In hemorrhagic and hypovolemic shock, which statement is true?

• A. A patient can lose about 1/4 of blood volume before signs appear; hypertension is a late sign
• B. Hypertension is an early sign of shock
• C. Shock is immediately apparent with any blood loss
• D. Fluid replacement is not required

Answer: (A)

In hemorrhagic and hypovolemic shock, the body can compensate for blood loss for a period, masking symptoms. Because these compensatory mechanisms (like tachycardia, vasoconstriction, and shifts in fluids) keep perfusion relatively intact early, signs of shock often don’t appear until a substantial portion of blood volume is lost. Clinically, this compensated stage can correspond to about a quarter of the total blood volume being lost before overt signs emerge. As shock advances and compensation fails, blood pressure tends to fall rather than rise, so hypertension is not an early or reliable feature; if BP elevation is noted, it typically does not reflect stable perfusion in progressive shock. Therefore, the statement that a patient can lose about 1/4 of blood volume before signs appear correctly reflects the typical compensated phase of hemorrhagic/hypovolemic shock. The other options conflict with the reality that signs are not immediate, that shock progression often features falling, not rising, blood pressure, and that fluid replacement is indeed required.