A 19-year old-college student presents to the emergency room with fever, headache, and neck pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of her dorm mates have been vaccinated, but she hasn't been. Which of the following physical examination descriptions is most consistent with meningitis?
A) Head is normocephalic and atraumatic, fundi with sharp discs, neck supple with full range of motion
B) Head is normocephalic and atraumatic, fundi with sharp discs, neck with paraspinous muscle spasm and limited range of motion to the right
C) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck tender to palpation, unable to perform range of motion
D) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck supple with full range of motion
C) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck tender to palpation, unable to perform range of motion
Blurred disc margins are consistent with papilledema, and neck tenderness and lack of range of motion are consistent with neck stiffness, which in this scenario is likely to be caused by meningeal inflammation. Later, you will learn about Kernig's and Brudzinski's signs, which are helpful in testing for meningeal irritation on examination.
You might also like to view...
The nurse is assessing a patient who has become rapidly and exceedingly anxious because her fingernail polish is chipped. If the patient has remained in a prolonged state of anxiety, the nurse concludes the patient is demonstrating:
a. signal anxiety. b. general anxiety. c. anxiety traits. d. panic disorder.
The nurse is caring for a client who has had surgery the previous day. The client tells the nurse, "Breathing in using this thing (incentive spirometer) is a ridiculous waste of time." What is the nurse's best response?
a. "The spirometer will help you cough ef-fectively." b. "The spirometer will help your lungs ex-pand." c. "The spirometer will help prevent blood clots." d. "The spirometer will improve blood flow in your lungs."
A patient shouts at a nurse who just entered the room, "You're an incompetent fool. Leave me alone." The nurse's response should be based on which rationale?
a. The anger was created by a situation or significant person, not the nurse. b. The reaction probably results from transference and countertransference. c. The patient is probably reacting to fear of loss of emotional control. d. The patient has a right to openly express negative feelings.
Which patient outcomes are major goals of antiretroviral therapy? (Select all that apply.)
a. Prevention of opportunistic infections b. Conversion to an HIV-negative antibody status c. Reduction of the number of viral particles in the patient's blood d. Increase in CD4+ cells e. Decrease in CD8+ cells f. Prevention of disease spread