A patient with sepsis presents with fever (39°C), blood pressure 118/85 mmHg, and heart rate 120/min. What is the most appropriate initial additional treatment?

1. A

   Start IV fluids

2. B

   Start vasopressin

3. C

   Inform the physician

4. D

   Give broad-spectrum antibiotic drug as prescribed

Appeared in: NORCET 10 Prelims-2026

Explanation

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• The primary cause of sepsis is an infection, and administering broad-spectrum antibiotics is the definitive treatment to address this root cause.
• According to the Surviving Sepsis Campaign, there is a 7-8% increase in mortality for every one-hour delay in appropriate antibiotic administration in patients with septic shock.
• While other interventions like fluid resuscitation are important for support, they manage the symptoms (like hypotension), whereas antibiotics treat the underlying disease process.
• The patient's clinical presentation with fever and tachycardia meets the criteria for sepsis, making the initiation of antibiotics a time-critical priority.

Why Other Options Were Wrong

• Option A: This patient is not hypotensive (BP 118/85 mmHg). The Surviving Sepsis Campaign guidelines recommend a rapid 30 mL/kg fluid bolus for patients with hypotension or a lactate level of 4 mmol/L or higher. While fluids are important, antibiotics are the higher priority in a normotensive patient.
• Option B: Vasopressors are potent medications used to raise blood pressure in septic shock when hypotension persists despite adequate fluid resuscitation. This patient's blood pressure is normal, so vasopressors are not indicated and would be harmful.
• Option C: Informing the physician is a crucial communication step, but it is not a direct treatment intervention. Sepsis is a medical emergency, and delaying life-saving treatment to wait for communication is not the most appropriate initial action, especially when protocols or standing orders are in place.

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Clinical Relevance

• Nursing practice connection: Use the key finding related to Prioritization of nursing interventions in the initial management of sepsis to guide bedside assessment, documentation, and the next nursing action.
• Early recognition of sepsis is a critical nursing responsibility. Nurses are often the first to identify subtle changes like tachycardia or fever and must act quickly.
• Nurses are empowered by sepsis protocols to initiate life-saving interventions like drawing cultures and starting antibiotics, often before a physician is at the bedside. This autonomy is vital for improving patient outcomes.
• What if the patient's BP was 85/50 mmHg? In this case of septic shock, starting IV fluids and administering antibiotics would become equally high priorities, and the nurse would likely initiate both actions simultaneously while calling for immediate physician and/or rapid response team support.

How to Approach the Question

• First, identify the question type. This is a clinical scenario asking for the priority intervention.
• Analyze the patient's data: Temp 39°C (fever), HR 120/min (tachycardia), BP 118/85 mmHg (normotensive). Recognize these as signs of sepsis.
• Recall the standard of care for sepsis, which is the Surviving Sepsis Campaign bundle.
• Evaluate each option based on the bundle's priorities. The bundle prioritizes treating the underlying infection with antibiotics.
• Eliminate options that are not indicated (vasopressors) or are secondary to direct treatment (informing the physician).
• Differentiate between the top two priorities (fluids and antibiotics). Since the patient is not hypotensive, the immediate administration of antibiotics to treat the infection takes precedence over a large fluid bolus.

Concept Tested & Keywords

• Concept Tested: Prioritization of nursing interventions in the initial management of sepsis.
• Stem keywords: sepsis, fever, tachycardia, initial treatment
• Lead-in keywords: most appropriate, initial
• Clinical cues: Fever (39°C) and heart rate (120/min) are classic signs of a systemic inflammatory response, highly suggestive of sepsis.
• Clinical cues: Blood pressure (118/85 mmHg) is currently stable (normotensive), which influences the immediate priority of interventions like fluids and vasopressors.

Question ID

QASZvlL8XJ986axhEQ4uDC

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Reference Book

E6 Medicine Harrison 22e Part 2 pp. 224-226, 226-228

E6 Medicine Harrison 22e Part 1 p. 1031-1033