Sepsis Practice Questions

25 multiple-choice questions on Sepsis for paramedic and EMT students, from Chapter 27 (Infectious Diseases). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. An older patient with suspected sepsis has no obvious source. During your exam, you should:

   1. A. Skip the exam
   2. B. Look at the skin under clothing
   3. C. Check the throat and ears and stop there
   4. D. Assume the lungs are the source and move on
   Show answer

   Answer: B. Look at the skin under clothing

   Hidden sources include pressure injuries on the back and buttocks, infected wounds, cellulitis under dressings, and devices such as catheters and lines. Expose and examine the skin, then cover the patient to keep him warm.

2. A patient with chills and confusion took acetaminophen 1 hour ago, and his temperature is now 37.4 °C (99.3 °F). Regarding sepsis, this reading:

   1. A. Rules out sepsis
   2. B. Proves a viral cause
   3. C. Does not rule it out
   4. D. Shows he is improving
   Show answer

   Answer: C. Does not rule it out

   Antipyretics can lower the temperature without treating the infection. Ask about recent acetaminophen or ibuprofen, and judge sepsis by the whole picture, including mental status, respiratory rate, heart rate, and blood pressure.

3. The qSOFA criteria include:

   1. A. Fever, HR > 100, WBC > 12,000/µL
   2. B. Altered mentation, RR ≥ 22, SBP ≤ 100
   3. C. SpO2 < 90%, HR > 120, temp > 39 °C
   4. D. Rash, fever, and hypotension
   Show answer

   Answer: B. Altered mentation, RR ≥ 22, SBP ≤ 100

   Two or more qSOFA criteria suggest a higher risk of poor outcome.

4. Which vital sign is often the earliest abnormal finding in sepsis and is also the one most often estimated rather than counted?

   1. A. Blood pressure
   2. B. Body temperature
   3. C. Oxygen saturation
   4. D. Respiratory rate
   Show answer

   Answer: D. Respiratory rate

   Tachypnea is an early response to sepsis and its acidosis, and a rate of 22 or more is part of qSOFA. Count it for a full 30 to 60 seconds. Hypotension appears later, and temperature can be normal.

5. In a nursing home resident, which temperature is considered a fever that may signal serious infection?

   1. A. 37.8 °C (100 °F) or higher
   2. B. 39.5 °C (103 °F) or higher
   3. C. 40 °C (104 °F) or higher
   4. D. 41 °C (105.8 °F) or higher
   Show answer

   Answer: A. 37.8 °C (100 °F) or higher

   Older adults often mount a smaller fever. IDSA defines fever in long-term care residents as a single oral temperature of 37.8 °C (100 °F) or more, repeated readings above 37.2 °C (99 °F), or a rise of 1.1 °C (2 °F) over baseline. Waiting for a high fever delays care.

6. For fluid resuscitation in sepsis, current international guidelines suggest:

   1. A. D5W as the first-choice fluid
   2. B. Hypertonic 3% saline boluses
   3. C. Balanced crystalloid, such as LR
   4. D. Albumin before any crystalloid is given
   Show answer

   Answer: C. Balanced crystalloid, such as LR

   The Surviving Sepsis Campaign suggests balanced crystalloids such as lactated Ringer's over normal saline when available, and crystalloids rather than albumin as first-line fluid. D5W does not stay in the vessels.

7. Elevated lactate in sepsis indicates:

   1. A. Respiratory acidosis
   2. B. Adequate tissue oxygen
   3. C. Tissue hypoperfusion
   4. D. Low blood glucose
   Show answer

   Answer: C. Tissue hypoperfusion

   Lactate above 2 mmol/L suggests poor perfusion. Above 4 indicates high risk. Lactate is a metabolic acid, not a sign of CO2 retention. A high level means tissues are short of oxygen, and it does not measure blood glucose.

8. End-tidal CO2 below 25 mmHg in a suspected septic patient suggests:

   1. A. Respiratory acidosis from CO2 retention
   2. B. Poor perfusion or metabolic acidosis
   3. C. Normal perfusion and ventilation
   4. D. Hypoventilation from sedation
   Show answer

   Answer: B. Poor perfusion or metabolic acidosis

   Low ETCO2 correlates with elevated lactate.

9. The initial fluid bolus for septic shock in adults is:

   1. A. 5 mL/kg of D5W
   2. B. 500 mL of albumin
   3. C. 1 L of hypertonic saline
   4. D. 30 mL/kg of crystalloid
   Show answer

   Answer: D. 30 mL/kg of crystalloid

   Reassess lung sounds and vital signs after each bolus.

10. If hypotension persists after fluids in septic shock, the preferred vasopressor is:

    1. A. Norepinephrine
    2. B. Dopamine
    3. C. Phenylephrine
    4. D. Epinephrine IM
    Show answer

    Answer: A. Norepinephrine

    Norepinephrine is first line. Target a mean arterial pressure of at least 65 mmHg.

11. A man who had his spleen removed years ago was licked on a scratch by his dog 2 days ago and now has fever, purplish skin spots, and a BP of 78/40. You should suspect:

    1. A. An allergy to the dog's saliva
    2. B. A mild viral skin rash
    3. C. Overwhelming bacterial sepsis
    4. D. Rabies starting at the scratch
    Show answer

    Answer: C. Overwhelming bacterial sepsis

    Capnocytophaga, a bacterium in dog and cat mouths, can cause rapidly fatal sepsis with purpura in people without a spleen, heavy drinkers, or the immunocompromised, even after a minor scratch or lick. Treat the shock, tell the hospital about the asplenia and the animal contact, and transport rapidly.

12. Six days after hernia surgery, a patient has fever, a heart rate of 118, and a red, warm incision draining pus. For your sepsis assessment, the likely source is:

    1. A. A urinary tract infection
    2. B. Pneumonia from anesthesia
    3. C. A leg vein clot
    4. D. The surgical wound
    Show answer

    Answer: D. The surgical wound

    Surgical site infections often appear 3 to 7 days after an operation. Inspect incisions in any post-op patient with fever or tachycardia, report the drainage and redness, and do not remove dressings that the surgeon placed unless they must be checked for bleeding. A UTI, pneumonia, or a leg clot can cause fever after surgery, but the red, draining incision points directly to the wound.

13. Why is a prehospital sepsis alert valuable?

    1. A. It speeds hospital treatment
    2. B. It replaces early hospital care
    3. C. It confirms the diagnosis
    4. D. It avoids blood cultures
    Show answer

    Answer: A. It speeds hospital treatment

    Early notification lets the hospital prepare antibiotics and fluids.

14. Which patient is at highest risk for sepsis?

    1. A. A patient with seasonal allergies
    2. B. A patient on chemotherapy
    3. C. A patient with a new tattoo
    4. D. A healthy 25-year-old
    Show answer

    Answer: B. A patient on chemotherapy

    Immunosuppressed, elderly, and chronically ill patients are at highest risk. Allergies and a new tattoo do not weaken the immune system the way chemotherapy does.

15. SIRS criteria include:

    1. A. Temp > 39 °C, HR > 110, RR > 24
    2. B. Temp > 38 °C, HR > 90, RR > 20
    3. C. SBP ≤ 100, RR ≥ 22, altered mentation
    4. D. SpO2 < 90%, HR > 90, RR > 20
    Show answer

    Answer: B. Temp > 38 °C, HR > 90, RR > 20

    SIRS is sensitive but not specific for infection. SIRS also counts a temperature below 36 °C and the white count. The thresholds are 38 °C, 90, and 20, not 39, 110, and 24. Low blood pressure, RR 22, and altered mentation are qSOFA, and SpO2 is not a SIRS criterion.

16. A woman discharged after treatment for sepsis 3 weeks ago now has a fever again. Regarding sepsis survivors, you should know that:

    1. A. One episode makes later sepsis unlikely
    2. B. Sepsis leaves lasting immunity to bacteria
    3. C. New infections and readmission are common
    4. D. Fever after sepsis is rarely a concern
    Show answer

    Answer: C. New infections and readmission are common

    Many sepsis survivors are readmitted within 90 days, often with a new or recurrent infection, and they may have lasting weakness, cognitive problems, and lower immune function. Treat a new fever seriously and screen again for sepsis.

17. During an infusion through a home PICC line, a patient suddenly has shaking chills and a fever of 39.4 °C (103 °F). You should suspect:

    1. A. A bloodstream infection from the line
    2. B. An allergy to the normal saline flush
    3. C. A common viral cold coming on today
    4. D. Anxiety about the home infusion therapy
    Show answer

    Answer: A. A bloodstream infection from the line

    Rigors that start when a line is flushed or used suggest bacteria in the catheter being pushed into the blood. Treat as possible sepsis, tell the hospital about the line, and follow protocol about using it.

18. A urinary tract infection in an elderly patient may present as:

    1. A. Severe chest pain
    2. B. Isolated seizures
    3. C. Facial rash
    4. D. Sudden confusion
    Show answer

    Answer: D. Sudden confusion

    UTIs are a common cause of delirium and sepsis in older adults.

19. Fluid resuscitation in a septic patient with heart failure should:

    1. A. Be withheld entirely
    2. B. Be given rapidly without monitoring
    3. C. Be given by mouth instead
    4. D. Be cautious with reassessment
    Show answer

    Answer: D. Be cautious with reassessment

    Give smaller boluses and reassess for crackles.

20. Which finding is a sign of organ dysfunction in sepsis?

    1. A. Decreased urine output
    2. B. Normal, unchanged mental status
    3. C. Warm, dry skin
    4. D. Normal lactate
    Show answer

    Answer: A. Decreased urine output

    Kidney, brain, lung, and clotting dysfunction indicate severe sepsis.

21. Purpura fulminans in sepsis indicates:

    1. A. A drug rash from the antibiotic
    2. B. DIC with skin necrosis
    3. C. Pressure injury from lying still
    4. D. A viral rash
    Show answer

    Answer: B. DIC with skin necrosis

    It is seen with meningococcemia and has a high mortality rate. A drug rash or pressure injury does not spread rapidly with purple, dying skin and shock.

22. Five days after giving birth, a woman has a fever of 39 °C (102.2 °F), lower abdominal pain, foul-smelling vaginal discharge, and a heart rate of 120. You should suspect:

    1. A. Normal postpartum recovery
    2. B. Breast milk coming in
    3. C. Postpartum uterine infection
    4. D. A kidney stone in the right ureter
    Show answer

    Answer: C. Postpartum uterine infection

    Endometritis after delivery causes fever, uterine tenderness, and foul lochia, and it can progress to sepsis, a leading cause of maternal death. Treat as possible sepsis and transport.

23. A patient had cosmetic surgery abroad 2 weeks ago and now has fever and a draining wound. When you give your report, it is important to mention the overseas care because:

    1. A. Hospitals abroad use fully sterile tools
    2. B. It changes which IV fluids you can give
    3. C. Drug-resistant bacteria are more likely
    4. D. The hospital must contact the embassy first
    Show answer

    Answer: C. Drug-resistant bacteria are more likely

    Patients who had medical care in other countries are more likely to carry multidrug-resistant organisms, such as CRE, and may need screening, contact precautions, and broader antibiotics. Mentioning it helps the hospital choose initial treatment.

24. Hypothermia in a septic patient indicates:

    1. A. Antipyretics are working well
    2. B. A worse prognosis
    3. C. A viral rather than bacterial cause
    4. D. A mild infection
    Show answer

    Answer: B. A worse prognosis

    A low temperature in sepsis is associated with higher mortality. Hypothermia in sepsis is not caused by fever medicine, does not suggest a viral cause, and signals severe rather than mild illness.

25. A septic patient's family asks why you placed a large-bore IV and checked a glucose even though he is not diabetic. Checking glucose matters because sepsis can cause:

    1. A. High or low blood sugar
    2. B. Permanent type 1 diabetes
    3. C. Diabetes insipidus
    4. D. Thyroid storm
    Show answer

    Answer: A. High or low blood sugar

    Sepsis triggers stress hyperglycemia, but severe sepsis can also deplete glucose and cause hypoglycemia, especially in older adults, alcohol users, and those with liver disease. A low glucose can explain altered mental status and is easy to correct. Sepsis does not cause permanent type 1 diabetes, diabetes insipidus is a water-balance problem that a glucose check cannot detect, and a glucose reading cannot diagnose thyroid storm.