A patient with suspected sepsis has BP 88/60 mmHg, HR 132/min, temperature 39°C, and raised lactate. What is… - NORCET 10 Prelims-2026

NORCET 10 Prelims-2026

Medical & Surgical Nursing

Hard

Appeared in: NORCET 10 Prelims-2026

Explanation

The patient's vital signs and elevated lactate are indicative of septic shock, a life-threatening condition characterized by inadequate tissue perfusion.
The immediate priority in septic shock is to correct the circulatory collapse. This is achieved by rapidly restoring intravascular volume.
Guidelines from the Surviving Sepsis Campaign recommend an initial fluid bolus of 30 mL/kg of isotonic crystalloid to stabilize blood pressure and improve perfusion.
Addressing the hemodynamic instability is the most critical first step to prevent further organ damage and cardiovascular collapse.

Option A: While administering broad-spectrum antibiotics is a critical part of the sepsis bundle and must be done within one hour, it is not the first priority over stabilizing a collapsing circulatory system. Fluids address the immediate life threat of hypotension.
Option C: Vasopressors are a second-line treatment for septic shock. They are only indicated if hypotension persists despite adequate fluid resuscitation. Using them before correcting hypovolemia can worsen organ ischemia.
Option D: Sepsis is a medical emergency with high mortality if treatment is delayed. Nurses are empowered and expected to initiate life-saving protocols, such as the sepsis bundle, immediately upon recognition.

Visual 1: Flowchart: 'The Sepsis Hour-1 Bundle'. This visual would outline the 5 key steps (measure lactate, obtain cultures, give antibiotics, give fluids, apply vasopressors) to be initiated within the first hour, highlighting the sequence and rationale.
Visual 2: Infographic: 'Recognizing Septic Shock'. This would show the key signs and symptoms, including hypotension (SBP less than 90 mmHg), tachycardia (HR greater than 130 bpm), altered mental status, and elevated lactate (greater than 2 mmol/L).

Clinical Relevance

Nursing practice connection: Knowing Priority nursing interventions for septic shock helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Early recognition and rapid intervention by nurses are critical to improving outcomes in sepsis, which has a high mortality rate.
Nurses must be proficient in initiating the sepsis bundle, often before a physician is at the bedside, as every hour of delay in treatment significantly increases the risk of death.
Patient Safety: Failure to prioritize fluid resuscitation in a hypotensive septic patient can lead to irreversible organ damage, particularly to the kidneys and heart, and ultimately cardiovascular collapse.

How to Approach the Question

First, analyze the patient's data in the stem. Identify the key abnormal findings: low BP (hypotension), high HR (tachycardia), high temp (fever), and high lactate. Recognize that this combination points to septic shock.
Next, understand the question is asking for the 'priority' management. This means you must choose the most critical, life-saving action to perform first.
Evaluate the options based on pathophysiology and established guidelines (like ABCs - Airway, Breathing, Circulation). The patient's primary problem is circulatory collapse.
Option B, 'Fluid resuscitation', directly addresses the circulatory collapse by increasing intravascular volume and blood pressure.
Consider the other options. Antibiotics (A) treat the cause but don't fix the immediate circulatory failure. Vasopressors (C) are a second-line treatment after fluids. Waiting (D) is never appropriate in an emergency.
Conclude that stabilizing the circulation with fluids is the highest priority to prevent immediate death.

Concept Tested & Keywords

Concept Tested: Priority nursing interventions for septic shock
Stem keywords: sepsis, hypotension, tachycardia, raised lactate, priority management
Lead-in keywords: priority
Clinical cues: Hypotension (BP 88/60 mmHg) indicates circulatory compromise.
Clinical cues: Tachycardia (HR 132/min) is a compensatory response to low blood pressure.

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