The nurse is evaluating the status of a client who had a craniotomy 3 days ago. The nurse would suspect the client is developing meningitis as a complication of surgery if the client exhibits:
A. A negative Kernig’s sign.
B. A positive Brudzinski’s sign.
C. Absence of nuchal rigidity.
D. A Glascow Coma Scale score of 15.
Correct Answer: B. A positive Brudzinski’s sign
Signs of meningeal irritation compatible with meningitis include nuchal rigidity, positive Brudzinski’s sign, and positive Kernig’s sign. Brudzinski’s sign is positive when the client flexes the hips and knees in response to the nurse gently flexing the head and neck onto the chest. Brudzinski’s sign is characterized by reflexive flexion of the knees and hips following passive neck flexion. To elicit this sign, the examiner places one hand on the patient’s chest and the other hand behind the patient’s neck. The examiner then passively flexes the neck forward and assesses whether the knees and hips flex.
Option A: Kernig’s sign is positive when the client feels pain and spasm of the hamstring muscles when the knee and thigh are extended from a flexed-right angle position. The Kernig sign is one of the eponymous clinical signs of meningitis. This test typically is performed in patients while supine and is described as resistance (or pain) with passive extension of the knees. This resistance is thought to be due to meningeal inflammation in the setting of meningitis or other clinical entities that may irritate the meninges.
Option C: Nuchal rigidity is characterized by a stiff neck and soreness, which is especially noticeable when the neck is fixed. Nuchal rigidity is an inability to flex the neck forward due to rigidity of the neck muscles. Similar to Kernig’s sign, research has shown that many people with meningitis don’t have the Brudzinski sign or nuchal rigidity.
Option D: A Glasgow Coma Scale of 15 is a perfect score and indicates the client is awake and alert with no neurological deficits. The Glasgow Coma Scale (GCS) is used to objectively describe the extent of impaired consciousness in all types of acute medical and trauma patients. The scale assesses patients according to three aspects of responsiveness: eye-opening, motor, and verbal responses. Reporting each of these separately provides a clear, communicable picture of a patient’s state.
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