A 35-year-old female complains of headache and neck pain. The nurse's assessment reveals painful flexion of the neck to the chest. The nurse understands that nuchal rigidity is associated with?

1. A

   CVA

2. B

   Meningitis

3. C

   Brain tumor

4. D

   Subdural hematoma

Appeared in: HPSSC - 2015

Explanation

• The patient's key symptom is painful flexion of the neck to the chest, which is the definition of nuchal rigidity.
• Nuchal rigidity is a classic sign of meningeal irritation, an inflammatory response of the meninges.
• Meningitis is the inflammation of the meninges, making it the most direct cause of the patient's signs and symptoms among the given options.
• The triad of fever, headache, and nuchal rigidity is present in a significant number of bacterial meningitis cases.

Why Other Options Were Wrong

• Option A: A Cerebrovascular Accident (CVA), or stroke, characteristically presents with focal neurological deficits related to the area of the brain affected, such as unilateral weakness, aphasia, or facial droop.
• Option C: A brain tumor typically causes symptoms that develop gradually due to increasing intracranial pressure (ICP), such as morning headaches, vomiting, and personality changes.
• Option D: A subdural hematoma, usually linked to head trauma, presents with symptoms like headache, confusion, and a fluctuating level of consciousness. Nuchal rigidity is not a primary or common sign.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Assessment of meningeal irritation and its association with meningitis to guide bedside assessment, documentation, and the next nursing action.
• Prompt recognition of nuchal rigidity as a sign of meningitis is a critical nursing skill, as bacterial meningitis can be fatal if treatment is delayed.
• If bacterial meningitis is suspected, the nurse's first action should be to initiate droplet precautions to prevent transmission to others.
• Nurses play a key role in preparing for and assisting with a lumbar puncture, ensuring patient safety and proper specimen handling.

How to Approach the Question

• First, identify the key clinical finding presented in the question stem: 'painful flexion of the neck to the chest.'
• Recognize this finding by its clinical term, 'nuchal rigidity.'
• Recall the primary pathophysiology associated with nuchal rigidity, which is irritation or inflammation of the meninges.
• Evaluate the given options to determine which condition is fundamentally an inflammatory process of the meninges.
• Eliminate the other options based on their typical presentations: CVA (focal deficits), brain tumor (gradual ICP signs), and subdural hematoma (post-trauma cognitive changes).
• Select 'Meningitis' as it is the most common and direct cause of the classic signs of meningeal irritation.

Concept Tested & Keywords

• Concept Tested: Assessment of meningeal irritation and its association with meningitis.
• Stem keywords: headache, neck pain, painful flexion of the neck, nuchal rigidity
• Lead-in keywords: associated with
• Clinical cues: The combination of headache, neck pain, and nuchal rigidity is a classic triad for meningeal irritation.

Question ID

qa3NLDFt1X38v085BRpuW

Copy ID

Reference Book

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 742-744

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1568-1570