Which is an early sign indicating shock before hypotension develops?

• A. Restlessness and anxiety
• B. Hypotension
• C. Tachycardia and tachypnea
• D. Pale, cool skin

Answer: (A)

When shock is starting but blood pressure hasn’t dropped yet, the brain is the first organ to show distress. Restlessness and anxiety arise from cerebral hypoperfusion as the body’s sympathetic system tries to maintain perfusion. This mental-status change can be an early clue that the patient is moving into compensated shock, before hypotension appears.

Tachycardia and tachypnea are common compensatory responses to decreased perfusion, and they often accompany early shock, but restlessness and anxiety specifically signal that the brain is not receiving adequate blood flow yet. Hypotension is a later sign, and pale, cool skin reflects peripheral vasoconstriction that occurs as shock worsens, not an early indicator.