RAK Nursing Officer - 2019
Medical & Surgical Nursing
Easy
Which of the following can cause hypovolaemic shock?
Appeared in: RAK Nursing Officer - 2019
Explanation
- Hypovolemic shock is defined by a critical loss of intravascular fluid, which impairs tissue perfusion.
- Third-space shifting describes the process where fluid moves from the blood vessels into non-functional body spaces, such as the abdominal cavity (ascites).
- This fluid is effectively lost from the circulating volume, leading to decreased venous return, reduced cardiac output, and the clinical state of hypovolemic shock.
- Common causes of significant third-spacing include pancreatitis, peritonitis, and major burns.
Why Other Options Were Wrong
- Option A: An allergic reaction causes anaphylactic shock, a type of distributive shock. The primary mechanism is massive vasodilation and increased capillary permeability from histamine release, not direct volume loss.
- Option C: Sepsis leads to septic shock, which is also a form of distributive shock. It is caused by a dysregulated host response to infection, resulting in widespread vasodilation and capillary leakage.
- Option D: Profound bradycardia (a very slow heart rate) causes cardiogenic shock. The heart fails as a pump, unable to maintain adequate cardiac output, which is a different mechanism from volume loss.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Causes and classification of shock, specifically hypovolemic shock as background academic context rather than a clinical decision trigger.
- Nurses must rapidly identify the type of shock because treatment is type-specific. Giving vasopressors for hypovolemic shock without first restoring volume can worsen tissue ischemia.
- For a patient with suspected third-spacing causing hypovolemia (e.g., in pancreatitis), nursing assessment includes monitoring vital signs, urine output, and measuring abdominal girth daily to track fluid shifts.
- What if? If the patient had profound bradycardia and also had active bleeding, they would be in a state of mixed shock (cardiogenic and hypovolemic). Treatment would be complex, requiring simultaneous heart rate correction (e.g., pacing) and aggressive fluid/blood product resuscitation.
How to Approach the Question
- First, define the key term in the question: 'hypovolaemic shock'. This means shock caused by low blood volume ('hypo-' meaning low, 'vol-' for volume, '-aemic' in the blood).
- Evaluate each option based on this definition.
- Option A (allergic reaction) and Option C (sepsis) are classic examples of distributive shock, where the 'pipes' (blood vessels) become too wide, causing a relative lack of fluid.
- Option D (bradycardia) is a 'pump' problem, characteristic of cardiogenic shock.
- Option B (third-space shifting) describes fluid leaving the bloodstream, which is a direct cause of volume loss. This perfectly matches the definition of hypovolemic shock.
Concept Tested & Keywords
- Concept Tested: Causes and classification of shock, specifically hypovolemic shock.
- Stem keywords: hypovolaemic shock, cause
- Lead-in keywords: Which
Question ID
Q3ew5VJYI9OUxyJ6Sv_AYu
Reference Book
E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 143-145
E6 Physiology Guyton 4SAE Part 2A p. 26-28
Practise the full RAK Nursing Officer - 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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