ATI Priority Question Practice Flashcards

A nurse is caring for 4-year-old child who has dehydration. Which of the following finding should the nurse identify as the priority?

Blood glucose 110 mg/dL
Potassium 2.5 mEq/L
Sodium 142 mEq/L
Urine specific gravity 1.025

b. Potassium 2.5 mEq/L
The expected reference range for a potassium level is 3.4 to 4.7 mEq/L. The nurse should identify this finding as the priority because hypokalemia can lead to cardiac dysrhythmias or cardiac arrest.

A nurse is collecting data for a client who has a recent closed head injury. The nurse should recognize which of the following findings is a priority to report to the provider?

The client has bruising on his forehead.
The client has swelling over his injury.
The client is having difficulty speaking.
The client reports a mild headache.

The client is having difficulty speaking.
When using the urgent vs nonurgent approach to client care, the nurse determines that the priority finding is that the client is having difficulty speaking because this is an early manifestation of increased intracranial pressure and requires immediate intervention. Other early manifestations include decreased level of consciousness and change in pupils.

A nurse is caring for a client who has gastrointestinal (GI) bleed. Which of the following findings is the priority for the nurse to report to the provider?

Urine output of 50 mL in 2 hr
BUN 21 mg/dL
Positive fecal occult blood test
75 mL coffee ground emesis

a. urine output of 50 ml in 2 hr
The greatest risk to the client is complications related to hypovolemia from the GI bleed. The nurse should notify the provider of urine output less than 30 mL/hr. This may indicate poor blood flow to the kidneys, possibly resulting from hypovolemia. If left untreated, this can cause acute kidney injury (AKI).

A nurse at a long-term care facility is reviewing prescriptions for a client receiving mechanical ventilation. Which of the following interventions should the nurse identify the priority?

Applying thigh-high anti embolism stockings
Suctioning the airway as needed
Administering continuous feeding through a nasogastric tube
Providing the client with a communication board

b. Suctioning the airway as needed

When using the airway, breathing, circulation approach to client care, the nurse should determine that the priority intervention is to provide endotracheal suctioning as needed. The client's endotracheal tube must be kept clear of secretions in order for ventilation to be effective.

A nurse is caring for an older adult client with a history of stroke who has been prescribed several medications and expresses reluctance to take them because of his difficulty swallowing. Which of the following actions is the nurse's priority?

Check to see if the client's medications can be crushed and mixed with soft foods.
Observe for symmetry of the client's soft palate and uvula.
Notify the provider of the client's report.
Ask the pharmacist whether a liquid form of the medication can be substituted for the client.

Observe for symmetry of the client's soft palate and uvula.

A nurse is caring for a client who is experiencing an acute exacerbation of ulcerative colitis. The nurse should recognize that which of the following actions is the priority?

Review stress factors that can cause disease exacerbation.
Evaluate fluid and electrolyte levels.
Provide emotional support.
Promote physical mobility.

b. Evaluate fluid and electrolyte levels.
The first action the nurse should take when using the nursing process is to collect data about the fluid and electrolyte levels. The client who has ulcerative colitis loses fluids and electrolytes in diarrhea and can develop hypovolemia. Since problems related to fluid and electrolyte balance can affect all body systems, this is the most important nursing action for this client.

A nurse is caring for a child who is having a tonic-clonic seizure and vomiting. Which of the following actions is the nurse's priority?

Place a pillow under the child's head.
Move the child into a side-lying position.
Remove the child's eyeglasses.
Time the seizure.

Move the child into a side-lying position.
Placing the child in a side-lying position prevents aspiration of vomitus; therefore, this action is the nurse's priority.

A nurse is assisting in the care of a client who has a depressive disorder, Which of the following interventions is the nurse's priority?

Monitor for risk of self-harm.
Administer prescribed antidepressants.
Encourage adequate fluid intake.
Assist with activities of daily living.

Monitor for risk of self-harm.
Self-harm or suicide presents the greatest risk to the client; therefore, monitoring for risk of self-harm is the nurse’s priority intervention.

A nurse is caring for a client who is immobile. Which of the following actions is the priority for the nurse to contribute to the client's plan of care?

Auscultate breath sounds at least every 2 hr.
Perform range- of-motion exercises at least two to three times daily.
Make sure the client has an intake of 2,000 to 3,000 mL of fluid per day.
Apply antiembolic stockings.

Auscultate breath sounds at least every 2 hr.
The priority action the nurse should contribute to the plan of care when using the airway, breathing, circulation approach to client care is auscultating breath sounds to determine the client’s need for suctioning. With inactivity, secretions can pool in the airways, diminishing breath sounds and causing crackles and dyspnea.

A nurse is caring for a client who has alcohol use disorder and is experiencing withdrawal. Which of the following interventions is the nurse's priority?

Prevent the client from harming herself or others.
Support the client's coping skills.
Identify the use of defense mechanisms.
Develop goals for treatment.

Prevent the client from harming herself or others.
Using the greatest risk priority-setting framework, the greatest risk to the client at this time is self-harm or causing harm to others; therefore, the nurse’s priority intervention is to prevent the client from harming herself or others.

A nurse is reviewing the laboratory data for a client who is begin a new prescription for furosemide. Which of the following laboratory values is a priority for the nurse to check before administering this medication?

Hgb
Uric acid level
Potassium
WBC

Potassium
The greatest risk to this client is injury caused by a dysrhythmia due to hypokalemia; therefore, the priority action is to check the client’s potassium level. Furosemide is a loop diuretic and promotes excretion of potassium. The nurse should monitor the client’s serum potassium level before administering furosemide to prevent hypokalemia and life threatening dysrhythmias.

A nurse is assisting with the plan of care for a client who had an upper endoscopy 1 hr ago. The nurse should place the priority on monitoring which of the following?

Sore throat
Abdominal bloating
Gag reflex
Belching

Gag reflex
The greatest risk to this client is aspiration immediately after an upper endoscopy; therefore, monitoring gag reflex is the priority action.

A nurse is caring for a client who is rehabilitating from injures resulting from a motor vehicle crash. Which of the following client statements should the nurse identify as the priority?

"I will not be able to do my job as a result of these injuries."
"I have not been able to sleep at night because it hurts when I move."
"I'm scared that my partner will leave me if I can't recover from these injuries."
"I don't feel like I'm able to take care of my family anymore."

"I have not been able to sleep at night because it hurts when I move."
When using Maslow's hierarchy of needs, the nurse determines that the priority finding is the client's report of pain and difficulty sleeping. These are physiological needs that take priority over higher level needs.

A nurse is caring for a client after a radical neck dissection. To which of the following should the nurse give priority in the immediate postoperative period?

Malnourishment related to NPO status and dysphagia
Impaired verbal communication related to the tracheostomy
High risk for infection related to surgical incisions
Ineffective airway clearance related to thick, copious secretions

Ineffective airway clearance related to thick, copious secretions
According to the airway, breathing, circulation (ABC) priority-setting framework, the priority action is the client's need for adequate oxygenation. A client who has a new tracheostomy requires frequent suctioning in the early postoperative period because of copious secretions and the decreased effectiveness of the cough mechanism.

A nurse is assisting with the plan of the care for a client who is newly diagnosed with borderline personality disorder. Which of the following interventions is the nurse's priority?

Exploring reasons for her behavior
Protecting the client from self-harm behavior
Encouraging the client to talk about her feelings
Providing strategies for redirecting violent behavior

Protecting the client from self-harm behavior
The greatest risk to the client is harm to self or others; therefore this is the nurse’s priority.

A nurse is caring for a client who has dysphagia following a stroke. Which of the following is the priority action for the nurse to take when feeding the client?

Offer mouth care before meals.
Place food in the unaffected side of the mouth.
Encourage the client to take small bites.
Place the client in the upright position.

Place the client in the upright position.
The greatest risk to this client is injury from aspiration; therefore, the most important action for the nurse to implement is to place the client in the upright position for meals to facilitate swallowing and prevent aspiration.

A nurse is planning care for a child who has severe diarrhea. Which of the following actions is the nurse's priority?

Introduce a regular diet.
Rehydrate.
Maintain fluid therapy.
Assess fluid balance.

Assess fluid balance.
The first action the nurse should take is to assess fluid balance to determine severity of the dehydration.

A client states that his family would be better off if he were dead. Which of the following responses is the nurse's priority?

“Do you really think your family would be better off without you?”
“Are you thinking of killing yourself?”
“Tell me what is happening right now.”
“When did you first start feeling this way?”

“Are you thinking of killing yourself?”
When a client expresses suicidal intent, it is the nurse’s priority to determine the seriousness of the client’s intent, whether or not he has a plan and the means to follow through with it, and the lethality of the means.

A nurse is caring for a client who is unconscious following a stroke. Which of the following nursing interventions is the highest priority?

Perform passive range of motion on each extremity.
Monitor the client's electrolyte levels.
Suction saliva from the client's mouth.
Record the client's intake and output.

Suction saliva from the client's mouth.
The greatest risk to the unconscious client is inability to independently maintain a clear airway. The client is at risk for ineffective airway clearance; therefore, the priority nursing action is to maintain the client's airway.

A nurse is caring for a client who has partial-thickness and full-thickness burns of his head, neck, and chest. The nurse should recognize which of the following is the priority risk to the client?

Airway obstruction
Infection
Fluid imbalance
Contractures

Airway obstruction
When using the airway, breathing, circulation approach to client care, the nurse determines that the priority risk to this client is airway obstruction. Burns in this area can involve damage to the upper airway, resulting in swelling and respiratory compromise. The nurse should monitor the client for manifestations of respiratory distress.

A nurse is caring for a client who had total hip arthroplasty 1 day ago and is receiving morphine sulfate by PCA pump for pain control. The client reports nausea and vomiting. Which of the following actions is the priority for the nurse to take?

Provide an antiemetic.
Make the client NPO.
Administer a stimulant laxative.
Auscultate bowel sounds.

Auscultate bowel sounds.
Opioids used in patient controlled analgesia cause adverse effects that include constipation, nausea and vomiting, urinary retention, and pruritus. Nausea and vomiting may occur initially as a side effect but often resolves within 24 to 48 hours of starting the opioid. It is important for the nurse to assess the actual cause of the nausea in order to treat it effectively, which requires an evaluation of the client’s bowel sounds and bowel habits.

A nurse is assigned a group of postoperative clients. Which of the following client findings should the nurse identify as the priority?

SaO2 88%
Client report of incisional pain at a level of 6 on a 0 to 10 scale
Infiltration of client's IV access
Temperature 36.1° C (97.0° F)

SaO2 88%
When using the airway, breathing, circulation approach to client care, the nurse determines that the priority finding is an SaO2 of 88% , which is below the expected reference range of 95% to 100%. The nurse should encourage this client to turn, cough, and deep breathe. The nurse should continue monitoring the pulse oximetry and apply supplemental oxygen as needed.

A nurse is caring for a client who has a cast in place for a fractured tibia. The nurse should recognize that which of the following interventions is a priority?

Check for capillary refill distal to the client's cast.
Discuss cast care with the client.
Inspect the client's cast for cracks.
Apply lotion to the skin around the client's cast.

Check for capillary refill distal to the client's cast.
The priority action the nurse should take when using the airway, breathing, and circulation (ABC) approach to client care is to check capillary refill. Reduced capillary refill can indicate a change in neurovascular status due to the injury or pressure from the cast. The nurse should monitor color, movement, temperature, sensation, and capillary refill of the toes on the affected extremity.

A nurse is assisting in the care of a client who is 2 hours postoperative following a wedge resection of the left lung and has a chest tube to suction. Which of the following is the priority finding the nurse should report to the provider?

Abdomen is distended
Chest tube drainage of 70 mL in the last hour
Subcutaneous emphysema is noted to the left chest wall
Pain level of 6 on a 0 to 10 scale

Abdomen is distended
When using the airway, breathing, circulation approach to client care, the nurse should recognize the presence of abdominal distention has the potential to compromise the client’s respiratory status as the distention increases abdominal pressure on the diaphragm and impairs ventilation. This is the priority finding for the nurse to report.

A nurse is collecting date on a client who has a major burn injury. The nurse should recognize which of the following findings as a priority?

The client has large blistered areas over his chest.
The client has decreased sensation over the burn areas.
The client produces black colored sputum.
The client has edema at the burn site.

The client produces black colored sputum.
When using the urgent vs. nonurgent approach to client care, the nurse determines the priority finding is black colored sputum which is a manifestation of smoke inhalation and can lead to pulmonary failure and respiratory distress.

A nurse is reviewing the admission laboratory values for a client who has a history of bulimia nervosa. Which of the following findings is the nurse priority?

Serum chloride 96 mEq/L
Potassium 2.8 mEq/L
Hgb 11g/dL
Serum amylase 240 units/L

Potassium 2.8 mEq/L
Clients who have bulimia nervosa are likely to develop hypokalemia if volume depletion occurs due to self-induced vomiting or inappropriate use of diuretics. A potassium level of 2.8 mEq/L is below the therapeutic level of 3.5 to 5.0 mEq/L. This potassium level indicates a critical level of hypokalemia (below 3.0 mEq/L) and places the client at the greatest risk for injury related to life-threatening cardiac dysrhythmias.

A nurse is caring for a client who came to the emergency department with abdominal distention and is now on the medical-surgical unit with an NG tube in place to low gastric suction. The client reports anxiety, discomfort, and a feeling of bloating. Which of the following actions is the nurse's priority?

Request a prescription for a medication to ease the client's anxiety.
Irrigate the NG tube with 100 mL of sterile water.
Check to see if the suction equipment is working.
Remove and reinsert the NG tube.

Check to see if the suction equipment is working.
The first action the nurse should take using the nursing process is to collect data. The nurse should check for the most obvious reason why the client’s symptoms have returned. If the suction equipment has malfunctioned, the nurse should adjust it or replace it with working equipment.

A nurse is caring for a school-age child who has a fracture to the right femur. Which of the following findings is the nurse's priority?

2+ right pedal pulse
Respiratory rate 24/min
Capillary refill less than 2 seconds
Tingling in the right foot

Tingling in the right foot
Tingling in the child's right foot indicates paresthesia and should alert the nurse of circulatory compromise. This finding is the priority.

A nurse is assisting in monitoring a client who is receiving a tube feeding. Which of the following findings should the nurse identify as the priority?

Temperature 38.2° C (100.8° F)
Respiratory rate 12/min
Hematocrit 45%
Urine specific gravity 1.015

Temperature 38.2° C (100.8° F)
A fever can indicate an infection. Therefore, the priority finding to report is the client's temperature.

A nurse is caring for a client who is postoperative following a thyroidectomy. Which of the following is a priority for the nurse to monitor during the first 24 hr of care for the client?

Airway patency
Hoarseness
Visual deficits
Pain control

Airway patency
When using the airway, breathing, circulation approach to client care, the nurse determines that the priority to monitor is airway patency. A thyroidectomy can result in edema or bleeding that can obstruct the airway. Provide humidification and elevate the client's head of bed to reduce swelling.

A nurse is receiving change-of-shift report for four clients. Which of the following findings should the nurse identify as the priority?

A client who had a blood transfusion and has a blood pressure of 138/76 mm Hg
A client who is 4 hr postoperative following a total hip arthroplasty and has a urinary output of 15 mL/hr
A client who has dementia and is alert and oriented to person
A client who has skeletal traction for a femur fracture and reports incisional discomfort of 4 on a scale of 0 to 10

A client who is 4 hr postoperative following a total hip arthroplasty and has a urinary output of 15 mL/hr
When using the urgent vs. nonurgent approach to client care, the nurse determines that the priority finding is a client who is postoperative and has a urinary output of 15 mL/hr. Urine output less than 20/mL hr can indicate decreased perfusion to the kidneys and impending shock; therefore, this is the priority finding.

A nurse is caring for a client is who is 4 hr postoperative following a transurethral resection of the prostate (TURP). Which of the following is the priority finding for the nurse report to the provider?

Emesis of 100 mL
Oral temperature of 37.5° C (99.5° F)
Thick, red-colored urine
Pain level of 4 on a 0 to 10 rating scale

Thick, red-colored urine
The nurse should recognize viscous drainage that is red in color may indicate hemorrhage and should be reported to the provider immediately.

A nurse in an addiction rehabilitation center is contributing to the plan of care for a newly admitted client who has alcohol use disorder. Which of the following interventions is the nurse's priority?

Pad the side rails of the bed with towels.
Place the client in a private room.
Accompany the client when ambulating.
Determine the client's level of disorientation.

Determine the client's level of disorientation.
The greatest risk to the client is injury and adverse effects of withdrawal; therefore, this intervention is the highest priority of the nurse.

A nurse in an urgent care center is caring for a client who is having acute asthma exacerbation. After administering high-flow oxygen, which of the following actions is the nurse's highest priority?

Review relaxation techniques with the client.
Provide immediate rest for the client.
Remind the client not to try to talk.
Administer a short-acting beta-adrenergic medication

Administer a short-acting beta-adrenergic medication
The greatest risk to the client’s safety is airway obstruction. Beta-adrenergic medications decrease the inflammatory response that triggers narrowing of the airways. They provide prompt relief of airflow obstruction and are the initial intervention when a client has an acute asthma exacerbation; therefore, the priority action for the nurse to take is to administer a short-acting beta-adrenergic medication.

A nurse is collecting data on a client who has infective endocarditis. The nurse should recognize which of the following findings is the priority to report to the provider?

Anorexia
Dyspnea
Fever
Malaise

Dyspnea
When using the airway, breathing, circulation (ABC) approach to client care, the nurse determines the priority finding is dyspnea. Dyspnea can be an indication of left-sided heart failure, or a pulmonary infarction due to embolization; therefore it is the priority finding to report.

A nurse is assigned four clients who are postoperative. Which of the following findings should the nurse identify as a priority to report to the charge nurse?

A client whose capillary blood glucose was 110 mg/dL at 0800 and is 198 mg/dL at 1200
A client whose temperature is 99º F (37.2º C)
A client who reported a pain level of 2 on a scale from 0 to 10 at 0800 and a 6 at 1200
A client whose blood pressure was 138/86 mm Hg at 0800 and is 106/60 mm Hg at 1200

A client whose blood pressure was 138/86 mm Hg at 0800 and is 106/60 mm Hg at 1200
When using the urgent vs. nonurgent approach to client care, the nurse determines that a drop in blood pressure could indicate internal bleeding and should be reported to the charge nurse.

A home health nurse is visiting a client who has COPD and is receiving oxygen at 2 L/min via nasal cannula. The client tells the nurse she has been having difficulty breathing. Which of the following actions is the nurse's priority at this time?

Instruct the client to use a pursed-lip breathing technique.
Evaluate the client's respiratory status.
Increase the oxygen flow to 3L/min.
Have the client cough and expectorate secretions.

Evaluate the client's respiratory status.
The first action the nurse should take when using the nursing process is to collect data from the client. The nurse should immediately evaluate the client's respiratory status before determining the appropriate interventions.

A nurses collecting data from a client who has acute gastroenteritis. Which of the following data collection findings should the nurse identify as the priority?

Weight loss of 3% of total body weight.
Blood glucose 150 mg/dL
Potassium 2.5 mEq/L
Urine specific gravity 1.035

Potassium 2.5 mEq/L
When using the airway, breathing, circulation approach to client care, the nurse determines that the priority finding is a potassium level of 2.5 mEq/dL. In the presence of fluid volume deficit, potassium depletion can occur. Complications from hypokalemia include cardiac and respiratory manifestations.

A nurse is collecting data on a client who has a prescription for morphine. The nurse should recognize that which of the following data is a priority to obtain before administering this medication?

Blood pressure
Apical heart rate
Respiratory rate
Temperature

Respiratory rate
The priority action the nurse should take when using the airway, breathing, and circulation (ABC) approach to client care is to evaluate the client’s respirations. The respiratory rate is a priority because opioid analgesics such as morphine can cause respiratory depression.

A nurse is monitoring a client who is receiving chemotherapy and has a platelet count of 22,000 mm³. Which of the following finding should the nurse identify as the priority?

Anorexia
Fatigue
Ecchymosis
Fever

Ecchymosis
The greatest risk to this client is injury from bleeding due to a platelet count that is below the expected reference range; therefore, the priority intervention is to monitor for and report indications of bleeding, such as ecchymosis, immediately.

A nurse is caring for a client who develops a pulmonary embolism. Which of the following interventions is the priority for the nurse to take?

Administer IV morphine.
Begin oxygen therapy.
Start an IV infusion of lactated Ringer's.
Initiate cardiac monitoring.

Begin oxygen therapy.
When using the airway, breathing, circulation approach to client care, the nurse determines that the priority is administering oxygen therapy to the client to alleviate difficulty breathing and treat hypoxia.

A nurse is caring for a client who has burns to his face, ears, and eyelids. Which of the following is the priority finding to report to the provider?

Urinary output 25 mL/hr
Difficulty swallowing
Heart rate 122/min
Lip edema

Difficulty swallowing
When using the airway, breathing, circulation approach to client care, the nurse determines that the priority finding is difficulty swallowing, because it is an indication that the client’s airway is becoming obstructed. Therefore this is the priority finding to report to the provider.

A nurse is assisting with monitoring a client following a bronchoscopy. Which of the following actions should the nurse identify as the priority?

Checking the client's temperature
Auscultating heart sounds
Confirming presence of a gag reflex
Measuring blood pressure

Confirming presence of a gag reflex
The priority action the nurse should take when using the airway, breathing, circulation approach to client care is to confirm that the client has a gag reflex. Absence of the gag reflex places the client at risk for impaired airway from aspiration.

A nurse is assisting with the care of a client who is postoperative following surgical repair of a fractured mandible. The client's jaw is wired shut to repair and stabilize the fracture. The nurse should recognize which of the following is the priority action?

Relieve the client's pain.
Check the client's pressure points for redness.
Provide oral hygiene.
Prevent aspiration.

Prevent aspiration.
When using the airway, breathing, circulation approach to client care, the nurse should determine the priority action is to prevent aspiration. Since the client’s jaws are wired together, aspiration is a risk if the client vomits. Therefore, the client should receive medication for nausea, as indicated, and wire cutters and suction are kept at the bedside at all times in case of vomiting or difficulty breathing.

A nurse is caring for a client who ingested a poison and is now having seizures. Which of the following is the priority action the nurse should take?

Maintain the patency of the client's airway.
Identify the poison the client ingested.
Measure the client's blood pressure.
Position the client on her side.

Maintain the patency of the client's airway.
The priority action the nurse should take when using the airway, breathing, circulation (ABC) approach to client care is to check the patency of the client’s airway. Poisoning or its treatment often causes vomiting, which can obstruct the airway and lead to asphyxiation. During seizures, assuring patency of the airway is also a priority.

A nurse is collecting data from a client who has leukemia. Which of the following findings has the highest priority?

Hematocrit 35%
Platelet count 125,000/mm³
Weight loss
Bone pain

Platelet count 125,000/mm³
The greatest risk for this client is hemorrhage due to a very low platelet count. Therefore, this is the priority finding.

A nurse is caring for a client following an open reduction and internal fixation of a fractured femur. which of the following findings is the nurse's priority?

Altered level of consciousness
Oral temperature of 37.7° C (100° C)
Muscle spasms
Headache

Altered level of consciousness
When using the airway, breathing, circulation approach to client care, the nurse determines that the priority finding is for the nurse to monitor the client's altered level of consciousness. A fracture of one of the long bones of the body places the client is at risk for fat embolism, which causes a decrease in oxygenation and alters the client's level of consciousness.

A nurse is collecting data on client who is postoperative following a transurethral resection of the prostate (TURP). The nurse should recognize which of the following findings is the priority?

The client has bright red urine in his urinary catheter.
The client reports a continuous urge to void.
The client has small blood clots in his urinary catheter.
The client reports burning around the urinary catheter.

The client has bright red urine in his urinary catheter.
When using the urgent vs non-urgent approach to client care, the nurse determines that the priority finding is bright red urine which is a manifestation of hemorrhage. The provider may prescribe traction to the client’s catheter and irrigation to reduce the bleeding.

A nurse in an acute care mental health facility caring for a client who is experiencing an acute manic episode. Which of the following is the nurse's priority intervention?

Discourage the client's inappropriate sexual expression.
Control the client's use of loud and vulgar language.
Maintain the client's contact with family members.
Protect the client and others from impulsive behavior.

Protect the client and others from impulsive behavior.
The client who is experiencing acute mania is often unable to control impulsive behavior and is likely to be hostile, irritable, and exhibit paranoia. The greatest risk to the client is harm to self or others; therefore, protecting the client and others from the client’s impulsive behavior is the nurse’s priority intervention.

A nurse is caring for a 4-year-old child who is 2 days postoperative following the insertion of a ventriculoperitoneal shunt. Which of the following findings should the nurse identify as the priority?

Lethargy
Lying flat on the unaffected side
Respiratory rate 20/min
Urine output 50 mL in 2 hr

Lethargy
Lethargy is the priority finding because can indicate a decreased level of consciousness or increasing intracranial pressure.