Ati Paediatrics Proctored Exam (Cni College)
A nurse is assessing an infant following a motor vehicle crash. Which of the following findings should the nurse monitor to identify increased intracranial pressure?
Explanation & Rationale
A. Brisk pupillary reaction indicates normal neurological function and does not suggest increased intracranial pressure (ICP). B. Depressed fontanels are associated with dehydration, not increased ICP; bulging or tense fontanels are the concerning finding. C. Increased sleepiness or difficulty arousing the infant is a classic early sign of increased ICP, reflecting cerebral dysfunction. D. Tachycardia may occur as a compensatory response to stress or pain but is not a reliable early indicator of increased ICP; bradycardia is more typical as ICP rises.
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