Which of the following statements about shock is accurate?

INI-CET EXAM -2025

Medical & Surgical Nursing

Medium

Appeared in: INI-CET EXAM -2025

Explanation

Hemorrhagic shock is classified into four stages based on the percentage of blood volume lost.
Class I involves up to 15% loss, and Class II involves 15-30% loss.
Severe, decompensated shock begins with Class III (30-40% loss) and progresses to Class IV (>40% loss).
Since Class III and IV shock are considered severe and involve blood loss greater than 20%, the statement is clinically and factually correct.

Option A: Uterine inversion leads to massive hemorrhage, causing hypovolemic shock due to volume loss, not neurogenic shock which results from failed sympathetic tone.
Option B: The term 'endotoxic shock' specifically refers to shock caused by endotoxins (LPS) from the cell walls of Gram-negative bacteria. Gram-positive bacteria cause septic shock via other mechanisms like exotoxins.
Option D: This describes the hyperdynamic ('warm') phase of distributive shock (e.g., septic shock) only. It is not a characteristic of all shock types; cardiogenic and hypovolemic shock are characterized by low cardiac output.

Visual 1: Table: Classification of Hemorrhagic Shock - A table showing the four classes of hemorrhagic shock with corresponding percentages of blood loss, heart rate, blood pressure, and clinical signs. This would visually clarify why '>20% loss' encompasses severe shock.
Visual 2: Flowchart: Pathophysiology of Shock Types - A flowchart illustrating the different primary mechanisms for hypovolemic, cardiogenic, distributive, and obstructive shock, highlighting the differences in cardiac output and systemic vascular resistance.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiology and Classification of Shock as background academic context rather than a clinical decision trigger.
Recognizing the type and severity of shock is a critical nursing skill for initiating appropriate and timely interventions, such as fluid resuscitation for hypovolemia or vasopressors for distributive shock.
In a patient with postpartum bleeding, a nurse must immediately suspect hypovolemic shock and not be misled by other potential causes. Rapid assessment of blood loss and vital signs is paramount.
What if? If a patient has signs of infection (fever, high WBC) and is hypotensive but has warm extremities and a bounding pulse, the nurse should suspect early septic (distributive) shock, where cardiac output can be high, rather than hypovolemic shock.

How to Approach the Question

Read the question stem to understand the core topic: identifying an accurate statement about shock.
Evaluate each option as a standalone factual statement.
For Option A, recall the primary consequence of uterine inversion (hemorrhage) and link it to the correct shock type (hypovolemic).
For Option B, differentiate between the causes of septic shock in general and the specific definition of 'endotoxic' shock.
For Option C, recall the classification of hemorrhagic shock and determine if 'severe shock' can occur with a blood loss greater than 20%.
For Option D, consider if 'increased cardiac output' is a universal feature of all shock or specific to one type. This helps identify it as an overgeneralization.

Concept Tested & Keywords

QBCtM8nJqZF64gPZImW5br