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Stage 1: Emergency Department A 73-year-old male presents to the emergency department with worsening shortness of breath, productive cough, and fever for 4 days. History COPD Type 2 Diabetes Mellitus Hypertension Assessment Temp: 39.4°C (102.9°F) HR: 124/min RR: 30/min BP: 98/58 mmHg SpO₂: 88% on room air Physical Findings Confused and restless Crackles in right lower lobe Delayed capillary refill Skin warm and flushed Labs WBC: 21,000/mm³ Lactate: 2.8 mmol/L Glucose: 268 mg/dL Question 1 Which assessment finding is the highest priority? A. Fever B. Elevated glucose
C. Altered mental status D. Crackles in right lower lobe ⸻ Question 2 The nurse suspects sepsis. Which provider prescription should the nurse implement first? A. Acetaminophen B. Blood cultures C. Broad-spectrum antibiotics D. Chest x-ray ⸻ Question 3 Which finding best supports impaired tissue perfusion? A. Crackles B. Fever C. Delayed capillary refill D. Productive cough ⸻ Stage 2: Condition Worsens One hour later:
Question 6 (SATA) The nurse recognizes manifestations of worsening tissue hypoperfusion. Select all that apply. A. Elevated lactate B. Oliguria C. Hypotension D. Confusion E. Bradycardia F. Warm flushed skin ⸻ Stage 3: ICU Transfer The client receives 30 mL/kg normal saline. Despite treatment: BP 80/42 mmHg MAP 55 Urine output remains low The provider initiates norepinephrine. Question 7 What is the primary purpose of norepinephrine? A. Reduce fever B. Increase systemic vascular resistance
C. Increase urine output D. Treat infection ⸻ Question 8 Which finding best indicates improvement? A. WBC decreases B. Temperature decreases C. MAP increases to 68 mmHg D. Heart rate decreases to 110/min ⸻ Stage 4: New Complication Twelve hours later: Assessment Increasing dyspnea RR 38/min SpO₂ 82% despite nonrebreather mask ABGs PaO₂ 54 mmHg Chest X-ray Bilateral diffuse infiltrates Question 9
Which laboratory value requires immediate intervention? A. Creatinine 3. B. BUN 48 C. Potassium 6. D. Lactate 2. ⸻ Question 12 Which ECG finding should the nurse anticipate? A. ST elevation B. Peaked T waves C. Atrial fibrillation D. Prolonged QT interval ⸻ Question 13 (NGN Priority) The nurse receives the following prescriptions. Which should be implemented first? A. Kayexalate B. IV calcium gluconate C. Repeat BMP in 4 hours D. Restrict dietary potassium
Answer Key C — Altered mental status is an early sign of decreased cerebral perfusion. B — Blood cultures should be obtained before antibiotics if possible. C — Delayed capillary refill indicates impaired perfusion. B — Rising lactate indicates worsening tissue hypoxia. B — Aggressive fluid resuscitation is first-line treatment. A, B, C, D B — Norepinephrine increases vascular tone and blood pressure. C — MAP ≥65 is the goal in septic shock. C — Bilateral infiltrates and severe hypoxemia suggest ARDS. B — Mechanical ventilation with PEEP improves oxygenation. C — Hyperkalemia can cause fatal dysrhythmias. B — Peaked T waves are classic for hyperkalemia. B — Calcium gluconate stabilizes the myocardium immediately. ATI Level 3 Concepts Tested: Sepsis recognition Septic shock bundle Lactate interpretation MAP goals Vasopressor management ARDS AKI Hyperkalemia prioritization NGN clinical judgment
