# A 70-year-old client in the medical ICU with septic shock from urosepsis is started on the Surviving Sepsis Hour-1 bundle at 18:00. Lactate, mean arterial pressure (MAP), and norepinephrine dose are tracked. Review the trend and select the correct interpretation.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=393481&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 70-year-old client in the medical ICU with septic shock from urosepsis is started on the Surviving Sepsis Hour-1 bundle at 18:00. Lactate, mean arterial pressure (MAP), and norepinephrine dose are tracked. Review the trend and select the correct interpretation.

| Time | Data |
| --- | --- |
| 18:00 (bundle start) | MAP 58, lactate 4.2 mmol/L, T 39.0 C, on 30 mL/kg crystalloid bolus, no vasopressor yet |
| 19:00 | MAP 62, lactate 3.8 mmol/L, on norepinephrine 0.05 mcg/kg/min |
| 21:00 | MAP 70, lactate 2.8 mmol/L, on norepinephrine 0.10 mcg/kg/min |
| 23:00 | MAP 75, lactate 1.8 mmol/L, weaning norepinephrine to 0.05 mcg/kg/min |

Q1. Across the four time points, the trend is best described as which of the following?

Improving
Stable
Deteriorating

Q2. Which of the following is the priority response at 23:00?

Continue the sepsis bundle and reassess at the next interval
Stop norepinephrine immediately and remove all IV fluids
Discontinue antibiotics now that vital signs are stable
Escalate to a second vasopressor for additional pressure

## Explanation

Trend interpretation
Lactate falls from 4.2 to 1.8 mmol/L, MAP rises from 58 to 75 mmHg, and norepinephrine dose is being weaned. The pattern is improving — the sepsis bundle is working. Continue the bundle and reassess.

## In-depth explanation

Step 1 — Anchor the targets
Surviving Sepsis goals: MAP at or above 65 mmHg, falling lactate, and weaning vasopressor. All three move in the right direction here.

Step 2 — Read the trajectory
Lactate 4.2 → 3.8 → 2.8 → 1.8 mmol/L is a consistent fall across 5 hours.
MAP 58 → 62 → 70 → 75 mmHg crosses the 65 mmHg target by 21:00 and remains above target.
Norepinephrine titration: 0.05 → 0.10 → 0.05 (weaning at 23:00 reflects the patient is responding).

Step 3 — Choose the response
The bundle is working. Continue the sepsis bundle and reassess at the next interval. Do not escalate when targets are being met. Do not wean off vasopressor abruptly. Do not stop antibiotics early — duration is set by the source.

Key concept
Trend questions test the ability to recognize a positive trajectory and avoid unnecessary escalation. NCLEX rewards clinical inertia in the right direction: stay the course when the bundle is working.

## Clinical scenario

Scenario
70-year-old male, MICU, septic shock from urosepsis. Surviving Sepsis Hour-1 bundle initiated at 18:00 (broad-spectrum antibiotics, 30 mL/kg crystalloid, blood cultures, lactate, source identification).

Tracking
The nurse documents MAP, lactate, and norepinephrine dose hourly. Review the trend and decide what to do next.

Background
Surviving Sepsis Campaign targets MAP at or above 65 mmHg, falling lactate as a marker of reperfusion, and reduction of vasopressor support over time.

## Key concepts

- **Surviving Sepsis Hour-1 bundle** — Lactate measurement, blood cultures, broad-spectrum antibiotics, 30 mL/kg crystalloid for hypotension or lactate above 4, and norepinephrine if MAP remains under 65 after fluid.
- **Mean arterial pressure (MAP)** — Average arterial pressure during a cardiac cycle, calculated as approximately diastolic + 1/3 (systolic - diastolic). Sepsis target is 65 mmHg or higher to maintain organ perfusion.
- **Lactate** — Marker of tissue hypoperfusion in shock. Failure to clear lactate over 6 to 8 hours predicts higher mortality. Trend is more useful than a single value.

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