A nursing home patient is brought to the ED with complaints of fever and generalized weakness. Skin is warm, dry and flushed. The patient is mildly agitated - an abnormal situation for this patient. Vital signs are HR 110/min, respirations 26/min, and temperature 101.8° F (28.8° C). A Foley catheter is draining cloudy yellow urine. You suspect this patient to have which of the following?

A urinary tract infection

Hyperdynamic sepsis

Hypodynamic sepsis

Toxic shock syndrome

Answer and Explanation

The Correct Answer is B

Rationale:
A. A urinary tract infection is likely the source of infection, as indicated by the cloudy urine and Foley catheter; however, the presence of systemic signs such as fever, tachycardia, tachypnea, altered mental status, and flushed skin indicates that the infection has progressed beyond a localized UTI. Therefore, UTI alone does not fully explain the patient’s current condition.
B. Hyperdynamic sepsis (early sepsis or septic shock phase) is characterized by warm, flushed skin, fever, tachycardia, tachypnea, and changes in mental status due to widespread vasodilation and increased cardiac output. This patient’s vital signs, warm flushed skin, agitation, and evidence of infection strongly support hyperdynamic sepsis as the most likely diagnosis.
C. Hypodynamic sepsis (late sepsis) typically presents with cool, pale, clammy skin, hypotension, decreased cardiac output, and signs of poor perfusion. These findings are not present in this patient, making this option incorrect.
D. Toxic shock syndrome presents with sudden high fever, hypotension, diffuse rash, and multisystem involvement, often associated with tampon use or surgical wounds. The clinical presentation and urinary source of infection do not support this diagnosis.

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Correct Answer is D

Explanation

Rationale:
A. Increased urine output is not expected in the compensatory stage of shock. Early in shock, the body activates the renin-angiotensin-aldosterone system to conserve fluid, resulting in decreased urine output (oliguria).

B. Decreased heart rate is not typical in compensatory shock. The body usually responds to early hypovolemia with tachycardia to maintain cardiac output and perfusion to vital organs.

C. Hyperactive bowel sounds are not a hallmark of early shock. In fact, perfusion to the gastrointestinal system is reduced during shock, which may lead to hypoactive or diminished bowel sounds.

D. Cool, clammy skin is an expected finding in the compensatory stage of shock. The body shunts blood away from the skin and non-vital organs to maintain perfusion of vital organs (brain, heart, lungs). Peripheral vasoconstriction reduces skin perfusion, causing the skin to feel cool and moist due to sympathetic nervous system activation and increased catecholamines.

A. Increased hematocrit. B. Increased temperature. C. Increased heart rate. D. Increased blood pressure. E. Increased respiratory rate.

Correct Answer is ["C","D","E"]

Explanation

Rationale:
A. Increased hematocrit is not expected in fluid overload. Fluid overload causes hemodilution, which typically results in a decreased hematocrit due to dilution of red blood cells in excess plasma volume.
B. Increased temperature is not a characteristic finding of fluid overload. Elevated temperature is more commonly associated with infection or inflammation rather than excess fluid volume.
C. Increased heart rate is expected in fluid overload because the heart must work harder to circulate the increased blood volume. Tachycardia may occur as a compensatory response to maintain adequate cardiac output.
D. Increased blood pressure is a common finding in fluid overload due to the expanded intravascular volume, which increases vascular pressure and workload on the heart.
E. Increased respiratory rate is expected in fluid overload, especially if fluid accumulates in the lungs. Pulmonary congestion or edema leads to impaired gas exchange, prompting tachypnea as the body attempts to improve oxygenation.

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Naxlex Comprehensive Predictor Exams

The emergency nurse is admitting a patient experiencing a GI bleed who is believed to be in the compensatory stage of shock. What assessment finding would be most consistent with the early stage of compensation?

Correct Answer is D

Explanation

A nurse is assessing a client who has fluid overload. Which of the following findings should the nurse expect? (Select all that apply.)

Correct Answer is ["C","D","E"]

Explanation

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