When assessing a patient with a head injury, the nurse recognizes that which sign is the earliest indication of increased intracranial pressure?

A. Sluggish pupillary response to light: Changes in pupillary response typically occur as increased intracranial pressure (ICP) progresses and cranial nerve III becomes compressed. This is a later sign and may indicate significant neurologic compromise. B. Vomiting: Vomiting can result from increased ICP due to stimulation of the vomiting center in the medulla. However, it is a nonspecific symptom and often occurs after early neurologic changes. C. Headache: Headache is a common symptom of elevated ICP caused by stretching of pain-sensitive structures in the meninges. While it may appear early, it is subjective and can be difficult to assess, especially in patients with altered consciousness. D. Change in level of consciousness: Alteration in level of consciousness, such as confusion, restlessness, or drowsiness, is the earliest and most sensitive indicator of rising ICP. It reflects the brain’s response to pressure before overt focal neurologic deficits or cranial nerve changes occur.