A nurse is triaging a child who has suspected bacterial meningitis. The nurse recognizes which of the following as the initial action?

Initiate isolation protocols.

Administer IV antibiotics.

Prepare for a lumbar puncture.

Obtain blood cultures.

Answer and Explanation

The Correct Answer is A

A.   Bacterial meningitis is highly contagious, and isolation precautions are necessary to prevent the spread of the infection to others. This should be the nurse's first action to protect both the child and others.
B.   While antibiotics are crucial in treating bacterial meningitis, initiating isolation protocols is the first priority to prevent transmission to others.
C.   A lumbar puncture is needed to confirm the diagnosis of meningitis, but isolation protocols should be established first to prevent spread.
D.   Blood cultures are important for diagnosing bacterial meningitis but are secondary to ensuring proper isolation to prevent contagion.

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Correct Answer is A

Explanation

A. Increased somnolence or lethargy is a common sign of increased intracranial pressure in infants.
B. Increased heart rate may initially occur but can later slow down as intracranial pressure rises, leading to bradycardia.
C. Depressed fontanels are indicative of dehydration, not increased intracranial pressure. Bulging fontanels are more indicative of increased intracranial pressure.
D. Brisk pupillary reaction to light is normal; a sluggish or absent reaction could indicate increased intracranial pressure.

A. Administering a bolus (250 ml) of Normal saline intravenous fluid B. Administering oxygen C. Administering pain medication D. Administering antipyretics

Correct Answer is C

Explanation

A. While hydration is important to help with blood flow, pain management takes precedence during an SCD crisis.
B. Oxygen may be necessary in certain cases but is not the priority in the acute pain crisis, where pain control is the primary concern.
C. Pain management is the priority in sickle cell disease (SCD) crisis, as it helps alleviate the intense pain associated with vaso-occlusive events.
D. Antipyretics are not the priority unless the child has a fever. Pain relief is more urgent during a crisis.

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A nurse is triaging a child who has suspected bacterial meningitis. The nurse recognizes which of the following as the initial action?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing an infant following a motor vehicle crash. Which of the following findings indicate increased intracranial pressure in an Infant?

Correct Answer is A

Explanation

The nurse provides care to a client who is admitted for a sickle cell disease (SCD) crisis. Which of the following is the priority prescription for the nurse to Implement when providing patient care?

Correct Answer is C

Explanation

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