Trauma Nurse Core Course (TNCC) Practice Exam

Which of the following is a late sign of increased intracranial pressure?

1. Restlessness or drowsiness

2. Nausea and vomiting

3. Decreased respiratory effort

4. Amnesia and anxiety

The correct answer is: Decreased respiratory effort

Increased intracranial pressure (ICP) can manifest through various signs and symptoms, and understanding the distinction between early and late signs is crucial in clinical practice. Decreased respiratory effort is recognized as a late sign of increased ICP. This occurs as the pressure within the cranial cavity rises, potentially affecting brainstem function, which is responsible for the automatic control of breathing. The brainstem is sensitive to changes in pressure, and when it becomes compromised, it can lead to altered respiratory patterns, including decreased effort or even irregular breathing. As ICP increases, other late signs may also become more pronounced, reflecting a deterioration in neurological status. The brain’s ability to maintain normal physiological functions can be overwhelmed, leading to efforts to maintain homeostasis being suppressed. Monitoring respiratory drive is vital, given that changes can signal significant impingement on brain function, prompting immediate medical intervention to prevent further neurological compromise.