Chapter 61: Viral Meningitis Flashcards
A 24-year-old client presents with a headache, fever, photophobia, and a stiff neck. A lumbar puncture (LP) is performed, and cerebrospinal fluid (CSF) analysis reveals lymphocytosis, with no organisms seen on Gram stain. What is the most likely diagnosis?
A. Bacterial meningitis
B. Viral meningitis
C. Encephalitis
D. Fungal meningitis
B. Viral meningitis
Rationale: The client presents with classic symptoms of meningitis, and the CSF analysis showing lymphocytosis without organisms on Gram stain is indicative of viral meningitis. This condition is self-limiting, and full recovery is expected.
Which of the following diagnostic tests is most commonly used to rapidly diagnose viral meningitis?
A. CT scan
B. Xpert EV test
C. MRI
D. Blood cultures
B. Xpert EV test
Rationale: The Xpert EV test is specifically used to rapidly diagnose viral meningitis, detecting enterovirus in the cerebrospinal fluid (CSF) within hours of symptom onset.
A client is diagnosed with viral meningitis. What is the primary treatment approach for this condition?
A. Antiviral medications
B. Broad-spectrum antibiotics
C. Steroid therapy
D. Symptomatic management
D. Symptomatic management
Rationale: Viral meningitis is self-limiting and typically managed symptomatically. Full recovery is expected, with rare sequelae such as persistent headaches or mild mental impairment.
During the evaluation of a patient with suspected meningitis, which of the following CSF findings would support a diagnosis of viral meningitis?
A. Increased white blood cell count with neutrophils predominating
B. Clear or cloudy CSF with lymphocytosis
C. Cloudy CSF with Gram-positive cocci
D. Increased protein and low glucose levels
B. Clear or cloudy CSF with lymphocytosis
Rationale: CSF analysis in viral meningitis typically shows clear or cloudy CSF with an increase in lymphocytes. There are no organisms seen on Gram stain or acid-fast smears, distinguishing viral from bacterial meningitis.
What is the most important nursing intervention while waiting for the results of a lumbar puncture (LP) in a client suspected of having viral meningitis?
A. Start broad-spectrum antibiotics
B. Administer antiviral medications immediately
C. Administer corticosteroids
D. Monitor for signs of increased intracranial pressure
A. Start broad-spectrum antibiotics
Rationale: Antibiotics should be initiated while awaiting the LP results to rule out bacterial meningitis, which is a more severe condition requiring immediate antibiotic treatment.
A patient with viral meningitis asks when they can expect to fully recover. What is the nurse’s best response?
A. “Recovery can take several months, but most people recover fully.”
B. “Recovery is uncertain, and you may experience ongoing symptoms.”
C. “Recovery typically occurs within a few weeks, and full recovery is expected.”
D. “You should expect to be hospitalized for several weeks for observation.”
C. “Recovery typically occurs within a few weeks, and full recovery is expected.”
Rationale: Viral meningitis is self-limiting, and most patients recover fully within a few weeks. Rare sequelae like persistent headaches or mild mental impairment may occur, but they are uncommon.
A patient is diagnosed with viral meningitis and is receiving symptomatic treatment. Which of the following symptoms should the nurse monitor most closely for complications?
A. Persistent headaches
B. Mild fever
C. Dehydration
D. Mild mental impairment
A. Persistent headaches
Rationale: Persistent headaches, though rare, can be a sign of a complication or sequela of viral meningitis. The nurse should monitor for signs of worsening symptoms or neurological impairment.
Which of the following is a common source of transmission for viral meningitis?
A. Direct contact with respiratory secretions
B. Contact with contaminated water
C. Direct contact with blood
D. Fecal-oral transmission
A. Direct contact with respiratory secretions
Rationale: Most viral meningitis cases are spread through direct contact with respiratory secretions, typically from an infected individual coughing or sneezing.
Which of the following CSF findings would be more indicative of bacterial rather than viral meningitis?
A. Increased white blood cell count with a predominance of lymphocytes
B. Decreased glucose levels and elevated protein levels
C. Clear CSF with no significant white blood cell count
D. Presence of enterovirus in the CSF
B. Decreased glucose levels and elevated protein levels
Rationale: Bacterial meningitis typically results in a significant increase in white blood cells, a decrease in glucose, and an increase in protein levels. This contrasts with viral meningitis, where the CSF may remain clear with lymphocytosis and normal glucose levels.
Which of the following is the most likely cause of viral meningitis in a 15-year-old patient?
A. Influenza virus
B. Herpes simplex virus
C. Enterovirus
D. Epstein-Barr virus
C. Enterovirus
Rationale: Enterovirus is the most common cause of viral meningitis, particularly in children and young adults. It spreads through respiratory secretions and can lead to the development of viral meningitis.
A patient with viral meningitis is experiencing severe photophobia. What should the nurse recommend?
A. Avoid bright lights and minimize exposure to light
B. Administer analgesics to reduce the discomfort
C. Apply warm compresses to the eyes to relieve pain
D. Encourage the patient to watch television in a dim room
A. Avoid bright lights and minimize exposure to light
Rationale: Photophobia, or sensitivity to light, is a common symptom of viral meningitis. The patient should avoid bright lights to reduce discomfort and help manage symptoms.
Which of the following diagnostic methods is most sensitive for detecting viral-specific DNA or RNA in cases of viral meningitis?
A. Xpert EV test
B. PCR (Polymerase chain reaction)
C. Gram stain
D. CSF glucose measurement
B. PCR (Polymerase chain reaction)
Rationale: PCR is the most sensitive method for detecting viral-specific DNA or RNA, making it highly effective for diagnosing viral meningitis by identifying the virus in the cerebrospinal fluid.
Which of the following clinical findings would be most concerning for the nurse in a patient with viral meningitis?
A. Elevated white blood cell count with predominance of lymphocytes
B. Cloudy cerebrospinal fluid with positive Gram stain
C. Full consciousness with no mental impairment
D. Persistent high fever despite antipyretics
D. Persistent high fever despite antipyretics
Rationale: Persistent high fever despite treatment can be a sign of complications or secondary infections and warrants further investigation. It is not a typical feature of viral meningitis, where fever is generally moderate and self-limiting.
A nurse is educating a patient diagnosed with viral meningitis. Which of the following should be included in the teaching plan?
A. “You will need to remain on antibiotics for several weeks to treat the infection.”
B. “Most people with viral meningitis recover completely within a few weeks.”
C. “You will likely need antiviral medications to recover.”
D. “You may experience permanent neurological deficits from this illness.”
B. “Most people with viral meningitis recover completely within a few weeks.”
Rationale: Viral meningitis is self-limiting, and most individuals recover completely. Although there may be mild mental impairment or persistent headaches in rare cases, the prognosis is generally excellent.
Which of the following statements made by a patient with viral meningitis indicates the need for further teaching?
A. “I need to stay hydrated and rest to help my recovery.”
B. “I will take antibiotics until my doctor tells me to stop.”
C. “I should avoid bright lights to relieve photophobia.”
D. “I expect to recover fully in a few weeks.”
B. “I will take antibiotics until my doctor tells me to stop.”
Rationale: Antibiotics are not needed for viral meningitis unless bacterial meningitis is suspected. The patient should be informed that antibiotics are only used initially while waiting for the CSF analysis results, which will guide treatment.
