A school nurse is assessing a child who fell from playground equipment and landed head-first. Which of the following manifestations indicates the presence of increased intracranial pressure (ICP)?

Choice A rationale Increased intracranial pressure (ICP) can cause pressure on cranial nerves, particularly the oculomotor, trochlear, and abducens nerves, which control eye movement. This pressure can disrupt the normal coordination of the eyes, leading to diplopia, or double vision. This is a significant neurological finding that indicates a potential problem within the cranium. Choice B rationale Hyperactivity is not typically a manifestation of increased intracranial pressure. Instead, increased ICP is more likely to cause lethargy, irritability, or a decreased level of consciousness as the pressure on the brain increases. Hyperactivity is more commonly associated with other neurological or behavioral conditions, not with acute cerebral edema. Choice C rationale Nuchal rigidity, or a stiff neck, is a classic sign of meningeal irritation, often associated with meningitis or subarachnoid hemorrhage. While it can be present with some severe head injuries, it is not a direct or primary indicator of increased intracranial pressure itself. The stiffness is caused by irritation of the meninges, not the pressure within the skull. Choice D rationale Tachycardia, an increased heart rate, is not a typical sign of increased intracranial pressure. In fact, a classic sign of increased ICP is bradycardia, or a decreased heart rate, which is part of Cushing's triad. This reflex response is the body's attempt to compensate for the increased pressure and maintain adequate cerebral perfusion pressure.