The nurse implements the plan of care for a patient with bacterial meningitis. Which intervention(s) would the nurse plan to implement? Select all that apply.

Assess blood glucose levels frequently.

Frequent neurologic checks

Administration of intravenous (IV) antibiotics

Decreasing environmental stimuli

Administration of IV anticonvulsants

Answer and Explanation

Correct Answer : B,C,D

A. Assess blood glucose levels frequently: Routine glucose monitoring is not a primary intervention for bacterial meningitis unless the patient has diabetes or is receiving corticosteroids or other glucose-altering therapies. Hyperglycemia is not a direct concern in uncomplicated bacterial meningitis.

B. Frequent neurologic checks: Frequent assessment of neurologic status, including level of consciousness, pupillary response, and motor function, is critical to detect early signs of increased intracranial pressure, cerebral edema, or complications such as seizures. Rapid identification of neurologic changes allows timely intervention and improves outcomes.

C. Administration of intravenous (IV) antibiotics: Prompt initiation of empiric IV antibiotics is the cornerstone of bacterial meningitis treatment. IV administration ensures rapid therapeutic levels in the bloodstream and cerebrospinal fluid, reducing bacterial proliferation and preventing further neurologic damage.

D. Decreasing environmental stimuli: Minimizing noise, light, and other stimuli helps reduce agitation, headache, and photophobia commonly experienced in meningitis. Creating a calm environment supports comfort, reduces ICP elevation from agitation, and facilitates rest, which is important during the acute phase of illness.

E. Administration of IV anticonvulsants: Anticonvulsants are not routinely administered prophylactically in bacterial meningitis. They are reserved for patients who develop seizures or are at high risk due to specific neurologic involvement. Routine prophylactic use is not indicated.

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Correct Answer is B

Explanation

A. Prepare the patient for platelet transfusion: In immune thrombocytopenic purpura (ITP), platelet destruction is immune mediated, and transfused platelets are often rapidly destroyed unless there is severe or life-threatening bleeding. Platelet transfusion is not the first intervention for petechiae and ecchymoses without active hemorrhage. Immediate safety measures take priority.

B. Institute bleeding precautions: ITP results in decreased platelet counts due to autoimmune destruction, increasing the risk for spontaneous bleeding. Implementing bleeding precautions—such as avoiding IM injections, using soft toothbrushes, and minimizing invasive procedures—reduces the risk of mucosal or internal hemorrhage. Preventing further bleeding is the priority upon admission.

C. Encourage active range-of-motion exercises: Vigorous activity may increase the risk of bruising or internal bleeding in patients with thrombocytopenia. While mobility is important, activity should be limited or modified until platelet levels are stabilized. Preventing trauma is more urgent than promoting exercise at this stage.

D. Administer aspirin for discomfort: Aspirin inhibits platelet aggregation by irreversibly blocking cyclooxygenase-1 (COX-1), impairing thromboxane A2 production. In a patient with already reduced platelet numbers, aspirin significantly increases bleeding risk and is contraindicated.

A. Glomerular filtration rate (GFR) B. Potassium level C. Blood urea nitrogen (BUN) level D. Urine volume

Correct Answer is A

Explanation

A. Glomerular filtration rate (GFR): GFR is the most direct indicator of overall kidney function because it reflects the rate at which the kidneys filter blood and clear waste products. In acute kidney injury, improvement is best demonstrated by a rising GFR toward baseline values, indicating recovery of nephron function and improved filtration capacity.

B. Potassium level: Serum potassium levels are important to monitor because hyperkalemia is a life-threatening complication of AKI. However, potassium can fluctuate due to medications, diet, or temporary shifts between intracellular and extracellular compartments, making it less specific for evaluating true renal recovery.

C. Blood urea nitrogen (BUN) level: BUN is commonly elevated in AKI due to reduced excretion of nitrogenous waste. However, BUN can also be influenced by hydration status, protein intake, and catabolic states, limiting its reliability as a sole marker of improving kidney function.

D. Urine volume: Increased urine output may suggest improvement, particularly during the recovery phase of AKI. However, urine volume alone does not necessarily reflect adequate filtration, as patients may produce urine without effectively clearing solutes. Filtration capacity is more accurately assessed by GFR.

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