NCLEX questions Meningitis

What position would be abnormal extension?

Assumes a decerebrate posture (hands out)

What position would be abnormal flexion?

Assumes a decorticate posture (in which the hands are toward the cord)

Bacterial Men. Usually requires

2 weeks of antibiotics. Therapy should begin 1-2 hours after prescribed

The nurse is preparing a client diagnosed with rule-out meningitis for a lumbar puncture. Which interventions should the nurse implement? Select all that apply. 1. Obtain an informed consent from the client or significant other. 2. Have the client empty the bladder prior to the procedure. 3. Place the client in a side-lying position with the back arched. 4. Instruct the client to breathe rapidly and deeply during the procedure. 5. Explain to the client what to expect during the procedure.

1. A lumbar puncture is an invasive procedure; therefore, an informed consent is required. 2. This could be offered for client comfort during the procedure. 3. This position increases the space between the vertebrae, which allows the HCP easier entry into the spinal column. 5. The nurse should always explain to the client what is happening prior to and during a procedure.

The nurse is caring for a client diagnosed with meningitis. Which collaborative intervention should be included in the plan of care? 1. Administer antibiotics. 2. Obtain a sputum culture. 3. Monitor the pulse oximeter. 4. Assess intake and output.

1. A nurse administering antibiotics is a collaborative intervention because the HCP must write an order for the intervention; nurses cannot prescribe medications unless they have additional education and licensure and are nurse practitioners with prescriptive authority.

The nurse is assessing the client diagnosed with meningococcal meningitis. Which assessment data would warrant notifying the HCP? 1. Purpuric lesions on the face. 2. Complaints of light hurting the eyes. 3. Dull, aching, frontal headache. 4. Not remembering the day of the week.

1. In clients with meningococcal meningitis, purpuric lesions over the face and extremity are the signs of a fulminating infection that can lead to death within a few hours.

The client diagnosed with septic meningitis is admitted to the medical floor at noon. Which health-care provider's order would have the highest priority? 1. Administer an intravenous antibiotic. 2. Obtain the client's lunch tray. 3. Provide a quiet, calm, and dark room. 4. Weigh the client in hospital attire.

1. The antibiotic has the highest priority because failure to treat a bacterial infection can result in shock, systemic sepsis, and death.

CDC recommends meningococcal vaccine between ages

11-12 and booster at 16 y/o

The nurse is developing a plan of care for a client diagnosed with aseptic meningitis secondary to a brain tumor. Which nursing goal would be most appropriate for the client problem "altered cerebral tissue perfusion"? 1. The client will be able to complete activities of daily living. 2. The client will be protected from injury if seizure activity occurs. 3. The client will be afebrile for 48 hours prior to discharge. 4. The client will have elastic tissue turgor with ready recoil.

2. A client with a problem of altered cerebral tissue perfusion is at risk for seizure activity secondary to focal areas of cortical irritability; therefore, the client should be on seizure precautions.

The client is diagnosed with meningococcal meningitis. Which preventive measure would the nurse expect the health-care provider to order for the significant others in the home? 1. The Haemophilus influenzae vaccine. 2. Antimicrobial chemoprophylaxis. 3. A 10-day dose pack of corticosteroids. 4. A gamma globulin injection.

2. Chemoprophylaxis includes administering medication that will prevent infection or eradicate the bacteria and the development of symptoms in people who have been in close proximity to the client. Medications include rifampin (Rifadin), ciprofloxacin (Cipro), and ceftriaxone (Rocephin).

Which statement best describes the scientific rationale for alternating a nonnarcotic antipyretic and a nonsteroidal anti-inflammatory drug (NSAID) every two (2) hours to a female client diagnosed with bacterial meningitis? 1. This regimen helps to decrease the purulent exudate surrounding the meninges. 2. These medications will decrease intracranial pressure and brain metabolism. 3. These medications will increase the client's memory and orientation. 4. This will help prevent a yeast infection secondary to antibiotic therapy.

2. Fever increases cerebral metabolism and intracranial pressure. Therefore, measures are taken to reduce body temperature as soon as possible, and alternating Tylenol and Motrin would be appropriate.

The public health nurse is giving a lecture on potential outbreaks of infectious meningitis. Which population is most at risk for an outbreak? 1. Clients recently discharged from the hospital. 2. Residents of a college dormitory. 3. Individuals who visit a third world country. 4. Employees in a high-rise office building.

2. Outbreaks of infectious meningitis are most likely to occur in dense community groups such as college campuses, jails, and military installations.

The nurse is assessing the client diagnosed with bacterial meningitis. Which clinical manifestations would support the diagnosis of bacterial meningitis? 1. Positive Babinski's sign and peripheral paresthesia. 2. Negative Chvostek's sign and facial tingling. 3. Positive Kernig's sign and nuchal rigidity. 4. Negative Trousseau's sign and nystagmus.

3. A positive Kernig's sign (client unable to extend leg when lying flat) and nuchal rigidity (stiff neck) are signs of bacterial meningitis, occurring because the meninges surrounding the brain and spinal column are irritated.

The wife of the client diagnosed with septic meningitis asks the nurse, "I am so scared. What is meningitis?" Which statement would be the most appropriate response by the nurse? 1. "There is bleeding into his brain causing irritation of the meninges." 2. "A virus has infected the brain and meninges, causing inflammation." 3. "This is a bacterial infection of the tissues that cover the brain and spinal cord." 4. "This is an inflammation of the brain parenchyma caused by a mosquito bite."

3. Septic meningitis refers to meningitis caused by bacteria; the most common form of bacterial meningitis is caused by the Neisseria meningitides bacteria.

GCS scores possible:

4- eye opening response 6-motor response 5-verbal response

Which type of precautions should the nurse implement for the client diagnosed with septic meningitis? 1. Standard Precautions. 2. Airborne Precautions. 3. Contact Precautions. 4. Droplet Precautions.

4. Droplet Precautions are respiratory precautions used for organisms that have a limited span of transmission. Precautions include staying at least four (4) feet away from the client or wearing a standard isolation mask and gloves when coming in close contact with the client. Clients are in isolation for 24 to 48 hours after initiation of antibiotics.

The 29-year-old client is admitted to the medical floor diagnosed with meningitis. Which assessment by the nurse has priority? 1. Assess lung sounds. 2. Assess the six cardinal fields of gaze. 3. Assess apical pulse. 4. Assess level of consciousness.

4. Meningitis directly affects the client's brain. Therefore, assessing the neurological status would have priority for this client.

A normal CVP reading in a spontaneously breathing patient is

5-10 cmH2O

Your patient is tachycardic, hypotensive and has a low urine output and poor capillary refill. You therefore suspect he is hypovolaemic and you insert a CVP line to aid your diagnosis and management. The initial CVP reading is 6 cmH2O. Which of the following statements is correct? A. No fluid replacement is needed as the CVP reading is within the normal range. B. Fluid replacement is justified but must be stopped as soon as the CVP reading starts to rise. C. Fluid replacement should continue until there is a sustained rise in the CVP reading.

C Fluid replacement should not be stopped at the first sign of a rise in CVP value.

Viral meningitis is treated how?

Goes away without treatment

Measure what

Measure his central venous pressure, and record intake and output accurately.

There are vaccines for three types of bacteria that can cause meningitis which are:

N. meningitidis Streptococcus pneumoniae Haemophilus influenza type b (Hib)

Brudzinski's sign

Place the patient in a dorsal recumbent position, and then put your hands behind his neck and bend it forward. Pain and resistance may indicate neck injury or arthritis. However, if the patient also flexes the hips and knees, chances are that he has meningeal irritation and inflammation, a sign of meningitis.

Romberg's test

Romberg's test detects a person's inability to maintain a steady posture with his eyes closed

Kernigs sign

Supine position- flex leg at hip and knee and then straighten the knee- pain or resistance suggests meningitis.

Who gets it? From which?

ages 16-21 from N. Meningitides

Be especially alert for a temperature increase up to 102º F (38.9º C), deteriorating LOC, onset of seizures, and altered respiration's, all of which may signal

an impending crisis

Fungal meningitis is treated with

anti-fungals

Meningitis treated with antibiotics and can also include other meds such as digoxin for

arrhythmias

S. pneumoniae and N. meningitidis are treated with

cephalosporins

Monitor the patient's fluid balance. Make sure he consumes • enough fluids to prevent

dehydration but avoid overload to decrease the risk of cerebral edema

Tylenol for

fever and headache

S/S of meningitis

fever, chills, malaise headache, vomiting nuchal rigidity, positive Brudzinski and Kernigs sign exaggerated and symmetrical DTRs Seizure Delirium, deep stupor

CVP is measured how

manually using a manometer or electronically using a transducer

countries where disease is common

sub-Saharan Africa has highest rates

mannitol for

to decrease cerebral edema