AIIMS Raipur - 2017 (Shift-3)
Medical & Surgical Nursing
Easy
Which among the following sign/symptom will be present in a patient with hypovolemia?
Appeared in: AIIMS Raipur - 2017 (Shift-3)
Explanation
- Hypovolemia leads to a decrease in circulating blood volume and reduced venous return to the heart.
- This drop in volume is detected by baroreceptors, which activate the sympathetic nervous system.
- Sympathetic stimulation causes the heart rate to increase (tachycardia) as a compensatory mechanism to maintain cardiac output and blood pressure.
- Therefore, an increased heart rate is one of the earliest and most common signs of hypovolemia.
Why Other Options Were Wrong
- Option B: Hypertension (high blood pressure) is the opposite of what occurs in hypovolemia. Reduced blood volume leads to hypotension (low blood pressure).
- Option C: A bounding pulse is a strong, forceful pulse. In hypovolemia, the pulse is typically weak and thready due to the decreased stroke volume.
- Option D: In hypovolemia, the body conserves fluid, leading to decreased urine output (oliguria), which is defined as less than 30 ml/hr for an adult. An output of 30 ml/hr is the minimum acceptable amount, and a value below this would be the expected sign.
Related Visual
- Visual 1: Flowchart: Illustrating the pathophysiological cascade of hypovolemia, starting from fluid loss and leading to compensatory responses like tachycardia and decreased urine output.
- Visual 2: Infographic: Comparing the signs and symptoms of hypovolemia (tachycardia, hypotension, weak pulse, oliguria) versus hypervolemia (bradycardia or tachycardia, hypertension, bounding pulse, edema).
Clinical Relevance
- Nursing practice connection: Use the key finding related to Recognition of the clinical signs and symptoms of hypovolemia (fluid volume deficit) to guide bedside assessment, documentation, and the next nursing action.
- Nurses must vigilantly monitor vital signs, especially heart rate and blood pressure, in patients at risk for hypovolemia (e.g., postoperative, trauma, or patients with vomiting/diarrhea).
- Accurate intake and output monitoring is a critical nursing responsibility. A urine output below 30 ml/hr must be reported promptly as it can indicate worsening fluid status and potential renal compromise.
- What if? If a patient with hypovolemia is taking a beta-blocker medication, their heart rate may not increase in response to fluid loss. In this case, other signs like hypotension, poor skin turgor, and decreased urine output become even more critical for assessment.
How to Approach the Question
- First, understand the term 'hypovolemia,' which means low blood volume.
- Think about the body's logical response to having less fluid in the circulatory system. The primary goal is to maintain blood pressure and perfusion to vital organs.
- Evaluate each option based on this physiological principle.
- Option A (Increased heart rate): The heart beats faster to compensate for the lower volume pumped with each beat. This is a plausible compensatory mechanism.
- Option B (Hypertension): Low volume would lead to low pressure (hypotension), not high pressure. This is incorrect.
- Option C (Bounding pulse): A bounding pulse indicates a large volume of blood being pumped. With low volume, the pulse would be weak or 'thready'. This is incorrect.
Concept Tested & Keywords
- Concept Tested: Recognition of the clinical signs and symptoms of hypovolemia (fluid volume deficit).
- Stem keywords: sign/symptom, patient, hypovolemia
- Lead-in keywords: Which among the following
- Negative lead-in flag: false
Question ID
QkVhWzF2Fn5tXtO7JRCh9c
Reference Book
E6 Nelson Textbook of Pediatrics 22nd Edition (2024) — Volume 2 p. 1067-1070
Practise the full AIIMS Raipur - 2017 (Shift-3)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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