MCQ Quiz: Management of Patients with Sepsis

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, and septic shock is a medical emergency with high mortality. As a cornerstone of the Acute Care/Critical Care module in the Patient Care VII curriculum, the management of sepsis requires rapid, evidence-based interventions. Pharmacists are integral members of the interprofessional team, responsible for optimizing antimicrobial therapy, guiding hemodynamic support with vasopressors, and providing crucial supportive care. This quiz will test your knowledge of the Surviving Sepsis Campaign guidelines and the critical management principles for treating patients with sepsis and septic shock.

1. According to the Sepsis-3 definition, sepsis is best defined as:

• a) A simple infection present in the bloodstream.
• b) Life-threatening organ dysfunction caused by a dysregulated host response to infection.
• c) The presence of a fever and an elevated white blood cell count.
• d) Low blood pressure that is responsive to fluid administration. Answer: b) Life-threatening organ dysfunction caused by a dysregulated host response to infection.

2. The qSOFA (quick Sequential Organ Failure Assessment) score is a screening tool for sepsis that includes which three clinical criteria?

• a) Fever, tachycardia, and leukocytosis
• b) Hypotension (SBP ≤100 mmHg), altered mental status, and tachypnea (RR ≥22/min)
• c) Low urine output, high creatinine, and elevated lactate
• d) Edema, high C-reactive protein, and positive blood cultures Answer: b) Hypotension (SBP ≤100 mmHg), altered mental status, and tachypnea (RR ≥22/min)

3. The “Hour-1 Bundle” for the management of sepsis emphasizes the importance of performing which action within the first hour of recognition?

• a) Administering broad-spectrum antibiotics.
• b) Placing a central venous catheter.
• c) Initiating parenteral nutrition.
• d) Starting stress ulcer prophylaxis. Answer: a) Administering broad-spectrum antibiotics.

4. What is the recommended initial intravenous fluid for resuscitation in most patients with sepsis-induced hypotension?

• a) Albumin 5%
• b) D5W
• c) Balanced crystalloids (e.g., Lactated Ringer’s)
• d) Hetastarch Answer: c) Balanced crystalloids (e.g., Lactated Ringer’s)

5. For an adult patient in septic shock, what is the recommended initial fluid bolus?

• a) 10 mL/kg
• b) 20 mL/kg
• c) 30 mL/kg
• d) 50 mL/kg Answer: c) 30 mL/kg

6. What is the first-line vasopressor agent for a patient in septic shock who remains hypotensive after adequate fluid resuscitation?

• a) Dopamine
• b) Phenylephrine
• c) Epinephrine
• d) Norepinephrine Answer: d) Norepinephrine

7. It is crucial to obtain blood cultures for a patient with suspected sepsis at what point in their management?

• a) After the first 24 hours of treatment
• b) After the first dose of antibiotics has been administered
• c) Before initiating antimicrobial therapy, if it does not cause a significant delay.
• d) Only if the patient develops a fever. Answer: c) Before initiating antimicrobial therapy, if it does not cause a significant delay.

8. Septic shock is a subset of sepsis characterized by persistent hypotension requiring vasopressors to maintain a MAP ≥ 65 mmHg and having a serum lactate level of:

• a) >2 mmol/L despite adequate volume resuscitation.
• b) >1 mmol/L
• c) <2 mmol/L
• d) Exactly 4 mmol/L Answer: a) >2 mmol/L despite adequate volume resuscitation.

9. The primary goal of hemodynamic support in septic shock is to maintain a mean arterial pressure (MAP) of at least:

• a) 55 mmHg
• b) 65 mmHg
• c) 85 mmHg
• d) 100 mmHg Answer: b) 65 mmHg

10. What is the role of vasopressin in the management of septic shock?

• a) It is the first-line vasopressor of choice.
• b) It can be added to norepinephrine as a second-line agent to decrease the norepinephrine requirement.
• c) It is used to treat bradycardia.
• d) It has strong inotropic effects. Answer: b) It can be added to norepinephrine as a second-line agent to decrease the norepinephrine requirement.

11. The selection of an empiric broad-spectrum antibiotic regimen for sepsis should be based on:

• a) The cost of the antibiotics only.
• b) The patient’s suspected site of infection, local resistance patterns, and individual risk factors for resistant organisms.
• c) The preference of the patient.
• d) A standard combination that is the same for every patient. Answer: b) The patient’s suspected site of infection, local resistance patterns, and individual risk factors for resistant organisms.

12. “De-escalation” of antimicrobial therapy in sepsis management refers to:

• a) Increasing the doses of all antibiotics.
• b) Stopping all antibiotics after 24 hours.
• c) Narrowing the antibiotic spectrum once culture and sensitivity results are available.
• d) Adding more broad-spectrum antibiotics. Answer: c) Narrowing the antibiotic spectrum once culture and sensitivity results are available.

13. A patient in septic shock who is refractory to fluids and vasopressors may be a candidate for which adjunctive therapy?

• a) Intravenous immunoglobulin (IVIG)
• b) High-dose statin therapy
• c) Intravenous hydrocortisone
• d) N-acetylcysteine Answer: c) Intravenous hydrocortisone

14. Serum lactate is a key monitoring parameter in sepsis because it is a marker of:

• a) Infection
• b) Inflammation
• c) Tissue hypoperfusion and anaerobic metabolism
• d) Liver function Answer: c) Tissue hypoperfusion and anaerobic metabolism

15. A patient with sepsis develops acute kidney injury (AKI). This complication would require the pharmacist to perform which crucial skill?

• a) Placing a dialysis catheter
• b) Adjusting medication doses for changing renal function
• c) Administering a fluid bolus
• d) Ordering a renal ultrasound Answer: b) Adjusting medication doses for changing renal function

16. Empiric antibiotic coverage for Pseudomonas aeruginosa would be appropriate in a septic patient with which risk factor?

• a) A recent history of a community-acquired urinary tract infection
• b) A diagnosis of neutropenic fever
• c) A mild skin cellulitis
• d) No significant medical history Answer: b) A diagnosis of neutropenic fever

17. What is the primary difference between sepsis and septic shock?

• a) Sepsis always involves a positive blood culture, while septic shock does not.
• b) Septic shock is a more severe state with profound circulatory, cellular, and metabolic abnormalities.
• c) Sepsis is treated with antibiotics, while septic shock is treated with fluids only.
• d) There is no difference between the two terms. Answer: b) Septic shock is a more severe state with profound circulatory, cellular, and metabolic abnormalities.

18. The pharmacist’s role in the management of sepsis includes:

• a) Leading antimicrobial stewardship efforts.
• b) Dosing and titrating vasopressors and sedatives.
• c) Dosing medications in the setting of organ dysfunction.
• d) All of the above. Answer: d) All of the above.

19. A patient with septic shock from an unknown source should receive empiric coverage for which types of organisms?

• a) Gram-positive bacteria only
• b) Gram-negative bacteria only
• c) Both Gram-positive and Gram-negative bacteria, including potentially resistant organisms.
• d) Fungi only Answer: c) Both Gram-positive and Gram-negative bacteria, including potentially resistant organisms.

20. In addition to norepinephrine, which vasopressor can be considered if the patient has a significant tachyarrhythmia?

• a) Epinephrine
• b) Dobutamine
• c) Phenylephrine
• d) Dopamine Answer: c) Phenylephrine

21. “Source control” is a critical non-pharmacologic intervention in sepsis management. It refers to:

• a) Controlling the patient’s blood glucose.
• b) Controlling the patient’s pain.
• c) Physically removing or draining the source of the infection (e.g., removing an infected catheter).
• d) Controlling the information given to the family. Answer: c) Physically removing or draining the source of the infection (e.g., removing an infected catheter).

22. Which of the following is NOT a component of the qSOFA score?

• a) Altered mental status
• b) Systolic blood pressure ≤ 100 mmHg
• c) Serum lactate level
• d) Respiratory rate ≥ 22/min Answer: c) Serum lactate level

23. The use of albumin for fluid resuscitation in sepsis is generally reserved for patients who:

• a) Are in the early stages of sepsis.
• b) Have required substantial amounts of crystalloids.
• c) Have normal albumin levels.
• d) Have heart failure. Answer: b) Have required substantial amounts of crystalloids.

24. What is the typical duration of antibiotic therapy for a patient with uncomplicated sepsis?

• a) 3 days
• b) 7-10 days
• c) 21 days
• d) 6 months Answer: b) 7-10 days

25. A patient in septic shock is found to have decreased cardiac output after adequate fluid resuscitation. The addition of which agent would be most appropriate?

• a) An inotrope like dobutamine
• b) A pure vasoconstrictor like phenylephrine
• c) A diuretic like furosemide
• d) A beta-blocker like metoprolol Answer: a) An inotrope like dobutamine

26. Why is it important to monitor blood glucose in a patient with sepsis, even if they do not have diabetes?

• a) Sepsis can cause stress-induced hyperglycemia.
• b) Vasopressors can cause hypoglycemia.
• c) Antibiotics can lower blood glucose.
• d) All septic patients should be treated with insulin. Answer: a) Sepsis can cause stress-induced hyperglycemia.

27. The term “refractory septic shock” refers to a state of:

• a) Hypotension that resolves with a single fluid bolus.
• b) A mild infection that does not require antibiotics.
• c) Persistent hypotension despite adequate fluid resuscitation and high-dose vasopressor therapy.
• d) Sepsis that occurs outside of a hospital. Answer: c) Persistent hypotension despite adequate fluid resuscitation and high-dose vasopressor therapy.

28. A patient is suspected of having sepsis due to a catheter-related infection. The empiric antibiotic regimen should definitely include coverage for:

• a) Atypical bacteria
• b) Viruses
• c) Gram-positive organisms like Staphylococcus aureus (including MRSA).
• d) Fungi only Answer: c) Gram-positive organisms like Staphylococcus aureus (including MRSA).

29. Which of the following is a common complication of sepsis?

• a) Acute Kidney Injury (AKI)
• b) Acute Respiratory Distress Syndrome (ARDS)
• c) Disseminated Intravascular Coagulation (DIC)
• d) All of the above Answer: d) All of the above

30. The pharmacist’s participation on ICU rounds for a septic patient exemplifies which Entrustable Professional Activity (EPA)?

• a) Performing administrative operations of a pharmacy practice site.
• b) Collaborating as a member of an interprofessional team.
• c) Educating the public.
• d) Fulfilling a medication order. Answer: b) Collaborating as a member of an interprofessional team.

31. The rationale for avoiding hetastarch and other synthetic colloids for fluid resuscitation in sepsis is due to their association with:

• a) Lower cost
• b) Increased risk of acute kidney injury and mortality.
• c) Improved survival rates
• d) Less fluid requirement Answer: b) Increased risk of acute kidney injury and mortality.

32. Normalizing lactate levels in a patient with septic shock is a sign of:

• a) Worsening perfusion
• b) Restored tissue perfusion
• c) Developing liver failure
• d) The need for more vasopressors Answer: b) Restored tissue perfusion

33. The management of sepsis is a core topic in the “Acute Care/Critical Care” module because it is:

• a) A rare condition in the ICU.
• b) A common, high-mortality condition requiring complex, time-sensitive pharmacotherapy.
• c) A condition managed solely by nurses.
• d) An easily treated condition with a simple protocol. Answer: b) A common, high-mortality condition requiring complex, time-sensitive pharmacotherapy.

34. What is the primary advantage of norepinephrine over pure alpha-agonists like phenylephrine in septic shock?

• a) Norepinephrine also has beta-1 agonist effects, which helps maintain cardiac output.
• b) Phenylephrine is more likely to cause tachycardia.
• c) Norepinephrine is less potent.
• d) Phenylephrine has a longer half-life. Answer: a) Norepinephrine also has beta-1 agonist effects, which helps maintain cardiac output.

35. A pharmacist receives a verbal order for an antibiotic for a septic patient in the ED. What is the most important immediate action?

• a) Wait for the written order before preparing the dose.
• b) Prepare and dispense the first dose as quickly as possible while ensuring order clarity.
• c) Question the diagnosis of sepsis.
• d) Ask the nurse to prepare the medication. Answer: b) Prepare and dispense the first dose as quickly as possible while ensuring order clarity.

36. A septic patient develops Disseminated Intravascular Coagulation (DIC). This hematologic emergency is characterized by:

• a) Widespread blood clotting and subsequent bleeding
• b) An extremely high platelet count
• c) A very low INR
• d) A reduced risk of thrombosis Answer: a) Widespread blood clotting and subsequent bleeding

37. The typical duration of a vasopressor infusion in septic shock is:

• a) A fixed 24 hours.
• b) Titrated down and weaned off as hemodynamic stability is achieved.
• c) Continued for at least 14 days.
• d) Stopped abruptly once the MAP is >65 mmHg. Answer: b) Titrated down and weaned off as hemodynamic stability is achieved.

38. The pharmacist can contribute to antimicrobial stewardship in sepsis by:

• a) Recommending the broadest spectrum antibiotics for every patient for 14 days.
• b) Promoting daily review of microbiology data to facilitate de-escalation.
• c) Discouraging the use of antibiotics.
• d) Restricting access to all infectious disease guidelines. Answer: b) Promoting daily review of microbiology data to facilitate de-escalation.

39. If a patient is on a norepinephrine infusion, what is a key monitoring parameter for peripheral perfusion?

• a) Color and temperature of fingers and toes
• b) Blood glucose
• c) White blood cell count
• d) Serum sodium Answer: a) Color and temperature of fingers and toes

40. A patient in the ICU on multiple IV medications for sepsis is at high risk for what type of medication error?

• a) Wrong patient error
• b) Wrong route error
• c) IV line or pump misconnections and programming errors
• d) Wrong time error Answer: c) IV line or pump misconnections and programming errors

41. The use of stress ulcer prophylaxis in septic patients is typically recommended for those with:

• a) Any type of infection.
• b) High-risk factors like mechanical ventilation or coagulopathy.
• c) A history of GERD.
• d) A low lactate level. Answer: b) High-risk factors like mechanical ventilation or coagulopathy.

42. Which of the following is NOT a primary goal of early sepsis management?

• a) Restore tissue perfusion
• b) Eradicate the infection
• c) Initiate long-term parenteral nutrition
• d) Modulate the host’s inflammatory response Answer: c) Initiate long-term parenteral nutrition

43. The SOFA (Sequential Organ Failure Assessment) score assesses the function of which organ systems?

• a) Respiration, Coagulation, Liver, Cardiovascular, CNS, and Renal
• b) Only Cardiovascular and Renal
• c) Only Respiration and CNS
• d) Only Liver and Coagulation Answer: a) Respiration, Coagulation, Liver, Cardiovascular, CNS, and Renal

44. What is the role of the pharmacist in choosing an empiric antibiotic for a septic patient with a severe penicillin allergy?

• a) To recommend a cephalosporin.
• b) To recommend a carbapenem.
• c) To recommend a non-beta-lactam alternative based on the likely source of infection.
• d) To recommend an allergy test before giving any antibiotic. Answer: c) To recommend a non-beta-lactam alternative based on the likely source of infection.

45. A patient with septic shock is receiving norepinephrine at a high dose. This vasopressor primarily acts on which receptors?

• a) Beta-2 adrenergic receptors
• b) Alpha-1 and Beta-1 adrenergic receptors
• c) Dopamine receptors
• d) Vasopressin receptors Answer: b) Alpha-1 and Beta-1 adrenergic receptors

46. Which of the following best describes the pathophysiology of septic shock?

• a) A primary cardiac pump failure
• b) A physical obstruction to blood flow
• c) Pathogen-induced widespread vasodilation, inflammation, and endothelial damage
• d) A massive loss of blood volume Answer: c) Pathogen-induced widespread vasodilation, inflammation, and endothelial damage

47. The reason for starting vasopressors through a central line rather than a peripheral line is to prevent:

• a) Tachycardia
• b) Bradycardia
• c) Extravasation and severe tissue necrosis
• d) A drug-drug interaction Answer: c) Extravasation and severe tissue necrosis

48. An effective pharmacist on an ICU team managing a septic patient must:

• a) Work independently and not communicate with other team members.
• b) Possess strong clinical knowledge and excellent interprofessional communication skills.
• c) Focus only on the cost of the medications used.
• d) Defer all decisions to the medical resident. Answer: b) Possess strong clinical knowledge and excellent interprofessional communication skills.

49. If a septic patient develops AKI and requires renal replacement therapy, how does this impact the dosing of drugs like vancomycin?

• a) The dose should be significantly increased.
• b) The dosing must be adjusted based on the type and timing of dialysis.
• c) The drug should be discontinued immediately.
• d) It has no impact on drug dosing. Answer: b) The dosing must be adjusted based on the type and timing of dialysis.

50. The ultimate goal of learning about sepsis management in the PharmD curriculum is to:

• a) Memorize the Surviving Sepsis guidelines.
• b) Be able to apply evidence-based principles to improve patient outcomes in a real-world clinical setting.
• c) Learn how to bill for sepsis care.
• d) Understand a single disease state in isolation. Answer: b) Be able to apply evidence-based principles to improve patient outcomes in a real-world clinical setting.