Question

A client has a head injury due to a motor vehicle accident. What would be the earliest indicator of increased intracranial pressure that the nurse would observe for? A. Seizures B. Ipsilateral pupils C. Headache D. Restlessness

Short answer

Answer: C. Headache

Step-by-step solution

Understand intracranial pressure

Intracranial pressure (ICP) is the pressure inside the skull, which can result from a head injury, brain tumor, or other causes. An increase in ICP can cause damage to the brain tissue and negatively affect brain function.

Analyze the given options

Analyze the four given indicators to determine which one is the earliest sign of increased intracranial pressure in a head injury case: A. Seizures: Seizures are a neurological event that can be caused by increased ICP, but it usually occurs at a later stage as the pressure worsens. B. Ipsilateral pupils: Unequal or non-reactive pupils can be an indicator of increased ICP, but it is not considered the earliest sign. C. Headache: A headache is an early and common symptom of increased ICP due to the pressure that is exerted on the brain's pain receptors. D. Restlessness: Restlessness, agitation, and irritability can be consequences of increased ICP. However, these symptoms usually occur later, as the pressure worsens and begins to create discomfort and distress.

Choose the correct option

Among the four given options, a headache is the earliest indicator of increased intracranial pressure. Therefore, the correct answer is: C. Headache