Which change in status should alert the nurse to increased intracranial pressure (ICP) in a child with a head injury?

The correct answer is A: Confusion and altered mental status. This change in status indicates increased ICP due to impaired brain perfusion. Confusion and altered mental status result from decreased cerebral blood flow, a hallmark of increased ICP. Increased diastolic pressure with narrowing pulse pressure (choice B) is a sign of Cushing's triad, a late sign of increased ICP. Irregular, rapid heart rate (choice C) and rapid, shallow breathing (choice D) are signs of physiological stress but not specific to increased ICP in a child with head injury.