A nurse is caring for a client who has increased intracranial pressure following a traumatic brain injury. Which of the following actions should the nurse take? (Select all that apply.)

Rationale: A. Maintain the head of the bed at a 30 degree angle: Elevating the head of the bed promotes venous drainage from the brain and helps lower intracranial pressure (ICP). A 30-degree position optimizes cerebral perfusion without compromising blood flow to the brain tissue. B. Administer stool softeners to the client: Stool softeners prevent straining during bowel movements, which increases intrathoracic and intracranial pressure. Preventing Valsalva maneuvers helps maintain stable ICP and reduces the risk of secondary brain injury. C. Encourage the client to cough and deep breathe: Coughing can sharply increase ICP due to the rise in intrathoracic pressure. Clients with elevated ICP should be discouraged from coughing or performing any action that increases pressure in the head. D. Obtain client vital signs every 8 hr: Clients with increased ICP require frequent monitoring, typically every 1 to 2 hours or continuously, depending on severity. Monitoring only every 8 hours is inadequate and could delay detection of critical changes in neurological status. E. Provide a quiet environment for the client: Reducing environmental stimuli, such as noise and bright lights, prevents agitation and minimizes fluctuations in ICP. A calm and quiet setting supports cerebral stability and promotes healing.