When caring for a patient with a head injury, a nurse must stay alert for signs and symptoms of increased intracranial pressure (ICP). Which cardiovascular findings are late indicators of increased ICP?

A. Hypertension and narrowing pulse pressure: Increased intracranial pressure leads to a widening pulse pressure rather than a narrowing one. As ICP rises, systolic pressure increases while diastolic pressure may remain stable or decrease, producing a widened pulse pressure. Narrow pulse pressure is not characteristic of late ICP elevation. B. Elevated systolic blood pressure and bradycardia: These are classic components of Cushing’s triad, a late and ominous sign of significantly increased ICP. Rising ICP decreases cerebral perfusion, triggering sympathetic-mediated hypertension to maintain blood flow. The resulting baroreceptor response causes reflex bradycardia, indicating brainstem involvement and impending herniation. C. Hypotension and tachycardia: Hypotension and tachycardia are more consistent with hypovolemia or shock rather than increased ICP. In elevated ICP, the body attempts to preserve cerebral perfusion by increasing systemic blood pressure, not lowering it. D. Hypotension and bradycardia: This combination does not reflect the compensatory physiologic response to increased ICP. Late ICP elevation is associated with systemic hypertension, not hypotension, as the body attempts to overcome reduced cerebral perfusion pressure.