A client recently sustained a closed head injury. Which finding should the nurse report as a priority?

• A. Headache with activity
• B. Difficulty speaking
• C. Nausea
• D. Dizziness

Answer: (B)

Recognizing acute neurologic change after head trauma is the key here: new difficulty speaking signals a potential progression of brain injury and requires immediate reporting. Difficulty speaking can indicate involvement of language centers, motor control of speech, or brainstem pathways, all of which may reflect worsening intracranial pathology such as edema or hematoma. This kind of focal neurologic deficit is prioritized because it can herald rapid deterioration and needs prompt assessment and intervention.

Other symptoms like headache with activity, nausea, or dizziness can occur after a head injury but are not as specific for acute change in brain function. They should be monitored, but they don’t by themselves indicate emergent deterioration in the same way that a new speech disturbance does. In practice, you’d rapidly assess the patient’s speech and overall neuro status, monitor vital signs, and notify the team immediately if speech changes are present.