The nurse is assessing a patient in the emergency department in whom meningitis is suspected. Which of the following symptoms would the nurse associate with meningitis?

Arched back with the neck flexed back
Inability to straighten legs without pain
Temperature of 103˚F

Explanation

• Symptoms of meningitis include fever, opisthotonos (abnormal positioning with arched back and head flexed backward), nuchal rigidity, and Brudzinski's sign and Kernig's sign, all of which are signs of meningeal irritation. Nuchal rigidity is seen in 30% of adult cases. Brudzinski's and Kernig's signs are seen in only 5% of adults with meningitis.

• Positive Kernig's sign is seen when the leg is flexed at the hip and the knee at 90 degree angles, and pain causes the patient to resist extension when the knee is straightened by the physician performing the assessment.

• Positive Brudzinski's sign is noted by flexion of the hip and knee in response to forward flexion of the neck, indicative of meningitis.

• Fluctuating muscle weakness that worsens with effort and improves with rest is the hallmark symptom of myasthenia gravis.

• Paralysis is not a symptom of meningitis. 

• For a person who has epilepsy, the characteristic symptom is seizures.

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