Meningitis (Bacterial and Viral), Encephalitis, Brain Abscess Flashcards
Which parameter should be monitored to prevent complications associated with fever in a patient with meningitis? 1 Fluid intake 2 Urine output 3 Blood pressure 4 Respiratory rate
1
A patient with a fever may develop dehydration, so the patient’s fluid intake should be assessed. Urine output, blood pressure, and respiratory rate might be altered with fever, but monitoring these parameters would not help prevent any complications in a patient with meningitis.
Which condition would lead to a risk of bacterial meningitis? 1 Skull fracture 2 Pulmonary infection 3 Bacterial endocarditis 4 Prior brain trauma or surgery
2
A patient with a pulmonary infection is at a risk of developing bacterial meningitis. A skull fracture, bacterial endocarditis, and prior brain trauma or surgery placesthe patient at risk of developing brain abscess.
Which statement is true about bacterial meningitis?
1
It can occur due to prior brain trauma.
2
It is considered as a medical emergency.
3
It is a chronic inflammation of meningeal tissues.
4
Staphylococcus aureus is the primary infective organism.
2
Bacterial meningitis is considered a medical emergency; untreated meningitis has a mortality rate close to 100 percent. Prior brain trauma may lead to a brain abscess. Bacterial meningitis is an acute inflammation. Staphylococcus aureus is the primary infective organism for a brain abscess.
The wife of the client diagnosed with septic meningitis asks the nurse, “I am so
scared. What is meningitis?” Which statement would be the most appropriate
response by the nurse?
1. “There is bleeding into his brain causing irritation of the meninges.”
2. “A virus has infected the brain and meninges, causing inflammation.”
3. “This is a bacterial infection of the tissues that cover the brain and spinal cord.”
4. “This is an inflammation of the brain parenchyma caused by a mosquito bite.”
- Septic meningitis refers to meningitis
caused by bacteria; the most common
form of bacterial meningitis is caused
by the Neisseria meningitides bacteria.
Which intervention should be performed to prevent cranial nerve III palsy in a patient with meningitis? 1 Providing low lighting 2 Administering antibiotics 3 Elevating the head of the bed 4 Performing cooling techniques
4
Fever may increase cerebral edema, which may cause cranial nerve III palsy. Therefore, any fever should be treated vigorously by performing cooling techniques.Low lighting should be provided if the patient develops hallucinations and delirium. Antibiotics are administered to treat the infection. The head of the bed should be elevated to provide relief from head and neck pain.
The registered nurse is teaching a student nurse about treatment outcomes of a patient with meningitis. Which statement made by the student nurse about treatment outcomes would need correction? 1 Pain can be controlled. 2 Hearing loss can be resolved. 3 Facial paresis can be resolved. 4 Neck stiffness can be resolved.
2
Hearing loss caused by irritation of cranial nerve VIII (vestibulocochlear nerve) may be permanent after the treatment; thus, that statement needs to be corrected. Pain can be controlled after the treatment. Facial paresis and neck stiffness are also caused by cranial nerve irritation and neurologic dysfunction, and these can be resolved.
The public health nurse is giving a lecture on potential outbreaks of infectious
meningitis. Which population is most at risk for an outbreak?
1. Clients recently discharged from the hospital.
2. Residents of a college dormitory.
3. Individuals who visit a third world country.
4. Employees in a high-rise office building.
2 Outbreaks of infectious meningitis are most likely to occur in dense community groups such as college campuses, jails, and military installations.
The nurse is assessing the client diagnosed with bacterial meningitis. Which clinical
manifestations would support the diagnosis of bacterial meningitis?
1. Positive Babinski’s sign and peripheral paresthesia.
2. Negative Chvostek’s sign and facial tingling.
3. Positive Kernig’s sign and nuchal rigidity.
4. Negative Trousseau’s sign and nystagmus.
3. A positive Kernig's sign (client unable to extend leg when lying flat) and nuchal rigidity (stiff neck) are signs of bacterial meningitis, occurring because the meninges surrounding the brain and spinal column are irritated.
The nurse is assessing the client diagnosed with meningococcal meningitis. Which
assessment data would warrant notifying the HCP?
1. Purpuric lesions on the face.
2. Complaints of light hurting the eyes.
3. Dull, aching, frontal headache.
4. Not remembering the day of the week.
1. In clients with meningococcal meningitis, purpuric lesions over the face and extremity are the signs of a fulminating infection that can lead to death within a few hours.
Which type of precautions should the nurse implement for the client diagnosed with septic meningitis? 1. Standard Precautions. 2. Airborne Precautions. 3. Contact Precautions. 4. Droplet Precautions.
- Droplet Precautions are respiratory
precautions used for organisms that
have a limited span of transmission.
Precautions include staying at least four
(4) feet away from the client or wearing
a standard isolation mask and gloves
when coming in close contact with the
client. Clients are in isolation for 24 to
48 hours after initiation of antibiotics.
The nurse is developing a plan of care for a client diagnosed with aseptic meningitis secondary to a brain tumor. Which nursing goal would be most appropriate for the client problem “altered cerebral tissue perfusion”?
- The client will be able to complete activities of daily living.
- The client will be protected from injury if seizure activity occurs.
- The client will be afebrile for 48 hours prior to discharge.
- The client will have elastic tissue turgor with ready recoil.
2. A client with a problem of altered cerebral tissue perfusion is at risk for seizure activity secondary to focal areas of cortical irritability; therefore, the client should be on seizure precautions.
The nurse is preparing a client diagnosed with rule-out meningitis for a lumbar puncture. Which interventions should the nurse implement? Select all that apply.
- Obtain an informed consent from the client or significant other.
- Have the client empty the bladder prior to the procedure.
- Place the client in a side-lying position with the back arched.
- Instruct the client to breathe rapidly and deeply during the procedure.
- Explain to the client what to expect during the procedure.
1. A lumbar puncture is an invasive procedure; therefore, an informed consent is required. 2. This could be offered for client comfort during the procedure. 3. This position increases the space between the vertebrae, which allows the HCP easier entry into the spinal column. 5. The nurse should always explain to the client what is happening prior to and during a procedure.
The nurse is caring for a client diagnosed with meningitis. Which collaborative intervention should be included in the plan of care?
- Administer antibiotics.
- Obtain a sputum culture.
- Monitor the pulse oximeter.
- Assess intake and output.
1. A nurse administering antibiotics is a collaborative intervention because the HCP must write an order for the intervention; nurses cannot prescribe medications unless they have additional education and licensure and are nurse practitioners with prescriptive authority.
A patient with bacterial meningitis has increased cerebral edema and is experiencing frequent seizures. What intervention would be used to treat these complications? 1 Perform tepid sponge baths 2 Provide supplemental feeding 3Provide additional low lighting 4Maintain antibiotic therapy
1
A patient with meningitis who is experiencing increased cerebral edema and frequent seizures has a fever.A tepid sponge bath would help to lower a patient’s temperature. Supplemental feeding should be provided to maintain adequate nutritional intake. Additional low lighting should be provided if the patient develops delirium. An antibiotic schedule would be redesigned to treat fever.
After noting that a patient with a head injury has clear nasal drainage, which action should the nurse take?
a.Have the patient blow the nose.
b.
Check the nasal drainage for glucose.
c.
Assure the patient that rhinorrhea is normal after a head injury.
d.
Obtain a specimen of the fluid to send for culture and sensitivity
ANS: B
Clear nasal drainage in a patient with a head injury suggests a dural tear and cerebrospinal fluid (CSF) leakage. If the drainage is CSF, it will test positive for glucose. Fluid leaking from the nose will have normal nasal flora, so culture and sensitivity will not be useful. Blowing the nose is avoided to prevent CSF leakage.
A patient has psychomotor seizures. Which lobe of the brain would show the presence of an abscess on a computed tomography (CT) scan? 1 Frontal lobe 2 Parietal lobe 3 Occipital lobe 4 Temporal lobe
4
When an abscess is formed in the temporal lobe, there is a chance of developing psychomotor seizures. The formation of an abscess in the frontal and parietal lobe may lead to a local or systemic infection. The formation of an abscess in the occipital lobe may lead to visual impairment and hallucinations.
A patient who has bacterial meningitis is disoriented and anxious. Which nursing action will be included in the plan of care?
a.
Encourage family members to remain at the bedside.
b.
Apply soft restraints to protect the patient from injury.
c.
Keep the room well-lighted to improve patient orientation.
d.
Minimize contact with the patient to decrease sensory input.
ANS: A
Patients with meningitis and disorientation will be calmed by the presence of someone familiar at the bedside. Restraints should be avoided because they increase agitation and anxiety. The patient requires frequent assessment for complications; the use of touch and a soothing voice will decrease anxiety for most patients. The patient will have photophobia, so the light should be dim.
The community health nurse is developing a program to decrease the incidence of meningitis in adolescents and young adults. Which nursing action is most important?
a.
Vaccinate 11- and 12-year-old children against Haemophilus influenzae.
b.
Emphasize the importance of hand washing to prevent spread of infection.
c.
Immunize adolescents and college freshman against Neisseria meningitides.
d.
Encourage adolescents and young adults to avoid crowded areas in the winter.
ANS: C
The Neisseria meningitides vaccination is recommended for children ages 11 and 12, unvaccinated teens entering high school, and college freshmen. Hand washing may help decrease the spread of bacteria, but it is not as effective as immunization. Vaccination with Haemophilus influenzae is for infants and toddlers. Because adolescents and young adults are in school or the workplace, avoiding crowds is not realistic.
While caring for a patient who has just been admitted with meningococcal meningitis, the RN observes all of the following. Which one requires action by the RN?
a.
The bedrails at the head and foot of the bed are both elevated.
b.
The patient receives a regular diet from the dietary department.
c.
The nursing assistant goes into the patients room without a mask.
d.
The lights in the patients room are turned off and the blinds are shut.
ANS: C
Meningococcal meningitis is spread by respiratory secretions, so it is important to maintain respiratory isolation as well as standard precautions. Because the patient may be confused and weak, bedrails should be elevated at both the foot and head of the bed. Low light levels in the room decrease pain caused by photophobia. Nutrition is an important aspect of care in a patient with meningitis.
. When assessing a patient with bacterial meningitis, the nurse obtains the following data. Which finding should be reported immediately to the health care provider?
a.
The patient has a positive Kernigs sign.
b.
The patient complains of having a stiff neck.
c.
The patients temperature is 101 F (38.3 C).
d.
The patients blood pressure is 86/42 mm Hg.
ANS: D
Shock is a serious complication of meningitis, and the patients low blood pressure indicates the need for interventions such as fluids or vasopressors. Nuchal rigidity and a positive Kernigs sign are expected with bacterial meningitis. The nurse should intervene to lower the temperature, but this is not as life threatening as the hypotension.
Which statement best describes the scientific rationale for alternating a nonnarcotic
antipyretic and a nonsteroidal anti-inflammatory drug (NSAID) every two (2) hours
to a female client diagnosed with bacterial meningitis?
1. This regimen helps to decrease the purulent exudate surrounding the meninges.
2. These medications will decrease intracranial pressure and brain metabolism.
3. These medications will increase the client’s memory and orientation.
4. This will help prevent a yeast infection secondary to antibiotic therapy.
- Fever increases cerebral metabolism
and intracranial pressure. Therefore,
measures are taken to reduce body temperature as soon as possible, and alternating Tylenol and Motrin would be appropriate.
The client diagnosed with septic meningitis is admitted to the medical floor at noon.
Which health-care provider’s order would have the highest priority?
1. Administer an intravenous antibiotic.
2. Obtain the client’s lunch tray.
3. Provide a quiet, calm, and dark room.
4. Weigh the client in hospital attire.
1. The antibiotic has the highest priority because failure to treat a bacterial infection can result in shock, systemic sepsis, and death.
The 29-year-old client is admitted to the medical floor diagnosed with meningitis.
Which assessment by the nurse has priority?
1. Assess lung sounds.
2. Assess the six cardinal fields of gaze.
3. Assess apical pulse.
4. Assess level of consciousness.
- Meningitis directly affects the client’s
brain. Therefore, assessing the
neurological status would have priority
for this client.
The charge nurse observes an inexperienced staff nurse who is caring for a patient who has had a craniotomy for a brain tumor. Which action by the inexperienced nurse requires the charge nurse to intervene?
a.
The staff nurse suctions the patient every 2 hours.
b.
The staff nurse assesses neurologic status every hour.
c.
The staff nurse elevates the head of the bed to 30 degrees.
d.
The staff nurse administers a mild analgesic before turning the patient.
ANS: A
Suctioning increases intracranial pressure and is done only when the patients respiratory condition indicates it is needed. The other actions by the staff nurse are appropriate.
