Meningitis

All aminoglycosides end in?

"mycin" Vancomycin

All aminoglycosides are nephrotoxic

All aminoglycosides are ototoxic

Which of the following would lead the nurse to suspect that a child with meningitis has developed disseminated intravascular coagulation (DIC)? a.) Hemorrhagic skin rash b.) Edema c.) Cyanosis d.) Dyspnea on exertion

A ~ DIC is characterized by skin petechiae and a purpuric skin rash caused by spontaneous bleeding into the tissues. An abnormal coagulation phenomenon causes the condition.

A nurse is caring for a patient with meningitis who has a positive Brudzinski sign. Which assessment led to this conclusion? a. Flexed hips when the neck is flexed by the nurse b. Inability to extend the flexed leg fully because of hamstring pain c. Resisting efforts of the nurse to flex his or her neck d. Flexing the big toe upward and fan out the other toes

A ~ Inflamed meninges will stimulate hip flexion to reduce meningeal discomfort.

A client is prescribed levetiracetam (Keppra). Which laboratory tests does the nurse monitor for potential adverse effects of this medication? a. Serum electrolyte levels b. Kidney function tests c. Complete blood cell count d. Antinuclear antibodies

B ~ Adverse effects of levetiracetam (Keppra) include coordination problems and renal toxicity. The other laboratory tests are not affected by levetiracetam.

The cerebrospinal (CSF) fluid laboratory finding the nurse would expect in a client with bacterial meningitis is a. clear color. b. decreased glucose level. c. decreased protein level. d. negative nitrates.

B ~ Clients with bacterial meningitis show the following: elevated CSF pressures, elevated CSF protein, decreased CSF glucose, and usually increased cell count with predominantly polymorphonuclear leukocytes.

A nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which of the following would be included in the plan of care? a.) No precautions are required as long as antibiotics have been started b.) Maintain enteric precautions c.) Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics d.) Maintain neutropenic precautions

C ~ A major priority of nursing care for a child suspected of having meningitis is to administer the prescribed antibiotic as soon as it is ordered. The child is also placed on respiratory isolation for at least 24 hours while culture results are obtained and the antibiotic is having an effect.

The pediatric nurse prepares a care plan for a patient admitted to the intensive care unit for meningitis. Which nursing interventions does the nurse include in the care plan for this patient? (SATA) A. Assess and treat pain as needed. B. Implement transmission-based precautions. C. Initiate and maintain IV access. D. Monitor vital signs every 4 hours. E. Monitor neurological status and symptoms.

A, B, C, E ~ The nurse should initiate transmission-based precautions to help prevent transmission of infection. The nurse should initiate and maintain intravenous access (specify fluids and rate) as ordered. The nurse should monitor vital signs every 1 to 4 hours (depending on severity of symptoms) and place the patient on a cardiac monitor as indicated. The nurse should monitor neurological status and symptoms closely, comparing with baseline values for the child. Patients with meningitis often have pain, especially headaches, and the nurse should be prepared to assess and treat.

A nurse is preparing to discharge a 10-year-old child who was diagnosed with bacterial meningitis. Which action by the nurse takes priority? A. Arrange home health-care visits for antibiotic infusions. B. Consult with physical therapy about a home exercise plan. C. Ensure the parents can plan high-protein meals. D. Make a social work referral for long-term care placement.

A ~ Children with bacterial meningitis are often discharged with a PICC line in place for home IV antibiotic infusions. Depending on the needs of the child, the other options may or may not be appropriate.

The nurse is taking the health history of a client suspected of having bacterial meningitis. Which question is most important for the nurse to ask? a. Do you live in a crowded residence? b. When was your last tetanus vaccination? c. Have you had any viral infections recently? d. Have you traveled out of the country in the last month?

A ~ Meningococcal meningitis tends to occur in outbreaks. It is most likely to occur in areas of high-density population, such as college dormitories, prisons, and military barracks. The other questions do not identify risk factors for bacterial meningitis.

A nurse admits a 5-year-old child with bacterial meningitis to the pediatric intensive care unit. Which information obtained by the nurse during the intake history is most helpful for the nurse to document? A. Fell off swing hitting head 2 months ago B. History of recent sinus infection C. Mother with history of herpes simplex D. Sibling with upper respiratory infection

B ~ In a child this age, common causes of bacterial meningitis include septicemia, surgical procedures involving the CNS, penetrating wounds, otitis media, sinusitis, cellulitis of the scalp or face, dental cavities, pharyngitis, and orthopedic diseases. Blunt trauma from falling off a swing and a sibling with a URI are noncontributory. Herpes simplex is an important cause of neonatal viral meningitis.

A child has been admitted with bacterial meningitis. Which action by the nurse takes priority? A. Administering broad-spectrum antibiotics B. Assessing and treating pain aggressively C. Facilitating blood cultures and lumbar puncture D. Maintaining a quiet, nonstimulating environment

C ~ All actions are appropriate for the child with acute bacterial meningitis. However, the priority is obtaining cultures so that appropriate therapy can be identified. After cultures are obtained, the nurse will administer broad-spectrum antibiotics until the culture and sensitivity results are known.

Three days following intracranial surgery a client develops fever, nuchal rigidity, and headache. The nurse would suspect a. cerebral emboli. b. extradural hematoma. c. increased ICP. d. meningitis.

D ~ The classic manifestations of meningitis are nuchal rigidity (rigidity of the neck), Brudzinskis sign and Kernigs sign, and photophobia. Intracranial surgery places the client at high risk of developing meningitis.

A nurse obtains a focused health history for a client who is suspected of having bacterial meningitis. Which question should the nurse ask? a. Do you live in a crowded residence? b. When was your last tetanus vaccination? c. Have you had any viral infections recently? d. Have you traveled out of the country in the last month?

A ~ Meningococcal meningitis tends to occur in multiple outbreaks. It is most likely to occur in areas of high-density population, such as college dormitories, prisons, and military barracks. A tetanus vaccination would not place the client at increased risk for meningitis or protect the client from meningitis. A viral infection would not lead to bacterial meningitis but could lead to viral meningitis. Simply knowing if the client traveled out of the country does not provide enough information. The nurse should ask about travel to specific countries in which the disease is common, for example, sub-Saharan Africa.

The nurse should observe a client with bacterial meningitis for a. changes in sensorium. b. high blood pressure. c. hypothermia. d. muscle spasms.

A ~ Other general manifestations related to infection are also present, such as fever, tachycardia, headache, prostration, chills, fever, nausea, and vomiting. The client may be irritable at first, but as the infection progresses, the sensorium often becomes clouded, and coma may develop.

A nurse is caring for a client with meningitis. Which laboratory values should the nurse monitor to identify potential complications of this disorder? (SATA) a. Sodium level b. Liver enzymes c. Clotting factors d. Cardiac enzymes e. Creatinine level

A, C ~ Inflammation associated with meningitis can stimulate the hypothalamus and result in excessive production of antidiuretic hormone. The nurse should monitor sodium levels for early identification of syndrome of inappropriate antidiuretic hormone. A systemic inflammatory response (SIR) can also occur with meningitis. A SIR can result in a coagulopathy that leads to disseminated intravascular coagulation. The nurse should monitor clotting factors to identify this complication. The other laboratory values are not specific to complications of meningitis.

A nurse evaluates the results of diagnostic tests on a clients cerebrospinal fluid (CSF). Which fluid results alerts the nurse to possible viral meningitis? (SATA) a. Clear b. Cloudy c. Increased protein level d. Normal glucose level e. Bacterial organisms present f. Increased white blood cells

A, C, D ~ In viral meningitis, CSF fluid is clear, protein levels are slightly increased, and glucose levels are normal. Viral meningitis does not cause cloudiness or increased turbidity of CSF. In bacterial meningitis, the presence of bacteria and white blood cells causes the fluid to be cloudy.

The nurse is assessing the results of diagnostic tests on a clients cerebrospinal fluid (CSF). Which values & observations does the nurse correlate as most indicative of viral meningitis? (SATA) a. Clear b. Cloudy c. Normal protein level d. Increased protein level e. Normal glucose level f. Decreased glucose level

A, D, E ~ Viral meningitis does not cause cloudiness or increased turbidity of CSF. Protein levels are slightly increased, and glucose levels are normal. In bacterial meningitis, the presence of bacteria and white blood cells causes the fluid to be cloudy.

The nurse is planning to bathe a client diagnosed with meningococcal meningitis. In addition to gloves, what personal protective equipment does the nurse use? a. Particulate respirator b. Isolation gown c. Shoe covers d. Surgical mask

D ~ Meningeal meningitis is spread via saliva and droplets. Caregivers should wear a surgical mask when within 6 feet of the client and should continue to use Standard Precautions. A particulate respirator, an isolation gown, and shoe covers are not necessary for Droplet Precautions.

During assessment of a 6-year-old child with meningitis, the nurse places the child supine and attempts to put the child's chin on her chest. The child cries out in pain and flexes her knees. How does the nurse document this assessment finding in the medical record? A. Absent Moro reflex B. Exaggerated Grey-Turner sign C. Negative Kernig sign D. Positive Brudzinski sign

D ~ Two assessment tests are used in evaluating a patient with meningitis: the Kernig sign and the Brudzinski sign. The nurse has demonstrated a positive Brudzinski sign. The Kernig sign is elicited by placing the patient supine with hips flexed and raising and straightening the leg. Pain behind the knee and resistance are abnormal findings possibly indicative of meningitis. The Moro reflex is done on infants. The Grey-Turner sign is bruising of the flanks, often accompanying pancreatitis.

A nurse prepares to provide perineal care to a client with meningococcal meningitis. Which personal protective equipment should the nurse wear? (SATA) a. Particulate respirator b. Isolation gown c. Shoe covers d. Surgical mask e. Gloves

D, E ~ Meningeal meningitis is spread via saliva and droplets, and Droplet Precautions are necessary. Caregivers should wear a surgical mask when within 6 feet of the client and should continue to use Standard Precautions, including gloves. A particulate respirator, an isolation gown, and shoe covers are not necessary for Droplet Precautions.