Page 1 of 32
Keith RN COVID ICU Case Study | FULL
Answers, Ventilator Settings, ARDS & Sepsis
Management | 2026 Update complete.
1. Based on the initial presentation, what is the most likely
primary diagnosis?
a) Bacterial pneumonia
b) COVID-19 pneumonia with septic shock
c) Cardiogenic pulmonary edema
d) Pulmonary embolism
2. Keith meets criteria for sepsis. According to Sepsis-3
definitions, which two parameters are required?
a) qSOFA ≥2 and confirmed infection
b) SOFA score increase ≥2 points with suspected infection
c) Lactate >4 mmol/L and hypotension
d) NEWS score >5 and positive blood culture
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3. Calculate Keith's qSOFA score using initial data. What is it?
a) 1
b) 2
c) 3
d) 0
4. Keith's initial lactate is 3.8 mmol/L. The 2026 Surviving
Sepsis Campaign guidelines recommend repeating lactate
within what timeframe?
a) 1 hour
b) 2-4 hours
c) 6 hours
d) Only if hypotension persists
5. What is the FIRST antimicrobial action indicated for Keith?
a) Obtain sputum culture then start antibiotics
b) Start broad-spectrum antibiotics within 1 hour of sepsis
recognition
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c) Start antivirals (remdesivir) only
d) Wait for COVID PCR before any antimicrobials
6. Which fluid resuscitation strategy is recommended for Keith
in 2026?
a) 30 mL/kg crystalloid bolus for all septic patients
b) 500-1000 mL crystalloid with frequent reassessment using
dynamic measures
c) 1L NS bolus followed by furosemide
d) Albumin 5% 500mL as first-line
7. Keith's BP remains 85/50 after initial fluid. You initiate
vasopressors. Which is the 2026 first-line vasopressor?
a) Dopamine
b) Vasopressin
c) Norepinephrine
d) Epinephrine
, Page 4 of 32
8. What is the target mean arterial pressure (MAP) for Keith?
a) ≥55 mmHg
b) ≥65 mmHg
c) ≥75 mmHg
d) ≥85 mmHg
9. A central line is placed. What is the preferred initial
vasopressin dose when added to norepinephrine?
a) 0.01 units/min
b) 0.04 units/min
c) 0.1 units/min
d) 0.4 units/min
10. Keith's COVID PCR returns positive. Which antiviral is
recommended for hypoxemic patients in 2026?
a) Remdesivir 200mg IV x1 then 100mg daily x 4 days
b) Paxlovid (nirmatrelvir/ritonavir) orally
Keith RN COVID ICU Case Study | FULL
Answers, Ventilator Settings, ARDS & Sepsis
Management | 2026 Update complete.
1. Based on the initial presentation, what is the most likely
primary diagnosis?
a) Bacterial pneumonia
b) COVID-19 pneumonia with septic shock
c) Cardiogenic pulmonary edema
d) Pulmonary embolism
2. Keith meets criteria for sepsis. According to Sepsis-3
definitions, which two parameters are required?
a) qSOFA ≥2 and confirmed infection
b) SOFA score increase ≥2 points with suspected infection
c) Lactate >4 mmol/L and hypotension
d) NEWS score >5 and positive blood culture
,Page 2 of 32
3. Calculate Keith's qSOFA score using initial data. What is it?
a) 1
b) 2
c) 3
d) 0
4. Keith's initial lactate is 3.8 mmol/L. The 2026 Surviving
Sepsis Campaign guidelines recommend repeating lactate
within what timeframe?
a) 1 hour
b) 2-4 hours
c) 6 hours
d) Only if hypotension persists
5. What is the FIRST antimicrobial action indicated for Keith?
a) Obtain sputum culture then start antibiotics
b) Start broad-spectrum antibiotics within 1 hour of sepsis
recognition
,Page 3 of 32
c) Start antivirals (remdesivir) only
d) Wait for COVID PCR before any antimicrobials
6. Which fluid resuscitation strategy is recommended for Keith
in 2026?
a) 30 mL/kg crystalloid bolus for all septic patients
b) 500-1000 mL crystalloid with frequent reassessment using
dynamic measures
c) 1L NS bolus followed by furosemide
d) Albumin 5% 500mL as first-line
7. Keith's BP remains 85/50 after initial fluid. You initiate
vasopressors. Which is the 2026 first-line vasopressor?
a) Dopamine
b) Vasopressin
c) Norepinephrine
d) Epinephrine
, Page 4 of 32
8. What is the target mean arterial pressure (MAP) for Keith?
a) ≥55 mmHg
b) ≥65 mmHg
c) ≥75 mmHg
d) ≥85 mmHg
9. A central line is placed. What is the preferred initial
vasopressin dose when added to norepinephrine?
a) 0.01 units/min
b) 0.04 units/min
c) 0.1 units/min
d) 0.4 units/min
10. Keith's COVID PCR returns positive. Which antiviral is
recommended for hypoxemic patients in 2026?
a) Remdesivir 200mg IV x1 then 100mg daily x 4 days
b) Paxlovid (nirmatrelvir/ritonavir) orally
