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Difficulty: EasyPhysiological Adaptation

A nurse is assessing a client who is at risk for developing hypovolemic shock due to excessive postoperative bleeding. Which of the following is typically the earliest clinical manifestation of hypovolemic shock?

  1. Unexplained mild tachycardiaAnswer
  2. B
    Significant hypotension
  3. C
    Decreased urine output to 10 mL/hr
  4. D
    Warm, flushed skin

Answer

Unexplained mild tachycardia
In hypovolemic shock, the body's initial compensatory response to a decrease in circulating blood volume is the activation of the sympathetic nervous system. This immediately causes an increase in heart rate (tachycardia) in an attempt to maintain adequate cardiac output and tissue perfusion before any significant drop in blood pressure occurs.

Step-by-Step Solution

1
Recall the body's physiological response to acute volume loss.
The sympathetic nervous system activates immediately to sustain cardiac output and tissue perfusion.
Understanding the sequence of compensatory mechanisms is necessary to identify early versus late signs.
2
Identify the earliest measurable clinical manifestation of sympathetic activation.
An increase in heart rate (tachycardia) occurs rapidly to compensate for the decreasing stroke volume.
Tachycardia preserves blood pressure in the early stages, making it an earlier indicator than hypotension.

Key Concept

Early recognition of shock compensatory mechanisms
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Topics

Physiological Adaptation

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