NCLEX Intracranial Pressure (ICP) Practice Exam

In a patient with increased ICP, which function should be assessed first when evaluating body functions?

Corneal reflex testing Pupillary reaction to light Extremity strength testing Circulatory and respiratory status

Correct Answer:

Circulatory and respiratory status

Explanation:

Increased intracranial pressure makes brain tissue extremely vulnerable to changes in oxygenation and perfusion, so the first priority is ensuring airway and breathing to maintain adequate oxygen delivery and ventilation, which supports cerebral perfusion. Hypoxia worsens brain injury, and elevated CO2 causes cerebral vasodilation that can raise ICP further. By stabilizing circulation and respiration, you preserve cerebral perfusion pressure (CPP = MAP − ICP), creating a reliable basis for further neurological assessment. Once the patient is adequately oxygenated and hemodynamically stable, you can more accurately interpret neurologic signs such as reflexes and motor strength.

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