A client presents to the health care clinic with a 3-day history of fever, chills, neck pain and stiffness, and headache. The nurse observes an elevated temperature of 102.5°F and pain with rotation of the head side to the side and decreased ability to flex the head forward. The nurse recognizes these findings as most likely the onset of what infectious process?

Bursitis

Meningitis

Spondylitis

Arthritis

Answer and Explanation

The Correct Answer is B

A.   Bursitis is the inflammation of the bursa, a small fluid-filled sac that reduces friction between bones and soft tissues. It typically causes localized pain and tenderness in the area of the bursa, often in the shoulders, elbows, or hips.

B.   Meningitis is an infection or inflammation of the protective membranes covering the brain and spinal cord (the meninges). It often presents with symptoms such as fever, headache, neck stiffness, and photophobia. The neck stiffness, particularly difficulty flexing the head forward (nuchal rigidity), is a classic sign.
C.   Spondylitis refers to inflammation of the spine. It can present with chronic back pain and stiffness but is typically associated with long-term symptoms rather than acute systemic symptoms like fever and chills. Conditions such as ankylosing spondylitis can cause chronic back pain and stiffness but are less likely to present with acute fever and headache.
D.   Arthritis is inflammation of the joints and can cause pain, swelling, and stiffness in the affected joints. While arthritis can affect the neck (cervical spine arthritis), it typically does not present with systemic symptoms such as fever and chills unless there is an associated infection or inflammatory process.

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Correct Answer is B

Explanation

A. The obturator sign is used to assess for appendicitis, not meningitis. To perform this test, the patient’s right knee is flexed to 90 degrees, and the nurse rotates the hip internally and externally. Pain during this maneuver can indicate irritation of the obturator muscle, which is associated with inflammation of the appendix.

B. The Brudzinski sign is a clinical test used to assess meningeal irritation. When the patient’s neck is passively flexed while lying supine, a positive Brudzinski sign is indicated if the patient involuntarily flexes their knees and hips in response to neck pain. This sign is often seen in meningitis as a result of irritation of the meninges.
C. The Phalen sign is used to diagnose carpal tunnel syndrome. The patient flexes their wrists and holds the position for a period of time to see if symptoms of numbness or tingling appear in the fingers, which would indicate median nerve compression at the wrist. This sign is unrelated to meningitis.
D. The Tinel sign is also used to diagnose carpal tunnel syndrome and other peripheral nerve issues. It involves tapping on the nerve (such as the median nerve at the wrist) to see if it causes tingling or a “pins and needles” sensation along the nerve’s distribution. Like the Phalen sign, it is not related to meningitis.

A. Lock the fingers together and pull against each other. B. Squeeze a thigh with the opposite hand. C. Stretch the arms over the head. D. Clench the jaw tightly

Correct Answer is A

Explanation

A. This maneuver is intended to engage other muscle groups and increase overall muscle tone. It can help facilitate the patellar reflex by increasing muscle tension and sensitivity. This technique can enhance the reflex response by engaging the client in a physical action that might make the reflex more pronounced.
B. Squeezing the thigh might create discomfort or involuntary muscle contraction, which could interfere with the reflex response. It is not a recommended technique for eliciting the patellar reflex and may not have a significant effect on reflex assessment.
C. Stretching the arms over the head does not directly influence the patellar reflex. Reflexes are typically assessed in a relaxed state, and this action might not be relevant for improving the patellar reflex response.
D. Clenching the jaw might increase overall muscle tone temporarily, but it does not directly impact the patellar reflex. This technique is less likely to influence the patellar reflex compared to techniques that engage lower body muscle groups.

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Naxlex Comprehensive Predictor Exams

A patient is diagnosed with Meningitis. During the physical examination in the supine position, the nurse flexed the patient's neck and the patient flexed his knees and hip while complaining of neck pain. This is known as:

Correct Answer is B

Explanation

A nurse is having difficulty eliciting a patellar reflex. Which of the following would be most appropriate for the nurse to have the client do?

Correct Answer is A

Explanation

While conducting an assessment the nurse suspects that a client is making up things in response to specific questions. What behavior is this client demonstrating?

A client is clenching the jaw closed to avoid taking a prescribed oral medication. The nurse can use this observation to confirm the client is demonstrating motor function of which cranial nerve?

During an assessment, the nurse asks a client to explain what the following means: "A penny saved is a penny earned." The nurse is assessing which of the following?

When implementing nursing interventions for a client who has attempted suicide, which of the following is most important?

The client presents to the nurse stating that his jaws feel "stuck". What joint should the nurse assess?

A nurse is conducting a physical examination of the musculoskeletal system of a client who reports having joint pain. Which signs indicate there is inflammation in the joints? Select all that apply.

A patient that is Comatose based on the Level of Consciousness (LOC) assessment using the Glasgow Coma scale is in what numeric range of the scale?