Your patient is a 47-year-old woman who has been in a car accident. She is not bleeding but has a large bruise on her chest and upper abdomen. She appears anxious and some of the things she says don't make any sense. You recognize that:

A. internal bleeding is the most obvious indicator that the patient will go into shock.
B. as a paranoid schizophrenic, she should not have been operating a motor vehicle.
C. she is about to have an ischemic stroke.
D. altered mental status is the most sensitive indicator for the presence of shock.

Answer: D