Question 1

Which action should the nurse implement to help reduce the fever in a patient with sepsis?

Accepted Answer

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?

Accepted Answer

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?

Accepted Answer

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?

Accepted Answer

1. Endothelial dysfunction occurs as a result of damage to the endothelial layers. MODS results because of a variety of factors. Vasoactive and procoagulant mediators are released. Vascular permeability and shunting occur.
2. Endothelial dysfunction is a primary cause of MODS.
3. Microvascular bleeding is a result, not a cause, of MODS.
4. Circulating pathogens do not cause destruction of organs, leading to MODS.

Question 5

What should the nurse include in the management plan for a patient with sepsis?

Accepted Answer

1. High tidal volumes should be avoided in the presence of ARDS and do not prevent its development.
2. Following initial stabilization of patients with severe sepsis, blood glucose should be maintained at less than 180 mg/dL with a goal of approximately 150 mg/dL.
3. Sources of infection should be removed as soon as possible.
4. CT and MRI scans are often helpful in identifying causes of sepsis.

Question 6

Which action is a part of the bundle of measures used to prevent nosocomial catheter-related infections?

Accepted Answer

1. Chlorhexidine is used in a scrubbing motion rather than in a circular motion.
2. Frequency of dressing change is dependent on dressing type. It is recommended that gauze dressings be changed every 2 days or as needed, whereas transparent dressings may be left in place for up to 7 days.
3. Current recommendations are to change IV tubing every 72 to 96 hours. Tubing may be changed more often if solutions with large concentrations of dextrose (such as TPN) are infused.
4. During insertion of a central line, the doctor should wear a cap, a mask, sterile gloves, and a gown. The patient should have a full body drape. These measures prevent catheter-related sepsis.

Question 7

What is the overall goal of providing fluid resuscitation and vasopressors to a patient in septic shock?

Accepted Answer

1. The goal is to maintain an adequate mean arterial pressure (increase perfusion) rather than to specifically increase systolic pressure.
2. The goal is to maintain an adequate mean arterial pressure (increase perfusion) rather than to specifically increase systolic pressure.
3. The overall goal of providing fluid resuscitation and vasopressors to the patient in septic shock is to increase tissue perfusion. Vasopressors are used if the initial fluid bolus fails to bring the mean arterial pressure over 65 mm Hg.
4. The goal is to maintain an adequate mean arterial pressure (increase perfusion) rather than to specifically increase systolic pressure.

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?

Accepted Answer

1. When a patient is identified with severe sepsis, septic shock, and/or lactate greater than 4 mmol/L (36 mg/dL), there are four evidence-based practices that the Surviving Sepsis Campaign states should be completed within the first 3 hours.
2. The sepsis management bundle has received universal support from the Surviving Sepsis Campaign.
3. When a patient is identified with severe sepsis, septic shock, and/or lactate greater than 4 mmol/L (36 mg/dL), there are four evidence-based practices that the Surviving Sepsis Campaign states should be completed within the first 3 hours.
4. For the best outcomes, the appropriate care should be instituted in the emergency department (ED) even before the patient is transferred to an ICU.

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?

Accepted Answer

1. Ecchymoses of the gums or skin is a sign that the patient has developed DIC.
2. The patient will show signs of bleeding. In this state, it would be unusual to find resistance when flushing a capped port of a central venous catheter.
3. The D-dimer will be increased due to fibrinolysis.
4. Fibrinogen and platelets will be decreased as they are used in the clotting cascade.

Question 10

What are the two most common sources of infection that can lead to sepsis when caring for an older patient?

Accepted Answer

1. Among older adults, the most common source of infection is the urinary tract, but pneumonia is also common, and fever in patients with pneumonia may be blunted or absent.
2. Skin and soft tissue account for a smaller percentage of sepsis. Diabetes increases the patient's risk for developing sepsis.
3. Other sources account for only 9-10% of sepsis cases.
4. Other sources account for only 9-10% of sepsis cases.

Question 11

The nurse assesses a patient for septic shock. Which statement best describes this health problem?

Accepted Answer

1. Septic shock is defined by the presence of sepsis plus refractory hypotension.
2. In septic shock, protein C would be elevated as a result of fibrinolysis.
3. This describes severe sepsis with signs of organ failure but not specifically septic shock.
4. This describes severe sepsis with signs of organ failure but not specifically septic shock.

Question 12

Why should the nurse identify interventions to prevent the development of sepsis in an older patient?

Accepted Answer

1. Current mortality rates for sepsis are estimated to range between 23% to 46% depending on the patient's age, underlying condition, and site of infection.
2. The majority of patients with sepsis are managed in the ICU or other specialty critical care area.
3. The Surviving Sepsis program aims to increase awareness, understanding, and knowledge; change perceptions and behavior; increase the pace of change in patterns of care; influence public policy; define standards of care in severe sepsis; and reduce the mortality associated with sepsis.
4. Because sepsis affects the elderly disproportionately, more than half of all annual costs in the United States-$8.7 billion-were spent on care of septic patients 65 years or older.

Question 13

Which evidence-based intervention should the nurse use to prevent pneumonia in the patient receiving mechanical ventilation?

Accepted Answer

1. Oral hygiene is a clean, rather than a sterile, procedure. 2. One of the evidence-based practices used to prevent ventilator-associated pneumonia includes the use of an H₂ antagonist to prevent peptic ulcers. 3. The head of the bed should be elevated at least 30 degrees. 4. The ventilator circuit is changed weekly.

Question 14

The nurse assesses a patient for severe sepsis. Which finding indicates that the patient is developing this health problem?

Accepted Answer

1. Decreased capillary filling and mottling are both related to sepsis instead of severe sepsis.
2. Fever and decreased urine output are both related to sepsis instead of severe sepsis.
3. The best description of severe sepsis is hypotension and lactic acidosis. These signs also represent altered cellular metabolism, which results in organ dysfunction.
4. In severe sepsis, a decreased, rather than increased, glomerular filtration rate would be expected.

Question 15

What should the nurse realize when meeting the nutritional needs of a patient experiencing sepsis?

Accepted Answer

1. TPN increases the chances of hyperglycemia as well as bloodstream infections due to the high dextrose content.
2. Nutritional needs should be met early to promote healing, ideally before 72 hours from the time of admission.
3. Enteral feedings are the preferred method of meeting nutritional needs because they prevent translocation of bacteria from the gastrointestinal tract.
4. Enteral feedings are the preferred method of meeting nutritional needs because they 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?

Accepted Answer

1. Patients with sepsis have abnormal renal and hepatic function; the pharmacist should be consulted to ensure that the prescribed dose results in serum concentrations that are both clinically effective and minimally toxic.
2. The goal is to narrow therapy once culture results identify the infecting organism. This has several benefits, including decreased cost, prevention of the development of resistance, and reduced toxicity.
3. This is not a true statement.
4. One antibiotic can ultimately reduce the patient's costs, but that is not the only purpose of this goal.

Question 17

Which hemodynamic parameters should the nurse expect to see in the patient with septic shock?

Accepted Answer

1. These parameters are outside those expected for septic shock.
2. These parameters are outside those expected for septic shock.
3. Septic shock is a form of distributive shock. Central venous pressure would be low, pulmonary artery pressure would be low, and systemic vascular resistance would be low.
4. These parameters are outside those expected for septic shock.

Question 18

The nurse evaluates a patient for the presence of systemic inflammatory response syndrome (SIRS). Which assessment data indicates the presence of SIRS?

Accepted Answer

1. This data does not support the finding of SIRS. 2. The definition of SIRS includes temperature 38°C, pulse greater than 90 beats per minute, respiratory rate greater than 20 breaths per minute, with a PaCO₂ less than 32 torr. 3. This data does not support the finding of SIRS. 4. This data does not support the finding of SIRS.

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?

Accepted Answer

1. Mortality attributable to these infections is between 4% and 20%, so between 500 and 4,000 patients in the United States die annually due to CVC-related bloodstream infections.
2. These infections prolong hospitalization by a mean of 7 days.
3. These infections prolong hospitalization by a mean of 7 days at a cost of between $3,700 to $29,000.
4. The risk of infection is significantly higher with central lines as compared to peripherally inserted catheters.

Question 20

Which statement accurately describes the purpose of sedation interruption for a patient to prevent ventilator-associated pneumonia?

Accepted Answer

1. Sedation interruption is necessary to accurately measure tidal volume and respiratory rate, which are criteria to assess readiness to extubate.
2. This is not the purpose of a sedation interruption.
3. Mechanical ventilation is discontinued sooner when close attention is given to measuring tidal volume and respiratory rate, which occurs during sedation interruption. Evidence indicates that appropriate use of daily interruption of sedation to determine readiness to wean decreases the patient's time on a ventilator.
4. There is concern among some nurses about the safety of interrupting sedation; therefore, most institutions have specific policies outlining for whom and when sedation interruption should be attempted.

Quiz 18: Care of the Patient With Sepsis