Which assessment finding would indicate potential increased intracranial pressure in a client with a ventriculoperitoneal shunt?

• A. Frequent, small urine output
• B. Lethargy and headache
• C. Stable vital signs
• D. No changes in pupils

Answer: (B)

Rising intracranial pressure from a ventriculoperitoneal shunt stretch is most clearly suggested by changes in consciousness and new headaches. When the shunt isn’t draining properly, CSF accumulates and pressure builds inside the skull, which can reduce blood flow to brain tissue and irritate pain-sensitive meninges. That combination often shows up as lethargy (a decreased level of alertness) and a new or worsening headache, signaling that the brain is under pressure and needs prompt assessment.

The other signs you listed don’t align as directly with ICP. Frequent small urine outputs aren’t a typical indicator of intracranial pressure changes, and stable vitals suggest the patient isn’t experiencing the autonomic changes that can accompany high ICP. While pupil changes can occur with rising ICP, the absence of pupil changes doesn’t rule it out, and the key alerted pattern here is the altered level of consciousness with headache.