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HP&C > 4400 final sepsis > Flashcards

4400 final sepsis Flashcards

1
Q

Which of the following are signs of SIRS?

a) RR >20/min
b) HR >80/min
c) Fever >38.2 degrees celcius or <36 degrees celcius
d) PaCO2 <30 mm Hg

A

A

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2
Q

Which of the following is true about the treatment of sepsis?

a. Antibiotics
b. Fluid resuscitation
c. Removal of the source
d. All of the above

A

D

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3
Q

Which of the following clinical values is not indicative of Systemic Inflammatory Response Syndrome (SIRS) as per LHSC’s Sepsis Screening Tool?

A: Respiratory rate 24
B: Heart rate 110
C: Oral temperature 37.8
D: All of the above are indicative of SIRS.

A

C

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4
Q

Who is at increased risk of sepsis?

A. Children & Elderly
B. Immunocompromised patients
C. Surgical patients
D. All of the above

A

D

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5
Q

You are a nurse working the night shift in the ER and the patient that has just come in is suspected to have sepsis based on presentation and vital signs. What would be the first step to take:

A) Begin with urine and blood cultures

B) begin with blood work and send it to the lab

C) Contact the doctor

D) Complete a head to toe assessment to look for source of infection

A

D

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6
Q

According to the sepsis continuum, what is the correct sequence in ascending order?

a) Sepsis–> MODS–> Severe sepsis–> SIRS–> Infection
b) MODS–> Severe sepsis–> Sepsis–> Sirs –> Infection
c) Infection–> Sirs–> Sepsis–> Severe Sepsis–> Mods
d) Infection–> Sepsis–>Severe sepsis–Mods–> Sirs

A

C

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7
Q

If a patient is hypotensive, which suggestion would you make to the team?

a) start the patient on fluids
b) get a chest x-ray
c) start narrow spectrum antibiotics
d) put a urinary catheter in the patient

A

A

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8
Q

You are working in the ER, and a patient has suspected sepsis. What intervention is NOT performed to meet the criteria of organisms adequately addressed, according to the Sepsis Screening Tool?

A) Urine cultures

B) Chest x-ray

C) Nasal swab

D) Blood cultures

A

C

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9
Q

Which of the following are signs or symptoms of severe sepsis? (Select all that apply)

a) thrombocytopenia
b) episodes of syncope
c) vision problems
d) altered level of consciousness
e) oliguria

A

a,d,e

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10
Q

Which of the following is not a symptom of severe sepsis?

a. Altered level of consciousness
b. Oliguria
c. Increased level of platelets in blood
d. Lactic acidosis

A

C

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11
Q

Which of the following people are more at risk of developing sepsis? Select all that apply.

A. 40 year old woman in good health

B. An elderly man who just had surgery

C. A teenage boy

D. An infant in the NICU

E. 40 year old woman who has stage 4 cancer

A

BDE

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12
Q

Which of the following regarding sepsis is false?

A)Sepsis may result in system vasodilation
B)Sepsis may result in elevated Blood pressure

C)Sepsis is a life threatening condition which requires immediate treatment

D) Sepsis has a greater than 50% survival rate.

A

B

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13
Q

What is not a sign of acute organ system failure related to hepatic system ?

  1. Jaundice
  2. Elevated liver enzyme
  3. Elevated albumin
  4. Decreased bilirubin
A

3

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14
Q

Which condition puts a patient most at risk for sepsis?

a) thrombocytopenia
b) neutropenia
c) hyperbilirubinemia
d) anemia

A

B

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15
Q

Q: What is the purpose of checking lactate levels?

A: Hyperlactataemia acts as a marker of tissue hypoperfusion suggesting severe sepsis (>2 mM) or septic shock (>4 mM)
B. To screen for lactose intolerance
C. To determine if there’s cardiac muscle damage
D. All of the the above

A

A

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16
Q

Common complications associated with sepsis include:

a. Persistent hypotension
b. Disseminated intravascular coagulation
c. Acute renal failure
d. Acute respiratory distress
e. All of the above

A

e

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17
Q

Patients are at an increased risk of sepsis if:

a) they’ve had a recent surgery
b) have a lower respiratory infection
c) experienced a trauma
d) all of the above

A

D

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18
Q

What is NOT a sign/symptom of sepsis?

a) Hypertension
b) Fever
c) Oliguria
d) Tachycardia

A

A

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19
Q

Patients receiving fluid replacement therapy should frequently monitored for:

a. adequate urinary output
b. changes in mental status
c. vital sign stability
d. all of the above

A

D

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20
Q

Which of the following is true regarding sepsis?

A. It is the number one cause of death in the ICU
B. It requires the collection of all serum, sputum, urine and wound cultures within 45 minutes of administering antibiotic agents
C. When evaluating a patient with sepsis, the number one priority of the nurse is to assess the ABCs
D. Hemodynamic stability is not a common symptom of sepsis
E. All of the above are true

A

E

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21
Q

Which of the following are NOT signs of systemic inflammatory syndrome (SIRS)? Select all that apply.

a) Temperature of 37 degrees celsius
b) 24 respirations/minute
c) Heart rate of 88 bpm
d) White blood cell count of 3000/uL

A

A,C

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22
Q

To confirm the presence of SIRS, how many of the following signs must be present?

  • temp >38.0 or <36
  • HR>90
  • RR>20 or PaCO2 <32
  • WBC>12,000 or <4000 or 10% immature band forms

A) 0
B) 1
C) 2
D) All of them.

A

D

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23
Q

John Doe comes to the emergency department complaining of a fever and a cough. When he is triaged and his vitals are done by the nurse on call it is found that he has a fever of 38.2oC, his HR is 90, RR 22, BP 90/67 and O2 is 89%. While listening to John’s chest the nurse hears crackling. The nurse requests the doctor send John for an x-ray. On the sepsis continuum where is John?

a. SIRS
b. INFECTION
c. SEPSIS
d. SEVERE SEPSIS

A

C

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24
Q

When you suspect sepsis, what is your first course of action?

a) check ABCs
b) recommend IV start
c) recommend norepinephrine
d) obtain blood cultures

A

A

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25
Q

In order to maintain a Mean Arterial Pressure (MAP) greater than 65 mm Hg, what is the first-line vasopressor to be given to patients with unresolved hypotension?

A) Norepinephrine

B) Epinephrine

C) Dopamine

D) Vasopressin

A

A

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26
Q

What are some common signs of acute organ system failure? Select all that apply.

a. Tachycardia
b. Decreased in liver size
c. Hypotension
d. Increase urinary output
e. Increase liver enzymes (AST, ALT)
f. Alteration in mental status

A

A,C,E,F

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27
Q

Sepsis can progress into:

a. circulatory systemic dysfunction
b. multiple organ failure
c. death
d. all of the above

A

D

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28
Q

Serum Lactate is used to measure tissue perfusion and metabolism, the normal values for an unstressed patient is 0.50-2.20. What are the levels for a patient with metabolic acidosis?

A) 0.1 - 0.3 mmol/L

B) 0.3 - 0.50 mmol/L

C) 0.50 - 2.20 mmil/L

D) >3 - 5 mmol/L

A

D

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29
Q

Which of the following statements regarding SIRS is incorrect?

A) Describes the inflammatory response of the body to a variety of insults

B) Infection must be present.

C) SIRS stands for Systemic Inflammatory Response System

D) SIRS is defined as the presence of more than one of the following clinical manifestations: temperature >38 or <36, heart rate >90, Respiratory Rate >20, and White Blood Cell Count >12000 or <4000

A

B

30
Q

All of the following are signs and symptoms of sepsis-related complications, except:

A. lactic acidosis

B. polyuria

C. thrombocytopenia

D. altered LOC

A

b

31
Q

Patient comes into the emergency department with a high fever and tachypnea. Upon assessment, the nurse documents the following vitals: T 39.9, HR 115, RR 33 BP 130/85, SPO2 92. At what stage would the patient most likely fall on the sepsis continuum?

Sepsis
MODS
SIRS
Infection

A

c

32
Q

For every hour of delay for antibiotic treatment, the patient has a ___% decrease in survival rate.

A. 10%

B. 8%

C. 12%

D. 14%

A

b

33
Q

Which of the following is CORRECT regarding sepsis?

Bradycardia is a presenting sign
Temperature greater than 38 or less than 36 is a sign
Sepsis is an inflammatory response in the presence of infection
A normal white blood cell count would be expected
B and C

A

e

34
Q

Which of the following sets of vitals signs would cause you to assume your patient is experiencing SIRS?

  • A. Temp 38.5, HR 85, RR 16
  • B. HR 94, PaCO2 30, RR 22
  • C. Temp 38, WBC 12,000
  • D. HR 100, PaCO2 35, RR 18
A

B

35
Q

Which of the following would indicate the patient is in the later stages of severe sepsis?

a) increased creatinine
b) febrile
c) tachycardic
d) increased liver function enzymes
e) none of the above

A

D

36
Q

A 40 year old man presents in the emergency room with a HR of 98, a temperature of 34 C, WBC count of 16.6 x 10^9/L, elevated creatinine and decreased urinary output. What stage of the sepsis continuum is this person likely in?

A) Sepsis

B) MODS

C) Severe Sepsis

D) SIRS

A

C

37
Q

Which of the following can cause SIRS?

A) Infection

B) Burns

C) Trauma

D) All of the above

A

D

38
Q

A 80 year old women arrives at the ER with a 3 day history of chest pain, a cough and a fever which she has been taking acetaminophen for. Her husband noticed she was quite weak that morning with some dizziness so he brought her in. Her temperature was 40.3, HR 120bpm, R 30/min, BP 70/35 mm Hg and spO2 of 82%.

Is there concern for:

A) MODS

B) Sepsis

C) SIRS

D) Severe sepsis

A

D

39
Q

Which of the following is not considered a high risk for sepsis according to LHSC sepsis protocol?

Pregnancy
Substance abuse
Elderly
Renal failure

A

A

40
Q

You are given some data on a client. Which of these findings could indicate sepsis?

PaCO2 at 29 mm Hg and Respirations at 12 per minute
Temperature at 40.4oC and Respirations at 12 per minute
Temperature at 35.1oC and Respirations at 27 per minute
Heart rate at 41 beats per minute and Respirations at 27 per minute
All of the following indicates sepsis

A

C

41
Q

When sepsis occurs along with systemic hypotension, the patient is experiencing:

a) Septic shock
b) Respiratory alkalosis
c) Metabolic acidosis
d) Hyperkalemia

A

A

42
Q

You are working on the acute medicine unit at LHSC. After receiving report from the night nurse, you walk into your patient’s room (admitted for endocarditis) to introduce yourself and observe that that the patient is in distress. They appear to be cyanotic, diaphoretic, and hyperventilating with a decreased LOC. Using your clinical judgement, you immediately take what action?

a) Administer broad spectrum IV antibiotics
b) Call CCOT
c) Administer oxygen by mask at 4L/min
d) Take vitals and then notify the physician

A

C

43
Q

Primary treatment for sepsis includes aggressive fluid resuscitation. Indicators for fluid overload related to rapid IV bolus infusion is/are:

a) crackles upon auscultation
b) dyspnea
c) jugular vein distention
d) all of the above

A

D

44
Q

Which of the following symptoms indicate the patient’s condition has escalated to severe sepsis?

A) Oliguria

B)Lactic Acidosis

C) Increased level of consciousness

D) A & B

A

D

45
Q

Which of the following is NOT a sign of severe sepsis?

a. ) Oliguria
b. ) Decreased respiratory rate
c. ) Thrombocytopenia
d. ) Lactic acidosis

A

B

46
Q

Which of the following is NOT a sign/symptom of sepsis?

a) respiratory rate less than 10
b) heart rate greater than 90 bpm
c) hyperglycaemia and abnormal clotting and bleeding
d) temperature greater than 38 or less than 36 degrees celsius

A

A

47
Q

Which of the following does not fall under early recognition for treatment of sepsis?

a) take a through history and physical

​b) take vitals

​c) check lactate levels ​

​d) fluid resuscitation

A

D

48
Q

Which of the following would categorize a patient with SIRS?

a) Fever of 37.5 and WBC of 11,000
b) Fever >38 and HR of 60
c) Fever >38 and WBC > 12,000
d) Fever >38 and RR of 18

A

C

49
Q

Which of the following statements is true?

a. Severe sepsis requires 2 or more signs of organ failure
b. The term SIRS is used when there’s a presumed or confirmed infection
c. SIRS can include respiratory alkalosis
c. Sepsis can lead to organ failure that is reversible

A

C

50
Q

Which of the following symptoms would suggest that a patient had systemic inflammatory response syndrome (SIRS)?

a) RR of 18/min
b) White blood cell count of 10,000/ul
c) Heart rate of 80/min
d) Temperature of 36.5 Celsius

A

B

51
Q

A patient presents to the hospital complaining of swelling and severe pain around an open wound on his arm. His heart rate is 95 bpm and his blood pressure is 88/62. He says his normal blood pressure is 130/80. The nurse determines that this patient…

Requires further screening to determine if he has sepsis
Is unlikely to have sepsis
Is likely to have sepsis
Likely has severe sepsis or septic shock

A

D

52
Q

All of the following are signs of acute organ system failure related to sepsis, except for:

a) Changes on the ECG displaying arrhythmias
b) Decreased urine output
c) Hyperactive bowel sounds
d) Respiratory distress

A

C

53
Q

When caring for a patient in acute septic shock, the nurse would anticipate

A) Administering osmotic and/or loop diuretics.
B) Infusing large amounts of intravenous fluids.
C) Administering intravenous diphenhydramine.
D) Insertion of a Urinary Catheter.
E) Answers B and D.
F) All of the Above.

A

B & D

54
Q

Jocelyn is 3 days post-op after a colectomy surgery. Her vital signs this morning were a temperature of 38.6 C ; HR of 118; RR of 28; SpO2 of 89%; and BP of 94/52. The nurse reported this to Jocelyn’s physician, and tests were ordered. The results of the blood test showed an increased creatinine level and increased WBC count, among others. Jocelyn’s urinary output has been 12ml per hour over the last two hours. At what stage of the Sepsis Continuum would Jocelyn be?

Infection
SIRS
Sepsis
Severe Sepsis
MODS
A

D

55
Q

Which finding would typically be seen in a patient with sepsis:

a - Low creatinine levels

b - Hypertension

c - Elevated lactic acid levels

d - Bradycardia

A

C

56
Q

Within the sepsis continuum what is first step/ the cause(s) that can bring on SIRS

a) Infection
b) trauma
c) burns
d) hemorrhage
e) all of the above
f) 2 of the above

A

E

57
Q

Every ____ hour(s) the mortality rate for sepsis increases by 8% without antibiotic treatment.

A) 1

B) 2

C) 4

D) 8

A

A

58
Q

A patient just received the diagnosis of sepsis. The RN in charge of her care follows the physician’s order to start an IV and give a bolus of 500 mL 0.9% NaCl. An hour has passed and the RN is checking the catheter bag for urinary output. She suspects the patient’s urinary output is low.

If the patient weights 130 lbs, how many mL/hr should the RN expect to see?

A. 32 mL/hr
B. 65 mL/hr
C. 40 mL/hr
D. 29.5 mL/ hr

A

D

59
Q

When undergoing fluid resuscitation treatment for a septic client, which of the following signs and symptoms is NOT indicative of fluid overload?

a) Hyponatremia
b) Shortness of breath
c) Bradycardia
d) Hypertension

A

C

60
Q

Which of the following would you expect to see in a client experiencing acute organ system failure? Select all that apply.

A : Hypotension

B : Increased respiratory rate

C : Bradycardia

D : Decreased level of consciousness

E : Increased O2

A

A,B,D

61
Q

A sepsis patient has a MAP of less than 65 mm Hg, what drug should the nurse expect to give first?

A) Corticosteroid

B) Epinephrine

C) Bolus of NS

D)Norepinephrine

A

D

62
Q

What symptoms occur when there is systemic vasodilation?

A) Blood pressure increases

B) Hypoperfusion of the organs

C) Hyperperfusion of the organs

D) Hypertension

A

B

63
Q

Which of the following is NOT a symptom of severe sepsis?

A. Lactic acidosis

B. Hypertension

C. Oliguria

D. Thrombocytopenia

A

B

64
Q

Severe sepsis is evidenced by which of the following:

A. Oliguria

B. Altered level of consciousness

D. Lactic acidosis

D. All of the above

A

D

65
Q

A nurse is caring for a client who presents with the following lab values. Which one lead the nurse to suspect that the client may be developing sepsis? Select all that apply.

A) WBC 8.3 x 10^9

B) Blood Glucose 9.8 mmol/L

C) Creatinine 2.3 mg/dL

D) INR 1.7

E) Platelet count 118,000 uL^-1

A

B,C,D

66
Q

A patient’s serum PCT level helps health care providers determine if the patient has a systemic bacterial infection causing sepsis. Which of the following PCT level results indicates sepsis?

a) 1.0 ng/mL
b) 0.04 ng/mL
c) 2.1 ng/dL
d) 11ng/dL

A

C

67
Q

During septic shock, dysfunction and sometimes failure of one or more organs can occur usually secondary to which of the following?

A. Hemorrhage

B. Systemic vasculitis or inflammation of the blood vessel walls

C. Decreased perfusion

D. Urinary tract symptoms

A

C

68
Q

A patient has been admitted to your floor with a high fever and suspected pneumonia. After your receive report you take a set of vitals. The results show that he patient has a T- 40.0; P – 121; R – 29; BP 112/52; SpO2 83%. What is the first nursing action you should take:

Collect two sets of blood cultures.
IV start for antibiotics
Head-toe assessment
Administer oxygen and reassess SpO2

A

D

69
Q

Which of the following can potentially cause Systemic Inflammatory Response Syndrome?

a) Burns
b) Severe trauma
c) Diabetic foot infection
d) All of the above

A

D

70
Q

Diabetic, Temp 37, HR 88, RR 26, drowsy, WBC 11, blood sugar 8.5, no focus of infection. What does this patient have?

A. None of the other answers

B. Sepsis

C. Severe Sepsis

D. SIRS

A

D

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