A nurse is caring for a child who has a suspected diagnosis of bacterial meningitis

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1) A nurse is putting together a presentation on meningitis. Which of the following microorganisms has not been linked to meningitis in humans?

1. S. pneumonia
2. H. influenza
3. N. meningitis
4. Cl. difficile

2) The mother brings a child to the health care clinic because of severe headache and vomiting. During the assessment of the health care nurse, the temperature of the child is 40 degree Celsius, and the nurse notes the presence of nuchal rigidity. The nurse is suspecting that the child might be suffering from bacterial meningitis. The nurse continues to assess the child for the presence of Kernig’s sign. Which finding would indicate the presence of this sign?

1. Flexion of the hips when the neck is flexed from a lying position
2. Calf pain when the foot is dorsiflexed
3. Inability of the child to extend the legs fully when lying supine
4. Pain when the chin is pulled down to the chest

3) Richard Barnes was diagnosed with pneumococcal meningitis. What response by the patient indicates that he understands the precautions necessary with this diagnosis?

1. “I’m so depressed because I can’t have any visitors for a week.”
2. “Thank goodness, I’ll only be in isolation for 24 hours.”
3. “The nurse told me that my urine and stool are also sources of meningitis bacteria.”
4. “The doctor is a good friend of mine and won’t keep me in isolation.”

4) A child is admitted to the pediatric unit with a diagnosis of suspected meningococcal meningitis. Which of the following nursing measures should the nurse do FIRST?

1. Institute seizure precautions
2. Assess neurologic status
3. Place in respiratory isolation
4. Assess vital signs

5) A 4-month-old with meningococcal meningitis has just been admitted to the pediatric unit. Which nursing intervention has the highest priority?

1. Instituting droplet precautions
2. Administering acetaminophen (Tylenol)
3. Obtaining history information from the parents
4. Orienting the parents to the pediatric unit

6) A client is admitted and has been diagnosed with bacterial (meningococcal) meningitis. The infection control registered nurse visits the staff nurse caring to the client. What statement made by the nurse reflects an understanding of the management of this client?

1. speech pattern may be altered
2. Respiratory isolation is necessary for 24 hours after antibiotics are started
3. Perform skin culture on the macular popular rash
4. Expect abnormal general muscle contractions

7) Patrick, a healthy adolescent has meningitis and is receiving I.V. and oral fluids. The nurse should monitor this client’s fluid intake because fluid overload may cause:

1. Cerebral edema
2. Dehydration
3. Heart failure
4. Hypovolemic shock

8) You are mentoring a student nurse in the intensive care unit (ICU) while caring for a patient with meningococcal meningitis. Which action by the student requires that you intervene immediately?

1. The student enters the room without putting on a mask and gown.
2. The student instructs the family that visits are restricted to 10 minutes.
3. The student gives the patient a warm blanket when he says he feels cold.
4. The student checks the patient’s pupil response to light every 30 minutes.

9) Which of these patients in the neurologic ICU will be best to assign to an RN who has floated from the medical unit?

1. A 26-year-old patient with a basilar skull structure who has clear drainage coming out of the nose
2. A 42-year-old patient admitted several hours ago with a headache and diagnosed with a ruptured berry aneurysm.
3. A 46-year-old patient who was admitted 48 hours ago with bacterial meningitis and has an antibiotic dose due
4. A 65-year-old patient with a astrocytoma who has just returned to the unit after having a craniotomy

10) You have just admitted a patient with bacterial meningitis to the medical-surgical unit. The patient complains of a severe headache with photophobia and has a temperature of 102.60 F orally. Which collaborative intervention must be accomplished first?

1. Administer codeine 15 mg orally for the patient’s headache.
2. Infuse ceftriaxone (Rocephin) 2000 mg IV to treat the infection.
3. Give acetaminophen (Tylenol) 650 mg orally to reduce the fever.
4. Give furosemide (Lasix) 40 mg IV to decrease intracranial pressure.

11) A 5-month-old infant is admitted to the ER with a temperature of 6°F and irritability. The mother states that the child has been listless for the past several hours and that he had a seizure on the way to the hospital. A lumbar puncture confirms a diagnosis of bacterial meningitis. The nurse should assess the infant for:

1. Periorbital edema
2. Tenseness of the anterior fontanel
3. Positive Babinski reflex
4. Negative scarf sign

12) A client, age 22, is admitted with bacterial meningitis. Which hospital room would be the best choice for this client?

1. A private room down the hall from the nurses’ station
2. An isolation room three doors from the nurses’ station
3. A semiprivate room with a 32-year-old client who has viral meningitis
4. A two-bed room with a client who previously had bacterial meningitis

13) The nurse is assessing a patient and notes a Brudzinski’s sign and Kernig’s sign. These are two classic signs of which of the following disorders?

1. Cerebrovascular accident (CVA)
2. Meningitis
3. Seizure disorder
4. Parkinson’s disease

14) The adolescent patient has symptoms of meningitis: nuchal rigidity, fever, vomiting, and lethargy. The nurse knows to prepare for the following test:

1. blood culture.
2. throat and ear culture.
3. CAT scan.
4. lumbar puncture.

15) A patient’s chart indicates a history of meningitis. Which of the following would you not expect to see with this patient if this condition were acute?

1. Increased appetite
2. Vomiting
3. Fever
4. Poor tolerance of light

16) Dexamethasone improves mortality in meningococcal meningitis

1. True
2. False

17) The client with suspected meningitis is admitted to the unit. The doctor is performing an assessment to determine meningeal irritation and spinal nerve root inflammation. A positive Kernig’s sign is charted if the nurse notes:

1. Pain on flexion of the hip and knee
2. Nuchal rigidity on flexion of the neck
3. Pain when the head is turned to the left side
4. Dizziness when changing positions

18) A 4 year old girl is admitted with pneumococcal meningitis. She has just returned from a holiday to Disneyland, Florida, 2 days before. What are you going to treat her with:

1. ceftriaxone
2. amoxicillin and gentamicin
3. benzylpenicillin and rifampicin
4. cefotaxime and vancomycin

19) A client is admitted with a diagnosis of meningitis caused by Neisseria meningitides. The nurse should institute which type of isolation precautions?

1. Contact precautions
2. Droplet precautions
3. Airborne precautions
4. Standard precautions

20) Among children aged 2 months to 3 years, the most prevalent form of meningitis is caused by which microorganism?

1. Hemophilus influenzae
2. Morbillivirus
3. Steptococcus pneumoniae
4. Neisseria meningitidis

21)  The nurse is evaluating the status of a client who had a craniotomy 3 days ago. The nurse would suspect the client is developing meningitis as a complication of surgery if the client exhibits:

1. A positive Brudzinski’s sign
2. A negative Kernig’s sign
3. Absence of nuchal rigidity
4. A Glascow Coma Scale score of 15

22)  A client is arousing from a coma and keeps saying, “Just stop the pain.” The nurse responds based on the knowledge that the human body typically and automatically responds to pain first with attempts to:

1. Tolerate the pain
2. Decrease the perception of pain
3. Escape the source of pain
4. Divert attention from the source of pain.

23)  During the acute stage of meningitis, a 3-year-old child is restless and irritable. Which of the following would be most appropriate to institute?

1. Limiting conversation with the child
2. Keeping extraneous noise to a minimum
3. Allowing the child to play in the bathtub
4. Performing treatments quickly

24)  Which of the following would lead the nurse to suspect that a child with meningitis has developed disseminated intravascular coagulation?

1. Hemorrhagic skin rash
2. Edema
3. Cyanosis
4. Dyspnea on exertion

25)  When interviewing the parents of a 2-year-old child, a history of which of the following illnesses would lead the nurse to suspect pneumococcal meningitis?

1. Bladder infection
2. Middle ear infection
3. Fractured clavicle
4. Septic arthritis

26)  The nurse is assessing a child diagnosed with a brain tumor. Which of the following signs and symptoms would the nurse expect the child to demonstrate? Select all that apply.

1. Head tilt
2. Vomiting
3. Polydipsia
4. Lethargy
5. Increased appetite
6. Increased pulse

27)  A lumbar puncture is performed on a child suspected of having bacterial meningitis. CSF is obtained for analysis. A nurse reviews the results of the CSF analysis and determines that which of the following results would verify the diagnosis?

1. Cloudy CSF, decreased protein, and decreased glucose
2. Cloudy CSF, elevated protein, and decreased glucose
3. Clear CSF, elevated protein, and decreased glucose
4. Clear CSF, decreased pressure, and elevated protein

28)  A nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which of the following would be included in the plan of care?

1. No precautions are required as long as antibiotics have been started
2. Maintain enteric precautions
3. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics
4. Maintain neutropenic precautions

29)  A nurse is reviewing the record of a child with increased ICP and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse would expect to note which of the following if this type of posturing was present?

1. Abnormal flexion of the upper extremities and extension of the lower extremities
2. Rigid extension and pronation of the arms and legs
3. Rigid pronation of all extremities
4. Flaccid paralysis of all extremities

30)  Which of the following assessment data indicated nuchal rigidity?

1. Positive Kernig’s sign
2. Negative Brudzinski’s sign
3. Positive homan’s sign
4. Negative Kernig’s sign

31)  Meningitis occurs as an extension of a variety of bacterial infections due to which of the following conditions?

1. Congenital anatomic abnormality of the meninges
2. Lack of acquired resistance to the various etiologic organisms
3. Occlusion or narrowing of the CSF pathway
4. Natural affinity of the CNS to certain pathogens

32)  Which of the following pathologic processes is often associated with aseptic meningitis?

1. Ischemic infarction of cerebral tissue
2. Childhood diseases of viral causation such as mumps
3. Brain abscesses caused by a variety of pyogenic organisms
4. Cerebral ventricular irritation from a traumatic brain injury

1. D. Cl. difficile . Cl. difficile has not been linked to meningitis.
2. C. Inability of the child to extend the legs fully when lying supine . Kernig’s sign is the inability of the child to extend the legs fully when lying supine. This sign is frequently present in bacterial meningitis. Nuchal rigidity is also present in bacterial meningitis and occurs when pain prevents the child from touching the chin to the chest.
3. B. “Thank goodness, I’ll only be in isolation for 24 hours.” Patient with pneumococcal meningitis require respiratory isolation for the first 24 hours after treatment is initiated.
4. C. Place in respiratory isolation . The initial therapeutic management of acute bacterial meningitis includes isolation precautions, initiation of antimicrobial therapy and maintenance of optimum hydration. Nurses should take necessary precautions to protect themselves and others from possible infection.
5. A. Instituting droplet precautions. Instituting droplet precautions is a priority for a newly admitted infant with meningococcal meningitis. Acetaminophen may be prescribed but administering it doesn’t take priority over instituting droplet precautions. Obtaining history information and orienting the parents to the unit don’t take priority.
6. B. Respiratory isolation is necessary for 24 hours after antibiotics are started . After a minimum of 24 hours of IV antibiotics, the client is no longer considered communicable. Evaluation of the nurse’s knowledge is needed for safe care and continuity of care.
7. A. Cerebral edema. Because of the inflammation of the meninges, the client is vulnerable to developing cerebral edema and increase intracranial pressure. Fluid overload won’t cause dehydration. It would be unusual for an adolescent to develop heart failure unless the overhydration is extreme. Hypovolemic shock would occur with an extreme loss of fluid of blood.
8. A. The student enters the room without putting on a mask and gown. Meningococcal meningitis is spread through contact with respiratory secretions so use of a mask and gown is required to prevent spread of the infection to staff members or other patients. The other actions may not be appropriate but they do not require intervention as rapidly. The presence of a family member at the bedside may decrease patient confusion and agitation. Patients with hyperthermia frequently complain of feeling chilled, but warming the patient is not an appropriate intervention. Checking the pupil response to light is appropriate, but it is not needed every 30 minutes and is uncomfortable for a patient with photophobia. Focus: Prioritization
9. C. A 46-year-old patient who was admitted 48 hours ago with bacterial meningitis and has an antibiotic dose due. This patient is the most stable of the patients listed. An RN from the medical unit would be familiar with administration of IV antibiotics. The other patients require assessments and care from RNs more experienced in caring for patients with neurologic diagnoses. Focus: Assignment.
10. B. Infuse ceftriaxone (Rocephin) 2000 mg IV to treat the infection. Untreated bacterial meningitis has a mortality are approaching 100%, so rapid antibiotic treatment is essential. The other interventions will help reduce CNS stimulation and irritation, and should be implemented as soon as possible. Focus: Prioritization
11. B. Tenseness of the anterior fontanel .Tenseness of the anterior fontanel indicates an increase in intracranial pressure. Periorbital edema is incorrect because periorbital edema is not associated with meningitis. Positive Babinski reflex is incorrect because a positive Babinski reflex is normal in the infant. Negative scarf sign is incorrect because it relates to the preterm infant, not the infant with meningitis.
12. B. An isolation room three doors from the nurses’ station . A client with bacterial meningitis should be kept in isolation for at least 24 hours after admission and, during the initial acute phase, should be as close to the nurses’ station as possible to allow maximal observation. Placing the client in a room with a client who has viral meningitis may cause harm to both clients because the organisms causing viral and bacterial meningitis differ; either client may contract the other’s disease. Immunity to bacterial meningitis can’t be acquired; therefore, a client who previously had bacterial meningitis shouldn’t be put at risk by rooming with a client who has just been diagnosed with this disease.
13. B. Meningitis. A positive response to one or both tests indicates meningeal irritation that is present with meningitis. Brudzinski’s and Kernig’s signs don’t occur in CVA, seizure disorder, or Parkinson’s disease.
14. D. lumbar puncture. Meningitis is an infection of the meninges, the outer membrane of the brain. Since it is surrounded by cerebrospinal fluid, a lumbar puncture will help to identify the organism involved.
15. A. Increased appetite. Loss of appetite would be expected.
16. B. False 
17. A. Pain on flexion of the hip and knee . Kernig’s sign is positive if pain occurs on flexion of the hip and knee. The Brudzinski reflex is positive if pain occurs on flexion of the head and neck onto the chest.
18. D. cefotaxime and vancomycin. The USA has a high rate of penicillin resistant pneumococi and first line treatment should include vancomycin until sensitivities are known.
19. B. Droplet precautions . This client requires droplet precautions because the organism can be transmitted through airborne droplets when the client coughs, sneezes, or doesn’t cover his mouth. Airborne precautions would be instituted for a client infected with tuberculosis. Standard precautions would be instituted for a client when contact with body substances is likely. Contact precautions would be instituted for a client infected with an organism that is transmitted through skin-to-skin contact.
20. A. Hemophilus influenzae . Hemophilus meningitis is unusual over the age of 5 years. In developing countries, the peak incidence is in children less than 6 months of age. Morbillivirus is the etiology of measles. Streptococcus pneumoniae and Neisseria meningitidis may cause meningitis, but age distribution is not specific in young children.
21. A. A positive Brudzinski’s sign. Signs of meningeal irritation compatible with meningitis include nuchal rigidity, positive Brudzinski’s sign, and positive Kernig’s sign. Nuchal rigidity is characterized by a stiff neck and soreness, which is especially noticeable when the neck is fixed. Kernig’s sign is positive when the client feels pain and spasm of the hamstring muscles when the knee and thigh are extended from a flexed-right angle position. Brudzinski’s sign is positive when the client flexes the hips and knees in response to the nurse gently flexing the head and neck onto the chest. A Glascow Coma Scale of 15 is a perfect score and indicates the client is awake and alert with no neurological deficits.
22. C. Escape the source of pain.  The client’s innate responses to pain are directed initially toward escaping from the source of pain. Variations in individuals’ tolerance and perception of pain are apparent only in conscious clients, and only conscious clients are able to employ distraction to help relieve pain.
23. B. Keeping extraneous noise to a minimum. A child in the acute stage of meningitis is irritable and hypersensitive to loud noise and light. Therefore, extraneous noise should be minimized and bright lights avoided as much as possible. There is no need to limit conversations with the child. However, the nurse should speak in a calm, gentle, reassuring voice. The child needs gentle and calm bathing. Because of the acuteness of the infection, sponge baths would be more appropriate than tub baths. Although treatments need to be completed as quickly as possible to prevent overstressing the child, any treatments should be performed carefully and at a pace that avoids sudden movements to prevent startling the child and subsequently increasing intracranial pressure.
24. A.Hemorrhagic skin rash. DIC is characterized by skin petechiae and a purpuric skin rash caused by spontaneous bleeding into the tissues. An abnormal coagulation phenomenon causes the condition.
25. B. Middle ear infection. Organisms that cause bacterial meningitis, such as pneumococci or meningococci, are commonly spread in the body by vascular dissemination from a middle ear infection. The meningitis may also be a direct extension from the paranasal and mastoid sinuses. The causative organism is a pneumonococcus. A chronically draining ear is frequently also found.
26. A. Head tilt, B. Vomiting, D. Lethargy. Head tilt, vomiting, and lethargy are classic signs assessed in a child with a brain tumor. Clinical manifestations are the result of location and size of the tumor.
27. B. Cloudy CSF, elevated protein, and decreased glucose.  A diagnosis of meningitis is made by testing CSF obtained by lumbar puncture. In the case of bacterial meningitis, findings usually include an elevated pressure, turbid or cloudy CSF, elevated leukocytes, elevated protein, and decreased glucose levels.
28. C. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics. A major priority of nursing care for a child suspected of having meningitis is to administer the prescribed antibiotic as soon as it is ordered. The child is also placed on respiratory isolation for at least 24 hours while culture results are obtained and the antibiotic is having an effect.
29. B. Rigid extension and pronation of the arms and legs. Decebrate posturing is characterized by the rigid extension and pronation of the arms and legs.
30. A. Positive Kernig’s sign.  A positive Kernig’s sign indicated nuchal rigidity, caused by an irritative lesion of the subarachnoid space. Brudzinski’s sign is also indicative of the condition.
31. B. Lack of acquired resistance to the various etiologic organisms. Extension of a variety of bacterial infections is a major causative factor of meningitis and occurs as a result of a lack of acquired resistance to the etiologic organisms. Preexisting CNS anomalies are factors that contribute to susceptibility.
32. B. Childhood diseases of viral causation such as mumps.  Aseptic meningitis is caused principally by viruses and is often associated with other diseases such as measles, mumps, herpes, and leukemia. Incidences of brain abscess are high in bacterial meningitis, and ischemic infarction of cerebral tissue can occur with tubercular meningitis. Traumatic brain injury could lead to bacterial (not viral) meningitis.