When preparing to test a client for meningeal irritation, which of the following would be most important for the nurse to do first?

Assess for Kerning and Burzinski signs.

Ensure no injury to the cervical spine

Check for a Babinski reflex

Position the client prone

Answer and Explanation

The Correct Answer is B

A) Assess for Kernig and Brudzinski signs: Kernig and Brudzinski signs are used to test for meningeal irritation, often associated with conditions like meningitis. However, these tests should not be performed if there is a risk of spinal injury, as they could potentially exacerbate any existing cervical spine injury.
B) Ensure no injury to the cervical spine: Before performing tests that involve neck movements, such as those for meningeal irritation, it is crucial to ensure that there is no existing cervical spine injury. Performing such tests on a client with a cervical spine injury could lead to further harm. Therefore, checking for cervical spine stability and injury is the most important initial step.
C) Check for a Babinski reflex: The Babinski reflex is used to assess neurological function but is not specifically related to detecting meningeal irritation. It is not the immediate priority when evaluating for possible cervical spine injury.

D) Position the client prone: Positioning the client prone is not relevant for assessing meningeal irritation and may not be appropriate depending on the client’s condition. The focus should be on ensuring the client's safety and stability before performing specific physical tests.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is C

Explanation

A. Glenohumeral joint: The glenohumeral joint is the shoulder joint. Pain with chewing is unlikely to be related to issues with the shoulder joint, as this joint is not involved in the chewing process.

B. Sternoclavicular joint: The sternoclavicular joint is where the clavicle meets the sternum. Problems here might affect shoulder and chest movement, but they would not typically cause pain specifically related to chewing.
C. Temporomandibular joint (TMJ): The TMJ is directly involved in the movement of the jaw, which is essential for chewing. Chronic pain during chewing often indicates a problem with the TMJ, such as TMJ disorder, which can cause pain, clicking, and other issues when moving the jaw.
D. Acromioclavicular joint: The acromioclavicular joint is located at the top of the shoulder where the clavicle meets the acromion of the scapula. This joint primarily affects shoulder movement, not chewing.

A. Romberg test B. Rapid alternating movement test C. Tinel test D. Allen test

Correct Answer is D

Explanation

A) Romberg test: The Romberg test is used to assess a person’s balance and proprioception by asking them to stand with their eyes closed. It does not evaluate the patency of the ulnar and radial arteries.
B) Rapid alternating movement test: The rapid alternating movement test evaluates motor function and coordination by asking the patient to perform tasks like rapidly alternating hand movements. This test is not related to assessing arterial patency.
C) Tinel test: The Tinel test is used to detect nerve compression or irritation by tapping over a nerve, such as the median nerve at the wrist, to see if it elicits a tingling sensation. It does not assess the patency of the ulnar and radial arteries.
D) Allen test: The Allen test is specifically designed to evaluate the patency of the ulnar and radial arteries. It involves occluding both arteries at the wrist while the patient makes a fist and then releasing one artery to assess blood flow to the hand. This test ensures that there is adequate blood supply to the hand if one of the arteries is compromised.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

When preparing to test a client for meningeal irritation, which of the following would be most important for the nurse to do first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse assesses a client who reports chronic pain with chewing. The nurse should assess which body area to investigate the client's problem further?

Correct Answer is C

Explanation

The test done to evaluate and compare the patency of the ulnar and radial arteries is:

Correct Answer is D

Explanation

A nurse is performing a complete physical examination on a patient. After examining the patient with the Snellen chart, the nurse documented distance vision in both eyes 20/40. The patient asks the nurse what 20/40 means:

The nurse is planning to inspect a client's apical heart impulses. What should the nurse do to ensure an accurate assessment of this organ?

How would the nurse assess CN VIII Acoustic, vestibulocochlear: Select all that Apply

When assessing an adult client experiencing diarrhea, the nurse notes a round "moon" face, a buffalo hump at the nape of the neck, and a velvety discoloration around the neck. What is the possible cause of these signs?

Assessment of the client reveals that he is unresponsive to all stimuli and his eyes remain closed. The nurse documents the client's level of consciousness as which of the following?

A nursing student asked the respiratory floor nurse why the adventitious wheezing breath sounds are present in asthmatic patients. The nurse should respond:

A nurse is assessing a patient that presents with a chief complaint of decreased sensation in the feet and non-healing ulcers on the soles of his foot. The picture below shows the patient's foot. What is likely causing the patient's symptoms?

A patient is diagnosed with a Pneumothorax on the right lung. During the assessment, when percussing this area the nurse expects to find the percussion note as: