CH 56 EAQ Inflammatory Conditions of the Brain

The nurse determines that a patient's mean arterial pressure (MAP) is below 70 mm Hg. What outcome of this MAP should be of most concern to the nurse? a. Decreased cerebral blood flow (CBF) b. Increased intracranial pressure (ICP) c. Increased cerebral perfusion pressure (CPP) d. Normal intracranial pressure (ICP)

ANS: A A MAP below 70 mm Hg results in a decreased CBF. It will not result in an increased or normal ICP. The cerebral perfusion pressure will be decreased. A MAP below 70 mm Hg does not necessarily guarantee a normal ICP.

The nurse is caring for a patient with meningitis that has a fever. Which parameter should be monitored to prevent complications for this patient? a. Fluid intake b. Urine output c. Blood pressure d. Respiratory rate

ANS: A A patient with a fever may develop dehydration, so the patient's fluid intake should be assessed. Urine output, blood pressure, and respiratory rate might be altered with fever, but monitoring these parameters would not help prevent any complications in a patient with meningitis.

What is the gold standard for measuring intracranial pressure (ICP)? a. Ventriculosotomy b. Fiberoptic catheter c. Air pouch/pneumatic d. Transcranial Doppler

ANS: A A ventriculosotomy is the gold standard for measurement of ICP. A fiberoptic catheter and air pouch/pneumatic are other measures for monitoring ICP, but they are not considered the gold standard. A transcranial Doppler evaluates blood flow in the brain.

A patient is diagnosed with viral encephalitis and is hospitalized. What drug does the nurse anticipate administering? a. Acyclovir b. Ampicillin c. Vidarabine d. Vancomycin

ANS: A Acyclovir is the drug of choice to treat viral encephalitis because it has fewer side effects. Ampicillin and vancomycin are used to treat bacterial meningitis. Vidarabine is used to treat encephalitis, but it has more side effects than acyclovir.

Why is an older adult patient who falls at a high risk for a chronic subdural hematoma? a. Larger subdural space b. Changes in vasculature c. Decrease in pain sensation d. Decrease in level of consciousness

ANS: A Chronic subdural hematomas are more common in older adults because of the potentially larger subdural space as a result of brain atrophy. With aging, pain sensation may be reduced, but this is not the physiologic cause for the risk of a chronic subdural hematoma. Changes in vasculature occur in the elderly as well but do not put the patient at risk for a subdural hematoma from a fall. The older adult patient normally does not experience a decreased level of consciousness; this is an alteration in mental status and is a pathologic symptom unrelated to the risk for chronic subdural hematoma.

The nurse is performing a neurologic assessment for a patient and observes a fixed unilateral dilated pupil. Which cranial nerve does the nurse suspect is being compressed? a. III b. IV c. V d. VIII

ANS: A Compression of CN III, the oculomotor nerve, is a result of the brain shifting from midline, compressing the trunk of the CN III, and paralyzing the muscles controlling pupillary size and shape. CN IV is the trochlear nerve, which moves the eye inward, down, and laterally. CN V (trigeminal nerve) is responsible for sensation in the face and motor functions such as biting and chewing. CN VIII is the vestibulocochlear nerve, which is responsible for hearing and balance.

The nurse is caring for four patients in the intensive care unit (ICU). Which patient with an infection is at the highest risk for the development of cerebral edema? a. A patient with encephalitis b. A patient with cerebral thrombosis c. A patient who sustained a contusion from a fall d. A patient with hydrocephalus from a malfunctioning shunt

ANS: A Encephalitis is a cerebral infection that can cause cerebral edema. Hydrocephalus is the buildup itself of fluid in the brain. A contusion is bruising. A thrombosis is a blood clot in the circulatory system.

A nurse is caring for a patient who has increased intracranial pressure and diabetes insipidus. When monitoring urine output, for what is the nurse assessing the patient? a. Hypernatremia b. Decreased urine output c. Dilutional hyponatremia d. Elevated blood glucose level

ANS: A Hypernatremia is a symptom of diabetes insipidus, so the nurse must monitor this patient's urine output carefully. Elevated blood glucose levels are not measured via urine output but rather with blood tests. Urine output is increased, not decreased, in the setting of diabetes insipidus, because of the decreased antidiuretic hormone. Dilutional hyponatremia is not a symptom of diabetes insipidus; rather, hypernatremia is.

The nurse is caring for a patient with increased intracranial pressure (ICP). Which osmotic diuretic does the nurse prepare to administer to lower the ICP? a. Mannitol b. Cimetidine c. Dexamethasone d. Hypertonic saline

ANS: A Mannitol is an osmotic diuretic that is given intravenously (IV) to decrease ICP. Hypertonic saline is an IV solution that can be used to help reduce cerebral swelling. Dexamethasone is a corticosteroid used to treat vasogenic edema. Cimetidine is a histamine (H 2) receptor blocker given to a patient receiving corticosteroids to prevent gastrointestinal ulcers and bleeding.

Which population has the highest rate of malignant brain tumors? a. White males b. Asian males c. Hispanic males d. African American males

ANS: A Of these groups, white males have the highest incidence of malignant brain tumors. Asian and Hispanic males have a lower incidence brain tumors. African American males have a higher incidence of benign tumors.

What medication with a rapid onset and a short half-life can be used for anxiety and agitation in a patient with increased intracranial pressure? a. Propofol b. Opioids c. Benzodiazepines d. Nondepolarizing neuromuscular blocking agents

ANS: A Propofol has a rapid onset, short half-life and is used for anxiety and agitation in the ICU. Analgesics like opioids are used for pain, not anxiety and agitation. Benzodiazepines are usually avoided in the patient with increased intracranial pressure unless used with neuromuscular blocking agents. A nondepolarizing neuromuscular blocking agent is a paralytic.

The nurse hears snoring sounds in a patient with increased intracranial pressure (ICP). What does the nurse recognize these sounds indicate that require immediate action? a. Obstruction b. Oversedation c. Normal finding e. Decreasing ICP

ANS: A Snoring sounds in a patient who has increased ICP is indicative of an obstruction, and this is an emergency. The ICP will not decrease with snoring, and snoring is not a normal finding with increased ICP. Snoring in a patient with increased ICP is not an indication of oversedation.

A patient with meningitis has a weakness of the left upper limb and lower limb, blurred speech, and reduced vision. The symptoms did not resolve after treatment. What does the nurse infer from these symptoms? a. Cerebral abscess b. Acute cerebral edema c. Neurologic dysfunction d. Increased intracranial pressure

ANS: A Weakness of the left upper limb and lower limb (hemiparesis), blurred speech (dysphasia), and reduced vision (hemianopsia) are symptoms that typically resolve after meningitis treatment. If these symptoms persist, cerebral abscess is suspected. Acute cerebral edema, neurologic dysfunction, and increased intracranial pressure are complications of meningitis that do not persist after meningitis is treated.

A patient with meningitis is scheduled for a lumbar puncture. When is the appropriate time for the nurse to prepare the patient for the procedure? Select all that apply. a. After the blood culture test b. Before starting the antibiotic therapy c. After the computed tomography (CT) scan d. Before the magnetic resonance imaging (MRI) scan e. Before the culture test of nasopharyngeal secretions

ANS: A B C A lumbar puncture is performed after a blood culture test because it may help assess infection. Antibiotic therapy should be given after a lumbar puncture, while awaiting the results of cerebrospinal fluid analysis. Computed tomography (CT) and magnetic resonance imaging (MRI) scan reveal increased intracranial pressure (ICP) and cerebral edema. If there is increased ICP, a lumbar puncture cannot be performed; therefore, a lumbar puncture cannot be performed before obtaining the results of these scans. A lumbar puncture cannot be performed before a culture test of nasopharyngeal secretions.

When performing a neurologic assessment, what is the nurse assessing when comparing the pupils? Select all that apply. a. Size b. Shape c. Reactivity d. Movement e. Visual acuity f. Corneal reflex

ANS: A B C D When a neurologic assessment is performed, the pupils are compared for reactivity, size, shape, and movement. Eliciting a corneal reflex provides information about cranial nerves V and VII, not neurologic functioning. Visual acuity is used to determine the smallest letters that can be seen, but this does not provide information about neurologic functioning.

Which are components of a secondary intracranial injury? Select all that apply. a. Hypoxia b. Ischemia c. Hypotension d. Blunt force trauma e. Impact of a car accident f. Increased intracranial pressure

ANS: A B C F Ischemia, increased intracranial pressure, hypoxia, and hypotension are components of a secondary intracranial injury. The impact of a car accident and blunt force trauma are primary components.

A patient with bacterial meningitis develops seizures. What are the appropriate nursing actions for this patient? Select all that apply. a. Convey an attitude of caring. b. Administer antiseizure medications. c. Forbid the patient from seeing visitors. d. Use a commanding voice to give explanations. e. Keep a familiar person at the patient's bedside.

ANS: A B E Antiseizure medications should be administered to decrease the frequency of seizures. An attitude of caring should be conveyed when a patient is having mental distortion. A familiar person should be kept at the bedside of a patient to help the patient to calm down. A soothing voice should be used to convey unhurried gentleness toward the patient with mental distortion.

The nurse is admitting a patient with a diagnosis of meningitis. When planning the care for this patient, what nursing actions should the nurse include? Select all that apply. a. Monitor temperature. b. Check for muscle pains. c. Check for retinal damage. d. Assess intraocular pressure. e. Assess the eye for sensitivity to light.

ANS: A B E The clinical manifestations associated with meningitis include fever, muscle pains, and photophobia. Thus temperature, muscle pains, and sensitivity to light should be monitored in a patient with meningitis. Retinal damage and intraocular pressure are not associated with meningitis.

The nurse is performing an assessment of the central nervous system (CNS) for a patient. What should the nurse be sure to include when documenting the assessment? Select all that apply. a. Speech b. Seizures c. Contusions d. Oxygen saturation e. Bowel and bladder incontinence f. Decerebrate or decorticate posturing

ANS: A B E F Decerebrate or decorticate posturing, speech, bowel and bladder incontinence, and seizures are all elements the nurse observes when assessing the CNS. Oxygen saturation is reflective of respiratory status, not the CNS, and contusions are a body surface assessment, unrelated to the CNS.

When teaching a patient about home care following meningitis, which instructions should the nurse provide regarding the patient's diet? Select all that apply. a. Take small frequent feedings. b. Avoid eating peanuts and peanut butter. c. Include chicken and lean meat in the diet. d. Include whole grains, potatoes, and cereals in the diet. e. Consume moderate quantities of alcohol and caffeinated beverages.

ANS: A C D As a part of home care, the nurse should provide instructions regarding the importance of adequate nutrition, with an emphasis on a high-protein and high-calorie diet. Whole grains, potatoes, and cereals are packed with calories and should be included in the diet. Chicken and lean meats are good sources of protein and should be an important component of the meal. The meals should be small and given more often at frequent intervals. Peanuts and peanut butter should also be included in the diet because they are good sources of protein and are calorie-dense. Alcohol and caffeinated beverages should be excluded from the diet.

A patient develops hydrocephalus. When planning for patient care, which cause does the nurse determine could be a contributing factor? Select all that apply. a. Overproduction of CSF b. Underproduction of CSF c. Defective reabsorption of CSF d. Rupture of cerebral blood vessels e. Obstruction to flow of cerebrospinal fluid (CSF)

ANS: A C E Hydrocephalus is the accumulation of CSF, which can be caused due to obstruction to flow of CSF and defective reabsorption and overproduction of CSF. Rupture of blood vessels causes intracranial bleeding. Underproduction of CSF is not a cause of hydrocephalus.

The nurse is caring for a patient in the neurologic intensive care unit with increased intracranial pressure (ICP). What nursing actions will promote the most positive outcome for the patient? Select all that apply. a. ICP monitoring b. Cerebral angiography c. Elevating the head of the bed 30 degrees d. Maintaining PaO 2 of 90 mm Hg or greater e. Taking a patient history and physical examination f. Maintaining a systolic arterial pressure of 100-160 mm Hg

ANS: A C F Elevating the head of the bed 30 degrees, ICP monitoring, and maintaining a systolic arterial pressure of 100-160 mm Hg are components of the expected management for a patient with increased ICP. Cerebral angiography, history, and a physical are diagnostic assessment tools rather than interventions. The PaO 2 should be maintained at 100 mm Hg or greater.

Otorrhea is suspected in a patient with head trauma. Which tests may be used to detect cerebral spinal fluid (CSF)? Select all that apply. a. Dextrostix b. Litmus test c. Guaiac test d. Tes-Tape strip e. Imaging scans f. Quantitative hCG

ANS: A D E A Dextrostix and Tes-Tape strip can be used to detect glucose, which is present in CSF. The appearance of a halo around blood in imaging studies may also be indicative of CSF. The litmus test analyzes the pH of the fluid, which does not provide information about CSF. The guaiac test is used to test stools for occult blood. Quantitative hCG is a test that measures the hormone hCG, which does not provide information about CSF.

The nurse is caring for a patient who is diagnosed with bacterial meningitis. What are the priority actions by the nurse? Select all that apply. a. Collect specimens for a culture to confirm the diagnosis. b. Wait for a confirmed diagnosis before starting antibiotics. c. Wait and watch until the fever reduces and next signs appear. d. Administer a corticosteroid along with the first dose of antibiotics. e. Initiate antibiotic therapy without waiting for a confirmed diagnosis.

ANS: A D E Collecting specimens to confirm the diagnosis and administering corticosteroids and antibiotics are the measures that must be taken immediately because bacterial meningitis is a medical emergency. Waiting and watching until the fever reduces and the next signs of meningitis appear and waiting for a confirmed diagnosis before starting antibiotics are not advisable, because they may aggravate the condition and may become life-threatening.

The nurse is caring for a patient who sustained a head injury during a fall. Which factors influence intracranial pressure (ICP)? Select all that apply. a. Posture b. Swallowing c. Drowsiness d. Temperature e. Carbon dioxide levels f. Intraabdominal pressure

ANS: A D E F Posture, temperature, intraabdominal pressure, and carbon dioxide levels all influence ICP. Swallowing does not affect ICP. Drowsiness may be a sign of increased ICP, but it does not influence it.

A patient sustains a skull fracture and has loose fragments of bone. For which procedure will the nurse prepare the patient? a. Cranioplasty b. Craniotomy c. Craniectomy d. Conservative treatment

ANS: B A skull fracture with loose fragments of bone requires a craniotomy to elevate the depressed bone and remove the bone fragments. A cranioplasty is a surgical repair of the bone. A craniectomy will be performed when large amounts of the bone are destroyed. In this procedure the bone is removed. Conservative treatment is used for less significant fractures.

The nurse is providing discharge instructions for a patient and a caregiver for the first three days after a head injury. Which information is important for the nurse to include? a. Resume driving. b. Abstain from alcohol. c. Restrict sodium in the diet. d. Wear a helmet when riding a bike.

ANS: B Alcohol is a central nervous system depressant and may mask important neurologic changes related to a head injury. The patient should refrain from driving because of potential neurologic changes from the head injury. A dietary sodium restriction is not necessary unless it is related to another medical condition. Wearing a helmet is a preventive measure not specific to patients with head injuries.

A patient sustained head trauma during a skiing accident and lost consciousness but was then awake and alert. What complication of a head trauma might this patient have developed that results in bleeding between the dura and the inner surface of the skull? a. Contusion b. Epidural hematoma c. Subdural hematoma d. Intracerebral hematoma

ANS: B An epidural hematoma is bleeding between the dura and the inner surface of the skull. The patient may lose consciousness followed by a period of being awake and alert. A subdural hematoma is bleeding between the dura and the arachnoid layer of the meninges. An intracerebral hematoma is bleeding into the brain tissue. A contusion is bruising of the brain tissue within a focal area.

When a patient's systemic arterial pressure is altered, how does the brain respond? a. It decreases intracranial pressure. b. It autoregulates. c. It increases intracranial pressure. d. It increases brain compliance.

ANS: B Autoregulation is a normal response that occurs in the brain when systemic arterial pressure is altered. Intracranial pressure alterations, decreasing or increasing, are not an initial response to systemic pressure changes. Compliance is the expandability of the brain and is not an initial response to systemic arterial pressure change.

A patient with meningitis developed loss of the corneal reflex. Which cranial nerve irritation would have led to the loss of the corneal reflex? a. Cranial nerve II b. Cranial nerve V c. Cranial nerve IV d. Cranial nerve VII

ANS: B Cranial nerve V is the trigeminal nerve; irritation of this nerve will lead to the loss of the corneal reflex. Cranial nerve II (optic nerve) irritation leads to blindness. Cranial nerve IV (trochlear nerve) irritation affects ocular movements. Cranial nerve VII (facial nerve) irritation causes facial paresis.

The registered nurse is teaching a student nurse about treatment outcomes of a patient with meningitis. Which statement made by the student nurse about treatment outcomes would need correction? a. Pain can be controlled. b. Hearing loss can be resolved. c. Facial paresis can be resolved. d. Neck stiffness can be resolved.

ANS: B Hearing loss caused by irritation of cranial nerve VIII (vestibulocochlear nerve) may be permanent after the treatment; thus, that statement needs to be corrected. Pain can be controlled after the treatment. Facial paresis and neck stiffness are also caused by cranial nerve irritation and neurologic dysfunction, and these can be resolved.

A patient with increased intracranial pressure (ICP) has an order for phenytoin. What does the nurse anticipate the expected outcome of administering phenytoin will be for the patient? a. Decreased ICP b. Prevention of seizures c. Decreased systolic pressure d. Prevention of gastrointestinal (GI) ulcers

ANS: B Phenytoin is used to control seizures, for which this patient is at risk. Histamine (H 2 receptor antagonists), not phenytoin, is used to prevent GI ulcers. Phenytoin will not affect systolic pressure. Mannitol is used to help decrease ICP.

How many doses of meningococcal conjugate vaccine are recommended for prevention of bacterial meningitis? a. One b. Two c. Three d. Four

ANS: B The meningococcal conjugate vaccine is given in two doses to prevent bacterial meningitis. The first dose is recommended for all 11 to 12 year old, with a booster dose given at age 16.

A patient with bacterial meningitis is given antibiotic therapy and symptomatic treatment. What is the expected treatment outcome? a. The patient may experience muscle aches. b. The patient may return to maximal neurologic function. c. The patient may have a chance of recurrence of infection. d. The patient may experience some discomfort while performing daily activities.

ANS: B The patient is expected to return to his or her maximal neurologic function after treating the meningitis. The patient is relieved of muscle aches after the treatment. The infection is not expected to recur after the treatment. The patient should not experience any discomfort while performing daily activities.

Which type of cerebral edema occurs mainly in the white matter and is characterized by leakage of large molecules from the capillaries into the surrounding space? a. Interstitial cerebral edema b. Vasogenic cerebral edema c. Hypoxic cerebral edema d. Cytotoxic cerebral edema

ANS: B Vasogenic cerebral edema occurs mainly in the white matter and is the most common type characterized by leakage of large molecules from the capillaries into the surrounding space. Interstitial cerebral edema is usually a result of hydrocephalus. Hypoxia is a lack of oxygen to the brain and does not cause cerebral edema, though the edema may cause the hypoxia. Cytotoxic cerebral edema results from disruption of the integrity of the cell membranes from lesions or trauma.

A patient with bacterial meningitis has a severe headache. Which symptoms should be monitored by the nurse to prevent complications? Select all that apply. a. Skin rash b. Vomiting c. Irritability d. Photophobia e. Neck stiffness

ANS: B C Vomiting and irritability should be monitored because they might be accompanied with a severe headache. Vomiting may cause discomfort to the patient, and irritability of cranial nerves leads to serious neurologic symptoms. Skin rashes, photophobia, and neck stiffness are associated with bacterial meningitis.

When managing a fever in a patient with acute meningitis, what actions should the nurse perform? Select all that apply. a. Encourage shivering in the patient to help reduce fever. b. Reduce fever with the use of acetaminophen. c. Use a cooling blanket on the patient to reduce fever. d. Reduce body temperature rapidly to provide relief. e. Lower temperature by the use of tepid water sponge baths.

ANS: B C E A cooling blanket can be used to reduce fever, acetaminophen may be used to reduce fever, and tepid water sponge baths may be effective in lowering temperature. Shivering should be prevented because it may cause a rebound effect and increase the temperature. Rapidly reducing temperature may result in shivering and is not advisable.

A patient experiences a head injury in a motor vehicle crash. Which priority actions does the nurse anticipate providing when planning the care of the patient? Select all that apply. a. Anticipate intubation. b. Administering oxygen. c. Maintain neck alignment. d. Maintaining normothermia. e. Administer fluids cautiously. f. Establish intravenous (IV) access.

ANS: B C F Administration of oxygen, assuming neck injury with head injury, and establishing IV access are priority interventions to ensure the health and safety of the patient. Maintaining normothermia, anticipating intubation, and administering fluids cautiously are part of ongoing monitoring to help prevent secondary injury; these interventions can take place after the priority interventions have.

When performing an assessment on a patient with a head injury, which objective data does the nurse record? Select all that apply. A. Headache B. Battle's sign C. Projectile vomiting D. Past health history E. Mechanism of injury F. Cranial nerve deficits

ANS: B C F Battle's sign, projectile vomiting, and cranial nerve deficits are objective data the nurse will record when assessing a patient with a head injury. A headache is considered subjective data. While the mechanism of injury may be helpful information, it is not part of the assessment itself. Past health history is considered subjective data.

Which are characteristics of Cushing's triad? Select all that apply. a. Tachycardia b. Bradycardia c. Systolic hypotension d. Systolic hypertension e. Widening pulse pressure f. Narrowing pulse pressure

ANS: B D E Cushing's triad is a neurological emergency characterized by a widening pulse pressure, bradycardia, and systolic hypertension. The heart rate slows, so Cushing's triad does not include tachycardia. Systolic blood pressure increases, so hypotension is not present. Pulse pressure widens, not narrows, with Cushing's triad.

The nurse caring for a patient with a diagnosis of acute meningitis. Which actions should the nurse perform? Select all that apply. a. Lower the head of the bed. b. Place the patient in a comfortable position. c. Instruct the patient to ambulate or walk around the room. d. Position the patient in a curled up position with the head slightly extended. e. Slightly elevate the head of the bed if permitted after lumbar puncture.

ANS: B D E In acute meningitis, the nurse should assist the patient to a comfortable position; often, curled up with the head slightly extended is best. The head of the bed should be slightly elevated when permitted after lumbar puncture. Lowering the head of bed may increase headaches in the patient. Making the patient walk in the room is not advisable because movement can aggravate the head and neck pain. The patient with meningitis may have delirium, and making the patient walk may increase risk of injury.

A patient with meningococcal meningitis is suspected to have Waterhouse-Friderichsen syndrome. Which possible findings would the nurse observe regarding this complication? Select all that apply. a. Diplopia b. Petechiae c. Pulmonary effusion d. Adrenal hemorrhage e. Disseminated intravascular coagulation (DIC)

ANS: B D E Waterhouse-Friderichsen syndrome is a complication of meningococcal meningitis, which is manifested by petechiae, adrenal hemorrhage, DIC, and circulatory collapse. Waterhourse-Friderichsen syndrome does not cause diplopia and pulmonary effusion.

A patient with meningitis is suffering from mental distortion. Which intervention should be performed to reduce mental distortion? a. Provide low lighting. b. Elevate the head of the bed. c. Minimize environmental stimuli. d. Apply a cool cloth over the eyes.

ANS: C A patient with a mental distortion may be frightened and misinterpret the environment. Therefore minimizing environmental stimuli may help to calm the patient. Low lighting is provided if the patient experiences photophobia. The head of the bed is slightly elevated if the patient experiences head and neck pain. A cool cloth should be applied over the eyes to decrease photophobia.

The nurse is caring for a group of patients on the acute care unit. Which patient is at greatest risk for the development of bacterial meningitis? a. A patient with a skull fracture b. A patient with prior brain trauma c. A patient with a pulmonary infection d. A patient with bacterial endocarditis

ANS: C A patient with a pulmonary infection is at a risk of developing bacterial meningitis. A skull fracture, bacterial endocarditis, and prior brain trauma or surgery places the patient at risk of developing brain abscess.

A patient has visual impairment and hallucinations. Which lobe of the brain would show a presence of an abscess on a computed tomography scan? a. Frontal lobe b. Parietal lobe c. Occipital lobe d. Temporal lobe

ANS: C An abscess in the occipital lobe may lead to visual impairment and hallucinations. Abscesses in the frontal and parietal lobe may result in a local or systemic infection. A temporal lobe abscess can cause psychomotor seizures.

The nurse is caring for a patient with acquired immunodeficiency syndrome (AIDS) who is suspected to have encephalitis. What type of encephalitis does the nurse anticipate the patient is at risk for? a. La Crosse encephalitis b. West Nile encephalitis c. Cytomegalovirus encephalitis d. Herpes simplex virus encephalitis

ANS: C Cytomegalovirus encephalitis is commonly found in patients with acquired immunodeficiency syndrome (AIDS). La Crosse encephalitis and West Nile encephalitis are epidemic diseases transmitted by ticks and mites. Herpes simplex virus encephalitis is a nonepidemic encephalitis.

The nurse is reviewing the laboratory results for a patient with bacterial meningitis. Which does the nurse anticipate observing in cerebrospinal fluid analysis? a. Decrease in neutrophils b. Decrease in lymphocytes c. Decrease in glucose level d. Decrease in protein level

ANS: C Glucose levels in the cerebrospinal fluid are decreased in a patient with bacterial meningitis. Neutrophils, lymphocytes, and protein levels are increased.

At which stage of increased intracranial pressure (ICP) does a loss of autoregulation occur? a. Stage I b. Stage II c. Stage III d. Stage IV

ANS: C In Stage III, there is a loss of autoregulation, and Cushing's triad will develop as decompensation increases. In Stage I, there is total compensation. In Stage II, compliance begins to decrease, and an increase in volume places the patient at risk for increased ICP. In Stage IV, the ICP rises to lethal levels, and brain herniation occurs.

When evaluating the diagnostic studies for a patient with bacterial meningitis, which factors should the nurse consider regarding lumbar puncture? Select all that apply. a. Lumbar puncture may require a contrast to be injected. b. Lumbar puncture is helpful in confirming diagnosis of brain tumor. c. Lumbar puncture is done after ruling out an obstruction in the foramen magnum. d. Lumbar puncture is usually helpful in confirming the diagnosis of bacterial meningitis. e. Lumbar puncture is done to analyze cerebrospinal fluid (CSF) in case of bacterial meningitis.

ANS: C D E Lumbar puncture is done to analyze CSF in case of bacterial meningitis and is done after ruling out an obstruction in the foramen magnum to prevent a fluid shift resulting in herniation. Lumbar puncture is usually helpful in verifying the diagnosis of bacterial meningitis. Lumbar puncture does not involve injection of contrast medium. The procedure is not helpful in confirming the diagnosis of brain tumor.

What type of skull fracture has multiple linear fractures with fragmentation of bone into many pieces? a. Linear b. Depressed c. Compound d. Comminuted

ANS: D A comminuted skull fracture has multiple linear fractures with fragmentation of bone into many pieces. A depressed fracture is an inward dentation of the skull. A linear fracture is a break in continuity of the bone, and a compound skull fracture involves a depressed skull fracture and scalp lacerations.

The nurse is monitoring a patient's intracranial pressure (ICP) after a craniotomy. Which finding must be reported immediately to the health care provider? a. An ICP of 5 mm Hg b. An ICP of 10 mm Hg c. An ICP of 15 mmHg d. An ICP of 20 mm Hg

ANS: D A sustained pressure of 20 mm Hg is abnormally high and must be treated. Normal ICP is 5 to 15 mm Hg, so ICPs of 5 mm Hg, 10 mm Hg, and 15 mm Hg do not require reporting.

The nurse is performing an assessment of a patient with a closed head injury from a blunt object. What is the most reliable clinical manifestation to determine the patient may be developing increased intracranial pressure (ICP)? a. Steady vital signs b. Reports of a headache c. Increased motor function d. An altered level of consciousness (LOC)

ANS: D Changes in the LOC are a result of impaired cerebral blood flow, which causes oxygen deprivation to the cerebral cortex and reticular activating system, so this is the most sensitive and reliable manifestation of ICP. A decrease, not increase, in motor function occurs as the ICP increases. A headache could indicate compression but could also be attributed to other causes. Changes in vital signs can be caused by increased ICP; they will not necessarily remain steady.

A patient is suspected of having disruption of motor fibers in the midbrain after sustaining a head injury. What clinical manifestation does the nurse anticipate finding as a result? a. Projectile vomiting b. Tentorial herniation c. Decorticate posturing d. Decerebrate posturing

ANS: D Decerebrate posturing is an expected clinical finding as a result of the disruption of motor fibers in the midbrain. Projectile vomiting is related to increased intracranial pressure (ICP). Tentorial herniation is a complication of increased ICP. Decorticate posturing is a result of interruption of voluntary motor tracts in the cerebral cortex.

Which intervention should be performed to prevent cranial nerve III palsy in a patient with meningitis? a. Providing low lighting b. Administering antibiotics c. Elevating the head of the bed d. Performing cooling techniques

ANS: D Fever may increase cerebral edema, which may cause cranial nerve III palsy. Therefore any fever should be treated vigorously by performing cooling techniques. Low lighting should be provided if the patient develops hallucinations and delirium. Antibiotics are administered to treat the infection. The head of the bed should be elevated to provide relief from head and neck pain.

The nurse assesses a patient for signs of meningeal irritation and observes for nuchal rigidity. What indicates the presence of this sign of meningeal irritation? A. Tonic spasms of the legs B. Curling in a fetal position C. Arching of the neck and back D. Resistance to flexion of the neck

ANS: D Nuchal rigidity is a clinical manifestation of meningitis. During assessment, the patient will resist passive flexion of the neck by the health care provider. Tonic spasms of the legs, curling in a fetal position, and arching of the neck and back are not related to meningeal irritation.

The family of a patient who was admitted 12 hours ago with suspected meningitis approaches the charge nurse stating "We do not understand. We were told the spinal tap looks good. Why is everyone still wearing gowns and masks"? What is the best response by the nurse? a. "I apologize. The isolation should have been discontinued." b. "These precautions need to be continued as long as the patient is in the hospital." c. "I will check with the health care provider and see if we can get the isolation discontinued." d. "The policy is that patients remain in isolation for a minimum of 24 hours, which is when the first culture report should be available."

ANS: D Patients who are suspected of having meningitis should be placed in respiratory isolation until the spinal fluid cultures are negative or effective antibiotic therapy has been in place for 24 to 48 hours. The earliest culture reports can be released is 24 hours. Standard precautions are still essential when the patient is removed from isolation. There is no need to contact the health care provider because infection control policies dictate the necessity of isolation. Even if the patient is diagnosed with meningitis, respiratory isolation will be discontinued once effective antibiotic therapy has been in place for a specified period.

A patient's cerebrospinal fluid (CSF) culture findings showed a white blood cell count of 1200 cells/µL, protein 600 mg/dL, and glucose 25 mg/dL. What could be the diagnosis for the patient? a. Brain abscess b. Viral meningitis c. Viral encephalitis d. Bacterial meningitis

ANS: D The normal range of white blood cell (WBC) count is 0 to 5 cells/µL, the normal range of protein is 15 to 45 mg/dL, and the normal range of glucose is 40 to 70 mg/dL in the cerebrospinal fluid. An increased WBC count, increased protein, and a decrease in glucose are signs of bacterial meningitis. A patient with a brain abscess would have an increased WBC count, normal protein levels, and a decrease or absence of glucose. In viral meningitis, increased WBC count and protein and a decreased or absence of glucose can be seen. In viral encephalitis, increased WBC count, slightly increased protein, and normal glucose levels are observed.

Using the Glasgow Coma Scale (GCS), the nurse assesses the patient and records a score of 5. What is the nurse's priority action? a. Notify the charge nurse. b. Continue to monitor the patient. c. Reassess the patient in an hour. d. Notify the rapid response team.

ANS: D The nurse must first notify the rapid response team. A GCS score of 5 or less generally indicates coma, and mechanical ventilation should be considered. The charge nurse will be notified, but the rapid response team is the priority. Continuing to monitor and reassess the patient within the hour is delaying proper management of the patient.

The nurse is monitoring a patient who has undergone a craniotomy. What is the priority action by the nurse? a. Monitor the patient for pain. b. Monitor the patient for infection. c. Monitor the patient for hemorrhaging. d. Monitor the patient for increased intracranial pressure (ICP).

ANS: D The priority action of the nurse caring for a patient following a craniotomy is to monitor for increased intracranial pressure (ICP), which can have serious life-threatening implications. The patient's pain should be managed, but pain is not an emergency. The patient should be monitored for infection, but the infection will not be immediately apparent. A hemorrhage will cause an increase in ICP if it is cerebral.

Which action should the nurse include in the plan of care for a patient who has bacterial meningitis? a. Restraining the patient in bed b. Increasing the patient's fluid intake c. Maintaining the patient in a flat supine position d. Reducing the patient's environmental stimuli as much as possible

ANS: D When a patient has bacterial meningitis, the meninges are inflamed and easily irritated by sensory input. For this reason environmental stimulation should be kept to a minimum to avoid causing seizures and neurologic discomforts. Patients with bacterial meningitis do not necessarily require restraints or an increase in fluid intake. The position of comfort for a patient with bacterial meningitis is supine with the head of bed elevated 30 to 45 degrees.