The advanced practice registered nurse (APRN) is assessing an 15 year-old who presents with sudden high fever, severe headache, and a stiff neck. From the health history, the APRN suspects meningitis. What maneuvers can the APRN perform to assess meningeal inflammation? SELECT ALL THAT APPLY.

A. Kernig sign is correct because it assesses meningeal irritation. The APRN flexes the patient’s hip and knee to 90° and then attempts to extend the knee. Pain or resistance in the hamstrings during this maneuver is a positive Kernig sign, suggestive of meningeal inflammation, commonly seen in meningitis. B. Murphy’s sign is incorrect because it is used to assess cholecystitis. Pain and inspiratory arrest upon palpation of the right upper quadrant occurs during Murphy’s test, which is unrelated to meningeal inflammation. C. Trendelenburg sign is incorrect because it assesses hip abductor muscle weakness, particularly in gluteus medius or minimus weakness, often associated with hip disorders. It does not assess meningeal irritation. D. Brudzinski sign is correct because it also evaluates meningeal irritation. When the APRN flexes the patient’s neck forward, involuntary hip and knee flexion indicates a positive Brudzinski sign, which is highly suggestive of meningitis.