A post-delivery patient has a heart rate of 120/min and systolic blood pressure of 88 mmHg. Calculate the shock index and choose the appropriate management.

1. A

   Shock index 0.6 – Normal

2. B

   Shock index 0.8 – Start IV fluids

3. C

   Shock index 1.2 – Start IV fluids

4. D

   Shock index 1.36 – Start blood transfusion

Appeared in: NORCET 10 Prelims-2026

Explanation

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• The Shock Index is calculated by dividing the heart rate by the systolic blood pressure: 120 / 88 = 1.36.
• In obstetric patients, a normal Shock Index is up to 0.9. An index greater than 1.1 indicates severe shock and strongly predicts the need for blood transfusion.
• A value of 1.36 signifies profound hypovolemic shock, making immediate blood transfusion the most critical and appropriate intervention to restore circulating volume and oxygen-carrying capacity.
• While IV fluids are also given, the option to start a blood transfusion addresses the severity of the shock more definitively.

Why Other Options Were Wrong

• Option A: The calculated Shock Index is 1.36, not 0.6. A value of 0.6 would be considered normal or even low in a postpartum patient and does not reflect the patient's critical condition.
• Option B: The calculated Shock Index is 1.36, not 0.8. An SI of 0.8 is within the normal range for a postpartum patient and would not warrant aggressive intervention.
• Option C: The calculated Shock Index is 1.36, not 1.2. Although an SI of 1.2 is severely elevated and requires intervention, 'Start blood transfusion' is a more appropriate and complete action for this level of shock than just starting IV fluids.

Related Visual

• Visual 1: Chart - A color-coded chart illustrating the different ranges of the Shock Index (Normal, Mild, Moderate, Severe) and the corresponding management actions for obstetric patients. This helps in quick visual correlation of the value with the required intervention.

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Calculation and clinical interpretation of the Shock Index in a postpartum patient to guide resuscitation in acute care settings.
• The Shock Index is a simple, rapid, and valuable bedside tool for nurses to quantify the degree of shock, often before blood pressure drops significantly.
• Early recognition of an elevated SI (greater than 0.9) in a postpartum patient allows for prompt escalation of care and can prevent progression to severe hemorrhage and coagulopathy.
• What if? If the patient's heart rate was 100 and SBP was 100, the SI would be 1.0. This would still be considered abnormal (moderate shock), and the nurse should immediately start IV fluids, administer uterotonics, and prepare for a possible transfusion while closely monitoring the patient's response.

How to Approach the Question

• First, identify the key clinical data provided in the question: Heart Rate (HR) = 120/min and Systolic Blood Pressure (SBP) = 88 mmHg.
• Recall the formula for the Shock Index (SI): SI = HR / SBP.
• Perform the calculation: 120 divided by 88 equals approximately 1.36.
• Scan the options to find the one that matches your calculation. Option D correctly identifies the SI as 1.36.
• Evaluate the management proposed in the correct option. Correlate the calculated SI of 1.36 with the clinical guidelines for obstetric shock. An SI greater than 1.1 indicates severe shock requiring blood transfusion.
• Confirm that 'Start blood transfusion' is the most appropriate and definitive management for this critically ill patient, making Option D the best answer.

Concept Tested & Keywords

• Concept Tested: Calculation and clinical interpretation of the Shock Index in a postpartum patient to guide resuscitation.
• Stem keywords: post-delivery, heart rate, systolic blood pressure, shock index
• Lead-in keywords: Calculate, choose
• Clinical cues: Tachycardia (HR 120/min) and hypotension (SBP 88 mmHg) are classic signs of shock.
• Clinical cues: The post-delivery context strongly suggests postpartum hemorrhage as the underlying cause.

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