Meningitis (Bacterial and Viral), Encephalitis, Brain Abscess

Question 1

Which parameter should be monitored to prevent complications associated with fever in a patient with meningitis?
1
Fluid intake
2
Urine output
3
Blood pressure
4
Respiratory rate

Answer 1

1
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.

Question 2

Which condition would lead to a risk of bacterial meningitis?
1
Skull fracture
2
Pulmonary infection
3
Bacterial endocarditis
4
Prior brain trauma or surgery

Answer 2

2
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 placesthe patient at risk of developing brain abscess.

Question 3

Which statement is true about bacterial meningitis?
1
It can occur due to prior brain trauma.
2
It is considered as a medical emergency.
3
It is a chronic inflammation of meningeal tissues.
4
Staphylococcus aureus is the primary infective organism.

Answer 3

2
Bacterial meningitis is considered a medical emergency; untreated meningitis has a mortality rate close to 100 percent. Prior brain trauma may lead to a brain abscess. Bacterial meningitis is an acute inflammation. Staphylococcus aureus is the primary infective organism for a brain abscess.

Question 4

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.”

Answer 4

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

Question 5

Which intervention should be performed to prevent cranial nerve III palsy in a patient with meningitis?
1
Providing low lighting
2
Administering antibiotics
3
Elevating the head of the bed
4
Performing cooling techniques

Answer 5

4
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.

Question 6

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?
1
Pain can be controlled.
2
Hearing loss can be resolved.
3
Facial paresis can be resolved.
4
Neck stiffness can be resolved.

Answer 6

2
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.

Question 7

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.

Answer 7

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

Question 8

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.

Answer 8

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.

Question 9

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.

Answer 9

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.

Question 10

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.

Answer 10

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.

Question 11

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.

Answer 11

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.

Question 12

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.

Answer 12

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.

Question 13

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.

Answer 13

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.

Question 14

A patient with bacterial meningitis has increased cerebral edema and is experiencing frequent seizures. What intervention would be used to treat these complications?
1 Perform tepid sponge baths
2 Provide supplemental feeding
3Provide additional low lighting
4Maintain antibiotic therapy

Answer 14

1
A patient with meningitis who is experiencing increased cerebral edema and frequent seizures has a fever.A tepid sponge bath would help to lower a patient’s temperature. Supplemental feeding should be provided to maintain adequate nutritional intake. Additional low lighting should be provided if the patient develops delirium. An antibiotic schedule would be redesigned to treat fever.

Question 15

After noting that a patient with a head injury has clear nasal drainage, which action should the nurse take?

a.Have the patient blow the nose.

b.

Check the nasal drainage for glucose.

c.

Assure the patient that rhinorrhea is normal after a head injury.

d.

Obtain a specimen of the fluid to send for culture and sensitivity

Answer 15

ANS: B

Clear nasal drainage in a patient with a head injury suggests a dural tear and cerebrospinal fluid (CSF) leakage. If the drainage is CSF, it will test positive for glucose. Fluid leaking from the nose will have normal nasal flora, so culture and sensitivity will not be useful. Blowing the nose is avoided to prevent CSF leakage.

Question 16

A patient has psychomotor seizures. Which lobe of the brain would show the presence of an abscess on a computed tomography (CT) scan?
1
Frontal lobe
2
Parietal lobe
3
Occipital lobe
4
Temporal lobe

Answer 16

4
When an abscess is formed in the temporal lobe, there is a chance of developing psychomotor seizures. The formation of an abscess in the frontal and parietal lobe may lead to a local or systemic infection. The formation of an abscess in the occipital lobe may lead to visual impairment and hallucinations.

Question 17

A patient who has bacterial meningitis is disoriented and anxious. Which nursing action will be included in the plan of care?

a.

Encourage family members to remain at the bedside.

b.

Apply soft restraints to protect the patient from injury.

c.

Keep the room well-lighted to improve patient orientation.

d.

Minimize contact with the patient to decrease sensory input.

Answer 17

ANS: A

Patients with meningitis and disorientation will be calmed by the presence of someone familiar at the bedside. Restraints should be avoided because they increase agitation and anxiety. The patient requires frequent assessment for complications; the use of touch and a soothing voice will decrease anxiety for most patients. The patient will have photophobia, so the light should be dim.

Question 18

The community health nurse is developing a program to decrease the incidence of meningitis in adolescents and young adults. Which nursing action is most important?

a.

Vaccinate 11- and 12-year-old children against Haemophilus influenzae.

b.

Emphasize the importance of hand washing to prevent spread of infection.

c.

Immunize adolescents and college freshman against Neisseria meningitides.

d.

Encourage adolescents and young adults to avoid crowded areas in the winter.

Answer 18

ANS: C

The Neisseria meningitides vaccination is recommended for children ages 11 and 12, unvaccinated teens entering high school, and college freshmen. Hand washing may help decrease the spread of bacteria, but it is not as effective as immunization. Vaccination with Haemophilus influenzae is for infants and toddlers. Because adolescents and young adults are in school or the workplace, avoiding crowds is not realistic.

Question 19

While caring for a patient who has just been admitted with meningococcal meningitis, the RN observes all of the following. Which one requires action by the RN?

a.

The bedrails at the head and foot of the bed are both elevated.

b.

The patient receives a regular diet from the dietary department.

c.

The nursing assistant goes into the patients room without a mask.

d.

The lights in the patients room are turned off and the blinds are shut.

Answer 19

ANS: C

Meningococcal meningitis is spread by respiratory secretions, so it is important to maintain respiratory isolation as well as standard precautions. Because the patient may be confused and weak, bedrails should be elevated at both the foot and head of the bed. Low light levels in the room decrease pain caused by photophobia. Nutrition is an important aspect of care in a patient with meningitis.

Question 20

. When assessing a patient with bacterial meningitis, the nurse obtains the following data. Which finding should be reported immediately to the health care provider?

a.

The patient has a positive Kernigs sign.

b.

The patient complains of having a stiff neck.

c.

The patients temperature is 101 F (38.3 C).

d.

The patients blood pressure is 86/42 mm Hg.

Answer 20

ANS: D

Shock is a serious complication of meningitis, and the patients low blood pressure indicates the need for interventions such as fluids or vasopressors. Nuchal rigidity and a positive Kernigs sign are expected with bacterial meningitis. The nurse should intervene to lower the temperature, but this is not as life threatening as the hypotension.

Question 21

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.

Answer 21

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.

Question 22

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.

Answer 22

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

Question 23

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.

Answer 23

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

Question 24

The charge nurse observes an inexperienced staff nurse who is caring for a patient who has had a craniotomy for a brain tumor. Which action by the inexperienced nurse requires the charge nurse to intervene?

a.

The staff nurse suctions the patient every 2 hours.

b.

The staff nurse assesses neurologic status every hour.

c.

The staff nurse elevates the head of the bed to 30 degrees.

d.

The staff nurse administers a mild analgesic before turning the patient.

Answer 24

ANS: A

Suctioning increases intracranial pressure and is done only when the patients respiratory condition indicates it is needed. The other actions by the staff nurse are appropriate.

Question 25

A patient is brought to the emergency department (ED) by ambulance after being found unconscious on the bathroom floor by the spouse. Which action will the nurse take first?

a.

Obtain oxygen saturation.

b.

Check pupil reaction to light.

c.

Palpate the head for hematoma.

d.

Assess Glasgow Coma Scale (GCS).

Answer 25

ANS: A

Airway patency and breathing are the most vital functions and should be assessed first. The neurologic assessments should be accomplished next and the health and medication history last.

Question 26

When caring for a patient who has had a head injury, which assessment information requires the most rapid action by the nurse?

a.

The patient is more difficult to arouse.

b.

The patients pulse is slightly irregular.

c.

The patients blood pressure increases from 120/54 to 136/62 mm Hg.

d.

The patient complains of a headache at pain level 5 of a 10-point scale.

Answer 26

ANS: A

The change in level of consciousness (LOC) is an indicator of increased intracranial pressure (ICP) and suggests that action by the nurse is needed to prevent complications. The change in BP should be monitored but is not an indicator of a need for immediate nursing action. Headache is not unusual in a patient after a head injury. A slightly irregular apical pulse is not unusual.

Question 27

A patient admitted with bacterial meningitis and a temperature of 102 F (38.8 C) has orders for all of these collaborative interventions. Which action should the nurse take first?

a.

Administer ceftizoxime (Cefizox) 1 g IV.

b.

Use a cooling blanket to lower temperature.

c.

Swap the nasopharyngeal mucosa for cultures.

d.

Give acetaminophen (Tylenol) 650 mg PO.

Answer 27

ANS: C

Antibiotic therapy should be instituted rapidly in bacterial meningitis, but cultures must be done before antibiotics are started. As soon as the cultures are done, the antibiotic should be started. Hypothermia therapy and acetaminophen administration are appropriate but can be started after the other actions are implemented.

Question 28

Three days following intracranial surgery a client develops fever, nuchal rigidity, and headache. The nurse would suspect
A. Cerebral emboli
B. Extradural hematoma
C. Meningitis 
D. Diabetic neuropathy

Answer 28

C. Meningitis

Rational
The classic manifestations of meningitis are nuchal rigidity (rigidity of the neck), Brudzinski’s sign and Kernig’s sign, and photophobia. Intracranial surgery places the client at high risk of developing meningitis.

Question 29

The nurse is assessing the results of diagnostic tests on a client's cerebrospinal fluid (CSF). Which values and observations does the nurse correlate as most indicative of bacterial meningitis? (select all that apply.)
A. Clear
B. Cloudy
C. Normal protein level
D. Increased protein level
E. Normal glucose level
F. Decreased glucose level

Answer 29

B. Cloudy
D. Increased protein level
F. Decreased glucose level

Rationale:
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.

Question 30

The nurse should observe a client with bacterial meningitis for 
A. Sensory deficits 
B. High blood pressure 
C. Hypothermia 
D. Muscle spasms

Answer 30

A. Sensory Deficits

Rationale:
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.

Question 31

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. “When was your last tetanus vaccination?”
B. “Do you live in a crowded residence?”
C. “Have you traveled out of the country in the last month?”
D. “Have you had any viral infections recently?”

Answer 31

B. “Do you live in a crowded residence?”

Rationale:
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.

Question 32

A client has meningitis following brain surgery. What comfort measures may the nurse delegate to the unlicensed assistive personnel (UAP)? (select all that apply)

A. Applying a cool washcloth to the head
B. Assisting the client to a position of comfort
C. Keeping voices soft and soothing
D. Maintaining low lighting in the room
E. providing antipyretics for fever

Answer 32

A. Applying a cool washcloth to the head
B. Assisting the client to a position of comfort
C. Keeping voices soft and soothing
D. Maintaining low lighting in the room

Rationale:
The client with meningitis often has high fever, pain, and some degree of confusion. Cool washcloths to the forehead are comforting and help with pain. Allowing the client to assume a position of comfort also helps manage pain. Keeping voices low and lights dimmed also helps convey caring in a nonthreatening manner. The nurse provides antipyretics for fever.

Question 33

Which drug is used to treat viral encephalitis?
1
Acyclovir
2
Ampicillin
3
Vidarabine
4
Vancomycin

Answer 33

1 Acyclovir

Question 34

A 68-year-old man with suspected bacterial meningitis has just had a lumbar puncture in which cerebrospinal fluid was obtained for culture. Which medication should the nurse administer first?
A. Codeine
B. Phenytoin (Dilantin)
C. Ceftriaxone (Rocephin)
D. Acetaminophen (Tylenol)

Answer 34

C
Bacterial meningitis is a medical emergency. When meningitis is suspected, antibiotic therapy (e.g., ceftriaxone) is instituted immediately after the collection of specimens for cultures, and even before the diagnosis is confirmed. Dexamethasone may also be prescribed before or with the first dose of antibiotics. The nurse should collaborate with the health care provider to manage the headache (with codeine), fever (with acetaminophen), and seizures (with phenytoin).

Question 35

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

Answer 35

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.

Question 36

Nurse on clinical unit is assigned to four patients. Which patient should she assess first?

a. Patient with a skull fracture whose nose is bleeding
b. Older patient with a stroke who is confused and whose daughter is present
c. Patient with meningitis who is suddenly agitated and reporting a headache of 10 on a 0-10 scale
d. Patient who had a craniotomy for a brain tumor who now 3 days postoperative had had continued vomiting

Answer 36

Correct answer: c
Rationale: The patient with meningitis should be seen first; patients with meningitis must be observed closely for manifestations of elevated ICP, which is thought to result from swelling around the dura and increased cerebrospinal fluid (CSF) volume. Sudden change in the level of consciousness or change in behavior along with a sudden severe headache may indicate an acute elevation of ICP. The patient who has undergone cranial surgery should be seen second; although nausea and vomiting are common after cranial surgery, it can result in elevations of ICP. Nausea and vomiting should be treated with antiemetics. The patient with a skull fracture needs to be evaluated for CSF leakage occurring with the nose bleed and should be seen third. Confusion after a stroke may be expected; the patient should have a family member present.

Question 37

Classic symptoms of bacterial meningitis include

a. papilledema and psychomotor seizures
b. high fever, nuchal rigidity, and severe headache
c. behavioral changes with memory loss and lethargy
d. positive Kernig’s and Brudzinski’s signs and hemiparesis

Answer 37

B. High fever, severe headache, nuchal rigidity, and positive Brudzinski’s and Kernig’s signs are such classic symptoms of meningitis that they are usually considered diagnostic for meningitis. Other symptoms, such as papilledema, generalized seizures, hemiparesis, and decreased LOC, may occur as complications of increased ICP and cranial nerve dysfunction.

Question 38

A patient with possible viral meningitis is admitted to the nursing unit after lumbar puncture was performed in the emergency department. Which action prescribed by the health care provider should the nurse question?

a. Elevate the head of the bed 20 degrees.
b. Restrict oral fluids to 1000 mL daily.
c. Administer ceftriaxone (Rocephin) 1 g IV every 12 hours.
d. Give ibuprofen (Motrin) 400 mg every 6 hours as needed for headache.

Answer 38

ANS: B
The patient with meningitis has increased fluid needs, so oral fluids should be encouraged. The other actions are appropriate. Slight elevation of the head of the bed will decrease headache without causing leakage of cerebrospinal fluid from the lumbar puncture site. Antibiotics should be administered until bacterial meningitis is ruled out by the cerebrospinal fluid analysis

Question 39

Which action will the public health nurse take to reduce the incidence of epidemic encephalitis in a community?

a. Encourage the use of effective insect repellents during mosquito season.
b. Remind patients that most cases of viral encephalitis can be cared for at home.
c. Teach about the importance of prophylactic antibiotics after exposure to encephalitis.
d. Arrange for screening of school-age children for West Nile virus during the school year.

Answer 39

ANS: A
Epidemic encephalitis is usually spread by mosquitoes and ticks. Use of insect repellent is effective in reducing risk. Encephalitis frequently requires that the patient be hospitalized in an intensive care unit during the initial stages. Antibiotic prophylaxis is not used to prevent encephalitis because most encephalitis is viral. West Nile virus is most common in adults over age 50 during the summer and early fall

Question 40

Which of the following would lead the nurse to suspect that a child with meningitis has developed disseminated intravascular coagulation?

Hemorrhagic skin rash
Edema
Cyanosis
Dyspnea on exertion

Answer 40

Hemorrhagic skin rash- 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.

Question 41

When interviewing the parents of a 2-year-old child, a history of which of the following illnesses would lead the nurse to suspect pneumococcal meningitis?

Bladder infection
Middle ear infection
Fractured clavicle
Septic arthritis

Answer 41

Middle ear infection

Question 42

Meningitis occurs as an extension of a variety of bacterial infections due to which of the following conditions?

Congenital anatomic abnormality of the meninges
Lack of acquired resistance to the various etiologic organisms
Occlusion or narrowing of the CSF pathway
Natural affinity of the CNS to certain pathogens

Answer 42

Lack of acquired resistance to the various etiologic organisms

Question 43

Which of the following pathologic processes is often associated with aseptic meningitis?

Ischemic infarction of cerebral tissue
Childhood diseases of viral causation such as mumps
Brain abscesses caused by a variety of pyogenic organisms
Cerebral ventricular irritation from a traumatic brain injury

Answer 43

Childhood diseases of viral causation such as mumps

Question 44

Which nursing actions should be performed on a patient hospitalized with meningitis? Select all that apply.
1 
Monitor temperature
2 
Check for muscle pains
3 
Check for retinal damage
4 
Assess intraocular pressure
5 
Assess the eye for sensitivity to light

Answer 44

1, 2,5 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.