse prepares a patient for surgery to repair an abdominal aortic aneurysm. Which intervention should reduce the patient's risk of developing a surgical site infection? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Administer prescribed antibiotic 1 hour before the surgery begins.
2) Discontinue intravenous antibiotics 24 hours after the surgery.
3) Shave abdominal region before the surgery.
4) Remove excess hair from abdominal area with an electric clipper.
5) Apply antiembolism stocking prior to surgery.

Question 26

A patient with severe sepsis is not responding to treatment. What should the nurse include when planning the care of this patient?
1) Select palliative care principles.
2) Reevaluate success of treatment every 8 hours.
3) Recommend the family go home to get some rest.
4) Suggest additional treatment measure to the physician.

Question 27

A patient with sepsis is intubated for mechanical ventilation. What should the nurse include in this patient's plan of care? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Begin around-the-clock pain medication.
2) Medicate with minimal amount of sedation.
3) Set the tidal volume at 6 mL/kg/lean body weight.
4) Maintain end-inspiratory pressures less than 30 mm H2O.
5) Establish a weaning schedule within 48 hours of intubation.

Question 28

The nurse prepares an infusion of norepinephrine for a patient in severe septic shock. Why is this medication being used for the patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) It will increase the patient's MAP.
2) It reverses hypotension when fluid resuscitation was unsuccessful.
3) It increases stroke volume.
4) It increases heart rate.
5) Effects are seen in 5 minutes.

Question 29

The nurse manager learns of an increase in the number of catheter-associated urinary tract infections (CAUTI) in the intensive care area. What action should be taken to help reduce the incidence of these infections going forward? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Insert using aseptic technique.
2) Maintain a closed drainage system.
3) Avoid unnecessary catheterizations.
4) Ensure an unobstructed flow of urine.
5) Change the collection bag every 8 hours.

Question 30

A patient with sepsis is experiencing an elevated temperature. Which medication should the nurse prepare to administer to this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Acetaminophen
2) Ibuprofen
3) Aspirin
4) Warfarin sodium
5) Heparin

Question 31

The nurse plans to complete a Sequential Organ Failure Assessment (SOFA) for a patient with suspected sepsis. What data should the nurse use for this assessment? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) MAP
2) PaO2/FiO2
3) Urine output
4) Hemoglobin level
5) Glasgow Coma Scale score

Question 32

A patient in the emergency department is demonstrating signs of sepsis. Which interventions should the nurse implement as part of the sepsis resuscitation bundle? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Draw blood for a serum lactate level.
2) Obtain blood cultures.
3) Provide a broad-spectrum antibiotic.
4) Administer low-dose steroids.
5) Provide insulin for blood glucose level 180 mg/dL.

Question 33

A patient receiving care for sepsis is having blood samples drawn to evaluate specific organ functioning. Why is this being done? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Evaluates the success of fluid resuscitation
2) Determines the source of a hospital-acquired infection
3) Identifies the microorganism causing the original infection
4) Procoagulation state forms clots that limit tissue perfusion
5) Systemic inflammation impairs perfusion of multiple organs

Question 34

A patient in the intensive care unit has been diagnosed with systemic inflammatory response syndrome (SIRS). What additional finding indicates that the patient is becoming septic? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Blood pressure 70/48 mm Hg
2) Urine output 10 mL/hr
3) Blood glucose level 185 mg/dL
4) Heart rate 88
5) Respiratory rate 16

Question 35

The dose of vasopressin has been titrated upward over several hours for a patient being treated for septic shock. Which finding indicates that the patient is experiencing toxic effects of this medication? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Heart rate 48
2) Onset of multifocal PVCs
3) Serum sodium 130 mEq/L
4) Respiratory rate 12 per minute
5) Blood pressure 180/100 mm Hg

Question 36

Which assessment finding should cause a nurse to be concerned that a patient is developing severe sepsis? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Serum creatinine level 2.0 md/dL
2) Absent bowel sounds
3) Onset of confusion
4) Heart rate 54
5) Blood pressure 148/90 mm Hg