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Nursing QUESTION #9226
Question 1
A Head Nurse is reviewing a patient in septic shock. According to Surviving Sepsis Campaign (SSC) 2018 guidelines, which bundle must be completed within the FIRST HOUR of sepsis recognition?
  • Administer antibiotics, obtain cultures, measure lactate, begin fluid resuscitation, start vasopressors if hypotensive✔️
  • Obtain CT scan, start corticosteroids, administer antipyretics, insert CVP line
  • Measure CVP, insert arterial line, transfuse packed red cells, begin renal replacement therapy
  • Intubate the patient, measure procalcitonin, administer albumin 5%, start dobutamine
Correct Answer Explanation
Correct Answer: A — The '1-Hour Bundle' (SSC 2018)

The Surviving Sepsis Campaign 1-hour bundle includes:
  1. Measure serum lactate (re-measure if initial lactate \(> 2 \text{ mmol/L}\))
  2. Obtain blood cultures before administering antibiotics
  3. Administer broad-spectrum antibiotics
  4. Administer \(30 \text{ mL/kg}\) crystalloid (IV fluid bolus) for hypotension or lactate \(\geq 4 \text{ mmol/L}\)
  5. Apply vasopressors if patient remains hypotensive during or after fluid resuscitation to maintain \(\text{MAP} \geq 65 \text{ mmHg}\)
Vasopressor of choice: Norepinephrine (first-line)
Lactate interpretation:
  • \(< 2 \text{ mmol/L}\): Normal
  • \(2 - 4 \text{ mmol/L}\): Elevated — monitor closely
  • \(> 4 \text{ mmol/L}\): Severe hypoperfusion — high mortality risk