A client is 6 days post craniotomy for removal of an intracerebral aneurysm. Which sign would most indicate increasing intracranial pressure?

• A. Hypertension
• B. Hypotension
• C. Tachypnea
• D. Hyperglycemia

Answer: (D)

Rising intracranial pressure triggers a compensatory response known as the Cushing reflex, where the body raises systemic blood pressure to keep cerebral perfusion adequate. This increase in blood pressure often comes with a slowing heart rate and irregular or slowed respirations. Among the options, hypertension is the sign most indicative of increasing ICP. Hypotension would worsen cerebral perfusion and isn’t a feature of rising ICP, tachypnea is nonspecific, and hyperglycemia is a stress response, not a direct indicator of ICP status. If hypertension accompanies changes in heart rate or breathing in a post-craniotomy patient, it should prompt immediate assessment for possible elevated ICP and appropriate neuro-monitoring actions.