Which intervention is most appropriate to reduce intracranial pressure in a client after a closed head injury?

• A. Elevate the head of bed 30 degrees
• B. Maintain the head midline with the bed flat
• C. Place the patient in Trendelenburg position
• D. Administer hypotonic IV fluids

Answer: (D)

Reducing intracranial pressure after a head injury revolves around improving brain venous drainage and avoiding factors that worsen cerebral edema. Elevating the head of the bed to about 30 degrees helps promote drainage of venous blood from the brain via the jugular veins, which lowers ICP. Keeping the head in a midline position prevents kinking or compression of neck veins, ensuring unobstructed venous outflow. Positioning the patient with the head down (Trendelenburg) would raise intracranial venous pressure and worsen ICP, so it is not appropriate. Administering hypotonic IV fluids would cause water to shift into brain tissue, increasing cerebral edema and ICP rather than reducing it; if fluids are needed, isotonic solutions are preferred to maintain circulating volume without worsening edema.