PGIMER Sangrur NO - 2023
Medical Surgical Nursing
Medium
Decrease blood pressure, rapid respiration, cold clammy & pale skin and decrease urine output all are clinical features seen in?
Appeared in: PGIMER Sangrur NO - 2023
Explanation
- The combination of symptoms describes the body's compensatory response to low blood volume, which is the definition of hypovolemic shock.
- Cold, clammy, and pale skin is a hallmark sign resulting from peripheral vasoconstriction, a mechanism to divert blood from the skin to vital organs like the heart and brain.
- Decreased blood pressure is a direct result of reduced circulating fluid volume.
- Rapid respiration (tachypnea) is a compensatory mechanism to counteract metabolic acidosis from tissue hypoxia.
- Decreased urine output (oliguria) occurs as the kidneys try to conserve fluid in response to reduced renal perfusion and hormonal signals (ADH, aldosterone).
Why Other Options Were Wrong
- Option B: Septicemia, leading to septic shock, typically presents in its early stages as 'warm shock' with warm, flushed skin due to massive vasodilation from the inflammatory response. Cold, clammy skin is a sign of late, decompensated septic shock, but the initial presentation is different.
- Option C: Fever is characterized by an elevated body temperature, which typically causes vasodilation to dissipate heat, resulting in warm, flushed, and often dry skin, not cold and clammy skin.
- Option D: Anaphylactic shock is a distributive shock caused by a severe allergic reaction. It involves widespread vasodilation, leading to flushed, warm skin, hives (urticaria), and angioedema, not cold, clammy skin.
Related Visual
Clinical Relevance
- Nursing practice connection: Knowing Recognition of the clinical manifestations of different types of shock, specifically hypovolemic shock helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
- Recognizing the signs of hypovolemic shock is a critical nursing skill, as rapid intervention is essential to prevent progression to irreversible organ damage and death.
- The nurse's first priorities are to restore circulating volume with IV fluids and/or blood products and to administer oxygen to improve tissue perfusion.
- Strict monitoring of urine output (aiming for at least 0.5 mL/kg/hr) is a vital indicator of the adequacy of fluid resuscitation and renal perfusion.
How to Approach the Question
- First, analyze the constellation of symptoms provided in the question: hypotension, tachypnea, cold/clammy skin, and oliguria.
- Identify the key differentiating symptom. In shock scenarios, skin temperature and appearance (cold/clammy vs. warm/flushed) are crucial clues.
- Evaluate each option based on its known pathophysiology. Recall that hypovolemic and cardiogenic shocks are 'cold shocks' due to vasoconstriction or pump failure.
- Contrast this with distributive shocks (septic, anaphylactic, neurogenic), which are typically 'warm shocks' due to widespread vasodilation.
- Conclude that the described 'cold shock' state with signs of volume loss is most consistent with hypovolemic shock.
Concept Tested & Keywords
- Concept Tested: Recognition of the clinical manifestations of different types of shock, specifically hypovolemic shock.
- Stem keywords: Decrease blood pressure, rapid respiration, cold clammy & pale skin, decrease urine output
- Lead-in keywords: clinical features seen in
- Negative lead-in flag: false
Question ID
Q6FVcDi-FgSJpqqOYWjth2
Reference Book
E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 146-148
E6 Pathology-Vandana Puri & Kavita Gaur Textbook of Pathology and Genetics p. 134-136
E6 Nursing Vital Signs p. 88-90
Practise the full PGIMER Sangrur NO - 2023
Attempt every question from this paper in a timed mock, then review the full solution for each one.
More Shock and Multisystem Failure Questions
- Identify the cannula which is used in patient with hemorrhagic shock shown in the picture:
- What is an early sign of hypovolemic shock?
- What is the risk factor for septic shock?
- A patient is suffering from bradycardia, warm dry skin and hypotension. Symptoms suggestive to neurogenic shock. What is another name of neurogenic s…
- A RTA patient brought into the emergency department with loss of massive blood with cervical spine injury, after assessment revealed that blood press…
- A patient has GI bleeding, with clot, BP 80/40 mm of hg. Priority nursing action is?
- Which of the following is a symptom of shock? (Choose the most appropriate option from below)
- A patient presents to the emergency with a history of multiple bee stings and a blood pressure of 80/50 mm Hg. He is having:
- The MAST garment is used for treatment of:
- The patient whose clinical condition needs monitoring and support of at least two or more organ systems should be admitted to
More PGIMER Sangrur NO - 2023 Questions
- During administration of an enema, a client reports having intestinal cramps. What should the nurse do?
- A patient was in an automobile accident and sustained a head injury following admission to the hospital a diagnosis of increased ICP was made. Which…
- Which of the following is considered as an indication for administering serum albumin?
- Protein is required for?
- A postpartum nurse is taking the vital signs of a woman who delivered a healthy newborn infant 4 hours ago. The nurse notes that the mother's tempera…
- A patient shows signs of "hotspots" on his leg cast. Which of the following indicators is recognized by the a nursing officer?
- Excessively high heart rate ( 170) can ?
- A child undergoes heart surgery to repair the defects associated with Tetralogy of Fallot. What behavior is essential for the nurse to prevent postop…
- A patient is taking OCP with h/o chronic smoking, now complaining shortness of breath with pain and his ABG report shows pH 7.5, SpO2 60, PCO2 29, HC…
- While a nurse is administering a cleansing enema, the client reports abdominal cramping. Which of the following actions should the nurse take?