Choose the correct tense: By the time the ambulance arrived, the patient ____ consciousness.
- A. loses
- B. has lost
- C. had lost
- D. will lose
Explanation
Two completed past events need the past perfect for whichever happened first, so had lost marks the loss of consciousness as earlier than the arrival. The present perfect has lost cannot be used because the sentence is anchored in the past by arrived. This is the classic use of by the time as a signal for the past perfect.
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