Ch 61: Viral Meningitis Flashcards
(20 cards)
A 25-year-old patient presents to the emergency department with fever, photophobia, and a stiff neck. The provider suspects viral meningitis. Which of the following diagnostic tests is most specific for confirming a viral cause?
A. Blood culture
B. Gram stain of cerebrospinal fluid
C. Xpert EV test
D. CT scan
C. Xpert EV test
Rationale: The Xpert EV test is a rapid diagnostic tool used to detect enteroviruses in CSF. It provides results within hours and is highly specific for viral meningitis, particularly those caused by enteroviruses. Blood cultures and Gram stains are more useful in bacterial meningitis, and a CT scan is not specific for viral causes.
Which cerebrospinal fluid (CSF) finding is most consistent with viral meningitis?
A. Cloudy CSF with neutrophil predominance
B. Clear CSF with high protein and low glucose
C. Lymphocytosis with organisms visible on Gram stain
D. Clear or cloudy CSF with lymphocytosis and no organisms on Gram stain
D. Clear or cloudy CSF with lymphocytosis and no organisms on Gram stain
Rationale: Viral meningitis usually presents with clear or cloudy CSF that shows an increased number of lymphocytes (lymphocytosis). Unlike bacterial meningitis, no organisms are seen on Gram stain, and glucose levels are typically normal or mildly decreased.
A patient with suspected meningitis undergoes a lumbar puncture (LP). The provider orders antibiotics to be started immediately afterward. What is the primary rationale for this action?
A. Antibiotics enhance viral clearance
B. Viral meningitis often converts to bacterial
C. Antibiotics prevent nosocomial infections post-LP
D. Bacterial meningitis must be ruled out while awaiting results
D. Bacterial meningitis must be ruled out while awaiting results
Rationale: Empirical antibiotics are initiated after LP to cover the possibility of bacterial meningitis, which can be life-threatening. Once CSF analysis confirms viral meningitis, antibiotics can be safely discontinued.
A nurse is assessing a patient with viral meningitis. Which of the following symptoms would the nurse expect to find? (Select all that apply.)
A. High fever
B. Photophobia
C. Decreased level of consciousness
D. Stiff neck
E. Petechial rash
A. High fever
B. Photophobia
D. Stiff neck
Rationale: Viral meningitis often presents with moderate to high fever, photophobia, headache, and nuchal rigidity (stiff neck). Decreased LOC and petechial rash are more typical of bacterial meningitis, especially meningococcal.
A nurse is caring for a patient diagnosed with viral meningitis caused by herpes simplex virus (HSV). What is the expected plan of treatment?
A. Symptom management and antiviral therapy
B. Empirical antibiotic therapy for 14 days
C. High-dose corticosteroids
D. Immediate neurosurgical intervention
A. Symptom management and antiviral therapy
Rationale: Viral meningitis is usually self-limiting, and treatment focuses on symptom relief. If HSV is the identified cause, antiviral medications like acyclovir are appropriate. Antibiotics are used only while ruling out bacterial infection.
Which of the following findings is most suggestive of a viral rather than bacterial meningitis?
A. Sudden onset of seizures
B. Cloudy CSF with Gram-positive cocci
C. Lymphocytosis in CSF with negative Gram stain
D. Positive blood culture
C. Lymphocytosis in CSF with negative Gram stain
Rationale: A hallmark of viral meningitis is lymphocytosis in the CSF with no organisms on Gram stain. Bacterial meningitis typically presents with neutrophilic predominance, positive Gram stains, and potentially positive blood cultures.
Which virus is not commonly associated with viral meningitis?
A. Herpes simplex virus (HSV)
B. Epstein-Barr virus (EBV)
C. Enterovirus
D. Human immunodeficiency virus (HIV)
B. Epstein-Barr virus (EBV)
Rationale: While EBV can cause neurological complications, it is not among the most common causes of viral meningitis. HSV, enteroviruses, HIV, and arboviruses are far more typical culprits.
A patient with suspected viral meningitis undergoes polymerase chain reaction (PCR) testing. Why is this test useful?
A. It visualizes viruses under a microscope
B. It detects viral-specific DNA or RNA in the CSF
C. It assesses for protein levels in the blood
D. It identifies antibiotic-resistant bacteria
B. It detects viral-specific DNA or RNA in the CSF
Rationale: PCR is a highly sensitive test that detects the presence of viral DNA or RNA in cerebrospinal fluid. It’s a cornerstone diagnostic tool for viral CNS infections, including viral meningitis.
Which patient is at the greatest risk of developing viral meningitis?
A. A 50-year-old with a history of hypertension
B. A 30-year-old who works in a healthcare setting
C. A 5-year-old in daycare during flu season
D. A 70-year-old with Parkinson’s disease
C. A 5-year-old in daycare during flu season
Rationale: Enteroviruses, a common cause of viral meningitis, are easily spread through respiratory secretions and fecal-oral contact—both of which are common in daycare settings. Young children are particularly vulnerable.
A nurse is educating a patient diagnosed with viral meningitis. Which statement by the patient indicates understanding?
A. “This condition should go away on its own.”
B. “I will need to take antibiotics for two weeks.”
C. “I need to stay in the hospital until the virus is completely gone.”
D. “I am at high risk for permanent brain damage.”
A. “This condition should go away on its own.”
Rationale: Viral meningitis is generally self-limiting, and most patients recover fully with supportive care. Hospitalization may be short-term or not required, and permanent neurologic complications are rare.
A nurse is reviewing CSF analysis results for a client with suspected meningitis. Which result most strongly supports a diagnosis of viral meningitis?
A. Lymphocytosis, normal glucose, and slightly elevated protein
B. Elevated neutrophils, low glucose, and high protein
C. Cloudy CSF, low glucose, and Gram-positive cocci present
D. Xanthochromia and red blood cells in CSF
B. Elevated neutrophils, low glucose, and high protein
Rationale: Viral meningitis typically presents with lymphocytic predominance, normal glucose, and mildly elevated protein in the CSF. Neutrophilic predominance, low glucose, and visible organisms suggest bacterial meningitis.
A college student is brought to the ED with headache, fever, photophobia, and neck stiffness. CSF shows lymphocytosis and a negative Gram stain. What is the priority nursing action?
A. Prepare the patient for intubation
B. Isolate the patient under droplet precautions
C. Initiate supportive care and monitor for changes in LOC
D. Administer high-dose corticosteroids
C. Initiate supportive care and monitor for changes in LOC
Rationale: The findings suggest viral meningitis. Supportive care is the mainstay of treatment. Isolation is not typically necessary unless bacterial meningitis is suspected. Corticosteroids are more often used in bacterial or TB meningitis with significant inflammation.
Which statement by a nursing student indicates the need for further education about viral meningitis?
A. “Enteroviruses are a common cause and spread through respiratory secretions.”
B. “We always treat viral meningitis with a full course of antibiotics.”
C. “The PCR test helps detect viral DNA or RNA in the CSF.”
D. “Viral meningitis is typically self-limiting and has a good prognosis.”
B. “We always treat viral meningitis with a full course of antibiotics.”
Rationale: Antibiotics are initially given to cover possible bacterial meningitis but should be discontinued once viral meningitis is confirmed. This statement shows a misunderstanding of appropriate treatment.
A client with viral meningitis reports severe headache and sensitivity to light. Which nursing intervention is most appropriate?
A. Keep the room brightly lit to assess neuro status
B. Encourage ambulation every hour
C. Place the client in Trendelenburg position
D. Dim the room lights and minimize noise
D. Dim the room lights and minimize noise
Rationale: Clients with meningitis often experience photophobia and headaches. A dark, quiet environment helps reduce stimulation and discomfort. Trendelenburg position increases ICP and should be avoided.
A patient is diagnosed with viral meningitis caused by an arbovirus. Which of the following transmission precautions should the nurse implement?
A. Contact precautions
B. Droplet precautions
C. Standard precautions
D. Airborne precautions
C. Standard precautions
Rationale: Arboviruses are typically transmitted via insect vectors (e.g., mosquitoes), not person-to-person. Standard precautions are sufficient for viral meningitis unless another infectious etiology is present.
A client recovering from viral meningitis asks, “Is there anything long-term I should worry about?” Which response by the nurse is most accurate?
A. “This condition usually resolves completely, but some people have lingering headaches or coordination issues.”
B. “You may need physical therapy for permanent neurological damage.”
C. “You will likely need antiviral therapy for life.”
D. “Expect memory loss and personality changes.”
A. “This condition usually resolves completely, but some people have lingering headaches or coordination issues.”
Rationale: Viral meningitis generally resolves without long-term effects, but some patients report persistent mild symptoms like headaches, slight mental fog, or coordination problems.
A nurse is caring for a patient undergoing testing for meningitis. Which of the following actions should be taken before a lumbar puncture?
A. Start antiviral medications
B. Position the patient in high Fowler’s
C. Collect a urine culture
D. Obtain a CT scan to rule out increased ICP
D. Obtain a CT scan to rule out increased ICP
Rationale: A CT scan may be done before LP to rule out increased ICP, which can result in herniation during the procedure. This is especially important if the patient shows signs of altered mental status or focal neuro deficits.
Which nursing diagnosis is most appropriate for a patient with viral meningitis?
A. Risk for fluid volume excess related to SIADH
B. Impaired verbal communication related to aphasia
C. Acute pain related to meningeal irritation
D. Risk for aspiration related to swallowing difficulty
C. Acute pain related to meningeal irritation
Rationale: One of the hallmark symptoms of viral meningitis is headache caused by meningeal inflammation. Addressing pain management is a priority in symptomatic care.
Which of the following signs would most strongly differentiate bacterial from viral meningitis?
A. Presence of photophobia
B. Fever >102°F
C. Positive Gram stain in CSF
D. Neck stiffness
C. Positive Gram stain in CSF
Rationale: A positive Gram stain in CSF strongly suggests bacterial meningitis. Photophobia, fever, and neck stiffness can be present in both viral and bacterial forms.
A patient has just been diagnosed with viral meningitis. The nurse is preparing discharge instructions. Which of the following should be included?
A. “Get plenty of rest and stay well hydrated.”
B. “You’ll need follow-up imaging in 3 days.”
C. “You should avoid all dairy products for two weeks.”
D. “Continue taking your prescribed antibiotics at home.”
A. “Get plenty of rest and stay well hydrated.”
Rationale: Viral meningitis is self-limiting. Discharge education should emphasize rest, hydration, and comfort measures. Antibiotics are not continued once a viral diagnosis is confirmed.
