Following an earthquake, a client who was rescued from a collapsed building is seen in the emergency department. He has blunt trauma to the thorax and abdomen. Which nursing observation most suggests the client is bleeding（）
A. Prolonged partial thromboplastin time (PTT).
B. Recent history of warfarin (Coumadin) usage.
C. Diminished breath sounds.
D. Orthostatic hypotension.
参考答案：D
解析：
Bleeding is a volume-loss problem, which causes a drop in blood pressure. As the bleeding persists and the body’s ability to compensate declines, orthostatic hypotension becomes evident. A prolonged PTT and a history of warfarin usage are causes of bleeding but aren’t evidence of bleeding. As bleeding persists and the client’s level of consciousness declines, breathing will become more shallow and breath sounds will diminish; however, this is a late and unreliable manifestation of bleeding.