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The nurse is assessing a patient with suspected bacterial meningitis and notes a positive Kernig sign. How should the nurse interpret this finding?

A.

Pain in the neck when the patient flexes their head towards the chest

B.

Involuntary flexion of the hips and knees when the neck is flexed

C.

Photophobia and headache triggered by bright light

D.

Pain and resistance when attempting to extend the patient's leg from a flexed position

Answer and Explanation

The Correct Answer is D

A. Pain in the neck when the patient flexes their head towards the chest. This describes nuchal rigidity, not Kernig sign.

B. Involuntary flexion of the hips and knees when the neck is flexed. This describes Brudzinski sign, not Kernig sign.

C. Photophobia and headache triggered by bright light. These are symptoms of meningitis, but they are not specific to Kernig sign.

D. Pain and resistance when attempting to extend the patient's leg from a flexed position. A positive Kernig sign is when there is pain and resistance to leg extension from a flexed hip and knee position, indicating meningeal irritation.


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Related Questions

Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"A,B"},"C":{"answers":"A"},"D":{"answers":"A,B"},"E":{"answers":"B"},"F":{"answers":"B"},"G":{"answers":"A,B"}}

Explanation

Polyuria/Polydipsia:

  • Supports both DKA and HHS as both conditions typically exhibit severe dehydration and excessive thirst and urination.

Heart Rate (tachycardia):

  • Consistent with both DKA and HHS due to dehydration and fluid shifts, though heart rate alone does not differentiate the two.

Respirations (Kussmaul's):

  • Suggests DKA; deep, labored Kussmaul respirations typically help compensate for metabolic acidosis, which is characteristic of DKA.

Mental Status (confusion, lethargy):

  • More common in HHS, where very high glucose and osmolality levels often lead to more profound neurologic changes. Can also occur in DKA.

Serum Glucose >600 mg/dL and Serum Osmolality >320 mOsm/kg:

  • Consistent with both DKA and HHS, though more frequently seen in HHS given the higher osmolality. In DKA, serum glucose usually elevated but often lower than in HHS. Osmolality may be increased but not as high as in HHS.

Insidious onset (days to weeks):

  • Suggests HHS, as it often has a slower onset than DKA, which typically presents more acutely.

Infection as precipitating factor:

  • Could support either condition as infections can precipitate both DKA and HHS.

Correct Answer is B

Explanation

A. Conjunctivitis. Conjunctivitis generally presents with redness and discharge but does not cause elevated intraocular pressure, severe pain, or visual disturbances like halos.

B. Acute angle-closure glaucoma. Acute angle-closure glaucoma is characterized by sudden severe eye pain, blurred vision, halos around lights, nausea, and vomiting, along with elevated intraocular pressure and a cloudy cornea.

C. Retinal detachment. Retinal detachment may cause sudden vision loss or flashing lights but typically lacks pain, nausea, or vomiting, and does not affect intraocular pressure.

D. Migraine with aura. A migraine with aura may cause visual disturbances but does not present with eye pain, red eye, or elevated intraocular pressure.

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