Chapter 61: Bacterial Meningitis

Question 1

A 20-year-old college student presents to the emergency department with fever, headache, nuchal rigidity, and photophobia. The nurse suspects bacterial meningitis. Which of the following individuals is at the highest risk of developing bacterial meningitis?

A. A 30-year-old living in a single-family home
B. A 20-year-old college student living in a dormitory
C. A 45-year-old with a history of seasonal allergies
D. A 55-year-old with well-controlled diabetes

Answer 1

B. A 20-year-old college student living in a dormitory

Rationale: Bacterial meningitis is more prevalent in individuals living in close quarters, such as dormitories or institutional settings (e.g., prisons). These environments facilitate the spread of infectious agents. While older adults and debilitated individuals are also at risk, the living conditions of college students in dormitories make them particularly vulnerable. Seasonal allergies and well-controlled diabetes do not significantly increase meningitis risk.

Question 2

A nurse is educating a group of college students about the prevention of bacterial meningitis. Which statement by a student indicates the need for further teaching?

A. “I should avoid sharing drinks and utensils with others.”
B. “The meningococcal vaccine can help prevent bacterial meningitis.”
C. “I don’t need to worry about bacterial meningitis unless I’m over 50.”
D. “If I develop flu-like symptoms, I should seek medical advice immediately.”

Answer 2

C. “I don’t need to worry about bacterial meningitis unless I’m over 50.”

Rationale: College students are at a high risk of bacterial meningitis due to close living quarters in dormitories, regardless of age. The statement “I don’t need to worry about bacterial meningitis unless I’m over 50” reflects a misunderstanding and a lack of awareness of the risk factors for this population. The other statements are accurate: avoiding the sharing of drinks and utensils, getting vaccinated, and seeking early medical attention are all preventive strategies.

Question 3

The nurse is caring for an older adult patient diagnosed with bacterial meningitis. Which finding should the nurse prioritize when monitoring this patient?

A. Presence of a headache
B. Fever of 101.5°F (38.6°C)
C. Photophobia
D. New onset of confusion

Answer 3

D. New onset of confusion

Rationale: In bacterial meningitis, neurological symptoms such as confusion or altered mental status indicate increased severity and potential complications, such as increased intracranial pressure. While headache, fever, and photophobia are common signs of meningitis, new or worsening confusion requires immediate attention to prevent further complications. Older adults are more prone to severe outcomes and atypical presentations, so mental status changes must be closely monitored.

Question 4

Which of the following patients is most at risk for bacterial meningitis caused by Streptococcus pneumoniae?

A. A 45-year-old with a basilar skull fracture
B. A 30-year-old who received the H. influenzae vaccine
C. A 21-year-old college student exposed to Neisseria meningitidis
D. A 50-year-old with a recent history of sinusitis

Answer 4

A. A 45-year-old with a basilar skull fracture

Rationale: Patients with a basilar skull fracture are at increased risk of bacterial meningitis due to direct extension of bacteria from fractured sinuses into the CNS. Streptococcus pneumoniae is one of the leading causes of bacterial meningitis. While Neisseria meningitidis is also a common cause, this scenario specifies Streptococcus pneumoniae. The H. influenzae vaccine has reduced meningitis cases from that organism. Sinusitis is a risk factor but less specific than a basilar skull fracture in this case.

Question 5

A nurse is reviewing the pathophysiology of bacterial meningitis. Which of the following statements indicates the nurse has a correct understanding?

A. “Purulent secretions from the infection remain localized in the upper respiratory tract.”

B. “Cerebral edema occurs due to inflammation of the brain parenchyma and increased CSF production.”

C. “Bacterial meningitis rarely causes increased intracranial pressure (ICP).”

D. “The inflammatory response limits the spread of infection in the CNS.”

Answer 5

B. “Cerebral edema occurs due to inflammation of the brain parenchyma and increased CSF production.”

Rationale: In bacterial meningitis, inflammation triggers an increase in CSF production and swelling around the dura, leading to cerebral edema and elevated ICP. Purulent secretions do not remain localized but spread throughout the brain via the CSF. Increased ICP is a hallmark complication, and the inflammatory response can exacerbate the spread of infection rather than contain it.

Question 6

The nurse is teaching a group of new nurses about the pathophysiology of bacterial meningitis. Which of the following would the nurse include? (Select all that apply.)

A. The infection can spread through the bloodstream or by direct extension from a skull fracture.
B. Purulent secretions spread throughout the brain via the CSF.
C. Increased CSF production decreases intracranial pressure.
D. Haemophilus influenzae remains the leading cause of bacterial meningitis.
E. Inflammation can lead to cerebral edema and increased ICP.

Answer 6

A. The infection can spread through the bloodstream or by direct extension from a skull fracture.
B. Purulent secretions spread throughout the brain via the CSF.
E. Inflammation can lead to cerebral edema and increased ICP.

Rationale:
* A: The organisms responsible for bacterial meningitis can gain access to the CNS via the bloodstream or direct extension from fractures.
* B: Purulent secretions spread through the CSF, covering intracranial structures.
* E: Inflammation associated with bacterial meningitis leads to cerebral edema and increased ICP.
Incorrect options:

• C: Increased CSF production raises, not decreases, intracranial pressure.
• D: Haemophilus influenzae was a leading cause in the past, but vaccination has significantly reduced its prevalence.

Question 7

A patient with bacterial meningitis is being monitored for increased intracranial pressure (ICP). Which of the following findings would most concern the nurse?

A. Decreased level of consciousness
B. Complaints of a mild headache
C. Temperature of 101°F (38.3°C)
D. Photophobia

Answer 7

A. Decreased level of consciousness

Rationale: Decreased level of consciousness is a serious sign of increased ICP and warrants immediate attention. While headache, fever, and photophobia are common symptoms of meningitis, they are not as critical as changes in neurological status, which indicate worsening cerebral edema or ICP.

Question 8

A nurse is caring for a patient with bacterial meningitis. Which statement regarding the role of increased ICP in bacterial meningitis is correct?

A. Increased ICP is caused by a decrease in cerebral blood flow.
B. Increased CSF production contributes to the development of increased ICP.
C. Increased ICP prevents purulent secretions from spreading in the CNS.
D. Increased ICP is unlikely to affect cranial nerves or brain structures.

Answer 8

B. Increased CSF production contributes to the development of increased ICP.

Rationale: The inflammatory response in bacterial meningitis leads to increased CSF production, which, combined with swelling around the dura, results in elevated ICP. Decreased cerebral blood flow can occur as a consequence of increased ICP, not the cause. Purulent secretions can still spread throughout the CNS, and increased ICP affects cranial nerves and brain structures.

Question 9

A patient is diagnosed with bacterial meningitis caused by Neisseria meningitidis. What should the nurse prioritize when caring for this patient?

A. Administering antibiotics within 24 hours of diagnosis
B. Monitoring for signs of decreased ICP
C. Encouraging oral hydration to reduce fever
D. Isolating the patient to prevent the spread of infection

Answer 9

D. Isolating the patient to prevent the spread of infection

Neisseria meningitidis is highly contagious, and patients must be placed on droplet precautions to prevent transmission. Antibiotics should be administered immediately, not delayed for 24 hours. Monitoring for increased, not decreased, ICP is crucial. Oral hydration may help with fever but is not a priority over isolation and infection control.

Question 10

A nurse is assessing a patient suspected of having bacterial meningitis. Which of the following clinical manifestations is considered a key sign of meningitis?

A. Polyuria
B. Chest pain
C. Nuchal rigidity
D. Bilateral ankle edema

Answer 10

C. Nuchal rigidity

Rationale: Nuchal rigidity (neck stiffness) is a hallmark sign of meningitis, along with fever, severe headache, nausea, and vomiting. Polyuria, chest pain, and ankle edema are not commonly associated with meningitis.

Question 11

The nurse is assessing a patient with bacterial meningitis caused by Neisseria meningitidis. The nurse observes petechiae on the patient’s trunk and lower extremities. What is the most appropriate action to confirm the nature of the rash?

A. Apply a cold compress to the area.
B. Perform the tumbler test using a glass.
C. Assess for itching and redness around the rash.
D. Palpate for induration around the rash.

Answer 11

B. Perform the tumbler test using a glass.

Rationale: A tumbler test is performed by pressing the base of a glass against the rash. If the rash does not blanch or fade under pressure, it suggests petechiae, which is a common manifestation of Neisseria meningitidis infection. Itching, redness, or induration are not definitive indicators of petechiae.

Question 12

A nurse is monitoring a patient with bacterial meningitis. Which finding would indicate increased intracranial pressure (ICP)?

A. Persistent vomiting
B. Mild headache
C. Normal pupil reaction to light
D. Clear and lucid speech

Answer 12

A. Persistent vomiting

Rationale: Persistent vomiting is a sign of increased ICP, which can occur due to inflammation and cerebral edema in bacterial meningitis. Mild headache and normal pupil reactions are not specific indicators of increased ICP. Altered speech is more indicative of neurological changes associated with increased ICP than clear and lucid speech.

Question 13

A patient with bacterial meningitis reports worsening headache and nausea. Which additional finding would suggest the need for urgent intervention?

A. Fever of 100.4°F (38°C)
B. Photophobia
C. Decreased level of consciousness (LOC)
D. Skin rash on the arms and trunk

Answer 13

C. Decreased level of consciousness (LOC)

Rationale: Decreased LOC is a critical sign that indicates worsening neurological status, possibly due to increased ICP or cerebral edema. Fever, photophobia, and rash are common manifestations of meningitis but are not as urgent as changes in consciousness.

Question 14

Seizures occur in approximately one-third of patients with bacterial meningitis. What is the primary nursing intervention during a seizure?

A. Insert a bite block to prevent tongue injury.
B. Turn the patient onto their side.
C. Administer antibiotics immediately.
D. Restrain the patient’s arms and legs.

Answer 14

B. Turn the patient onto their side.

Rationale: The priority during a seizure is to maintain the patient’s airway and prevent aspiration, which is achieved by turning the patient onto their side. Inserting a bite block or restraining the patient is contraindicated, as it may cause harm. Administering antibiotics is not a seizure management priority.

Question 15

A patient with bacterial meningitis develops irritability and restlessness. The nurse suspects increased ICP. Which of the following actions should the nurse take first?

A. Notify the healthcare provider immediately.
B. Elevate the head of the bed to 30 degrees.
C. Perform a neurological assessment.
D. Administer prescribed anti-inflammatory medication.

Answer 15

B. Elevate the head of the bed to 30 degrees.

Rationale: Elevating the head of the bed to 30 degrees helps reduce ICP by promoting venous drainage. While notifying the healthcare provider and performing a neurological assessment are important, positioning the patient takes priority to manage ICP immediately. Anti-inflammatory medications are not typically the first-line intervention for ICP.

Question 16

The nurse is caring for a patient with bacterial meningitis who is irritable and sensitive to light. What is the best intervention to promote the patient’s comfort?

A. Encourage the patient to ambulate regularly.
B. Maintain the room in a well-lit condition.
C. Reduce environmental stimuli.
D. Avoid administering pain medication.

Answer 16

C. Reduce environmental stimuli.

Rationale: Reducing environmental stimuli, such as dimming lights and minimizing noise, can help alleviate discomfort from photophobia and irritability. Encouraging ambulation and avoiding pain medication are not appropriate interventions for this patient. A well-lit room would exacerbate photophobia.

Question 17

A nurse is caring for a patient with bacterial meningitis who is at risk for seizures. What action should the nurse take to ensure the patient’s safety?

A. Maintain suction equipment at the bedside.
B. Administer antipyretics regularly.
C. Place the patient in a prone position.
D. Apply wrist restraints to prevent injury.

Answer 17

A. Maintain suction equipment at the bedside.

Rationale: Maintaining suction equipment at the bedside ensures the nurse can quickly clear the airway if the patient experiences a seizure and is at risk for aspiration. Administering antipyretics does not address seizure risk. Placing the patient in a prone position and using restraints are inappropriate and could cause harm during a seizure.

Question 18

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 18

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 19

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 19

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 20

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 20

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 21

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 21

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 22

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 22

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 23

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 23

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.

Question 24

Which of the following complications is most commonly associated with bacterial meningitis and is the major cause of altered mental status in patients?

A. Cerebral abscess
B. Increased intracranial pressure (ICP)
C. Waterhouse-Friderichsen syndrome
D. Hemiparesis

Answer 24

B. Increased intracranial pressure (ICP)

Rationale: Increased ICP is the most common complication of bacterial meningitis and is the major cause of altered mental status. While cerebral abscess, Waterhouse-Friderichsen syndrome, and hemiparesis may occur, they are less common.

Question 25

A patient recovering from bacterial meningitis reports persistent headaches several weeks after discharge. What is the most appropriate nursing intervention?

A. Administer prescribed pain medications as needed.
B. Reassure the patient that headaches will resolve over time.
C. Instruct the patient to avoid all physical activity.
D. Encourage the patient to decrease fluid intake.

Answer 25

A. Administer prescribed pain medications as needed.

Rationale: Persistent headaches may occur for months after bacterial meningitis due to residual inflammation. Pain management is essential to improve the patient’s quality of life. Reassurance is helpful but not sufficient, and physical activity or fluid restrictions are not typically indicated.

Question 26

The nurse is caring for a patient with meningococcal meningitis who develops petechiae, disseminated intravascular coagulation (DIC), and circulatory collapse. Which complication should the nurse suspect?

A. Cerebral abscess
B. Waterhouse-Friderichsen syndrome
C. Subdural empyema
D. Hydrocephalus

Answer 26

B. Waterhouse-Friderichsen syndrome

Rationale: Waterhouse-Friderichsen syndrome is a severe complication of meningococcal meningitis, characterized by petechiae, DIC, adrenal hemorrhage, and circulatory collapse. It is life-threatening and requires immediate intervention.

Question 27

Which of the following symptoms would indicate a possible noncommunicating hydrocephalus in a patient with bacterial meningitis?

A. Increased ICP and papilledema
B. Tinnitus and vertigo
C. Seizures and bradycardia
D. Petechiae and circulatory collapse

Answer 27

A. Increased ICP and papilledema

Rationale: Noncommunicating hydrocephalus occurs when exudate causes adhesions that obstruct CSF flow. This leads to increased ICP and papilledema. Tinnitus, vertigo, seizures, bradycardia, petechiae, and circulatory collapse are associated with other complications of meningitis.

Question 28

The nurse is caring for a patient with bacterial meningitis who develops hemiparesis, dysphasia, and hemianopsia. These symptoms resolve within a few days. If they persist, what complications should the nurse suspect?

A. Subdural empyema or cerebral abscess
B. Waterhouse-Friderichsen syndrome or DIC
C. Papilledema or noncommunicating hydrocephalus
D. Cranial nerve VIII irritation

Answer 28

A. Subdural empyema or cerebral abscess

Rationale: Hemiparesis, dysphasia, and hemianopsia are symptoms that can occur during meningitis and usually resolve. If they persist, it may indicate serious complications such as a cerebral abscess, subdural empyema, subdural effusion, or persistent meningitis.

Question 29

A patient with bacterial meningitis develops seizures and bradycardia. The nurse suspects acute cerebral edema. What additional finding would confirm this complication?

A. Petechiae on the trunk
B. Hypertensive coma
C. Loss of the corneal reflex
D. Tinnitus and vertigo

Answer 29

B. Hypertensive coma

Rationale: Acute cerebral edema can result in seizures, cranial nerve III palsy, bradycardia, hypertensive coma, and death. Petechiae, loss of the corneal reflex, tinnitus, and vertigo are associated with other complications.

Question 30

A patient with bacterial meningitis is diagnosed with obstructed CSF reabsorption due to exudate at the arachnoid villi. Which treatment is most likely indicated?

A. Corticosteroid therapy
B. Anticonvulsant therapy
C. Surgical implantation of a shunt
D. Administration of diuretics

Answer 30

C. Surgical implantation of a shunt

Rationale: When exudate obstructs CSF reabsorption, a noncommunicating hydrocephalus can develop. The treatment involves surgical implantation of a shunt to restore normal CSF flow. Corticosteroids, anticonvulsants, or diuretics are not definitive treatments for hydrocephalus.

Question 31

The nurse is preparing a patient with suspected bacterial meningitis for a lumbar puncture (LP). Which diagnostic test must be performed first to ensure patient safety?

A. MRI of the brain
B. Skull X-ray
C. Blood culture
D. CT scan

Answer 31

D. CT scan

Rationale: A CT scan must be done before a lumbar puncture to rule out an obstruction in the foramen magnum. This precaution prevents a fluid shift that could result in brain herniation during the LP.

Question 32

A patient undergoing evaluation for bacterial meningitis has specimens collected for diagnostic testing. Which specimen must be obtained before starting antibiotic therapy?

A. Blood culture
B. CSF sample
C. Sputum sample
D. All of the above

Answer 32

D. All of the above

Rationale: Specimens for blood culture, CSF analysis, sputum, and nasopharyngeal secretions must be collected before starting antibiotics to ensure accurate identification of the causative organism. Starting antibiotics beforehand can alter culture results.

Question 33

A Gram stain is performed on cerebrospinal fluid (CSF) from a patient suspected of having bacterial meningitis. Which finding supports a diagnosis of bacterial meningitis?

A. Presence of lymphocytes
B. Presence of neutrophils
C. Low glucose level
D. Elevated protein level

Answer 33

B. Presence of neutrophils

Rationale: The predominant white blood cell type in bacterial meningitis is neutrophils, which indicate an acute bacterial infection. Lymphocytes are more common in viral meningitis, while low glucose and elevated protein levels are additional findings but not specific to a Gram stain.

Question 34

A patient with bacterial meningitis undergoes a CT scan. Which finding would the nurse expect in cases of increased intracranial pressure (ICP)?

A. Normal CT results
B. Hydrocephalus
C. Infected sinuses
D. Brain herniation

Answer 34

B. Hydrocephalus

Rationale: CT findings in bacterial meningitis may show hydrocephalus in cases of increased ICP. A normal CT scan is typical in uncomplicated meningitis. Infected sinuses are identified through skull X-rays, and brain herniation is a complication that the CT scan is meant to help prevent.

Question 35

Which diagnostic study is most critical for confirming bacterial meningitis?

A. Blood culture
B. Lumbar puncture (LP) with CSF analysis
C. MRI of the brain
D. Skull X-ray

Answer 35

B. Lumbar puncture (LP) with CSF analysis

Rationale: A lumbar puncture with CSF analysis is the definitive diagnostic test for bacterial meningitis. It allows for identification of the causative organism and the cellular, protein, and glucose changes in the CSF. Other studies like blood cultures and imaging are supportive but not confirmatory.

Question 36

A patient is admitted with suspected bacterial meningitis. Which intervention should the nurse prioritize first?

A. Administering IV antibiotics
B. Performing a lumbar puncture
C. Collecting specimens for cultures
D. Administering dexamethasone

Answer 36

C. Collecting specimens for cultures

Rationale: Before starting antibiotic therapy, specimens for cultures must be collected to identify the causative organism. This ensures accurate targeting of therapy. Antibiotics and dexamethasone should be started immediately after specimen collection.

Question 37

The nurse is preparing to administer IV antibiotics to a patient with bacterial meningitis. Which medication is most likely to be included in the patient’s treatment plan?

A. Vancomycin
B. Amoxicillin
C. Gentamicin
D. Ciprofloxacin

Answer 37

A. Vancomycin

Rationale: Vancomycin is one of the primary antibiotics used to treat bacterial meningitis. It is often combined with other drugs such as ceftriaxone or cefotaxime for broad-spectrum coverage. Amoxicillin, gentamicin, and ciprofloxacin are not first-line treatments for bacterial meningitis.

Question 38

Dexamethasone is ordered for a patient with bacterial meningitis. The nurse knows that the primary reason for administering this medication is:

A. To prevent the development of hydrocephalus
B. To reduce cerebral edema and inflammation
C. To treat bacterial infections directly
D. To manage severe headache and nuchal rigidity

Answer 38

B. To reduce cerebral edema and inflammation

Rationale: Dexamethasone, a corticosteroid, is given to reduce inflammation in the meninges and prevent complications such as cerebral edema and increased ICP. It does not directly treat the infection or specifically target symptoms like headache or nuchal rigidity.

Question 39

A patient with bacterial meningitis is receiving ceftriaxone as part of their treatment. Which of the following nursing actions is essential when administering this drug?

A. Monitor the patient for signs of an allergic reaction.
B. Dilute the medication in dextrose 5% solution.
C. Administer the drug slowly over 1–2 hours.
D. Encourage the patient to increase fluid intake.

Answer 39

A. Monitor the patient for signs of an allergic reaction.

Rationale: Allergic reactions to antibiotics, including ceftriaxone, are a potential complication. The nurse should closely monitor for signs such as rash, itching, or anaphylaxis. The other actions are not specific requirements for ceftriaxone administration.

Question 40

The nurse collaborates with the healthcare provider to manage a patient’s fever associated with bacterial meningitis. Which intervention is appropriate to include in the plan of care?

A. Administer acetaminophen as prescribed.
B. Reduce environmental stimuli and light.
C. Apply cooling blankets as needed.
D. All of the above.

Answer 40

D. All of the above.

Rationale: Managing fever in bacterial meningitis involves multiple approaches, including pharmacologic interventions (e.g., acetaminophen), environmental modifications to reduce stimuli, and external cooling methods. These help lower the metabolic demands on the brain and minimize complications.

Question 41

A patient with bacterial meningitis is experiencing severe headache and neck stiffness. Which collaborative intervention should the nurse expect to implement?

A. Administering opioids for pain relief
B. Providing antipyretics to reduce fever
C. Administering IV fluids to prevent dehydration
D. Consulting physical therapy for neck exercises

Answer 41

A. Administering opioids for pain relief

Rationale: Pain management is a critical part of collaborative care for bacterial meningitis. Opioids may be used to manage severe headache and neck stiffness. Antipyretics address fever but not directly pain, and physical therapy is not appropriate in the acute phase of meningitis.

Question 42

The nurse is reviewing the diagnostic orders for a patient with suspected bacterial meningitis. Which combination of tests is most critical for confirming the diagnosis?

A. CT scan and PET scan
B. Skull X-ray and CBC
C. Blood culture and CSF analysis
D. Coagulation profile and platelet count

Answer 42

B. Skull X-ray and CBC

Rationale: Blood culture and CSF analysis are essential to confirm bacterial meningitis. Blood cultures identify the causative organism, while CSF analysis provides critical information about protein, WBC, glucose levels, and bacterial presence through Gram stain and culture. Imaging studies and bloodwork provide supportive data but are not confirmatory.

Question 43

A patient with bacterial meningitis has a fever of 102°F (38.9°C). Which medication should the nurse anticipate administering first to reduce the fever?

A. Acetaminophen
B. IV phenytoin
C. IV mannitol
D. Codeine

Answer 43

A. Acetaminophen

Rationale: Acetaminophen or aspirin is administered to manage fevers above 100.4°F (38°C). Fever management helps prevent increased metabolic demand on the brain. Phenytoin and mannitol are used for seizures and increased ICP, respectively, while codeine is for headache relief.

Question 44

The nurse is administering IV mannitol (Osmitrol) to a patient with bacterial meningitis. What is the primary goal of this medication?

A. To manage seizures
B. To reduce fever
C. To decrease intracranial pressure
D. To treat dehydration

Answer 44

C. To decrease intracranial pressure

Rationale: Mannitol is an osmotic diuretic used to reduce cerebral edema and decrease ICP in patients with bacterial meningitis. It is not used for seizures, fever, or dehydration.

Question 45

The nurse is preparing to administer IV phenytoin to a patient with bacterial meningitis. What is the primary indication for this medication?

A. Reducing ICP
B. Preventing seizures
C. Treating headache
D. Lowering fever

Answer 45

B. Preventing seizures

Rationale: IV phenytoin is used in bacterial meningitis to prevent or manage seizures, which can occur due to irritation of the meninges and increased ICP. It does not directly address ICP, headache, or fever.

Question 46

A patient diagnosed with bacterial meningitis is prescribed codeine. What is the primary purpose of this medication?

A. To manage pain from nuchal rigidity and headache
B. To reduce inflammation of the meninges
C. To prevent seizures associated with meningitis
D. To decrease cerebral edema

Answer 46

A. To manage pain from nuchal rigidity and headache

Rationale: Codeine is used to manage pain, especially severe headaches, and discomfort from nuchal rigidity in bacterial meningitis. It does not directly affect inflammation, seizure prevention, or cerebral edema.

Question 47

A patient with bacterial meningitis is receiving IV ceftriaxone. Which nursing action is essential during antibiotic administration?

A. Monitor liver enzyme levels regularly.
B. Administer the medication over 2–4 hours.
C. Observe for signs of an allergic reaction.
D. Assess for therapeutic effects within 6 hours.

Answer 47

C. Observe for signs of an allergic reaction.

Rationale: The nurse should monitor for allergic reactions when administering antibiotics like ceftriaxone. This includes watching for symptoms such as rash, itching, and anaphylaxis. Monitoring liver enzymes and therapeutic effects are important but not as immediate as assessing for allergic reactions.

Question 48

Which assessment finding in a patient with bacterial meningitis should the nurse prioritize?

A. Temperature of 101.8°F (38.8°C)
B. Urine output of 25 mL/hr
C. Blood pressure of 110/70 mmHg
D. Respiratory rate of 20 breaths/min

Answer 48

B. Urine output of 25 mL/hr

Rationale: A urine output of 25 mL/hr is below the normal range (≥30 mL/hr) and may indicate inadequate tissue perfusion, dehydration, or renal dysfunction, which are critical concerns in bacterial meningitis. While fever, blood pressure, and respiratory rate need monitoring, decreased urine output takes priority as it can signify a severe systemic issue.

Question 49

The nurse is formulating a plan of care for a patient with bacterial meningitis. Which goal is the most appropriate for this patient?

A. Achieve maximal neurologic functioning by discharge.
B. Maintain a body temperature of 102°F (38.9°C) to reduce ICP.
C. Increase fluid intake to at least 3 L per day to prevent cerebral edema.
D. Manage pain with PRN opioids only during severe episodes.

Answer 49

A. Achieve maximal neurologic functioning by discharge.

Rationale: A key goal in managing bacterial meningitis is to help the patient return to maximal neurologic functioning. Maintaining body temperature within the normal range (not elevated), managing fluids cautiously to avoid worsening cerebral edema, and ensuring effective pain control (not limited to severe episodes) are important components of care but not overarching goals.

Question 50

The nurse is evaluating the skin of a patient with bacterial meningitis. Which finding requires immediate intervention?

A. Petechiae on the lower extremities
B. Localized redness at the IV insertion site
C. Dry and scaly skin on the elbows
D. Diaphoresis noted on the chest and back

Answer 50

A. Petechiae on the lower extremities

Rationale: Petechiae are a serious finding in bacterial meningitis, as they may indicate meningococcal infection or complications like disseminated intravascular coagulation (DIC). Immediate intervention is necessary. Localized redness at the IV site, dry skin, and diaphoresis are less urgent findings.

Question 51

A patient with bacterial meningitis is experiencing severe headache and neck pain. Which intervention should the nurse prioritize?

A. Administer PRN IV antibiotics.
B. Perform a neurologic assessment every hour.
C. Administer prescribed analgesics and ensure a dark, quiet environment.
D. Encourage fluid intake of 2 L per day to prevent dehydration.

Answer 51

C. Administer prescribed analgesics and ensure a dark, quiet environment.

Rationale: Pain management is crucial for patient comfort in bacterial meningitis. A dark and quiet environment helps reduce photophobia and pain associated with meningitis. While antibiotics and frequent neurologic assessments are critical, immediate relief of pain and discomfort takes precedence. Encouraging fluid intake is also important but not the priority intervention in this context.

Question 52

Which intervention should the nurse prioritize when caring for a patient with bacterial meningitis who has a fever of 103°F (39.4°C)?

A. Administer a cooling blanket and acetaminophen.
B. Perform a tepid sponge bath every hour.
C. Lower the room temperature to 65°F (18.3°C).
D. Reduce the fever rapidly to decrease ICP.

Answer 52

A. Administer a cooling blanket and acetaminophen.

Rationale: Fever increases cerebral edema and the risk for seizures in bacterial meningitis. Administering antipyretics like acetaminophen and using a cooling blanket are appropriate interventions. Tepid sponge baths and environmental cooling are secondary measures and less effective alone. Rapidly reducing the fever can lead to shivering, which increases metabolic demands and ICP.

Question 53

The nurse is preparing to administer prophylactic antibiotics to a family member of a patient diagnosed with meningococcal meningitis. Which explanation is most appropriate?

A. “These antibiotics will help prevent you from contracting the disease.”
B. “These antibiotics will reduce the symptoms of meningitis if you are already infected.”
C. “This is a routine treatment for anyone exposed to bacterial infections.”
D. “You must complete the full course of antibiotics even if you feel fine.”

Answer 53

A. “These antibiotics will help prevent you from contracting the disease.”

Rationale: Prophylactic antibiotics are recommended for close contacts of a patient with meningococcal meningitis to prevent infection. While completing the antibiotic course is important, the primary purpose is prevention, not symptom management or routine exposure treatment.

Question 54

A patient with bacterial meningitis is experiencing photophobia and nuchal rigidity. Which nursing intervention is most appropriate?

A. Encourage frequent position changes to relieve discomfort.
B. Darken the room and apply a cool cloth over the patient’s eyes.
C. Elevate the patient’s legs to improve circulation.
D. Place the patient in a prone position to alleviate neck pain.

Answer 54

B. Darken the room and apply a cool cloth over the patient’s eyes.

Rationale: Photophobia and neck stiffness are common in bacterial meningitis. A darkened room and cool cloth can help reduce discomfort. Frequent position changes, elevating the legs, or prone positioning are not effective or appropriate for these specific symptoms.

Question 55

Which nursing action is most important when managing a patient with bacterial meningitis on respiratory isolation?

A. Ensure visitors wear surgical masks at all times.
B. Discontinue isolation precautions once symptoms resolve.
C. Confirm that cultures are negative before stopping isolation.
D. Limit family visitation to reduce the risk of spread.

Answer 55

C. Confirm that cultures are negative before stopping isolation.

Rationale: Respiratory isolation is required for patients with meningococcal meningitis until cultures are confirmed negative. Visitors must follow isolation precautions, but there is no need to limit visitation unnecessarily. Symptoms alone are not a reliable indicator for discontinuing isolation.

Question 56

Which dietary recommendation is most appropriate for a patient recovering from bacterial meningitis?

A. A low-calorie, high-protein diet with large meals.
B. A low-fat diet with minimal carbohydrate intake.
C. A fluid-restricted diet with reduced caloric intake.
D. A high-calorie, high-protein diet with small, frequent feedings.

Answer 56

D. A high-calorie, high-protein diet with small, frequent feedings.

Rationale: During recovery from bacterial meningitis, patients require a high-calorie, high-protein diet to support healing and maintain strength. Small, frequent meals are better tolerated, especially when energy levels are low. Restricting fluids or calories is not appropriate unless medically indicated.

Question 57

A patient recovering from bacterial meningitis reports persistent muscle rigidity in the neck and back of the legs. Which intervention should the nurse recommend?

A. Complete bedrest to avoid exacerbating the symptoms.
B. Apply warm compresses to the affected areas and perform range of motion exercises.
C. Provide cold packs to reduce inflammation in the muscles.
D. Administer muscle relaxants as the primary intervention.

Answer 57

B. Apply warm compresses to the affected areas and perform range of motion exercises.

Rationale: Persistent muscle rigidity can be managed with warm compresses and progressive range of motion exercises, which help to improve flexibility and circulation. Bedrest and cold packs are not indicated for this symptom. Muscle relaxants may be used, but non-pharmacologic interventions are prioritized.

Question 58

What is the nurse’s primary focus when managing a patient with bacterial meningitis who exhibits signs of delirium?

A. Limit interaction with staff to reduce overstimulation.
B. Maintain low lighting and a calm environment.
C. Administer PRN antipsychotic medications.
D. Frequently reorient the patient using complex explanations.

Answer 58

B. Maintain low lighting and a calm environment.

Rationale: Delirium in bacterial meningitis patients is best managed by minimizing environmental stimuli, such as maintaining low lighting and reducing noise, to decrease hallucinations and confusion. Frequent reorientation with complex explanations can increase agitation, and limiting interactions entirely may cause distress.

Question 59

A patient with bacterial meningitis is on IV antibiotics and reports difficulty concentrating due to frequent nursing interruptions. How should the nurse prioritize care?

A. Cluster care activities to allow uninterrupted rest periods.
B. Decrease the frequency of neurological assessments.
C. Allow the patient to refuse non-essential medications.
D. Schedule all care activities at night to avoid daytime interruptions.

Answer 59

A. Cluster care activities to allow uninterrupted rest periods.

Rationale: Clustering care activities reduces interruptions and promotes rest, which is essential for recovery. Neurological assessments cannot be decreased, and essential medications cannot be refused. Scheduling all care at night disrupts the patient’s circadian rhythm and rest.

Question 60

Which nursing intervention is essential to prevent dehydration in a patient with bacterial meningitis?

A. Provide IV fluids at a rate of 200 mL/hr regardless of intake.
B. Calculate replacement fluids based on temperature and output.
C. Restrict oral fluids to avoid fluid overload.
D. Administer diuretics to manage insensible fluid losses.

Answer 60

B. Calculate replacement fluids based on temperature and output.

Rationale: In bacterial meningitis, fluid replacement must be carefully calculated to address dehydration caused by fever, diaphoresis, and insensible losses. Overhydration and diuretics are contraindicated unless medically indicated.

Question 61

A patient with bacterial meningitis develops seizures. What is the nurse’s priority intervention?

A. Administer phenytoin or levetiracetam as prescribed.
B. Insert a tongue blade to prevent tongue biting.
C. Position the patient in high Fowler’s to improve breathing.
D. Restrain the patient to prevent injury.

Answer 61

A. Administer phenytoin or levetiracetam as prescribed.

Rationale: Seizures in bacterial meningitis are managed with antiseizure medications such as phenytoin or levetiracetam. Inserting a tongue blade and restraining the patient are unsafe practices. Positioning in high Fowler’s is not effective in managing seizures.

Question 62

What is the most important action to prevent the spread of meningococcal meningitis?

A. Provide immunizations to family members immediately.
B. Isolate all patients with meningitis regardless of etiology.
C. Ensure close contacts receive prophylactic antibiotics.
D. Require caregivers to wear N95 masks during patient care.

Answer 62

C. Ensure close contacts receive prophylactic antibiotics.

Rationale: Prophylactic antibiotics for close contacts are essential to prevent the spread of meningococcal meningitis. Immunizations are preventive but not effective post-exposure. Isolation is not required for all meningitis cases, and standard masks are sufficient.

Question 63

A nurse is assessing a patient who recently recovered from bacterial meningitis. Which finding warrants further evaluation?

A. Complaints of fatigue after minimal activity
B. Occasional mild headaches relieved by acetaminophen
C. Reports of muscle soreness in the neck and shoulders
D. Difficulty hearing conversations in a quiet room

Answer 63

D. Difficulty hearing conversations in a quiet room

Rationale: Hearing loss is a potential long-term complication of bacterial meningitis and requires further evaluation. Fatigue, mild headaches, and muscle soreness are expected findings during recovery and typically resolve with time and supportive care.

Question 64

Which of the following outcomes indicates that the patient with bacterial meningitis is achieving the expected cognitive function?

A. The patient can recall events from the past 24 hours.

B. The patient remains oriented to time, place, and person.

C. The patient demonstrates improved concentration after pain control.

D. The patient follows all nursing instructions without confusion.

Answer 64

B. The patient remains oriented to time, place, and person.

Rationale: Maintaining orientation to time, place, and person is a key indicator of appropriate cognitive function. While recall of events or improved concentration can be signs of cognitive improvement, orientation is a more direct measure of cognitive status.

Question 65

Which outcome would suggest that the patient with bacterial meningitis has effectively managed body temperature within a normal range?

A. The patient’s temperature fluctuates between 98.0°F (36.7°C) and 100.0°F (37.8°C) without antipyretics.

B. The patient’s temperature remains stable at 102.5°F (39.2°C) despite antipyretic treatment.

C. The patient maintains a temperature of 98.6°F (37°C) with adequate fluid intake and cooling measures.

D. The patient reports feeling feverish and experiences chills despite normal temperature readings.

Answer 65

C. The patient maintains a temperature of 98.6°F (37°C) with adequate fluid intake and cooling measures.

Rationale: A stable temperature within the normal range of 98.6°F (37°C), supported by appropriate fluid intake and cooling measures, indicates successful temperature management. Fluctuations or persistent fever despite treatment suggest inadequate control.