Which of the following is an early sign of shock?

• A. Altered LOC
• B. Mottling
• C. Absent peripheral pulses
• D. Cyanosis

Answer: (A)

In shock, the body prioritizes delivering blood to vital organs, and the brain is especially sensitive to reduced perfusion. That means changes in mental status often appear first. Altered level of consciousness—from anxiety or agitation to confusion or lethargy—reflects the brain receiving less oxygen and nutrients as perfusion falls, making it the earliest warning sign among these options.

Mottling of the skin happens later as circulation becomes more compromised and the body shunts blood away from the skin. Absent peripheral pulses indicate more advanced hypotension or vascular collapse, not an initial change. Cyanosis signals severely inadequate oxygenation and is typically a late finding in shock.