Which of the following is a sign of shock?

DSSSB 6 September 2024

Medical & Surgical Nursing

Easy

Appeared in: DSSSB 6 September 2024

Explanation

Shock causes inadequate tissue perfusion, leading to cellular hypoxia and metabolic acidosis.
The body compensates for acidosis by increasing the respiratory rate (tachypnea) to eliminate excess carbon dioxide (CO₂).
This compensatory mechanism aims to raise the blood pH and increase oxygen intake.
Initially, breathing may be deep and rapid, but it becomes shallow as the patient's condition deteriorates and respiratory muscles fatigue.

Option A: In shock, blood is shunted away from the kidneys to vital organs, causing decreased renal perfusion and a significant reduction in urine output (oliguria), not an increase.
Option C: Most forms of shock (hypovolemic, cardiogenic) are characterized by a weak, rapid, and thready pulse due to low cardiac output and compensatory vasoconstriction.
Option D: Hypotension (low blood pressure) is a defining characteristic of decompensated shock. Blood pressure does not rise; it falls as the body's compensatory mechanisms fail.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs and pathophysiology of shock as background academic context rather than a clinical decision trigger.
Early recognition of subtle signs like tachypnea is a critical nursing responsibility. It often appears before hypotension, providing a crucial window for early intervention and preventing progression to irreversible shock.
Nurses must continuously monitor respiratory rate and character, as a change from rapid, deep breathing to rapid, shallow breathing can indicate respiratory muscle fatigue and impending respiratory failure.
What if? If the patient was in the early 'warm' phase of septic shock, they might present with a bounding pulse and warm, flushed skin. However, tachypnea would still be a consistent and critical finding, highlighting its importance as a universal sign of shock.

How to Approach the Question

First, identify the core concept being tested, which is the clinical presentation of shock.
Recall the fundamental pathophysiology of shock: a state of inadequate tissue perfusion leading to cellular hypoxia.
Think systematically about how the body's major systems would compensate for this state. Consider the respiratory, cardiovascular, and renal systems.
Evaluate each option against this physiological understanding.
Option A (Increased urine output): Incorrect. The kidneys are non-vital in a crisis, so blood is shunted away, decreasing output.
Option B (Shallow and rapid respiration): Correct. The lungs work harder to blow off acid (CO₂) and take in more oxygen.

Concept Tested & Keywords

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