The client with suspected meningitis is admitted to the unit. The doctor is performing an assessment to determine meningeal irritation and spinal nerve root inflammation, A positive Kernig's sign is charted if the nurse notes?

1. A

   Pain on extension of the knee when the hip is flexed

2. B

   Nuchal rigidity on flexion of the neck

3. C

   Pain when the head is turned to the left side

4. D

   Dizziness when changing positions

Appeared in: DHS 2018 shift 1st

Explanation

• A positive Kernig's sign is a classic physical assessment finding indicating meningeal irritation.
• The test involves placing the patient in a supine position, then flexing their hip and knee to a 90-degree angle.
• A positive sign is elicited when a subsequent attempt to passively extend the knee causes pain and resistance in the hamstring muscles.
• This pain occurs because the movement stretches the inflamed meninges and spinal nerve roots.

Why Other Options Were Wrong

• Option B: This describes nuchal rigidity (stiff neck), which is another key sign of meningeal irritation but is a distinct and separate finding from Kernig's sign.
• Option C: Pain on turning the head is a non-specific finding and is not a formal diagnostic sign for meningitis like Kernig's or Brudzinski's sign.
• Option D: This symptom describes orthostatic (postural) hypotension, which is a drop in blood pressure upon standing. It is not related to meningeal irritation.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Assessment of meningeal irritation (Kernig's sign) to guide bedside assessment, documentation, and the next nursing action.
• Prompt and accurate assessment of meningeal signs like Kernig's is critical for the early diagnosis of meningitis, a medical emergency that requires immediate treatment to prevent severe complications or death.
• Nurses must be able to differentiate between Kernig's sign, Brudzinski's sign, and nuchal rigidity to provide precise documentation for the healthcare team.
• What if? If the patient was an infant younger than 18 months, Kernig's and Brudzinski's signs are often not consistently present. In this case, a bulging fontanelle, high-pitched cry, and irritability would be more reliable indicators of meningitis.

How to Approach the Question

• First, identify the key term in the question: 'positive Kernig's sign'.
• This is a factual recall question that requires you to know the definition of a specific clinical assessment.
• Mentally review the procedure for testing Kernig's sign: patient is supine, hip and knee are flexed, then the knee is extended.
• Recall the positive finding: pain upon knee extension.
• Compare this definition to the given options. Option A is a direct match.
• Rule out the other options by identifying what they describe: Option B is nuchal rigidity, and Options C and D are non-specific findings not related to the Kernig's test.

Concept Tested & Keywords

• Concept Tested: Assessment of meningeal irritation (Kernig's sign)
• Stem keywords: meningitis, meningeal irritation, Kernig's sign, assessment
• Lead-in keywords: notes
• Clinical cues: suspected meningitis
• Negative lead-in flag: false

Question ID

Q4BAkUKRKA28PlNuyrV1K-

Copy ID

Reference Book

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

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

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