A nurse is assessing a patient admitted with bacterial meningitis. She is expected to find all of the following signs, EXCEPT?

Appeared in: HPSSC - 2015

Explanation

Trismus, commonly known as lockjaw, is the inability to open the mouth due to sustained spasm of the jaw muscles.
It is a hallmark sign of tetanus, caused by the neurotoxin from Clostridium tetani, and is not associated with bacterial meningitis.
Therefore, it is the finding a nurse would NOT expect when assessing a patient for meningitis.

Option B: Brudzinski's sign is a classic indicator of meningeal irritation. It is considered positive when passive flexion of the patient's neck causes involuntary flexion of their hips and knees.
Option C: Nuchal rigidity, or neck stiffness, is one of the most common and earliest signs of meningitis, resulting from inflammation of the meninges around the spinal cord in the neck.
Option D: Kernig's sign is another key indicator of meningeal irritation. It is positive when the patient, lying supine with the hip flexed at 90 degrees, experiences pain and resistance upon attempted extension of the knee.

Clinical Relevance

Nursing practice connection: Use the key finding related to Signs of bacterial meningitis and meningeal irritation to guide bedside assessment, documentation, and the next nursing action.
Recognizing the signs of meningeal irritation is critical for nurses, as bacterial meningitis is a medical emergency requiring immediate antibiotic therapy to prevent severe neurological damage or death.
Upon suspecting meningitis, the nurse must immediately implement droplet precautions to prevent transmission, as pathogens like Neisseria meningitidis are highly contagious.
What if? If the patient were an infant or an elderly person, the classic signs of nuchal rigidity, Kernig's, and Brudzinski's may be absent or less pronounced. The nurse should instead look for other signs like a bulging fontanelle, high-pitched cry, and poor feeding in infants, or altered mental status and confusion in the elderly.

How to Approach the Question

First, identify the core of the question: it asks to find the sign that is NOT associated with bacterial meningitis. The keyword 'EXCEPT' is crucial, indicating you are looking for the outlier.
Second, review each option and recall its clinical association.
Evaluate Option A: Trismus. Recall that this is 'lockjaw' and is the classic sign of tetanus.
Evaluate Options B, C, and D: Brudzinski's sign, Nuchal rigidity, and Kernig's sign. Recognize these as the three classic signs of meningeal irritation.
Conclude that since the question asks for the exception, Trismus is the correct answer as it is not a sign of meningitis.

Concept Tested & Keywords

Concept Tested: Signs of bacterial meningitis and meningeal irritation
Stem keywords: bacterial meningitis, assessing, signs
Lead-in keywords: EXCEPT
Negative lead-in flag: The question asks for a finding that is NOT expected in a patient with bacterial meningitis.

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Practise the full HPSSC - 2015

Attempt every question from this paper in a timed mock, then review the full solution for each one.