A nurse is assessing a client who has meningitis and notices the client grimace in pain when extending the leg from a flexed position. Which of the following conditions is the client displaying?

Choice A reason: Kernig’s sign is a clinical indicator of meningitis, characterized by pain and resistance when extending the leg from a flexed position at the hip and knee. This occurs due to inflammation of the meninges, which causes irritation of the spinal nerve roots, leading to muscle stiffness and discomfort during leg extension, reflecting meningeal irritation.

Choice B reason: Brudzinski’s sign involves involuntary flexion of the hips and knees when the neck is flexed, indicating meningeal irritation in meningitis. It differs from Kernig’s sign, as it is elicited by neck movement rather than leg extension. While both signs suggest meningitis, Brudzinski’s sign is not observed in the described leg extension scenario.

Choice C reason: Nuchal rigidity refers to neck stiffness, a common meningitis symptom, where the client resists neck flexion due to meningeal inflammation. Unlike Kernig’s sign, it is not associated with leg movement. It reflects irritation of the meninges but is not the specific condition observed during the leg extension test described in the scenario.

Choice D reason: Bradykinesia, characterized by slow movement, is typically associated with neurological disorders like Parkinson’s disease, not meningitis. It involves impaired motor control due to basal ganglia dysfunction, unrelated to meningeal inflammation or leg extension pain. Therefore, it does not correspond to the clinical presentation described in the meningitis assessment scenario.

Choice A reason: Nuchal rigidity is a hallmark of bacterial meningitis due to meningeal inflammation but is not a direct indicator of increased intracranial pressure. It reflects irritation of the meninges, causing neck stiffness. While common in meningitis, it does not specifically signal rising ICP, which requires other neurological signs.

Choice B reason: Widened pulse pressure (e.g., high systolic, low diastolic) is a key indicator of increased intracranial pressure in bacterial meningitis, often part of Cushing’s triad (with bradycardia and irregular breathing). It results from cerebral compression affecting autonomic regulation, signaling a critical need for intervention to reduce ICP.

Choice C reason: Elevated temperature is common in bacterial meningitis due to infection but is not a specific indicator of increased intracranial pressure. Fever reflects the body’s immune response to bacterial invasion, not the mechanical pressure effects on brain tissue that characterize rising ICP in this condition.

Choice D reason: Pupils reactive to light indicate normal cranial nerve function and are not a sign of increased intracranial pressure. Fixed or dilated pupils suggest ICP elevation due to compression of the oculomotor nerve. Reactive pupils are reassuring but do not rule out early ICP changes.