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Meningitis NCLEX Detailed Questions and Expert Answers
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Meningitis NCLEX Detailed Questions and Expert Answers
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Meningitis NCLEX Detailed Questions and ExpertAnswers
A 68-year-old man with suspected bacterial meningitis has just had a lumbar
puncture in which cerebrospinal fluid was obtained for culture. Which medication
should the nurse administer first?
A. Codeine
B. Phenytoin (Dilantin)
C. Ceftriaxone (Rocephin)
D. Acetaminophen (Tylenol) - ANS C
Bacterial meningitis is a medical emergency. When meningitis is suspected,
antibiotic therapy (e.g., ceftriaxone) is instituted immediately after the collection
of specimens for cultures, and even before the diagnosis is confirmed.
Dexamethasone may also be prescribed before or with the first dose of antibiotics.
The nurse should collaborate with the health care provider to manage the
headache (with codeine), fever (with acetaminophen), and seizures (with
phenytoin).
The nurse assesses a patient for signs of meningeal irritation and observes for
nuchal rigidity. What indicates the presence of this sign of meningeal irritation?
A. Tonic spasms of the legs
B. Curling in a fetal position
C. Arching of the neck and back
D. Resistance to flexion of the neck - ANS D
, Nuchal rigidity is a clinical manifestation of meningitis. During assessment, the
patient will resist passive flexion of the neck by the health care provider. Tonic
spasms of the legs, curling in a fetal position, and arching of the neck and back are
not related to meningeal irritation.
Nurse on clinical unit is assigned to four patients. Which patient should she assess
first?
a. Patient with a skull fracture whose nose is bleeding
b. Older patient with a stroke who is confused and whose daughter is present
c. Patient with meningitis who is suddenly agitated and reporting a headache of 10
on a 0-10 scale
d. Patient who had a craniotomy for a brain tumor who now 3 days postoperative
had had continued vomiting - ANS Correct answer: c
Rationale: The patient with meningitis should be seen first; patients with
meningitis must be observed closely for manifestations of elevated ICP, which is
thought to result from swelling around the dura and increased cerebrospinal fluid
(CSF) volume. Sudden change in the level of consciousness or change in behavior
along with a sudden severe headache may indicate an acute elevation of ICP. The
patient who has undergone cranial surgery should be seen second; although
nausea and vomiting are common after cranial surgery, it can result in elevations
of ICP. Nausea and vomiting should be treated with antiemetics. The patient with a
skull fracture needs to be evaluated for CSF leakage occurring with the nose bleed
and should be seen third. Confusion after a stroke may be expected; the patient
should have a family member present.
A patient who has bacterial meningitis is disoriented and anxious. Which nursing
action will be included in the plan of care?
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