Certified Pediatric Emergency Nurse (CPEN) Practice Exam

What is a late sign of shock in children?

1. Decreased heart rate

2. Low blood pressure

3. High fever

4. Increased respiratory rate

The correct answer is: Low blood pressure

Low blood pressure is indeed a late sign of shock in children. In the context of shock, when the body is unable to maintain adequate blood flow and oxygen delivery to vital organs, it compensates initially through mechanisms such as increased heart rate and constriction of blood vessels. As the condition worsens, these compensatory mechanisms may fail, leading to a drop in blood pressure. In pediatric patients, blood pressure can be a more reliable indicator of shock in the later stages because children often maintain heart rate and respiratory rate until shock has progressed significantly. This means that low blood pressure may indicate a critical state where the body's compensatory mechanisms have begun to falter. Recognizing low blood pressure as a late sign is crucial for timely intervention, as it can signal an imminent risk of organ failure if not addressed promptly. The other options are not indicative of late shock signs. Decreased heart rate is typically not associated with shock in children, as the heart rate usually increases as a compensatory response. High fever indicates an inflammatory or infectious process rather than shock itself. Increased respiratory rate may occur early in the shock process as the body tries to compensate for decreased oxygen delivery but does not signify late-stage shock.