# Stage 2 — Analyze cues. Complete the current sepsis-screening and diagnostic principles by selecting the best option for each blank.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372453&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

Stage 2 — Analyze cues. Complete the current sepsis-screening and diagnostic principles by selecting the best option for each blank.

For acutely ill hospitalized adults, use ::선택::NEWS/NEWS2, MEWS, or SIRSurine color aloneqSOFA without clinical assessment over qSOFA as a single sepsis screening tool. Sepsis is a ::선택::laboratory-only findingclinical diagnosispositive-urinalysis diagnosis that cannot be ruled in or ruled out by one score, biomarker, or test. Collect blood cultures ::선택::only after antibiotics are completedas soon as possibleonly if lactate normalizes and ideally before antimicrobial therapy, while treatment and resuscitation ::선택::wait until every culture is finalbegin only after source imagingbegin immediately.

## Explanation

Current screening and diagnosis
For acutely ill adults in the hospital, the 2026 Surviving Sepsis Campaign recommends NEWS/NEWS2, MEWS, or SIRS over qSOFA as a single screening tool. Sepsis remains a clinical diagnosis that cannot be ruled in or out by one score, biomarker, urinalysis result, or culture. Blood cultures should be collected as soon as possible and ideally before antimicrobials, while treatment and resuscitation begin immediately.

## In-depth explanation

Step 1 — Use qSOFA correctly
Altered mentation, RR 24, and SBP 86 are concerning, but qSOFA should not be used as the sole hospital sepsis screen. Current guidance favors NEWS/NEWS2, MEWS, or SIRS for that screening role.

Step 2 — Preserve clinical judgment
Sepsis is a clinical diagnosis. No single test—including lactate, procalcitonin, urinalysis, or a screening score—can independently rule it in or out. This client requires synthesis of acute baseline change, perfusion, organ dysfunction, infection likelihood, and competing causes.

Step 3 — Analyze without delaying action
Collect blood cultures as soon as possible and ideally before antimicrobial therapy, but begin emergency treatment and resuscitation immediately. Diagnostic work and treatment overlap.

Key concept
Stage 2 asks the learner to distinguish a screening signal from a clinical diagnosis.

## Clinical scenario

Scenario (Stage 2 — Analyze cues)
Interpret the Stage 1 cues using current hospital screening and diagnostic principles rather than relying on qSOFA or urinalysis alone.

Background
NCJMM Stage 2 — Organize cues, assess competing explanations, and identify what the available evidence can and cannot establish.

## Key concepts

- **Hospital sepsis screening** — The 2026 Surviving Sepsis Campaign recommends NEWS/NEWS2, MEWS, or SIRS over qSOFA when one hospital screening tool is used. A positive screen prompts rapid clinical evaluation; it does not independently diagnose sepsis.
- **Clinical diagnosis of sepsis** — Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Diagnosis integrates clinical findings, organ dysfunction, infection likelihood, and alternative causes rather than one score or biomarker.
- **Diagnostic-treatment overlap** — Cultures and lactate should be obtained promptly, ideally with cultures before antimicrobials, while resuscitation and time-sensitive therapy proceed without avoidable delay.

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