You are caring for a patient with suspected bacterial meningitis. The physician performs a lumbar puncture to extract some cerebral spinal fluid (CSF) for testing.
Which of the following lab results would you expect if the patient does indeed have bacterial meningitis?
Absence of bacteria.
Decreased glucose.
Absence of leukocytes.
Absence of protein.
The Correct Answer is B
Choice A rationale
The presence of bacteria in the cerebrospinal fluid is a hallmark indicator of bacterial meningitis. Therefore, an absence of bacteria would typically rule out a bacterial infection, suggesting either a different etiology or a sterile CSF culture due to prior antibiotic administration.
Choice B rationale
In bacterial meningitis, bacteria consume glucose from the CSF for their metabolic needs. This leads to a characteristic decrease in CSF glucose levels (normal range 40-70 mg/dL or approximately 2/3 of blood glucose). This metabolic activity of the bacteria is a key diagnostic marker.
Choice C rationale
Bacterial meningitis is characterized by a significant inflammatory response within the central nervous system. This response includes a robust influx of leukocytes, predominantly neutrophils, into the cerebrospinal fluid. Therefore, an absence of leukocytes would contradict a diagnosis of bacterial meningitis.
Choice D rationale
The inflammation and increased permeability of the blood-brain barrier associated with bacterial meningitis often lead to an elevated protein concentration in the cerebrospinal fluid (normal range 15-45 mg/dL). Therefore, an absence of protein would be inconsistent with the expected findings.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
Choice A rationale
Daily sedation and weaning protocols, often termed "sedation vacations," reduce the duration of mechanical ventilation by allowing for spontaneous breathing trials. Decreased ventilation duration minimizes the risk of VAP by reducing exposure to invasive tubes and promoting earlier extubation and mobility.
Choice B rationale
Oral care with Chlorhexidine (CHG) significantly reduces the bacterial load in the oropharynx. This decreases the aspiration of pathogenic microorganisms into the lungs, which is a primary pathway for the development of ventilator-associated pneumonia (VAP), thereby disrupting biofilm formation.
Choice C rationale
Suctioning on a frequent schedule can actually increase the risk of VAP by introducing bacteria into the lower respiratory tract. Suctioning should only be performed as needed based on patient assessment, such as visible secretions or adventitious breath sounds, to minimize contamination.
Choice D rationale
Elevating the head of the bed (HOB) to 30 degrees or more helps prevent aspiration of oropharyngeal secretions and gastric contents into the lungs. This reduces the risk of VAP by minimizing the entry of bacteria from the upper airway and gastrointestinal tract into the sterile lower respiratory tract.
Choice E rationale
Hand hygiene is paramount in preventing healthcare-associated infections, including VAP. Proper handwashing or alcohol-based hand rub use before and after patient contact, and especially before manipulating the ventilator circuit, reduces the transmission of pathogens to the patient.
Correct Answer is A
Explanation
Choice A rationale
The patient's initial unconsciousness, followed by a lucid interval and then declining consciousness (appearing to fall asleep, unable to verbally reply), is a classic presentation of an epidural hematoma. This condition requires immediate medical attention as expanding hematomas can lead to brain herniation. Notifying the MD and preparing for a burr-hole procedure to relieve intracranial pressure is the highest priority to prevent irreversible brain damage.
Choice B rationale
While pain management is important, it is not the priority in a patient with a rapidly deteriorating neurological status. Administering pain medication without addressing the underlying intracranial pathology could mask critical neurological signs and delay life-saving interventions. The immediate concern is the potential for brain compression, not comfort.
Choice C rationale
Placing the patient on a nasal cannula at 2 Lpm for a patient with deteriorating consciousness is insufficient and potentially inappropriate. If the patient's respiratory drive is compromised due to increased intracranial pressure, more aggressive airway management, potentially intubation, might be required. Oxygenation should be assessed and managed, but it is not the initial priority without evaluating the airway and breathing comprehensively in a declining patient.
Choice D rationale
Obtaining a stat EKG is not the priority action in a patient presenting with acute neurological deterioration following head trauma. While cardiac function is important, the immediate threat to life in this scenario is neurological compromise due to potential intracranial bleeding and rising intracranial pressure. An EKG would be a secondary assessment after stabilizing the primary neurological issue.
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