1. A patient presents to the unit with complaints of a headache and nuchal rigidity. During examination it is noted that the flexion of the patient’s neck causes flexion of the hips and knees. This finding is known as a positive__________ sign:
- Kernig’s
- Chvostek’s
- Brudzinski’s
- Trousseau’s
- Rationale: Kernig’s sign is positive if pain occurs on flexion of the hip and knee. Positive Chvostek’s and Trousseau’s are noted if a patient has hypocalcemia
2. Signs of meningeal irritation compatible with meningitis include all of the following except:
- Nucheal rigidity
- Negative Kernig’s sign
- Positive Brudzinki’s sign
- Throbbing headache
- Rationale: A POSITIVE Kernig’s sign would be indicative of meningeal irritation
3. A diagnosis of meningitis is made through the analysis of CSF. Which of the following results would be expected with a diagnosis of bacterial meningitis?
- Cloudy CSF, elevated WBC, elevated protein and decreased glucose
- Clear CSF, decreased WBC, elevated protein and elevated glucose
- Cloudy CSF, decreased WBC, decreased protein and elevated glucose
- Clear CSF, elevated WBC, decreased protein and decreased glucose
- Rationale: In the case of bacterial meningitis, findings usually include an elevated pressure, turbid or cloudy CSF, elevated leukocytes, elevated protein, and decreased glucose levels. This is attributed to the inflammatory response and the breaching of the blood brain barrier by bacteria
4. Which of the following statements regarding viral (aseptic) meningitis is TRUE?
- Viral meningitis is often caused by the pathogens meningococcus (Neisseria meningitidis) and pneumococcus (Streptococcus pneumoniae).
- Viral meningitis is limited to the meninges and the CSF will not have an identifiable pathogen.
- Viral meningitis is a rare form of meningitis and is caused by inhalation of fungal spores.
- Viral meningitis is spread through contaminated saliva, respiratory tract secretions and respiratory droplets thereby requiring droplet isolation.
- Rationale: #1 and #4 are true for bacterial meningitis. #3 is true for fungal meningitis
5. The NP provides education to a patient diagnosed with bacterial meningitis. All of the following statements confirm that the patient understands her diagnosis EXCEPT:
- “Bacterial meningitis is the inflammation of the meninges, the protective membrane that surrounds the brain and spinal cord.”
- “Bacterial meningitis can lead to serious complications including septic shock, cerebral edema and increased intracranial pressure.”
- “There is no current treatment for bacterial meningitis and it should resolve within 7-10 days.”
- “My headache and stiff neck pain are caused by irritability of the cervical and spinal nerves.”
- Rationale: Treatment of bacterial meningitis includes rapid diagnosis, antibiotic administration, steroid therapy and supportive measures