👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Reduction of Risk Potential🔖 Free to read, print, and share
Also known as: increased ICP · raised intracranial pressure · brain swelling
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Use this quick-reference guide to spot, treat, and prevent Increased Intracranial Pressure on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
🩺 Signs
↓ LOC = earliest sign
Cushing's triad = late, ominous
↑ BP, ↓ HR, irregular RR
📌 More
Unequal/fixed pupils, HA
Projectile vomiting, posturing
Widened pulse pressure
✅ Do
HOB 30°, head midline
Mannitol, hypertonic saline
Avoid suction, clustering care
📌 Avoid
No hip flexion, neck flexion
Prevent Valsalva, coughing
📚 Increased Intracranial Pressure — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Increased ICP is elevated pressure inside the rigid skull from swelling, bleeding, or excess CSF. Because the skull cannot expand, rising pressure compresses brain tissue and reduces perfusion. A change in level of consciousness is the earliest and most sensitive sign.
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Key points
Understand these first
Earliest sign: decreasing level of consciousness / restlessness
Headache, vomiting (often projectile), and unequal or sluggish pupils
In infants: bulging fontanel and high-pitched cry
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Nursing priorities
What to do, in order
Elevate head of bed 30° with the head midline to promote venous drainage
Keep the environment calm; avoid clustering care and anything that raises ICP
Prevent Valsalva — avoid straining, coughing, and hip flexion
Give osmotic diuretics (mannitol) as ordered; monitor neuro status closely
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Red flags — report now
Escalate immediately
Cushing's triad, fixed/dilated pupils, or sudden LOC drop — neurologic emergency
Avoid suctioning longer than 10 seconds and avoid Trendelenburg position
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Patient teaching
What patients must know
Report worsening headache, vomiting, or vision changes promptly
❓ Increased Intracranial Pressure: NCLEX FAQs
What are the priority nursing interventions for Increased Intracranial Pressure?
Elevate head of bed 30° with the head midline to promote venous drainage. Keep the environment calm; avoid clustering care and anything that raises ICP. Prevent Valsalva — avoid straining, coughing, and hip flexion. Give osmotic diuretics (mannitol) as ordered; monitor neuro status closely.
What are the warning signs of Increased Intracranial Pressure a nurse must report?
Cushing's triad, fixed/dilated pupils, or sudden LOC drop — neurologic emergency. Avoid suctioning longer than 10 seconds and avoid Trendelenburg position.
What do I need to know about Increased Intracranial Pressure for the NCLEX?
Earliest sign: decreasing level of consciousness / restlessness. Cushing's triad (late): hypertension with widening pulse pressure, bradycardia, irregular respirations. Headache, vomiting (often projectile), and unequal or sluggish pupils. In infants: bulging fontanel and high-pitched cry.
What patient teaching is important for Increased Intracranial Pressure?
Report worsening headache, vomiting, or vision changes promptly.
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Quick Tip
Earliest sign: decreasing level of consciousness / restlessness.