Skip to content
Free NREMT practice questionsFree Paramedic practice questions · Medical/Obstetrics/Gynecology

10 free Paramedic practice questions: Sepsis and Septic Shock

These are real questions from the same bank the app draws from. Each one is written to the NREMT Paramedic content specifications and kept inside the Paramedic scope of practice. Pick an answer and you get the full rationale, including why the other three options are wrong.

Work through all 10, then move on to the next topic. When you want the full picture, the free Paramedic diagnostic covers every topic in one sitting. No account needed for any of it.

Question 1 of 10

An 80-year-old patient with a history of heart failure has pneumonia, and there are crackles at both lung bases. The vital signs are BP 86/52, P 118, R 28, and SpO₂ 90% on room air. How should fluid be given?

Show the answer and rationale

Correct answer · In small boluses, reassessing the lung sounds each time

This patient is in septic shock from pneumonia and also has heart failure. The pressure is 86/52 and the pulse is 118. There are already crackles at both lung bases. Septic shock usually gets 30 mL/kg of fluid. Heart failure usually means you hold fluid back. This patient has both, so neither habit works by itself. Give the fluid in small boluses. After each bolus, recheck the lung sounds, the work of breathing, and the perfusion you can see. That recheck tells you whether to keep going or stop. Heart failure and kidney patients get smaller volumes, not zero. The volume this patient lost to septic shock is real, and a vasopressor cannot replace it.

Why the others are wrong

As a maintenance drip only, with the pressure watched closely: A maintenance drip sounds like a safe middle ground between doing nothing and doing harm. Maintenance rates are too slow to fix the volume this patient is missing. The patient stays underfilled, and the pressure stays low.

As a full 30 mL/kg bolus run in as fast as the line allows: A full 30 mL/kg bolus is the standard volume for sepsis. This patient has heart failure and already has crackles at both bases. Running that much fluid in fast without rechecking fills the lungs, and the patient trades one problem for another.

Not at all, moving straight to a vasopressor instead: Holding all fluid makes sense if you only look at the crackles. Heart failure patients still get fluid, just in smaller amounts. A vasopressor squeezes the blood vessels, and squeezing does not replace missing volume.

Question 2 of 10

A 66-year-old patient with sepsis has received 30 mL/kg of isotonic crystalloid over 40 minutes, and the lungs remain clear. The vital signs are now BP 78/44, P 126, R 26, and SpO₂ 93% on room air. What should the paramedic do next?

Show the answer and rationale

Correct answer · Start a norepinephrine infusion titrated to the pressure

This patient is in septic shock that has not responded to fluid. The patient got 30 mL/kg of isotonic crystalloid over 40 minutes, and the pressure is still 78/44 with a pulse of 126. Septic shock is distributive. The body's response to the infection makes the blood vessels dilate. Once the fluid has been given, the problem left is the vessels and not the volume. Norepinephrine tightens the vessels back down by working mostly on alpha-1 receptors, with only a little beta-1 effect. The alpha effect raises the pressure without pushing the heart rate much higher. This is the point to move from fluid to a vasopressor. Keep listening to the lungs for any sign of fluid overload.

Why the others are wrong

Give another 30 mL/kg of isotonic crystalloid: Fluid is the first treatment for sepsis, and clear lungs make another bolus look safe. The pressure is still 78/44 after the full 30 mL/kg. The problem has moved from volume to the vessels, and more crystalloid will not fix the vessels.

Start a dopamine infusion titrated to the pressure: Dopamine is a real vasopressor and used to be the standard drug for septic shock. Dopamine works on both alpha and beta receptors, so it raises the pressure and the heart rate. This patient's heart rate is already 126. Dopamine causes more fast dysrhythmias than norepinephrine for the same rise in pressure. That's why dopamine is second line here.

Give push-dose epinephrine every 2 minutes during transport: Push-dose epinephrine is a real bridge for a short, severe drop in pressure while an infusion is being set up. This patient's low pressure is not a short dip. The pressure has stayed low through 40 minutes of treatment. A dose every 2 minutes treats each drop as it comes, while an infusion keeps working on the dilated vessels the whole time.

Question 3 of 10

A 58-year-old with two days of fever and abdominal pain is hypotensive and tachycardic, and a partner raises occult gastrointestinal bleeding as the cause. The skin is warm, red, and dry, and the neck veins are flat. The vital signs are BP 82/46, P 128, R 26, and SpO₂ 93% on room air. Which finding argues against the bleeding explanation?

Show the answer and rationale

Correct answer · Warm, red, dry skin rather than pale, cool, clammy skin

The warm, red, dry skin argues against bleeding and fits septic shock. This patient has had two days of fever and abdominal pain. Bleeding and sepsis look almost the same on the vital signs. Both give you a fast heart rate, a low blood pressure, and flat neck veins, because in both the blood vessels are underfilled. A finding that both conditions share cannot tell them apart. The skin is where bleeding and sepsis split. In a bleeding patient, the blood vessels clamp down, and the skin turns pale, cool, and clammy. In sepsis the blood vessels open up wide. That's why this patient's skin is warm, red, and dry.

Why the others are wrong

A heart rate of 128 rather than a normal heart rate: A heart rate of 128 fits bleeding just as well as it fits sepsis. A fast heart rate is the body trying to make up for poor perfusion. The heart speeds up no matter what caused the poor perfusion.

Flat neck veins rather than distended neck veins: Flat neck veins are a real finding, and they show up with both bleeding and sepsis. Bleeding leaves less blood in the vessels. Sepsis opens the vessels wider. Either one leaves the neck veins flat.

A systolic pressure of 82 rather than a normal pressure: A systolic pressure of 82 is exactly what heavy blood loss gives you. The number tells you this patient is in shock, not which kind of shock.

Question 4 of 10

A 22-year-old is hypotensive with warm, dry, pink skin. Which single finding most strongly favors neurogenic shock over septic shock?

Show the answer and rationale

Correct answer · A heart rate of 56

A heart rate of 56 points to neurogenic shock. Neurogenic shock and septic shock are both distributive shock, where the blood vessels dilate. That's why both can give you a hypotensive patient with warm, dry, pink skin. The heart rate is what separates them. In neurogenic shock, a spinal cord injury cuts off the sympathetic signals that would speed the heart up. The pulse stays normal or slow while the blood pressure falls. Septic shock gives you a fast heart rate along with the low blood pressure.

Why the others are wrong

A capillary refill of 4 seconds: tells you perfusion is poor. Perfusion is poor in both neurogenic and septic shock. Slow capillary refill confirms shock without telling you which kind.

A systolic pressure of 80: the low blood pressure the question already gives you. Septic shock gets to a systolic of 80 just as easily as neurogenic shock.

A respiratory rate of 24: fits sepsis better than neurogenic shock. Septic patients often breathe fast to make up for acidosis. A rate of 24 points you toward sepsis, not away from it.

Question 5 of 10

An 80 kg patient with suspected sepsis has a systolic pressure of 84, clear lung sounds, and established vascular access. Which fluid plan matches the resuscitation standard for this patient?

Show the answer and rationale

Correct answer · Isotonic crystalloid toward 30 mL/kg, given in reassessed increments

Give isotonic crystalloid toward 30 mL/kg, in increments, with a reassessment after each one. Suspected sepsis with a systolic pressure of 84 calls for weight-based fluid. For an 80 kg patient, 30 mL/kg is about two and a half liters. That volume goes in steps, not all at once. After each step, you check whether the lungs are still clear and whether perfusion is getting better. The reassessment is what makes that much fluid safe to give.

Why the others are wrong

One liter of isotonic crystalloid run wide open without interruption: One liter is a reasonable size for a first increment, so the volume is not the problem. Running it wide open without stopping skips the reassessment. The reassessment is what tells you when to stop.

A single 250 mL bolus, then transport with no further fluid: A 250 mL bolus is a real way to give fluid in small steps when protocol calls for it. Stopping after one bolus leaves most of the weight-based volume ungiven in a hypotensive septic patient.

Fluid withheld until the systolic pressure falls below 70: Waiting for a systolic below 70 means waiting until the body can no longer compensate at all. A systolic of 84 with suspected sepsis already calls for weight-based fluid.

Question 6 of 10

A 77-year-old in septic shock has received two increments of isotonic crystalloid. The mental status is unchanged, and new crackles are now audible at both bases with rising work of breathing. Which action fits these findings?

Show the answer and rationale

Correct answer · Stop the fluid and reassess before any further volume goes in

This patient is developing pulmonary edema from fluid overload. After two increments of fluid, there are new crackles at both bases and the work of breathing is rising. The mental status has not improved. New crackles are the clearest sign to stop fluid. The crackles mean the fluid is backing up into the lungs instead of filling the vessels. The rising work of breathing comes from the same fluid in the lungs. That's why fluid goes in as increments, with lung sounds checked between each one. Stop the fluid now, and reassess this patient before any more volume goes in.

Why the others are wrong

Add a second line and run fluid through both sites at once: A second line gives you faster delivery and a backup route. Running fluid through both lines at once doubles how fast the fluid goes in. The new crackles are telling you to stop the fluid, not to give more.

Increase the fluid rate so the pressure comes up faster: Raising the rate is what you do when the pressure is still low and the lungs are clear. These lungs are already filling with fluid. Pushing fluid faster makes the oxygenation worse and does not improve perfusion.

Continue the same fluid rate and recheck the lungs at the hospital: Keeping the same rate treats the new crackles as if they do not matter. The crackles are the one finding that tells you the next increment will go into the lungs instead of the circulation.

Question 7 of 10

A 61-year-old in septic shock remains hypotensive after adequate fluid, and norepinephrine is started per protocol. Which property of that drug addresses the primary problem in this patient?

Show the answer and rationale

Correct answer · Alpha-1 vasoconstriction that raises systemic vascular resistance

In septic shock, the vessels dilate, the resistance falls, and the blood pressure falls with it. This patient is still hypotensive after adequate fluid, so the volume is already there. What is left to fix is the tone of the blood vessels. Alpha-1 receptors are the receptors that constrict the blood vessels. Norepinephrine works mostly on alpha-1 receptors and raises the systemic vascular resistance. That's why norepinephrine is the recommended first choice once fluid alone is not fixing the hypotension. Norepinephrine also has some beta-1 effect. The beta-1 effect is a side benefit, not the reason the drug was chosen.

Why the others are wrong

Beta-2 stimulation that relaxes bronchial smooth muscle: Beta-2 stimulation relaxes the smooth muscle in the airways, and you want that in bronchospasm. Beta-2 does nothing for blood vessels that are dilated. Norepinephrine also has very little beta-2 effect.

Beta-1 stimulation that raises heart rate and contractile force: Beta-1 stimulation raises the heart rate and the force of each beat, and norepinephrine does have some. Beta-1 support helps a heart that is pumping weakly. This patient has had adequate fluid, and the problem left is blood vessels that will not hold the pressure around that fluid.

Dopaminergic dilation that preserves renal and mesenteric flow: Dopaminergic effects dilate the blood vessels to the kidneys and the gut. Protecting kidney blood flow sounds helpful in a septic patient. More dilation goes the wrong direction when this patient's vessels are already dilated.

Question 8 of 10

A 57-year-old with septic shock is breathing 32 times a minute with clear lung sounds and an SpO₂ of 95% on an NRB. A partner suggests rapid sequence intubation to protect the airway. Which action should the paramedic take?

Show the answer and rationale

Correct answer · Continue volume and vasopressor support and defer intubation

Keep giving volume and vasopressor support, and hold off on intubation. A respiratory rate of 32 looks like the patient is about to fail if the rate is all you look at. The lungs are clear, the SpO₂ is 95% on an NRB, and the patient is moving air. In septic shock, the fast breathing is making up for metabolic acidosis. This patient is also low on volume. The drugs used for intubation take away the fast breathing that is compensating. Positive pressure ventilation lowers the blood returning to the heart at the same time. Losing the compensation and losing blood return at the same moment is what causes a patient to arrest around intubation. Save intubation for real respiratory failure.

Why the others are wrong

Sedate without a paralytic to slow the respiratory rate down: Sedating without a paralytic sounds gentler, and it avoids a tube. Slowing the respiratory rate is the exact harm you are trying to avoid, because the fast rate is doing needed work.

Begin positive pressure ventilation at 20 breaths per minute: Ventilating at 20 breaths per minute moves less air than this patient is moving alone, so carbon dioxide builds up. Positive pressure also raises the pressure in the chest of an underfilled patient. Less blood returns to the heart.

Perform rapid sequence intubation before the rate climbs further: Intubating early to get ahead of a failing airway is the right move in a lot of patients. Here the lungs are clear and the SpO₂ is 95%. Intubating now takes away the fast breathing that is keeping the acidosis in check. Positive pressure drops the blood return to the heart at the same time.

Question 9 of 10

A 60-year-old in septic shock was breathing 34 times a minute before intubation and is now intubated. Which ventilation plan protects this patient?

Show the answer and rationale

Correct answer · Match the minute volume the patient was generating alone

This patient in septic shock was breathing 34 times a minute to make up for a metabolic acidosis. Breathing that fast blows off carbon dioxide and holds the pH up against the acid. Putting in a tube does not make the acidosis go away. If you drop the minute volume to a normal ventilator setting, the carbon dioxide is going to climb. Then the pH falls even further, and the patient loses the compensation that was holding the pH up. Match the ventilations to the minute volume the patient was moving on their own. Patients this sick can collapse around intubation, so resuscitate first, then match the minute volume.

Why the others are wrong

Ventilate to an EtCO₂ target of 45 mmHg to correct the low value: Ventilating to an EtCO₂ of 45 mmHg makes a normal looking number the goal. This patient's EtCO₂ is low because of the acidosis and the poor perfusion. Pushing the reading up to normal means you are underventilating the patient.

Ventilate at 8 breaths per minute with a large tidal volume: A slow rate with a large tidal volume tries to make up the minute volume with deeper breaths. Large tidal volumes injure the lungs in sepsis. At 8 breaths a minute, the minute volume is still far below what this patient was moving at 34.

Ventilate at 10 breaths per minute to allow full exhalation: A rate of 10 is a reasonable default for most intubated adults. Letting the patient fully exhale matters with obstructive lung disease. This patient was breathing 34 times a minute. At 10 breaths a minute, you give about a third of the minute volume this patient needs to stay compensated.

Question 10 of 10

A patient in septic shock has been placed on oxygen and has an intravenous line in place. Breath sounds are clear bilaterally, and there is no increase in the work of breathing. The vital signs are BP 84/50, P 128, R 32, SpO₂ 94%. Which is the most appropriate next step?

Show the answer and rationale

Correct answer · Administer an isotonic fluid bolus per protocol and reassess

This patient is in septic shock and needs fluid. The blood pressure is 84/50 and the pulse is 128. The respiratory rate of 32 is not respiratory failure. The breath sounds are clear, and there is no increase in the work of breathing. The fast breathing is the body making up for metabolic acidosis in a septic patient who is low on volume. Give an isotonic fluid bolus per protocol and reassess. Intubation is for real respiratory failure. If this patient ever does need ventilation, match the ventilation to the patient's own minute volume.

Why the others are wrong

Perform rapid sequence intubation to protect the airway: Rapid sequence intubation is for real respiratory failure. This patient's fast breathing is compensation for the acidosis. The induction drugs and positive pressure ventilation take that compensation away. Positive pressure also drops preload at the same moment. In a septic patient who is low on volume, the combination can cause collapse during the intubation. Fluid resuscitation comes first.

Assist ventilations with a BVM: A BVM is for a patient whose own breathing is not adequate. This patient has clear breath sounds and no increased work of breathing. Nothing here says the ventilation is inadequate. Taking over with a BVM removes the compensation the same way intubation would.

Administer a sedative to reduce the respiratory rate: A sedative slows the fast breathing that is compensating for the acidosis. Slower breathing lets the acidosis get worse. A sedative also does nothing for the low volume and low blood pressure that are causing the fast breathing.

Find out which Paramedic topics are costing you points

Ten questions on one topic tell you about that topic. The free diagnostic covers every Paramedic topic and breaks your results down by topic, so you know what to drill next. No card, no signup to try it.

Take the free Paramedic diagnostic

More free Paramedic practice questions by topic