The nurse is assessing a patient with suspected bacterial meningitis and notes a positive Kernig sign. How should the nurse interpret this finding?
Pain in the neck when the patient flexes their head towards the chest
Involuntary flexion of the hips and knees when the neck is flexed
Photophobia and headache triggered by bright light
Pain and resistance when attempting to extend the patient's leg from a flexed position
The Correct Answer is D
A. Pain in the neck when the patient flexes their head towards the chest. This describes nuchal rigidity, not Kernig sign.
B. Involuntary flexion of the hips and knees when the neck is flexed. This describes Brudzinski sign, not Kernig sign.
C. Photophobia and headache triggered by bright light. These are symptoms of meningitis, but they are not specific to Kernig sign.
D. Pain and resistance when attempting to extend the patient's leg from a flexed position. A positive Kernig sign is when there is pain and resistance to leg extension from a flexed hip and knee position, indicating meningeal irritation.
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Correct Answer is B
Explanation
A. The glomerular filtration rate decreases because there is a reduction of blood flow to the kidneys. Reduced blood flow to the kidneys, or renal hypoperfusion, decreases the glomerular filtration rate (GFR) because less blood is being filtered through the kidneys. This can occur in conditions such as shock, severe dehydration, or heart failure, but it is not the primary mechanism in acute tubular necrosis (ATN).
B. The glomerular filtration rate decreases because there is injury to the renal tubular cells. In ATN, the injury to renal tubular cells impairs their function, leading to reduced reabsorption and filtration ability, which contributes to the decrease in GFR.
C. The glomerular filtration rate decreases because inflammatory cells invade the already damaged kidneys. While inflammation may be present, it is not the primary cause of decreased GFR in acute tubular necrosis; reduced blood flow and tubular cell injury are more direct causes.
D. The glomerular filtration rate decreases because there is obstruction leading to the filtration system backing up and eventually shutting the kidneys down. Obstruction is not typically a characteristic of acute tubular necrosis; ATN is usually caused by ischemic or toxic injury, not physical obstruction.
Correct Answer is A
Explanation
A. Hypovolemia leading to decreased renal perfusion. Hypovolemia from dehydration and low blood pressure reduces blood flow to the kidneys, resulting in pre-renal AKI, characterized by elevated BUN and creatinine.
B. Acute tubular necrosis. Acute tubular necrosis may cause AKI but is often due to prolonged hypoperfusion, nephrotoxic drugs, or ischemia, not the immediate presentation seen here.
C. Urinary tract obstruction. A urinary tract obstruction leads to post-renal AKI, often with symptoms like flank pain or difficulty urinating, not dehydration and low blood pressure.
D. Chronic kidney disease. Chronic kidney disease is a long-term condition and would not cause the acute symptoms or sudden onset of AKI as seen in this patient.