The nurse notes documentation that a child with meningitis is exhibiting a positive Kernig's sign. Which observation is a characteristic of this sign?
Petechial and purpuric rashes are noted on the child's trunk
Neck flexion causes adduction and flexion movements of the lower extremities
The child is not able to extend the leg when the thigh is flexed anteriorly at the hip
The child complains of muscle and joint pain
The Correct Answer is C
C. This is characteristic of Kernig's sign. Kernig's sign is elicited when the thigh is flexed at the hip and then attempts to extend the leg at the knee are met with resistance or pain due to inflammation of the meninges.
A. Petechial and purpuric rashes are associated with meningococcal meningitis, not specifically with Kernig's sign. These rashes result from bleeding into the skin and are a characteristic feature of meningococcal sepsis. However, they are not directly related to Kernig's sign.
B. This observation describes Brudzinski's sign, not Kernig's sign. Brudzinski's sign occurs when passive flexion of the neck causes involuntary flexion of the hips and knees due to meningeal irritation.
D. Muscle and joint pain can be symptoms of meningitis, but they are not specific to Kernig's sign. Kernig's sign specifically refers to resistance or pain experienced when attempting to extend the leg at the knee.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
D. Pancreatic enzymes should not be mixed with acidic foods or liquids, as this can reduce their effectiveness. Instead, the enzymes should be sprinkled on soft, non-acidic foods or swallowed whole with a glass of water or juice.
A. Pancreatic enzymes are generally safe and well-tolerated when taken as prescribed but they can cause side effects in some individuals. Common side effects may include abdominal pain, diarrhea, constipation, nausea, and bloating.
B. Pancreatic enzymes help individuals with cystic fibrosis digest fat, as well as proteins and carbohydrates. In cystic fibrosis, the pancreas does not produce enough digestive enzymes, leading to malabsorption of nutrients, particularly fat. Supplemental pancreatic enzymes help compensate for this deficiency and improve nutrient absorption.
C. Pancreatic enzymes are typically taken with meals or snacks to aid in digestion. However, if the child is consuming a small meal or snack that contains minimal fat, the enzymes may not be necessary. It's important for the mother to follow the healthcare provider's instructions regarding when and how to administer the enzymes.
Correct Answer is D
Explanation
D. Place resuscitation equipment at the child's bedside. This is because epiglottitis can lead to a life- threatening emergency requiring immediate intervention, and having resuscitation equipment readily available is essential for rapid response.
A. Establishing intravenous access may be necessary for administering fluids and medications but it is not the nurse's priority action when caring for a child with suspected epiglottitis.
B. Droplet precautions help reduce the risk of transmission of respiratory pathogens to others. However, the priority is to address the child's respiratory distress and potential airway compromise.
C. Providing blow-by humidified oxygen can be beneficial in managing the child's respiratory status. However, securing the airway takes precedence over other interventions, as indicated by the guidelines for managing epiglottitis.
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