Ch 61: Bacterial Meningitis

Question 1

A 19-year-old college freshman who lives in a dormitory presents to the student health clinic with complaints of a severe headache, stiff neck, photophobia, and fever. Based on the client’s living situation and symptoms, which condition should the nurse suspect?

A. Bacterial meningitis
B. Acute sinusitis
C. Viral encephalitis
D. Subarachnoid hemorrhage

Answer 1

A. Bacterial meningitis

Rationale: This patient lives in a high-risk environment (dormitory) and presents with hallmark symptoms of bacterial meningitis: headache, nuchal rigidity (stiff neck), photophobia, and fever. These symptoms and the risk factor of close living quarters strongly suggest bacterial meningitis. While subarachnoid hemorrhage can also cause sudden headache and neck stiffness, it typically presents with a “thunderclap” headache and altered consciousness. Viral encephalitis is usually less severe and presents differently, while sinusitis would not cause neck stiffness.

Question 2

An 82-year-old man with a history of diabetes and recent hospitalization for pneumonia now presents with confusion, fever, and a generalized seizure. The provider suspects bacterial meningitis. Which factor most increases this patient’s risk for developing meningitis?

A. Age and chronic illness
B. Seizure activity
C. Prior head injury
D. Dehydration from fever

Answer 2

A. Age and chronic illness

Rationale: Older adults and individuals with chronic diseases like diabetes are more vulnerable to bacterial meningitis due to a weakened immune system and impaired systemic defense mechanisms. Seizure activity is a symptom, not a risk factor. While prior head injury and dehydration can contribute to complications, they are not the most significant predisposing factors in this context.

Question 3

Which of the following clients are at increased risk for developing bacterial meningitis?

A. A college student living off-campus in a private apartment
B. A 78-year-old living in a long-term care facility
C. A prisoner in a correctional facility
D. A healthy 35-year-old working from home
E. A 6-month-old infant in daycare
F. A person with HIV/AIDS

Answer 3

B. A 78-year-old living in a long-term care facility
C. A prisoner in a correctional facility
E. A 6-month-old infant in daycare
F. A person with HIV/AIDS

Rationale: Clients at increased risk include the elderly (due to weakened immunity), those in institutionalized settings (e.g., prisoners), young children in daycare, and immunocompromised individuals (e.g., HIV/AIDS). While college students living in dorms are high risk, living off-campus decreases exposure. A healthy adult working from home is not considered high risk.

Question 4

A nurse is teaching a group of new graduate nurses about meningitis. Which statement by a nurse indicates correct understanding of the disease?

A. “Bacterial meningitis is a chronic condition with low mortality.”
B. “It most commonly occurs during the summer months.”
C. “Prompt treatment is crucial because bacterial meningitis has a high mortality rate if untreated.”
D. “It is only spread through contaminated food and water.”

Answer 4

C. “Prompt treatment is crucial because bacterial meningitis has a high mortality rate if untreated.”

Rationale: Bacterial meningitis is a medical emergency. Without prompt antibiotic therapy, it has a high mortality rate. It most often occurs during fall, winter, or early spring and spreads via respiratory droplets—not food or water. It is an acute, not chronic, illness.

Question 5

A nurse in the ICU is caring for a 25-year-old male diagnosed with bacterial meningitis. The patient is disoriented, febrile (102.6°F), and experiencing photophobia and severe headache. What is the priority nursing intervention?

A. Administer acetaminophen and dim the lights
B. Initiate droplet precautions and obtain blood cultures
C. Encourage oral fluids to prevent dehydration
D. Elevate the head of the bed and encourage coughing

Answer 5

B. Initiate droplet precautions and obtain blood cultures

Rationale: This is a priority infection-control situation. Meningitis is highly contagious until 24 hours after antibiotics are started, and droplet precautions must be implemented immediately. Obtaining blood cultures helps guide antibiotic therapy. Acetaminophen and dimming lights are helpful for symptoms but not the immediate priority. Encouraging coughing could increase ICP and worsen symptoms.

Question 6

A public health nurse is reviewing data on recent cases of bacterial meningitis. Which seasonal pattern should the nurse expect to see?

A. Most cases occur in mid-summer due to increased dehydration.
B. Meningitis occurs sporadically and has no seasonal correlation.
C. Late spring is associated with peak cases due to pollen exposure.
D. Fall, winter, and early spring have the highest incidence.

Answer 6

D. Fall, winter, and early spring have the highest incidence.

Rationale: Bacterial meningitis is most often associated with respiratory infections, which are more common in colder seasons. It does not typically peak in the summer or late spring, nor is it associated with pollen exposure. The cold-weather association may be due to increased indoor crowding and viral co-infections.

Question 7

Which of the following organisms is most frequently responsible for bacterial meningitis in adults in the post-vaccine era?

A. Haemophilus influenzae
B. Streptococcus pneumoniae
C. Escherichia coli
D. Listeria monocytogenes

Answer 7

B. Streptococcus pneumoniae

Rationale: Since the introduction of the H. influenzae type B (Hib) vaccine, Streptococcus pneumoniae and Neisseria meningitidis have become the leading causes of bacterial meningitis, particularly in adults. Listeria is more common in neonates, elderly, and immunocompromised patients.

Question 8

A 26-year-old male presents to the ED with a fever, nuchal rigidity, photophobia, and a recent basilar skull fracture. Based on the patient’s history, which pathophysiologic mechanism is most likely responsible for the development of bacterial meningitis?

A. Entry of bacteria through bloodstream from a UTI
B. Direct extension from a sinus fracture
C. Viral reactivation from latent infection
D. Inhalation of fungal spores into the lungs

Answer 8

B. Direct extension from a sinus fracture

Rationale: Penetrating skull wounds or fractures of the sinuses, especially in basilar skull injuries, can allow bacteria direct access into the CNS. This route bypasses hematologic spread and is a well-known cause of meningitis.

Question 9

A patient with suspected bacterial meningitis is experiencing a decreasing level of consciousness and has a new onset of vomiting. What is the nurse’s priority assessment?

A. Temperature and oxygen saturation
B. Blood glucose level
C. Neurologic signs of increased intracranial pressure
D. Urine output and fluid balance

Answer 9

C. Neurologic signs of increased intracranial pressure

Rationale: The patient shows signs suggestive of increased ICP—decreased LOC and vomiting. Monitoring for signs such as altered LOC, pupillary changes, and posturing is critical, as increased ICP is a potentially life-threatening complication of bacterial meningitis.

Question 10

Which of the following subgroups of Neisseria meningitidis is responsible for most meningococcal meningitis cases worldwide?

A. A, B, C, Y, W
B. D, F, J, M, X
C. H, I, K, L, Z
D. B, E, G, N, T

Answer 10

A. A, B, C, Y, W

Rationale: Five of the 13 subtypes of Neisseria meningitidis—A, B, C, Y, and W—account for the majority of cases worldwide. This is relevant for vaccination and public health planning.

Question 11

Which of the following statements best explains why patients with bacterial meningitis are at risk for cerebral edema?

A. Inflammation increases glucose delivery to the brain.
B. Cerebral edema results from protein loss in the CSF.
C. Purulent secretions block venous return.
D. Inflammation extends into the brain parenchyma, disrupting blood-brain barrier function.

Answer 11

D. Inflammation extends into the brain parenchyma, disrupting blood-brain barrier function.

Rationale: The inflammatory response can extend into brain tissue and disrupt the blood-brain barrier, allowing fluid and cells to move into the brain and cause cerebral edema. This can significantly increase ICP and worsen outcomes.

Question 12

Which of the following are possible routes by which organisms enter the central nervous system to cause bacterial meningitis? (SATA)

A. Upper respiratory tract
B. Bloodstream
C. Lymphatic drainage
D. Direct extension from skull fractures
E. GI tract via the vagus nerve

Answer 12

A. Upper respiratory tract
B. Bloodstream
D. Direct extension from skull fractures

Rationale: Pathogens typically enter the CNS through the respiratory tract, the bloodstream, or direct extension from trauma (e.g., skull fractures or sinus injury). The lymphatic system and vagus nerve are not recognized primary entry points for CNS infection.

Question 13

A patient with bacterial meningitis develops dilated pupils, irregular respirations, and hypertension with widening pulse pressure. What should the nurse suspect?

A. Septic shock
B. Brain herniation due to increased ICP
C. Respiratory alkalosis
D. Meningeal irritation only

Answer 13

B. Brain herniation due to increased ICP

Rationale: These are classic signs of severely increased intracranial pressure progressing to herniation—Cushing’s triad includes irregular respirations, widened pulse pressure, and bradycardia. Immediate intervention is required to prevent death.

Question 14

What role does increased cerebrospinal fluid (CSF) production play in the pathophysiology of bacterial meningitis?

A. It improves immune response by diluting bacterial toxins.
B. It reduces inflammation by flushing out cytokines.
C. It contributes to increased intracranial pressure and cerebral edema.
D. It protects the cranial nerves from damage.

Answer 14

C. It contributes to increased intracranial pressure and cerebral edema.

Rationale: In bacterial meningitis, inflammation leads to increased CSF production, which—along with purulent secretions—raises intracranial pressure. This can impair cerebral perfusion and increase the risk of brain damage or herniation.

Question 15

A 20-year-old college student with bacterial meningitis caused by Neisseria meningitidis is admitted. What infection control precautions should be initiated?

A. Droplet precautions
B. Airborne precautions
C. Standard precautions only
D. Contact precautions

Answer 15

A. Droplet precautions

Rationale: Meningococcal meningitis is transmitted via large respiratory droplets. Therefore, droplet precautions should be implemented immediately and maintained until at least 24 hours after effective antibiotic therapy has started.

Question 16

Which of the following best describes how purulent secretions contribute to complications in bacterial meningitis?

A. They neutralize the blood-brain barrier, allowing antibiotics to enter the brain faster.
B. They act as reservoirs for viral coinfections.
C. They spread rapidly through CSF, covering cranial nerves and causing damage.
D. They stimulate the production of dopamine, worsening hallucinations.

Answer 16

C. They spread rapidly through CSF, covering cranial nerves and causing damage.

Rationale: Purulent secretions in bacterial meningitis spread through the CSF and coat cranial nerves and brain structures. This can result in cranial nerve dysfunction, increased ICP, and widespread neurologic complications.

Question 17

A nurse is assessing a client with suspected bacterial meningitis. Which clinical finding should the nurse recognize as a hallmark sign of meningeal irritation?

A. Productive cough
B. Nuchal rigidity
C. Hyperreflexia
D. Jaundice

Answer 17

B. Nuchal rigidity

Rationale: Nuchal rigidity (stiff neck) is a cardinal symptom of meningitis and indicates inflammation of the meninges. It is commonly assessed in conjunction with headache and photophobia. Cough is not typically associated with meningitis, and jaundice or hyperreflexia are not defining features.

Question 18

A 25-year-old patient with confirmed Neisseria meningitidis infection presents with fever, photophobia, and altered mental status. The nurse notices a petechial rash on the patient’s legs. What is the most appropriate action?

A. Document findings and recheck in 2 hours
B. Apply warm compresses to the petechiae
C. Perform the tumbler test to assess blanching
D. Administer diphenhydramine for a suspected allergic reaction

Answer 18

C. Perform the tumbler test to assess blanching

Rationale: The tumbler (glass) test helps determine if a rash is non-blanching, which is characteristic of meningococcal infection. A non-blanching rash can indicate serious systemic involvement and should prompt urgent medical attention. Diphenhydramine is inappropriate, as this is not an allergic rash.

Question 19

A patient with bacterial meningitis begins to have tonic-clonic seizures. What is the nurse’s priority action?

A. Restrain the patient’s limbs
B. Document the length of the seizure
C. Turn the patient to the side and protect the airway
D. Place the patient in a supine position and insert an oral airway

Answer 19

C. Turn the patient to the side and protect the airway

Rationale: Airway protection is always the first priority during a seizure. Placing the patient on their side helps prevent aspiration. Restraints are dangerous during a seizure. Documentation is important but not the immediate priority. Oral airways should not be inserted during active convulsions.

Question 20

The nurse is monitoring a patient with bacterial meningitis. Which clinical manifestation requires immediate intervention?

A. Mild photophobia
B. Severe headache with vomiting
C. Petechial rash on the lower extremities
D. Coma and unresponsiveness

Answer 20

D. Coma and unresponsiveness

Rationale: Coma in bacterial meningitis is a late sign and is associated with a poor prognosis. It can indicate increased ICP, brain herniation, or severe neurologic compromise. While the other signs are serious, coma demands urgent intervention.

Question 21

A nurse is assessing a client suspected of having bacterial meningitis. Which of the following symptoms should the nurse expect? (SATA)

A. Severe headache
B. Nausea and vomiting
C. Hyperactive deep tendon reflexes
D. Photophobia
E. Petechial rash on mucous membranes

Answer 21

A. Severe headache
B. Nausea and vomiting
D. Photophobia
E. Petechial rash on mucous membranes

Rationale: Common symptoms of bacterial meningitis include headache, N/V, photophobia, and in meningococcal meningitis, petechial rash. Hyperactive reflexes are not a hallmark of meningitis and are not listed in the expected manifestations.

Question 22

A nurse is teaching students about the progression of symptoms in bacterial meningitis. Which description best characterizes the headache experienced by patients?

A. Sharp, intermittent, and worsens with inspiration
B. Pulsating and improved by lying down
C. Gradual onset that becomes progressively worse and may be accompanied by vomiting
D. Sudden and resolved with ibuprofen

Answer 22

C. Gradual onset that becomes progressively worse and may be accompanied by vomiting

Rationale: The headache associated with bacterial meningitis is progressive and severe. It may be accompanied by nausea, vomiting, and irritability. It does not typically resolve with over-the-counter analgesics and does not fluctuate with respiratory movement.

Question 23

A nurse is assessing a patient with bacterial meningitis who suddenly becomes disoriented and confused. Which complication should the nurse suspect?

A. Residual cranial nerve dysfunction
B. Increased intracranial pressure (ICP)
C. Chronic headache
D. Hemianopsia

Answer 23

B. Increased intracranial pressure (ICP)

Rationale: Altered mental status is commonly caused by elevated ICP in patients with bacterial meningitis. Most patients with bacterial meningitis develop increased ICP due to inflammation, cerebral edema, and increased CSF volume.

Question 24

A nurse is evaluating a patient with cranial nerve dysfunction due to bacterial meningitis. Which of the following assessment findings support this complication? (SATA)

A. Facial droop
B. Ptosis and unequal pupils
C. Hyperreflexia
D. Tinnitus and vertigo
E. Corneal reflex present bilaterally

Answer 24

A. Facial droop
B. Ptosis and unequal pupils
D. Tinnitus and vertigo

Rationale: Facial droop (CN VII), ptosis/unequal pupils (CN III, IV, VI), and tinnitus/vertigo (CN VIII) are all signs of cranial nerve involvement. Hyperreflexia is not a common CN manifestation, and the presence (not loss) of the corneal reflex indicates normal function of CN V.

Question 25

A 37-year-old patient recovering from meningitis reports persistent severe headaches two months post-hospitalization. What is the best nursing action? A. Reassure the patient that headaches are expected and offer rest B. Advise increasing fluid intake to relieve headache C. Refer the patient for psychiatric evaluation D. Administer pain medications and assess pain characteristics

Answer 25

D. Administer pain medications and assess pain characteristics Rationale: Persistent headaches are common after meningitis due to prolonged irritation and inflammation. Nurses should implement appropriate pain management and monitor for worsening symptoms that may indicate another complication like hydrocephalus.

Question 26

A patient with a history of bacterial meningitis is unresponsive with a blown right pupil, bradycardia, and irregular respirations. What complication is most likely occurring? A. Noncommunicating hydrocephalus B. Seizure disorder C. Increased ICP with brain herniation D. Post-meningitis headache syndrome

Answer 26

C. Increased ICP with brain herniation Rationale: Signs such as a dilated pupil (CN III palsy), bradycardia, and irregular respirations indicate severe increased ICP and possible brain herniation, a life-threatening emergency requiring immediate intervention.

Question 27

Which cranial nerve is most likely involved when a patient develops blindness after bacterial meningitis? A. CN III B. CN V C. CN II D. CN VIII

Answer 27

C. CN II Rationale: The optic nerve (CN II) may be compressed by elevated ICP, causing papilledema and potential blindness. The other options involve eye movement (CN III), facial sensation (CN V), and hearing/balance (CN VIII).

Question 28

A patient with bacterial meningitis has ptosis, double vision, and unequal pupils. These findings suggest damage to which group of cranial nerves? A. CN II and CN V B. CN III, IV, and VI C. CN VII and CN IX D. CN I and CN VIII

Answer 28

B. CN III, IV, and VI Rationale: CN III (oculomotor), IV (trochlear), and VI (abducens) are responsible for eye movement. Inflammation or compression may result in ptosis, diplopia (double vision), and unequal pupils.

Question 29

A patient with a recent diagnosis of meningitis develops hemiparesis and expressive aphasia. The nurse expects these symptoms to resolve but they persist for several weeks. What complication should be suspected? A. Chronic pain syndrome B. Subdural empyema or cerebral abscess C. Noncompliance with therapy D. Post-traumatic stress disorder

Answer 29

B. Subdural empyema or cerebral abscess Rationale: Hemiparesis and dysphasia are neurologic complications that may resolve over time. If persistent, they suggest more severe intracranial pathology, such as a cerebral abscess or subdural empyema, requiring diagnostic imaging and possible surgical intervention.

Question 30

Which signs and symptoms are associated with CN VIII involvement following bacterial meningitis? (SATA) A. Vertigo B. Hearing loss C. Facial droop D. Tinnitus E. Photophobia

Answer 30

A. Vertigo B. Hearing loss D. Tinnitus Rationale: Cranial nerve VIII (vestibulocochlear) is responsible for hearing and balance. Irritation can result in vertigo, tinnitus, and potential permanent hearing loss. Facial droop is CN VII; photophobia is a nonspecific symptom, not related to CN VIII.

Question 31

Which finding indicates noncommunicating hydrocephalus secondary to meningitis? A. Rapid resolution of headache after analgesics B. Bradycardia, vomiting, and papilledema C. Generalized urticaria and itching D. Sudden improvement in mental status

Answer 31

B. Bradycardia, vomiting, and papilledema Rationale: Noncommunicating hydrocephalus results from blockage in CSF flow, leading to increased ICP. Classic signs include vomiting, bradycardia, and papilledema. It may require surgical intervention, such as shunt placement.

Question 32

The nurse is caring for a patient with confirmed meningococcal meningitis who suddenly develops petechiae, hypotension, and a distended abdomen. Which complication is most likely? A. Brain abscess B. Syndrome of inappropriate ADH secretion (SIADH) C. Waterhouse-Friderichsen syndrome D. Acute respiratory distress syndrome (ARDS)

Answer 32

C. Waterhouse-Friderichsen syndrome Rationale: This life-threatening complication is caused by meningococcemia and involves adrenal hemorrhage, petechiae, DIC, and circulatory collapse. It is a medical emergency and requires aggressive supportive care.

Question 33

A 22-year-old patient recovering from meningococcal meningitis is developing sudden bruising, oozing from IV sites, and hypotension. What laboratory abnormality is most anticipated? A. Elevated INR and decreased fibrinogen B. Elevated platelets C. Hypernatremia D. Metabolic alkalosis

Answer 33

A. Elevated INR and decreased fibrinogen Rationale: These are classic lab findings associated with disseminated intravascular coagulation (DIC), a severe complication of meningococcal infection. It involves widespread clotting and bleeding due to depletion of clotting factors.

Question 34

Which neurologic complication is most likely to become permanent after bacterial meningitis? A. Tinnitus B. Diplopia C. Hearing loss D. Facial droop

Answer 34

C. Hearing loss Rationale: Although most cranial nerve dysfunctions resolve over time, hearing loss from CN VIII involvement can be permanent. Early recognition and audiology follow-up are critical.

Question 35

A nurse is monitoring a patient with acute cerebral edema from bacterial meningitis. Which assessment finding should be immediately reported to the provider? A. Mild headache B. Heart rate 58 bpm and new-onset pupil dilation C. Photophobia and neck stiffness D. Irritability and insomnia

Answer 35

B. Heart rate 58 bpm and new-onset pupil dilation Rationale: Bradycardia and pupil changes are late signs of increased ICP and impending herniation. This requires urgent intervention. The other findings, while concerning, do not indicate immediate neurological deterioration.

Question 36

Which of the following is the most definitive treatment for noncommunicating hydrocephalus secondary to bacterial meningitis? A. Intravenous diuretics B. Pain management and corticosteroids C. Ventriculoperitoneal shunt placement D. Bed rest and CSF sampling

Answer 36

C. Ventriculoperitoneal shunt placement Rationale: If adhesions block CSF flow due to inflammatory exudate, hydrocephalus can develop. The only definitive treatment is surgical shunting of CSF, typically via a ventriculoperitoneal (VP) shunt.

Question 37

A nurse is caring for a patient suspected of having bacterial meningitis. Which diagnostic action should the nurse expect to be performed first? A. CT scan of the head B. Intravenous antibiotic administration C. Lumbar puncture D. MRI of the brain

Answer 37

A. CT scan of the head Rationale: A CT scan must be done before a lumbar puncture (LP) to rule out any obstruction at the foramen magnum. If an LP is performed in the presence of an obstruction, it can cause a rapid shift in cerebrospinal fluid (CSF) and result in fatal brain herniation.

Question 38

A 56-year-old patient presents with fever, headache, photophobia, and confusion. The provider suspects bacterial meningitis and orders a CT scan followed by a lumbar puncture. The nurse reviews the CSF analysis results: turbid appearance, elevated WBC count with neutrophilic predominance, elevated protein, and decreased glucose. How should the nurse interpret these findings? A. Normal CSF findings B. Indicative of viral meningitis C. Suggestive of bacterial meningitis D. Indicative of subarachnoid hemorrhage

Answer 38

C. Suggestive of bacterial meningitis Rationale: Bacterial meningitis typically presents with cloudy CSF, neutrophilic predominance, high protein, and low glucose levels due to bacterial metabolism. Viral meningitis often shows lymphocytic predominance and normal glucose.

Question 39

Why is it essential to collect cultures of CSF, sputum, and nasopharyngeal secretions before initiating antibiotic therapy in suspected bacterial meningitis? A. Antibiotics enhance pathogen detection B. Culture results are unaffected by antibiotic administration C. Early antibiotics prevent need for further testing D. Antibiotics can alter culture accuracy and obscure the causative organism

Answer 39

D. Antibiotics can alter culture accuracy and obscure the causative organism Rationale: Cultures should be collected before starting antibiotics, as antibiotics can sterilize the CSF and reduce the chances of identifying the causative bacteria. Early administration can lead to false-negative cultures.

Question 40

A patient with signs of bacterial meningitis is rapidly deteriorating. The provider orders a blood culture and CT scan prior to lumbar puncture. Which nursing action is most appropriate? A. Delay antibiotics until CSF results are confirmed B. Assist with immediate lumbar puncture to save time C. Obtain blood cultures and ensure CT scan is done promptly D. Administer mannitol to reduce ICP before diagnostic studies

Answer 40

C. Obtain blood cultures and ensure CT scan is done promptly Rationale: Blood cultures should be collected immediately, and a CT scan must precede any lumbar puncture to ensure it’s safe to proceed. LP without CT in a patient with elevated ICP risks brain herniation.

Question 41

Which of the following diagnostic tests or findings support the diagnosis of bacterial meningitis? (SATA) A. MRI showing early inflammation B. CSF with neutrophil predominance C. Gram stain showing gram-negative diplococci D. X-ray revealing sinus infection E. CSF glucose higher than serum glucose

Answer 41

B. CSF with neutrophil predominance C. Gram stain showing gram-negative diplococci D. X-ray revealing sinus infection Rationale: Neutrophilic CSF predominance is typical of bacterial meningitis. A Gram stain may show organisms such as Neisseria meningitidis (gram-negative diplococci). X-rays may show sinus infections, which are potential sources. MRI is usually normal in early stages, and CSF glucose should be lower, not higher, than serum glucose in bacterial meningitis.

Question 42

A patient undergoes a lumbar puncture for suspected meningitis. Which CSF finding is most characteristic of bacterial meningitis? A. Clear fluid, lymphocytes, normal glucose B. Cloudy fluid, neutrophils, decreased glucose C. Bloody fluid, monocytes, elevated glucose D. Clear fluid, eosinophils, decreased protein

Answer 42

B. Cloudy fluid, neutrophils, decreased glucose Rationale: In bacterial meningitis, CSF is usually cloudy or turbid, contains neutrophils, and shows low glucose and high protein. These findings help differentiate it from viral or fungal meningitis.

Question 43

Which imaging study is likely to be normal in a patient with early, uncomplicated bacterial meningitis? A. MRI of the brain B. PET scan C. X-ray of the chest D. CT scan of the brain

Answer 43

D. CT scan of the brain Rationale: CT scans may appear normal in uncomplicated cases of bacterial meningitis, especially early in the disease process. However, they are essential to rule out contraindications to lumbar puncture. MRI may also be normal early but is not the first-line imaging tool in this setting.

Question 44

A nurse is caring for a patient with suspected bacterial meningitis. The provider orders blood cultures and a CT scan. What should the nurse anticipate as the next priority action? A. Wait for CSF results before beginning treatment B. Administer prescribed IV antibiotics immediately after cultures are drawn C. Give acetaminophen and reassess in 1 hour D. Apply cooling measures for fever before diagnostic procedures

Answer 44

B. Administer prescribed IV antibiotics immediately after cultures are drawn Rationale: Bacterial meningitis is a medical emergency. Antibiotics must be started immediately after cultures are collected, even before the diagnosis is confirmed, to reduce mortality. Delays in antibiotic therapy can be fatal.

Question 45

A 19-year-old college student presents to the emergency department with a fever, severe headache, photophobia, and nuchal rigidity. The provider suspects bacterial meningitis. The nurse collects blood and sputum cultures, and a CT scan is pending. Which of the following actions is most appropriate? A. Start broad-spectrum IV antibiotics B. Administer dexamethasone after antibiotic therapy begins C. Wait to administer antibiotics until LP results return D. Begin antiviral therapy to cover all potential causes

Answer 45

A. Start broad-spectrum IV antibiotics Rationale: Broad-spectrum antibiotics (e.g., ceftriaxone, vancomycin) should be started immediately after cultures are collected, without waiting for lumbar puncture results. Time is critical. Dexamethasone is effective only if given before or with the first dose of antibiotics.

Question 46

A provider orders ceftriaxone and vancomycin for a patient diagnosed with bacterial meningitis. What is the rationale for using these two antibiotics together? A. To decrease the likelihood of allergic reactions B. To treat both gram-positive and gram-negative organisms C. To reduce the need for additional CSF analysis D. To minimize the need for corticosteroids

Answer 46

B. To treat both gram-positive and gram-negative organisms Rationale: Empiric antibiotic therapy for meningitis typically involves broad-spectrum coverage. Ceftriaxone (a third-generation cephalosporin) targets gram-negative bacteria, while vancomycin is effective against resistant gram-positive organisms like Streptococcus pneumoniae.

Question 47

Why is dexamethasone administered before or with the first dose of antibiotics in bacterial meningitis? A. It prevents the spread of infection to the bloodstream B. It enhances antibiotic penetration into the CSF C. It reduces inflammation and neurologic complications D. It suppresses the immune system to improve comfort

Answer 47

C. It reduces inflammation and neurologic complications Rationale: Dexamethasone is a corticosteroid given before or with the first dose of antibiotics to reduce inflammation, lower ICP, and decrease the risk of neurologic complications such as hearing loss. Timing is crucial for effectiveness.

Question 48

A patient receiving treatment for bacterial meningitis continues to have a fever and neck stiffness despite antibiotic therapy. Which interprofessional action should the nurse take next? A. Contact the dietitian for fluid recommendations B. Encourage the patient to ambulate and perform neck exercises C. Increase IV fluid rate to flush out infection D. Collaborate with the provider for pain and fever management orders

Answer 48

D. Collaborate with the provider for pain and fever management orders Rationale: Persistent fever, headache, and nuchal rigidity require symptom-specific supportive care. The nurse should work closely with the provider to manage these issues. Early symptom control helps prevent further complications and improves patient comfort and outcomes.

Question 49

A nurse is caring for a patient admitted with suspected bacterial meningitis. Which laboratory test is most critical for confirming the diagnosis? A. Serum glucose B. Coagulation profile C. CSF analysis via lumbar puncture D. Complete blood count (CBC)

Answer 49

C. CSF analysis via lumbar puncture Rationale: A lumbar puncture with CSF analysis is the definitive test for diagnosing bacterial meningitis. It evaluates WBC count, protein, glucose, and may include Gram stain and culture to identify the organism.

Question 50

A 28-year-old patient with bacterial meningitis has a temperature of 101.9°F, complains of a throbbing headache, and is receiving IV ceftriaxone. Which medication should the nurse anticipate administering next? A. Acetaminophen B. IV heparin C. Lorazepam D. Oral ibuprofen

Answer 50

A. Acetaminophen Rationale: Acetaminophen is appropriate for treating fever over 100.4°F and is preferred in meningitis due to its low risk of bleeding. Headaches associated with meningitis may also benefit from pain management like acetaminophen or codeine.

Question 51

The provider prescribes IV mannitol for a patient with bacterial meningitis. What is the purpose of this drug? A. To manage nausea and vomiting B. To reduce seizure activity C. To promote diuresis and lower increased ICP D. To enhance CSF glucose transport

Answer 51

C. To promote diuresis and lower increased ICP Rationale: Mannitol is an osmotic diuretic used to reduce cerebral edema and elevated ICP, a common and dangerous complication of bacterial meningitis.

Question 52

A patient with bacterial meningitis is receiving IV phenytoin. What is the rationale for this treatment? A. To prevent hydrocephalus B. To control or prevent seizures C. To reduce nausea associated with antibiotics D. To decrease meningeal inflammation

Answer 52

B. To control or prevent seizures Rationale: Seizures occur in up to one-third of patients with bacterial meningitis. IV phenytoin, an anticonvulsant, is often administered prophylactically or in response to seizure activity.

Question 53

Which finding indicates the therapeutic effectiveness of dexamethasone in a patient with bacterial meningitis? A. Decreased temperature within 2 hours B. Reduction in ICP and improved neurologic function C. Increase in urinary output D. Increased CSF glucose concentration

Answer 53

B. Reduction in ICP and improved neurologic function Rationale: Dexamethasone is a corticosteroid that helps reduce inflammation, limit ICP, and minimize neurologic complications such as hearing loss. Its benefit is maximized when given before or with the first dose of antibiotics.

Question 54

A 46-year-old patient with bacterial meningitis is receiving IV fluids, ceftriaxone, and codeine. The patient rates their headache as 9/10 and has a temperature of 100.8°F. What is the nurse’s next best action? A. Call the provider to request an opioid increase B. Hold all pain medications until the temperature lowers C. Administer the prescribed codeine and reassess pain D. Apply ice packs to the patient’s neck

Answer 54

C. Administer the prescribed codeine and reassess pain Rationale: Codeine is used in bacterial meningitis to relieve the severe headache caused by inflammation and ICP. Administering it as prescribed is appropriate, and reassessment ensures pain management is effective.

Question 55

Which of the following are included in the routine diagnostic workup for suspected bacterial meningitis? (SATA) A. PET scan B. CSF culture C. Electrolyte levels D. CT scan E. Cardiac echocardiogram

Answer 55

A. PET scan B. CSF culture C. Electrolyte levels D. CT scan Rationale: The diagnostic workup includes CSF culture, electrolyte levels (to assess fluid balance), CT scan (to rule out elevated ICP before LP), and occasionally PET scan to evaluate for cerebral inflammation. An echocardiogram is not a standard part of meningitis diagnostics.

Question 56

A patient with bacterial meningitis is prescribed IV ceftriaxone. What should the nurse do before administering this antibiotic? A. Collect cultures from CSF, blood, and sputum B. Start IV mannitol to protect the kidneys C. Administer dexamethasone 6 hours before the antibiotic D. Assess respiratory rate for signs of apnea

Answer 56

A. Collect cultures from CSF, blood, and sputum Rationale: Before antibiotics are started, cultures must be collected to avoid altering the ability to identify the causative organism. Early antibiotic administration without cultures may lead to false-negative results.

Question 57

What is the primary reason for obtaining a coagulation profile in a patient with bacterial meningitis? A. To predict antibiotic resistance B. To determine steroid dosing C. To assess risk for bleeding or DIC D. To evaluate kidney function

Answer 57

C. To assess risk for bleeding or DIC Rationale: Meningitis, especially meningococcal, can lead to coagulopathies such as disseminated intravascular coagulation (DIC). A coagulation profile is critical in monitoring this risk.

Question 58

Which medication should the nurse administer for a patient with bacterial meningitis who has a persistent fever of 102.3°F? A. Acetaminophen B. Morphine C. Diphenhydramine D. Ibuprofen only if no infection is present

Answer 58

A. Acetaminophen Rationale: For temperatures over 100.4°F (38°C), acetaminophen or aspirin is recommended to manage fever in bacterial meningitis. Fever increases metabolic demand and ICP, so prompt treatment is essential.

Question 59

A nurse is caring for a patient with bacterial meningitis. Which assessment finding is most concerning and should be reported immediately? A. Blood pressure of 132/84 mmHg B. Urine output of 240 mL over 8 hours C. New onset of irregular respirations and dilated pupils D. Temperature of 100.6°F (38.1°C)

Answer 59

C. New onset of irregular respirations and dilated pupils Rationale: These are classic signs of increased intracranial pressure (ICP) and potential brain herniation. They require immediate intervention to prevent neurologic deterioration or death.

Question 60

A patient with bacterial meningitis has a nursing diagnosis of altered body temperature. The patient has a temperature of 102.8°F (39.3°C), is restless, and diaphoretic. Which intervention should the nurse implement first? A. Apply cooling blankets and increase IV fluids B. Administer prescribed acetaminophen and reduce room temperature C. Notify the provider of the temperature D. Provide oral fluids and reassess in 2 hours

Answer 60

B. Administer prescribed acetaminophen and reduce room temperature Rationale: Fever increases metabolic demand and ICP, so it must be managed promptly. Administering antipyretics and reducing environmental heat are first-line, safe, and effective nursing actions.

Question 61

Which is the primary goal of nursing care when planning treatment for a patient with bacterial meningitis? A. Increase sensory stimulation to maintain alertness B. Promote complete independence with ADLs C. Maintain a fluid-restricted environment D. Return the patient to maximal neurologic functioning

Answer 61

D. Return the patient to maximal neurologic functioning Rationale: The top nursing goal is to support neurologic recovery, as bacterial meningitis can lead to lasting deficits. Independence with ADLs may follow, but neuro recovery is the priority.

Question 62

A nurse is monitoring a patient with bacterial meningitis. Which nursing intervention is most important to prevent inadequate tissue perfusion? A. Keep the room dark and quiet B. Elevate the head of the bed to 30 degrees C. Monitor mean arterial pressure (MAP) and serum lactate D. Assist the patient to ambulate every 4 hours

Answer 62

C. Monitor mean arterial pressure (MAP) and serum lactate Rationale: Inadequate tissue perfusion may result from sepsis or elevated ICP. Monitoring MAP ensures cerebral perfusion, and elevated lactate can signal poor systemic perfusion—both are essential in critically ill patients.

Question 63

Which of the following nursing assessments are essential in a patient admitted with bacterial meningitis? (SATA) A. Monitor fluid intake and output B. Perform hourly blood glucose checks C. Perform frequent neurologic assessments D. Assess lung and skin condition E. Measure intracranial pressure with a portable doppler

Answer 63

A. Monitor fluid intake and output C. Perform frequent neurologic assessments D. Assess lung and skin condition Rationale: I&O, neuro assessments, and evaluation of lung/skin status are all part of a thorough nursing assessment for meningitis. Glucose checks are only needed for diabetic or septic patients. A Doppler is not used to measure ICP.

Question 64

A nurse caring for a patient with bacterial meningitis prioritizes pain management. Which intervention is most appropriate? A. Offer cool compresses and repositioning B. Dim lights and minimize environmental stimuli C. Encourage frequent range-of-motion exercises D. Administer stool softeners to reduce discomfort

Answer 64

B. Dim lights and minimize environmental stimuli Rationale: Photophobia and headache are common in meningitis. Reducing light and noise helps relieve pain and minimize ICP elevation due to stimulation. ROM and stool softeners are supportive but not the priority here.

Question 65

A patient recovering from bacterial meningitis is improving and reports mild headache and fatigue. Vitals are stable, and neuro checks are normal. Which action reflects appropriate nursing planning at this stage? A. Encourage early discharge and follow-up by phone B. Focus on medication adherence education C. Promote ambulation and activity as tolerated D. Limit sensory input to prevent overstimulation

Answer 65

C. Promote ambulation and activity as tolerated Rationale: As the patient stabilizes, nursing goals shift toward mobility and rehabilitation. Gradual activity helps prevent deconditioning and supports the goal of returning to maximal neurologic function.

Question 66

A college health nurse is providing education on meningococcal prevention. Which statement made by a student indicates the need for further teaching? A. “Once I’m vaccinated, I can’t get meningitis.” B. “The vaccine protects me from the most common strains that cause meningitis.” C. “There are two different meningococcal vaccines available.” D. “I should still seek care if I develop symptoms of meningitis, even if I’m vaccinated.”

Answer 66

A. “Once I’m vaccinated, I can’t get meningitis.” Rationale: Vaccination reduces the risk but does not eliminate the possibility of developing meningitis. The student should understand that vaccines don’t protect against all serogroups or other causes of meningitis.

Question 67

A 17-year-old high school senior is preparing to move into a college dorm. The student’s immunization record shows no history of meningococcal vaccination. What should the nurse recommend? A. MMR booster B. Seasonal flu vaccine only C. Meningococcal conjugate vaccine D. Tetanus-diphtheria booster

Answer 67

C. Meningococcal conjugate vaccine Rationale: Students entering college dormitories are at higher risk for meningococcal disease. MCV4 (Menactra or Menveo) is recommended for this age group. Flu vaccine is also important, but MCV4 is the priority in this case.

Question 68

A public health nurse is planning a vaccination clinic for meningococcal prevention. Which groups should be targeted for Serogroup B meningococcal vaccine (e.g., Bexsero, Trumenba)? A. Adults over 65 years of age B. All children under 5 years old C. College students in outbreak-prone areas D. Pregnant women in their third trimester

Answer 68

C. College students in outbreak-prone areas Rationale: Serogroup B vaccines are typically given to adolescents and young adults, especially during outbreaks. Serogroup B is not covered by MCV4 and requires separate vaccination in certain populations.

Question 69

Which of the following are appropriate health promotion strategies to reduce the incidence of bacterial meningitis? (SATA) A. Annual influenza vaccination B. Timely treatment of ear infections C. Prophylactic antibiotics for close contacts D. Avoiding public transportation during flu season E. Pneumococcal vaccination

Answer 69

A. Annual influenza vaccination B. Timely treatment of ear infections C. Prophylactic antibiotics for close contacts E. Pneumococcal vaccination Rationale: Prevention includes influenza and pneumococcal vaccines, early treatment of infections, and prophylactic antibiotics for close contacts. Avoiding public transportation is not a recommended or evidence-based strategy.

Question 70

A patient has been in close contact with someone recently diagnosed with meningococcal meningitis. What is the nurse’s priority action? A. Schedule meningococcal vaccination within 72 hours B. Advise the patient to isolate for 10 days C. Recommend prophylactic antibiotics per protocol D. Monitor for signs of respiratory distress

Answer 70

C. Recommend prophylactic antibiotics per protocol Rationale: Close contacts of individuals with meningococcal meningitis should receive prophylactic antibiotics (e.g., rifampin, ciprofloxacin, or ceftriaxone) to prevent disease. Vaccination is important for prevention, but antibiotics are the immediate post-exposure priority.

Question 71

Which population is most appropriate to receive pneumococcal and influenza vaccines as part of bacterial meningitis prevention? A. Healthy 25-year-old adults B. Elderly adults and immunocompromised individuals C. College athletes only D. Infants under 2 weeks of age

Answer 71

B. Elderly adults and immunocompromised individuals Rationale: Pneumococcal and influenza vaccines are essential for older adults and those with weakened immune systems, as respiratory tract infections in these groups can lead to secondary bacterial meningitis.

Question 72

A pediatric nurse is reviewing vaccine records for a 10-year-old child. The child has received all routine childhood vaccinations, including the Hib and pneumococcal vaccines. The parent asks about meningitis protection. What is the nurse’s best response? A. “Your child will receive meningococcal vaccines during early adulthood.” B. “Your child is fully protected from all types of meningitis now.” C. “Meningococcal vaccines are not necessary unless your child travels abroad.” D. “Your child may still need the meningococcal conjugate vaccine during adolescence.”

Answer 72

D. “Your child may still need the meningococcal conjugate vaccine during adolescence.” Rationale: While the Hib and pneumococcal vaccines protect against certain causes of meningitis, MCV4 is routinely given at age 11–12 with a booster at age 16. This helps protect against N. meningitidis, which becomes more relevant in adolescence.

Question 73

A nurse caring for a patient with bacterial meningitis observes that the patient is curled in a fetal position with the head slightly extended. What is the appropriate nursing action? A. Reposition the patient to a flat supine position B. Document this as a position of comfort and provide supportive care C. Encourage the patient to lie prone to promote CSF drainage D. Apply soft wrist restraints to prevent movement

Answer 73

B. Document this as a position of comfort and provide supportive care Rationale: Patients with meningitis often assume a curled-up position with slight head extension for comfort due to head and neck pain. This should be supported rather than corrected unless it interferes with care.

Question 74

A 23-year-old patient with meningitis has a temperature of 103.4°F (39.7°C), is diaphoretic, and is receiving acetaminophen with minimal effect. What is the nurse’s next best action? A. Increase room temperature to reduce shivering B. Apply a cooling blanket and wrap extremities in towels C. Administer ibuprofen and place the patient under a fan D. Pack the patient’s body in ice to lower temperature rapidly

Answer 74

B. Apply a cooling blanket and wrap extremities in towels Rationale: A cooling blanket is used when fever is not responsive to medications. Wrapping extremities helps prevent shivering, which can increase ICP and worsen the patient’s condition. Rapid cooling is avoided.

Question 75

The nurse notes a patient with meningitis is having auditory hallucinations, is frightened, and frequently calls out. What is the best nursing intervention? A. Administer haloperidol as ordered B. Increase room lighting to improve orientation C. Reduce environmental stimuli and speak calmly D. Place the patient in full restraints for safety

Answer 75

C. Reduce environmental stimuli and speak calmly Rationale: Patients may experience delirium or sensory distortion. Calm communication and reducing stimuli can help reorient and soothe the patient. Restraints and bright lights worsen agitation.

Question 76

Why should the nurse avoid rapid reduction of fever in patients with bacterial meningitis? A. It can lead to an allergic reaction B. It may increase metabolic demand C. It can cause rebound fever due to shivering D. It lowers antibiotic effectiveness

Answer 76

C. It can cause rebound fever due to shivering Rationale: Rapid cooling triggers shivering, which increases metabolic rate and ICP, potentially worsening cerebral edema. Fever should be reduced gradually with supportive measures.

Question 77

A patient with bacterial meningitis develops a seizure. What is the nurse’s priority action? A. Administer IV phenytoin as ordered B. Document the seizure activity C. Position the patient flat and monitor heart rate D. Hold all medications and call the neurologist

Answer 77

A. Administer IV phenytoin as ordered Rationale: Seizures are a common complication due to cortical irritation. Phenytoin or levetiracetam are used to treat and prevent seizures. While documentation is important, intervention takes priority.

Question 78

The nurse is assessing a patient with bacterial meningitis. Which assessment finding requires immediate intervention? A. Photophobia and nuchal rigidity B. A low-grade fever C. Decreased level of consciousness D. Pain when turning the head

Answer 78

C. Decreased level of consciousness Rationale: A change in LOC may signal worsening ICP or cerebral edema. It requires immediate attention. The other findings are expected in meningitis but not emergencies.

Question 79

Which nursing interventions are appropriate for a patient with severe photophobia from bacterial meningitis? (SATA) A. Darken the room B. Apply a cool cloth over the eyes C. Keep the lights on for orientation D. Limit visitors E. Elevate the head of the bed

Answer 79

A. Darken the room B. Apply a cool cloth over the eyes E. Elevate the head of the bed Rationale: Photophobia is best managed by darkening the room, using cool compresses, and elevating the HOB to reduce ICP. Bright lights and overstimulation should be avoided.

Question 80

What is the most important reason to monitor intake and output in a patient with bacterial meningitis? A. To prevent urinary tract infection B. To determine electrolyte levels C. To assess for dehydration from fever and diaphoresis D. To evaluate pain medication effectiveness

Answer 80

C. To assess for dehydration from fever and diaphoresis Rationale: High fever and diaphoresis increase insensible fluid loss, putting patients at risk for dehydration. Close monitoring helps maintain fluid and electrolyte balance.

Question 81

A nurse is planning care for a patient with meningococcal meningitis. Which infection control measure is most appropriate? A. Standard precautions for all care B. Droplet precautions until cultures are negative C. Airborne isolation for 48 hours D. Contact precautions for 7 days

Answer 81

B. Droplet precautions until cultures are negative Rationale: Meningococcal meningitis requires droplet precautions due to its contagious nature. Isolation continues until 24 hours after effective antibiotic therapy and negative cultures.

Question 82

Which action by the nurse helps reduce environmental stimuli for a delirious patient with bacterial meningitis? A. Leave the television on for background noise B. Turn on bright lights to avoid shadows C. Speak loudly to maintain patient alertness D. Minimize room entries and noise levels

Answer 82

D. Minimize room entries and noise levels Rationale: Delirium is common in meningitis due to inflammation and sensory hypersensitivity. Reducing noise and interruptions helps prevent agitation and confusion.

Question 83

A patient with bacterial meningitis is receiving IV antibiotics. What is the nurse’s priority to ensure the therapy is effective? A. Monitor for allergic reactions B. Maintain scheduled dosing to ensure therapeutic blood levels C. Educate the family about side effects D. Assess for signs of depression

Answer 83

B. Maintain scheduled dosing to ensure therapeutic blood levels Rationale: Antibiotics must be administered on schedule to maintain therapeutic drug levels and combat the rapidly progressing infection.

Question 84

Which medication is most appropriate for treating severe head pain in a patient with bacterial meningitis without causing excessive sedation? A. Morphine B. Codeine C. Lorazepam D. Hydromorphone

Answer 84

B. Codeine Rationale: Codeine provides effective pain relief without undue sedation, which is important for frequent neurologic assessments.

Question 85

A nurse is calculating fluid replacement for a patient with bacterial meningitis and a fever of 102.4°F (39.1°C). What is the appropriate total amount of fluid loss to replace? A. 900 mL/day B. 1000 mL/day C. 1100 mL/day D. 1200 mL/day

Answer 85

C. 1100 mL/day Rationale: 800 mL/day for respiratory loss + 100 mL per degree >100.4°F. This patient has a 2°F increase, so: 800 + (2 × 100) = 1100 mL/day.

Question 86

What action should the nurse take when applying a cooling blanket to a febrile meningitis patient? A. Wrap extremities to prevent shivering B. Reduce temperature as fast as possible C. Leave arms and legs exposed D. Use ice packs along with the cooling blanket

Answer 86

A. Wrap extremities to prevent shivering Rationale: Shivering can increase metabolic demand and ICP, so wrapping extremities helps control thermal balance during external cooling.

Question 87

Which assessments are priorities for monitoring a patient with acute bacterial meningitis? (SATA) A. Vital signs B. Electrocardiogram C. Lung sounds D. Skin integrity E. Liver enzyme levels

Answer 87

A. Vital signs C. Lung sounds D. Skin integrity Rationale: Monitoring vitals, lung sounds, and skin is essential to track systemic effects and complications. ECGs and liver enzymes are not routine unless specific concerns arise.

Question 88

A patient recovering from bacterial meningitis appears confused and disoriented. The nurse sits beside the patient and speaks in a soft, calm tone while explaining care. What is the rationale for this approach? A. To meet therapeutic communication goals B. To stimulate neurologic recovery C. To minimize environmental stress and prevent injury D. To assess response to verbal stimuli

Answer 88

C. To minimize environmental stress and prevent injury Rationale: Patients may experience hypersensitivity and confusion, so using a calm, gentle approach helps reduce anxiety, avoid overstimulation, and prevent accidental harm.

Question 89

A patient with bacterial meningitis is lethargic and febrile. The nurse notes decreased urine output and dry mucous membranes. What action is most appropriate? A. Encourage increased oral intake B. Administer diuretics to reduce fever C. Notify the provider and prepare for IV fluid bolus D. Increase ambient room temperature

Answer 89

C. Notify the provider and prepare for IV fluid bolus Rationale: High fever and diaphoresis can cause dehydration, which must be corrected to prevent shock and maintain perfusion. IV fluids are typically required.

Question 90

What is the primary reason fever is treated aggressively in patients with bacterial meningitis? A. To keep the patient comfortable B. To reduce the need for antibiotics C. To prevent seizures and reduce cerebral edema D. To improve sleep patterns

Answer 90

C. To prevent seizures and reduce cerebral edema Rationale: High fever increases ICP and seizure risk, which can worsen neurologic outcomes. Aggressive fever control is essential in preventing complications.

Question 91

Which statement best reflects the need for respiratory isolation in bacterial meningitis? A. All bacterial meningitis cases require isolation B. Respiratory isolation is needed for meningococcal meningitis only C. Isolation is required for 72 hours for all meningitis types D. Standard precautions are sufficient for meningococcal infections

Answer 91

B. Respiratory isolation is needed for meningococcal meningitis only Rationale: Meningococcal meningitis is highly contagious and requires droplet precautions. Other types may not need isolation unless other factors are present.

Question 92

The nurse is preparing to assess a patient with suspected bacterial meningitis. Which action should the nurse take first? A. Begin neurologic assessment and vitals B. Administer PRN antipyretic C. Place the patient in a dark room D. Obtain a urine sample for culture

Answer 92

A. Begin neurologic assessment and vitals Rationale: Initial assessment must include vital signs and neuro status, which guide urgency and next steps such as isolation, antibiotics, and imaging.

Question 93

A patient recovering from bacterial meningitis asks when they can return to their full work schedule. What is the best response by the nurse? A. “You can return to work as soon as you feel less tired.” B. “You may return to work once your muscle rigidity is gone.” C. “Once your fever is gone, you can return to all normal activities.” D. “Recovery can take several weeks; gradually increase activity as tolerated.”

Answer 93

D. “Recovery can take several weeks; gradually increase activity as tolerated.” Rationale: Patients often need several weeks of recovery post-meningitis. Fatigue and residual neurologic symptoms may linger, so a gradual return to activity is encouraged to avoid setbacks.

Question 94

A 42-year-old patient recovering from bacterial meningitis continues to have neck stiffness and reports difficulty walking due to leg tightness. What is the most appropriate nursing intervention? A. Encourage high-impact exercise B. Recommend warm baths and progressive range-of-motion exercises C. Suggest opioid therapy to reduce rigidity D. Refer to a spine specialist for surgical evaluation

Answer 94

B. Recommend warm baths and progressive range-of-motion exercises Rationale: Muscle rigidity of the neck and legs is a common lingering symptom. ROM exercises and warm baths promote flexibility and reduce discomfort. Surgery is not indicated.

Question 95

Which dietary recommendation should the nurse make during a patient’s ambulatory recovery from bacterial meningitis? A. Low-carb, low-fat diet to reduce inflammation B. High-protein, high-calorie diet in small, frequent meals C. Clear liquid diet to prevent nausea D. High-fiber diet to improve neurologic status

Answer 95

B. High-protein, high-calorie diet in small, frequent meals Rationale: During recovery, the body needs extra energy and protein for healing. Small, frequent meals ensure intake without overwhelming the patient’s appetite or GI system.

Question 96

Which assessment is most important during the follow-up visit for a patient who recently recovered from bacterial meningitis? A. Cardiac rhythm and blood pressure B. Respiratory function and blood glucose C. Cognitive, sensory, and motor function D. Pain level and skin turgor

Answer 96

C. Cognitive, sensory, and motor function Rationale: Residual neurologic complications such as dementia, hemiplegia, seizures, and sensory deficits are common. A thorough neuro exam is crucial to detect any long-term sequelae.

Question 97

A nurse is following up with a patient who recently recovered from meningococcal meningitis. The patient reports new-onset ringing in the ears and difficulty hearing. What should the nurse do next? A. Reassure the patient that symptoms are temporary B. Refer the patient for audiologic evaluation C. Recommend using white noise to mask tinnitus D. Instruct the patient to stop all medications

Answer 97

B. Refer the patient for audiologic evaluation Rationale: Hearing loss and tinnitus can be permanent complications of meningitis due to cranial nerve VIII damage. Early referral to audiology supports timely intervention and management.

Question 98

The family of a patient recovering from bacterial meningitis expresses concern about the patient’s forgetfulness and slow thinking. What is the best nursing response? A. “This is unusual and you should schedule a neurological consult.” B. “These symptoms are permanent and will not improve.” C. “Cognitive changes can occur and should be monitored over time.” D. “This is a sign the infection is returning.”

Answer 98

C. “Cognitive changes can occur and should be monitored over time.” Rationale: Cognitive dysfunction is a known sequela. While some deficits may improve, others can be permanent. Ongoing assessment and referral as needed is essential.

Question 99

Which referrals might be appropriate for a patient experiencing sequelae from bacterial meningitis? (SATA) A. Physical therapy B. Audiology C. Occupational therapy D. Dermatology E. Speech-language pathology

Answer 99

A. Physical therapy B. Audiology C. Occupational therapy E. Speech-language pathology Rationale: Depending on the specific deficits, referrals may include physical therapy (motor function), audiology (hearing loss), occupational therapy (daily functioning), and speech therapy (language or swallowing difficulties). Dermatology is unrelated.

Question 100

The spouse of a patient recovering from bacterial meningitis voices emotional exhaustion and fear about long-term care needs. What is the most appropriate nursing intervention? A. Offer a referral to a support group or social worker B. Reassure them the stress will resolve soon C. Suggest they talk to a friend or neighbor D. Recommend they take a vacation immediately

Answer 100

A. Offer a referral to a support group or social worker Rationale: Caregivers of patients recovering from serious illness often experience emotional strain. Providing support through referrals helps reduce caregiver burden and promotes holistic care.

Question 101

A nurse is evaluating the care outcomes for a patient recovering from bacterial meningitis. Which finding indicates that the goal of maintaining appropriate cognitive function has been met? A. The patient is alert, oriented, and able to recall recent events B. The patient sleeps more than 12 hours per day without stimulation C. The patient responds to painful stimuli by withdrawing D. The patient states, “I feel like I’m in a dream and nothing is real."

Answer 101

A. The patient is alert, oriented, and able to recall recent events Rationale: Cognitive function is assessed through orientation, memory, and responsiveness. Alertness and appropriate recall demonstrate that the patient has regained baseline neurologic status, fulfilling this outcome.

Question 102

A nurse is evaluating a patient 48 hours after admission for bacterial meningitis. The patient’s temperature is 98.9°F (37.1°C), they rate their headache pain at 2/10, and are alert and cooperative. What conclusion can the nurse draw? A. The patient is demonstrating signs of worsening neurologic function B. The patient is not tolerating treatment and needs reassessment C. Expected outcomes for infection resolution and comfort are being met D. Further isolation precautions are required

Answer 102

C. Expected outcomes for infection resolution and comfort are being met Rationale: The patient’s normal temperature, low pain level, and intact cognition reflect that key goals of care—normal body temperature, pain control, and cognitive stability—are being achieved. This supports successful evaluation.

Question 103

A nursing measure that can reduce the potential for seizures and increased intracranial pressure in the patient with bacterial meningitis is a. administering codeine for relief of head and neck pain. b. controlling fever with prescribed drugs and cooling techniques. c. maintaining strict bed rest with the head of the bed slightly elevated. d. keeping the room dark and quiet to minimize environmental stimulation.

Answer 103

b. controlling fever with prescribed drugs and cooling techniques.

Question 104

A patient who has bacterial meningitis is disoriented and anxious. Which action will the nurse include 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 104

a. Encourage family members to remain at the bedside. Rationale: 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 105

The public health nurse is planning a program to decrease the incidence of meningitis in teenagers and young adults. Which action is most likely to be effective? a. Emphasize the importance of hand washing before meals. b. Encourage immunization for adolescents and college freshmen. c. Tell adolescents and young adults to avoid crowds in the winter. d. Support serving healthy nutritional options in the college cafeteria.

Answer 105

b. Encourage immunization for adolescents and college freshmen. Rationale: The Neisseria meningitidis vaccination is recommended for children ages 11 and 12 years, unvaccinated teens entering high school, and college freshmen. Hand washing may help decrease the spread of bacteria, and good nutrition may increase resistance to infection, but those are not as effective as immunization. Because adolescents and young adults are usually in school or the workplace, avoiding crowds is not realistic.

Question 106

A patient has been admitted with meningococcal meningitis. Which observation by the nurse requires action? a. The patient received a regular diet tray. b. Staff turned off the lights in the patient‘s room. c. The bedrails on both sides of the bed are elevated. d. Staff have entered the patient‘s room without a mask.

Answer 106

d. Staff have entered the patient‘s room without a mask. Rationale: 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 107

When assessing an adult who has bacterial meningitis, the nurse obtains the following data. Which finding requires the most immediate intervention? a. The patient exhibits nuchal rigidity. b. The patient has a positive Kernig‘s sign. c. The patient‘s temperature is 101F (38.3C). d. The patient‘s blood pressure is 88/42 mm Hg.

Answer 107

d. The patient‘s blood pressure is 88/42 mm Hg. Rationale: Shock is a serious complication of meningitis, and the patient‘s low blood pressure indicates the need for interventions such as fluids or vasopressors. Nuchal rigidity and a positive Kernig‘s 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 108

Which patient is most appropriate for the intensive care unit (ICU) charge nurse to assign to a registered nurse (RN) who has floated from the medical unit? a. A 45-yr-old patient receiving IV antibiotics for meningococcal meningitis b. A 35-yr-old patient with intracranial pressure monitoring after a head injury c. A 25-yr-old patient admitted with a skull fracture and craniotomy the previous day d. A 55-yr-old patient who is receiving hyperventilation therapy for increased ICP

Answer 108

a. A 45-yr-old patient receiving IV antibiotics for meningococcal meningitis Rationale: An RN who works on a medical unit will be familiar with administration of IV antibiotics and with meningitis. The patient recovering from a craniotomy, the patient with an ICP monitor, and the patient on a ventilator should be assigned to an RN familiar with the care of critically ill patients.

Question 109

A patient being admitted with bacterial meningitis has a temperature of 102.5F (39.2C) and a severe headache. Which prescribed intervention would the nurse implement first? a. Administer ceftizoxime (Cefizox) 1 g IV. b. Give acetaminophen (Tylenol) 650 mg PO. c. Use a cooling blanket to lower temperature. d. Swab the nasopharyngeal mucosa for cultures.

Answer 109

d. Swab the nasopharyngeal mucosa for cultures. Rationale: Antibiotic therapy would be started quickly in bacterial meningitis, but cultures must be done before antibiotics are started. After the cultures are done, the antibiotic would be started. Hypothermia therapy and acetaminophen administration are appropriate but can be started after the other actions are implemented.

Question 110

A patient with possible meningitis is admitted to the nursing unit after a lumbar puncture was performed in the emergency department. Which action prescribed by the health care provider would the nurse question? a. Restrict oral fluids to 1000 mL/day. b. Elevate the head of the bed 20 degrees. c. Administer ceftriaxone 1 g IV every 12 hours. d. Give ibuprofen 400 mg every 6 hours as needed for headache.

Answer 110

a. Restrict oral fluids to 1000 mL/day. Rationale: The patient with meningitis has increased fluid needs due to infection, so oral fluids would 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 would be administered until bacterial meningitis is ruled out by the cerebrospinal fluid analysis.