Answer to Question 1
ANS: D
Two assessment tests are used in evaluating a patient with meningitis: the Kernig sign and the Brudzinski sign. The nurse has demonstrated a positive Brudzinski sign. The Kernig sign is elicited by placing the patient supine with hips flexed and raising and straightening the leg. Pain behind the knee and resistance are abnormal findings possibly indicative of meningitis. The Moro reflex is done on infants. The Grey-Turner sign is bruising of the flanks, often accompanying pancreatitis.
Answer to Question 2
ANS: C
All actions are appropriate for the child with acute bacterial meningitis. However, the priority is obtaining cultures so that appropriate therapy can be identified. After cultures are obtained, the nurse will administer broad-spectrum antibiotics until the culture and sensitivity results are known.
The nurse conducts the health history as the first step in the nursing assessment
Patient teaching: neck assessment
Patient teaching: male genetalia assessment
A Japanese American child in California tagged for relocation to an internment camp.
Madonna and Child with St. Anne and Infant St. John the Baptist.