What is the correct order of the AVPU scale from most to least responsive?

• A. Verbal, Alert, Pain, Unresponsive
• B. Awake, Verbal, Pain, Unresponsive
• C. Alert, Verbal, Pain, Unresponsive
• D. Alert, Pain, Verbal, Unresponsive

Answer: (C)

AVPU measures how awake and responsive a patient is, using four levels from most to least. A patient who is Alert is fully awake and can follow commands. If the patient isn’t fully awake but responds to voice or spoken questions, that’s Verbal. If there’s no response to voice but the patient reacts to a painful stimulus, that’s Pain. If there’s no response at all, that’s Unresponsive. This ordering—Alert, Verbal, Pain, Unresponsive—follows the progressive increase in decreased consciousness and is the standard way to rate responsiveness in the field. The alternative that uses Awake isn’t the standard AVPU terminology, so it isn’t the best representation of the correct order.