RN Nursing · Neurological Disorders in Children · Practice question
The nurse assesses an adolescent client who reports sudden severe headache and a stiff neck. Vital signs are as follows: blood pressure 112/72 mmHg, heart rate 88 beats/min, respiratory rate 20 breaths/min, temperature 102.4 F, SpO2 98% on room air. Which assessment finding should be most concerning and require immediate follow-up?
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Patellar reflexes at a +2
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Curvature of spine
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PERRLA bilaterally
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✓
Positive Kernig's sign
Answer & explanation
Correct: Positive Kernig's sign
A positive Kernig's sign is a classic meningeal irritation sign. It is elicited by flexing the patient's hip and knee to 90 degrees and then attempting to extend the knee — pain and resistance indicate meningeal irritation. In the context of sudden severe headache, stiff neck, and a fever of 102.4°F, a positive Kernig's sign strongly supports the diagnosis of meningitis and requires immediate follow-up including emergent lumbar puncture and initiation of empiric antibiotics. This constellation of findings represents a neurological emergency. Patellar reflexes rated at +2 are completely normal and do not warrant concern. Curvature of the spine may represent scoliosis but is unrelated to the acute presentation. PERRLA bilaterally — pupils equal, round, and reactive to light and accommodation — is a reassuring, normal neurological finding indicating no increased intracranial pressure or cranial nerve involvement at that moment. Among all the listed findings, only the positive Kernig's sign is a direct indicator of meningeal irritation and correlates specifically with the suspected diagnosis of meningitis in this acutely ill adolescent.
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