SIRS
Which finding is part of the criteria for SIRS?
A. HR 72 bpm
B. Temperature 38.5°C (101.3°F)
C. WBC 8,000/mm³
D. PaCO₂ 40 mmHg
Answer: B. Temperature 38.5°C (101.3°F)
Rationale: SIRS criteria include temp >38°C or <36°C, HR >90, RR >20 or PaCO₂ <32, WBC >12,000 or <4,000.
How is sepsis defined?
A. SIRS with an identified or suspected infection
B. Inflammation after surgery
C. Hypotension caused by dehydration
D. Fever with unknown cause
Answer: A. SIRS with an identified or suspected infection
Rationale: Sepsis = SIRS + infection (confirmed or suspected).
What does MODS stand for?
A. Multiple Organ Dysfunction Syndrome
B. Major Organ Damage System
C. Multisystem Overload Disease State
D. Multiple Organ Disorder Syndrome
Answer: A. Multiple Organ Dysfunction Syndrome
Rationale: MODS = progressive failure of two or more organ systems due to uncontrolled systemic inflammation.
Normal ABG values include:
A. pH 7.20–7.30
B. PaCO₂ 35–45 mmHg
C. HCO₃⁻ 10–15 mEq/L
D. PaO₂ 30–40 mmHg
Answer: B. PaCO₂ 35–45 mmHg
Rationale: Normal values → pH 7.35–7.45, PaCO₂ 35–45, HCO₃⁻ 22–28, PaO₂ 80–100.
Which best describes non-invasive ventilation (NIV)?
A. Requires endotracheal intubation
B. Uses CPAP or BiPAP via a mask
C. Provides 100% oxygen through nasal cannula
D. Only used during CPR
Answer: B. Uses CPAP or BiPAP via a mask
Rationale: NIV = positive pressure delivered via mask interface (CPAP, BiPAP). Invasive ventilation requires intubation.
Which patient is most at risk for developing SIRS?
A. A healthy adult after mild exercise
B. An older adult after major surgery
C. A teenager with seasonal allergies
D. A child with a small cut on the hand
Answer: B. An older adult after major surgery
Rationale: SIRS risk factors = age extremes, baseline organ dysfunction, malnutrition, immunosuppression, major surgery/trauma.
Which lab result best indicates possible severe sepsis?
A. Sodium 138 mEq/L
B. Lactate 4.0 mmol/L
C. Hemoglobin 13 g/dL
D. Potassium 4.1 mEq/L
Answer: B. Lactate 4.0 mmol/L
Rationale: Elevated lactate >2 mmol/L suggests tissue hypoperfusion, often seen in severe sepsis or septic shock.
Which organ system is most commonly the first to fail in MODS?
A. Kidneys
B. Lungs
C. Heart
D. Liver
Answer: B. Lungs
Rationale: The lungs often fail first → acute respiratory distress syndrome (ARDS), refractory hypoxemia.
ABG: pH 7.30, PaCO₂ 50, HCO₃⁻ 24. How should this be interpreted?
A. Respiratory acidosis, uncompensated
B. Respiratory alkalosis, compensated
C. Metabolic acidosis, uncompensated
D. Metabolic alkalosis, compensated
Answer: A. Respiratory acidosis, uncompensated
Rationale: Low pH + high PaCO₂ = respiratory acidosis. HCO₃⁻ is normal → no compensation yet.
A patient on the ventilator triggers a high-pressure alarm. What is the nurse’s priority action?
A. Increase the ventilator’s tidal volume
B. Assess for kinks, secretions, or patient coughing
C. Silence the alarm and continue assessment
D. Check if oxygen tank is empty
Answer: B. Assess for kinks, secretions, or patient coughing
Rationale: High pressure alarms = resistance in circuit or patient (secretions, biting tube, coughing, ↓ compliance). The priority is to assess and fix the cause.
SIRS is best described as:
A. A normal immune response to infection
B. A widespread inflammatory response that may or may not involve infection
C. A late sign of chronic kidney disease
D. A mild reaction to stress
Answer: B. A widespread inflammatory response that may or may not involve infection
Rationale: SIRS is a systemic inflammatory state, triggered by infection or non-infectious causes (burns, trauma, pancreatitis).
A patient with sepsis remains hypotensive after receiving 30 mL/kg of IV fluids. MAP is 58 mmHg. What should the nurse anticipate?
A. Administering norepinephrine infusion
B. Giving more fluids until MAP is >70 mmHg
C. Starting nicardipine infusion
D. Discontinuing oxygen therapy
Answer: A. Administering norepinephrine infusion
Rationale: Persistent hypotension despite fluids = septic shock. First-line vasopressor = norepinephrine.
A patient with MODS develops hyperglycemia despite no history of diabetes. Which system is affected?
A. Cardiac
B. Endocrine
C. Hematologic
D. Gastrointestinal
Answer: B. Endocrine
Rationale: MODS often triggers endocrine dysfunction, including stress-induced hyperglycemia, requiring insulin infusions.
Which condition causes a right shift of the oxyhemoglobin dissociation curve?
A. Alkalosis, hypothermia, low CO₂
B. Acidosis, hyperthermia, high CO₂
C. Decreased 2,3-DPG
D. Carbon monoxide poisoning
Answer: B. Acidosis, hyperthermia, high CO₂
Rationale: Right shift = less affinity for O₂ → easier release to tissues. Occurs with low pH, high temp, ↑ CO₂, ↑ 2,3-DPG.
Which ventilator mode provides full support with a set tidal volume and rate, regardless of patient effort?
A. SIMV (Synchronized Intermittent Mandatory Ventilation)
B. Pressure Support Ventilation
C. Assist-Control Ventilation
D. CPAP
Answer: C. Assist-Control Ventilation
Rationale: AC mode delivers a set tidal volume at a set rate; every patient-initiated breath also receives the set volume. It provides full support.
A patient meets 2 SIRS criteria. What is the nurse’s next priority?
A. Begin teaching relaxation breathing
B. Start antibiotics immediately
C. Assess for and treat possible underlying cause
D. Place patient in restraints for safety
Answer: C. Assess for and treat possible underlying cause
Rationale: SIRS itself signals a systemic response. The underlying cause (infection, trauma, pancreatitis, etc.) must be identified and managed. Antibiotics (B) are only if infection is confirmed/suspected.
Which clinical finding best distinguishes septic shock from sepsis?
A. Fever >38°C
B. WBC 15,000/mm³
C. Hypotension that does not improve after fluids
D. Tachycardia >90 bpm
Answer: C. Hypotension that does not improve after fluids
Rationale: Septic shock = sepsis with refractory hypotension despite adequate fluid resuscitation.
Which finding best indicates renal involvement in MODS?
A. Decreased urine output and rising creatinine
B. Elevated liver enzymes and jaundice
C. Petechiae and prolonged PT/INR
D. Hypoxemia with increased FiO₂ requirements
Answer: A. Decreased urine output and rising creatinine
Rationale: Renal involvement = oliguria, elevated BUN/creatinine, electrolyte imbalance.
A patient’s V/Q mismatch shows ventilation without perfusion. Which condition fits this finding?
A. Pulmonary embolism
B. COPD exacerbation
C. Pneumonia
D. ARDS
Answer: A. Pulmonary embolism
Rationale: V/Q mismatch = “dead space” when air reaches alveoli but no blood flow → pulmonary embolism.
A patient with status asthmaticus is intubated. Which ventilator setting change is most important to reduce risk of air-trapping?
A. Increase tidal volume
B. Decrease respiratory rate and lengthen expiratory time
C. Increase PEEP to 15 cm H₂O
D. Set FiO₂ to 100% for entire treatment
Answer: B. Decrease respiratory rate and lengthen expiratory time
Rationale: In status asthmaticus, risk = air trapping/auto-PEEP. Ventilator settings should allow more time to exhale (↓ RR, longer expiratory phase).
Which lab finding best supports the presence of SIRS?
A. WBC 3,000/mm³ with 12% bands
B. Hemoglobin 12 g/dL
C. Sodium 140 mEq/L
D. Platelets 220,000/mm³
Answer: A. WBC 3,000/mm³ with 12% bands
Rationale: SIRS includes WBC <4,000 or >12,000, or >10% bands (immature neutrophils). Other values are normal.
Which intervention is part of the Surviving Sepsis 1-hour bundle?
A. Start broad-spectrum antibiotics
B. Hold fluids until blood cultures return
C. Delay vasopressors until MAP <50 mmHg
D. Wait for procalcitonin results before treatment
Answer: A. Start broad-spectrum antibiotics
Rationale: The bundle includes: measure lactate, obtain cultures, start antibiotics, give fluids (30 mL/kg), and add vasopressors if MAP <65. Treatment should not be delayed.
Which intervention is most important for managing MODS?
A. Treating each organ failure individually
B. Early recognition and treatment of sepsis/SIRS
C. Limiting oxygen therapy to avoid dependency
D. Waiting until multiple organs fail before escalating care
Answer: B. Early recognition and treatment of sepsis/SIRS
Rationale: The best strategy is prevention — early recognition and management of infection, sepsis, and shock before progression to MODS.
Which nursing intervention is most important for a patient with metabolic acidosis (pH 7.28, HCO₃⁻ 18)?
A. Restrict fluids
B. Identify and treat the underlying cause
C. Administer sedatives to reduce RR
D. Increase afterload with vasopressors
Answer: B. Identify and treat the underlying cause
Rationale: Treatment depends on cause (DKA → insulin, sepsis → fluids/antibiotics, renal failure → dialysis). Supportive care is important, but correcting the cause is priority.
Which finding indicates a patient is ready for ventilator weaning?
A. PaO₂ 55 mmHg on FiO₂ 60%
B. Alert, following commands, FiO₂ 40%, stable vitals
C. Agitated, tachycardic, on norepinephrine infusion
D. Sedated, on FiO₂ 100%, PEEP 10 cm H₂O
Answer: B. Alert, following commands, FiO₂ 40%, stable vitals
Rationale: Weaning readiness = adequate oxygenation (FiO₂ ≤40%, PEEP ≤5–8), hemodynamic stability, and mental alertness.