In extreme hypothermia, shivering may cease.

• A. Shivering ceases
• B. Pulse rate increases rapidly
• C. Skin becomes warm and flushed
• D. Breathing rate increases significantly

Answer: (A)

Shivering may cease as hypothermia becomes severe because the body's heat-generating mechanism relies on an active nervous system and enough energy to power muscle activity. When core temperature drops toward the severe range, the brain and metabolic processes slow dramatically, and skeletal muscles can no longer sustain shivering. This loss of shivering is a warning sign that the patient’s body has exhausted its basic coping mechanisms and is at high risk for further decline, including dangerous heart rhythms.

Think about what happens to other signs as temperature falls: the pulse tends to slow rather than speed up, becoming bradycardic; the skin feels cold, pale, or mottled rather than warm and flushed; and the breathing rate tends to decrease or become irregular rather than increase. So the best answer—that shivering can stop in extreme hypothermia—fits with the overall pattern of CNS and metabolic depression seen in severe cold injury.

In practice, recognizing cessation of shivering signals the need for careful rewarming and ongoing monitoring, with gentle handling and protection from further heat loss, while watching for changes in vital signs.