NCLEX-RN® NGN Case Study: Older Adult with Early Sepsis and Possible Septic Shock

An NGN case study on a 67-year-old admitted with a UTI whose picture is quietly worsening — cues that flag early sepsis, how to rank the differentials, and the safe order of bundle nursing actions.

A deceptively quiet first hour that turns dangerous fast

A 67-year-old is admitted to a step-down unit from the emergency department with a urinary tract infection that has not responded to oral antibiotics. Vitals on arrival are "almost normal": temperature 38.2°C, heart rate 102, blood pressure 118/72, respiratory rate 22, SpO₂ 95% on room air. The client is alert but slightly confused — the daughter at the bedside says, "Mum is just not herself today."

A urine culture is pending. Lactate is 2.4 mmol/L. The client has Type 2 diabetes, mild chronic kidney disease, and was recently on a course of corticosteroids for an asthma flare. The night nurse mentions in handoff, "She looks fine, just a little out of it. Maybe sundowning."

That is the entire opening of this NGN case study. Nothing on screen says "sepsis". The case asks you to behave like the RN who refuses to be lulled by an almost-normal blood pressure when the rest of the picture is whispering something more serious.

What this case is testing

The case is built around early sepsis progressing toward septic shock because it forces a full pass through the NCSBN Clinical Judgment Measurement Model on a time-sensitive infection emergency:

  • Recognize cues that change "stable UTI" to "early sepsis" — the trend in mental status, the borderline vitals, the qSOFA elements, and the lactate.
  • Analyze cues the way an acute-care nurse would — knowing how an immunocompromised host masks the classic infection picture and how compensatory tachycardia hides hypotension until it suddenly does not.
  • Prioritize hypotheses when more than one differential could explain the picture — sepsis, dehydration, occult bleed, cardiac event, electrolyte derangement, sundowning.
  • Generate solutions that match the Hour-1 Surviving Sepsis bundle — fluid resuscitation, blood cultures before antibiotics where time allows, broad-spectrum antibiotic timing, vasopressor readiness, and lactate re-check intervals.
  • Take action in the right order — the case will test whether you know which step cannot wait and which can be done in parallel.
  • Evaluate outcomes after the first interventions using new vitals, a new lactate, urine output, and the client's own report.

Underneath the case you will touch several Client Needs categories at once: Safe and Effective Care Environment, Physiological Adaptation, Pharmacology and Parenteral Therapies (crystalloids, antibiotics, vasopressors), Reduction of Risk Potential, and Safety and Infection Prevention and Control for the source-control reasoning.

Who this case is good for

This is a senior-level NCLEX-RN® case study. It is a strong fit for:

  • Senior nursing students preparing for NCLEX-RN® who have completed a med-surg rotation.
  • Recent graduates working through NGN cases in the final stretch of a 30-, 60-, or 90-day NCLEX-RN® study plan.
  • Internationally educated nurses preparing for NCLEX-RN® who want practice with the US sepsis-bundle rhythm and the timing rules around cultures and antibiotics.
  • Anyone who can list the SIRS criteria but freezes when the bedside picture is "almost normal" instead of textbook.

It is not the right first NGN case for a student who has only done multiple-choice questions so far. If that's you, start with the in-app NGN tutorial the first time you open any case — it walks the six clinical-judgment steps in plain language.

What you will work through, step by step

Inside the case you will move through six linked sub-items. Each ties to a single step in the CJMM clinical-judgment cycle and unlocks the next.

  • The opening sub-item asks you to highlight the cues that change the story from "stable UTI" to "early sepsis". Picking too many cues is as wrong as picking too few.
  • The analyse sub-item asks you to match cues to a probable physiological process — distributive shock, dehydration, or something else.
  • A prioritisation sub-item asks you to rank the differentials by how dangerous they would be if missed, not by what feels most likely.
  • An action sub-item asks for the single first nursing action. Two of the choices look almost identical — separating them is the whole point of the item.
  • A handoff sub-item asks you to assemble an SBAR report to the rapid-response provider using building blocks instead of free text.
  • The closing sub-item asks you to evaluate the response after the first round of interventions using a repeat lactate, urine output, and the client's own words.

At the end you will see your overall score, sub-item by sub-item feedback, and a short reflection prompt that feeds your Mistake DNA inside RN Clarity.

Why this case shows up in NCLEX-RN® prep so often

Sepsis is one of the most-tested presentations on the current NCLEX-RN® test plan because it rewards exactly the reasoning the exam was designed to measure — multiple body systems, a time-sensitive bundle, and a single ordered series of nursing actions where minutes change outcomes.

If you can think your way through this case calmly, you will have practised the same clinical-reasoning loop NCLEX-RN® test writers reward, on a presentation you are likely to meet within your first week as a nurse.

Try the full case

There is no spoiler here on purpose. An NGN case is about the reasoning you do while the screen is in front of you, not the answer key afterward. The case is open to free-preview members and full subscribers inside the RN Clarity NGN bank.

Try this case →

See also:

NCLEX-RN® Hub: Clinical Judgment Guide · NGN Case Studies Hub

Practice on RN Clarity: NGN Case Studies · Question Bank · Drug Cards