Septic shock causes system wide vasodilation which leads to an increase in systemic vascular resistance. In addition, septic shock causes increased capillary permeability and clot formation in the microcirculation throughout the body.
2. A patient is diagnosed with septic shock. As the nurse you know this is a __________ form of shock. In addition, you’re aware that __________ and _________ are also this form of shock.
A. obstructive; hypovolemic and anaphylactic
B. distributive; anaphylactic and neurogenic
C. obstructive; cardiogenic and neurogenic
D. distributive; anaphylactic and cardiogenic
3. Your patient, who is post-op from a gastrointestinal surgery, is presenting with a temperature of 103.6 ‘F, heart rate 120, blood pressure 72/42, increased white blood cell count, and respirations of 21. An IV fluid bolus is ordered STAT. Which findings below indicate that the patient is progressing to septic shock? Select all that apply:
A. Blood pressure of 70/34 after the fluid bolus
B. Serum lactate less than 2 mmol/L
C. Patient needs Norepinephrine to maintain a mean arterial pressure (MAP) greater than 65 mmHg despite fluid replacement
D. Central venous pressure (CVP) of 18
4. You’re providing care to four patients. Select all the patients who are at risk for developing sepsis:
A. A 35-year-old female who is hospitalized with renal insufficiency and has a Foley catheter and central line in place.
B. A 55-year-old male who is a recent kidney transplant recipient.
C. A 78-year-old female with diabetes mellitus who is recovering from colon surgery.
D. A 65-year-old male recovering from right lobectomy for treatment of lung cancer.
5. A patient with a severe infection has developed septic shock. The patient’s blood pressure is 72/44, heart rate 130, respiration 22, oxygen saturation 96% on high-flow oxygen, and temperature 103.6 ‘F. The patient’s mean arterial pressure (MAP) is 53 mmHg. Based on these findings, you know this patient is experiencing diminished tissue perfusion and needs treatment to improve tissue perfusion to prevent organ dysfunction. In regards to the pathophysiology of septic shock, what is occurring in the body that is leading to this decrease in tissue perfusion? Select all that apply:
A. Absolute hypovolemia
B. Vasodilation
C. Increased capillary permeability
D. Increased systemic vascular resistance
E. Clot formation in microcirculation
F. A significantly decreased cardiac output
6. A patient with a fever is lethargic and has a blood pressure of 89/56. The patient’s white blood cell count is elevated. The physician suspects the patient is developing septic shock. What other findings indicate this patient is in the “early” or “compensated” stage of septic shock? Select all that apply:
A. Urinary output of 60 mL over 4 hours
B. Warm and flushed skin
C. Tachycardia
D. Bradypnea
7. Your patient is receiving aggressive treatment for septic shock. Which findings demonstrate treatment is NOT being successful? Select all that apply:
A. MAP (mean arterial pressure) 40 mmHg
B. Urinary output of 10 mL over 2 hours
C. Serum Lactate 15 mmol/L
D. Blood glucose 120 mg/dL
E. CVP (central venous pressure) less than 2 mmHg
8. The physician orders a patient in septic shock to receive a large IV fluid bolus. How would the nurse know if this treatment was successful for this patient?
A. The patient’s blood pressure changes from 75/48 to 110/82.
B. Patient’s CVP 2 mmHg
C. Patient’s skin is warm and flushed.
D. Patient’s urinary output is 20 mL/hr.
9. A patient in septic shock receives large amounts of IV fluids. However, this was unsuccessful in maintaining tissue perfusion. As the nurse, you would anticipate the physician to order what NEXT?
A. IV corticosteroids
B. Colloids
C. Dobutamine
Norepinephrine
10. A patient is on IV Norepinephrine for treatment of septic shock. Which statement is FALSE about this medication?
A. “The nurse should titrate this medication to maintain a MAP of 65 mmHg or greater.”
B. “This medication causes vasodilation and decreases systemic vascular resistance.”
C. “It is used when fluid replacement is not unsuccessful.”
D. “It is considered a vasopressor.”
11. Your patient’s blood pressure is 72/56, heart rate 126, and respiration 24. The patient has a fungal infection in the lungs. The patient also has a fever, warm/flushed skin, and is restless. You notify the physician who suspects septic shock. You anticipate that the physician will order what treatment FIRST?
A. Low-dose corticosteroids
B. Crystalloids IV fluid bolus
C. Norepinephrine
D. 2 units of Packed Red Blood Cells
