Nurse is assessing a patient admitted with bacterial meningitis. She is expected to find all of the following signs except?

Appeared in: HPSSSB Staff Nurse - 2016

Explanation

Trismus, commonly known as lockjaw, is a spasm of the jaw muscles that prevents the mouth from opening fully.
This sign is a classic hallmark of tetanus, caused by the neurotoxin produced by Clostridium tetani.
Bacterial meningitis affects the meninges, leading to signs of neck stiffness and nerve root irritation, but does not typically cause the jaw muscle spasms seen in trismus.

Option B: Nuchal rigidity, or a stiff neck, is one of the most common and classic signs of meningeal irritation in bacterial meningitis.
Option C: A positive Kernig's sign is a key indicator of meningeal irritation. It involves pain and resistance when attempting to straighten a flexed leg.
Option D: A positive Brudzinski's sign, where neck flexion causes involuntary hip and knee flexion, is another classic sign of meningeal irritation.

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical signs of bacterial meningitis to guide bedside assessment, documentation, and the next nursing action.
Bacterial meningitis is a medical emergency. Prompt recognition of meningeal signs (nuchal rigidity, Kernig's, Brudzinski's) is crucial for early diagnosis, immediate antibiotic administration, and implementation of droplet precautions to prevent transmission.
Failure to identify these signs can delay treatment, leading to severe neurological complications such as brain damage, hearing loss, seizures, or death.
What if? If a patient presented with trismus and a recent history of a puncture wound, the nurse's priority would shift to suspecting tetanus. This would require different immediate interventions, including wound debridement, administration of tetanus immune globulin (TIG), and muscle relaxants, in addition to antibiotics.

How to Approach the Question

First, identify the core concept of the question, which is the clinical presentation of bacterial meningitis.
Note the negative keyword 'except'. This means you are looking for the option that is NOT a sign of bacterial meningitis.
Review each option: Trismus, Nuchal rigidity, Kernig's Sign, and Brudzinski's Sign.
Recall or deduce the pathophysiology of meningitis. It involves inflammation of the meninges, leading to specific signs of irritation.
Evaluate each sign. Nuchal rigidity, Kernig's, and Brudzinski's are all well-known tests for meningeal irritation.
Identify Trismus (lockjaw) as the outlier. This sign is classically associated with tetanus, not meningitis. Therefore, it is the correct answer.

Concept Tested & Keywords

QwUJEtCWvkhKT2tNq4ssAQ

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

E6 Medicine Harrison 22e Part 1 p. 1161-1163

Practise the full HPSSSB Staff Nurse - 2016

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