A nurse in the emergency room is assessing a client who was brought in following a seizure. The nurse suspects the client may have meningococcal meningitis. Assessment findings include nuchal rigidity and a petechial rash. After Implementing droplet precautions, which of the following actions should the nurse initiate next?
Complete a vascular assessment.
Assess the cranial nerves
Decrease environmental stimuli.
Administer an antipyretic.
The Correct Answer is B
A. Complete a vascular assessment: Although meningococcal meningitis can lead to complications such as septicemia, which affects vascular status, assessing cranial nerves is more immediately pertinent. Identifying neurological deficits can provide crucial information about the extent and location of meningitis-related brain involvement.
B. Assess the cranial nerves: This is the correct action to initiate next. Meningococcal meningitis can affect the central nervous system, leading to cranial nerve involvement. Assessing the cranial nerves helps to identify any neurological deficits early, which is crucial for guiding treatment and monitoring progression.
C. Decrease environmental stimuli: While this is important for managing a patient with meningitis to prevent further neurological irritation, it is not as immediate a priority as assessing cranial nerve function to detect any neurological impairment.
D. Administer an antipyretic: Fever management is important, but it is not the next immediate priority after initiating droplet precautions. Assessing cranial nerves provides vital information about the patient's neurological status, which directly impacts immediate clinical decisions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. "Wear an eye patch on the right eye at all times."
An eye patch may be recommended alternating between eyes for short periods to relieve diplopia, but wearing it continuously on one eye can lead to eye strain and decreased depth perception.
B. "Implement a schedule to include periods of rest."
Fatigue is a common and debilitating symptom in clients with MS. Scheduling regular rest periods helps prevent overexertion, which can worsen symptoms and increase the risk of relapse.
C. "Engage in a vigorous exercise program."
Vigorous exercise may exacerbate MS symptoms, particularly fatigue and heat sensitivity. Instead, a moderate, low-impact exercise program (e.g., swimming, yoga) is more appropriate.
D. "Plan to relax in a hot tub spa each day."
Heat can worsen MS symptoms (a phenomenon known as Uhthoff’s sign). Hot environments, such as hot tubs or spas, should be avoided to prevent symptom exacerbation.
Correct Answer is C
No explanation
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.