Which observation should raise concern for a nurse assessing a client with a recent head injury?

Widened pulse pressure is a significant observation that could indicate increased intracranial pressure or brain injury. In the context of a recent head injury, monitoring vital signs is critical, as changes can reflect alterations in cerebral physiology. A widened pulse pressure, defined as an increase in the difference between systolic and diastolic blood pressure, may suggest elevated intracranial pressure or impending herniation, both of which require immediate medical attention.

The other observations, while concerning, may not indicate a direct urgent threat in the same way that a widened pulse pressure does. For example, decreased pupil response or difficulty with balance can point to brain hemisphere or cranial nerve involvement, which is certainly alarming but may not represent a systemic deterioration as directly as a widened pulse pressure. Similarly, increased reflexes can indicate neurological activity or irritation but do not convey the same level of immediate risk as changes in blood pressure would. Thus, the significance of a widened pulse pressure in this context makes it a critical observation for nursing assessment following a head injury.